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Articles 
Jiang He, Dongfeng Gu, Xigui Wu, Jichun Chen, Xiufang Duan, Jing Chen, and Paul K. Whelton The authors examined the effect of soybean supplements to the diet in 302 participants with an initial untreated systolic blood pressure of 130 to 159 mm Hg, diastolic blood pressure of 80 to 99 mm Hg, or both. Systolic and diastolic blood pressure both decreased. Increasing soybean protein intake may help to prevent and treat hypertension.
Nassim P. Assefi, Karen J. Sherman, Clemma Jacobsen, Jack Goldberg, Wayne R. Smith, and Dedra Buchwald This randomized, sham-controlled trial compared true acupuncture with sham acupuncture in patients with fibromyalgia. Participants, data collection staff, and data analysts were blinded to treatment group. The mean subjective pain rating among patients was the same in both treatment groups.
Morgane Ethgen, Isabelle Boutron, Gabriel Baron, Bruno Giraudeau, Jean Sibilia, and Philippe Ravaud The authors found that trials of pharmacologic treatment for rheumatic disease report adverse effects of therapy more often than nonpharmacologic trials. Failure to report harm is an important barrier to evaluating the balance of benefit and harm of nonpharmacologic treatments.
Medicine and Public Issues
Thomas Bodenheimer and Alicia Fernandez In the first 3 articles, this series on health care costs offered several explanations for high and rising health care expenditures in the United States. This final article addresses the physician's role. Specifically, what strategies might enable physicians to take an active role in reducing costs while protecting health care quality?
Clinical Guidelines
U.S. Preventive Services Task Force* The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen for HIV in all adolescents and adults at increased risk for HIV infection but makes no recommendation for or against routine screening for adolescents and adults who are not at increased risk. The USPSTF recommends that clinicians screen all pregnant women for HIV.
Roger Chou, Ariel K. Smits, Laurie Hoyt Huffman, Rongwei Fu, and P. Todd Korthuis This systematic review supports the U.S. Preventive Services Task Force recommendation on HIV screening in pregnant women.
Roger Chou, Laurie Hoyt Huffman, Rongwei Fu, Ariel K. Smits, and P. Todd Korthuis This systematic review supports the U.S. Preventive Services Task Force recommendations on HIV screening in adults and adolescents.
Editorials
Jeffrey A. Cutler and Eva Obarzanek The evidence on the environmental determinants of increased blood pressure supports 4 recommendations for lifestyle intervention: controlling body weight, reducing dietary salt, increasing physical activity, and maintaining moderate alcohol use. Our editorial summarizes several studies of another factor, dietary protein.
Victor R. Fuchs Recently, Annals has published 4 articles on health care costs, the last of which appears in this issue. This editorial, written by an economist for physicians, differentiates sharply between levels of expenditures and their rates of growth, addresses the question of why either should be of concern for public policy, and discusses strategies for containing expenditures.
Andrew S. Levey and Cynthia D. Mulrow Several recent studies have tried to characterize the effects of a lower-than-usual target blood pressure on progression of nondiabetic kidney disease. An observational study, the Modification of Diet in Renal Disease Study, showed long-term benefit. The randomized African-American Study of Kidney Disease and Hypertension showed no benefit, nor did the recently published Ramipril Efficacy in Nephropathy 2 Trial. Here's our take on these conflicting study results.
On Being a Doctor
Jason Ryan It had been a frenetic day for me and my team. We were swamped with patients, and keeping up was exacting, made worse by the pace. But in addition to the volume of admissions, our night felt increasingly overwhelming from a unique and novel burden: We had to finish everything by 11:00 p.m. This was medical training under the mandatory work-hour restrictions for physicians.
Letters Clinical Experience and Quality of Health Care
"Practice Makes Perfect"...or Does It?
Correction: "Practice Makes Perfect"... or Does It?
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