Transgender individuals have a gender identity that does not align with their sex assignment at birth (gender incongruence). They account for about approximately 0.4% of the US population (1 million people).1 Some transgender people experience gender dysphoria, distress caused by the discrepancy between gender identity and birth-assigned sex, linked to lifetime suicide attempt rates of 40%.2 Some may

Sepsis, most succinctly defined as organ dysfunction due to infection, is estimated to account for more than 5 million deaths around the world each year and to cause or contribute to approximately half of all deaths occurring in hospitals in the United States.1,2 A 2016 report from the Healthcare Cost and Utilization Project estimated the cost of treating sepsis in US hospitals in 2013 at $24 billion

The JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA® and 11 other specialty Network journals. JAMA does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of JAMA, the American Medical Association, or the institution

The request of our secretary for a contribution to this meeting suggested to me an extension of my discussion1 on the psychobiologic level of medical facts (presented two years ago in San Francisco and published in The Journal of the American Medical Association, 1915), a consideration of my present plan of teaching psychopathology and psychiatry and of some principles characteristic of the plan. No

A novel method to physically expand small biopsy tissue samples could help pathologists predict and diagnose disease more accurately using light microscopy. Researchers at the Massachusetts Institute of Technology, Harvard Medical School, and the Broad Institute developed the method, called expansion pathology (ExPath). In ExPath, clinical samples are attached to a polymer that swells when wet. An

Researchers at Harvard University and Boston University have developed a lightweight, soft robotic exosuit that improves gait in patients who have experienced a stroke. In a small study of 9 patients who ranged from 9 months to more than 14 years poststroke, the exosuit worn on the partially paralyzed lower limb improved forward propulsion and ground clearance during treadmill and overground walking

In Reply We agree with Dr Zimmerman and colleagues about the need for a more comprehensive process of medication reconciliation, and there is substantial overlap between the approach we presented in our Viewpoint and the vision they describe. They also emphasize the importance of standardized nomenclature to refer to medication reconciliation, lest a variety of terms for the same concept impede the

In Reply Dr Colloff correctly points out that moving high-cost patients from private exchanges to Medicare would save money immediately for the federal government, but potentially at the expense of hospitals and physicians. The alternatives currently being debated in Congress to replace the Affordable Care Act, however, would be far worse. With 22 million newly uninsured people seeking health care

To the Editor Dr Rose and colleagues1 proposed that medication reconciliation goes beyond comparing medication lists at admission or discharge and instead comprises the establishment of a correct medication list by completion of 6 levels of reconciliation: clinician agreement, patient agreement, deprescribe, decrease patient burden, minimize out-of-pocket expenses, and inform outside entities.

In Reply We agree with Dr Grossman and colleagues that the size of the discordant population between the USPSTF B recommendation and ACC/AHA class I guideline recommendation will depend on overall guideline adherence and how many lower-risk individuals have an informed conversation with their clinician and decide to initiate statin therapy. We also agree that informed patient-physician discussions

To the Editor In a Viewpoint, Drs Skinner and Volpp1 discussed principles for health insurance reform drawing on behavioral economics. One principle was to shift high-cost enrollees into Medicare rather than creating new taxes to pay for subsidies. However, there is an unspoken consequence of this recommendation. They pointed out that “inpatient private insurance reimbursements are 75% higher than

To the Editor Dr Pagidipati and colleagues1 compared the US Preventive Services Task Force (USPSTF) recommendations and American College of Cardiology/American Heart Association (ACC/AHA) guidelines on primary prevention of cardiovascular disease (CVD) with statins. We agree that understanding the population effect of these guidelines is important. We wish to emphasize that the USPSTF issued 2 recommendations

Patients who have mild, nonerosive gastroesophageal reflux disease (GERD) have many valid treatment options, but patients with severe erosive GERD (those with endoscopy showing large esophageal mucosal breaks extending between mucosal folds) have only 2: take proton pump inhibitors (PPIs) indefinitely or have antireflux surgery with fundoplication.1 No medication other than PPIs (and potassium-competitive

The influence of hormone therapy on the health of women has been a subject of controversy for decades. In the 1960s, when estrogen therapy was first introduced for the treatment of menopausal symptoms, hormones were viewed as a fountain of youth. One of the early hormone advocates, Robert Wilson in his 1966 book about menopause and hormones, stated that “Instead of being condemned to witness the death

Not until the very end of the 19th century did physicians or patients think that breast cancer was curable. Women only presented when the tumors were large and had spread to the axilla and beyond. Attempts to remove these lesions failed and resected cancers recurred so fast it seemed that the surgery fueled their growth. Halstead, operating just before the turn of the 20th century (at Johns Hopkins

“If there is a doctor on board, would you please make yourself known to a member of the cabin crew?” Reflexively, my hand shoots up to press the button. Seven times I have responded to such requests. Mostly it has worked out well. Twice I thought the passenger had had too much alcohol. Once I comforted an anxious woman. Another time a young army recruit heading for basic training had unexplained arm

