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Am Fam Physician. 2000;61(8):2309-2310

Tobacco Will Not Be Under FDA Jurisdiction Despite Health Hazards

The Supreme Court ruled in a 5 to 4 decision that the U.S. Food and Drug Administration (FDA) does not have the authority to regulate tobacco as a drug. In the decision announced on March 21, Justice Sandra Day O'Connor reviews whether Congress has specifically addressed the issue of FDA jurisdiction and concludes that, “Congress has directly spoken to the issue here and precluded the FDA's jurisdiction to regulate tobacco products.” She notes that “The [FDA] has amply demonstrated that tobacco use, particularly among children and adolescents, poses perhaps the single most significant threat to public health in the United States.” However, without congressional action, tobacco will remain outside of the agency's jurisdiction. Justice O'Connor was joined in the majority opinion by Chief Justice William H. Rehnquist and Justices Antonin Scalia, Anthony M. Kennedy and Clarence Thomas. The dissenting opinion, written by Justice Stephen G. Breyer, states, “Far more than most, this particular drug and device risks the life-threatening harms that administrative regulation seeks to rectify.” He was joined by Justices John Paul Stevens, David H. Souter and Ruth Bader Ginsburg. Following the decision, tobacco stocks gained ground.

NCI and CDC Collaborate on a Comprehensive Cancer Surveillance and Control System

The National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC) have announced a major collaboration to develop a comprehensive, federally integrated cancer surveillance and cancer control research system, using the resources of both agencies. The joint effort will allow the agencies to coordinate training, technical assistance, methodology development, and other aspects of cancer registry management, as well as allow for coordination of major cancer information. “We see this joint effort as critical to moving forward with a national cancer surveillance plan that includes other partners as well, such as the American Cancer Society, the American College of Surgeons, the North American Association of Central Cancer Registries and the National Cancer Registrar's Association,” said Robert Hiatt, M.D., Ph.D., deputy director of the NCI Division of Cancer Control and Population Sciences. The NCI and CDC will continue to expand their separate capabilities in their registries, while simultaneously coordinating public release of pooled data. Together with NCI and the states, the CDC will assess regional and national cancer rates and provide access to data for public use. For more information about cancer, visit NCI's Web site at and the CDC's Web site on cancer information at

Initial Fill Rates for Family Practice Residency Programs Are Announced

Preliminary information available from the National Resident Matching Program indicates that the initial 2000 fill rate for family practice residency programs is 2,603 positions filled out of 3,206 positions offered (81.2 percent). In 1999, the initial number of students who selected family practice was 2,697 (82.6 percent of 3,265 available positions). This is the third year that the match program has experienced a decline in positions filled. The percentage of students matching with family practice residencies has ranged from 65.0 percent in 1991 to the record of 90.5 percent in 1996. Fifty-nine fewer family practice positions (1.8 percent) were offered in 2000 than in 1999, which may be due in part to the Balanced Budget Act of 1997. The American Academy of Family Physicians (AAFP) reports that the reasons behind the decline are varied, and range from personal choices to economics to how the various specialties are viewed.

In addition to family practice, the other three primary care specialties also had fewer students choosing their residency programs. These include pediatrics-primary, internal medicine-pediatrics and internal medicine-primary. According to the NRMP, 25,056 individuals participated in the match this year, a slight decrease from the 26,462 who participated in 1999. Detailed information on the 2000 residency match program can be found on the AAFP Web site ( or the Web site of the Association of American Medical Colleges (

Troglitazone (Rezulin) Has Been Withdrawn from the Market

After a request from the FDA on March 21, the manufacturer of troglitazone (Rezulin), a drug used in the treatment of type 2 diabetes mellitus (formerly known as non–insulin-dependent diabetes mellitus) agreed to remove the product from the market. The FDA took this action after its review of recent safety data on troglitazone and two similar drugs, rosiglitazone (Avandia) and pioglitazone (Actos), showed that troglitazone is more toxic to the liver than the other two drugs. To date, data show that rosiglitazone and pioglitazone offer the same benefits as troglitazone without the same risk. At least 61 deaths have been linked to troglitazone. “When considered as a whole, the pre-marketing clinical data and post-marketing safety data from Rezulin as compared to similar, alternative diabetes drugs indicate that continued use of Rezulin now poses an unacceptable risk to patients,” said Dr. Janet Woodcock, director of FDA's Center for Drug Evaluation and Research. “We are now confident that patients have safer alternatives in this important class of diabetes drugs,” she noted.

Five New Members Are Named to the National Advisory Council of the NHSC

Health and Human Services Secretary Donna Shalala recently appointed five new members to the National Advisory Council of the National Health Service Corp. They are Michael Fine, M.D., Hillside Avenue Family and Community Medicine, Pawtucket, R.I.; Susan Fleischman, M.D., director of medical services, Venice Family Clinic, Venice, Calif.; Kresten Kang, NHSC scholar, Piscataway, N.J.; Lucio Torres-Florez, president, Salt Creek Enterprises, Inc., Pueblo, Colo.; and Kimberley B. Williams-Barnes, D.D.S., director of dental services, North County Community Health Center, Flagstaff, Ariz. Current member Angela Z. Monson, a state senator in Oklahoma, was appointed the new chair.

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