Restrictive covenant laws in many U.S. states allow noncompete clauses in contracts between employers and physicians. The Federal Trade Commission (FTC) recently issued a final rule stating that noncompete clauses are in violation of the FTC Act, and most analysts expect the Supreme Court will have to resolve these differences. This article reviews the history of restrictive covenant laws, contrasts the perspectives of physicians and employers, and describes the legal issues.

Accounting for race and ethnicity in estimating disease risk may improve the accuracy of predictions, but there is debate about this practice because it may also encourage a racialized view of medicine. This article presents a decision analytic framework for considering the potential benefits of race-aware over race-unaware risk predictions, using cardiovascular disease, breast cancer, and lung cancer as case studies.

In their article, Coots and colleagues investigate the effect of what they describe as “race-aware” versus “race-unaware” risk prediction models. The editorial discusses the findings and notes that the entire population does not experience racism in the same ways, so the benefits and harms of interventions need to be specifically evaluated for the groups that are currently suffering the most.

In this episode of Annals On Call, Dr. Centor discusses why guidelines recommending that clinicians advise patients on lifestyle changes may be a questionable approach to improving public health with Dr. Minna Johansson.

A recent study indicates that substantial minorities of U.S. physicians intend to reduce their clinical effort in the next year or leave their current organizations during the next 2 years. Other studies indicate that low physician control of their overall work conditions is associated with low physician satisfaction and high stress, burnout, and intent to leave. This study identifies which specific and modifiable aspects of work control are associated with burnout and workforce attrition.

In 2019, the U.S. Advisory Committee on Immunization Practices recommended that clinicians with adult patients aged 27 to 45 years who are unvaccinated against human papillomavirus discuss vaccination with their patients. Relatively few clinicians are following this recommendation, perhaps because studies have found that vaccinating these adults produces relatively small health benefits. This article identifies subgroups of patients who are expected to have greater benefit.

The benefits of glucagon-like peptide-1 receptor agonists (GLP-1RAs) are substantial, and the drugs seem to be increasingly cost-effective, but their cumulative budget impact can be immense. This article considers the ethics and effectiveness of 7 strategies to help health plans and government programs bear the cost of GLP-1RAs for weight management while allowing fair access.

The reduction in motor vehicle crash deaths is often held up as an example that public health interventions can also prevent firearm-related deaths. The authors note that while motor vehicles are not intended to produce injury, injury is the intended purpose of firearms. This difference presents a challenge to a public health approach to reduce firearm-related deaths.

Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.

Denosumab is an injectable antiresorptive therapy. Due to its more potent inhibitory effect on bone resorption compared with other antiresorptive drugs, it may cause more severe hypocalcemia. The risk for hypocalcemia is heightened in patients with chronic kidney disease (CKD) because they have an impaired ability to regulate calcium levels. This retrospective cohort study aims to compare the risk for severe hypocalcemia in patients with CKD receiving denosumab, intravenous bisphosphonates, or oral bisphosphonates.

Although medical devices are widely used in clinical practice, clinicians and the public have limited access to information on how devices are tested, regulated, and used, posing challenges to patient safety. This article uses Cook Medical’s Celect inferior vena cava filter, a medical device used for prevention of pulmonary embolism, as a case study of the transparency gap in medical device regulation.

Despite evidence-based clinical guidelines recommending earlier integration of palliative care (PC) as a critical component of high-quality cancer care, utilization of specialty PC remains surprisingly low, primarily due to prevailing health care payment structures. The authors of this commentary argue that effective expansion of PC requires a shift toward value-based insurance design and describes how an enhanced value assessment framework can facilitate this transition.

Participating in high-quality peer review makes for better researchers and clinicians. In this commentary, Editorial Fellows from Annals of Internal Medicine provide practical suggestions for those new to peer review.

Cases of Oropouche virus infection in South America have increased dramatically in 2023 and 2024, perhaps due to genetic reassortment of the virus making it more virulent. Cases have now been reported in Cuba and the Dominican Republic. Of great concern, the virus may be transmitted in utero, leading to stillbirth and neonatal death. Physicians need to educate themselves about this condition and counsel patients planning to travel, especially those who are pregnant or plan to become pregnant.

Preoperative evaluation requires assessment of functional capacity. This scoping review provides an overview of the different tools studied to assess functional capacity before elective noncardiac surgery. The authors categorize studies by different criteria including the nature of the tool, the outcomes studied, and the populations studied. Details on the types of tools studied are also provided.

Hemoglobin A_1c (HbA_1c) is a test for diabetes used to monitor glycemic control. Racial differences in the absolute levels of HbA_1c have been observed. Some experts consider HbA_1c a “less accurate,” “inappropriate” test in certain racial or ethnic groups, calling for race-specific HbA_1c cut points. The author argues why we should not modify HbA_1c targets based on race or ethnicity.

