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Articles 
Robert A. Brodsky, Lyle L. Sensenbrenner, B. Douglas Smith, Donna Dorr, Phillip J. Seaman, Shing M. Lee, Judith E. Karp, Isadore Brodsky, and Richard J. Jones High-dose cyclophosphamide therapy without bone marrow transplantation produces durable treatment-free remission in severe aplastic anemia. This approach deserves further study in patients with severe aplastic anemia who are not suitable candidates for allogeneic bone marrow transplantation.
Emanuel N. Vergis, Mary K. Hayden, Joseph W. Chow, David R. Snydman, Marcus J. Zervos, Peter K. Linden, Marilyn M. Wagener, Barbara Schmitt, and Robert R. Muder Vancomycin resistance is an independent predictor of death from enterococcal bacteremia. Early, effective antimicrobial therapy is associated with significant improvement in survival.
Joel A. Simon, Donald B. Hunninghake, Sanjay K. Agarwal, Feng Lin, Jane A. Cauley, Christine C. Ireland, James H. Pickar for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group Estrogen plus progestin therapy among postmenopausal women with known coronary disease resulted in a small, marginally significant increase in the risk for biliary tract surgery.
Brief Communications
Theodore E. Warkentin and John G. Kelton Delayed-onset heparin-induced thrombocytopenia should be suspected when patients present with thrombocytopenia and thrombosis up to 3 weeks after exposure to heparin. This syndrome could be caused by high titers of platelet-activating IgG induced by heparin.
Academia and Clinic
Jan P. Vandenbroucke and Anton J.M. de Craen The scientific behavior of adherents of conventional medicine toward one form of alternative medicine—homeopathy—suggests that physicians may reject seemingly solid evidence because it is not compatible with theory. Further reflection, however, shows that physicians do the same within conventional medical science: Sometimes they discard a theory because of new facts, but other times they cling to a theory despite the facts.
Medicine and Public Issues
Dave Wendler and Kiran Prasad The National Bioethics Advisory Commission has recently proposed new safeguards for clinical research with adults who are unable to consent. Three other major U.S. groups have also proposed additional safeguards, and existing Canadian and European guidelines already include such safeguards. This paper compares the guidelines, highlights their major points of consensus, analyzes their significant differences, and distills six core safeguards.
Position Papers
Sankey V. Williams, Stephan D. Fihn, and Raymond J. Gibbons This article is the first of two papers about the care of patients with chronic stable angina. Both articles have been adapted from materials created by the American College of Cardiology, the American Heart Association, and the American College of Physicians–American Society of Internal Medicine. The adaptations in these articles are intended to make the information more useful for clinicians who do not specialize in the care of patients with heart disease.
Editorials
Janis L. Abkowitz In this issue, Brodsky and colleagues report on a new option for initial treatment of aplastic anemia: high-dose cyclophosphamide without allogeneic hematopoietic stem cells. Survival at 2 years was 84%. Although the study was small and uncontrolled, the data are provocative.
E. Magnus Ohman and Eric Peterson In this issue and a subsequent issue, two papers present an abbreviated outline of the complete guidelines for the management of patients with chronic stable angina. Guidelines are the first step to synthesizing the evidence and taking advantage of excellent cardiovascular clinical trials and the collective wisdom achieved from careful clinical observation over the past several decades.
Letters Prevention of Bleeding in Older Patients Taking Warfarin
Inflation of Precision in Medical Reports
Severe Liver Injury
Correction: Ivermectin Dose in Update in Dermatology
Correction: Sprout-Associated Infections
Timothy E. Quill, Robert M. Arnold, and Frederic Platt In emotionally challenging situations, many physicians attempt to respond empathically by stating "I'm sorry." Although frequently appropriate, this phrase may be misinterpreted and misdirected. Saying "I wish ... (things were different)" to the patient and family is a more effective initial response. This paper explicates some of the challenges of saying "I'm sorry" and explores the potential benefits of saying "I wish ..." in difficult clinical scenarios.
Sewa S. Legha
Roberta Ness
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