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Articles 
Ramachandran S. Vasan, Michael J. Pencina, Mark Cobain, Matthew S. Freiberg, and Ralph B. D'Agostino The authors estimated the short-term, long-term, and lifetime risks of 4117 Framingham participants becoming overweight or obese. People seldom progressed from normal weight to obesity in 4 years. In 4 years, the transition from overweight to obese occurred in 12% of men and 16% to 23% of women, depending on age. The 30-year risk for a body mass index of 35 kg/m2 or greater was 11% to 13%. The risk for a body mass index of 40 kg/m2 or greater was 2.5% to 5%.
Trip J. Meine, Manesh R. Patel, Venita DePuy, Lesley H. Curtis, Sunil V. Rao, Bernard J. Gersh, Kevin A. Schulman, and James G. Jollis People have speculated that patients who have an acute myocardial infarction in December have worse outcomes because evidence-based therapies are less available during the holiday season. The authors compared patients hospitalized with acute myocardial infarction in December and in other months. Patients hospitalized in December received evidence-based therapies at the same rate as in other months but had higher 30-day mortality rates (21.7% vs. 20.1%).
Brian Custer, Michael P. Busch, Anthony A. Marfin, and Lyle R. Petersen The authors assessed the cost-effectiveness of nucleic acid amplification testing of the U.S. blood supply for West Nile virus (WNV). They considered several strategies for testing minipool (pools of 6 to 16 donations) or individual donations. Cost-effectiveness was $483 000 per quality-adjusted life-year for year-long nationwide testing of minipools. Strategies involving individual donation testing were less cost-effective. Testing the U.S. blood supply for WNV is not cost-effective by current criteria.
Academia and Clinic
Bernard Lo and Mitchell H. Katz In public health emergencies, the needs of a population of affected people may compete with the needs of a physician's patient, which may change the physician's role as advocate for the patient. According to the authors, physicians can advocate for an individual patient by seeking exceptions to policies and by giving care to lessen the adverse consequences of public health measures.
Reviews
Hyon K. Choi, David B. Mount, and Anthony M. Reginato Researchers have recently made advances in defining the pathogenesis of gout, including elucidating its risk factors and tracing the molecular mechanisms of renal urate transport and crystal-induced inflammation. This article reviews recent advances in understanding the pathogenesis of gout.
Clinical Guidelines
Amir Qaseem, Mark Aronson, Nick Fitterman, Vincenza Snow, Kevin B. Weiss, Douglas K. Owens for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians* The purpose of this guideline is to teach internists and other primary care physicians to be aware of screening, case-finding, and genetic testing strategies for hereditary hemochromatosis. The target patient population is all persons who may develop hereditary hemochromatosis, including the relatives of individuals who already have the disease.
Brian Schmitt, Robert M. Golub, and Richard Green This background review supports the American College of Physicians' clinical practice guideline on screening for hereditary hemochromatosis.
Editorials
James P. AuBuchon The incredibly rapid adaptation of nucleic acid tests for West Nile virus (WNV), along with declining WNV incidence in many parts of the United States, has allowed blood banks and patients to breathe much easier. However, in this issue, Custer and colleagues provide a careful and circumspect cost-effectiveness analysis of WNV screening in blood banks. Their model shows that from a population perspective, WNV testing is very costly relative to its benefits, which affect relatively few people.
Gregory A. Poland Two recent studies have shown that vaccines designed to prevent herpes zoster (shingles) and pertussis are safe and effective. These vaccines expand the growing paradigm of active disease prevention in adults. The author discusses vaccination in this context and what clinicians can do to provide the best care to their patients.
Letters Fumbled Handoffs
L-Thyroxine plus Liothyronine in Hypothyroidism
C-Reactive Protein and Risk for Colorectal Cancer
The Diabetes Prevention Program and the Metabolic Syndrome
Modafinil for the Treatment of Fatigue in Primary Biliary Cirrhosis
Interaction between Simvastatin and L-Thyroxine
Correction: Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility
Kim A. Carmichael
John R. Middleton
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