Interview with Laura Mosqueda, MD, author of Elder Abuse and Self-neglect: "I Don't Care Anything About Going to the Doctor, to Be Honest..."

Interview with Michael Paasche-Orlow, MD, MA, MPH, author of Caring for Patients With Limited Health Literacy: A 76-Year-Old Man With Multiple Medical Problems. Summary Points: 1. Massively increase patient education. 2. Systematically reduce unneeded complexity and variability. 3. Universal precautions (not screening), flip the default, and confirm comprehension (T2G).

Interview with Steven C. Zweig, MD, MSPH, author of The Physician's Role in Patients' Nursing Home Care. Summary Points: 1. Prevalent, fragile population, cared for until the end of life. 2. Care must be interdisciplinary (Facility, staff, physicians; Residents, family members). 3. Understand and anticipate natural history of aging and decline in long-term care, including planning, assessment, continuing care, acute care, and end-of-life care.

Interview with Daniel Leffler, MD, MS, author of Celiac Disease Diagnosis and Management: A 46-Year-Old Woman With Anemia. Summary points: 1. Celiac disease can present at any age with a wide variety of signs and symptoms and delay in diagnosis is common. 2. Testing for celiac disease with IgA tissue transglutaminase is accurate and cost-effective. 3. The only treatment for celiac disease is the gluten-free diet, but this is very burdensome and requires ongoing education and support.

Interview with Harold Sox, MD, author of New American Cancer Society Process for Creating Trustworthy Cancer Screening Guidelines. Summary Points: 1. Trustworthy guidelines require transparency about purpose, process, evidence, and rationale. 2. Trustworthy guidelines require a systematic review of the pertinent evidence. 3. Expertise in evaluating evidence and freedom from financial conflicts of interest are the main requirements for membership on a guidelines panel. If these are present, then clinical skills are important.

Interview with David S. Ludwig, MD, PhD, author of Weight Loss Strategies for Adolescents: A 14-Year-Old Struggling to Lose Weight. Summary Points: 1. Childhood obesity arises from a complex interplay of biology, behavior, and the environment.  Consequently, successful treatment requires targeting multiple determinants of body weight. 2. Family-based treatment offers the most immediate and effective approach for childhood obesity, with benefits for all family members. 3. Ultimately, the solution to the obesity epidemic will require a comprehensive public health strategy to make the social environment healthier for children and adults.

Interview with James T. Pacala, MD, MS, author of Hearing Deficits in the Older Patient: "I Didn't Notice Anything". Summary Points: 1. Age-related hearing loss is extremely common and underrecognized by most health care providers. 2. There are many effective methods of detection of hearing loss that are easy and efficient. 3. Although the main stay of treatment is amplification, there remain many challenges to effective hearing aid use.

Interview with Mary A. Whooley, MD, author of Diagnosis and Treatment of Depression in Adults With Comorbid Medical Conditions: A 52-Year-Old Man With Depression. Summary Points:

• Depression screening has no benefit unless it is combined with team-based management
• Self-management strategies (behavioral activation and exercise) improve depression
• "TEAMcare" can improve both depression and chronic medical conditions

Interview with Peter B. Bach, MD, MAPP, author of Benefits and Harms of CT Screening for Lung Cancer: A Systematic Review; and George T. O’Connor, MD, MS, author of Lung Cancer Screening, Radiation, Risks, Benefits, and Uncertainty. Summary Points:

• Three randomized trials examined computed tomography (CT) screening for lung cancer’s effect on lung cancer mortality—one showed a benefit, the other 2 did not but were smaller studies.
• CT screening does not appear to reduce mortality from causes other than lung cancer.
• There are still a lot of uncertainties regarding the risks and how to mitigate them.

Interview with Melanie A. Thompson, MD, and Paul A. Volberding, MD, authors of Antiretroviral Treatment of Adult HIV Infection 2012 Recommendations of the International Antiviral Society-USA Panel. Summary Points:

• Antiretroviral treatment is recommended and should be offered to all persons with HIV, regardless of CD4 cell count.
• Particular attention should be paid to the design of an antiretroviral regimen for persons with concurrent conditions, such as viral hepatitis, opportunistic infections, and other medical diseases, because of the potential for drug interactions.
• Monitoring of entry into and retention in HIV care, adherence to antiretroviral therapy, and quality of care indicators are recommended and should be used to increase care engagement and quality.

Interview with Philip Greenland, MD, author of Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate-Risk Individuals. Summary Points:

• In comparison with other competing biomarkers and risk factors, coronary artery calcium (CAC) is currently the most potent risk marker of subclinical coronary heart disease (CHD).
• CAC was shown in several observational studies to improve the prediction of risk beyond traditional risk factors.
• In this JAMA paper, CAC outperformed various competing risk assessment markers among asymptomatic people at intermediate risk for CHD. Whether CAC should be used in routine clinical practice, however, is still a matter of personal opinion or further research.

