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The authors randomly assigned 351 perimenopausal or menopausal women to herbal treatments (black cohosh, multibotanical, or multibotanical plus counseling about dietary soy), estrogen with or without progesterone, or placebo. At 3, 6, and 12 months, estrogen substantially decreased vasomotor symptoms, but the herbal interventions had no greater effect than placebo.

The authors sought to measure the complication rate of colonoscopy in community practice. They searched the electronic health records of a large, multisite group practice for patients who had died or had complications within 30 days of colonoscopy. Of 16 318 eligible procedures, 82 involved serious complications. Of the 82 complications, 95% followed biopsy or removal of polyps, two thirds of which were smaller than 10 mm. The perforation rate was 1 in 1000 procedures. One death was related to colonoscopy.

Inability to read the labels on prescription medication containers is a possible reason for poor medication adherence. In this study of patients in community health centers, many were unable to understand the labels for 5 commonly used medications. Lower literacy levels and taking many medications predicted poor understanding. Even among patients who understood the labels, only a few could demonstrate correct pill-taking.

The authors tried to improve patients' adherence to a referral for screening colonoscopy by sending a brochure that provided information about the procedure and its potential benefits and harms. In a randomized trial, 70.7% of the group that received the brochure and 59.0% of the usual care group completed the colonoscopy.

The purpose of this systematic review was to compare aggressive medical therapy and angioplasty with stent for atherosclerotic renal artery stenosis. The authors found no randomized trials, but other evidence suggested similar kidney outcomes and better blood pressure control after angioplasty. According to weak evidence, the rates of mortality and cardiovascular events were similar. No study directly compared adverse event rates.

Chronic myeloid leukemia (CML) was the first type of cancer in humans to be linked to a single, acquired genetic abnormality. The central role of the BCR-ABL kinase fusion protein in the pathogenesis of CML led to a rational molecular targeted therapy. This review provides an update on the underlying pathophysiology of disease progression, imatinib mesylate resistance, and the development of new targeted tyrosine kinase inhibitors for managing CML.

Hot flashes and night sweats are the most common vasomotor symptoms of menopause. Since the results from the Women's Health Initiative showed that estrogen therapy increases the risk for serious events, women have sought safer, effective therapies. In this issue, Newton and colleagues report the results of the Herbal Alternatives for Menopause Trial. The study's results on soy for vasomotor symptoms were equivocal. However, through rigorous testing they found strong evidence that black cohosh is not effective for these symptoms.

The U.S. health care system largely operates under the assumption that all patients have high English-language literacy skills. In fact, many do not. In this issue, Davis and coworkers carefully show that a significant proportion of users of the U.S. health care system does not understand the instructions on prescription bottle labels and cannot correctly execute the instructions.

There were few questions about the advantages of subcutaneous unfractionated heparin (UFH) relative to low-molecular-weight heparin (LMWH) for venous thromboembolism until publication of the Fixed Dose (FIDO) heparin trial in August 2006. The investigators found no statistically or clinically significant difference in recurrent venous thromboembolism in those receiving UFH and those receiving LMWH. The trial's most important contribution is its suggestion that a new weight-based dosing regimen for subcutaneous UFH is safe and effective for treatment of acute venous thromboembolism.

My latest palliative care consult lies in bed in front of me. I almost want to call him a boy, because he's only 25 years old. The Ewing sarcoma has spread to his meninges and brain, and third-nerve palsy keeps one eye shut. The other eye scrunches up, his mouth turns down, and he cries, inconsolable. Like a little boy, I think. Like my 4-year-old son when he isn't getting what he wants and can't understand why.