2019 health articles of most interest to doctors

The Journal of the American Medical Association, or JAMA as it is known to most, is among the most widely read and cited, most influential, and most prestigious medical journals in the world.

The journal just called “JAMA” is the flagship, but the other vessels in the fleet, such as JAMA Internal Medicine, and JAMA Pediatrics, along with 11 others representing diverse medical specialties — are all highly respected in their own right.

Accordingly, when JAMA takes stock at year’s end, in a now recurring tradition, of what its large and global readership of physicians, other health professionals, biomedical researchers, and health journalists read, shared, and cited most — it is a robust indication of the medical community’s extant interests. Admittedly, this is only a proxy for a formal study of the medical preoccupations of the current moment, but for purposes of this column, a proxy will nicely suffice.

Here are titles for the top 5 most viewed papers of the year, in order: Pushup Capacity and Future Cardiovascular Events in Active Men; Anticholinergic Drug Exposure and the Risk of Dementia; Physical Activity Guidelines for Americans; Fluoride Exposure During Pregnancy and IQ in Offspring; Guidelines for Perioperative Care in Cardiac Surgery.

I don’t think I can improve on this assessment by JAMA’s editorial staff: “Reflecting the remarkable interest in lifestyle medicine, our topviewed article of the year wasn’t about a blockbuster drug but rather the humble pushup.”

Of the top 5 articles, only one has anything directly to do with a drug, but not because of blockbuster treatment effects. Rather, the second most popular article of JAMA’s year found a heightened risk of dementia among those exposed routinely to the large family of drugs known as anticholinergics, used to treat allergies, depression, and various disorders of the GI tract and bladder. The one drug to rank among “most popular,” in other words, was an entire class of drugs registering as a precautionary tale.

Only the last entry, presenting perioperative care guidelines, was reliably ensconced within the bounds of conventional medical practice and preoccupation yet even here, the guidelines extended into nutritional management.

A summary judgment seems justified: the medical community — as represented by the readership of JAMA — was more provoked, intrigued, and attracted by matters of lifestyle in 2019 than by new drugs, new devices, new techniques, or specific study methods. Nothing on the list of mostread papers has any hope of garnering a Nobel Prize, while all relate to using what we know to add years to lives, and life to years.

As a health journalist, I am natively inclined to ask: “why?” about these results. As a former president of the American College of Lifestyle Medicine, I am equally inclined to infer a range of plausible answers.

We hear a lot on the matter of medical burnout these days. This is for many reasons beyond the scope of this column, but the formula is partly fueled by an endless cycle of diseases we have long known how to prevent, treated with drugs long known to cause side effects, leading to prescriptions to offset the ills of other prescriptions, leading to the complications and consequences of polypharmacy, and… well, you get the idea. This is a commonplace cascade in the prevailing “disease care” system where there is not only a drug for every malady, but occasionally the invention of a new malady to justify the use of some drug. Maybe doctors are starting to say: “enough!”

As 2020 burgeons, perhaps you will resolve to contemplate JAMA’s verdict that the most fascinating advances in modern medicine are much about the decisions you make, and the actions you take. Perhaps we may yet find our way to a “health care” system after all. If we do, it will be in no small part… because of you. My best wishes to you and yours for the best of health in the New Year. Prevailing medical interest points the way.