Jennifer L. Pomeranz, Emily M. Broad Leib, Dariush Mozaffarian
This Viewpoint discusses the US Food and Drug Administration’s authority over food safety, including prior regulations surrounding ingredients, preemption, and federal vs state laws.
{"title":"Food Ingredients, State Actions, and Federal Preemption","authors":"Jennifer L. Pomeranz, Emily M. Broad Leib, Dariush Mozaffarian","doi":"10.1001/jama.2026.0366","DOIUrl":"https://doi.org/10.1001/jama.2026.0366","url":null,"abstract":"This Viewpoint discusses the US Food and Drug Administration’s authority over food safety, including prior regulations surrounding ingredients, preemption, and federal vs state laws.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"37 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miriam T. H. Harris, Zoe M. Weinstein, Alexander Y. Walley
Importance Opioid use disorder (OUD) involves compulsive opioid use that causes substantial distress or impairment at work, school, or home. OUD, which is the third most prevalent substance use disorder worldwide, affected an estimated 3.7% of US adults (9 367 000) in 2022 and caused 53 774 deaths in the US in 2024. Medications for opioid use disorder (MOUD) reduce morbidity and mortality. Individuals with OUD also benefit from medications to treat opioid withdrawal and reverse acute opioid overdose. Observations Methadone, buprenorphine, and naltrexone are medications approved by the US Food and Drug Administration (FDA) to reduce unregulated opioid use. Methadone and buprenorphine reduce the risks of overdose and all-cause mortality. However, only 25.1% of people in the US with OUD were treated with these medications in 2022. MOUD should be selected based on shared decision-making that considers availability and convenience of treatment options and patient preferences. Buprenorphine and naltrexone are prescribed in office-based settings and can be taken at home. Outpatients with OUD in the US can only obtain methadone in person at federally regulated clinics. After stopping or substantially reducing use of opioids, individuals with OUD develop symptoms of opioid withdrawal, such as anxiety, insomnia, pain, nausea, vomiting, and diarrhea. Medications for opioid withdrawal include opioid agonists (eg, methadone and buprenorphine), α 2 -receptor agonists (eg, lofexidine and clonidine), and medications to treat pain (ibuprofen) and nausea (ondansetron). Individuals being treated for acute withdrawal should also be prescribed MOUD to decrease the risk of all-cause mortality (adjusted hazard ratio, 0.52; 95% CI, 0.42-0.63 for MOUD vs no MOUD). Individuals who use opioids may develop opioid overdose, which can cause respiratory depression, stupor, and, if severe, coma and death. Opioid overdose can be treated or can be reversed with naloxone, an opioid antagonist that is FDA approved and should be administered at the lowest dose needed to restore a normal respiratory rate (eg, naloxone 0.4 mg intramuscularly or 2-4 mg intranasally). Community-wide distribution of naloxone to people who use opioids and their social networks has been associated with 25% to 46% lower community opioid overdose rates. Conclusions and Relevance All individuals with OUD should be offered treatment with MOUD to reduce opioid use. Methadone and buprenorphine decrease opioid-associated and all-cause mortality in patients with OUD. Opioid withdrawal symptoms may be treated with opioid agonists, α 2 -receptor agonists, and medications for pain and nausea. All individuals with OUD should have access to opioid antagonists, such as naloxone, to treat opioid overdose.
