[Registration of clinical trials: a statement from the International Committee of Medical Journal Editors]. / Registratie van klinische trials: een verklaring van het International Committee of Medical Journal Editors.

Altruistic motives and trust are central to scientific investigations involving people. These prompt volunteers to participate in clinical trials. However, publication bias and other causes of the failure to report trial results may lead to an overly positive view of medical interventions in the published evidence available. Registration of randomised controlled trials right from the start is therefore warranted. The International Committee of Medical Journal Editors has issued a statement to the effect that the 11 journals represented in the Committee will not consider publication of the results of trials that have not been registered in a publicly accessible register such as www.clinicaltrials.gov. Patients who voluntarily participate in clinical trials need to know that their contribution to better human healthcare is available for decision making in clinical practice.

Physicians' views of the relative importance of thirty medical innovations.

In response to a mail survey, 225 leading general internists provided their opinions of the relative importance to patients of thirty medical innovations. They also provided information about themselves and their practices. Their responses yielded a mean score and a variability score for each innovation. Mean scores were significantly higher for innovations in procedures than in medications and for innovations to treat cardiovascular disease than for those to treat other diseases. The rankings were similar across subgroups of respondents, but the evaluations of a few innovations were significantly related to physicians' age. The greatest variability in response was usually related to the physician's patient mix.

Commentary of "Hospitalists and the doctor-patient relationship".

The use of the hospitalist is a means to increase the efficiency of hospitals by achieving equal or better outcomes of care while reducing the cost of care. I comment on David Meltzer's controlled study of the costs and outcomes of hospitalist care, which showed increased cost savings and no change in patients' satisfaction with their care. Relative to full-time community practice, Meltzer's findings probably exaggerate the effect of hospitalists on costs. The physicians in charge of the control group of patients were full-time academic faculty, who typically spend 1 or 2 months per year doing inpatient care, in contrast to hospitalists, who spent most of their time caring for hospitalized patients. His findings probably minimize differences in satisfaction with care. Resident physicians did most of the bedside care for the hospitalist patients and the control group patients, an arrangement that would reduce any intrinsic differences.

US women's attitudes to false-positive mammography results and detection of ductal carcinoma in situ: cross-sectional survey.

OBJECTIVE: To determine women's attitudes and knowledge of both false-positive mammography results and the detection of ductal carcinoma in situ after screening mammography. DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: A total of 479 women aged 18 to 97 years who did not report a history of breast cancer. Main outcome measures Attitudes and knowledge about false-positive results and the detection of ductal carcinoma in situ after screening mammography. RESULTS: Women were aware that false-positive results do occur. Their median estimate of the false-positive rate for 10 years of annual screening was 20% (25th percentile estimate, 10%; 75th percentile estimate, 45%). The women were highly tolerant of false-positive results: 63% thought that 500 or more false-positives per life saved was reasonable, and 37% would tolerate a rate of 10,000 or more. Women who had had a false-positive result (n = 76) expressed the same high tolerance: 30 (39%) would tolerate 10,000 or more false-positives. In all, 62% of women did not want to take false-positive results into account when deciding about screening. Only 8% of women thought that mammography could harm a woman without breast cancer, and 94% doubted the possibility of nonprogressive breast cancers. Few had heard of ductal carcinoma in situ, a cancer that may not progress, but when informed, 60% of women wanted to take into account the possibility of it being detected when deciding about screening. CONCLUSIONS: Women are aware of false-positive results and seem to view them as an acceptable consequence of screening mammography. In contrast, most women are unaware that screening can detect cancers that may never progress but think that such information would be relevant. Education should perhaps focus less on false-positive results and more on the less-familiar outcome of the detection of ductal carcinoma in situ.