Week of May 20, 1998
American Medical Association Science News Updates are made available to the
public after 3 p.m. Central time (U.S.) on the first four Tuesdays of each
month. We keep some back issues on this issue and have a list of available releases.
THIS WEEK'S CONTENTS
CHICAGOIntervention programs that focused on abstinence and safer sex
were effective in curbing risky sexual behavior that can lead to contracting HIV
in African American adolescents, according to an article in the May 20 issue of
The Journal of American Medical Association (JAMA).
John B. Jemmott III, Ph.D., of Princeton University in Princeton, N.J., and
colleagues recruited 659 African American middle school students in Philadelphia
to evaluate the effects of abstinence and safer-sex HIV risk reduction programs
on the adolescents' sexual risk behaviors. The adolescents were randomized into
three groups: an abstinence program that stressed delaying sexual intercourse
or reducing the frequency; a safer-sex program that stressed the use of condoms
during sexual intercourse; and a control group that focused on health concerns
unrelated to sexual behavior. All groups were followed up in three-, six- and
The researchers found that the abstinence program participants were less
likely to report having sexual intercourse three months after the program than
the participants in the control group (12.5 percent vs. 21.5 percent), but that
was not the case during the six- or 12-month follow-up. The participants in the
safer-sex program were more than three times more likely than the control groups
participants to report using condoms after three months and at a higher
frequency at the rest of the follow-ups.
The authors conclude: "Our finding that the safer-sex intervention
curbed unprotected sexual intercourse, whereas the abstinence intervention did
not, suggests that if the goal is reduction of unprotected sexual intercourse,
the safer-sex strategy may hold the most promise, particularly with those
adolescents who are already sexually experienced. Moreover, safer-sex
interventions may have longer-lasting effects than abstinence interventions."
The researchers also found that among the adolescents who were already
sexually experienced at the beginning of the intervention program, the safer-sex
program participants reported less sexual intercourse at six- and 12-month
follow-up than the control and abstinence groups and less unprotected
intercourse at all follow-ups than the control group.
Previous research has established the fact that African American adolescents
are at high risk of sexually transmitted infection with HIV, which causes AIDS.
The authors believe that both abstinence and safer-sex intervention programs can
reduce HIV sexual risk behaviors in African American adolescents, but safer-sex
interventions may be especially effective with sexually experienced adolescents
and may have longer lasting effects.
Addressing the concern that safe-sex education programs encourage sexual
activities, the authors found that the adolescents who received the safer-sex
intervention were not more likely to report having sex than the adolescents in
the control group. The authors stress that the findings of this study may not
be generalized to all inner city African American adolescents or if the same
results would be observed in older African American adolescents or suburban
white adolescents. They encourage further research in other adolescent
populations and settings: "By conducting such research, it may be possible
to reduce the risk of sexually transmitted HIV infection that adolescents may
face as they prepare for adulthood."
Editorial: Culturally Sensitive Intervention Programs Work
In an accompanying editorial, Ralph J. DiClemente, Ph.D., of Emory
University's Rollins School of Public Health in Atlanta states that Jemmott and
colleagues' findings demonstrate that culturally sensitive, cognitive-behavioral
interventions can reduce sexual risk behavior among African American
adolescents. DiClemente writes: "To promote the health of adolescents,
public health policy should be empirically driven, not ideologically motivated.
Ideologically motivated policy decisions may inadvertently cause a grave
disservice to our youth, many of whom are ill-equipped with the knowledge and
skills necessary to reduce high-risk sexual behaviors. In the end, we risk
jeopardizing the health and well-being of a generation of youth."
Note: The Jemmott study was funded by the National Institute of
Mental Health. See the
JAMA Patient Page regarding this article.
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CHICAGOBeing more educated and having a less-than-optimum health
status are predictors of who will likely use alternative medicine, according to
an article in the May 20 issue of The Journal of the American Medical
In addition, alternative medicine users tend to hold a philosophical
orientation toward health that can be described as holistic and are more likely
to have had some type of transformational experience that changed their world
view in a significant way, according to John A. Astin, Ph.D., a researcher at
Stanford University's School of Medicine in Palo Alto, Calif. Astin surveyed
1,035 randomly selected people from throughout the U.S. for the study.
Respondents were asked whether they had experienced any of a list of 26
health-related problems within the past year. They were then asked to list the
three most "bothersome" or "serious" ones. The top five
responses were: back problems (19.7 percent); allergies (16.6 percent);
sprains/muscle strains (15.7 percent); digestive problems (14.5 percent); and
lung problems, pneumonia or respiratory infections (13 percent).
Astin writes: "Forty percent of respondents reported using some form
of alternative health care during the past year. The top four treatment
categories were chiropractic (15.7 percent); lifestyle diet (8 percent);
exercise/movement (7.2 percent); and relaxation (6.9 percent). The most
frequently cited health problems treated with alternative therapies were chronic
pain (37 percent); anxiety, chronic fatigue syndrome and 'other health
condition' (31 percent each); sprains/muscle strains (26 percent); addictive
problems and arthritis (both 25 percent); and headaches (24 percent)."
