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Articles 
Marieke J.H.A. Kruip, Monique G.L. Leclercq, Cees van der Heul, Martin H. Prins, and Harry R. Büller A normal perfusion lung scan or normal D-dimer levels in a patient with a low clinical probability safely excludes pulmonary embolism. When these tests do not exclude pulmonary embolism, second-level diagnostic strategies include spiral computed tomography, tests for deep venous thrombosis, and pulmonary angiography.
Andreas Fritsche, Matthias Axel Schweitzer, Hans-Ulrich Häring the 4001 Study Group* In patients taking glimepiride for type 2 diabetes, the risk for nocturnal hypoglycemia was lower with morning or bedtime insulin glargine than with bedtime neutral protamine Hagedorn (NPH) insulin. Morning insulin glargine provided better glycemic control than did bedtime insulin glargine or bedtime NPH insulin.
Jane E. Sisk, William Whang, Jay C. Butler, Vishnu-Priya Sneller, and Cynthia G. Whitney Cost-effectiveness analysis supports not only the current recommendation to vaccinate high-risk people but also extending that recommendation to everyone age 50 through 64 years.
Brief Communications
Kristin B. Highland, Charlie Strange, and John E. Heffner Inhaled steroids probably do not modify the long-term decline in lung function in patients with chronic obstructive pulmonary disease.
Improving Patient Care
William B. Runciman, Alan F. Merry, and Fiona Tito The authors argue that our society's need to blame is often counterproductive in health care because it inhibits changes in the systems that contribute to medical error. We need to assure fair and timely compensation to victims of medical error without necessarily affixing blame.
Reviews
Hershel Raff and James W. Findling An understanding of the physiologic characteristics of the hypothalamic–pituitary–adrenal axis is essential in formulating strategies to confirm the diagnosis of the Cushing syndrome and establish its cause.
Perspectives
James L. Reinertsen The author calls for physicians to practice the science of medicine as a community of professionals so that society will allow physicians to continue practicing the art of medicine as individual professionals. In a Zen-like paradox, physicians must give up autonomy in order to regain it.
Editorials
Harold C. Sox With the paper by Runciman and colleagues, this issue marks the debut of Improving Patient Care, a new Annals section that will feature articles about quality improvement and patient safety. The new section will be about the organization of practice rather than the clinical content of care.
Paul Barach and Donald M. Berwick This issue launches a new series called Patient Safety and the Reliability of Health Care Systems. The articles will describe the scientific basis of new and robust ways to transform our culture of health care into a culture of safety.
Pierce Gardner In this issue, Sisk and colleagues provide strong impetus to reducing the recommended age for universal pneumococcal vaccination to 50 years. What are the concerns and potential problems with such a change?
Paul E. Epstein Highland and colleagues' report in this issue convincingly shows that in patients with chronic obstructive pulmonary disease (COPD) (but no asthmatic component), the decline in FEV1 was no slower in those treated with inhaled corticosteroids than in untreated patients and that the initial FEV1 did not affect the results. As important as these results might be, do they sound the death knell for inhaled corticosteroid use in COPD?
On Being a Doctor
John Chamberlain It was one of those rare lulls practitioners savor. Brief but refreshing. The piles could wait. The mood invited reflection. But then. ... "Dr. C., I finished with my last patient. Can I tell you about her? She says your sons are friends. She is real interesting for an old person."
On Being a Patient
Helen W. I kept buttoning and unbuttoning my black leather coat, responding to the alternating waves of heat and chill typical of narcotic withdrawal. It was a familiar sensation, but instead of being at home with the flu, I was sitting in a circle of fellow substance abusers sharing the misery and confusion of early sobriety.
Letters Simvastatin
The Relative Safety of Ephedra Compared with Other Herbal Products
Statin-Associated Myopathy with Normal Creatine Kinase Levels
The In-Training Examination in Internal Medicine
Fish Oil Therapy in Recurrent IgA Nephropathy
Correction: The Relative Safety of Ephedra Compared with Other Herbal Products
Jennifer Fisher Wilson
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