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JAMA. 2002;287:1763.

St John's Wort, Placebo, and Antidepressant Trials
Results of studies of the effectiveness of St John's wort (Hypericum perforatum) for the treatment of major depression and depressive symptoms have been inconsistent. In this randomized trial, the Hypericum Depression Trial Study Group (SEE ARTICLE) used a placebo control and sertraline as an active comparator to evaluate the efficacy of St John's wort in adult outpatients with moderately severe major depression. After 8 weeks of treatment, change from baseline in the Hamilton Depression (HAM-D) scale and rates of full response were not significantly different from placebo in either the St John's wort or sertraline group. Walsh and colleagues (SEE ARTICLE) reviewed placebo-controlled trials of medications for major depressive disorder published between 1981 and 2000 and observed that the response to placebo was variable, but often substantial, and was significantly correlated with the year of publication, increasing in recent years. In an editorial, Kupfer and Frank (SEE ARTICLE) describe the current debate about the use of placebo controls in randomized clinical trials and discuss their contention that placebo-controlled trials of antidepressant therapy will be necessary for the forseeable future.

Fish, Omega-3 Fatty Acid Intake and CHD Risk in Women
Current dietary guidelines recommend fish consumption twice weekly for the prevention of coronary heart disease (CHD). The association between consumption of fish and long-chain omega-3 fatty acids and reduced risk of CHD has been documented primarily in men. In this analysis of data from the Nurses' Health Study, a prospective cohort study of women aged 34 to 59 years at baseline, Hu and colleagues found that higher consumption of fish and omega-3 fatty acids was associated with a significantly lower risk of incident CHD events (CHD deaths and nonfatal myocardial infarction) during 16 years of follow-up.

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Cesarean vs Vaginal Delivery for Breech Presentation
The Term Breech Trial, a randomized trial that compared planned cesarean delivery with planned vaginal delivery for pregnancies with breech presentation at term, found a significant reduction in adverse perinatal outcomes with planned cesarean delivery and a low but slightly increased risk of maternal mortality or serious maternal morbidity during the first 6 weeks after delivery. In this follow-up study, Hannah and colleagues compared a variety of maternal outcomes in the 2 study groups at 3 months post partum, including breastfeeding, urinary, flatal, or fecal incontinence, and sexual relations. Women in the planned cesarean delivery group were less likely to report urinary incontinence than those in the planned vaginal delivery group, but other maternal outcomes were not significantly different.

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Adult Survivors of Childhood Cancer
Adults who have survived childhood cancer are at risk for adverse effects related to the malignancy and to the cancer therapy. Kadan-Lottick and colleagues conducted a cross-sectional survey of individuals 18 years or older participating in the Childhood Cancer Survivor Study, a cohort study of individuals who have survived at least 5 years after a cancer diagnosis at age 21 years or younger, to assess their knowledge of their primary cancer diagnosis and associated therapies. Only 74% of respondents provided an accurate general summary of all elements of their cancer history, and none provided an accurate detailed history.

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A Piece of My Mind
"I know I can't scream here. There is enough screaming in this place; why add to it?" From "Cord."

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Medical News & Perspectives
New findings about physical changes that occur in the brain's emotional centers during episodes of major depression give new meaning to the old idea that the disorder is "all in the head."

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CLINICIAN'S CORNER
Contempo Updates
A review of the function of and current indications for cardiac pacemakers and implantable cardioverter defibrillators.

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MSJAMA
Mental illness: perceptions and misperceptions.

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JAMA Patient Page
For your patients: Information about childhood cancer.

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