Body surface area (BSA) measurement is fundamental to proper drug dosing, estimating glomerular filtration rate, and assessing aortic valve area. This article reviews the origins of current formulas for estimating BSA and how they perform poorly in persons with obesity, placing these patients at risk for adverse clinical outcomes. These authors call for better reconsideration for how we approach these measurements.

In their article, Daza and colleagues summarize the currently available tools for assessing patients’ functional capacity during preoperative evaluation. The editorialists discuss the findings, reflect on how preoperative cardiovascular risk assessment has changed over the last 50 years, and note that the focus is evolving from risk prediction to development of a comprehensive approach to optimizing patients’ clinical status.

This Annals Video Summary discusses the following article: “Clinical Tools to Assess Functional Capacity During Risk Assessment Before Elective Noncardiac Surgery: A Scoping Review.”

Clinical guidelines recommend weight loss as part of the management of polycystic ovarian syndrome (PCOS), but how weight loss affects clinical manifestations of PCOS is unclear. This systematic review summarizes randomized clinical trial findings on the effect of diverse weight loss interventions on metabolic, hormonal, and other clinical markers of PCOS.

Physicians in the later years of their career are at risk for developing illness or other conditions that could interfere with patient care. Some health care organizations have developed programs for managing these possibilities, and this article describes 18 of those programs.

Our veteran’s life was one dedicated to a continuous fight for what is right, for duty, for one’s country.

This Annals Video Summary discusses the following article: “Effect of Weight Loss Interventions on the Symptomatic Burden and Biomarkers of Polycystic Ovary Syndrome: A Systematic Review of Randomized Controlled Trials.”

This retrospective cohort study using Medicare data aimed to identify beneficiaries who would face financial precarity if exposed to the $1600 Medicare Part A hospital deductible. Among 4881 beneficiaries (population weighted n = 26 619 823), 45.0% had insufficient funds in checking and savings accounts to pay the Medicare hospital deductible. Financial precarity was more prevalent among Black and Hispanic patients, those with less versus more than high school education, and those with multiple chronic conditions or functional limitations. The findings suggest a large population of Medicare beneficiaries with modest incomes are at risk for experiencing financial hardship from costs of a single hospital stay.

The primary screening methods for colorectal cancer (CRC) include colonoscopy and fecal testing. However, adherence rates for these tests remain suboptimal. Recently, a novel cell-free DNA blood test (cf-bDNA) received approval from the U.S. Food and Drug Administration (FDA) for CRC screening. The main advantage of cf-bDNA is its higher acceptability among patients. In addition, an enhanced version of the multitarget stool DNA test also received FDA approval. The aim of the current study is to project CRC incidence, mortality, quality-adjusted life-years, and costs with emerging blood-based and stool-based CRC screening tests compared with existing screening methods.

Rosuvastatin and atorvastatin are the most widely prescribed moderate- to high-intensity statins, but evidence on their efficacy and safety during actual use is limited. This study compared the real-world effectiveness and safety of rosuvastatin and atorvastatin among adults with data in the China Renal Data System and UK Biobank databases.

Subject matter experts from the U.S. Department of Veterans Affairs and the U.S. Department of Defense updated the 2020 clinical practice guidelines for the management of headache. This article summarizes some of the important updates from the 2023 guideline that are particularly relevant to primary care, including recommendations for pharmacotherapy or invasive therapies for treatment and prevention of migraines and tension-type headaches, as well as for the use of nonpharmacologic interventions.

Caregivers face challenges when trying to prevent injury, respect autonomy, and avoid conflict in the care of community-dwelling persons with dementia who have access to firearms. This randomized trial examines the effectiveness of "Safety in Dementia," an online decision aid to assist caregivers' decisions about firearm access for persons with dementia who are under their care.

Guidelines recommend initiating colorectal cancer screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years. This retrospective cohort study evaluated fecal immunochemical test completion and yield in patients aged 45 to 49 years versus 50 years.

Artificial intelligence–based image analysis technology has been developed for colonoscopy. In fact, adding computer-aided detection (CADe) to standard colonoscopy has been shown in several trials to improve overall colon polyp detection. However, it is unclear whether the improved detection applies to high-risk or advanced polyps. The objective of this systematic review and meta-analysis was to compare the performance of CADe-enhanced and conventional colonoscopy.

The farm bill, which is the largest agricultural legislation in the United States, is due for reauthorization. This commentary summarizes some of the farm bill’s implications for nutrition and health and urges health care professionals to advocate for a shift toward the production of healthier foods.

This Annals Video Summary discusses the following article: “Artificial Intelligence–Assisted Colonoscopy for Polyp Detection: A Systematic Review and Meta-analysis.”