Intracellular Bacterial Persistence in Preventing Surgical Site Infections in Tibial Fractures—Reply
https://jamanetwork.com/journals/jama/fullarticle/2852510
In Reply We thank Chen and colleagues for their insights into potential reasons why the TOBRA (Topical Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) trial found that tobramycin plus vancomycin powder applied locally in the wound of periarticular tibial fractures at the time of definitive fixation did not reduce risk of deep surgical site infection compared with vancomycin alone. Notably, in the subgroup of 302 patients with open tibial fractures, tobramycin plus vancomycin was associated with increased deep SSI risk (hazard ratio, 2.08; 95% CI, 1.06–4.37), raising the possibility of harm in this high-risk group.
https://jamanetwork.com/journals/jama/fullarticle/2852510
In Reply We thank Chen and colleagues for their insights into potential reasons why the TOBRA (Topical Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) trial found that tobramycin plus vancomycin powder applied locally in the wound of periarticular tibial fractures at the time of definitive fixation did not reduce risk of deep surgical site infection compared with vancomycin alone. Notably, in the subgroup of 302 patients with open tibial fractures, tobramycin plus vancomycin was associated with increased deep SSI risk (hazard ratio, 2.08; 95% CI, 1.06–4.37), raising the possibility of harm in this high-risk group.
Intracellular Bacterial Persistence in Preventing Surgical Site Infections in Tibial Fractures
https://jamanetwork.com/journals/jama/fullarticle/2852511
To the Editor A recent randomized clinical trial evaluating adjunctive intrawound tobramycin in periarticular tibial fractures reported lack of benefit with combination therapy, which is notable, particularly given the common assumption that broader or higher local antibiotic exposure should translate into improved infection prevention.
https://jamanetwork.com/journals/jama/fullarticle/2852511
To the Editor A recent randomized clinical trial evaluating adjunctive intrawound tobramycin in periarticular tibial fractures reported lack of benefit with combination therapy, which is notable, particularly given the common assumption that broader or higher local antibiotic exposure should translate into improved infection prevention.
Food Politics, Obesity, and the “Wicked Mess” We Are In
https://jamanetwork.com/journals/jama/fullarticle/2852509
What led to the current obesity epidemic in the US and how it can be addressed are discussed by JAMA Senior Editor Derek C. Angus, MD, MPH, and Marion Nestle, PhD, MPH, Paulette Goddard Professor and professor emerita at New York University, for the Healthy Dialogue podcast.
https://jamanetwork.com/journals/jama/fullarticle/2852509
What led to the current obesity epidemic in the US and how it can be addressed are discussed by JAMA Senior Editor Derek C. Angus, MD, MPH, and Marion Nestle, PhD, MPH, Paulette Goddard Professor and professor emerita at New York University, for the Healthy Dialogue podcast.
Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest
https://jamanetwork.com/journals/jama/fullarticle/2852508
This randomized adaptive-allocation trial assesses the effect of increasing durations of therapeutic hypothermia at 33 °C on 90-day neurological function among comatose survivors of out-of-hospital cardiac arrest.
https://jamanetwork.com/journals/jama/fullarticle/2852508
This randomized adaptive-allocation trial assesses the effect of increasing durations of therapeutic hypothermia at 33 °C on 90-day neurological function among comatose survivors of out-of-hospital cardiac arrest.
Iron Delivery Amid Nutritional and Infectious Adversity
https://jamanetwork.com/journals/jama/fullarticle/2852553
Providing sufficient iron for brain development while protecting children from infection in malaria-endemic areas has remained an unresolved public health goal for more than 2 decades. A landmark study conducted on Pemba Island, Tanzania, brought the complex relationship between iron and malaria to the forefront by demonstrating that universal prophylactic iron supplementation increased the risk of hospitalization and death among young children in areas of high malaria transmission. Subsequent analyses suggested that the risk was concentrated among iron-replete rather than iron-deficient children. Preventing iron deficiency and maintaining an adequate supply of iron to the brain during the first 1000 days of life is likely far more effective than remediation after iron deficiency occurs. Even transient iron deficiency during critical developmental windows may produce long-lasting alterations in brain development and function.
