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7 October 2003 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These 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.

Belief May Keep Some Lung Cancer Patients From Beneficial Surgery

Almost 40 percent of 626 patients in pulmonary and lung-cancer clinics in five locations believed that exposure of lung cancer to air at the time of cancer surgery promotes spread of the cancer (Article, p. 558). The survey participants were predominantly middle-aged or elderly men using a voluntary, self-administered questionnaire. This belief was more common among those with lower incomes, less education, and among African-Americans. Based on this belief, 24 percent would reject lung cancer surgery, and 19 percent would reject surgery even if their physician recommended it. This finding is troubling, the lead researcher says, because no scientific evidence shows that exposure to air spreads lung cancer. And it's particularly troubling for African-Americans because they have lower rates of lung cancer surgery and lower five-year survival rates than whites. (NOTE: This article is the subject of a video news release. Call for coordinates.)

SARS Taught Four Important Lessons

SARS, which caused a little more than 8,435 infections and 813 deaths, probably received more media and public attention than it warranted compared to other illnesses, such as HIV/AIDS, malaria, TB, pneumonia, and diarrhea that each cause more sickness and death every year, says Ezekiel Emanuel, a physician and ethicist (Perspective, p. 589). In fact, he says, the global response to SARS taught four lessons:

The author notes that 20 years ago, when HIV/AIDS was erupting, some physicians and health care workers refused to care for any of the "4-H" patients: homosexuals, hemophiliacs, Haitians, and heroin addicts. But in the recent SARS epidemic, health care professionals stepped up to the plate, and many died. The response to SARS (with quick identification of cause and fairly successful containment) was a test run for a future major influenza or other pandemic.

NOTE: This edition of Annals contains the print versions of two other SARS articles, "An Outbreak of SARS among Hospital Workers in a Community Hospital in Hong Kong" and an editorial, "Listening to SARS," which were released on August 5 on the publication's Web site

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