{"title":"Medications for Opioid Use Disorder, Opioid Withdrawal, and Opioid Overdose","authors":"Miriam T. H. Harris, Zoe M. Weinstein, Alexander Y. Walley","doi":"10.1001/jama.2025.26348","DOIUrl":"https://doi.org/10.1001/jama.2025.26348","url":null,"abstract":"Importance Opioid use disorder (OUD) involves compulsive opioid use that causes substantial distress or impairment at work, school, or home. OUD, which is the third most prevalent substance use disorder worldwide, affected an estimated 3.7% of US adults (9 367 000) in 2022 and caused 53 774 deaths in the US in 2024. Medications for opioid use disorder (MOUD) reduce morbidity and mortality. Individuals with OUD also benefit from medications to treat opioid withdrawal and reverse acute opioid overdose. Observations Methadone, buprenorphine, and naltrexone are medications approved by the US Food and Drug Administration (FDA) to reduce unregulated opioid use. Methadone and buprenorphine reduce the risks of overdose and all-cause mortality. However, only 25.1% of people in the US with OUD were treated with these medications in 2022. MOUD should be selected based on shared decision-making that considers availability and convenience of treatment options and patient preferences. Buprenorphine and naltrexone are prescribed in office-based settings and can be taken at home. Outpatients with OUD in the US can only obtain methadone in person at federally regulated clinics. After stopping or substantially reducing use of opioids, individuals with OUD develop symptoms of opioid withdrawal, such as anxiety, insomnia, pain, nausea, vomiting, and diarrhea. Medications for opioid withdrawal include opioid agonists (eg, methadone and buprenorphine), α <jats:sub>2</jats:sub> -receptor agonists (eg, lofexidine and clonidine), and medications to treat pain (ibuprofen) and nausea (ondansetron). Individuals being treated for acute withdrawal should also be prescribed MOUD to decrease the risk of all-cause mortality (adjusted hazard ratio, 0.52; 95% CI, 0.42-0.63 for MOUD vs no MOUD). Individuals who use opioids may develop opioid overdose, which can cause respiratory depression, stupor, and, if severe, coma and death. Opioid overdose can be treated or can be reversed with naloxone, an opioid antagonist that is FDA approved and should be administered at the lowest dose needed to restore a normal respiratory rate (eg, naloxone 0.4 mg intramuscularly or 2-4 mg intranasally). Community-wide distribution of naloxone to people who use opioids and their social networks has been associated with 25% to 46% lower community opioid overdose rates. Conclusions and Relevance All individuals with OUD should be offered treatment with MOUD to reduce opioid use. Methadone and buprenorphine decrease opioid-associated and all-cause mortality in patients with OUD. Opioid withdrawal symptoms may be treated with opioid agonists, α <jats:sub>2</jats:sub> -receptor agonists, and medications for pain and nausea. All individuals with OUD should have access to opioid antagonists, such as naloxone, to treat opioid overdose.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146153312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carmel Shachar, David Blumenthal, I. Glenn Cohen, Nicole Huberfeld
This Viewpoint discusses the executive order signed by President Trump regarding a national policy framework for artificial intelligence (AI), including what it means for medical AI regulation, the legal questions it raises, and the merits of state-level experimentation in health care regulation.
{"title":"Preemption at the Intersection of Health Care and Artificial Intelligence","authors":"Carmel Shachar, David Blumenthal, I. Glenn Cohen, Nicole Huberfeld","doi":"10.1001/jama.2026.0061","DOIUrl":"https://doi.org/10.1001/jama.2026.0061","url":null,"abstract":"This Viewpoint discusses the executive order signed by President Trump regarding a national policy framework for artificial intelligence (AI), including what it means for medical AI regulation, the legal questions it raises, and the merits of state-level experimentation in health care regulation.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses the need to develop systematic review processes for medications during pregnancy, including routine randomized clinical trials (RCTs), rather than relying on observational study data.
{"title":"Why It Is Unethical Not to Conduct Randomized Trials in Pregnancy","authors":"Alyssa Bilinski","doi":"10.1001/jama.2026.0805","DOIUrl":"https://doi.org/10.1001/jama.2026.0805","url":null,"abstract":"This Viewpoint discusses the need to develop systematic review processes for medications during pregnancy, including routine randomized clinical trials (RCTs), rather than relying on observational study data.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146146212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses the benefits and risks of systemic hormone therapy in breast cancer survivors following the US Food and Drug Administration’s removal of black box warnings from menopausal hormone therapy.
{"title":"What Systemic Hormone Therapy Black Box Removal Means for Breast Cancer Survivors","authors":"Versha Pleasant, Kari Ring","doi":"10.1001/jama.2026.0025","DOIUrl":"https://doi.org/10.1001/jama.2026.0025","url":null,"abstract":"This Viewpoint discusses the benefits and risks of systemic hormone therapy in breast cancer survivors following the US Food and Drug Administration’s removal of black box warnings from menopausal hormone therapy.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this narrative medicine essay, a critical care physician who recovered from a critical illness reflects on the importance of empathy and how patients and families can feel and see things physicians can’t.
