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This Week in JAMA
JAMA. 2007;298:9.
Morbidity in von Hippel-Lindau Disease
The common finding of endolymphatic sac tumors and sensorineural hearing loss and vestibulopathy in patients with von Hippel-Lindau disease has led to prospective screening of patients for these tumors. However, the pathophysiology of the audiovestibular morbidity is not clear. Butman and colleagues analyzed serial imaging and clinical findings in a consecutive series of 35 patients with von Hippel-Lindau disease to determine the mechanisms of sensorineural hearing loss and vestibular dysfunction. The authors found that sensorineural hearing loss and vestibulopathy occurred suddenly in patients with tumor-associated intralabyrinthine hemorrhage and more gradually in patients with endolymphatic hydrops. These outcomes were not related to tumor size.
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Effects of Cocoa Intake on Blood Pressure
Preliminary evidence suggested that regular consumption of polyphenols in cocoa (equivalent to  100 g of chocolate per day) was associated with lower blood pressure (BP). Given concerns about the high sugar, fat, and calorie intake from cocoa consumption of this magnitude, the effects of low doses of cocoa would be of interest. Taubert and colleagues report results of a clinical trial in which 44 older adults who had untreated prehypertension or stage 1 hypertension were randomly assigned to either 6.3 g (28.9 kcal) per day of dark chocolate containing 30 mg of polyphenols or a matching amount of polyphenol-free white chocolate. At the 18th week of follow-up, the authors found that participants consuming dark chocolate had experienced reductions from baseline in mean (SD) systolic and diastolic BP of 2.9 (1.6) mm Hg and 1.9 (1.0) mm Hg, respectively, without changes in body weight or other adverse effects. Persons who were consuming white chocolate experienced no change in BP.
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Prescription Drug Cost Sharing
In a systematic review of the literature, Goldman and colleagues analyzed the association of cost-sharing features of prescription drug benefits, such as co-payments, tiering, or coinsurance, with patient access to prescription medications, medical spending, and health outcomes. Among the authors' findings were that increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of treatment. For some chronic conditions, higher levels of prescription cost-sharing were associated with increased use of medical services and worse clinical outcomes.
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CLINICIAN'S CORNER
EGFR Inhibition in Aerodigestive Carcinomas
Clinical Review
Inhibition of the epidermal growth factor receptor (EGFR), which regulates important cellular functions in epithelial malignancies and is overexpressed in some aerodigestive carcinomas, is the goal of several novel chemotherapies. Karamouzis and colleagues summarize the biology of EGFR inhibitors and their therapeutic efficacy in aerodigestive carcinomas, including patient and tumor characteristics that may be associated with or predict efficacy.
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A Piece of My Mind
"He is primed for autonomic overload, the anxiety that won't subside, the depression that is too heavy to bear, the nightmare that won't go away." From "Stress, Redeployed."
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Medical News & Perspectives
Studies of the mechanisms underlying migraine and rare pain disorders are providing insights that may help efforts to develop treatments that selectively target sources of pain.
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XDR-TB and Public Health
Public health powers and challenges relating to extensively drug-resistant tuberculosis (XDR-TB).
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Tobacco Litigation
Possible public health benefits of recent litigation against the tobacco industry.
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Global Health
Why everyone should care about global health.
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Clinical Trial Registration
An update from the International Committee of Medical Journal Editors.
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JAMA Patient Page
For your patients: Information about adult hearing loss.
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