Interview with Robert W. Haley, MD, author of Controlling Urban Epidemics of West Nile Virus Infection. Summary Points:

• Epidemics of West Nile neuroinvasive disease have become a serious medical and public health challenge that will be with us for the foreseeable future.
• Ultra low-volume aerial spraying of urban areas, guided by surveillance of mosquito trap positivity and human cases, is necessary and cost-effective to prevent chronic neurologic disability and death.
• Complete, accurate, and timely diagnosis of West Nile viral disease in an epidemic is vitally important to spare patients needless prolonged antimicrobial therapy and build support for public health control measures.

Interview with Nancy A. Rigotti, MD, author of Strategies to Help a Smoker Who Is Struggling to Quit. Summary Points:

• Treat tobacco use like the chronic disease that it is. Don't give up if your first few efforts do not succeed.
• Medications and brief counseling are each effective, but combining the two is most effective.
• Link your smokers to free national resources like the tobacco quit lines (1-800-QUIT-NOW). New noncombustible tobacco products are coming.

Interview with Laura N. Gitlin, PhD, author of Nonpharmacologic Management of Behavioral Symptoms in Dementia. Summary Points:

• Attending to behavioral symptoms is part of comprehensive dementia care and requires ongoing long-term management.
• Use 6 steps to systematically prevent, assess, manage, eliminate or reduce behavioral symptoms.
• Use combination of nonpharmacologic approaches.
• Keep trying—nonpharmacologic approaches are relatively adverse free.
• Create a health professional team to offset time needed for provision of nonpharmacologic approaches.

Interview with Robert H. Shmerling, MD, author of Management of Gout: A 57-Year-Old Man With a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency. Summary Points:

• Risk factor modification: alcohol intake, excess weight, diet, medications (although overall impact on gout uncertain).
• Acute gout can be treated with NSAIDs, colchicine, corticosteroids, or a combination of these.
• Urate-lowering treatment to prevent attacks and tophi is appropriate for certain patients with gout. (In my opinion, allopurinol is the best initial choice to suppress uric acid.)
• Urate-lowering treatment should suppress uric acid to 6.0 mg/dL or less; allopurinol should start no higher than 100 mg/d but titrate up based on uric acid levels; it is common to require more than 300 mg/d.
• Concomitant prophylaxis (eg, low-dose colchicine, 0.6 mg/d) is appropriate for 6-9 months or longer.

Take home message:
We now have new therapies and guidelines for the treatment of gout. Appropriate use of therapeutics for gout—both new and old—will provide optimal outcomes for the increasing number of patients with this common disease.

Interview with Daniel J. Buysse, MD, author of Insomnia. Summary Points:

• Insomnia is a frequent comorbid condition that increases costs and worsens outcomes.
• Insomnia is a chronic condition for which there are effective and widely available acute treatments (medications) and effective but hard-to-find long-term treatments (behavioral).
• Need to consider other health professionals such as nurses, physician assistants, and behavioral health managers (smoking, obesity, diet, exercise, sleep/insomnia).

Interview with Phillip M. Boiselle, MD, author of Computed Tomography Screening for Lung Cancer. Summary Points:

• CT screening reduced lung cancer-specific mortality by 20% in a large randomized trial of a high-risk population.
• CT is associated with a high false-positive rate, with associated risks and costs associated with follow-up CT and the potential for more invasive diagnostic procedures.
• Physicians should consider discussing CT screening with their high-risk patients who meet criteria in published guidelines.

This Viewpoint proposes a framework for international cooperation among governments and organizations to replace competition and hoarding with equitable global distribution of COVID-19 therapeutics and vaccines as they are developed.

This Viewpoint proposes that universal respiratory precautions in the operating room—use of respirators with face masks and eye protection—could protect staff from possible coronavirus disease 2019 (COVID-19) infection and facilitate resumption of elective surgeries canceled during the first wave of the pandemic.

Listen to the JAMA Editor’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA.

Meeting basic food and shelter needs of a growing population and catering to the insatiable consumer demands of people profoundly influences the quality of our environment. President Nixon observed that many of our present social problems may be related to the fact that we have had only 50 years in which to accommodate the second 100 million Americans. To provide for the increasing needs and demands of people, we are polluting our air, soil, and water. Unchecked population growth, people pollution, is not merely a problem, it is a paradox. It is an issue that is intimately private and yet inescapably public.

In this narrative medicine essay, a physician reflects on the rise of professional boundaries; on the ways in which such boundaries can in some instances foster uncaring patient-physician relationships; and on ways physicians might balance providing objective medical care and addressing social and economic injustices in the lives of their patients.

In this narrative medicine essay, the author discusses the inaccuracies of generational stereotypes and unfounded criticisms about trainees, and the problems that faculty members who voice these criticisms can cause among physicians.

This narrative medicine essay summarizes ways in which physicians can use polite and scripted interruption to help patients effectively communicate their medical concerns, encourage further details, improve accuracy of the diagnosis, and set the agenda for the medical visit.

In this essay, a young medical student describes her struggle with depression and how the experience of vulnerability has bred a deep compassion for her patients and peers.

In this narrative medicine essay, a medical school dean talks about the reticence most women feel when considering leadership roles and urges women to work out of their comfort zones, seize diverse opportunities, and step into leadership roles.