Astin adds: "Although certain alternative therapies tended to be used
more frequently, a broad range of alternatives were, in fact, being used for the
majority of health problems. For example, although chiropractic care
represented close to 50 percent of all alternative treatments used for
headaches, individuals also reported using acupuncture, homeopathy,
megavitamins, spiritual healing, lifestyle diets, relaxation, massage, folk
medicine, exercise, psychotherapy and art/music therapy to treat this health
Astin discovered that negative attitudes/experiences with conventional
medicine were not predictive of alternative health care use. Racial/ethnic
differences also did not predict use of alternative medicine. Use was found
across all racial/ethnic groups. No significant differences were found with
respect to sex. Forty-one percent of women and 39 percent of men reported use
of alternative health care. Neither income nor age predicted use, either, he
Of the sample surveyed, only 4.4 percent was categorized as relying
primarily on alternative forms of health care. He writes that this population
has a distrust of conventional physicians and hospitals and a dissatisfaction
with conventional practitioners, different than the group using alternative
medicine in conjunction with conventional medicine.
The most frequently cited benefits from alternative medicine by the entire
sampling included getting relief from symptoms; pain or discomfort is less or
goes away; feeling better; and the treatment works better for particular health
problems than standard medicine's; and the treatment promotes health rather than
just focusing on illness."
Astin writes: "As policymakers and health care professionals continue
to debate reforms of the present health care system, it seems important to
understand why a significant portion of the population is going outside
mainstream biomedicine to treat a variety of illnesses and to maintain their
general health and well-being."
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CHICAGOThe nation needs an office of drug safety with the authority,
independence, funding, and legal mandate to undertake all the responsibilities
of drug safety monitoring, according to a commentary in the May 20 issue of The
Journal of the American Medical Association (JAMA).
Thomas J. Moore of the Center for Health Policy Research at George
Washington University Medical Center in Washington, D.C., and colleagues, note
that an estimated 1.5 million people require hospitalization and 100,000 die
each year because of injuries linked to prescription drugs. Overall, 51 percent
of approved drugs have serious adverse effects which are not detected prior to
approval. They point out that the diet drug fenfluramine was approved 24 years
before studies on heart valve damage prompted the Food and Drug Administration
(FDA) to pull it from the market.
The authors write that an effective program to protect the American public
from the health risks of marketed drugs should address four specific tasks:
Estimating the number and cause of serious injuries and deaths. Without
this information, it is impossible to determine if serious injuries associated
with adverse effects of prescription drugs are declining, or if an epidemic of
drug-induced injury may be taking place. The authors write: "It makes no
more sense to monitor drug safety without knowing the extent of serious injuries
than to have a National Highway Transportation Safety Administration operating
without information about automobile accidents, or a Federal Aviation
Administration not knowing how many airplane crashes have occurred."
Identifying new serious reactions. The FDA's Division of Pharmacovigilance
and Epidemiology (DPE) devotes most of its staff and resources to this task.
Reports of adverse reactions to recently marketed drugs are collected from
consumers, physicians, pharmacists, nurses, and other health professionals. But
the authors point out that the FDA estimates only about one percent of adverse
events are ever reported. And they add: "A spontaneous reporting system
also cannot capture adverse effects that manifest themselves as a disease with
high prevalence or with a long delay between exposure and clinical
manifestations. Cancer is the classic example."
Monitoring the effect of previous safety alerts. The FDA has no organized
program to check whether important warning messages about product labeling about
drug use are being heeded. But the limited information available suggests that
some warnings are not received, or have little effect. The authors write: "It
is important to discover why important safety warnings are not being heeded.
Are 'Dear Doctor' letters and label changes being lost in the avalanche of
pharmaceutical marketing and advertising information being sent to the
physician's office? Or do physicians disbelieve the message?"
Operating an early-warning system. Rather than waiting passively for
spontaneous reports of adverse reactions, the authors say active surveillance is
needed to check for sensitive indicators of possible problems: "In
particular, regular monitoring is needed to check for drug involvement in
reported cases of birth defects, agranulocytosis, a disorder primarily caused by
drugs, and aplastic anemia, which is frequently caused by drugs. So many
drugs--including tricyclic antidepressants, agents for migraine headaches, diet
drugs, class I antiarrhythmics, non-sedating antihistamines, and cardiac
glycosides--have been linked to arrhythmia and other cardiac effects that a
cardiac early-warning system may also be warranted."
The authors propose that funding for an expanded drug safety program should
come from user fees collected from pharmaceutical companies: "The drug
industry should be no less liable for the costs of its safety regulation than
the nuclear power industry, which pays for the full costs of the Nuclear
Regulatory Commission. Even if the pharmaceutical industry, already the
nation's most profitable as measured by return on investment, passes on the
whole burden to consumers, the added cost would be small. Just one penny per
prescription would yield approximately $24 million for an enhanced drug safety
They conclude: "This investment in drug safety has the potential to
save thousands of lives and prevent tens of thousands of serious injuries every
(JAMA. 1998; 279:1571-1573)
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- AGGRESSIVE MANAGEMENT OF CHEST PAIN LESS LIKELY IN ELDERLY
Patients between 75 and 93 years of age were less likely than younger patients to receive aspirin, ß-blockers and referral for cardiac catheterization, according to a study in the May 25 issue of the AMA's Archives of Internal Medicine. The researchers examined practice variations in the treatment of patients hospitalized with unstable angina two years before the 1994 Agency for Health Care Policy and Research (AHCPR) guidelines were released.
The researchers write: "Older patients were less likely to receive standard therapies for unstable angina before release of the 1994 AHCPR guidelines. Patients presenting with congestive heart failure also received care that was more discordant with guideline recommendations."
They continue: "The AHCPR guidelines allows identification of patients who receive nonstandard care and, if applied to those patients with the greatest likelihood to benefit, could lead to improved health care delivery."
(Arch Intern Med. 1998;158:1113-1120)
Read the abstract or full text of the article.
Note: This study was supported by a grant from the National Institutes of Health in Bethesda, Md.
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