The Journal of the American Medical Association
110 Years of Continuous Publication
George D. Lundberg, MD
Deputy Editor: Richard M. Glass, MD
Deputy Editor (West): Drummond Rennie, MD
Senior Editor: Margaret A. Winker, MD
Senior Contributing Editor: M. Thérèse Southgate, MD
Contributing Editors: Charles B. Clayman, MD, Helene M.
Cole, MD, David S. Cooper, MD, Harriet S. Meyer, MD, Carin
M. Olson, MD, Jeanette M. Smith, MD, Jody W. Zylke, MD
Consulting Editors: Roger C. Bone, MD, C. Thomas Caskey,
Statistical Editor: Naomi Vaisrub. PhD
Associate Senior Editor: Annette Flanagin
Medical News and Humanities Director: Phil
Medical News & Perspectives—Editor: Marsha F. Goldsmith;
Associate Editors: Charlene Breediove, Roxanne .
Correspondent: Dennis L. Breo
Editorial Systems and Administration Manager:
Production Director: Carl Braun
Production Manager: Susan Price
Electronic Production Director: Mary C. Steermann
Editorial Processing Director: Cheryl Iverson
Circulation Director: Beverly Martin
Fulfillment Director: Ray Healy
Assistant Editors: Kate Whetzle, Helga Wutz
Staff Assistant: Bonnie Van eleven
Electronic Coordinator: Mary Ellen Johnston
Production Supervisors: Thomas J. Handrigan (Illustrations),
Jaye Matthews (Electronic Production), Teresa H. Omiotek
(Proofreading), JoAnne Weiskopf (Layout)
Copy Editing: Jane C. Lantz (Director), Vickey Golden (Free¬
lance Manager), Richard T. Porter (Assistant Free-lance Co¬
ordinator), Paul Frank (Senior Copy Editor/Atex Specialist), Jen¬
nifer Sperry (Senior Copy Editor), Susan R. Benner, Pete Johlie,
Kris A. Mainellis, Martin Suter
Proofreading: Gwen Chatten, Laura King
Production Associates: Anita Henderson, Linda Knott
Senior Production Assistants: Valerie Balkcom, Karen Branham, Brenda Chandler-Haynes, Leslie Koch, Mary Ann Kuranda. Jennifer Reiling, Lana Rivera, Regina Vander Reyden
Production Assistant: Janey Stennis
Reprint Coordinator: Joseph Rekash
Cover Editor: M. Thérèse Southgate, MD
Editorial Supervisors: Patricia Joworski, Gale Saulsberry
Editorial Assistants: Linda Baker, Mary Cannon, Kemberly
Evans, Shirley Gogins, Gwenn Gregg, Lisa Hardin, Sharon
Iverson, Mary Ann Lilly, Cheryl Manno, Ethel Pinkston, Dorothy
White, Lenette Williams
Electronic Input Specialist: Vee Bailey
Administrative Assistant: Mary C. Taylor
Scientific and Socioeconomic Indexing Department: Nor¬
man Frankel (Director), George Kruto, Mary Kay Tinerella
JAMA, The Journal of the American Medical Association
(ISSN 0098-7484), is published four issues per month by the
State St, Chicago, IL
American Medical Association, 515
60610- Phone (312) 464-5000. Cable address "Medic" Chicago.
rate per year is
$20, which is included in the annual AMA membership dues.
Nonmembers are charged a higher than basic rate of $110 for
1 year, $203 for 2 years in the United States and US posses¬
sions; in all other countries, 1 year $185; 2 years $353 for
expedited air delivery. Nonmember medical students and res¬
idents are also charged a higher than basic rate of $55 for 1 year
in the United States and US possessions. Rates for subscrip¬
tions for delivery to Japan or South Korea are available through
respective exclusive agents. Address all subscription commu¬
nications to Subscriber Services Center, American Medical As¬
sociation, 515 State St, Chicago, IL 60610. Phone: (800)
262-2350. Fax (312) 464-5831.
changes to JAMA, The Journal of the American Medical As¬
sociation, attention: Subscription Department, 515 State St,
Chicago, IL 60610. Notification of address change must be
made at least 6 weeks in advance; include both old and new
addresses, a recent mailing label, and your new ZIP code.
Second-class postage paid at Chicago and additional mailing
GST Registration Number: R 126 225 556.
JAMA® Registered in the US Patent and Trademark Office.
