The story of sirolimus began in 1975 on Easter Island, in the South Pacific, a remote, enigmatic place known for the prominent stone statues that punctuate its landscape. An actinomycete, Streptomyces hygroscopicus, cultured from a sample of the island's ...

Because the prevalence of colonic neoplasms before the age of 50 is thought to be low, screening for colonic neoplasms by colonoscopy is currently recommended for people 50 years of age or older. In this retrospective study, investigators reviewed the records of 906 consecutive persons 40 to 49 years of age who participated in an employer-sponsored colonoscopic-screening program. No cancers were detected in this group, but hyperplastic polyps, tubular adenomas, or lesions scored as “advanced neoplasms” were found in 21 percent of those screened. Between 250 and 1000 people 40 to 49 years old would need to be screened to detect a single case of colon cancer.

Aspirin and clopidogrel, alone or together, reduce the rate of cardiovascular events in patients with coronary disease, but their relative cost effectiveness is uncertain. In this study, the use of aspirin in all patients eligible to receive it was very cost effective. In contrast, clopidogrel as a substitute for or in addition to aspirin was not cost effective. At its current price, clopidogrel was cost effective only when used in the small number of patients who cannot take aspirin.

The systemic amyloidoses comprise a spectrum of acquired and hereditary diseases caused by the deposition of characteristic fibrillar material in various organs and tissues throughout the body. These fibrils are 7 to 10 nm wide, rigid, and nonbranching, ...

In this issue of the Journal, Gaspoz et al.¹ examine the relative benefits of various therapeutic strategies for the secondary prevention of coronary heart disease. This is a critical area of inquiry, given the unenviable position of heart disease as the ...

The announcement that most of the nation's biggest insurers — Aetna, CIGNA, Humana, the United Health Group, and Wellpoint Health Network — will be introducing a new kind of health plan during the next year or two signals the beginning of a new era in ...

To the Editor: Chasan-Taber and Stampfer (Dec. 20 issue)¹ state that there is increasing evidence that third-generation oral contraceptives are safer than previous formulations in terms of cardiovascular risk. Part of the evidence provided by Tanis et ...

To the Editor: In the study by the Diabetes Prevention Program Research Group (Feb. 7 issue),¹ the protocol did not include a washout period after metformin therapy. Such an approach could have been used to determine whether the subjects' plasma glucose ...

To the Editor: The study by Coiffier et al. (Jan. 24 issue)¹ raises several issues. First, the Southwest Oncology Group had clearly established the superiority of three courses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) followed ...

To the Editor: Skjærven et al. (Jan. 3 issue)¹ analyzed data from the Medical Birth Registry of Norway and concluded that an extended interval between births is a previously unrecognized risk factor for preeclampsia. After adjustment for the interval ...

To the Editor: Between 1978, when tamoxifen was first marketed in the United States, and April 2001, there were 43 cases, reported either to the Food and Drug Administration (FDA) or in the medical literature,¹ of uterine sarcoma that developed in women ...

To the Editor: Peanuts and tree nuts are often the cause of fatal or nearly fatal allergic reactions induced by food.¹,² Accidental exposure through ingestion is common, but there are rare reports of transmission of allergens through kissing.³–⁵ We were ...

When it comes to conflicts of interest, moral huffing is in plentiful supply, whereas careful analysis and ethical insight are scarce. Conflict of Interest in the Professions, a collection of 17 chapters edited by Michael Davis and Andrew Stark, is a ...

Since ancient times, people have disagreed about the permissibility of suicide, assisted suicide, and physician-assisted suicide. This book presents an overview of the issues involved in the debate about physician-assisted suicide at the end of the 20th ...

Case Records of the Massachusetts General Hospital (Case 10-2002) Case Records of the Massachusetts General Hospital, N Engl J Med 2002:346;1009-1015.. Line 7 of paragraph 2 in the left-hand column of page 1014 should have read, “variably express surface ...

Improving Protection for Research Subjects Health Policy Report, N Engl J Med 2002:346;1425-1430.. Reference 19 should have read as follows: “La Mantia C. Final report for adverse event investigation involving protocol entitled Methionine and Homocysteine ...