Viewpoints in JAMA





Computed Tomographic Screening for Lung Cancer - An Opportunity to Evaluate Other Diseases


Onno M. Mets, M.D., of the University Medical Center Utrecht, the Netherlands, and colleagues note that computed tomographic lung cancer screening can provide valuable information that can be used to screen for other diseases, including cardiovascular disease and chronic obstructive pulmonary disease.

“The results of current computed tomography-based lung cancer screening are promising, but the risks associated with cigarette smoking include more than just lung cancer. Because other data are available from lung cancer screening, it is important to discuss how to leverage the additional information for the diagnosis of other diseases, leading to more efficient and effective health care.”

(JAMA. 2012;308[14]:1433-1434.


The Need for Rigorous Evidence on Medication Use in Preterm Infants - Is It Time for a Neonatal Rule?


Jonathan M. Davis, M.D., of the Floating Hospital for Children at Tufts Medical Center, Boston, and colleagues write that “approximately 200,000 infants born annually in the United States require admission to a neonatal intensive care unit for treatment of prematurity, costing more than $26 billion per year. Preterm infants are at substantial risk of death or developing serious morbidity that can affect them for life. Unlike treatments used in other fields of medicine, most medications administered to preterm infants lack convincing data to support their safety and efficacy with more than 90 percent not approved by the U.S. Food and Drug Administration for the prescribed indication.”

The authors discuss the need for improved research and assessment regarding medications for preterm infants. “Efforts to engage industry leaders in research involving newborns are needed. Industry must accept the need to conduct studies of new and existing agents in the neonatal intensive care unit and develop appropriate formulations for infants and children. Neonatologists should work collaboratively with industry earlier in the drug development process so that simple study designs with easily achievable and validated end points can be achieved.”

(JAMA. 2012;308[14]:1435-1436.


The FDA Safety and Innovation Act


Robert Steinbrook, M.D., of the Yale School of Medicine, New Haven, Conn., and Joshua M. Sharfstein, M.D., of the Maryland Department of Health and Mental Hygiene, Baltimore, examine the U.S. Food and Drug Administration’s (FDA) Safety and Innovation Act, which reauthorizes for 5 years the collection of user fees from industry for the reviews of prescription drugs and medical devices and establishes new user fee programs for generic drugs and “biosimilar” biological products.

“The overwhelming support in Congress for the Safety and Innovation Act should allow the FDA to continue its work without major disruption. The tasks of the FDA include safety and efficiently helping to bring clinically important products to the bedside and leading efforts to address critical unresolved issues. Unfortunately, the continuing uncertainty over the federal budget may interfere with the agency's ability to use fees from industry. Congress should specify the FDA's authority to collect and spend all the user fees authorized by the act, including the new fees for generic drugs and biosimilar biological products. Once the funding is finally in hand, the agency will face the challenge of validating the broad support for the legislation. The FDA's success in advancing public health will depend on its performance.”

(JAMA. 2012;308[14]:1437-1438. ]


Innovations in Care Delivery to Slow Growth of U.S. Health Spending


Arnold Milstein, M.D., M.P.H., of the Stanford University School of Medicine, and Stephen Shortell, Ph.D., M.B.A., M.P.H., of the University of California, Berkeley, write that “the United States needs to slow its rate of growth in inflation-adjusted per capita health spending by 2.5 percentage points annually without sacrificing health or slowing biomedical technology advances. The consequences of failure may include shifting of funding away from resources for elementary and high school education, infrastructure (such as highways), and basic science research, as well as weakening the global competitiveness and financial health of U.S. workers and their employers.”

In this Viewpoint, the authors suggest and discuss four care delivery innovations for helping to address this issue: preventing expensive health crises among medically fragile patients; helping patients in late stages of serious illness avoid dying in a hospital; increasing patient flow through hospitals to lower average fixed cost per hospitalization; and reducing hospital readmissions.

(JAMA. 2012;308[14]:1439-1440.