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Articles 
Véronique L. Roger, Steven J. Jacobsen, Susan A. Weston, Tauqir Y. Goraya, Jill Killian, Guy S. Reeder, Thomas E. Kottke, Barbara P. Yawn, and Robert L. Frye Over time, the incidence of hospitalized myocardial infarction decreased in men but increased in women and elderly persons. Survival benefits were clustered among younger persons. These results suggest that both incidence and survival contribute to the contrasting mortality trends by age and sex and that the burden of coronary disease has shifted toward elderly persons.
Vijaya Sundararajan, Nandita Mitra, Judith S. Jacobson, Victor R. Grann, Daniel F. Heitjan, and Alfred I. Neugut Adjuvant therapy with 5-fluorouracil is significantly associated with reduced mortality in older patients with node-positive colon cancer, similar to the association found in randomized, controlled trials among younger patients. More frequent use of this therapy in older patients would probably reduce the rate of death from colon cancer.
Tait D. Shanafelt, Katharine A. Bradley, Joyce E. Wipf, and Anthony L. Back In this study, burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
Brief Communications
Neal Dickert, Ezekiel Emanuel, and Christine Grady Most organizations pay some research subjects, but few have written policies on payment. Because investigators and institutional review boards make payment decisions with little specific guidance, standards vary.
Academia and Clinic
Ted J. Kaptchuk This essay reviews the historical and theoretical framework of acupuncture, the scientific evidence for its claims to effectiveness, its safety profile, and methods for providing this therapy.
Perspectives
Virginia U. Collier, Jack D. McCue, Allan Markus, and Lawrence Smith Despite recent curricular reforms, an alarming number of current medicine residents report depressive symptoms, increasing cynicism, and decreasing humanism, which were associated with increasing educational debt and a need to moonlight for financial survival. Ongoing curricular reform, legislative relief from early loan repayment, and salary increases may be necessary to address these problems.
Position Papers
Susan L. Coyle for the Ethics and Human Rights Committee, American College of Physicians–American Society of Internal Medicine* This is part 1 of a 2-part paper on ethics and physician–industry relationships. Part 1 offers recommendations to individual physicians, mainly clinicians and clinician-researchers, about acceptance of gifts and other financial relationships with industry.
Susan L. Coyle for the Ethics and Human Rights Committee, American College of Physicians–American Society of Internal Medicine* This is part 2 of a 2-part paper on ethics and physician–industry relationships. Part 2 addresses ethical concerns relevant to medical education providers, academic units that accept industry support, and medical professional societies.
Editorials
Linda Hawes Clever Is burnout in residents a malignant disease? Do exhaustion, cynicism, and ineffectiveness start small, then grow, spread, and harm? If burnout in residents and other health professionals has been a silent but costly malignancy, the article by Shanafelt and colleagues in this issue makes a good start at exposing the problem.
Jordan J. Cohen There is ample reason to be concerned about the health and welfare of today's medical residents. Indeed, data such as those presented by Collier and colleagues in this issue reconfirm what we have known for some time: The burdens that residents labor under are extracting an unacceptable toll on their well-being.
On Being a Doctor
Jack Coulehan The guy's an iceberg. I feel the cold breeze the moment I walk into the office, where he stands beside the examining table, his arms crossed, a thin man, pale eyes, dour face, measured stare.
Letters Measuring Quality
The Crisis in Local Institutional Review Boards
Should We Screen for Depression in Primary Care?
Leonard H. Sigal Twenty-five years after the description of Lyme disease, we have come far: Clinical features are well described, accurate tests support the diagnosis, effective therapy is available, and there is an effective vaccine. It is time to reflect on the jargon that contributes to misdiagnosis and mistreatment.
Ann C. Klassen
Kenneth D. Rothstein
George N. Braman
Anne E. Hills
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