The complexity of the disaster risk landscape and the exposure of large human populations to prolonged and potentially traumatizing events were on full display during Hurricane Harvey. During the 5 days of Hurricane Harvey, more than 33 trillion gallons of rain fell on Texas and Louisiana and set a continental US record for rainfall at 51.88 in (131.78 cm). Among 13 million persons directly affected

On July 28, 2017, US Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, announced a comprehensive regulatory plan to expedite reducing the toll of more than 480 000 annual tobacco-related deaths in the United States.1 The plan is predicated on recognition that “nicotine—while highly addictive—is delivered through products that represent a continuum of risk and is most harmful when

Drug development in oncology has traditionally focused on therapies that directly target cancer cells—surgery, radiation therapy, chemotherapy, and kinase inhibitors. However, for more than a century it has also been recognized that the immune system interacts with cancer. The immune surveillance hypothesis, proposed in the 1950s, posited that the immune system could recognize and reject cancer cells

Guidelines for the academic promotion of university faculty members are essential for the achievement and maintenance of high academic quality. However, these guidelines and criteria vary widely around the world and in the United States, with increasing differentiation between faculty focused on careers in investigation vs those who focus on clinical care and teaching. For example, the University of

For 100 years, Planned Parenthood has been leading the effort to expand and protect reproductive health and rights in the United States and has made major contributions to public health during this time. Through innovations in health care delivery and dogged advocacy over the past century, Planned Parenthood has substantially improved health outcomes for women.

The sexually transmitted nature of cervical cancer was recognized by Rigoni-Stern in the 19th century, and human papillomavirus (HPV) infection was known from the early 20th century to cause genital and nongenital warts. However, the medical importance of these viruses was not clearly established until the 1980s with the breakthrough discovery by zur Hausen1 and colleagues that HPV type 16 (HPV-16)

The JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA® and 11 other specialty Network journals. JAMA does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of JAMA, the American Medical Association, or the institution

In the Reader’s Digest for September appears an article by Paul de Kruif entitled “Found: A One Day Cure for Syphilis,” heralded by the editors of that periodical as “the medical sensation of the year.” In this article Mr. de Kruif states that “now there actually is promise of a one day cure.” He asserts without, of course, any basis in fact that “the standard eighteen month course of treatment is

A subcutaneous formulation of the human monoclonal antibody belimumab has been approved for adults with active, autoantibody-positive systemic lupus erythematosus (SLE) who receive standard therapy. An intravenous formulation was approved in 2011. Patients will be able to self-administer the medication at home after training from a clinician. Subcutaneous belimumab can be injected once a week from

A new 3-drug combination medication for adults with chronic hepatitis C virus (HCV) infection has received FDA approval. The drug is indicated for patients with any of 6 viral genotypes who have either no cirrhosis or only a mild case of the liver disease. Marketed as Vosevi, the drug is a fixed-dose tablet containing 2 previously approved medications—sofosbuvir and velpatasvir—and a new drug, voxilaprevir

In Reply It is encouraging to see the growing interest in avoiding COI on practice guidelines panels. The RIGHT checklist is a step in the right direction.1 Ms Morciano and colleagues call for government action to regulate the management of COI in guidelines when guideline producers fail to deal with the problem. This approach may be successful in some countries, and it will be interesting to share

To the Editor Dr Sox examined the issue of COI in practice guidelines panels.1 He reported that, when available, policies for managing COI performed poorly according to 2 studies2,3 published around the time of the 2011 IOM report.4

To the Editor Dr Sox1 examined conflict of interest (COI) of practice guidelines panels at 2 levels: the individual panel members and the sponsoring organizations. He proposed 4 principles of management of COI that complement the 2011 standards from the Institute of Medicine (IOM; now the National Academy of Medicine).2 The Guidelines International Network also released principles for disclosure of

In Reply We agree with Dr Lauche and colleagues that in our pooled analysis, the comparison groups were heterogeneous. However, based on published data, we judged them to be far less heterogeneous with respect to their expected effectiveness on pain and function in patients with acute low back pain. The comparison groups included ones that were intended to be ineffective, proven to be ineffective,

In Reply Dr Smilowitz points out that some patients who had sepsis or atrial fibrillation and were adjudicated as having a nonischemic etiology as the cause of their elevated hsTnT measurements after noncardiac surgery actually may have had an imbalance in myocardial oxygen supply and demand (ie, an ischemic etiology). We agree with his comment; however, this is often difficult to determine clinically

To the Editor Spinal manipulative therapy (SMT) is very popular; an estimated 19.1 million adults consulted with chiropractors in 2012 in the United States, with spinal pain being the main medical condition for which chiropractic care was sought.1 As such, the systematic review and meta-analysis by Dr Paige and colleagues2 on this topic is important.

To the Editor In the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION), postoperative high-sensitivity troponin T (hsTnT) levels were significantly associated with 30-day mortality.1 I question the authors’ decision to exclude some patients with a presumed nonischemic etiology of troponin elevation from their definition of myocardial injury after noncardiac surgery (MINS).