This Week in JAMA FREE

Erectile dysfunction is a frequent complication in men with diabetes mellitus. In this trial by Rendell and colleaguesArticle, men with erectile dysfunction and type 1 or type 2 diabetes mellitus were randomly assigned to receive a flexible dose of oral sildenafil or placebo for 12 weeks. Improvement in erectile function was significantly greater in the sildenafil group than in the placebo group. Cardiovascular adverse events were uncommon and were similar in the 2 groups. In a commentary, Lipshultz and KimArticle discuss treatment strategies for erectile dysfunction in men with diabetes.

If bacterial infections increase the risk of acute myocardial infarction (MI), then antibiotic use for any reason might decrease the risk of acute MI. In this large case-control study, Meier and colleaguesArticle found that individuals with a first MI were much less likely to have used tetracycline antibiotics or quinolones in the previous 3 years than were matched controls. In an editorial, FolsomArticle emphasizes that evidence supporting an infectious etiology of atherosclerotic vascular disease is inconclusive and not sufficient to warrant the addition of antibiotics to established interventions for the prevention or treatment of MI.

By altering the availability of medical services and physician practice patterns, managed care may have system-wide effects that influence the care of patients whether or not they are enrolled in a managed care plan. Using regression models to test this hypothesis, BakerArticle found that increased market share of health maintenance organizations was associated with decreased expenditures for the care of patients in traditional Medicare fee-for-service plans. In an editorial, ReinhardtArticle discusses models of physician behavior that might explain Baker's findings.

Previous studies have suggested an association between blood pressure and cognitive function in the elderly. In this longitudinal study of elderly individuals, Glynn and coworkers examined the relationship between blood pressure and performance on 2 brief tests of cognition and memory. In general, blood pressure measurements at baseline or 9 years prior to baseline were not predictive of a change in cognitive function. Slightly increased error rates on 1 of the tests during 6 years of follow-up, however, were observed in individuals with elevated or low blood pressure at baseline or 9 years before baseline relative to those with normal blood pressure.

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In this Grand Rounds at The Johns Hopkins Hospital, Auwaerter discusses the case of a previously healthy 42-year-old man who presented with fever, gastrointestinal symptoms, and fatigue. A prolonged febrile illness followed with pneumonia, hepatitis, and eventually pharyngitis. Test results for hepatitis A, B, and C were negative. White blood cell counts were normal, but inspection of a peripheral blood smear in the fourth week of illness provided diagnostic clues.

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"The presence of a want does not equate with the existence of a need." From "A Vision of Health Care in the Next Millennium."

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George D. Lundberg ousted as editor.

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Health care policy experts tell what to expect in the quality arena this year, including federal legislation, private initiatives, and national guidelines.

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Is there a point at which continued growth in medical care is likely to produce harm? An examination of how more medical care may lead to unintended harm and how to avoid harmful practices.

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JAMA and editorial independence.

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Revisiting the history and traditions underlying medicine's symbols: the white coat, serpents, staffs, and Aesculapius.

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For your patients: Basics of high blood pressure.

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