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This Week in JAMA
JAMA. 2008;299(15):1745.
JAMA-EXPRESS
MC-1 in High-Risk CABG Surgery
Ischemia-reperfusion injury is a significant factor contributing to morbidity and mortality following coronary artery bypass graft (CABG) surgery. Pyridoxal 5'-phosphate monohydrate (MC-1), a naturally occurring pyridoxine metabolite, prevents cellular calcium overload, and some data suggest it may reduce ischemia-reperfusion injury. In the MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II Trial (MEND-CABG II), intermediate- to high-risk patients undergoing CABG with cardiopulmonary bypass were randomly assigned to receive 250 mg/d of MC-1 or placebo immediately before and for 30 days after surgery. The MEND-CABG II investigators found no difference in the composite outcome of cardiovascular death or nonfatal myocardial infarction among patients who received MC-1 vs placebo during the 30-day follow-up.
(SEE ARTICLE)
JAMA-EXPRESS
Strategies to Improve Angioplasty Outcomes
Valgimigli and colleagues report results of the MULTISTRATEGY randomized trial, in which patients presenting with ST-elevation myocardial infarction or new left bundle-branch block were assigned to 1 of 4 strategies of percutaneous coronary intervention: abciximab with an uncoated stent, abciximab with a sirolimus-eluting stent, tirofiban with an uncoated stent, or tirofiban with a sirolimus-eluting stent. The investigators found that tirofiban was noninferior to abciximab for achieving at least 50% resolution of ST-segment elevation at 90 minutes after the intervention. During 8 months of follow-up, patients who received sirolimus-eluting stents had a significantly lower risk of major adverse cardiac events compared with patients who received uncoated stents.
(SEE ARTICLE)
Industry Manipulation of Medical Science
Examination of published articles and internal Merck & Co documents that became available during litigation involving rofecoxib provide evidence that the company may have inappropriately influenced the publication and reporting of scientific research relating to rofecoxib. Ross and colleagues (SEE ARTICLE) examined the authorship of articles on rofecoxib to assess the extent of guest authorship and ghostwriting. They found that although the articles were often prepared by Merck employees or contract medical writers, first authorship was commonly attributed to academically affiliated investigators—who may not have been involved in the conduct of the study or analysis of the reported data—and who may have failed to disclose Merck's financial support. In a second article, Psaty and Kronmal (SEE ARTICLE) reviewed documents relating to clinical trials of rofecoxib in patients with cognitive impairment and found that the risk-benefit profile of rofecoxib described in published articles and in analyses submitted to the US Food and Drug Administration was more favorable than that revealed in Merck's internal analyses of the trial data. In an editorial, DeAngelis and Fontanarosa (SEE ARTICLE) discuss the adverse effects of industry influence on medical research and propose policies to safeguard the integrity of medical science.
CLINICIAN'S CORNER
Palliative Care in Head and Neck Cancer
Perspectives on Care at the Close of Life
A comprehensive and multidisciplinary approach to patients with head and neck cancers, to address the physical and psychological effects associated with treatment.
(SEE ARTICLE)
A Piece of My Mind
"Nearly four years since completing my residency, . . . I returned to my home country for the first time as a full-fledged internist and accidental tourist." From "Rediscovery."
(SEE ARTICLE)
Medical News & Perspectives
Critics charge that proposed federal guidelines for distributing reprints of journal articles that discuss off-label uses of drugs and devices would allow companies to continue to use the reprints as marketing tools.
(SEE ARTICLE)
Commentaries
International recruitment of nurses: justice and human rights
(SEE ARTICLE)
"Gizmo idolatry" in medicine
(SEE ARTICLE)
Author in the Room Teleconference
Join Barbara Howard, PhD, and William Howard, MD, on May 21, 2008, from 2 to 3 PM eastern time to discuss lower blood pressure and cholesterol targets in diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
Readers Respond
How would you manage a 50-year-old man with chronic low back pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is April 30.
JAMA Patient Page
For your patients: Information about coronary artery bypass grafting.
(SEE ARTICLE)
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