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ACP: Ban flavoring and advertising for e-cigarettes; more news

Annals of Internal Medicine tip sheet for April 21, 2015

American College of Physicians

1. American College of Physicians: Ban flavoring and advertising for e-cigarettes

A new position paper from the American College of Physicians (ACP) offers strong recommendations for regulating electronic nicotine delivery systems (ENDS), including banning characterizing flavors and television advertising. An executive summary of ACP's paper, Electronic Nicotine Delivery Systems: An American College of Physicians Policy Position Paper, is published in Annals of Internal Medicine.

Electronic nicotine delivery systems (ENDS), such as e-cigarettes, are growing in popularity, with global sales expected to surpass $50 billion in the next 15 years. Although evidence of their safety and efficacy and as a smoking cessation aid is limited, the federal government does not currently regulate ENDS. As such, many experts believe that availability of these products should be restricted. In 2010, ACP called for regulation and oversight of ENDS, noting that the products may expose users and bystanders to toxic constituents. The College developed its current position paper to provide updated policy and regulatory guidance to policymakers addressing the growing ENDS market. It is not intended to offer clinical guidance.

ACP's official policy positions and recommendations cover regulation and oversight, taxation, flavorings, promotion, indoor and public use, and research of ENDS. In addition to recommending a ban on characterizing flavors of all tobacco products, including ENDS, ACP supports legislative or regulatory efforts to restrict promotion and marketing for ENDS products in the same manner as for combustible cigarettes, including prohibition of television advertising. ACP's full paper, including a rationale for each policy position and recommendation, will be posted at when the embargo lifts.

Note: For an embargoed PDF, please contact Megan Hanks at To arrange an interview with someone from ACP, please contact David Kinsman at

2. Statins cost-effective for older patients but adverse effects could be an issue

A modeling study suggests that statins are cost-effective for the primary prevention of cardiovascular disease in older patients, but even small increases in geriatric-specific adverse effects could offset the cardiovascular benefit. The article is published in Annals of Internal Medicine.

Clinical guidelines vary on the use of statins in patients over the age of 75 due to uncertainty about the balance between the benefits and risks for adverse events such as myalgia, fatigue, reduced levels of physical activity, and cognitive impairment. Using information from clinical trials, researchers created a computer simulation to forecast the population benefit and cost-effectiveness of statins in persons aged 75 and older without a history of cardiovascular disease. The models suggest that statins are cost-effective and could help to prevent a significant number of myocardial infarction and coronary heart disease deaths in adults aged 75 to 94. However, even a small increased risk for functional limitation or cognitive impairment could offset the cardiovascular benefit.

Note: For an embargoed PDF, please contact Megan Hanks at To arrange an interview with the lead author, please contact Michelle Klampe at or 541-737-0784.

3. Use of electronic health records could drive appropriate use of diagnostic radiology

Computerized clinical decision support integrated with the electronic health record (EHR) can improve appropriate use of diagnostic radiology by a moderate amount and decrease use by a small amount, according to an article published in Annals of Internal Medicine. Strong evidence shows that diagnostic imaging is overused and interventions have been suggested to encourage more appropriate use of these tests. Some of these interventions have made use of the computerized clinical decision support (CCDS) capabilities of EHRs. Researchers conducted a systematic review and meta-analysis of EHR-based interventions to determine if they improve the appropriate use of diagnostic imaging. The evidence suggests that in addition to improving appropriate use, EHR-based interventions including a "hard stop" and those done in an integrated care delivery setting may be more effective than interventions without such features.

Note: For an embargoed PDF or for an interview with the lead author, please contact Megan Hanks at

4. Annals goes 'Beyond the Guidelines' to discuss real-world application of lung cancer screening recommendations

New multicomponent educational program features challenging clinical cases from Beth Israel Deaconess Medical Center Grand Rounds Sessions

See patient video at

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 who currently smoke or have quit smoking in the past 15 years. While the guidelines are clear, their application in clinical practice might present challenges based on individual patient characteristics. A multicomponent article published in Annals of Internal Medicine goes 'Beyond the Guidelines' to discuss differing approaches to care for a real patient who does not clearly fit the current USPSTF recommendations for lung cancer screening.

Ms. D is a 60-year-old former smoker with a complex medical history that includes several comorbid conditions, some of them very serious. The article debates her care in a moderator-led format that includes video of the patient and two experts with opposing opinions. The paper is the first in a new educational series called, 'Beyond the Guidelines.' All 'Beyond the Guidelines' papers are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center in Boston. A list of topics is available at

Note: The URLs, including video link, will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks at To interview the lead author, please contact Jerry Berger at or 617-667-7308.


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