Paper of the Week: 6th January 2020

This week’s blog is brought to you by: Professor Sir Muir Gray and Dr Joe McManners

For privacy reasons SoundCloud needs your permission to be loaded.
I Accept

These articles have been selected by our editors as the most important published by JAMA between 2010 and 2019.

Click below to read them for free. 

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
Mervyn Singer, MD, FRCP; Clifford S. Deutschman, MD, MS; Christopher Warren Seymour, MD, MSc; et alManu
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; et al
Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial
Paulina Salminen, MD, PhD; Hannu Paajanen, MD, PhD; Tero Rautio, MD, PhD; et al
Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; et al for the SPRINT Research Group
Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs
Varun Gulshan, PhD; Lily Peng, MD, PhD; Marc Coram, PhD; et al
JAMA Machine Learning Website
United States Health Care Reform: Progress to Date and Next Steps
Barack Obama, JD
Health Care Spending in the United States and Other High-Income Countries
Irene Papanicolas, PhD; Liana R. Woskie, MSc; Ashish K. Jha, MD, MP
The Association Between Income and Life Expectancy in the United States, 2001-2014
Raj Chetty, PhD; Michael Stepner, BA; Sarah Abraham, BA; et al
JAMA Health Disparities Website
Eliminating Waste in US Health Care
Donald M. Berwick, MD, MPP; Andrew D. Hackbarth, MPhil
Video Interview: Association Between Income and Life Expectancy in the United States

Implications for value based healthcare

The American Medical Association has been a conservative, indeed reactionary body in times past, as has the BMA too of course. However it is now a leading voice in advocating the need at least to look at universal health coverage as indeed is the NEJM which recently published a paper highlighting the crisis of healthcare for poor people in the United States titled The U.S. Insulin Crisis — Rationing a Lifesaving Medication Discovered in the 1920s (1)

After a decade in which the newspapers have been full of technological  developments, MRI, automated lab testing and chemotherapy to name but three, it is perhaps surprising how little ‘high tech’  features.

It is good to see the Obama paper and to think how he would  be looking at healthcare policy now and it is very good to see waste, value and equity stand out as issues in this list of papers. These issues are of course different in the USA because there is no commitment to universal healthcare a point tellingly made in the New England Journal of Medicine about the inability of poor people with Type 1 Diabetes to fund their insulin treatment and it is important to note that the NEJM, still the publication of choice for ‘high tech healthcare has also published papers on equity, waste and value, albeit with a different meaning to the term value. Waste and value are also key issues  raised in the two papers on blood pressure control  where an arbitrary line to be chosen for the definition of a ‘disease’. One of these papers relates to population ageing, one of the key themes globally and raising the issue that whereas there was once concern about the undertreatment of older people because of ageism there is growing concern about overtreatment. There have also been important, similar papers on Type 2 Diabetes in JAMA which must have made the short list.

High blood pressure is a ‘condition’ or simply a risk factor,  rather than a discrete disease unlike acute appendicitis which can be diagnosed unequivocally but needs judgement as to which intervention is best for which patient and this is the most conventional research paper in the selection. What is striking is the absence of any paper showing an impact of genomics from the list but perhaps this will be different in the publication of a similar review of the Twenties on 31st December 2029.

These papers are available through the excellent JAMA network which highlights key papers on a weekly basis and , as can be seen from the text above ,JAMA has also developed of the JAMA Machine Learning Website and the JAMA Health Disparities Website

Would the balance be very different in a review of the BMJ and other leading journals in the past decade? Probably not in our opinion!



  1. The U.S. Insulin Crisis — Rationing a Lifesaving Medication Discovered in the 1920s Michael Fralick, M. and  Kesselheim, A.D, N Engl J Med 2019; 381:1793-1795 DOI: 10.1056/NEJMp1909402