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Articles 
Jean S. Kutner, Marlaine C. Smith, Lisa Corbin, Linnea Hemphill, Kathryn Benton, B. Karen Mellis, Brenda Beaty, Sue Felton, Traci E. Yamashita, Lucinda L. Bryant, and Diane L. Fairclough Little is known about the effectiveness of massage in managing pain during palliative care. Kutner and colleagues randomly assigned 380 patients with advanced cancer to either massage therapy or simple-touch sessions. Pain and mood improved more after massage therapy than after simple touch, but the 2 treatments had equal effects on pain, quality of life, and analgesic use as measured over 3 weeks. Adverse effects were infrequent and similar in both groups.
Todd A. Lee, A. Simon Pickard, David H. Au, Brian Bartle, and Kevin B. Weiss In this large case–control study, Lee and coworkers measured the association between medications and risk for death in veterans with newly diagnosed chronic obstructive pulmonary disease. Inhaled corticosteroids were associated with decreased risk for death, whereas theophylline and ipratropium were associated with increased risk for respiratory and cardiovascular death, respectively.
Monika Sarkar, Sean Hennessy, and Yu-Xiao Yang Some studies suggest that proton-pump inhibitors (PPIs) increase risk for community-acquired pneumonia (CAP). In this large, nested case–control study of adults in general practices in the United Kingdom, long-term PPI use was not associated with increased risk for CAP. However, recently started PPI therapy was associated with increased CAP risk: The adjusted odds ratios for CAP occurring after starting PPIs within 2, 7, and 14 days of CAP diagnosis were 6.5, 3.8, and 3.2, respectively.
Vincent Mallet, Hélène Gilgenkrantz, Jeanne Serpaggi, Virginie Verkarre, Anaïs Vallet-Pichard, Hélène Fontaine, and Stanislas Pol Mallet and associates studied regression of liver cirrhosis in 96 patients with chronic hepatitis C and biopsy-proven cirrhosis after treatment with an interferon-based regimen. Eighteen patients had biopsy-proven regression of cirrhosis. These patients had better 10-year survival rates than did patients without regression (100% vs. 74%). The study suggests that cirrhosis may be reversible in some patients with chronic hepatitis C.
Academia and Clinic
Furman S. McDonald, Colin P. West, Carol Popkave, and Joseph C. Kolars McDonald and colleagues surveyed 22 653 internal medicine residents in their final year of residency to determine the relationship between educational debt and reported career plans. They found that the amount of educational debt is associated with such plans. These associations are more pronounced for U.S. medical graduates than for international medical graduates.
History of Medicine
Carl Power and John E.J. Rasko This myth of Prometheus—the Greek god whose immortal liver was feasted on day after day by Zeus' eagle—invariably provokes the question: Did the ancient Greeks know about the liver's amazing capacity for self-repair? Power and Rasko address this question by exploring the origins of Greek myth and medicine, examining the general theme of regeneration in Greek mythology, and surveying several scholarly interpretations of Prometheus' torture.
Clinical Guidelines
Amir Qaseem, Vincenza Snow, Paul Shekelle, Robert Hopkins, Jr., Mary Ann Forciea, Douglas K. Owens for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians This guideline presents current evidence on pharmacologic treatments to prevent fractures in men and women with low bone density or osteoporosis. The American College of Physicians recommends that clinicians offer pharmacologic treatment to men and women with osteoporosis or a history of fragility fractures. Physicians should consider pharmacologic treatment for men and women at risk for osteoporosis. When choosing among pharmacologic treatments for osteoporosis, physicians should make a patient-specific assessment of their potential harms and benefits.
Editorials
Martin Black and Rebecca Thomas Many consider treatment of cirrhotic patients too late in the natural history of progressive liver disease to be worthwhile. The concept of treating cirrhotic patients, however, has recently gained popularity. Viral eradication is sometimes accompanied by reversal of cirrhosis, as Mallet and colleagues document in this issue. They demonstrate that the reported improvement in histology is associated with a reduction in cirrhosis-related complications and prolonged survival.
Atul Grover In this issue, McDonald and colleagues demonstrate the relationship between student debt and plans for specialization among internal medicine residents. We may need to look beyond financial issues to understand what attracts physicians to more specialized areas of practice and work to address not only income but also how general internists and specialists practice medicine and what this means for our patients.
On Being a Doctor
Charles A. Wittnam In the Yellowstone River Valley of Montana, a handshake is still important. Here, handshakes are used to settle the sale of land, timber, and cattle and are always offered in greeting and in farewell. Montanans believe that a handshake provides important information about a person's character, and it is never taken lightly.
Charity Thoman There on the far wall, skulls peered down. Rows and rows and rows of human skulls. Each sat neatly next to the other, as if politely decapitated to take its place on the wall. They were eclectic and haunting. Who had they been? How had their bones ended up as part of this one man's personal collection?
Letters Is Patient Cost-Sharing the Best Way to Protect the Medical Commons?
Monitoring Cholesterol Levels: Understanding Variance and Finding the Most Useful Data
Sildenafil-Induced Thrombocytopenia
Correction: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naive to Treatment
Correction: Seeding Trials: Just Say "No"
C. Donald Combs
Mary Bessesen
Paul Rousseau
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