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  • PerspectiveOnline First

    In recent decades, biomarkers have become essential in diagnosing disease and assessing patients' responses to therapy. The increasing quantitative rigor and efficiency of these tests have led to the possibility of "personalized medicine." Despite such progress, the way in which a physician uses…

    • May 23, 2012
    • Kesselheim A.S. and Karlawish J.
    • 10.1056/NEJMp1204164
    • Free Full Text

    In recent decades, biomarkers have become essential in diagnosing disease and assessing patients' responses to therapy. The increasing quantitative rigor and efficiency of these tests have led to the possibility of “personalized medicine.” Despite such ...

  • PerspectiveOnline First

    The political seas roiled by the Affordable Care Act (ACA) have grown more volatile in the 2 years since its passage. Whether it is the constitutionality of the insurance mandate, the economic feasibility of the Medicaid expansion, or controversy over the conscience clauses, much has been said and…

    • May 16, 2012
    • Breen J.O.
    • 10.1056/NEJMp1202039
    • Free Full Text

    The political seas roiled by the Affordable Care Act (ACA) have grown more volatile in the 2 years since its passage. Whether it is the constitutionality of the insurance mandate, the economic feasibility of the Medicaid expansion, or controversy over the ...

  • Perspective

    Although the media and the U.S. public focused primarily on the minimum-coverage requirement, or individual mandate, during the recent oral arguments in the challenges to the Affordable Care Act (ACA) before the Supreme Court, the most important issue before the Court may well be the…

    • May 3, 2012
    • Jost T.S.
    • N Engl J Med 2012; 366:e27
    • Free Full Text

    Although the media and the U.S. public focused primarily on the minimum-coverage requirement, or individual mandate, during the recent oral arguments in the challenges to the Affordable Care Act (ACA) before the Supreme Court, the most important issue ...

  • Perspective

    During the last week in March, much of the country was riveted by 3 days of Supreme Court arguments in the constitutional challenge to the Patient Protection and Affordable Care Act (ACA). The Court devoted more than six times the normal amount of time to oral arguments — a ratio not seen since…

    • April 19, 2012
    • Hall M.A.
    • N Engl J Med 2012; 366:1462-1463
    • Free Full Text
    • Audio

    Supreme Court oral arguments may reveal the justices' views of fundamental political and social issues — including, in the case of the Affordable Care Act, what it means to ensure liberty and where the proper balance lies between judicial activism and deference to Congress.

  • Perspective

    What began, in Douglas v. Independent Living Center of Southern California, as a challenge to a series of California laws aimed at reducing Medicaid payments to health care providers grew into a profoundinquiry — not into the merits of state versus federal law, but into the appropriateness of the…

    • April 12, 2012
    • Rosenbaum S.
    • N Engl J Med 2012; 366:e22
    • Free Full Text

    In the Douglas case, health care providers and Medicaid patients attacked California laws reducing Medicaid payments, arguing that they violated federal standards and jeopardized patients' health. The Supreme Court punted, sending the case back for further development.

  • Correspondence

    To the Editor: Despite research on the overall costs of the U.S. medical liability system, national data are limited on the costs associated with resolving medical malpractice claims — defense costs — and how they vary according to physician specialty. The frequency of malpractice claims and…

    • April 5, 2012
    • N Engl J Med 2012; 366:1354-1356
    • Free Full Text

    In this analysis of defense costs associated with malpractice claims closed between 1995 and 2005, the mean defense cost per claim was about $23,000. Costs were higher for claims resulting in an indemnity payment, and defense costs varied widely across specialties.

  • Perspective

    When AIDS emerged in the 1980s, fear and misunderstanding about the disease prevailed. Patients with AIDS faced a grim prognosis, with no effective treatments. They confronted discrimination in the workplace and throughout society and had little legal recourse for combating it. Simply getting…

    • April 5, 2012
    • Szent-Gyorgyi L.E., Desai S., Kim D., Sax P.E., Greenberg J.O.
    • N Engl J Med 2012; 366:1268-1270
    • Free Full Text

    HIV infection is now a chronic, treatable disease, and transmission is readily preventable. The Centers for Disease Control and Prevention recommend expanding HIV screening and eliminating unique requirements for informed consent, but not all states have done so.

