CINXE.COM
Just a moment...
<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "jamanetwork.com",cType: 'managed',cRay: '917c2a701d468970',cH: 'gOVFp94BHU14q_yD8uowQYW4IdlXdvrCg.xzSYWnxtk-1740533383-1.2.1.1-8k66YUKv76lHy84_tXr1K_Ce0nLsJJdbQp9Iwv9i7OoKnOrK0rgFDoALC9QwW9Gr',cUPMDTk: "\/collections\/6258\/for-patients?__cf_chl_tk=o2X3J4AxhsADTiHxIh7JHxh_Pk9RZFZryLAEYweSGYA-1740533383-1.0.1.1-A9wP6xczblGAIp.YxtFmEfqlHwsKmWS8l0lcBzZkC.w",cFPWv: 'b',cITimeS: '1740533383',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/collections\/6258\/for-patients?__cf_chl_f_tk=o2X3J4AxhsADTiHxIh7JHxh_Pk9RZFZryLAEYweSGYA-1740533383-1.0.1.1-A9wP6xczblGAIp.YxtFmEfqlHwsKmWS8l0lcBzZkC.w",md: "pt6V08oXRp.cOUQhPegYZUjFBVIDmck2ONszxiX7FGE-1740533383-1.2.1.1-ppL21uVqwAWl_fU3cdtuwRD7VEcPIJQDHtcvt5rNSFMpi3AtZEWybqjKGqc4Pfz9EC0rvw1YOKiJW2o.xu85QLEZZnZL95rkAp2tQrSpEnSLnXOWr8btVaIKijTVABzUfZw59n5hfrmyjQ.Y5p9jvG_noc4BK4zg2N0sJOY.PJ_oKEJkjGgZIaBUjV7viThHjtHiCCpwlQ8uvVaDfvIXo88tw4GQtTVPqJ1SFSto0bUCPQWgQXHwadyS.D7yAOS0KdXgAP8Jm1bNVzKYUinVbRi9ETT23PmykrTIv8iZ9lLKWYM2rvXbQfjlMRIpYoRArWb1OMM593x6bis3gvH75TfIjGZrNAPUuEmNh_KvBXDnDSYOwVH6m4ebdASALXy9hxJRc3Jf8xGjtDke.TQ7S8qMxI81JnsfeiIm4S2mIRvunnJgGwcYj6fqze1BCccxjqrTCl1oSCQWUCfffyorlexH0jAbkxqC9aNu8bH_blld7.ZDFVONojwc5jAiOyEgIGtmdFqFqJx7JItRkfziaOjVI.mceVGMqp.WPgTf7Wo2p41c.O_3CfgGBmCS.RnQmI6XRlcFVtPWEqi.2KcKIwxoZv95I0gHUpt5h54P5n95OOeCU3RmjF32WG7PMEc.oi4wT5BOEqvirCkgxEPljSZuDefb1uk8YZbgNa6xM962XQNl2G_rtjMvJDXzdf85qzYEWHl_YvasrW7hbNbpbvtrZ3LEhwEAjQBQ3RkTBxhD3YwBu4bRjulPNV87Rq4QGSLTF99WxX4yWbaFQdD4YQ9_nP9I44_3yjcWtp2IJOsQhO55FxGk1YBwnzZI_qTO9QTZosgwYRnzTRwNCr27NRVE6aS_nWcXLFDtXL8TS15PtAihfXQWmGCP34pH1rxfoM87.FyBh8QQ8YA2U8xwrUeopXLgoNWAFVhVW5aTcUUL2lsmOHWzlo0bHLIxUxLTPleubGW9AGrgDxkMzTXjX9I8UaYjB2xQe8xTGsONDsHq4jX7_CDE3WjSFImHuOe1xyJaBVVutS7qbj4Ckiz_ehegyW5a9.FzI4wUW.CqLcO3Ujao53mht4QwRmjn9CdY.EFy1GRM_Bg2WGnpNeXbXT6Tc4J05Q8FdYTVNGXVDhTHmtK.ImN7aX6bwa01wzN2NO95NfVsiTOZa8eq6