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Articles 
Joel G. Ray, Clive Kearon, Qilong Yi, Patrick Sheridan, Eva Lonn for the Heart Outcomes Prevention Evaluation 2 (HOPE-2) Investigators* In observational studies, elevated plasma homocysteine levels were associated with venous thromboembolism. Ray and colleagues investigated the effect of homocysteine lowering on venous thromboembolism in a multicenter trial of folic acid and B vitamins to reduce cardiovascular events. Five years of therapy with folic acid and vitamins B6 and B12 decreased homocysteine levels compared with placebo, but the incidence of venous thromboembolism was the same in both groups, even in participants with the highest levels of homocysteine.
Lisa Ward and Peter Franks Health economists hypothesize that persons who gain health insurance after being uninsured may use more care after becoming insured than do persons who are continuously insured. This study examined heath care expenditures over 2 years for continuously uninsured persons, continuously insured persons, and persons in transition from no insurance to insurance or vice versa between the first and second year. Expenditures were higher during insured than during uninsured years. However, expenditures of newly insured persons were similar to those of continuously insured persons.
Sudeep S. Gill, Susan E. Bronskill, Sharon-Lise T. Normand, Geoffrey M. Anderson, Kathy Sykora, Kelvin Lam, Chaim M. Bell, Philip E. Lee, Hadas D. Fischer, Nathan Herrmann, Jerry H. Gurwitz, and Paula A. Rochon Gill and associates examined the association between treatment with antipsychotics and all-cause mortality. The risk for death was determined at 30, 60, 120, and 180 days after the initial dispensing of antipsychotic medication. New use of atypical antipsychotics was associated with a statistically significant increase in the risk for death at 30 days compared with nonuse in a community-dwelling cohort and a long-term care cohort. The excess risk seemed to persist to 180 days. Compared with atypical antipsychotics, conventional antipsychotics were associated with a higher risk for death at all time points.
Liset H.M. Pengel, Kathryn M. Refshauge, Christopher G. Maher, Michael K. Nicholas, Robert D. Herbert, and Peter McNair Exercise and advice are common treatments for subacute low back pain, but their effectiveness is unclear. Pengel and coworkers assigned 259 adults with subacute low back pain to receive 12 real or sham physiotherapist-directed exercise sessions and 3 real or sham advice sessions over 6 weeks. The patients who received real exercise and real advice had the most benefit at 6 weeks. However, only a small benefit on patient-reported function persisted at 12 months.
Reviews
Kunihiro Nishimura, Daisuke Sugiyama, Yoshinori Kogata, Goh Tsuji, Takashi Nakazawa, Seiji Kawano, Katsuyasu Saigo, Akio Morinobu, Masahiro Koshiba, Karen M. Kuntz, Isao Kamae, and Shunichi Kumagai Rheumatoid factor (RF) and autoantibodies against cyclic citrullinated peptide (CCP) are markers that might help in the diagnosis of rheumatoid arthritis. The investigators examined whether anti-CCP antibody more accurately identifies patients with rheumatoid arthritis and better predicts radiographic progression than does RF. Anti-CCP antibodies are more specific than RF for diagnosing rheumatoid arthritis and may better predict erosive disease.
History of Medicine
Alan G. Wasserstein The cultivation of medical humanism can ameliorate the problems of contemporary medicine by grounding us in our humanity and by bridging the gap between ourselves and our work. In this regard, it is instructive to review the case of the French philosopher Michel de Montaigne, whose bouts of renal colic may have played a decisive role in shaping his outlook. Montaigne's experience of nephrolithiasis seeded a transition from an elitist Renaissance Stoicism to a warmer humanism that provides a worthy model for our own medical humanism.
Editorials
Giancarlo DiMassa and José J. Escarce In this issue, Ward and Franks used data from the Medical Expenditure Panel Survey to compare health care expenditures among continuously insured persons, continuously uninsured persons, and persons who gained or lost insurance from one year to the next. But is this question really the important one? We believe that a much more important issue is the effect of insurance on health outcomes.
Axel Finckh and Matthew H. Liang In their well-done meta-analysis, Nishimura and colleagues confirm that autoantibodies against cyclic citrullinated peptide (CCP) are more specific than rheumatoid factor for diagnosis of rheumatoid arthritis, a finding that corroborates results of 2 systematic reviews. Although anti-CCP antibodies are an important addition to our diagnostic armentarium, clinical judgment remains of paramount importance in making a timely diagnosis of rheumatoid arthritis.
On Being a Doctor
Keiki Hinami The driver was a talkative man who delighted in having a captive audience. The theme of the conversation was his alcoholism, which was the last thing I wanted to talk about with a driver entrusted with safely transporting me from the hospital to the airport.
Letters Colorectal Screening after Polypectomy
Effect of Inhaled Insulin on Fasting and Postprandial Plasma Glucose
Pay-for-Performance and Accountability
Treatment of Familial Mediterranean Fever with Anakinra
Rakiba Belkhir, Luc Moulonguet-Doleris, Eric Hachulla, Jacques Prinseau, Alain Baglin, and Thomas Hanslik Epstein–Barr Virus–Associated Cholecystitis
Jeffrey I. Mechanick
Daniel F. Dilling
This issue provides a clinical overview of asthma, focusing on prevention, screening, diagnosis, treatment, and practice improvement. Readers can complete the accompanying CME quiz for 1.5 credits. | |||||||||||||||||||||||||||||||||||||||||||
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