A substantial proportion of U.S. doctors support national health insurance, a new study finds (Article, p. 795). Among 1,650 primary care physicians, surgeons, and specialists responding to a survey, 49 percent supported governmental legislation to establish universal national health insurance, and 40 percent opposed it. Nearly one quarter (26 percent) supported a program in which the government would pay for all health care. Support for national health insurance varied by specialty, location and practice setting. Doctors were most likely to back national health insurance if they practiced in inner cities or in nonprivate settings and if at least 20 percent of their patients were on Medicaid. An editorial says "physicians may disagree on how best to cover the uninsured," but that "the status quo should be everyone's last choice" (Editorial, p. 858).
Mammography Is Cost-Effective Beyond Age 65, Study Finds
A cost-effectiveness analysis of data in 10 published studies finds that mammography screening for breast cancer every two years reduces death at reasonable cost for 65- to 80-year-old women who have no serious life-threatening health conditions (Review, p. 835). The strength of the conclusions is limited somewhat by the scarcity of high quality research on breast cancer screening and treatment in this age group, but the authors say the results should provide information to guide clinical recommendations, clinical standards of care, and policy on optimal use of breast cancer screening for older women.
Intensive HIV Therapy Can Be Started Later Than Thought, With Caveats
A new observational study of 1,422 HIV-infected adults found that patients with CD4 counts of 200 cells/uL (cells per microliter) or above who complied with the drug regimens of highly active antiretroviral therapy (HAART) had low death rates (Article, p. 810). Among patients who adhered to treatment, survival was similar regardless of the CD4 cell counts at initiation of therapy. Patients with CD4 cell counts of 200 and above who did not refill their drug prescriptions regularly and who presumably did not comply with complicated HAART regimens had higher death rates. The authors conclude that delaying HAART until the CD4 cell count falls to 200 does not increase the mortality rate if the patients comply with the drug regimens. Adherence to the medication regimens is the critical determinant of survival, not the CD4 cell count when HAART is begun, they say.
Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.
Journal
Annals of Internal Medicine