In Pursuit of Slaves

Captain John Gabriel Stedman (1744-1797) was a professional soldier who fought to suppress an 18th-century slave rebellion in Suriname and subsequently published the March Through a Swamp in Pursuit of Slaves. Although slavery was not abolished in Suriname until 1873, the publication of Stedman’s narrative in 1790 helped to erode public support for the slave trade in Europe and its colonies. The book was translated into several languages and published in more than 25 editions. Stedman’s descriptions of the brutality of plantation life debunked the myth that slavery was a benign, civilizing influence. By his own admission, Stedman was a mercenary, who also told the truth, and his narrative endures as a case study of violence and human rights abuses. To counter the argument that slaves were better off on New World plantations than living under comparatively primitive conditions in their native lands, Stedman storied that in the Maroon rebellion the slaves preferred to endure hardships and fight in order to escape get their freedom.

JAMA. 2015;314(5):434-435

Stent versus surgery in carotid stenosis

In a study published in NEJM Rosenfield et al report the findings of a trial that compared carotid artery stenting with “embolic protection” to carotid endarterectomy.

In this trial, the authors compared carotid-artery stenting with “embolic protection” and carotid endarterectomy in 1453 patients who were 79 years of age or younger who had severe carotid stenosis and were asymptomatic.  Patients were followed for up to 5 years. The primary composite end point of death, stroke, or myocardial infarction within 30 days after the procedure or ipsilateral stroke within 1 year was tested at a non-inferiority margin of 3 percentage points.

The rate of stroke or death within 30 days was 2.9% in the stenting group and 1.7% in the endarterectomy group (P=0.33). From 30 days to 5 years after the procedure, the rate of freedom from ipsilateral stroke was 97.8% in the stenting group and 97.3% in the endarterectomy group (P=0.51), and the overall survival rates were 87.1% and 89.4%, respectively (P=0.21). The cumulative 5-year rate of stroke-free survival was 93.1% in the stenting group and 94.7% in the endarterectomy group (P=0.44).

The authors concluded that stenting was not inferior to endarterectomy with regard to the rate of the primary composite end point at 1 year. In analyses that included up to 5 years of follow-up, there were no significant differences between the study groups in the rates of non–procedure-related stroke, all stroke, and survival.

N Engl J Med 2016; 374:1011-1020