Vol. 1 No. 6

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NEJM Evidence, a digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.

Original Articles

Harm-to-Benefit of Three Decades of Prostate Cancer Screening in Black Men
  • S.P. Basourakos and Others
The authors estimated prostate cancer overdiagnoses and overtreatment for all races and for Black men 50 to 84 years of age until 2016, by calculating the NND and NNT to prevent one prostate cancer death. Estimates incorporating a lag between incidence and mortality resulted in a NND and a NNT for Black men that were well into the low single digits.
E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis
  • L.P. Hariri and Others
Four patients with chronic lung disease attributable to e-cigarette use had shortness of breath, chest pain, and mild progressive airway obstruction. Surgical lung biopsy showed small airway–centered fibrosis (constrictive bronchiolitis) and MUC5AC overexpression. Over 1 to 4 years, disease reversed partially, but not completely, for those who ceased vaping.
Real-Time Artificial Intelligence–Based Optical Diagnosis of Neoplastic Polyps during Colonoscopy
  • I. Barua and Others
Colonoscopists diagnosed small colonic polyps as benign or malignant on the basis of their appearance. The results were compared in real time to see if CADx could distinguish among polyps requiring removal. For standard visual inspection versus CADx, we determined sensitivity for diagnosis (88.4% vs. 90.4%) and high confidence in assessment (74.2% vs. 92.6%).
Phentermine/Topiramate for the Treatment of Adolescent Obesity
  • A.S. Kelly and Others
This randomized controlled trial evaluated phentermine/topiramate for weight management in obese adolescents 12 to 17 years of age. Phentermine/topiramate at both mid and top doses, as an adjunct to lifestyle therapy, significantly reduced body-mass index and waist circumference compared with placebo, with a safety profile similar to that observed in adults.

Editorials

Should Recommendations for Cancer Screening Differentiate on Race?
  • H.G. Welch
  • and A.S. Adamson
Cancer screening recommendations routinely differentiate among individuals on the basis of their age. Starting and stopping ages are an attempt to hit the screening sweet spot: the effort to capture a population at relatively high risk of dying from the target cancer (i.e., not too young), while still at relatively low risk of dying from something else (i.e., not too old). Recommendations may also differentiate on the basis of sex (e.g., breast cancer screening is only recommended for women, although men do die from the disease) or a history of high-risk behaviors (e.g., lung cancer screening in heavy smokers).
Chronic Airway Disease and Vaping — A First Step
  • M.B. Beasley
The 2019 outbreak of acute lung disease associated with vaping led to the characterization of electronic cigarette (e-cigarette) or vaping-associated lung injury (EVALI), which primarily corresponds histologically to diffuse alveolar damage, acute fibrinous and organizing pneumonia, or organizing pneumonia on its own.1-3 Although at least one case report described respiratory bronchiolitis in a surgical lung biopsy from a former smoker with persistent fixed airway obstruction after 9 months of vaping,4 histologic evidence of long-term sequelae from vaping, outside the setting of EVALI, is largely lacking.
Big Brother Is Watching: Artificial Intelligence in Endoscopy — Hype or Reality?
  • H.I. Cheema
  • and B. Tharian
Artificial intelligence (AI) has become a part of many image-based specialties, such as radiology and pathology, as well as medical specialties in which “oscopy” is the key to current practice. In gastroenterology, for example, AI is being explored as an aid to endoscopists to visually distinguish precancerous lesions in upper and lower endoscopy. Although there have been a variety of approaches to the employment of AI for this purpose, deep-learning algorithms, which combine the extraction and classification of image features using deep neural networks,1 have the capability of self-learning.

Review Article

Adolescent Substance Use Disorders
  • K.M. Simon
  • , S.J. Levy, and O.G. Bukstein
Substance use disorders contribute to the leading causes of death among adolescents, including homicide and suicide. Here, Simon et al. review the most recent published data on adolescent substance use disorders and the implications for clinical practice.

Clinical Trials Workshop

Clinical Trials in the 21st Century — Promising Avenues for Better Studies
  • M.J. Pencina
  • and B.T. Thompson
Medical evidence is rooted in randomized controlled trials but there is a pressing need for innovative designs. Pencina and Thompson introduce a new series that reviews the most promising innovations in trial design and interpretation.

Morning Report

A 42-Year-Old Man with Back Pain and Lower Extremity Weakness
  • S.M. Gaignard and Others
A 42-year-old man with HIV presented for evaluation of acute-onset back pain and lower-extremity weakness. How do you approach the evaluation, and what is the diagnosis?

Tomorrow’s Trial

Pharmacologic Thromboprophylaxis for Patients Admitted to General Medicine — Is It Necessary?
  • M. Fralick
  • and M. Sholzberg
It is a busy night on call, with 15 new admissions to general internal medicine. The senior resident checks over the admission orders, including low–molecular-weight heparin for venous thromboembolism prophylaxis. The resident wonders: Does everyone admitted to general medicine really require pharmacologic thromboprophylaxis?

Patient Platform

Failure to Screen — My Experience with Prostate Cancer
  • C. Hughley
In this Patient Platform, Carston Hughley relays his experiences with prostate cancer.

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