Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
Recent evidence indicates that drugs that interfere with the action of estrogen on breast tissue can lower the risk that breast cancer will occur in women at high risk. The U.S. Preventive Services Task Force (USPSTF) considered this evidence in its recommendation that women at low or average risk for breast cancer avoid taking drugs such as tamoxifen or raloxifene to prevent breast cancer. The USPSTF says that women at high risk for breast cancer and at low risk for serious side effects from the drugs should talk with their doctors about the risks and benefits of taking the drugs to prevent breast cancer. The recommendations and a background summary of the evidence for the recommendations are published in today's Annals of Internal Medicine (Clinical Guidelines: Recommendations, p. 56; Summary of Evidence, p. 59). An editorial says that the recommendation to discuss drug therapy with selected patients "raises more questions for clinicians than it answers," (Editorial, p. 52). The writers say that current medical research on this issue is incomplete, and that both women and their physicians "need to understand the limits of what we know and what we can control about the future."
Measuring blood levels of the enzyme, serum alanine aminotransferase (ALT), is the most common way to test for liver disease. Blood enzyme levels above a certain value indicate liver disease. A new study recommends lowering the current upper limit of normal blood ALT levels (Article, p. 1). Researchers suspected that the studies that set the currently accepted normal levels included patients with liver disease that could not be detected when the studies were done. They studied 6,835 first-time blood donors who tested negative for hepatitis C virus (HCV). Defining the "normal" level of ALT as the mean value of ALT levels of those at lowest risk for liver disease, the researchers found a substantially lower value for the upper end of the range of normal ALT than laboratories currently use. They recommend using the new, lower level to define ALT levels that would indicate liver disease.
An editorial says that the study "was carefully done and the results unquestionably correct" (Editorial, p. 49). But using the new normal limits for ALT to decide who has liver disease would cause many millions of patients to be identified with "abnormal" ALT levels. Evaluting these people for liver disease could "overwhelm the health care system," the writer says. Most of these people would be found to have liver diseases that are not serious and seldom progress to serious liver disease.
Annals of Internal Medicine celebrates its 75th anniversary with a review of highlights of its most recent 25 years (History of Medicine, p. 34). An accompanying editorial surveys topics of concern to all medical journals, such as research design, editorial practices, standardization among journals, popularization of content and format, cost, and accessibility to researchers and the public. The editorial writer is not sure that medical journals have done all they could to play their part in the stunning progress in the science of medicine over the past 25 years (Editorial, p. 46).