Please ensure you are connected to the internet and tap below to try again.Restart the Reader
If you continue to experience trouble, please contact the American Medical Association's Unified Service Center at 1-800-262-2350 or +1-312-670-7827 or write to firstname.lastname@example.org.
©2014 American Medical Association. All Rights Reserved.
It appears that you are offline. Reload when you are back online.
The JAMA Network Reader gives you anytime, anywhere access to the research, reviews, and viewpoints that matter most to your practice.
*If you have never created an AMA account, please do so now to continue.
Accessible from any platform or device, no downloads, app stores, or manual updates.
Save entire issues and articles to read offline.
Watch and listen to authors discuss their research.
©2014 American Medical Association. All Rights Reserved.
The JAMA Network Reader™ gives you instant, easy access to the vital information you want and need. It's your customizable resource for anytime, anywhere access to the vital research, reviews, and viewpoints that matter most to your practice, from across the entire JAMA portfolio.
© 2014 American Medical Association. All Rights Reserved.
Information we collect -- When you browse our www.ama-assn.org or www.jamanetwork.com, for example, and do not interact with the site for any online service or product from the AMA, you browse anonymously. Information that identifies you personally--such as your name, address, phone number and email address--is not collected as you browse.
When you create an account to become a registered user on our sites, or choose to interact with us in other ways, such as subscribing to AMA publications, purchasing an AMA product, applying for AMA membership, participating in online surveys, submitting questions or comments or requesting information or materials, we will collect certain personal information from you. The type will vary but may include name, address, phone number, birth date, billing and delivery information, email address, credit card information and other demographic information. We do not collect Social Security numbers via any AMA website. The product or service that you seek will determine the personal information collected.
How we use personal information -- Once collected, we may use your personal information for the following purposes:
You can manage your account, limit alerts or opt-out of some or all future communications. All e-mail communications contain an unsubscribe option in case you want to discontinue the communication at any time. Contact us via the phone number or contact form on our website at any time to:
When we hire vendors to deliver emails to you on our behalf, they are under agreement and limited from using your email address and other personal information for any other purpose.
These email messages may contain "clear GIFs" or "Web beacons" to measure the offer's effectiveness so we know how to serve you better. We do not collect information that identifies you personally through "clear GIFs" or "Web beacons." You may refuse or remove the placement of these and other cookies by selecting the appropriate settings on your web browser.
How to opt out of email -- To opt out of future emails and newsletters, go to our AMA e-newsletter sign-up page or click the "unsubscribe" link at the bottom of any email or e-newsletter from the AMA. You also can call the AMA Unified Service Center at (800) 621-8335.
With whom we may share information -- The AMA may share personal information (except your email address) with our business partners in order to provide them an opportunity to offer products or services that may be of interest to you. The AMA also occasionally hires other companies to provide limited services on our behalf including, but not limited to, processing credit card transactions, packaging, mailing and delivering purchases, answering customer questions about products or services, consulting services, data modeling, printing, sending postal mail and processing membership and event registration. We will only provide those companies the information they need to deliver the service. They are prohibited from using that information for any other purpose. Except as described in this section, third parties may not collect personally identifiable information about your online activities over time or across different Web sites when you use our web sites.
Tracking activity on our website We track how our sites are used by both anonymous visitors and registered users who interact with the site. One way we track is by using "cookies." A cookie is a small file or string of text on the site user's computer that is used to aid Web navigation. Two types of cookies are commonly used. A session cookie is created by a website when that website is accessed; that type of cookie is automatically deleted by closing the Web browser. A persistent cookie is a cookie that is stored on the hard drive of the user's computer for a period of time chosen by the website that set the cookie, usually for a number of years, unless the user deletes it manually. This policy distinguishes between short-lived cookies and long-lasting cookies. Short-lived cookies include all session cookies and those persistent cookies that are set to be stored for no more than one week. AMA-related websites may at times require users to accept short-lived cookies in order for the websites to function properly. Long-lasting cookies may be used on the site to track visitor practices to help determine which site features and services are most important and guide editorial direction. Other long-lasting cookies may make it possible for the user to access the site without requiring entry of a user name or password, allow the user to view different restricted areas of the site without reregistering, allow the user to personalize the site for future use and provide other features and benefits. Users who do not desire the functionality created by the long-lasting cookie can disable the long-lasting cookie function, either by indicating when asked that they do not wish to have a long-lasting cookie created or by disabling the long-lasting cookie function on their Web browser. Individuals can opt out of long-lasting cookie functions at any time.