  • Perspective

    The Supreme Court is now reviewing a federal appeals court decision that the individual mandate in the Affordable Care Act (ACA), which requires that individuals either purchase health insurance or pay a penalty, is unconstitutional. If the Court agrees, it will then consider whether to invalidate…

    • March 29, 2012
    • Sessions S.Y. and Detsky A.S.
    • N Engl J Med 2012; 366:e19
    • Free Full Text

    If the Supreme Court deems the Affordable Care Act's individual mandate unconstitutional, it will consider whether to invalidate other ACA provisions because the mandate cannot be “severed” from them. The ACA's fate may therefore depend on the mandate's severability.

  • Perspective

    Later this month, the U.S. Supreme Court will examine the constitutionality of the Affordable Care Act (ACA), potentially producing a landmark decision. For most cases, the Supreme Court allocates 1 hour for oral argument — 30 minutes for each side. For the health care reform case, the Court has…

    • March 15, 2012
    • Curfman G.D., Abel B.S., Landers R.M.
    • N Engl J Med 2012; 366:977-979
    • Free Full Text
    • Interactive/Multimedia

    In late March, the Supreme Court will examine the constitutionality of the Affordable Care Act, potentially producing a landmark decision. The Court will determine whether, in crafting the ACA's individual mandate and Medicaid expansion, Congress exceeded its powers.

  • Correspondence

    To the Editor: The Needlestick Safety and Prevention Act (NSPA) (HR.5178) was signed into law on November 6, 2000. It required employers to provide safety-engineered devices to employees who are at risk for exposure to bloodborne pathogens, to include frontline workers in selecting these devices,…

    • February 16, 2012
    • N Engl J Med 2012; 366:670-671
    • Free Full Text

    According to this analysis of needlestick injuries in a sample of U.S. hospitals before and after passage of the NSPA in 2000, the number of percutaneous injuries per 100 full-time hospital employees declined after enactment of the legislation.

  • Perspective

    Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help…

    • February 16, 2012
    • Neumann P.J.
    • N Engl J Med 2012; 366:585-586
    • Free Full Text

    New ethics guidelines from the American College of Physicians calling for physicians to practice “parsimonious care” have reignited a debate about the role and responsibility of physicians in addressing problems with health care costs.

  • Perspective

    As a treatment for end-stage renal disease (ESRD), kidney transplantation is superior to dialysis for improving patient survival rates and quality of life. Its long-term success, however, requires ongoing treatment with immunosuppressive drugs. Ironically, although many of the pivotal discoveries…

    • February 16, 2012
    • Gill J.S. and Tonelli M.
    • N Engl J Med 2012; 366:586-589
    • Free Full Text

    Since U.S. kidney-transplant recipients don't benefit from a coherent funding policy for immunosuppressive drugs, thousands of them are at risk for allograft failure and premature death. Ensuring lifetime access to these medications would save lives and money.

  • Perspective

    The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the past several decades, this relationship has evolved along three interrelated axes — as it is defined in clinical care, research, and…

    • February 16, 2012
    • Truog R.D.
    • N Engl J Med 2012; 366:581-585
    • Free Full Text
    • Audio

    The relationship between patients and doctors is at the core of medical ethics, anchoring many important debates in the field. Over the past several decades, this relationship has evolved along three axes — as it is defined in clinical care, research, and society.

  • Perspective

    It has been clear for some time that the political fight over the minimum-insurance-coverage requirement in the Affordable Care Act (ACA) would eventually reach the U.S. Supreme Court. What few would have predicted was that the question of the constitutionality of the latest in a long line of…

    • February 9, 2012
    • Rosenbaum S. and Jost T.S.
    • N Engl J Med 2012; 366:487-489
    • Free Full Text

    In appealing to the Supreme Court, 26 states are arguing that the Affordable Care Act unconstitutionally coerces them into expanding their Medicaid programs. But although states may face a hard choice about participating in Medicaid, that's not a constitutional matter.

