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JAMA. 2003;290:1417.

Antibiotic Therapy for Coronary Artery Disease
Chlamydia pneumoniae has been implicated in the pathogenesis of atherosclerosis, but clinical trials of antibiotic therapy in patients with coronary artery disease have had conflicting results. In this randomized trial among stable patients with previous myocardial infarction and evidence of C pneumoniae exposure, O'Connor and colleagues (SEE ARTICLE) found that 12 weeks of azithromycin therapy was not associated with a significant reduction in the composite end point of death, nonfatal reinfarction, coronary revascularization, or hospitalization for angina. In an editorial, (SEE ARTICLE) Pislaru and Van de Werf question whether clinical trials of antibiotics fail to improve outcomes of patients with coronary artery disease because C pneumoniae does not play a role in atherogenesis or because the antibiotic regimens in negative trials have not been optimal or focused on patients most likely to benefit.

Suicide Risk in Bipolar Disorder
In the United States, anticonvulsants, especially divalproex and other newer agents, have increasingly been used for treatment of bipolar disorder, and lithium use has declined. In an analysis of data from administrative databases of 2 large integrated health plans, Goodwin and colleagues (SEE ARTICLE) found, however, that risks of suicide attempt and suicide death were significantly higher during treatment with divalproex than during treatment with lithium. In an editorial, (SEE ARTICLE) Baldessarini and Tondo underscore the serious risk of suicide associated with bipolar disorder and discuss the effectiveness of treatments for the various phases of this illness.

Magnetic vs Sham-Magnetic Insoles for Plantar Heel Pain
To evaluate the effectiveness of magnetic insoles for the treatment of plantar heel pain, Winemiller and colleagues conducted a randomized trial comparing cushioned insoles with embedded active bipolar magnets with identical insoles containing sham magnets among adults who had plantar heel pain for at least 30 days. After 8 weeks of treatment, intensity of morning foot pain decreased in both the active magnet and sham magnet treatment groups, but there were no significant differences in symptom improvement between the groups.

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Distal Forearm Fractures in Children and Adolescents
Khosla and colleagues used data from the Rochester Epidemiology Project to estimate the incidence of distal forearm fractures that occurred in residents of Rochester, Minn, younger than 35 years during 4 time periods—1969-1971, 1979-1981, 1989-1991, and 1999-2001. The incidence of distal forearm fractures in children and adolescents increased significantly between 1969-1971 and 1999-2001. The peak incidence and greatest increase occurred between ages 11 and 14 years in boys and 8 and 11 years in girls.

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Quality of Care in Commercial vs Medicaid Managed Care
Many states have turned to commercial managed care organizations to provide care to children enrolled in Medicaid programs. In this analysis of 1999 data collected through the Health Plan Employer Data and Information Set (HEDIS), Thompson and colleagues report that in health plans that served both Medicaid and commercially enrolled children and adolescents, performance scores on most quality indicators for children enrolled through Medicaid were significantly lower than performance scores for commercially enrolled children.

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Medical News & Perspectives
Scientists studying the mechanisms that malignant cells use to resist the effects of cancer drugs are gaining insights that may help in the development of new therapies.

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Retrospective Drug Review
Analysis of data from 6 Medicaid programs shows no reduction in the rate of exceptions (potential prescribing errors) after implementation of retrospective drug utilization review.

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Claims and Kinetics of Herbal Products
Misleading promotional claims by vendors of herbal products and risk of serious drug interactions emphasize the need for more effective regulation of dietary supplements.

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CLINICIAN'S CORNER
Contempo Updates
Natural history, diagnosis, and treatment of syphilis.

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JAMA Patient Page
For your patients: Information about plantar fasciitis.

(SEE ARTICLE)

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