Alzheimer's disease, early-onset cancer, and more stories

Physicians managing patients with Alzheimer's disease have gained some new potential tools over the past few years, with increased availability of blood biomarker testing and two new drugs aimed at slowing cognitive decline. But neither the tests nor the treatments are a panacea, and use of both can be complicated in clinical care. Our story reviews the data behind the new drugs, discusses potential uses for the new blood tests, and offers information on alternative interventions to help promote brain health.

Much has been made of rising cancer rates in younger adults, or those under age 50. Revised federal guidelines now recommend earlier consideration or discussion of screening for certain types of cancer, while others, including ACP, believe the increases are clinically insignificant and screening younger patients can do more harm than good. Our story aims to put the numbers in perspective, review the latest on the risks and benefits of screening, and stress the importance of working up symptoms and promoting other methods of cancer prevention. Another story discusses the management of patients with BRCA1 and BRCA2 mutations, which can substantially increase risk for breast and ovarian cancer.

Brand-name drugs are often approved for several different indications, and federal law allows generic manufacturers to gain FDA approval for "skinny-label" versions that include only indications that are no longer patent-protected. A recent court case, though, found a generic manufacturer of a skinny-label drug liable for infringement due to marketing practices, which some fear could have a chilling effect on generic development and increase U.S. drug costs. A Q&A looks at the potential implications and discusses what could come next.

Our conference coverage in this issue is from the University of Texas San Antonio's second annual Updates in Hospital Medicine, held in October. One expert offers a perspective on the importance of preventing chronic obstructive pulmonary disease exacerbations and why they could be considered a "lung attack." Also in this issue, our I.M. Ready feature talks to the authors of a study finding that patients and physicians often had different opinions of what constituted a diagnostic error, and our Pearls from I.M. Peers feature discusses why obstetrics should always be part of a good, thorough history.

The President's Message addresses the primary care shortage, while the Washington Perspective offers a primer on the U.S. budget and appropriations process. Finally, learn more about current candidates for ACP governance.

Have your patients been asking about Alzheimer's tests and treatments? Let us know.

Sincerely,

Jennifer Kearney-Strouse
Executive Editor