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March 24, 2011  Vol. 364 No. 12

Audio Summary of this Issue

Perspective
1085-1087

No provision of the health care reform law is more beleaguered than the individual mandate — the requirement that most Americans obtain health insurance or pay a penalty. If the mandate cannot be sustained politically or constitutionally, alternatives exist.

1087-1089

Since we can define subgroups of patients who have high rates of response and disease control in phase 1 trials of targeted cancer drugs, the traditional long pathway to FDA approval of these drugs is increasingly under fire for medical and ethical reasons.

1090-1091

Health information technology holds promise for facilitating vast improvements in care and, ultimately, in the health of Americans, but transforming electronic health records into effective clinical tools will require progress on multiple fronts.

Original Articles
1093-1103
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An important goal in the treatment of COPD is the prevention of exacerbations. In this trial, the investigators found that treatment with tiotropium, as compared with salmeterol, prolonged the time to the first exacerbation of COPD and decreased the number of exacerbations.

1104-1115

This study examined whether pioglitazone can reduce the risk of type 2 diabetes mellitus in adults with impaired glucose tolerance. As compared with placebo, pioglitazone reduced the conversion of IGT to diabetes by 72% but was associated with significant weight gain and edema.

1116-1125

Stored toenail clippings were used to assess mercury exposure in men and women who had had incident cardiovascular events and in matched controls. Participants with higher mercury exposures did not have a higher risk of cardiovascular events, even after adjustment for fish consumption.

1126-1133

In this prospective study, Han Chinese subjects who were candidates for carbamazepine therapy were screened for the HLA-B*1502 allele because of its association with the Stevens–Johnson syndrome and toxic epidermal necrolysis.

1134-1143

A strong association between the HLA-B*1502 allele and SJS and TEN induced by carbamazepine has been shown. This study involving Europeans implicates a different HLA allele, HLA-A*3101, in conferring susceptibility to a broad range of carbamazepine-induced reactions.

Review Article
1144-1153
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This article reviews recent pharmacogenetic and pharmacogenomic advances and discusses how such advances are reflected in the labeling of drugs.

Images in Clinical Medicine
1154
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A 44-year-old man with diabetes mellitus presented to the hospital after 4 days of fever and abdominal pain. The initial evaluation revealed tachycardia, hypotension, and abdominal discomfort in the right upper quadrant.

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A 36-year-old man presented to an Ethiopian clinic with a 20-year history of skin nodules, pain, and edema involving his legs and feet. He was otherwise healthy and worked as a farmer. Circulating filarial antigen tests for the presence of Wuchereria ...

Case Records of the Massachusetts General Hospital
1155-1165
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A 37-year-old man was admitted to the hospital because of flushing and hypotension with near-syncope. Similar episodes had occurred with increasing frequency during the past 12 years. A test result was received.

Editorial
1167-1168

Chronic obstructive pulmonary disease (COPD) is a progressive airway inflammatory condition that is associated with accelerated decline of lung function and is characterized by worsening dyspnea with episodes of increased number and severity of symptoms, ...

Sounding Board
1169-1173

Over the past 75 years, many medical and surgical specialties have emerged. In this Sounding Board article, the authors outline the history of medical and surgical specialization and subspecialization and frame the issues faced by the public and the profession.

Clinical Implications of Basic Research
1174-1175

Engraftment of transplanted hematopoietic stem cells in the developing fetus is achieved with variable rates of success. A recent study suggests that immune surveillance by maternal T cells is an obstacle to engraftment.

Correspondence
1176

To the Editor: We would like to retract our article, “A Genomic Strategy to Refine Prognosis in Early-Stage Non–Small-Cell Lung Cancer,”1 which was published in the Journal on August 10, 2006. Using a sample set from a study by the American College of ...

1177

To the Editor: Lassen and colleagues (Dec. 23 issue)1 should be congratulated for striving to reduce thromboembolic events after hip replacement, but their choice of primary efficacy outcome, which combines clinically important variables (death and ...

1178

To the Editor: In their article on the use of oral rivaroxaban for the treatment of acute deep-vein thrombosis (DVT), the EINSTEIN investigators (Dec. 23 issue)1 report that rivaroxaban had noninferior efficacy, as compared with subcutaneous enoxaparin ...

1178-1180

To the Editor: Kaiser et al. (Dec. 9 issue)1 shed important light on the issue of the safety and efficacy of drug-eluting stents in large coronary arteries. The characteristics of the patients and their lesions were very well matched between the groups, ...

1181-1182

To the Editor: The study by Wu et al. (Dec. 16 issue)1 has serious methodologic issues that limit the interpretation of their estimate of the effectiveness of a 2009 pandemic influenza A (H1N1) vaccine. First, the cumulative incidence of influenza was ...

Corrections
1182

Glycemic Control in the ICU Clinical Practice, N Engl J Med 2010;363:2540-2546. In the Studies of Intensive Insulin Therapy subsection of Management (page 2541), the first sentence in the third paragraph should have cited reference 8, rather than 9, and ...

1182

Emergence of a Multidrug-Resistant Pandemic Influenza A (H1N1) Virus (September 30, 2010;363:1381-2). In the third paragraph (page 1382), the date mentioned should have been January 4 rather than February 9, and in Figure 1 (page 1381), the dates on the x ...

1182

Case 4-2009: A 39-Year-Old Pregnant Woman with Fever after a Trip to Africa Case Records of the Massachusetts General Hospital, N Engl J Med 2009;360:508-516. In the third paragraph (page 508), the fifth sentence should have begun, “She took mefloquine ...