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JAMA Network Most Recent Articles

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Vaccine Distribution—Equity Left Behind?

Science

Over the past 2 weeks numerous states have announced a major shift in coronavirus disease 2019 (COVID-19) vaccination programs—from a textured approach that includes individual risk factors for morbidity and mortality (eg, age and high-risk medical conditions), occupational risk factors for exposure (eg, first responders and correctional officers), and other societal priorities (eg, essential workers such as teachers, grocery store employees, and public transportation workers) to an approach focused on vaccinating all individuals aged 65 years and older. Concerns have been raised that the more detailed approach has been difficult to implement, thus slowing the rollout of vaccines, and may leave decisions regarding who gets vaccinated to people not adequately trained to make such a decision.
JAMA Network     Mar 02, 2021

Association of IVIG Plus Methylprednisolone With Persistent or Recurrent Fever in Children With MIS-C

Science

This cohort study estimates the association of use of intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone with treatment failure for multisystem inflammatory syndrome in children (MIS-C), defined as fever persistence at 2 days or fever recurrence within 7 days.
JAMA Network     Mar 02, 2021

Patient Information: Necessity of 2 Doses of the Pfizer and Moderna COVID-19 Vaccines

Science

This JAMA Patient Page describes how the new Pfizer and Moderna COVID-19 vaccines available in the US work and explains why 2 doses of these vaccines are needed to confer adequate immunity.
JAMA Network     Mar 02, 2021

Researchers Investigate What COVID-19 Does to the Heart

Science

This Medical News article discusses reports of myocardial injury and myocarditis among patients with COVID-19.
JAMA Network     Mar 02, 2021

Blinatumomab for Children With High-risk Relapsed B-Cell Acute Lymphoblastic Leukemia

Science

Acute lymphoblastic leukemia (ALL), the most common childhood cancer, is a highly curable disease, with approximately 85% of patients being long-term survivors when treated with current chemotherapy regimens. Risk-adapted, intensified chemotherapy regimens have greatly improved the outcome for children, adolescents, and young adults with newly diagnosed B-cell ALL (B-ALL), which comprises approximately 20% of patients with ALL, and can be safely delivered with proper supportive care measures. Intensification of chemotherapy as salvage therapy, frequently adopting the same agents used during initial therapy, has also been successful at inducing sustained remissions for patients with late relapses. However, this approach has been largely unsuccessful for high-risk patients who experience relapse within 3 years from diagnosis because survival outcomes for these patients remain poor. Additionally, mortality associated with toxicity related to therapy contributes significantly to the poor survival.
JAMA Network     Mar 02, 2021

Monthly Injection Is Approved for Patients With HIV

Science

The FDA has approved a treatment regimen that will allow some patients with HIV infection to trade their daily pills for a once-a-month injection.
JAMA Network     Mar 02, 2021

Import Alert on Hand Sanitizers From Mexico

Science

As the novel coronavirus pandemic continues in the US, FDA officials said they’ve seen a sharp increase in hand sanitizers from Mexico labeled to contain ethanol—also known as ethyl alcohol—that were contaminated with methanol. Methanol, or wood alcohol, can be toxic when absorbed through the skin and is life-threatening if ingested.
JAMA Network     Mar 02, 2021

Hair Loss Diagnosis and Treatment in Primary Care

Science

This JAMA Insights Clinical Update reviews the differential diagnosis, patterns, evaluation, and management of the most common causes of nonscarring hair loss, including male pattern balding, telogen effluvium, and alopecia areata.
JAMA Network     Mar 02, 2021

Trade-offs in Public Health Insurance Design

Science

The importance of access to health care and the financial protections that insurance should provide have never been more salient, and the potential consequences of the costs and gaps within the patchwork system in the US have never been more dire. Would the US population be better off with a simple, single-payer, uniform Medicare-for-all type of insurance plan?
JAMA Network     Mar 02, 2021

“A General Practitioner,” or All for Mercy’s Sake

Science

As long ago as in the issue of this Journal for Oct. 13,1894, the promising merits of Ian Maclaren, the now popular story-teller, were recognized. We there spoke of Maclaren’s “A General Practitioner,” as “a classic of its kind,” although it was far from being in classic dress at that time; it was then to be found only in a penny paper of London, called the British Weekly. Since that time, the features of the Highland country doctor, Dr. Weelum MacLure, have been made known all the world round in the “Bonnie Brier Bush” stories. And his physiognomy is everywhere recognized as that of one of the sturdiest and noblest medical characters that have ever appeared in fiction. If there is anywhere in fiction a more worthy, admirable and attractive personage than Dr. MacLure of Drumtochty, we will be thankful to have him pointed out to us. As his portrait has not, so far as we know, been seen in any medical gallery, we will here give space to a sketch taken from the earliest publication by Maclaren:
JAMA Network     Mar 02, 2021