Copyright© 1993 by the
American Medical Association» BPA
Vol 270, No. 4
Original Contributions
A Successful System of Scientific Data Audits for Clinical
. 459
Trials: A Report From the Cancer and Leukemia Group
R. B. Weiss, Washington, DC; N. J. Vogelzang, Chicago, III;
B. A. Peterson, Minneapolis, Minn; L. C. Panasci. Montreal, Quebec, Canada;
J. T. Carpenter, Birmingham, Ala; M. Gavigan, Chapel Hill, NC;
K. Sartell, Lebanon, NH; E. Frei III, Boston, Mass; O. R. Mclntyre, Lebanon, NH
Decreased Ankle/Arm Blood Pressure Index
and Mortality in Elderly Women.465
M. T. Vogt, J. A. Cauley, A. B. Newman, L. H. Kuller, Pittsburgh, Pa;
S. B,
Associate Editors: Paul Cotton, Charles Marwick
ton, DC), Teri Randall, Andrew Skolnick
July 28, 1993,
To promote the science and art of medicine and the betterment of the
San Francisco, Calif
Pneumocystis carinii Pneumonia Among US Children
Perinatally Acquired HIV Infection.470
R. J. Simonds, M. J. Oxtoby, M. B. Caldwell, M. L. Gwinn,
M. F. Rogers, Atlanta, Ga
The Lifetime Cost of Treating
F. J. Hellinger, Rockville, Md
Person With HIV.474
Special Communication
New Tobacco Industry Strategy to Prevent
Local Tobacco Control.479
M. P. Traynor, M. E. Begay, S. A. Glantz, San Francisco, Calif
Brief Report
Morbidity and Mortality in Hypertensive Adults
a Low Ankle/Arm Blood Pressure Index.487
A. B. Newman, K. Sutton-Tyrrell, M. T. Vogt, L. H. Kuller, Pittsburgh, Pa
Involuntary Smoking in the Restaurant Workplace:
A Review of Employee Exposure and Health Effects.490
M. Siegel, Berkeley, Calif
AIDS Policy: Two Divisive Issues.494
D. E. Rogers, J. E. Osborn, Washington, DC
Accountability, Audit, and Reverence
for the Publication Process.495
D. Rennie, Chicago, III
Ankle/Arm Blood Pressure Index:
A Useful Test for the Clinical Setting?.497
W. B. Applegate, Memphis, Tenn
JAMA 100 Years
The Public Press and the Physicians.
The Present Status of the Surgery of the Prostate.
The Cover.413
Mrs Gardner in Venice, Anders Zorn,
Resident Forum
AMA-RPS Governing Council and Trustee
Downloaded From: on 12/22/2014
Southgate, Chicago,
( Table of Contents continued on next page.)
Medical News &
Rural Health Care Faces Reform Too; Providers Sow Seeds for Better Future... Cause of Cuban
Outbreak Neuropathologic Puzzle... Court Ruling on 'Junk Science' Gives Judges More Say
About What Expert Witness Testimony to Allow
From the Congressional Office
of Technology Assessment....
The Journal of the American Medical Association
Therapy Under Medicare
Cholera Associated With a Newly Described Toxigenic Vibrio cholerae 0139 Strain—
California, 1993
Update: Hantavirus Infection—United States, 1993 Salmonella Serotype
Tennessee in Powdered Milk Products and Infant Formula—Canada and United States, 1993
My Mind
Washing Clothes
Domestic Abstracts.436
Reference Directories
Meetings Outside the United States. 442
Officials, April 7, 1993; US Meetings, July 7, 1993; Organizations of Medical Interest,
July 14, 1993; State Associations and Examinations and Licensure. July 21, 1993
for Otitis Media With Effusion: The
Pittsburgh Response E I Cantekin,
Rockette, C. D. Bluestone, J, L. Paradise, R. J. Nozza
The Era of the Patient R. S. Banner, A, S, Papp, S. J, Reiser
Screening for Colorectal Cancer: The Accuracy of Fecal Occult Blood D H Greegor, G P. Young,
D. J. B. St. John, D. A. Ahlquist, D. B. McGill, C. G. Moertel, C. L. Loprinzi, M. J. O'Connell
Classification of Human Papillomavirus Infection
Morrison, R. D. Burk
Radiography for Ankle Injuries R. Hatch, J. F. Waller, I. G. Stiell, G. H. Greenberg, R. D. Mcknight
Dietary Supplement Use: Significant Information in the Medical History S L Nightingale
Antimicrobial Therapy
R. M. Rosenfeld, E. M. Mandel, H. E.
Poetry and
A. Plotnikoff, MD, Minneapolis, Minn
Uwe E. Reinhardt, PhD, Princeton, NJ
Chicago, III
Anne Colston Wentz. MD,
Bassel Atallah, MD, JAMA—Middle East
Bologna, MD, JAMA—Italy
AMA Officers
President: Joseph T. Painter, MD*
President-Elect: Robert E. McAfee, MD*
Immediate Past President: John L. Clowe, MD
Obituary Listing.499
With Patients: A Basic Clinical Skill
(Myerscough) Reviewed by B. Bates
Medicine and Shakespeare in the English Renaissance (Hoeniger) Reviewed by
Easier Said Than Done: Moral Decisions in Medical Uncertainty (Heifetz) Reviewed by M. M Schapira
The Medicine Society (Scriven) Reviewed by B. Liskow
Current Opinion in Urology (Chlsholm, Paulson, eds) Reviewed by A. L. Soben, P. Soben
ASC: Anesthesia Simulator Consultant... Rhythm & Pulse: Advanced Cardiac Life Support
Simulator (Schwid, O'Donnell) Reviewed by T. Sloan
J B, Holds, M C, Kincaid
Peripheral Neuropathy in Cuba?
