JAMA

In this podcast, JAMA Deputy Editors Linda Brubaker, MD, and Preeti Malani, MD, MSJ, discussed the latest science published in JAMA:

➡️ Physical Activity and Outcomes,
➡️ Adverse Effects in Treatment
➡️ -Led Payer Integration Systems, and more

🎧 Listen now: https://ja.ma/4fhUczm

💬 Perspective by Attila J. Hertelendy, PhD, Lawrence O. Gostin, JD, and Gregory R. Ciottone, MD: The recent outbreak aboard the MV Hondius resulted in 10 cases and 3 deaths across multiple countries, with the causative Orthohantavirus andesense, which is endemic to Patagonia and capable of limited person-to-person transmission.

Although the outbreak remained bounded, delayed detection, fragmented operational authority, and inconsistent public health implementation revealed ongoing gaps in global pandemic preparedness, particularly in cross-jurisdiction coordination and point-of-entry capacities.

https://ja.ma/3PKRXdt

A cruise ship outbreak of communicable resulted in passenger isolation in quarantine units across two US cities.

In this podcast, JAMA Medical News Senior Staff Writer Rita Rubin spoke with semiretired oncologist Stephen Kornfeld, MD, about coordinating care with limited resources, managing isolation, and lessons for outbreak response in maritime settings.

🎧 Listen now: https://ja.ma/4vgrdjX

affects nearly 55 million US adults, with 35 million experiencing mild loss and 20 million experiencing moderate or greater loss.

Hearing aids are the primary intervention, improving hearing-related quality of life in adults with mild to moderate loss.

Although traditional Medicare does not cover hearing aids, the US Food and Drug Administration now allows adults to purchase over-the-counter (OTC) hearing aids without professional fitting, broadening access, especially for individuals with mild loss.

💡 Learn more in this JAMA Insights: https://ja.ma/4uBthDj

Med News: As turned a vacation cruise into a global public health concern, a semi-retired oncologist stepped up to care for patients when the ship’s physician fell ill.

In this interview from quarantine, Stephen Kornfeld, MD, shares insight into the challenges of managing an infectious disease outbreak at sea and the unique responsibilities he faced during the crisis.

"Is There a Doctor on the Ship?" This Medical News article is an interview with Stephen Kornfeld, MD, about his experience filling in for the ship's ailing physician when hantavirus turned his vacation cruise into a global public health concern.

Med News: A rare virus with no vaccine or specific treatment is spreading in the Democratic Republic of the Congo.

Learn more about the outbreak and the challenges making containment especially difficult:

Why This Ebola Outbreak Will Be Hard to Contain This Medical News article discusses ongoing developments in the Ebola outbreak primarily in the Democratic Republic of the Congo and the challenges in containing the rare Bundibugyo virus, which has no vaccine or specific treatment.

💬 Viewpoint by Leemore Dafny, PhD: The Break Up Big Medicine Act (BUBMA), recently introduced in Congress, proposes prohibiting vertical integration across the health care supply chain, including common ownership between medical service providers, insurers, pharmacy benefit managers, and wholesalers.

While BUBMA aims to address inherent conflicts of interest and competition concerns, it would force sweeping breakups of many organizations and may produce significant disruption.

https://ja.ma/4o50d4D

💬 Editorial by JAMA Deputy Editor Mary McDermott, MD, and Stephen Persell, MD, MPH: is prevalent in >116 million people in the US, with most requiring multiple medication classes for effective control. A network meta-analysis of antihypertensive drug classes found that angiotensin II receptor blockers (ARBs), alone or combined with calcium channel blockers (CCBs), were significantly less likely to be discontinued due to adverse events compared with placebo.

These findings support consideration of ARBs as initial therapy for patients without comorbidities requiring alternative medications, as improved adherence may reduce cardiovascular event rates.

https://ja.ma/3PNMimI

A network meta-analysis of 716 short-term randomized clinical trials found that discontinuation rates due to adverse events from blood pressure–lowering drugs varied substantially by class and combination.

Regimens containing angiotensin II receptor blockers ( ), especially ARB plus calcium channel blocker ( ), were associated with fewer treatment discontinuations than placebo, while CCB monotherapy and certain combinations had higher discontinuation rates.

All drug regimens increased dizziness, but most reduced headache compared with placebo. Several combination therapies were better tolerated than monotherapies, providing important insights for antihypertensive regimen selection.

https://ja.ma/4wWKJna

💬 Editor's Note by Jiani Yu, PhD, and JAMA Deputy Editor Joseph Ross, MD, MHS: Hospital-led provider-sponsored health plans (PSHPs) increased nationally from 18% in 2018 to 27% in 2023, with the most rapid growth observed in the western US. These PSHPs were largely nonprofit and affiliated with medical schools.

Integration of payer and provider functions has potential to enhance and care coordination, though it may also introduce market consolidation risks and affect clinician payment structures and patient access to specialty care.

https://ja.ma/4uDBXJe

Between 2018 and 2023, hospital-led provider-sponsored health plans ( ) in the US increased from 18.3% to 27.2%. Growth was largest in the West and most prevalent among nonprofit and medical school–affiliated hospitals, reflecting alignment with population health and financial risk-sharing missions.

PSHPs offer integrated care-and-coverage models, potentially reducing payer-provider friction, but may have limited customer service capabilities and unique implications for clinicians and employers. Ongoing evaluation is needed to determine the long-term effects on patient access, cost, and care quality.

https://ja.ma/4u5XZDs