Feb. 15, 2005, Annals of Internal Medicine...( 1. 14-Year Clinical Trial Finds that ...),Health

In a new study of 5,887 middle-aged smokers with mild lung disease, those who were randomly assigned to a quit-smoking program had a lower death rate than those assigned to usual care even though only 21.7 percent of them actually quit smoking (Article, p. 233).

The annual death rates were 8.8 per 1000 patients in the quit-smoking program and 10.4 per 1000 in the usual care group. The annual death rates for those who quit smoking were 6.0 per 1000 patients compared with 11.0 per 1000 in those who did not quit smoking (46 percent lower in the quit-smoking group).

An editorial writer says that these new findings from the Lung Health Study were based on experiment rather than observation and were of "sufficient size and duration" to prove that smoking causes an increased risk for death in smokers (Editorial, p. 299). "No one can make a serious claim to the contrary in light of this randomized trial evidence," the writer says.

(The smoking cessation article is the subject of a video news release. Call for coordinates.)

2. Older Doctors Are Not Better Doctors, Study Finds

Researchers examined 59 medical research articles that measured quality of care or medical knowledge (Improving Patient Care, p. 260).

The majority of the studies found that older or more experienced physicians had worse measures of health care quality or medical knowledge than younger physicians. Only one study showed that older physicians had better quality measures than younger physicians.

The negative association was consistent across medical specialties and measures of performance.

Editorial writers from two internal medicine organizations said the "striking" findings mean that medical practice "must be accompanied by ongoing active effort to maintain competence and quality of care." (Editorial, p. 302.)

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Contact: Susan Anderson
sanderson@acponline.org
215-351-2653
American College of Physicians
14-Feb-2005