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7 March 2006 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Editors Discuss Research Fraud and How to Cleanse the Medical Literature

Two medical journal editors discuss the problem of scientific fraud and outline steps for correcting scientific literature polluted by fraudulent research. They show how the key responsibilities -- investigating the misconduct, correcting the scientific literature, and preventing misconduct -- can be shared by the offending scientist's institution, their co-authors, and the editors of the journals that published the fraudulent research.

(Note: This Medicine and Public Issues article is being released early online. It will appear in the April 18, 2006, issue of Annals of Internal Medicine.)

Community-Acquired Staph Could be the Next Big, Really Bad Thing

Two articles in the March 7, 2006, issue of Annals of Internal Medicine, discuss MRSA, methicillin-resistant Staphylococcus aureus, a bacterium highly resistant to many antibiotics and, until recently, seen mostly in hospital settings. Recently, MRSA has appeared in the community and, unlike its hospital cousin, can infect healthy people. Identification of MRSA infection is important so that it can be adequately treated with the correct antibiotics.

In one study, researchers examined 384 people who had acquired S. aureus skin or soft-tissue infections and found that 72 percent had community-acquired MRSA (Article, p. 309). Most clinicians did not recognize that community-acquired MRSA was becoming a leading cause of skin and soft-tissue infection in their community and recommended treatment with antimicrobial agents that were not effective against MRSA.

In another study, researchers looked at 2001-2002 data from the most recent National Health and Nutrition Examination Survey (NHANES) and estimated that 84 million people in the United States (31.6 percent of U.S. adults) carry MSSA (Staphylococcus aureus that is sensitive to the antibacterial methicillin), while 2 million (0.84 percent) carry MRSA (S. aureus that is resistant to methicillin (Article, p. 318). An editorial writer calls the rise in cases of community-acquired MRSA in the United States and elsewhere an 'epidemic' (Editorial, p. 368).

Aspirin Is More Cost-Effective than Statins in Preventing CHD in Men

Researchers developed a computer model, using published information, to estimate what might happen and how much it would cost if men with various risks for coronary heart disease took aspirin, statins, both drugs, or neither (Article, p. 326). They found that among the four options, aspirin is the most cost-effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5 percent (7.5 in 100). The addition of a statin to aspirin becomes more cost-effective when the patient's 10-year CHD risk is 10 percent or higher (10 out of 100).

In a Small Trial, Adding Chloroquine to Chemo- and Radiotherapy for a Brain Tumor Extended Life. Larger Phase II Trials Are Now Needed.

(Article, p.337; Editorial, p. 372.)

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