Cookies are required for the Members-Only and e-commerce sections of the website. Cookies are essential for site administration and security. Another way we track site activity is by using transparent electronic images called "clear GIFs," "Web bugs," or "Web beacons" on Web pages. These images count the number of users who visit that page from specific banner ads outside www.ama-assn.org or through email links. A similar image, sometimes called a "spotlight tag," is used on Web pages where transactions take place. The spotlight tag collects numeric information, such as the dollar amount of an online purchase, to help us understand usage of the site. We do not use any of these electronic images to collect personally identifiable information.
Children under 13 -- We do not knowingly solicit data online from or market online to children under the age of 13.
Information security -- The AMA implements security measures to protect against unauthorized access to or unauthorized alteration, disclosure or destruction of data. We restrict access to personal information to our employees and the AMA's business partners who may need to know that information in order to operate, develop or improve our services. These individuals are bound by confidentiality obligations and may be subject to discipline, including termination and criminal prosecution, if they fail to meet these obligations.
SSL technology and how you benefit from it -- AMA realizes the importance of security, so we've taken a number of steps to enhance the protection of personal information sent to or from AMA over the Internet. First, we require that a "secure session" be established, using Secure Socket Layer (SSL) technology. This is done any time you supply or access information in one of our secure online areas.
SSL technology creates a private conversation that only your computer and AMA systems can understand. The SSL technology encodes information as it is being sent over the Internet between your computer and AMA systems, helping to ensure that the transmitted information remains confidential.
User ID and password -- Many areas of the site require the use of a user ID and password as an additional security measure that helps protect your information. This allows AMA to verify who you are, thereby allowing you access to your account information and preventing unauthorized access. When you have finished using a secure area of AMA's website, make sure you always click on the "Log Out" link which appears on every secure page. When you click on the "Log Out" link, you will be given the option to end your secure session. No further secure transactions can be conducted without re-entering your user ID and password. You should be aware that browser software often "caches" a page as you look at it, meaning that some pages are saved in your computer's temporary memory. Therefore, you may find that clicking on your "Back" button shows you a saved version of a previously viewed page. Caching in no way affects the security of your confidential user ID or password.
No guarantee -- Unfortunately, no data transmission over the Internet can be guaranteed to be 100% secure. Accordingly, and despite our efforts, AMA cannot guarantee or warrant the security of any information you transmit to us, or to or from our online products or services. Email messages sent to or from a website may not be secure. Confidential information should not be sent by e-mail. Site visitors sending e-mail accept the risk that a third party may intercept e-mail messages.
You should be aware that other Internet sites that link to the AMA sites or to an AMA email may contain privacy provisions that differ from these. To ensure your privacy is protected, we recommend that you review the privacy statements of other Internet sites you visit.
If you are a registered user of an AMA website, subscriber to AMA publications, purchaser of AMA products or an AMA member, you may review and update or correct your information online or by contacting the AMA Unified Service Center at (800) 621-8335.
Physicians and medical students may update or correct any information the AMA may have on file by going online or calling (800) 621-8335. Updates or corrections to certain types of information (e.g., physician licensure, medical education or training, etc.) will require independent verification prior to effectuating any (permanent) change to our files.
Last Updated: December 19, 2013
© 2014 American Medical Association. All Rights Reserved.
The JAMA NetworkTM is a consortium of peer-reviewed print and online medical publications that includes JAMA® and 9 specialty Journals.
All access to and use of The JAMA NetworkTM platform and websites or portal are conditioned on compliance with the following terms and conditions.
Revised: September 25, 2012
Any controversy arising out of or relating to this Agreement shall be arbitrated by the American Arbitration Association under its appropriate procedures in Chicago, Illinois, by a single arbitrator whose award shall be final and binding. The courts of the State of Illinois and/or the United States District Court for the Northern District of Illinois shall have exclusive jurisdiction over any action concerning the enforcement of an arbitration award and the parties hereto agree to submit to the jurisdiction of the courts of the State of Illinois and the United States District Court for the Northern District of Illinois. In the case of public institutions, nothing herein shall be construed to alter or waive the application of state statutes conditioning contracts of such institutions. If any provision hereof is held to be unenforceable or contrary to public policy, the parties agree that the remaining portions are enforceable.
1. Definitions. "The JAMA Network" includes JAMA®, The Journal of the American Medical Association, and the family of medical specialty journals known as the JAMA Network Publications, all published by the AMA.
"The JAMA NetworkTM platform and websites" or "JAMA Network portal" include the various components referred to above including all journal content products, services, features, functionalities, content related sites, and other information accessible through the JAMA Network portal [whether provided by the AMA or any third party].
Related sites include JAMA on Facebook, JAMA on Twitter, Calendar of Events, JAMA and Archives CME, For The Media, JAMAevidence, AMA Manual of Style, JAMA Career Center, ICMJE, WAME.