  • Perspective

    The Patient Protection and Affordable Care Act of 2010 (ACA) is arguably the most significant health legislation enacted in generations. As remarkable a political and policy achievement as it was, what the reform will actually accomplish is largely yet to be determined. Whether it slows the growth…

    • January 26, 2012
    • Jones D.K.
    • N Engl J Med 2012; 366:e7
    • Free Full Text

    The fate of the Affordable Care Act depends on the outcome of four events in 2012: state legislative sessions, the Supreme Court ruling on the law's constitutionality, the application deadline for grants for establishing health insurance exchanges, and the elections.

  • Perspective

    On December 1, 2011, in Flynn v. Holder, the U.S. Court of Appeals for the Ninth Circuit held that the ban on selling "bone marrow" that is part of the National Organ Transplant Act (NOTA) of 1984 does not encompass "peripheral blood stem cells" obtained through apheresis. This ruling means that…

    • January 26, 2012
    • Cohen I.G.
    • N Engl J Med 2012; 366:296-297
    • Free Full Text

    On December 1, 2011, in Flynn v. Holder, the U.S. Ninth Circuit Court of Appeals held that the ban on selling “bone marrow” that is part of the National Organ Transplantation Act of 1984 does not encompass “peripheral blood stem cells” obtained through apheresis.

  • Perspective

    Nearly all media and scholarly discussion of the constitutionality of the Affordable Care Act (ACA), has focused on the individual mandate to obtain health insurance. The Supreme Court has now promised to review not only that issue but also the issue of whether the ACA's Medicaid expansion violates…

    • January 12, 2012
    • Cohen I.G. and Blumstein J.F.
    • N Engl J Med 2012; 366:103-104
    • Free Full Text
    • Audio

    The Supreme Court has promised to review not only the constitutionality of the Affordable Care Act's individual mandate but also the issue, raised by Florida and 25 other states, of whether the ACA's Medicaid expansion violates the U.S. Constitution.

  • Perspective

    The parties who have brought legal challenges to the Affordable Care Act's (ACA's) individual mandate to obtain health insurance claim that the Constitution's Commerce Clause authorizes the regulation of only commercial activity, not inactivity, and thus gives Congress no power to force individuals…

    • January 5, 2012
    • Elhauge E.
    • N Engl J Med 2012; 366:e1
    • Free Full Text

    Those who have legally challenged the Affordable Care Act's individual mandate to obtain health insurance argue that Congress cannot regulate “inactivity.” But Congress does in fact have the power to force purchases.

  • Perspective

    For three decades after its publication, in 1975, the Mini–Mental State Examination (MMSE) was widely distributed in textbooks, pocket guides, and Web sites and memorized by countless residents and medical students. The simplicity and ubiquity of this 30-item screening test — covering such…

    • December 29, 2011
    • Newman J.C. and Feldman R.
    • N Engl J Med 2011; 365:2447-2449
    • Free Full Text

    Moves to protect the copyright of the Mini–Mental State Examination, the standard of care for cognitive screening, have left clinicians at risk of legal action for infringement and distribution and made a new tool, apparently seen as derivative, unavailable.

  • Special Report

    PART TWO OF TWO Presented as the 36th annual Joseph Garland Lecture of the Boston Medical Library on October 25, 2011. Dr. Garland was editor-in-chief of the Journal from 1947 through 1967. In the spring of 2009, the Department of Health and Human Services (DHHS) faced a daunting project: to lead…

    • December 22, 2011
    • Blumenthal D.
    • N Engl J Med 2011; 365:2426-2431
    • Free Full Text

    The 2009 HITECH Act allocated $29 billion to support the adoption of health information technology. The author reviews the accomplishments to date and the challenges ahead in creating a nationwide, interoperable, and secure electronic health information system.

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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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