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Articles 
Bradley S. Quon, Rafael Firszt, and Mark J. Eisenberg The authors compared retail prices at Canadian Internet pharmacies and major U.S. chain pharmacies that provide prices on their Web sites. Of 44 brand-name medications examined, 40 were less expensive in Canada. By purchasing from Canadian Internet pharmacies rather than from U.S. major drug store chains, consumers would save an average of 35%.
Lydia Abásolo, Margarita Blanco, Javier Bachiller, Gloria Candelas, Paz Collado, Cristina Lajas, Marcelino Revenga, Patricia Ricci, Pablo Lázaro, Maria Dolores Aguilar, Emilio Vargas, Benjamín Fernández-Gutiérrez, César Hernández-García, Loreto Carmona, and Juan A. Jover The authors evaluated the potential cost-effectiveness of a population-based clinical program offered to patients with recent onset of work disability in Madrid, Spain. The intervention and control groups had similar numbers of disability episodes, but patients in the intervention group had shorter episodes, received less long-term disability compensation, and had lower direct and indirect costs.
Richard A. Hansen, Gerald Gartlehner, Kathleen N. Lohr, Bradley N. Gaynes, and Timothy S. Carey The authors systematically evaluated studies of the efficacy, effectiveness, and tolerability of commonly prescribed second-generation antidepressants for major depressive disorder. Second-generation antidepressants probably do not differ substantially, and current evidence is not helpful in deciding which agent is most appropriate for a given patient.
Improving Patient Care
Joshua Chodosh, Sally C. Morton, Walter Mojica, Margaret Maglione, Marika J. Suttorp, Lara Hilton, Shannon Rhodes, and Paul Shekelle The authors examined studies of the effectiveness of self-management programs for osteoarthritis, hypertension, and diabetes mellitus. Self-management programs appear to produce clinically important benefits for patients with hypertension and diabetes, but the evidence is not sufficient to identify the program elements that are most responsible for improved outcomes.
Reviews
Grazia Arpino, Rodolfo Laucirica, and Richard M. Elledge This review describes the types of premalignant breast lesions. It describes their likelihood of becoming invasive cancer and the molecular events of progression to invasive cancer. It also outlines the evidence about how to manage these lesions.
Medicine and Public Issues
Jennifer L. Wolff and Chad Boult Chronic disease is common in Medicare beneficiaries, yet Medicare's benefit structure and reimbursement mechanisms do not encourage high-quality chronic disease care. This paper describes state-of-the-art innovations in such care, discusses how the Centers for Medicare & Medicaid Services is trying to improve chronic disease care through changes in benefit structure and provider reimbursement, and suggests opportunities to accelerate progress.
Editorials
David M. Lawrence The care of patients with chronic disease is one of the most urgent medical challenges facing the United States. Although the articles by Chodosh and colleagues and Wolff and Boult are useful, studies of one intervention divert attention from underlying issues. The bigger picture combines health care providers and their interactions, support staff, care pathways, diagnostic and therapeutic technologies, information and communications infrastructure, clinical decision-making systems, and real-time evaluation and learning loops, all applied over the lifetime of a chronic illness. A silver bullet won't cure what ails us.
John G. Bartlett and Frederick G. Hayden Influenza experts have been predicting a pandemic flu for many years. What they fear most is an epidemic like the Spanish flu of 1918 to 1919—the largest outbreak of fatal infectious disease during the past century. Avian influenza (influenza A [H5N1]) appears to have the potential to cause a worldwide pandemic. So how real is this risk?
On Being a Doctor
Mansoina Baweja Lauren was 26 years old when she received the diagnosis of advanced, aggressive lymphoma. She started chemotherapy at my institution when I was a first-year hematology–oncology fellow. Basically cheerful, she remained upbeat. She had an 8-month-old son, and she was in and out of the hospital all the time. In all those admissions, I never heard her complain about anything. Many days when I was overwhelmed with the fellowship and my 3-year-old, I would think of her and feel lucky.
Letters Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin Alone
Leukopenia and Thrombocytopenia Caused by Thiazolidinediones
New Onset of Myelofibrosis in Association with Pulmonary Arterial Hypertension
Uday Popat, Adaani Frost, Enli Liu, Romelia May, Remzi Bag, Vishnu Reddy, and Josef T. Prchal Improving the Introductions of Manuscripts
Correction: Meta-Analysis: Surgical Treatment of Obesity
Jennifer Fisher Wilson
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