JAMA

In Reply In their letters about our article, Dr Mei and colleagues and Dr Zhang and colleagues raise the possibility of using noninvasive screening tests as an option for deimplementing routine, colonoscopy-based surveillance. We welcome this suggestion and, in the Discussion section of our article, highlighted the importance of an ongoing trial in the US comparing fecal immunochemical testing vs colonoscopy-based surveillance for older adults with prior polypectomy.

This JAMA Patient Page describes primary and secondary male hypogonadism along with common symptoms and information about diagnosis and treatment.

In Reply We appreciate the letters about our Review on endometrial cancer.

To the Editor A recent study provided valuable competing risk data for surveillance decisions in adults aged 75 years or older with prior colonoscopy. In their cohort, 10-year colorectal cancer incidence was higher among individuals with prior adenoma than among those without adenoma, but the absolute difference was small (1.1% vs 0.7%). Colorectal cancer mortality was similarly low, whereas noncolorectal cancer death was approximately 48%, and increased to 82% among those with severe frailty. The accompanying Editorial appropriately framed these findings as a challenge to reflexive surveillance in late life.

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.

To the Editor A recent Review offered a comprehensive overview of endometrial cancer, highlighting the emerging significance of molecular classification in informing prognosis and treatment, which reflects the growing role of molecular classification in clinical care. Nevertheless, the practical implementation of molecular classification was inadequately explored. Access to comprehensive molecular testing is inconsistent across health care systems. Even in high-resource settings, the availability of assays such as polymerase epsilon (POLE) sequencing is variable and result interpretation lacks standardization. These challenges are more pronounced in low-resource settings, resulting in a disparity between theoretical optimal care and real-world clinical practice.

The American Academy of Pediatrics (AAP) and the American College of Obstetricians & Gynecologists (ACOG) released statements criticizing a recent executive order on childhood vaccine recommendations.

The study evaluated whether an integrated multicomponent telehealth-based rehabilitation program across the intensive care unit, hospital ward, and postdischarge periods improves health-related quality of life at 90 days after hospital discharge in adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation.

The US Food and Drug Administration (FDA) approved the first pill combining acetaminophen with naproxen sodium, a nonsteroidal anti-inflammatory drug (NSAID).

E-scooter riders may face higher risk of certain injuries than motorcyclists and bicyclists, according to a recent study.

Glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with a lower risk of fragility fracture in patients with type 2 diabetes, a study published in JAMA Network Open found.

The US Food and Drug Administration (FDA) approved the nation’s first freeze-dried plasma product.

The incidence of gestational hypertension increased by 73% from 2016 to 2024, according to a report from the US Centers for Disease Control and Prevention (CDC) National Vital Statistics System.

This cohort study examines the absolute risk of progression to cognitive impairment and rates of cognitive decline per the blood-based biomarker plasma phosphorylated tau 217 (p-tau217) among cognitively unimpaired older adults.

This Medical News article discusses a push for human-centric research models, such as mini-organs grown from human cells, to complement or replace animal studies.

This JAMA Insights discusses vibriosis, an infection with noncholera species of Vibrio, including its clinical presentation and diagnosis, risk factors, and effective treatments.

This Medical News article discusses how the ongoing US cyclosporiasis outbreak, centered in Michigan, exposed weaknesses in the nation’s foodborne disease surveillance system and what needs to change to detect and contain future surges more quickly.

This international randomized clinical trial evaluates the efficacy of high-dose intravenous vitamin C in reducing 28-day mortality and persistent organ dysfunction (dependence on mechanical ventilation, kidney replacement therapy, or vasopressor/inotrope support at day 28) in patients with severe burn injury.

Such is the question asked and somewhat briefly discussed by Dr. Charles L. Dana in The Forum for September. It is not unlike the question propounded a few years ago, and learnedly discussed in a book—“Is Life worth Living?” the obvious answer to which was that it depended on the liver. “Addison once said,” says Dr. Dana, “that man should take more care for the direction of his life than the preservation of it. We of this century are inclined perhaps not to reverse Addison’s sentence, but to lay much more stress on the question of preservation.” Addison should have shown how a life could have direction without being preserved, but he did not.

This study estimates the share of US-born and non–US-born US medical graduates (USMGs) and international medical graduates (IMGs) in the US internal medicine workforce, as well as the share of underserved patients cared for by these physicians.

The origins of glucagon-like peptide-1s (GLP-1s) and what comes next are discussed by JAMA Senior Editor Derek C. Angus, MD, MPH, and Jens Juul Holst, MD, DMSc, a professor of medical physiology at the University of Copenhagen, and Lotte Bjerre Knudsen, DMSc, professor, for the Healthy Dialogue podcast.

To the Editor In a recent Review of endometrial cancer, the major hormonal risk factors associated with this malignancy were discussed. However, polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), the most common endocrine disorder affecting reproductive-aged women, was not addressed. This omission is noteworthy given the substantial evidence linking PMOS to an increased risk of endometrial cancer, particularly among premenopausal women. This association primarily concerns low-grade endometrioid carcinomas, which typically arise through estrogen-dependent pathways.

In this narrative medicine essay, a hospital chaplain exhorts her colleagues to understand the yin and yang of giving and receiving as an act of faith and resistance.

