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November 19, 2009  Vol. 361 No. 21

Audio Summary of this Issue

Perspective
2009-2012

Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health care reform. Sara Rosenbaum examines Medicaid under the House and Senate health care reform proposals.

2012-2015

Under the microscope of the national health care reform debate, questions have been raised about the appropriateness of the Massachusetts model for the country as a whole, given the costs of the program. Joel Weissman and Dr. JudyAnn Bigby discuss the ...

2015-2017

Alexandra Stewart writes that mandatory vaccination of health care workers raises important questions about a state's power to compel individuals to engage in particular activities in order to protect the public.

e46

In 2007, the United States spent about 15% of its gross domestic product (GDP) on health care, whereas Israel's health care spending was about 8% of its GDP (see graph, Panel A). In other words, on average, Americans work almost 2 months a year to pay ...

e47

Accelerating progress toward the Democrats' goal of enacting health care reform legislation, House Speaker Nancy Pelosi (D-CA) unveiled a bill on October 29 that would establish a mandate for most legal U.S. residents to obtain health insurance. The bill ...

e48

Congressional leaders and President Barack Obama are moving ahead to develop a single piece of major health care legislation, which will be debated, voted on by both houses of Congress, and, if enacted, sent to the President for his approval and ...

Other Points of View
e107

The health care reform effort in the United States is driven by the desires for cost control and expanded coverage. However, as Daniel Callahan recently wrote, “cost controls that are likely to be politically acceptable will not be very effective, and ...

Original Articles
2019-2032

Anemia is associated with an increased risk of cardiovascular and renal events among patients with type 2 diabetes and chronic kidney disease. This placebo-controlled trial randomly assigned such patients to receive darbepoetin alfa or placebo. The two composite end points were death or cardiovascular disease and death or end-stage renal disease. Darbepoetin alfa did not reduce either outcome and was associated with an increased risk of stroke.

2033-2045

Genetic analyses showed that mutations affecting the interleukin-10 receptor are associated with early-onset colitis. Further molecular analyses showed that the mutations abrogated interleukin-10 signaling. Treatment of one of the affected children by means of allogeneic hematopoietic stem-cell transplantation was successful.

2046-2055

This article describes a group of 11 patients between the ages of 6 and 21 years who had recurrent sinopulmonary infections, extensive cutaneous viral infections, severe allergies, and elevated serum levels of IgE; some of the patients also had asthma or reactive airway disease or susceptibility to cancer. All patients had loss-of-function mutations in the DOCK8 gene.

2056-2065

Kuru, a neurodegenerative disease associated with endocannibalism in Papua New Guinea, is the classic example of prion disease. Certain polymorphisms at codon 129 of the prion protein gene (PRNP) are highly associated with susceptibility to the development of kuru. In this report, further investigation involving kuru-exposed survivors in Papua New Guinea shows that certain polymorphisms in PRNP codon 127 lead to genetic resistance to kuru.

Review Article
2066-2078

This review gives an account of recent advances in our knowledge of the intestinal immune system and how it becomes perturbed in Crohn's disease and ulcerative colitis. The importance of genetic factors in these diseases has been increasingly recognized, and this article emphasizes their roles.

Images in Clinical Medicine
2079
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A 73-year-old man with history of smoking, hypertension, chronic obstructive pulmonary disease, and type 2 diabetes mellitus presented with respiratory distress. The trachea was intubated, and the patient was admitted to the intensive care unit. On the ...

e49
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A 77-year-old man presented with painful swelling of his right elbow. When pressure was applied, a toothpastelike, white, chalky substance was easily expressible.

Case Records of the Massachusetts General Hospital
2080-2087

A 23-year-old man was transferred to this hospital because of cough, hoarseness, fever, and abnormalities on chest imaging. One month before admission, a nonproductive cough developed, followed by hoarseness, dyspnea on exertion, and fever. Imaging studies at another facility showed pulmonary and mediastinal masses and a lesion in the pelvis. Positron-emission tomographic scans obtained at this hospital showed 18F-fluorodeoxyglucose–avid lesions. A diagnostic procedure was performed.

Editorials
2089-2090

Anemia associated with chronic kidney disease and end-stage renal disease is due, in large part, to reduced production of renal erythropoietin and abnormalities in extracellular-fluid volume homeostasis.1 Moreover, anemia and disordered salt and water ...

2091-2093

In this issue of the Journal, Glocker et al.1 provide the first substantial support for a functional role for the immunosuppressive cytokine interleukin-10 in the pathogenesis of inflammatory bowel disease in humans. By performing genetic-linkage and ...

Clinical Implications of Basic Research
2094-2096

Treatment of a mouse model of aggressive pancreatic cancer with an inhibitor of the hedgehog pathway enhanced tumor sensitivity to gemcitabine and resulted in the stabilization of disease.

Correspondence
2097-2100

To the Editor: In the August 6 issue, Kallmes et al.1 report on the Investigational Vertebroplasty Safety and Efficacy Trial (ClinicalTrials.gov number, NCT00068822), and Buchbinder et al.2 report on a randomized trial of vertebroplasty for painful ...

2100-2101

To the Editor: Lassen and colleagues (Aug. 6 issue)1 state that apixaban and enoxaparin had similar efficacy, based on the point estimate for the relative risk of all types of venous thromboembolism; this end point was driven mainly by asymptomatic ...

2101-2102

To the Editor: In their Clinical Practice article (June 25 issue),1 Silverman and Sandhaus mention two small trials of augmentation therapy for alpha1-antitrypsin (AAT) deficiency that have been performed2,3 and note that there were “marginally ...