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News from Annals of Internal Medicine tip sheet -- Oct. 7, 2014

American College of Physicians

1. Sesame Street inspires physicians to advocate for criminal justice reform

Note: Sound bites and b-roll footage with the authors and Sesame Street are available. Satellite coordinates and feed times are below.

The authors of an article being published in Annals of Internal Medicine say that physicians are getting a wake-up call about the effects of mass incarceration from an unexpected place: Sesame Street. Currently, more than two million people are incarcerated in the United States - more than any other country in the world. The authors of "Sesame Street Goes to Jail: Physicians Should Follow" argue that while many people need to be in prison for the safety of society, a majority are incarcerated due to behaviors attributable to treatable diseases such as mental illness and addiction. The authors suggest policy changes that would allow doctors to steer eligible defendants into treatment programs rather than correctional facilities, when appropriate. When incarceration is necessary, doctors and correctional medicine should coordinate transfer of patient care upon release so that any gains made during incarceration are not lost. They say that physicians also should be aware of social issues such as education, housing, race, and poverty because they can adversely affect health. These same issues also increase the risk of incarceration.

The authors were inspired to call physicians to action by Sesame Street's Little Children, Big Challenges: Incarceration initiative. A Muppet named Alex provides support and a voice for young kids, while the online toolkit provides caregivers with a range of materials to help guide children through the challenges associated with the incarceration of a loved one. This is important, say the authors, because incarceration plays a role in health and health disparities for not only the person incarcerated, but also for their families.

Note: The article URL will be live at 5:00 p.m. on Monday, October 6 and can be included in news stories. Lynn Chwatsky from Sesame Street can be reached through Pam Hacker at Pam.Hacker@sesame.org or 212-875-6225. Lead author, Dr. Dora Dumont (RI Department of Health) can be reached directly at Dora.Dumont@health.ri.gov or 401-222-4804. Dr. Josiah Rich (Brown University) may be reached through David Orenstein at david_orenstein@brown.edu or 401-863-1862. Dr. Scott Allen (UC Riverside) may be reached through Iqbal Pittalwala at iqbal@ucr.edu or 951-827-6050.


2. Opinion: Hospitals should promote "justice-friendly" hiring of former inmates

Hospitals can help to improve the health and wellbeing of former inmates by offering them a job, according to an article being published in Annals of Internal Medicine. The authors write that the collateral consequences of incarceration can follow former inmates for decades. These include systematic exclusion from housing, public benefits, federal student loans, voting rights, and access to employment. Exclusion from the workforce may worsen health and propagate health disparities for formerly incarcerated persons, they write. The authors from Montefiore Medical Center in Bronx, New York, say their institution has teamed up with community-based organizations to match formerly incarcerated persons with stable employment. They urge physicians at other institutions to advocate for fair hiring practices in their own hospitals. "A good job may be the best preventive medicine we can offer," they write.

Note: The article URL will be live at 5:00 p.m. on Monday, October 6 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Tracy Gurrisi at tgurrisi@montefiore.org or 718-920-4011, or Joe Soldevere at jsoldeve@montefiore.org.


3. Ties to industry money influenced reviewers' findings on flu treatment

Authors of review articles with financial ties to the pharmaceutical company were more likely to report positive findings on neuraminidase inhibitors and recommend their use for influenza than review authors without such ties, according to a retrospective analysis being published in Annals of Internal Medicine. Neuraminidase inhibitors are used in the prophylaxis and treatment of seasonal and pandemic flu. Systematic reviews analyzing evidence on the effectiveness of these agents have exhibited wide variation in their conclusions, ranging from strong endorsements of their use to assessments questioning the evidence of their safety and efficacy. Financial conflicts of interest have been shown to contribute to bias in the synthesis and interpretation of scientific evidence. Researchers analyzed reviews of neuraminidase inhibitors published between 2005 and 2014 to examine the association between financial conflicts of interest and researcher conclusions. They found that reviewers who received drug company funding were more likely to report favorable findings on the use of neuraminidase inhibitors, which may explain the inconsistent study conclusions. The authors suggest that financial disclosures and other measures may be necessary to prevent compromise of scientific evidence.

Note: The article URL will be live at 5:00 p.m. on Monday, October 6 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Keri Stedman at Keri.Stedman@childrens.harvard.edu or 617-919-3110.


4. Efavirenz-free regimens prove effective for initial treatment of HIV

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Patients who cannot take efavirenz for initial treatment of HIV have effective options, according to an article being published in Annals of Internal Medicine. Efavirenz is a component of many effective antiretroviral regimens used to treat people with HIV. However, women who are considering becoming pregnant or patients with a history of severe psychiatric disorders are not good candidates for treatments that include efavirenz because it can cause birth defects and suicidal thoughts. Finding efavirenz-free regimens with equivalent virologic efficacy and tolerability is important for these patients. Researchers randomly assigned more than 1,800 patients with HIV to receive one of three efavirenz-free treatment regimens for 96 weeks: 300 mg/d of atazanavir with 100 mg/d of ritonavir; 800 mg/d of darunavir with 100 mg/d of ritonavir; or 400 mg/bid of raltegravir. All participants received 200 mg/d of emtricitabine and 300 mg/d of tenofovir disoproxil fumarate in addition to the assigned regimen. The authors found that the three regimens similarly suppressed HIV in the blood and restored function of the immune system; however, the tolerability differed among the tested regimens. The study authors concluded that the drugs tested are good options for initial HIV antiretroviral therapy that do not contain efavirenz. Note: The article URL will be live at 5:00 p.m. on Monday, October 6 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Holly Korschun at hkorsch@emory.edu or 404-727-3990, or Juliette Merchant at juliette.merchant@emory.edu or 404-778-1503.

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