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Articles 
Robert I. Berkowitz, Ken Fujioka, Stephen R. Daniels, Alison G. Hoppin, Stanford Owen, Arlette C. Perry, Melinda S. Sothern, Cheryl L. Renz, Mark A. Pirner, Julia K. Walch, Olga Jasinsky, Ann C. Hewkin, Vicky A. Blakesley for the Sibutramine Adolescent Study Group* The authors compared the effects of sibutramine and placebo in 498 obese adolescents who all received behavior therapy. The mean weight of participants was 215 lb. At the end of 1 year of treatment, participants receiving sibutramine had greater reductions in body mass index and body weight than did those who received placebo. The difference in change in weight was 18 lb.
Rob M. van Dam, Walter C. Willett, JoAnn E. Manson, and Frank B. Hu In 102 400 women from the Nurses' Health Study II, those with higher body mass indices at age 18 years had a greater risk for obesity during adulthood and for premature death. Differences in the adult body mass index of those who had been obese as adolescents only partly explained their increased rate of premature death.
Tien Yin Wong, Ronald Klein, Cong Sun, Paul Mitchell, David J. Couper, Hong Lai, Larry D. Hubbard, A. Richey Sharrett for the Atherosclerosis Risk in Communities Study The authors studied 10 405 persons 49 to 73 years of age who had no history of stroke or coronary heart disease. People with early-stage age-related macular degeneration had a higher cumulative incidence of stroke. Those who had a stroke had higher systolic blood pressure and more diabetes, cigarette smoking, and use of antihypertensive medications. Statistical adjustment for differences in these stroke risk factors did not substantially alter the association with macular degeneration, suggesting that it is a risk factor for stroke.
Improving Patient Care
Carol M. Mangione, Robert B. Gerzoff, David F. Williamson, W. Neil Steers, Eve A. Kerr, Arleen F. Brown, Beth E. Waitzfelder, David G. Marrero, R. Adams Dudley, Catherine Kim, William Herman, Theodore J. Thompson, Monika M. Safford, Joe V. Selby for the TRIAD Study Group* The authors studied the effects of disease management by physician groups. Using disease management strategies was associated with better diabetes care, but better diabetes care was not associated with improved intermediate outcomes, such as lower hemoglobin A1c level, or more intense efforts to correct unfavorable intermediate outcomes. The authors believe that disease management programs should give more feedback about intermediate outcomes and what physicians are doing to improve them.
Reviews
Kevin Douglas, Patrick G. O'Malley, and Jeffrey L. Jackson In 13 of 15 randomized studies involving 1384 patients, statins reduced albuminuria and proteinuria. Since these outcomes were not the primary goals of the 15 clinical trials, we need larger trials that focus on the effect of statins on these renal outcomes and on progression of chronic kidney disease.
Arshag D. Mooradian, Marla Bernbaum, and Stewart G. Albert The authors briefly review the pharmacologic characteristics of currently available insulin products and describe 3 common blood glucose profiles in patients with diabetes. They suggest an initial insulin regimen for each profile and show how to modify it according to the patient's response.
History of Medicine
Isaac Starr This article is a republication of an eyewitness account of the 1918 Spanish influenza pandemic. The author, Isaac Starr, cared for influenza victims as a medical student in Philadelphia. His article first appeared in Annals of Internal Medicine in 1976.
Medicine and Public Issues
John G. Bartlett In this paper, the author describes several important aspects of planning for pandemic influenza and appraises our prospects for preparedness. Getting from our present state of readiness to full preparedness will require an unprecedented effort.
Position Papers
American College of Physicians* The threat of an H5N1 influenza virus (avian flu) pandemic is substantial. The success of the current U.S. influenza pandemic response plan depends on effective coordination among state and local public health authorities and individual health care providers. This article summarizes a public policy paper developed by the American College of Physicians to address physician-related issues in the U.S. Department of Health and Human Services Pandemic Influenza Plan.
Editorials
William H. Dietz Effective weight loss strategies for overweight children and adolescents may reduce the risks for obesity-associated diseases or the premature death reported by van Dam and colleagues in this issue. As Berkowitz and colleagues demonstrated, weight loss requires substantial therapist time and drug costs. Preventing children and adolescents from becoming overweight may be a more cost-effective approach to weight control.
Marcello Tonelli In this issue, Douglas and colleagues report the results of a rigorous systematic review on the effect of statins on urinary protein excretion. The strength of their conclusions is limited by the relatively poor quality of the available studies. An ideal study would evaluate whether statins (as an add-on to conventional therapy) reduce time to doubling of serum creatinine level or end-stage renal disease, especially in a high-risk population with overt proteinuria. In the meantime, it is premature to recommend statin therapy solely to achieve renal benefit.
On Being a Doctor
Stephen W. Hwang "There's a new man here to see you," said Joyce, the nurse at the Toronto homeless shelter where I see patients once a week. "He just had his leg cut off. Says it hurts a lot."
Letters Appropriateness of Excluding Pulmonary Embolism
Imatinib Mesylate in the Treatment of Refractory Idiopathic Pulmonary Arterial Hypertension
A Rare Cause of Nonalcoholic Fatty Liver Disease
Sandra Ciesek, Johannes Hadem, Judith Fischer, Michael P. Manns, and Christian P. Strassburg Recurrent Iodide Mumps after Repeated Administration of Contrast Media
Correction: Which Antihypertensive Agents in Chronic Kidney Disease?
Correction: Brief Communication: Better Ways To Question Patients about Adverse Medical Events
George N. Braman
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