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Articles 
Robert P. Smith, Robert T. Schoen, Daniel W. Rahn, Vijay K. Sikand, John Nowakowski, Dennis L. Parenti, Mary S. Holman, David H. Persing, and Allen C. Steere In major endemic areas in the United States, Lyme disease commonly presents as erythema migrans with homogeneous or central redness and nonspecific flu-like symptoms. Clinical outcome is excellent if antibiotic therapy is administered soon after symptom onset.
Jacques Cornuz, Jean-Paul Humair, Laurence Seematter, Rebecca Stoianov, Guy van Melle, Hans Stalder, and Alain Pécoud A smoking cessation training program that was based on behavioral theory and practice with standardized patients significantly increased the quality of physicians' counseling, smokers' motivation to quit, and rates of smoking abstinence at 1 year.
Florent Boutitie, François Gueyffier, Stuart Pocock, Robert Fagard, Jean Pierre Boissel for the INDANA Project Steering Committee Several studies in hypertensive patients receiving treatment have described the relationship between blood pressure and mortality as J-shaped, with an increased risk for events in patients with low blood pressure. This study found that the increased risk for events in patients with low blood pressure was not related to antihypertensive treatment and was not specific to blood pressure–related events. Poor health conditions leading to low blood pressure and an increased risk for death probably explain the J-shaped curve.
Brief Communications
Louis D. May, Jay H. Lefkowitch, Michael T. Kram, and David E. Rubin As suggested by the patient described in this report, patients receiving pioglitazone may develop serious liver injury and should be observed for evidence of hepatitis.
Reviews
David J. Vaughn, Gretchen A. Gignac, and Anna T. Meadows This case-based discussion focuses on the primary care physician's evaluation and management of a long-term survivor of testicular cancer who was previously treated with surgery and chemotherapy.
Perspectives
Daniel E. Moerman and Wayne B. Jonas The authors provide a new perspective with which to understand what for a half-century has been known as the "placebo effect." As currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. The authors propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of "meaning," to which sick people often respond.
Editorials
Robert B. Nadelman and Gary P. Wormser In this issue, Smith and colleagues describe the clinical manifestations of illness and outcome in a group of U.S. patients with erythema migrans and laboratory evidence of Borrelia burgdorferi infection. Their findings suggest that objective review of the information from clinical studies should change the way we think about diagnosing and treating early Lyme disease.
David W. Nierenberg What should the busy internist do when his or her patient, while taking several medications, suddenly develops a new clinical problem, such as hepatitis? Is the acute hepatitis drug related? If so, which drug is to blame? In this issue, May and colleagues discuss liver injury attributed to use of pioglitazone.
On Being a Doctor
Munsey S. Wheby Petty illness, trifling fever, transient myalgias had led me to something more: a desperate need to hold on to that something that is the very essence of doctoring.
On Being a Patient
Myrtle Lundberg What happened to that skinny kid—the one so skinny her ribs could be counted just by looking? Today, she is a twittery, purse-clutching, cane-wielding, pill-popping little old lady living alone.
Letters Caring for Patients at the End of Life
Diagnosing Primary HIV Infection
Regression and Progression of Valvulopathy Associated with Fenfluramine and Phentermine
Appropriate Use of Antibiotics: Pharyngitis
Sleep Apnea and Gastroesophageal Reflux Disease
A Rollover Epidemic in North Dakota from 1994 to 1997
Amy A. Pruitt
Jerrold B. Leikin
Nancy C. Dolan, Karen Freund, and Judith Walsh This Update discusses issues affecting women of reproductive age, breast cancer treatment, hormone replacement therapy, osteoporosis, cancer screening, and sexual dysfunction. | |||||||||||||||||||||||||||||||||||||||||||||||
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