The De-adoption of Low-Value Health Care

Tech

To the Editor In their Viewpoint, Dr Powers and colleagues analyzed 3 forces governing de-adoption of low-value care: evidence, eminence, and economics. A common denominator underlies them: the interest and convenience of the health care producers, providers, and purchasers. Fee-for-service creates strong incentives to continue delivering low-value but profitable care and technological abuse. More generally, it incentivizes provision of services with a profitable differential between the production costs and the fee applied by purchasers. The production cost is physician- or hospital team–specific, based also on specific skills and preferences, whereas the applied fees are not hospital- or physician-specific, further limiting targeted tariff policies. Aligned with pressure from patients and induced by technology producers and professional societies, fee-for-service multiplies outputs, which translates into financial and career benefits for hospitals, physicians, and producers. Therefore, low-value care for patients and society can be of high value for the producers, hospitals, and physicians selling it. A distorted rewarding model for health players puts the health systems in struc...
JAMA Network     Mar 02, 2021

Antiretroviral Drug Recommendations for HIV Treatment and Prevention

Science

To the Editor As HIV clinicians, we read with interest the new antiretroviral treatment guidelines published on behalf of the International Antiviral Society–USA. Nevertheless, we believe these guidelines failed to integrate emerging evidence and may have reflected implicit commercial bias.
JAMA Network     Mar 02, 2021

Ticagrelor vs Clopidogrel for Patients With Acute Coronary Syndrome Undergoing Percutaneous Intervention

Science

To the Editor A recent retrospective cohort analysis by Dr You and colleagues demonstrated that compared with clopidogrel, ticagrelor was not associated with better outcomes in patients from the US and South Korea with acute coronary syndrome (ACS) undergoing percutaneous intervention (PCI). However, there are several important discrepancies between this cohort analysis and the randomized Platelet Inhibition and Patient Outcomes (PLATO) trial.
JAMA Network     Mar 02, 2021

The De-Adoption of Low-Value Health Care—Reply

Science

In Reply We agree with Dr Donzelli that reforming health care payment is an essential step in reducing the delivery of low-value services. This is core to our argument around the economic forces that guide the de-adoption of low-value care. Within this realm of economic levers, Donzelli makes an important distinction between pay-for-performance and pay-for-health models, noting some inconsistent results from the former. Although there is evidence that targeted payment policies can reduce the provision of low-value care, we agree that more holistic value-based payment models are needed. Our understanding of how to best pay for health continues to evolve and requires precise measurement of and alignment around the definition of health. One approach raised by Donzelli is to move toward risk-adjusted capitated payments, an approach already used at scale within the Medicare Advantage program. There is also some evidence to suggest that other global payment structures influence the provision of low-value services. As the adoption of value-based payment continues to grow, it will be important to rigorously evaluate the impact on low-value care.
JAMA Network     Mar 02, 2021

An EUA for Bamlanivimab—A Monoclonal Antibody for COVID-19

Science

This Medical Letter review summarizes the evidence underlying the US Food and Drug Administration’s emergency use authorization of bamlanivimab, an investigational neutralizing IgG1 monoclonal antibody for treatment of COVID-19, including specification of high-risk patient groups eligible for the drug and its dosage and administration.
JAMA Network     Mar 02, 2021

Funding of Pharmaceutical Innovation During and After the COVID-19 Pandemic

Science

This Viewpoint considers whether the shift away from private investment toward government funding of drug and vaccine development and commercialization during the coronavirus disease 2019 (COVID-19) pandemic is sustainable, arguing that the same or greater level of public investment will be necessary if drug prices are to remain affordable and if the US wants to maintain its global leadership position.
JAMA Network     Mar 02, 2021

Antiretroviral Drug Recommendations for HIV Treatment and Prevention—Reply

Science

In Reply Our recommendations for initial antiretroviral therapy are based on evidence from randomized clinical trials demonstrating superiority of InSTI-based therapy vs comparators that included boosted protease inhibitors or efavirenz. Additional benefits of dolutegravir-based and bictegravir-based therapies include a low risk of treatment-emergent resistance, lack of need for pretreatment genotype results, few significant drug interactions, and a highly favorable tolerability profile, along with a very low rate of discontinuation due to adverse effects.
JAMA Network     Mar 02, 2021

Ticagrelor vs Clopidogrel for Patients With Acute Coronary Syndrome Undergoing Percutaneous Intervention—Reply

Science

In Reply Dr Kim and colleagues state that the results of our study are not comparable with those of PLATO and suggest that our findings may differ because patients enrolled in PLATO had a higher proportion of prior myocardial infarction. First, as we mention in our article, PLATO failed to show benefit in North America and included few Asian patients. It did show that ticagrelor reduced ischemic events and increased the rate of nonprocedural bleeding. However, several studies have demonstrated that high-risk patients with ACS do not have a net benefit with ticagrelor. For example, the SWEDEHEART registry showed that ticagrelor was associated with higher rates of bleeding and increased mortality in patents with ACS who were aged 80 years or older. A reduction in ischemic outcomes from ticagrelor was also not observed in this study. The open-label randomized clinical trial POPular AGE demonstrated that clopidogrel is favored for older patients with non–ST-elevation ACS, a high-risk subgroup. The TICA-KOREA trial showed that ticagrelor use was not associated with fewer ischemic events but was associated with increased risk of bleeding in Korean patients with ACS treated with PCI.
JAMA Network     Mar 02, 2021