To the Editor A recent study reported that among adults aged 75 years or older, the 10-year cumulative incidence of colorectal cancer after a prior adenoma was only 1.1% and colorectal cancer–specific death was 0.5%, whereas noncolorectal cancer mortality approached half of the cohort. The absolute excess associated with prior adenoma was therefore modest, making these data clinically important for decisions about surveillance intensity. However, 2 issues deserve attention before these findings are translated into broad deimplementation.

today I saw an aphasic Parkinsonian man say: I love you more profoundly to his wife with a careful loving caress of her cheek with the back of his hand than any words I have heard spoken it simultaneously filled my heart and blew it to pieces

To the Editor With regard to colorectal cancer surveillance in older adults, a recent study presented compelling data highlighting that the risk of noncolorectal cancer death far exceeds the risk of colorectal cancer in adults aged 75 years or older, even among those with a prior adenoma. This finding is important for shared decision-making and supports the deescalation of surveillance in this population. However, we wish to raise 2 points regarding the interpretation of these results that are highly relevant to current clinical practice.

In poetry, like in medicine, life is often experienced in extremis, each individual’s vantage point offering a distinct window into the most beautiful or tragic conditions that can attend human beings. Because it also deeply confronts such intensity, poetry can be a key to cathartically unlocking the inescapable pain felt in medical care. In his foundational treatise Poetics, Aristotle explained poetry’s cathartic power as the providing of a space where one can assimilate and cognitively hold overwhelming pathos in a controlled, often communal setting. In contrast with Sigmund Freud, who, centuries later from a more medicalized perspective, viewed catharsis as a curative release accompanied by resolution of suffering, Aristotle emphasized instead the value of creating understanding, usually through harnessing pity or fear without any explicit goal of purgation. The poem “unspoken” in its stunning brevity elicits a lightning bolt of emotion by depicting an interaction in clinic between a patient with Parkinson disease and his wife. Creating a raw image of an expression of enduring love through the slightest of gestures, ironically without words, the poem allows readers to feel simultaneously a devastating diagnosis and also the heartening tenderness between lovers. Yet the astonishing weight of the encounter is quietly and carefully balanced by the limits of the poem’s constrained parameters and the familiar dimensions of the page. Here, art offers a means of catharsis for healers by offering a structure to hold and make sense of primal emotion, not to be cleansed of it, even when curing seems impossible.

This narrative review examines how liquid biopsy, particularly circulating tumor DNA, can guide treatment decisions by helping clinicians monitor cancer progression, detect minimal residual cancer, and identify genetic sequence variations.

This study examines the patient- and hospital-level variation in time to initiation of inpatient management among patients admitted to general medical services.

Alzheimer disease is the most common cause of dementia in older individuals. Cerebrospinal fluid biomarkers and amyloid positron emission tomography (PET) can accurately detect Alzheimer disease brain pathology, but the perceived risks, costs, and limited availability have contributed to low rates of biomarker testing in the clinic. With recent approvals of disease-modifying, amyloid-targeting therapies, incorporation of biomarkers into clinical practice has become more important for medical decision-making. Fortunately, blood-based biomarkers of Alzheimer disease pathology have advanced rapidly in recent years and are now increasingly used in research, clinical trials, and clinical practice. Blood-based biomarkers are highly scalable and promise to improve accurate diagnosis of Alzheimer disease, with the potential for much greater reach than cerebrospinal fluid or PET tests. Among the blood-based biomarkers, plasma phosphorylated tau 217 (p-tau217) has demonstrated the highest accuracy in detecting amyloid pathology and also reflects tau pathology to some degree.

This Perspective discusses the advantages and disadvantages of physician-led medical care vs that provided by artificial intelligence (AI).

This JAMA Clinical Guidelines Synopsis summarizes the 2025 recommendations on human papillomavirus (HPV) screening and self-collected vaginal samples from the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee.

To the Editor A recent Perspective framed clinician burnout as a systems-level issue, describing lessons from parallels to the patient safety and quality movement.

This randomized clinical trial assesses the effect of an integrated multicomponent telehealth-based rehabilitation intervention, compared with usual care, on health-related quality of life at 90 days after hospital discharge among adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation.

In Reply We appreciate the thoughtful letter by Drs Nadkarni and Fromson regarding our Perspective on accelerating workforce well-being. We agree that intersectionality is essential to understanding and addressing burnout.

In this issue of JAMA, Stoppe and colleagues present the results of an international randomized clinical trial that provides evidence that high-dose intravenous vitamin C does not improve outcomes in patients with large burns. The data from the VICTORY trial even suggest that use of vitamin C in patients with large burns might increase mortality. This well-designed study had strict criteria for stopping based on futility or harm. It is clear that the possibility of vitamin C improving outcomes in major burns is extremely low.

Artificial intelligence (AI) is reshaping research and scientific publishing at an unprecedented pace, with extraordinary promise. We as editors embrace AI as a tool that can be helpful to researchers and authors by reducing the burdens of some tasks and improving efficiency in some contexts. However, as use of AI in scientific publishing grows exponentially, so do concerns about such use. Journals have adopted policies regarding appropriate and responsible use of AI by authors, reviewers, and editors, which range from encouragement of AI use, provided that such use is disclosed, to restrictions on some specific types of use. Yet very low rates of disclosure of AI use by authors have been reported. Reasons reported by authors for failure to disclose use of AI include concern that it may lead to biased editorial assessments and unfavorable editorial decisions and lack of understanding of journal policies of what should be disclosed. Recognizing that transparency is central to the integrity of the scholarly record, recommendations for more uniform disclosure of AI use by authors may be helpful. Efforts to develop guidelines that promote responsible use and disclosure and related initiatives are underway. In the interim, we offer guidance to authors for responsible use, highlighting what is permitted and not permitted and what needs to be disclosed (Table and BoxBox).

The objective of this study was to determine whether high-dose intravenous vitamin C improves a composite of 28-day mortality and persistent organ dysfunction in patients with severe burn injury.