This Week in JAMA FREE

Genetic and biochemical markers associated with cardiovascular disease risk are the subject of 2 articles in this issue. In the first article, Elliott and colleagues Article report the association of C-reactive protein (CRP) gene variants with CRP levels and coronary heart disease risk. In a genome-wide association study, the authors confirmed that several common gene polymorphisms are associated with CRP levels, but in a mendelian randomization study, they found no association between the CRP gene variants and coronary heart disease risk. The second article by Melander and colleagues Article reports the utility of adding novel and conventional biomarkers to conventional risk factors to predict incident cardiovascular disease in a low-risk population. The authors found that several biomarkers predicted future cardiovascular events. However, risk classification incorporating these biomarkers improved minimally compared with classification schemes based on conventional risk factors alone, and improvement was largely confined to the identification of intermediate-risk individuals unlikely to experience cardiovascular events. In an editorial, Shah and de Lemos Article discuss the role of biomarkers in cardiovascular disease causality, risk assessment, and treatment.

Recombinant bone-morphogenetic proteins (BMPs)—factors that promote bone creation and remodeling—were approved by the US Food and Drug Administration in 2002 to support bone fusion in anterior lumbar spine surgery. To assess rates and patterns of use of BMP, associated complications, and hospital charges, Cahill and colleagues analyzed data from the National Inpatient Sample database from 328 468 patients who had undergone spinal fusion procedures from 2002 through 2006. The authors found that BMP was used in approximately 25% of all spinal fusion procedures. The use of BMP in anterior cervical fusion procedures was associated with a higher rate of complications than fusions that did not use BMP and use of BMP accounted for greater inpatient charges for all categories of fusions.

Participation in biomedical research is often considered above and beyond the call of duty, resulting in praise for persons who participate and no loss of regard for persons who do not. Taking an alternate position, Schaefer and colleagues argue that biomedical knowledge is a public good from which everyone benefits; thus, all persons have a duty to participate in biomedical research. The authors discuss implications of obligatory participation for research progress and society and consider potential objections to their perspective.

Ms A, a 70-year-old woman, was seen in the emergency department with a several-day history of right ear pain, numbness and tingling over her right jaw, and eruption of painful lesions in these areas. Whitley discusses the natural history, pathogenesis, and management of herpes zoster (shingles) in an immunocompetent elderly adult and reviews the indications for the varicella and shingles vaccines.

“Every physician will encounter at least one patient for whom the question of futility hangs like a heavy cloud.” From “The Quiet Storm.”

Physicians who treat elderly patients living with persistent pain should avoid prescribing nonsteroidal anti-inflammatory drugs and consider the use of opioids, according to a new guideline from the American Geriatrics Society.

Collection, storage, and use of public health data

Medical care and public health

Public ownership of patient data

Harmful effects of health care

Join Charles M. Morin, PhD, Wednesday, July 15, from 2 to 3 PM eastern time to discuss cognitive behavioral therapy alone or with medication to treat persistent insomnia. Register at http://www.ihi.org/AuthorintheRoom. Send questions to replies@jama-archives.org.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about shingles.