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ACP urges immediate global action to avert devastating effects of climate change

American College of Physicians

1. ACP: Urgent global action needed now to avert devastating public health consequences of climate change*

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*ACP President Dr. Wayne Riley is available for live interviews via satellite on Tuesday morning, April 19, from the National Press Club in Washington, DC. To book Dr. Riley for an interview, contact Sue Higgins ( or 212-736-2727) at DS Simon Media.

Climate change will have devastating consequences for public and individual health unless aggressive, global action is taken now to curb greenhouse gas emissions, the American College of Physicians (ACP) says in a new policy paper published in Annals of Internal Medicine.

ACP cites higher rates of respiratory and heat-related illnesses, increased prevalence of diseases passed by insects, water-borne diseases, food and water insecurity and malnutrition, and behavioral health problems as potential health effects of climate change. The elderly, the sick, and the poor are especially vulnerable.

ACP says that physicians have a role in combatting climate change, especially as it relates to human health. ACP calls on the health care sector to implement environmentally sustainable and energy efficient practices and prepare for the impacts of climate change to ensure continued operations during periods of elevated patient demand.

ACP encourages physicians to become educated about climate change, its effect on human health, and how to respond to future challenges. ACP recommends that medical schools and continuing medical education providers incorporate climate change-related coursework into curricula.

Note: For an embargoed PDF, please contact Cara Graeff. For a phone interview with Dr. Riley before April 19, please contact Steve Majewski at or 215-351-2514.

2. Medicaid expansions improve health care coverage and outcomes for the poor



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States that have enacted the Patient Protection and Affordable Care Act (ACA) Medicaid expansions are seeing better outcomes in many aspects of health care for their low-income residents. The study findings are published in Annals of Internal Medicine.

In 2014, 26 states and the District of Columbia chose to expand Medicaid eligibility to low-income adults as a way to increase access to health care and improve health. Whether or not the expansion improved patient outcomes is of interest to policymakers who continue to debate enacting this policy.

Using data from the National Health Interview Survey for 2010 to 2014, researchers evaluated whether the state Medicaid expansions were associated with changes in insurance coverage, access and utilization of health care, and self-reported health. They compared changes in outcomes for residents of expansion and nonexpansion states before and after the 2014 expansions.

The data showed that states implementing the Medicaid expansions saw improvements in several outcomes, including insurance coverage and health care utilization. In addition, these states saw an increase in the rates of diagnosis of diabetes and high cholesterol among low-income residents. There was no improvement in self-reported health status among enrollees. According to the authors, these finding show that the Medicaid expansions are helping to achieve the broader goals of the ACA.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Laura Wherry, please contact Enrique Rivero at or 310-794-2273.

3. Evidence supports metformin as first-line treatment for diabetes

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A systematic evidence review and meta-analysis supports current guidelines recommending metformin as first-line therapy for type 2 diabetes. The review is published in Annals of Internal Medicine.

Type 2 diabetes is a significant public health problem and most patients with the disease eventually require glucose-lowering medications to reduce their risk of long-term complications. More than seven classes of diabetes medications are recommended as first- or second-line therapy. As evidence on the newer versus older diabetes medications continues to amass, clinicians and patients need updated evidence on their comparative effectiveness and safety to make informed treatment choices.

Researchers reviewed published studies to compare the effectiveness and safety of monotherapy (thiazolidinediones, metformin, sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor antagonists) and selected metformin-based combinations in adults with type 2 diabetes. The evidence showed that metformin monotherapy was associated with a lower risk for cardiovascular mortality compared with sulfonylurea monotherapy and also had favorable effects on blood glucose and body weight. Given its benefits and relative safety profile, the evidence supports metformin as a first-line therapy for diabetes.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Nisa M. Maruthur, please contact Marin Hedin at or 410-502-9429.

Also in this issue:

Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study

Kevin A. Brown, PhD; Makoto Jones, MD; Nick Daneman, MD; Frederick R. Adler, PhD; Vanessa Stevens, PhD; Kevin E. Nechodom, BSc; Matthew B. Goetz, MD; Matthew H. Samore, MD; and Jeanmarie Mayer, MD

Original Research

Network Meta-Analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma

Benjamin Rouse, MHS; Andrea Cipriani, MD, PhD; Qiyuan Shi, MHS; Anne L. Coleman, MD, PhD; Kay Dickersin, MA, PhD; and Tianjing Li, MD, MHS, PhD

Research and Reporting Methods

Uncertainty in Treatment Rankings: Reanalysis of Network Meta-analyses of Randomized Trials

Ludovic Trinquart, PhD; Nassima Attiche, MSc; A?¨da Bafeta, PhD; Raphae¨ l Porcher, PhD; and Philippe Ravaud, MD, PhD

Research and Reporting Methods

Judging the Past: How History Should Inform Bioethics

Barron H. Lerner, MD, MPH and Arthur L. Caplan, PhD

History of Medicine


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