True, the kind of preoccupation with progress that has been described as "the traditional American love of new gadgetry and dread of being caught up in a fad past its prime" [1] can be excessive. And it is true that "too much progress," the fixation on what's new, what's the fashion, and what's "hot," can and does lead to the premature adoption of practices that at first blush seem rational and attractive but later fade because evidence for their effectiveness is lacking or unsuspected toxicity emerges [2]. And it is also true that the amount of fundamentally new information brought forward in medicine at any one time is generally quite small, so that even at the "cutting edge," thin layers of the new are spread over a thick substrate of the well established. The true "paradigm shift" is a rare and noteworthy event, in medicine as elsewhere [3].

But the world does change, and knowledge evolves, and medicine in many areas needs all the progress it can get. We are pleased to note, therefore, that this issue of Annals contains the first of a special series that will be published within the new Updates format over the coming months [4]. Modeled along the lines of the many and justifiably popular yearbooks, ACP Journal Club, and other "synoptic" publications, this special series is designed to filter out of the immense journal literature a highly select group of studies published in the preceding 12 to 18 months. These studies are chosen not only because they meet rigorous design and analytic standards but also because they fill important gaps in clinical knowledge. The authors have explicitly tried to identify those relatively few key papers that should be making a difference in daily clinical practice: the kind of new information that will be uniquely useful in dealing with the common, the serious, the difficult to manage, the uncertain.

The authors assemble the information in the Updates series in the course of preparing the series of Updates presented at the American College of Physicians' Annual Session. Under the editorship of Dr. John Roberts, they have now reworked the material for publication to a wider audience as "enduring materials." We are pleased with the result and hope Annals readers will be, too. As always, we welcome comments.