"You" or "Your" means any individual or institution authorized to access the JAMA Network content, platform and websites (collectively the "JN portal").
"AMA" means the American Medical Association and any of its subsidiaries or affiliates and their personnel, agents and representatives. "AMA Parties" means, collectively, the AMA and its editorial and publishing departments, plus its suppliers, advertisers, promotional partners, licensors, Silverchair Information Services, Inc. and/or other parties directly engaged in the delivery of the components, products, services, features or functionalities or content of The JAMA Network portal.
4. License and Use Restrictions. Components, products, services, features, functionalities or content accessible through the JN portal may contain limitations [e.g., restrictions on the number of users or type of user] on Your use. AMA and/or its authorized representative(s), shall have the right to audit and inspect Your use to verify Your compliance with any such limitations. If Your use is non-conforming, You shall immediately conform to such limitations or pay any amounts then due and owing for such non-conforming use, at AMA's option. AMA reserves the right to terminate your access to the JN portal and/or the Services in the event of non-conforming use.
To ensure that each authorized user can enjoy the JN portal, You shall not (a) provide, disclose, divulge or make available to or permit use of the JN portal to or by anyone who is not also an authorized user; (b) copy or reproduce any part of the JN portal including its components, products, services, features, functionalities or content; (c) interfere, or attempt to interfere, with the JN portal in any way; (d) modify, change, alter, translate, create derivative works from, reverse engineer, disassemble or decompile the JN portal or its components, products, services, features, functionalities or content or discover or attempt to discover the source code of all or any portion of the JN portal in any way for any reason; (e) engage in spamming, mail bombing, spoofing or any other fraudulent, illegal or unauthorized use of the JN portal or the AMA Parties' systems; (f) introduce into or transmit through the JN portal or any licensor system any virus, worm, trap door, back door, timer, clock, counter or other limiting routine, instruction or design; (g) attempt to create a link from the JN portal; (h) copy or create any frames at any other websites pertaining to or using any of the content or information accessible through the JN portal; or (i) copy, remove or alter any trademark, logo, copyright or other proprietary notices, legends, symbols or labels located on the JN portal.
You warrant You will abide by all applicable local, state, national and international laws and regulations with respect to Your use of The JAMA NetworkTM portal. Your use must respect the proprietary rights [including copyright, trademark, service mark, trade dress, trade name, logo, brand or other distinctive identification or patent or trade secret] of AMA and any third party whose information or content is accessed via the JN portal. Any use of such proprietary information or content, apart from Your permitted use of the JN portal without the express prior written consent of the owner thereof, is prohibited.
The JN portal enables access to third party provided information and content [including, software, products and/or services and links to third party websites and/or downloads of third party material]. As noted above, third party provided information and content [including materials available on or through third party websites] may be proprietary in nature and protected by proprietary rights.
You are responsible for preserving the privacy and security of Protected Health Information of Your patients as required by applicable laws and regulations including, without limitation, the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA").
6. User-Generated Content. The following provisions apply to user-generated content submitted to any JAMA Network Publication, to the news@JAMA blog or to the JN portal in connection with the material and services. By submitting content You affirm Your acceptance of and compliance with the following provisions, which may be amended from time to time:
A. You acknowledge that You alone are fully responsible for the content that You submit. You agree that You will not post or submit any content that (i) is false, defamatory, obscene, or abusive, (ii) violates or infringes upon the proprietary, privacy or publicity rights of any person or third party, (iii) violates or encourages the violation of any applicable local, state, national, or international law, rule, or regulation, or (iv) is otherwise inappropriate. You agree not to submit any personal information of or about another (especially Protected Health Information), unless it is necessary, relevant and You possess and provide to our editors a duly executed Patient Consent for Publication Form. You will indemnify AMA from any claim or demand, including reasonable attorneys’ fees, made by any third party due to or arising out of the content You submit. You understand and agree that AMA is not responsible for content submitted by third parties.
B. The editors of JAMA and the JAMA Network Publications, in their sole discretion, reserve the right to reject, edit, remove, or otherwise alter any content submitted for any reason, or no reason at all. AMA reserves the right, in its sole discretion, to revoke a user’s privilege to submit content.
C. You agree that by submitting content, You hereby grant to AMA a perpetual, irrevocable, royalty-free worldwide license to use, reproduce, sublicense, modify, retrieve, display, translate, publicly perform, create derivative works from, and distribute that material, in whole or in part, and incorporate it into other AMA publications and services, in any form, media, or technology now known or later developed. You authorize AMA to publish Your name, affiliation and location (city, state and/or country) and email address in connection with any use of Your submission and in identifying yourself and location, You represent that you have done so accurately. Once Your submission is posted, You forfeit the right to have it removed or edited.
