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Articles 
Deborah A. Marshall, Adrian R. Levy, Humberto Vidaillet, Elisabeth Fenwick, April Slee, Gordon Blackhouse, H. Leon Greene, D. George Wyse, Graham Nichol, Bernie J. O'Brien and the AFFIRM and CORE Investigators* In the Atrial Fibrillation Follow-up Investigation of Rhythm Management randomized trial, a strategy of controlling the rate of atrial fibrillation was less costly than trying to achieve and maintain normal sinus rhythm. Since the 2 strategies led to similar clinical outcomes, rate control is the preferred initial management approach from an economic perspective.
Gabriel M. Leung, Anthony J. Hedley, Lai-Ming Ho, Patsy Chau, Irene O.L. Wong, Thuan Q. Thach, Azra C. Ghani, Christl A. Donnelly, Christophe Fraser, Steven Riley, Neil M. Ferguson, Roy M. Anderson, Thomas Tsang, Pak-Yin Leung, Vivian Wong, Jane C.K. Chan, Eva Tsui, Su-Vui Lo, and Tai-Hing Lam This analysis of 1755 cases from the Hong Kong epidemic of severe acute respiratory syndrome (SARS) found that most patients became infected in hospitals and residential buildings. The observed patterns suggest that SARS had low transmissibility, except in settings of intimate contact or environmental contamination.
G. Boudewijn C. Vasbinder, Patricia J. Nelemans, Alfons G.H. Kessels, Abraham A. Kroon, Jeffrey H. Maki, Tim Leiner, Frederik J.A. Beek, Michael B.J.M. Korst, Karin Flobbe, Michiel W. de Haan, Willem H. van Zwam, Cornelis T. Postma, M. G. Myriam Hunink, Peter W. de Leeuw, Jos M.A. van Engelshoven for the Renal Artery Diagnostic Imaging Study in Hypertension (RADISH) Study Group* Computed tomographic angiography and magnetic resonance angiography are not sufficiently reproducible or sensitive to rule out renal artery stenosis in hypertensive patients. Therefore, digital subtraction angiography is still the best diagnostic test for renal artery stenosis.
Improving Patient Care
Jane G. Zapka, Stephenie C. Lemon, Elaine Puleo, Barbara Estabrook, Roger Luckmann, and Stephen Erban A mailed educational video about colorectal cancer screening had no effect on the overall rate of screening in primary care practices. It modestly improved sigmoidoscopy screening rates.
Reviews
Victor C. Lee, David C. Rhew, Michelle Dylan, Enkhe Badamgarav, Glenn D. Braunstein, and Scott R. Weingarten Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers have similar efficacy for reducing all-cause mortality and rates of rehospitalization for heart failure in patients with chronic heart failure or high-risk acute myocardial infarction. Angiotensin-receptor blockers are suitable alternatives to ACE inhibitors.
Perspectives
Peter Zimetbaum and Mark E. Josephson The patients in randomized trials comparing rate control with antiarrhythmic therapy were highly selected and did not receive a uniform approach to rhythm control. Therefore, although the trials showed no advantage to achieving and maintaining sinus rhythm, this strategy remains appropriate in selected patients.
Medicine and Public Issues
Richard A. Cooper Is the United States headed for a physician shortage? This paper reviews the evidence that economic growth is associated with increased health care spending and demand for physicians. It also examines trends in clinical practice, signals from the medical market, and recent physician shortages in other countries and concludes that we do need to substantially increase our production of physicians.
In the Balance
Miriam J. Alter, Leonard B. Seeff, Bruce R. Bacon, David L. Thomas, Michael O. Rigsby, and Adrian M. Di Bisceglie The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for hepatitis C virus (HCV) infection in high-risk adults. We disagree with waiting several decades to measure the impact of detecting and treating HCV before symptoms appear. We advocate continuing to screen asymptomatic persons for risk factors; testing those at increased risk; and counseling, evaluating, and treating infected persons.
Ned Calonge and Gurvaneet Randhawa When the U.S. Preventive Services Task Force (USPSTF) finds insufficient evidence to determine the balance of benefits or harms of a preventive service, it assigns a letter grade of I (insufficient evidence). The USPSTF found insufficient evidence to recommend for or against screening for hepatitis C virus infection in high-risk individuals. This recommendation reflects the Task Force's judgment that we need adequate evidence before assessing the net health benefit of screening for this infection.
Editorials
Tristram D. Bahnson and Augustus O. Grant Two papers in this issue raise questions about managing atrial fibrillation: Does rhythm control have any role in treating patients similar to the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study sample? Is it useful in any other patients? Does being in normal sinus rhythm provide significant benefits? If so, why didn't the rhythm control group in AFFIRM have better outcomes? Finally, what is a reasonable approach to treating patients with atrial fibrillation?
Stephen C. Textor Vasbinder and colleagues' study of noninvasive tests for diagnosing renal artery stenosis reminds us that vascular imaging methods are fallible. While clinicians must know what they can reasonably expect from diagnostic imaging, it is even more important for them to decide whether the results of the imaging procedures would change their management of the patient.
Alan M. Garber and Harold C. Sox In this issue, Cooper argues that the United States will have 200 000 fewer physicians than needed in 2020. Demographic and economic trends could increase the demand for physician services, but his forecast contains too many uncertainties to serve as the basis for taking immediate action. Several factors can have as yet unforeseeable effects on the demand for physician services: a healthier aging population, changes in government policy, new technology, physician-induced demand for health care, and changes in the price of health care.
Christine Laine and Harold C. Sox In February 2002, the American Board of Internal Medicine Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine published the Charter on Medical Professionalism. With the intent of bringing the concepts of professionalism closer to the bedside and the office, Annals will publish a special series in collaboration with the American Board of Internal Medicine. The series will consist of 6 essays, each with an accompanying commentary, that illustrate how the principles contained in the Charter can illuminate the dilemmas of daily practice.
Charles K. Francis According to the Charter on Professionalism, 3 principles lie at the core of professionalism in medicine: primacy of patient welfare, patient autonomy, and social justice. In the poignant essay, "A Lesson from the Third Year," a medical student encounters each of these principles as he cares for an elderly Chinese immigrant.
On Being a Doctor
Eric Helms What a sad and lonely outcome: to be relegated to a state nursing facility where he could speak to no one and had limited understanding of the reason for his placement. I could picture it as a prison of both the mind and the body—and in our zeal to be doctors, we handed Mr. L that sentence.
Letters To Butterfly or To Needle: The Specimen Testing Question
Low-Carbohydrate Diets
Rosiglitazone for Treatment of HIV Lipodystrophy
Residents' Work Hours
Corticosteroids for Septic Shock
Peter C. Minneci, Katherine J. Deans, Steven M. Banks, Peter Q. Eichacker, and Charles Natanson Tadalafil in Primary Pulmonary Arterial Hypertension
Correction: Update in Gastroenterology and Hepatology
Correction: Screening for Chlamydia trachomatis in Women 15 to 29 Years of Age
Jerald Winakur
Harold C. Sox | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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