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A new study to determine the best strategy to handle a large-scale anthrax attack on a mid-sized U.S. city suggests that post-attack vaccination plus antibiotic therapy is the most effective and least expensive strategy (Article, p. 601). An editorialist finds the analysis limited because it fails to consider factors such as social panic, disintegration of the medical infrastructure, evacuation and decontamination costs, and the current federal decision to stockpile only 75 million doses of anthrax vaccine nationwide (Editorial, p. 667).
An analysis of data from a large randomized, controlled trial in which participants were assigned to take metformin, a drug that lowers blood sugar levels, or to lifestyle change (intensive weight loss diet and exercise), or to a placebo pill, found that in the group that did not have metabolic syndrome at the beginning of the study, both the drug and lifestyle intervention reduced development of the syndrome (Article, p. 611). Among those that already had metabolic syndrome, both lifestyle change and the drug resulted in increased likelihood that the syndrome would disappear compared to the placebo pill. In both cases, the benefit of the diet and exercise program was larger than the benefit of the drug.
(Article, p. 593; Editorial p. 664)
The U.S. may be headed for "boutique medicine" for those who can afford it, primary care in large integrated systems for those who have health insurance, and "a poorly compensated, disorganized group of safety-net providers," say editorialists introducing a special supplement on primary care, (Editorial, p. 671; 5 articles begin p. 689). "(W)e need to develop better, more compelling evidence, strong public advocacy groups; and more potent efforts to work with media and with lawmakers and regulators …to create a situation where the public good will prevail," they say.