N. S,
Lincoff, J, G, Odel, M, Hirano
Clinical Decision Making:
From Theory to Practice
Three Battles to Watch in the 1990s D M
ADVERTISING PRINCIPLES—Advertisements in this issue have
been reviewed to comply with the principles governing advertising
in AMA publications. A copy of these principles is available on re¬
JAMA Journal Club Reading Assignments.539
Index to Advertisers.540
Downloaded From: on 12/22/2014
AMA guarantee or endorsement of the product
made for the product by the manufacturer.
the claims
Printed in the USA.
Instructions for
New York, NY 10016 (Representatives: Alice Harvey-Herman,
Cliff Vanderhoof [212-867-6640]); Midwest/Farwest: 515 State
St, Chicago, IL 60610; Classified Advertising: 312-464-2456
quest. The appearance of advertising in AMA publications is
Letter From Havana
AMA Trustees
Lonnie R. Bristow, MD* (Chairman); Nancy W. Dickey, MD*
(Secretary); Palma E. Formica, MD; Michael Goldrich, MD (Res¬
ident); William E. Jacott, MD* (Vice-Chairman); Donald T. Lew¬
ers, MD; Thomas R. Reardon, MD; Raymond Scalettar, MD;
Jerald R. Schenken, MD; P. John Seward, MD*; Randolph D.
Smoak, Jr, MD; Frank B. Walker, MD*; Percy Wootton, MD
Executive Committee.
ADVERTISING OFFICES: Eastern: 600 Third Ave, Suite 3700,
Secretary-Treasurer: Nancy W. Dickey, MD*
Speaker, House of Delegates: Daniel H. Johnson, Jr, MD
Vice-Speaker, House of Delegates: Richard F. Corlin, MD
Executive Vice President: James S. Todd, MD
Deputy Executive Vice President: Kenneth E. Monroe
Senior Vice President: Larry E. Joyce
Vice President, Publishing: Robert L. Kennett
Editor-in-Chief, Scientific Publications: George D. Lundberg, MD
Associate Publisher: Peter J. Murphy
Director, Publishing Operations Division: NawJn Gupta, PhD
Books Received
Sarcoidosis Involving the Lacrimal Gland G G
Ragini Jain, MD, JAMA—India
Evin Kantermir, MD, JAMA—Turkey
Yong Kak Lee, MD, JAMA—Korea
Zhang Hongkai, MD, JAMA—China
Books, Journals, Software
Yuichiro Goto, MD,
Tania L. R. Martinez, MD, JAMA—Brazil
Azam Soorma, MBBS, JAMA—Pakistan
Jin Widimsky, MD, DrSc, JAMA—Czech/Slovak
Prof David Todd, JAMA—Southeast Asia
Miguel Vilardell Tarres, MD, JAMA—Spanish Language
Body Especial J Sklllman
'Outbreak' of
Arndt, MD, Boston, Mass
Marjorie A. Bowman, MD. MPA, Winston-Sa lem, NC
James E. Daten, MD, Tucson, Ariz
Lois DeBakey, PhD, Houston, Tex
R. Gordon Douglas, Jr, MD, New York, NY
Ronald G. Evens, MD, St Louis, Mo
William H. Foege, MD, Atlanta, Ga
Renee C. Fox, PhD, Philadelphia, Pa
William T. Friedewald, MD, New York, NY
Vincent A. Fulginiti, MD, Denver, Colo
Morton F. Goldberg, MD, Baltimore, Md
Samuel Hellman, MD, Chicago, III
Michael E. Johns, MD, Baltimore, Md
Robert J. Joynt, MD, PhD, Rochester, NY
Donald A. B. Lindberg, MD, Bethesda. Md
Gordon K. MacLeod, MD, Pittsburgh, Pa
William W. McLendon, MD, Chapel Hill, NC
Arno G. Motulsky, MD, Seattle, Wash
Claude H. Organ, Jr, MD, Oakland, Calif
Edmund D. Pellegrino, MD, Washington, DC
Michèle Deker, MD, JAMA—France
Kenneth A.
Robert J. Blendon, ScD, Boston, Mass
From the Centers for Disease Control
and Prevention
A Piece of
All articles published, including editorials, let¬
ters, and book reviews, represent the opin¬
ions of the authors and do not reflect the
official policy of the American Medical Asso¬
ciation or the institution with which the author
is affiliated, unless this is clearly specified.
American Medical Association
Physicians dedicated to the health of America