JAMA Clinical Reviews

Norbert Stefan, MD, a leading endocrinologist and MASLD researcher, discusses metabolic dysfunction-associated steatotic liver disease. He reveals alarming global prevalence rates, especially in obesity and diabetes. Geographic variations in MASLD highlight rising incidences in Asia and harsher impacts in Eastern Europe. Stefan explains the role of diet, alcohol, and exercise in managing MASLD and outlines the diagnosis process through ultrasound and advanced imaging. He also covers innovative treatments, including medication and lifestyle changes to combat this growing health concern.

Frederick P. Rivara, a pediatrician and firearms injury prevention expert at the University of Washington, joins host Kirsten Bibbins-Domingo to discuss the recent JAMA Summit on reducing firearm violence. They explore the public health crisis of firearm deaths and outline a ambitious roadmap for a safer future by 2040. Rivara shares insights from a diverse group of 60 experts, highlighting five strategic steps to reduce firearm harms, and emphasizes the importance of community-based interventions and systems change in tackling violence.

Mackenzie R. Wehner, an Assistant Professor of Dermatology at MD Anderson Cancer Center, dives into the world of keratinocyte carcinomas, a prevalent form of skin cancer. She discusses risk factors like UV exposure and the impact of childhood sunburns. Indoor tanning's contribution to cancer risk reveals alarming truths, while sunscreen advice highlights the importance of SPF 30+. Wehner clarifies how to distinguish actinic keratoses from more serious conditions, and emphasizes the need for regular skin exams and careful monitoring to minimize recurrence.

Benjamin Solomon, PhD, a medical oncologist from the Peter MacCallum Cancer Centre, discusses the troubling rise of lung cancer in nonsmoking individuals, accounting for 15-20% of cases globally. He highlights the influence of environmental factors like air pollution and the peculiar histological differences, with adenocarcinoma being prevalent in nonsmokers. Solomon also tackles the lack of screening guidelines for this demographic, the challenges in early detection, and the importance of targeted therapies, emphasizing the need for better understanding and support for these patients.

Franco Chevalier, an infectious disease physician and Deputy Medical Director at the San Francisco City Clinic, dives into the alarming rise of syphilis cases in the U.S. He discusses the serious complications of untreated syphilis, including potential blindness and dementia. Chevalier outlines effective serologic testing strategies, illuminates when to consider lumbar punctures for neurosyphilis, and talks about emerging rapid testing options. He emphasizes the importance of early treatment with penicillin and the latest prevention guidelines, reminding clinicians of syphilis's complex clinical presentations.

David Christiani, a Professor of Environmental Genetics at Harvard, explores the pressing issue of microplastic pollution. He reveals the shocking presence of microplastics in human tissues and their potential health risks, linking them to respiratory and cardiovascular issues. The conversation touches on how microplastics interact with harmful chemicals and their prevalence in everyday items. Christiani emphasizes the need for innovative policy measures to combat this man-made crisis and instills hope for a cleaner future.

Join Juan Carlos Cardet, an Associate Professor specializing in Allergy and Immunology, as he unpacks the complexities of managing severe refractory asthma. He explains the significance of Type 2 asthma and identifies key tests essential for accurate diagnosis. Dr. Cardet highlights the role of inhaled corticosteroids and outlines when to consider biologic therapies. He also discusses the promising impact of these therapies on reducing exacerbations and hospitalizations, while addressing disparities in access to specialized care.

Epidemiologist Brian Lee from Drexel University discusses his groundbreaking study on acetaminophen use in pregnancy and its potential link to autism and neurodevelopmental issues. He delves into the study's findings that suggest initial associations may vanish when sibling analyses are considered, challenging the notion of causality. Lee also addresses the rigorous design of the study, the importance of dose-response analysis, and how clinicians can effectively counsel expectant mothers amidst conflicting advice. This engaging conversation demystifies critical concerns for parents.

Angela Fagerlin, a leading researcher at the University of Utah, shares her insights on communicating medical numbers effectively. She emphasizes the importance of using numeric probabilities instead of vague terms, which can mislead patients. Fagerlin advocates for consistent denominators to simplify comparisons and prefers absolute differences over relative risks for clarity. Visual displays, like pictographs, enhance understanding, while providing context for unfamiliar biomarker numbers improves patient decision-making. Ultimately, informed choices hinge on clear numeric communication.

In this discussion, Behnood Bikdeli, a cardiologist at Brigham and Women’s Hospital, delves into the complexities of superficial vein thrombosis (SuVT). He outlines the pathophysiology, risk factors, and crucial symptoms associated with the condition. Bikdeli emphasizes the significance of Doppler ultrasound in diagnosis and the potential transition to deep vein thrombosis. Treatment strategies, including the use of warm compresses and the selective application of anticoagulation, are also thoroughly explored, highlighting tailored approaches for high-risk patients.