Ann Intern Med
· 2026 Jun · PMID 42224692
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For centuries, physicians have lamented the proliferating medical literature. This article traces the evolving strategies by which physicians have attempted to render this literature navigable for the purposes of researc...For centuries, physicians have lamented the proliferating medical literature. This article traces the evolving strategies by which physicians have attempted to render this literature navigable for the purposes of research, teaching, and patient care. Beginning with John Shaw Billings' foundational indexing work at the Library of the Surgeon General's Office, the article examines successive (and overlapping) search regimes-including personal curation practices, abstract journals, pharmaceutical industry information services, citation indexing, and computerized retrieval systems-analyzing how each embedded value judgments about what counted as important or useful medical knowledge. Even as systems of search have evolved over time in conjunction with new technologic capabilities, business models, and search-related behavioral patterns, they have also grappled with enduring tensions between selectivity and comprehensiveness, between commercialism and scientific merit, and among the very boundaries of the conditions to be categorized and navigated. This history underscores how systems of search are not external maps of the knowledge ecosystem but are constitutive of it, influencing everything from journal rankings to research priorities to clinical practice. As literature search becomes integrated with artificial intelligence capabilities, a historical perspective helps physicians appreciate how such technologies condition what they know.
Koutouratsas T, Dammad T, Mylonakis E
… +1 more, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Jun · PMID 42224686
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GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Public Health: [Formula: see text].GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Public Health: [Formula: see text].
Jensen J, Merritt E, Olarewaju BA
… +4 more, Tejon JB, Asif MB, Lanpher BC, Osundiji MA
Ann Intern Med Clin Cases
· 2026 May · PMID 42205176
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Comorbid nutritional disorders can present with clinical management challenges. Phenylalanine hydroxylase (PAH) deficiency and celiac disease are both associated with dietary protein intolerance, yet they are different d...Comorbid nutritional disorders can present with clinical management challenges. Phenylalanine hydroxylase (PAH) deficiency and celiac disease are both associated with dietary protein intolerance, yet they are different disorders. Phenylalanine hydroxylase deficiency is a rare genetic disorder that results in elevated levels of phenylalanine (Phe) in the blood. It causes multisystemic abnormalities, including neurologic findings, seizures, episodic tremor, ataxia, and cognitive and sensory disturbances. In contrast, celiac disease is a common nutritional disorder that arises from immune-mediated enteropathy against dietary gluten. Herein, we describe the clinical findings in an adult with PAH deficiency and celiac disease to showcase some opportunities for improved personalized nutritional management.
Del Prato S, Heine RJ, Pérez Manghi FC
… +8 more, Hsia SH, Gomez-Valderas E, Zeytinoglu M, Razzoli E, Kiljanski J, Sharma P, Knights A, Thieu VT
Ann Intern Med
· 2026 May · PMID 42184419
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BACKGROUND: Initiation of treatment with tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1RA), early after a diagnosis of type 2 diabetes (T2D) ma...BACKGROUND: Initiation of treatment with tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1RA), early after a diagnosis of type 2 diabetes (T2D) may establish better and more durable glycemic control than current treatment approaches per guidelines and clinical practice. OBJECTIVE: To assess the efficacy and safety of tirzepatide versus intensified conventional care (ICC) in participants with early T2D who have inadequate glycemic control with diet, exercise, and metformin. DESIGN: Randomized, open-label, parallel-group, phase 4 trial (SURPASS-EARLY). (ClinicalTrials.gov: NCT05433584). SETTING: 78 sites in 10 countries. PARTICIPANTS: 794 adults with at most 4 years of T2D history treated with metformin. INTERVENTION: Tirzepatide (15 mg or maximum tolerated dose) or ICC (including GLP-1RAs but excluding tirzepatide) used in clinical practice and supported by local treatment guidelines. MEASUREMENTS: The primary objective was to show the noninferiority of tirzepatide to ICC for change in hemoglobin A (HbA) from baseline to 2 years. Secondary objectives were to show the superiority of tirzepatide for change in HbA, weight, and waist circumference. RESULTS: Tirzepatide was superior to ICC for mean changes from baseline to 2 years in HbA (-1.99 percentage points [95% CI, -2.12 to -1.87 percentage points] vs. -1.32 percentage points [CI, -1.44 to -1.19 percentage points]; estimated treatment difference [ETD], -0.68 percentage points [CI, -0.84 to -0.51 percentage points]; < 0.001), weight (ETD, -8.0 kg [CI, -9.39 to -6.50 kg]; < 0.001), and waist circumference (ETD, -6.2 cm [CI, -7.54 to -4.93 cm]; < 0.001) (treatment regimen estimand). More participants achieved normoglycemia (HbA <5.7%) with tirzepatide (60.2%) than ICC (24.0%). The most common adverse events were gastrointestinal in both groups. LIMITATION: Open-label design. CONCLUSION: In participants with early T2D uncontrolled with metformin, tirzepatide treatment resulted in superior reductions in HbA, weight, and waist circumference, and more participants achieved normoglycemia (HbA <5.7%) with tirzepatide than ICC after 2 years. PRIMARY FUNDING SOURCE: Eli Lilly and Company.
Johnson D, Manaker S, Algase LF
… +2 more, Watkins C, Medical Practice and Quality Committee of the American College of Physicians
Ann Intern Med
· 2026 May · PMID 42184418
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The growing involvement of private equity in the health care sector raises important questions about its effect on cost, quality, access, and the physician workforce. Private equity investment in health care is associate...The growing involvement of private equity in the health care sector raises important questions about its effect on cost, quality, access, and the physician workforce. Private equity investment in health care is associated with increased costs and, in some settings, adverse effects on care delivery and outcomes. Rising costs, administrative burdens, workforce shortages, and declining reimbursement have made independent practice increasingly difficult, contributing to physician transitions to corporate ownership models. Physicians employed by private equity-owned health care organizations may also experience challenges due to the evolving dynamics of their work environment. State and federal regulators, as well as lawmakers, should consider implementing policy interventions to address these challenges. Although corporate investment may improve efficiency and, in limited instances, care delivery, private equity in this sector raises important questions about its role and effects. This American College of Physicians (ACP) position paper builds on the previous ACP position paper on financial profit in medicine, which explored the growing influence of corporate interests and private equity investment in the health care industry. This paper examines the effect of private equity investment on clinical autonomy, health care costs, quality, access, equity, and innovation. It emphasizes the need for more vigorous enforcement of regulatory measures and policy solutions to preserve the quality of patient care and protect the physician workforce. It also offers recommendations to strengthen oversight, transparency, and accountability related to private equity's effects on clinical autonomy, care delivery, and organizational decision making. Finally, it discusses the potential opportunities and challenges associated with private equity investment in health care, including increased consolidation and corporatization.