{"title":"Building Empathy","authors":"Ian J. Barbash","doi":"10.1001/jama.2026.0009","DOIUrl":"https://doi.org/10.1001/jama.2026.0009","url":null,"abstract":"In this narrative medicine essay, a critical care physician who recovered from a critical illness reflects on the importance of empathy and how patients and families can feel and see things physicians can’t.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris Chaeha Lim, Jonathan A. Race, Parneet Kaur, Honghyok Kim, Ran Wei, Xiaojiang Li, Ladd Keith, Lynn B. Gerald, Brian Drummond, Noah M. Tolby, N. Clay Mann
This study compares US sociodemographic and geographic trends in heat-related and non–heat-related emergency medical services (EMS) activations from 2019 to 2024.
{"title":"Trends and Disparities in Heat-Related Emergency Medical Services Activations","authors":"Chris Chaeha Lim, Jonathan A. Race, Parneet Kaur, Honghyok Kim, Ran Wei, Xiaojiang Li, Ladd Keith, Lynn B. Gerald, Brian Drummond, Noah M. Tolby, N. Clay Mann","doi":"10.1001/jama.2025.26586","DOIUrl":"https://doi.org/10.1001/jama.2025.26586","url":null,"abstract":"This study compares US sociodemographic and geographic trends in heat-related and non–heat-related emergency medical services (EMS) activations from 2019 to 2024.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"398 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebeca Ortiz Worthington, Lindsey M. Eastman, Jason T. Alexander
This JAMA Clinical Guidelines Synopsis summarizes the American College of Obstetricians and Gynecologists’ 2023 recommendations for management of premenstrual disorders.
本JAMA临床指南摘要总结了美国妇产科医师学会2023年对经前疾病管理的建议。
{"title":"Management of Premenstrual Disorders","authors":"Rebeca Ortiz Worthington, Lindsey M. Eastman, Jason T. Alexander","doi":"10.1001/jama.2025.26054","DOIUrl":"https://doi.org/10.1001/jama.2025.26054","url":null,"abstract":"This JAMA Clinical Guidelines Synopsis summarizes the American College of Obstetricians and Gynecologists’ 2023 recommendations for management of premenstrual disorders.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"287 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shakia T. Hardy, Byron C. Jaeger, Ezekiel Emanuel, Paul Muntner
This study used National Health and Nutrition Examination Survey 2021 to 2023 data to describe the proportion of US adults with uncontrolled blood pressure.
{"title":"Blood Pressure Above Goal Among US Adults With Hypertension","authors":"Shakia T. Hardy, Byron C. Jaeger, Ezekiel Emanuel, Paul Muntner","doi":"10.1001/jama.2025.25657","DOIUrl":"https://doi.org/10.1001/jama.2025.25657","url":null,"abstract":"This study used National Health and Nutrition Examination Survey 2021 to 2023 data to describe the proportion of US adults with uncontrolled blood pressure.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"216 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jurgen M. Piek, Jolijn Schauwaert, Laura Burney Ellis, Ignacio Zapardiel, François Planchamp, Kata Koblos, Joanna Kacperczyk-Bartnik, Sarah J. Bowden, Houssein El Hajj, Mihaela Grigore, Miranda P. Steenbeek, Nicolò Bizzarri, Maria Kyrgiou, Murat Gültekin
Importance The fallopian tube epithelium has been demonstrated to be an important source of tubo-ovarian carcinoma. Therefore, removal of the fallopian tubes during unrelated pelvic or abdominal surgery (opportunistic salpingectomy) can potentially lower future ovarian cancer risk. Objectives To assess current evidence on the efficacy, risks, and long-term outcomes of opportunistic salpingectomy and to develop consensus statements for the European Society of Gynaecological Oncology. Evidence Review An international working group of 14 individuals including a patient representative was formed to develop consensus statements on opportunistic salpingectomy. The MEDLINE database was used to conduct a literature review of English-language studies from January 1, 2000, through March 1, 2025, evaluating opportunistic salpingectomy for reduction of tubo-ovarian carcinoma, complication rates, additional surgical time, and impact on ovarian function. Statements were subsequently drafted collaboratively based on the review of the literature and adapted in an iterative process in conference call meetings with opportunity for anonymous and nonanonymous feedback. The anonymous voting