https://jamanetwork.com/journals/jama/fullarticle/2852553
Providing sufficient iron for brain development while protecting children from infection in malaria-endemic areas has remained an unresolved public health goal for more than 2 decades. A landmark study conducted on Pemba Island, Tanzania, brought the complex relationship between iron and malaria to the forefront by demonstrating that universal prophylactic iron supplementation increased the risk of hospitalization and death among young children in areas of high malaria transmission. Subsequent analyses suggested that the risk was concentrated among iron-replete rather than iron-deficient children. Preventing iron deficiency and maintaining an adequate supply of iron to the brain during the first 1000 days of life is likely far more effective than remediation after iron deficiency occurs. Even transient iron deficiency during critical developmental windows may produce long-lasting alterations in brain development and function.
Communicating With Patients About Physical Activity
https://jamanetwork.com/journals/jama/fullarticle/2852552
This JAMA Insights discusses suggested methods for communicating about and promoting physical activity among patients with chronic medical conditions and how to tailor these conversations to individual patient needs.
https://jamanetwork.com/journals/jama/fullarticle/2852552
This JAMA Insights discusses suggested methods for communicating about and promoting physical activity among patients with chronic medical conditions and how to tailor these conversations to individual patient needs.
Abreast of Titulology
https://jamanetwork.com/journals/jama/fullarticle/2852551
Why are editors so fastidious about titles of manuscripts? Clearly, a title is not just a name, even when it is an eponym. It should have some logical link with the manuscript’s topic.
https://jamanetwork.com/journals/jama/fullarticle/2852551
Why are editors so fastidious about titles of manuscripts? Clearly, a title is not just a name, even when it is an eponym. It should have some logical link with the manuscript’s topic.
Peanut Allergen Exposure
https://jamanetwork.com/journals/jama/fullarticle/2852550
To the Editor Dr Anagnostou and colleagues comprehensively address peanut allergy via ingestion, yet one plausible route remains absent from current guidance: parenteral delivery through blood transfusion products. Peanut allergens, like pathogens, reach sensitized individuals through pathways that differ markedly in risk. Airborne and skin-contact exposures carry minimal clinical significance; current evidence explicitly discourages nut bans in schools and on aircraft as ineffective. Although the dominant route remains oral ingestion, as detailed by the authors, the intravenous route has been overlooked.
https://jamanetwork.com/journals/jama/fullarticle/2852550
To the Editor Dr Anagnostou and colleagues comprehensively address peanut allergy via ingestion, yet one plausible route remains absent from current guidance: parenteral delivery through blood transfusion products. Peanut allergens, like pathogens, reach sensitized individuals through pathways that differ markedly in risk. Airborne and skin-contact exposures carry minimal clinical significance; current evidence explicitly discourages nut bans in schools and on aircraft as ineffective. Although the dominant route remains oral ingestion, as detailed by the authors, the intravenous route has been overlooked.
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Audio Highlights August 7, 2026
https://jamanetwork.com/journals/jama/fullarticle/2852773
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
https://jamanetwork.com/journals/jama/fullarticle/2852773
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
Daylight Saving Time Linked to Higher Risk of Retinal Vascular Diseases
https://jamanetwork.com/journals/jama/fullarticle/2852757
Daylight saving time may be tied to higher risk of retinal vascular diseases, a study suggests.
https://jamanetwork.com/journals/jama/fullarticle/2852757
Daylight saving time may be tied to higher risk of retinal vascular diseases, a study suggests.
Compounded GLP-1 Drugs Remain Prevalent After Drug Shortage
https://jamanetwork.com/journals/jama/fullarticle/2852756
The compounded glucagon-like peptide-1 (GLP-1) receptor agonist market remains robust, even after the end of the semaglutide and tirzepatide shortage, a study published in JAMA Health Forum suggests.
https://jamanetwork.com/journals/jama/fullarticle/2852756
The compounded glucagon-like peptide-1 (GLP-1) receptor agonist market remains robust, even after the end of the semaglutide and tirzepatide shortage, a study published in JAMA Health Forum suggests.
