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• Improve the affordability of cancer care by leveraging existing efforts to reform payment and eliminate waste. ASCO supports the recommendations and has already launched initiatives to improve the quality of care delivery, said ASCO president Clifford Hudis, MD, who is also a medical oncologist and researcher at Memorial Sloan-Kettering Cancer Center in New York City. “The IOM committee members did indeed highlight key opportunities to improve delivery of cancer care in the United States, and it would be wise to address some of the shortcomings they identify,” he said.

NIH, FDA Setting Up Research Centers to Generate Evidence Base to Inform Tobacco Regulation Mike Mitka, MSJ


he federal government will spend $53 million in fiscal year 2013 on tobacco-related research designed to ensure that US tobacco regulatory actions and activities are based on sound and relevant scientific evidence. Thefunding,announcedSeptember19by the Food and Drug Administration (FDA) and theNationalInstitutesofHealth(NIH),willcreate 14 Tobacco Centers of Regulatory Science. The FDA and NIH will award more than $273 million over 5 years to the program, in hopes that the initiative will provide scientific evidence to help inform and assess the FDA’s prior,ongoing,andpotentialfutureregulatory activities. Research areas to be studied by the centers include diversity of tobacco products, reducing addiction, reducing toxicity and carcinogenicity, adverse health consequences, communications, marketing of tobacco products, and economics and policies. Legislation passed in 2009 gave the FDA authority to regulate the manufacture, marketing, and distribution of tobacco products to protect public health. The FDA, which has expertise in tobacco regulatory science, teamed up with the NIH, which has the infrastructureforthesolicitation,review,andmanagement of research. The program will be coordinated by the NIH’s Office of Disease Prevention and administered by the NIH’s 1550

National Cancer Institute, the National Institute on Drug Abuse, and the National Heart, Lung, and Blood Institute. “The FDA is committed to a sciencebased approach that addresses the complex public health issues raised by tobacco product regulation,” said FDA Commissioner Margaret A. Hamburg, MD, in a release. The 14 centers will each run several projects on a diverse array of tobacco topics. For example, a center being run by the American Heart Association will conduct 3 projects researching the cardiovascular toxicity of tobacco products, cardiovascular injury due to tobacco use, and the perception of tobacco use in vulnerable populations. Other centers are based at Georgia State University, Atlanta; the Ohio State University, Columbus; Penn State College of Medicine/ Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; University of California, San Francisco; University of Maryland, College Park; University of North Carolina at Chapel Hill (2 centers); University of Pennsylvania, Philadelphia; University of Southern California, Los Angeles; University of Texas Health Sciences Center, Houston; University of Vermont and State Agriculture College, Burlington; Virginia Commonwealth University, Richmond; and Yale University, New Haven, Connecticut.


[email protected] FROM JAMA’S DAILY NEWS SITE

Stagnant HIV-Related Lymphoma Survival Survival rates for US patients with HIV and AIDS who develop lymphoma appear stagnant, even in the era of antiretroviral therapy (ART). Data from 476 patients treated for HIV infection and lymphoma at 8 US sites showed shifting trends in HIV-related lymphoma between 1996, when ART was introduced, and 2010. Patients’ average age increased, the proportion of Latino patients increased, and patients had improved health indicators—lower levels of HIV in their blood and higher numbers of CD4 T cells, the immune cell that HIV attacks. But no significant survival improvements emerged during the 14-year study period. Narcotics and Imaging for Back Pain More patients with back pain are receiving narcotic drugs or imaging scans despite consistent recommendations to begin treatment with more conservative approaches. Recent data showed that the use of nonsteroidal anti-inflammatory drugs or acetaminophen for back pain declined from 36.9% to 24.5% between 1999 and 2010, while prescriptions for narcotics increased from 19.3% to 29.1%. The number of patients undergoing computed tomography or magnetic resonance imaging scans also increased from 7.2% to 11.3% over the same period. Back and neck pain account for about 10% of office visits and $86 billion in health care spending. Who Should Cut Health Care Costs? Most physicians say they feel some responsibility to reduce health care costs but that the “major responsibility” for doing so is up to others. In a recent survey of 2556 physicians, 60% said that a major responsibility for reducing health care costs lies with trial lawyers. A similar percentage named health insurance companies, pharmaceutical and device manufacturers, and hospitals and health systems as major players in reducing costs. About half said patients play a major role, but only 36% said physicians have a major responsibility. Only 4% said physicians have no responsibility to rein in health costs.

For more on these stories and other medical news, visit

JAMA October 16, 2013 Volume 310, Number 15

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• Expand the depth of data collected in cancer research through a common set of data elements that capture patient-reported outcomes, relevant patient characteristics, and health behaviors. • Develop an information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. • Develop a national quality reporting program for cancer care as part of a learning health care system. • Implement a national strategy to reduce disparities in access to cancer care for underserved populations by leveraging community interventions.

NIH, FDA setting up research centers to generate evidence base to inform tobacco regulation.

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