TdJOWDPDi1dC8gDvNYRgrUL0tFZdnFe8UiKWMJfPD0SvBJ5PFyonDkZsanPR36FEKAOYqOn6tO5R3zOXg4Hma01StPiWYPtvg8aBn_V9vrMts79MAovBTKsUr6QQ7KdtH5YNzu4opy9wbyEBXgDwOZSJVeJUNOk9EmMsWt4NmSv_lHpQWpDi21_xl8TQZyrmF79bYR2GSGwVY186AG5Y1Ld1ZTokrwiH5FrbVP3mFrLlk6byiudPtgVEUtlgcHm3wcrA3ZWE.9aSUI13NLv1vjbuoGG83ruLCNyRWJLYinYxbxEOfJWjW0329rKYkb572OEr9A9FOCH1fPWEC6zO3i5SjmNIcBXV2l1q5SwtlvW9tM3EJAa3NbT4ly6hPg8wjxGvB1y4_v5kqbFYoTZmd4zsqdJ_1fJ70iUDv6dHD1in3JjCIPB2D.vEuVSm06ei7LpP2_pHBPra714_Gh6fS4FfTDRKHRFj7OOIg7s0aCaWoBTeaAx6MZZYU3zuE8Kk08MNNZE9f6fMjdQlSPl1xhWnVJEH5wTp8aVPxzS9.mii7NEAR96K_GZzTiGX15vlvmZMVqucsCw1Sw8ey5YnMlJax9syE9w4SnLSkkBnYB1iH6WqsC1AN5_tGp85L9r4e6q8u74Ucc33FpdT_d9A9Qhcv038T8bHfFBi3N.16JfX2J4.dJkaBaOfAcOCx0oLkXBjBswliDVH5st0bZ5T0HeF1CVA6bCC1wnIb2qfo_7qRPhy.wRHjL0rWPVkGYtonPuuSGyMozsoHX1wWbBBshd74FT_88MWn8h1gOyePITKfZs03JkAikBL_Z5Wxj_6XaByig3Bdth7zz0QdnoGQnTfRQ.KKuacUwcHbt8Jb1uzo6SINxrfGTRMuSxHaBehtlhRFRFm.d13moP2jY.KBpvJuF0eHRvyQprLJRraI_DUBsKGz1mV8MBlKMgipqwaTYAUgazl3u44iuwltHHUY9BvUNvXAwAJKBdpNeqPHj31K5QIuhIo7SV5nmw2hOXIYuXyWGggWZgZazZlqQrrIwwrIZ4NrrIh107Jk7ror0O2KVKfIG6b5y67gUsikz14KZMaGIlLmNfOpTCYgC3gmGnMmzlPCXoA7JvDljKmqjMc96TE4mfTnBXsVdwSB9wAoSth7eLvxWcY97zSmyJ72Z2GEeKKFcTZc47Ov_ZAlfbSlyv2T4.HW23WBuDH04gp8rOQB8FlCUoimXRNG8ldCOGTD_yjnR09nb_qDU6_X3lTTM5TNDshOq5cxKso2lqdoB1e6bj79sVhgpg0AYo93UZFlQih_NoZQUOtrZB1Z7HjlBQkhhowaha..xXg5emLQX.YKbJrGSxOTYX2fJsrdoG2ye_q.GjYdyW09iIO3jqTkD1poQI3JyAZcgyPOSqYIOr1w",mdrd: "VFrQWuK4Wmj1zRdoHr5VgH3pmH1armRa.bXffCUV9tA-1740533383-1.2.1.1-CNaliNBhM4uFJGWKAT4TC92dyRiZRhIkbjPZDn8uV8nCmQ2vJbiIeyOZbXzWjhXBYonJlDalF3TUIorJFHVAiBvCITJj052kfRWWETdGmvOamH3xAeZruBxnLuPRGMS5wodCDwWAjn9tjSAQ.qn.IzbLW_sFTH0TxalxAd9Y5SrKOquQsIlwAll4FT_9el5RFO17d45k8fOHRUUQrDQhMnr7dJesZNaexK9oCEgxDZcNzAlYYRBqTuzsXdrxe9ocgTXovXzajswTMqA7tgV54Gp.ad6.dp5_hvwsNZbUIuv7aRdW8FufxsZjVWRyiE6IjC5LrFujrIIICmN9YHWmWX0WUWmzX6P_EgKhzTAH9NbROLqa155TqAtNBcK1ui8oWU9C0znW.TzLdR70oUUPi4.u7V3zLWyUrAhzOyRhKRcEHamVAQVutV.wyOhZjYW4TnB1e5O_kijR9t7Az3dDIhr4qWoMNbi5Syj.LH.bg83xPG7rTiNwGOtsXeDb1b6yjgX_BOaNaJO0ycgmFSUSgJE.oZ9bsFeYQTFzBX58ay3NVWTnRM9v8yQvxZD4i8nktYLC1hR31qfOUZqheiRy0Jy3G8L8Y3VtVI2Mn2VFS4vCvUT4Fd2nZS9ZtcSdim9UpeUNPghJm1RS0jEngeLHNznzaVWt67vAUQNKGQUZ5n3T5apsuzdhEzzJI5tkt0W.t0sn42RTq9VExlv92oZJDXkLAt8GSYl40gfKAEm8QrI0oR9N0JtdsKH5pqw9L9cwmJF1yr1Rodx2bXnI3Z2ec6UhnuBIUje0JuHvVOk17ys8ZOPNK41TyuWyQ8CKEJAbQgjVpgR2GVRElf0yYZxC97JmV6NA1yWMBuKoAS30jHKMjPRTQa71N9J1OK.0o6FrB8pGNMHKtbt_meFG91pb.1Wa3xG.AEpVwRtVgseV3vwqyyKVJTCUSYExj7Env..s_voR0qAUGEU8yuw8wr7YTsocd4mI6rZ8Sg_1B1hx58.VVpGSEiV4Z_91wSzWazbxhTFpp3m_epVv62KxI5A9MyomEeH_ej4GW6MbpNTVfCtAePzGkgbfg92t75uYuE5ym5A0GwZXQBhmmb1UdrFxk0.wwFBgq.6gJtSzk3Pfb9pz5h.NBURq5y9O_ZX_6BRj0gCZVv8ag4SkTbRWrGZ2fN8oVDffXSmhHpObn76n_kaiJFmvD8HmgK217fUe7qF9USheruCtj1RCznDnMYF6ZQSJQrueDigITKcjPeYjhTQ1W6qgRRuf5OX9Om9NtqLta8GCY8GwUkTJeEQaahMckhby4CvYMkhfzexlKzEKXd_huhC2EW.djvu6EM.xmn3vdZqKVqPGj7YngPjEhxKPKTAC9uwWjNzpSC8VKdv2TXeyNa5tR7tg7_VQUALW6WXWUrZNM8bsV7wBLRRXsdxGxb.H2nHrESlCK73OesoxbB6B0aFLFP3lgBm8HPN.lEz8s8z_zRV5rZtDPm6af0ZycxB_L0NcDe2Zlqrtt8f8LZyt8WvRvZpTSGPJUQe84S4H_PZxilKTGk9uejhiVNDKcu8iCNoRiaz.QOUZ1RUXOJb.0a3lhf3VakWNCaM.Agon6Y8I1Z6DKskvAgVHsalEXBUl4p1Yf_FrVXqv5mt7iPnxMpIfmjAPJnUl1Ip8ob6qVleUWSPx536qvtFLES53YSj8LD98y5HjbCGe0y5CfoRdMGeEsWi0WbVW7GCQdAN_LpqdmmqTaTAsF_Zr_rbFwfFVllPUxWjSLMzK9OfEnNWtTjtdW4gtZnyN1FtvfJUSp9D5GsKlWpiOCyanlhXilo8wA.0hxnQI87pesKDonTsXiuQNKRhtn1d48.bZ20DSMauEqjVLuXom.O9HrnmobXRfZSmez9VVXaHLFgfMjuNLJ.iUsBVSIeYHkRNHKZQsObRaVdP0Lt1F7dpeJRTHcYmTnX5Vkssyj7IRBAar_FK6RkqGqm3iXmxQcUrZNoGk"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/b/orchestrate/chl_page/v1?ray=917c2a701d468970';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/collections\/6258\/for-patients?__cf_chl_rt_tk=o2X3J4AxhsADTiHxIh7JHxh_Pk9RZFZryLAEYweSGYA-1740533383-1.0.1.1-A9wP6xczblGAIp.YxtFmEfqlHwsKmWS8l0lcBzZkC.w" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>