CDC Reports Increase in Candida auris Infections
https://jamanetwork.com/journals/jama/fullarticle/2852755
The US Centers for Disease Control and Prevention (CDC) reported that cases of Candida auris infection increased from 2022 to 2024.
https://jamanetwork.com/journals/jama/fullarticle/2852755
The US Centers for Disease Control and Prevention (CDC) reported that cases of Candida auris infection increased from 2022 to 2024.
Errors in Text, Table, and Figure
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852483
Corrections have been made to the article, “Heavy Drinking, Alcohol Use Disorder, and Obesity,” that was published online first on April 20, 2026, and in the June 2026 issue of JAMA Internal Medicine. The authors have explained in a Letter to the Editor that they identified a coding error that affected the weighted prevalence estimates of adults with obesity presented. The corrections affect the text, Table, and Figure. There were no changes to the underlying data, analyses, or conclusions.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852483
Corrections have been made to the article, “Heavy Drinking, Alcohol Use Disorder, and Obesity,” that was published online first on April 20, 2026, and in the June 2026 issue of JAMA Internal Medicine. The authors have explained in a Letter to the Editor that they identified a coding error that affected the weighted prevalence estimates of adults with obesity presented. The corrections affect the text, Table, and Figure. There were no changes to the underlying data, analyses, or conclusions.
Automation Is Not Always the Answer
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852482
Despite ample evidence for the benefits of lung cancer screening, the uptake of low-dose computed tomography (LCDT) for both initial and annual follow-up screening remains low. Among individuals eligible for screening with a negative baseline LDCT finding, adherence to LDCT has been estimated at 61.2% in the time window for a 12-month follow-up, and adherence falls to near 50% in the window for a 24-month follow-up. Physicians, scientists, and health system leaders have explored multiple approaches to alerting both patients and physicians to the need for screening, yet many eligible individuals remain unscreened.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852482
Despite ample evidence for the benefits of lung cancer screening, the uptake of low-dose computed tomography (LCDT) for both initial and annual follow-up screening remains low. Among individuals eligible for screening with a negative baseline LDCT finding, adherence to LDCT has been estimated at 61.2% in the time window for a 12-month follow-up, and adherence falls to near 50% in the window for a 24-month follow-up. Physicians, scientists, and health system leaders have explored multiple approaches to alerting both patients and physicians to the need for screening, yet many eligible individuals remain unscreened.
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Intensification and Deintensification of Diabetes Medications Among Older Adults
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852481
This cohort study explores the prevalence of diabetes medication adjustment based on health status and hemoglobin A1c level among patients 65 years or older.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852481
This cohort study explores the prevalence of diabetes medication adjustment based on health status and hemoglobin A1c level among patients 65 years or older.
Use of Race in Clinical Algorithms
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852480
To the Editor We read with great interest the Research Letter by Diao et al. We agree that the use of race in clinical algorithms remains debated, and it is great to see public support for physicians’ use of all available information, including race, to optimize care. In our view, the salient issue is not whether, but rather how to use racial identity in medicine. As a social variable, racial identity informs collection of a social history, along with health-relevant social exposures, needs, and support. By contrast, the use of race in individual-level clinical algorithms or race-based medical prescribing are separate issues. The concern voiced by many has been the practice of assigning population-level differences across social variables, such as racial and ethnic identity, equally to individual group members, which is known methodologically as the ecologic fallacy, the inappropriate transfer of aggregate social variable results to individuals. Thus, one cannot quantify individual risk from social group risk. It is not an issue of racial or social justice or opinions, but of methodological rigor.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852480
To the Editor We read with great interest the Research Letter by Diao et al. We agree that the use of race in clinical algorithms remains debated, and it is great to see public support for physicians’ use of all available information, including race, to optimize care. In our view, the salient issue is not whether, but rather how to use racial identity in medicine. As a social variable, racial identity informs collection of a social history, along with health-relevant social exposures, needs, and support. By contrast, the use of race in individual-level clinical algorithms or race-based medical prescribing are separate issues. The concern voiced by many has been the practice of assigning population-level differences across social variables, such as racial and ethnic identity, equally to individual group members, which is known methodologically as the ecologic fallacy, the inappropriate transfer of aggregate social variable results to individuals. Thus, one cannot quantify individual risk from social group risk. It is not an issue of racial or social justice or opinions, but of methodological rigor.