was binary (agree/disagree) for each potential statement. Final statements reached consensus with more than 75% agreement. Findings In the literature review, 230 studies were identified, of which 129 were deemed relevant to consensus statement development. Consensus was achieved on 18 statements, with grades of recommendation ranging from B to D and levels of evidence from II to V. Opportunistic salpingectomy is significantly associated with a lower risk of subsequent tubo-ovarian carcinoma, with no adverse short-term impact on ovarian function. The procedure appears safe across surgical approaches, with little additional operative time. Existing evidence does not indicate harm to ovarian function or premature menopause, although long-term evidence is not available. Salpingectomy is feasible during both gynecological and nongynecological procedures and should be considered in women undergoing gynecological surgery and, where possible, in women undergoing selected nongynecological pelvic or abdominal surgeries. Conclusions and Relevance Existing evidence demonstrates that opportunistic salpingectomy is significantly associated with a lower risk of developing tubo-ovarian carcinoma. Clinicians should include this prevention intervention in preoperative counseling of eligible women.
{"title":"Opportunistic Salpingectomy for Prevention of Tubo-Ovarian Carcinoma","authors":"Jurgen M. Piek, Jolijn Schauwaert, Laura Burney Ellis, Ignacio Zapardiel, François Planchamp, Kata Koblos, Joanna Kacperczyk-Bartnik, Sarah J. Bowden, Houssein El Hajj, Mihaela Grigore, Miranda P. Steenbeek, Nicolò Bizzarri, Maria Kyrgiou, Murat Gültekin","doi":"10.1001/jama.2025.24510","DOIUrl":"https://doi.org/10.1001/jama.2025.24510","url":null,"abstract":"Importance The fallopian tube epithelium has been demonstrated to be an important source of tubo-ovarian carcinoma. Therefore, removal of the fallopian tubes during unrelated pelvic or abdominal surgery (opportunistic salpingectomy) can potentially lower future ovarian cancer risk. Objectives To assess current evidence on the efficacy, risks, and long-term outcomes of opportunistic salpingectomy and to develop consensus statements for the European Society of Gynaecological Oncology. Evidence Review An international working group of 14 individuals including a patient representative was formed to develop consensus statements on opportunistic salpingectomy. The MEDLINE database was used to conduct a literature review of English-language studies from January 1, 2000, through March 1, 2025, evaluating opportunistic salpingectomy for reduction of tubo-ovarian carcinoma, complication rates, additional surgical time, and impact on ovarian function. Statements were subsequently drafted collaboratively based on the review of the literature and adapted in an iterative process in conference call meetings with opportunity for anonymous and nonanonymous feedback. The anonymous voting was binary (agree/disagree) for each potential statement. Final statements reached consensus with more than 75% agreement. Findings In the literature review, 230 studies were identified, of which 129 were deemed relevant to consensus statement development. Consensus was achieved on 18 statements, with grades of recommendation ranging from B to D and levels of evidence from II to V. Opportunistic salpingectomy is significantly associated with a lower risk of subsequent tubo-ovarian carcinoma, with no adverse short-term impact on ovarian function. The procedure appears safe across surgical approaches, with little additional operative time. Existing evidence does not indicate harm to ovarian function or premature menopause, although long-term evidence is not available. Salpingectomy is feasible during both gynecological and nongynecological procedures and should be considered in women undergoing gynecological surgery and, where possible, in women undergoing selected nongynecological pelvic or abdominal surgeries. Conclusions and Relevance Existing evidence demonstrates that opportunistic salpingectomy is significantly associated with a lower risk of developing tubo-ovarian carcinoma. Clinicians should include this prevention intervention in preoperative counseling of eligible women.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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