D. You agree to post or submit content and comments only for non-commercial purposes.
E. Submissions to the user-generated content portions of the JN portal Services must be legible, comprehensible, and written in the English language, and be relevant to the article, issue or topic that allegedly prompted You to submit.
Medical Disclaimer. The JN portal is intended to facilitate academic and clinical research and the delivery of patient care by licensed physicians and other appropriately qualified healthcare professionals. Use of the JN portal does not substitute for professional medical advice, diagnosis, or treatment. Neither AMA nor any of the AMA Parties shall be responsible, and each expressly disclaims responsibility, for damages of any kind arising out of the use of, reference to, or reliance on, the JN portal.
7. Warranties Disclaimed. THE JN PORTAL AND THE SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE." EXCEPT AS EXPRESSLY PROVIDED BY A THIRD PARTY WITH REGARD TO ITS PRODUCTS AND/OR SERVICES, NEITHER AMA NOR ANY OF THE AMA PARTIES PROVIDE ANY EXPRESS OR IMPLIED REPRESENTATION OR WARRANTY OF ANY KIND INCLUDING, WITHOUT LIMITATION, ANY REPRESENTATION OR WARRANTY THAT: (a) THE JN PORTAL, OR ANY RESULTS THAT MAY BE OBTAINED BY YOU, ARE COMPLETE, ACCURATE, RELIABLE OR NON-INFRINGING; (b) ACCESS TO THE JN PORTAL WILL BE UNINTERRUPTED, TIMELY, SECURE, OR ERROR FREE; (c) THE QUALITY OF ANY PRODUCTS, SERVICES, CONTENT, INFORMATION OR OTHER MATERIAL PURCHASED OR OBTAINED BY YOU THROUGH THE JN PORTAL WILL MEET YOUR EXPECTATIONS; OR (d) THE JN PORTAL OR ITS COMPONENTS OR PRODUCTS, SERVICES, FEATURES, FUNCTIONALITIES OR CONTENT WILL REMAIN UNCHANGED OR ACCESSIBLE ON THE JN PORTAL. ALL WARRANTIES, EXPRESS OR IMPLIED, ARE DISCLAIMED TO THE FULLEST EXTENT PERMITTED BY LAW INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND/OR NONINFRINGEMENT OF INTELLECTUAL PROPERTY.
8. Limitation of Liability. THE AMA PARTIES SHALL NOT BE LIABLE, AND DISCLAIM ANY LIABILITY, FOR ANY CLAIM, LOSS OR DAMAGE, DIRECT OR INDIRECT, INCLUDING, WITHOUT LIMITATION, COMPENSATORY, CONSEQUENTIAL, INCIDENTAL, INDIRECT, SPECIAL, EXEMPLARY OR PUNITIVE DAMAGES OF ANY KIND WHATSOEVER IN CONNECTION WITH, AS A RESULT OF, OR ARISING: (a) OUT OF THE USE OF OR INABILITY TO USE THE JN PORTAL OR THE SERVICES; (b) FROM ANY INTERRUPTION IN AVAILABILITY; (c) FROM ANY LOSS OF DATA AND/OR FROM ANY EQUIPMENT FAILURE; (d) FROM UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; (e) OUT OF THE USE OF, REFERENCE TO, OR RELIANCE ON, THE JN PORTAL OR THE SERVICES; (f) OUT OF ANY THIRD PARTY MATERIALS, INFORMATION, PRODUCTS AND SERVICES CONTAINED ON, OR ACCESSED THROUGH, THE JN PORTAL; (g) OUT OF ANY CONTENT, MATERIALS, ACCURACY OF INFORMATION, AND/OR QUALITY OF THE PRODUCTS, SERVICES OR MATERIALS PROVIDED BY YOU OR PROVIDED BY OR ADVERTISED ON ANY THIRD PARTY PORTAL; OR (h) OUT OF ANY OTHER MATTER RELATING TO THE JN PORTAL OR THE SERVICES.
9. Exclusions Permitted by Law. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF CERTAIN WARRANTIES OR CONDITIONS OR THE LIMITATION OR EXCLUSION OF LIABILITY FOR LOSS OR DAMAGE CAUSED BY NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF IMPLIED TERMS, OR INCIDENTAL OR CONSEQUENTIAL DAMAGES. ACCORDINGLY, ONLY THE ABOVE LIMITATIONS WHICH ARE LAWFUL IN YOUR JURISDICTION WILL APPLY.
13. Statute of Limitations. Any Claim arising out of or related to Your use of the JN portal or the Services must be filed by You within one (1) year after such Claim arose.
Revised September 25, 2012
© 2014 American Medical Association. All Rights Reserved.