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doi: 10.1001/jama.1993.03500160019004pmid: N/A
SEEKING to keep "junk science" from influencing deliberations on a variety of vital matters in the nation's courtrooms, the American Medical Association (AMA) and its journal, JAMA, have each joined with several other scientific groups in filing amicus curiae briefs as the US Supreme Court considers the case of Daubert v Merrell Dow Pharmaceuticals Inc. When is expert scientific testimony to be allowed in court to be heard and weighed by a jury? When and on what grounds is it to be ruled out? For the first time, the Court will try to define the criteria judges should use to decide on admitting testimony by expert witnesses. The case that led the Court to agree to attempt to resolve the issue came up for argument last month. The plaintiffs allege that the antinausea drug Bendectin is a teratogen that causes limb reduction defects. Action was brought against its manufacturers, now
doi: 10.1001/jama.1993.03500160020005pmid: N/A
THE ODDS that a trauma specialist will correctly interpret certain fatal gunshot wounds are no better than the flip of a coin, according to a recent study at a level 1 trauma center. The study, which looked at single, perforating (exiting) gunshot wounds and multiple gunshot wounds, found that trauma specialists made errors in 52% of the cases, either in differentiating the entrance and exit wound, or in determining the number of bullets that struck the victim. Investigators at the Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC, compared the postmortem findings of a board-certified forensic pathologist with the medical records of emergency medicine physicians, trauma surgeons, and neurosurgeons. The study is the first to quantify the forensic acumen of these specialists, says Vincent DiMaio, MD, a forensic pathologist and editor of The American Journal of Forensic Medicine and Pathology. The study's coauthors, Kim Collins, MD, a fourth-year
doi: 10.1001/jama.1993.03500160023006pmid: N/A
THERE are signs that some Americans may be slipping in their healthy habits. Although there appears to be a 20-year trend toward a healthier life-style including reduced smoking, more exercise, and dietary changes, there are some indications to the contrary now from a new survey by Louis Harris and Associates, Washington, DC. For 10 years, Harris has surveyed American health habits annually. The latest survey, done in December and released last month, consists of telephone interviews with 1251 randomly selected adults across the United States. Over the years, many of the questions and survey procedures have remained the same, Haris says, so that the answers can be compared. The new survey, which cost $75000, was sponsored by Baxter International Inc, Deerfield, Ill. William Friedewald, MD, formerly chief, Disease Prevention Office, National Institutes of Health, Bethesda, Md, and now with Metropolitan Life Insurance Co, New York, NY, notes that the Harris
doi: 10.1001/jama.1993.03500160024007pmid: N/A
A LONG-AWAITED plan for more effective use of vaccines is in the hands of the assistant secretary for health, Philip Lee, MD. By unanimous vote, an advisory committee to the National Vaccine Program Office approved the plan and recommended that the program office's director, Kenneth J. Bart, MD, send it to Lee. If it is put into effect, the plan's drafters believe that some 25 major human diseases caused by viruses or bacteria can be eliminated or at least controlled by vaccines. Given the Clinton administration's much-publicized Comprehensive Childhood Vaccination Initiative, which calls for universal immunization of all eligible children, the plan amounts to a blueprint for almost certain action. Although the emphasis is on fully immunizing children by the age of 2 years, the plan also deals with the need to immunize adults. (The most recent "Standards for Pediatric Immunization Practices," recommended by the National Vaccine Advisory Committee and
doi: 10.1001/jama.1993.03500160025008pmid: N/A
A REVOLUTION is under way in acquiring, analyzing, and using data of public health significance. Computerized systems are being developed that incorporate public health principles into clinical medicine. Says Andrew Friede, MD, MPH, chief, Public Health Information Systems Branch, Information Resources Management Office, Centers for Disease Control and Prevention (CDC), Atlanta, Ga: "The world is changing. Today we need accurate and timely information, not just data, to make decisions affecting the public health." The focus, Friede told members of the American Public Health Association during their annual meeting in Washington, DC, is "on speeding and simplifying hypotheses about the distribution and determinants of diseases in populations into usable information in ways that will support public health practice." Ultimately, he says, "as these improved computerized data and information systems come into operation they should lead to new ways of thinking and practicing public health." Real-Time Epidemiology Not that there is anything
doi: 10.1001/jama.1993.03500160029009pmid: N/A
NEW POLICIES at the Food and Drug Administration (FDA) should substantially aid the understanding and advancement of women's health issues. The date of the official announcement and policy change had not been set at press time. But Eileen Leonard, MD, of the agency's Center for Drug Evaluation and Research, confirms that the rule against including fertile women in early clinical trials, enacted in 1977, is being lifted. "We are increasingly aware that there are approaches to ensuring the safety of the fetus other than completely excluding women of childbearing potential," says Leonard. Other precautions can be taken, such as informing women of the risks, ensuring that they practice contraception, doing pre-enrollment pregnancy testing, and the like, she says. 'Other Players' "Also, we recognize that there are other players in clinical trials who should have a say in that decision. Clearly the women, the investigators, and IRBs [institutional review boards] should
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