Updated Guidance for Author Use of AI in Medical Publication
https://jamanetwork.com/journals/jama/fullarticle/2852772
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).
https://jamanetwork.com/journals/jama/fullarticle/2852772
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).
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The Supreme Court and Public Health Regulation
https://jamanetwork.com/journals/jama/fullarticle/2852624
This Viewpoint summarizes the ways in which federal health agencies and state-level safeguards work in parallel to ensure public health and highlights how 3 recent Supreme Court rulings have reduced the independence of federal agencies, expanded political control over them, and curtailed state-level protections meant to challenge and supplement federal standards.
https://jamanetwork.com/journals/jama/fullarticle/2852624
This Viewpoint summarizes the ways in which federal health agencies and state-level safeguards work in parallel to ensure public health and highlights how 3 recent Supreme Court rulings have reduced the independence of federal agencies, expanded political control over them, and curtailed state-level protections meant to challenge and supplement federal standards.
Monotherapy in EGFR-Mutated Non–Small Cell Lung Cancer
https://jamanetwork.com/journals/jama/fullarticle/2852633
In recent years, the therapeutic landscape of epidermal growth factor receptor (EGFR)–mutated non–small cell lung cancer (NSCLC) has evolved rapidly, and combination strategies in the first-line metastatic setting are now a standard of care. The FLAURA2 trial showed an improvement in median overall survival from 37.6 to 47.5 months for the combination of osimertinib plus platinum-pemetrexed compared with osimertinib monotherapy (hazard ratio [HR] for death, 0.77; 95% CI, 0.61-0.96; P = .02). The MARIPOSA trial similarly demonstrated an overall survival benefit from the combination of amivantamab and lazertinib over osimertinib monotherapy with an HR for death of 0.75 (95% CI, 0.61-0.92; P = .005), for a median overall survival not estimable yet in the combination group and 36.7 months in patients receiving osimertinib monotherapy. However, these combinations come at the cost of substantially higher rates of toxicity and a more complex treatment journey, whereas osimertinib monotherapy offers the convenience of an oral regimen and a favorable tolerability profile. This raises the critical question of whether all patients truly require treatment intensification or whether some may still derive sufficient benefit from osimertinib alone, sparing them the toxic effects of combination regimens. This question is further complicated by the observation that one-third of patients receiving first osimertinib monotherapy never receive second-line therapy in clinical trials as well as in real-world studies, probably due to clinical deterioration at progression.
https://jamanetwork.com/journals/jama/fullarticle/2852633
In recent years, the therapeutic landscape of epidermal growth factor receptor (EGFR)–mutated non–small cell lung cancer (NSCLC) has evolved rapidly, and combination strategies in the first-line metastatic setting are now a standard of care. The FLAURA2 trial showed an improvement in median overall survival from 37.6 to 47.5 months for the combination of osimertinib plus platinum-pemetrexed compared with osimertinib monotherapy (hazard ratio [HR] for death, 0.77; 95% CI, 0.61-0.96; P = .02). The MARIPOSA trial similarly demonstrated an overall survival benefit from the combination of amivantamab and lazertinib over osimertinib monotherapy with an HR for death of 0.75 (95% CI, 0.61-0.92; P = .005), for a median overall survival not estimable yet in the combination group and 36.7 months in patients receiving osimertinib monotherapy. However, these combinations come at the cost of substantially higher rates of toxicity and a more complex treatment journey, whereas osimertinib monotherapy offers the convenience of an oral regimen and a favorable tolerability profile. This raises the critical question of whether all patients truly require treatment intensification or whether some may still derive sufficient benefit from osimertinib alone, sparing them the toxic effects of combination regimens. This question is further complicated by the observation that one-third of patients receiving first osimertinib monotherapy never receive second-line therapy in clinical trials as well as in real-world studies, probably due to clinical deterioration at progression.
Colorectal Cancer and Mortality Among Older Adults With vs Without Adenoma on Prior Colonoscopy
https://jamanetwork.com/journals/jama/fullarticle/2852632
To the Editor A recent study reported that among adults 75 years of age 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.
https://jamanetwork.com/journals/jama/fullarticle/2852632
To the Editor A recent study reported that among adults 75 years of age 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.