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A Trial of Darbepoetin Alfa to Reduce Cardiovascular Events
The use of darbepoetin alfa in patients with diabetes, chronic kidney disease, and moderate anemia did not reduce the risk of either of two primary composite outcomes (either death or a cardiovascular event or death or a renal event) and was associated with an increased risk of stroke.
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Published Online October 30, 2009 (DOI: 10.1056/NEJMoa0907845)
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Inflammatory Bowel Disease and Interleukin-10 Signaling
Genetic analyses showed that mutations affecting the interleukin-10 receptor are associated with early-onset colitis. Treatment of an affected child by means of allogeneic hematopoietic stem-cell transplantation was successful.
Published Online November 4, 2009 (DOI: 10.1056/NEJMoa0907206)
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Combined Immunodeficiency Associated with DOCK8 Mutations
This article describes 11 patients between 6 and 21 years of age who had recurrent sinopulmonary infections, extensive cutaneous viral infections, severe allergies, and elevated serum levels of IgE; some also had asthma, reactive airway disease, or susceptibility to cancer. All patients had loss-of-function mutations in the DOCK8 gene.
Published Online September 23, 2009 (DOI: 10.1056/NEJMoa0905506)
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A Novel Protective Prion Protein Variant and Kuru Exposure
Kuru, a neurodegenerative disease associated with endocannibalism, is the classic example of prion disease. In this report, investigation involving kuru-exposed survivors in Papua New Guinea shows that certain polymorphisms in PRNP codon 127 lead to genetic resistance to kuru.
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Inflammatory Bowel Disease
This review gives an account of recent advances in our knowledge of the intestinal immune system and how it becomes perturbed in Crohn’s disease and ulcerative colitis. The importance of genetic factors in these diseases is emphasized.
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A Man with Cough, Hoarseness, and Abnormalities on Chest Imaging
A 23-year-old man had cough, hoarseness, fever, and dyspnea on exertion. Imaging studies showed pulmonary and mediastinal masses and a lesion in the pelvis.
CME Exam
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Pancreatic Cancer and the Hedgehog
Pathway
Treatment of a mouse model of aggressive pancreatic cancer with an inhibitor of the hedgehog pathway enhanced tumor sensitivity to gemcitabine and resulted in the stabilization of disease.
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Health Care Reform — A Republican View
Senator Chuck Grassley (R-IA) argues that the health care reform proposals pending in Congress would make a bad situation worse: they would fail to lower the cost of health insurance premiums, reduce the deficit, or slow the growth of health care costs.
Free Full Text
 November 18, 2009 (DOI: 10.1056/NEJMp0911111)
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The Consequences of “No”
Dr. Arthur Kellermann and Lawrence Lewin predict the ramifications of a failure to pass health care reform, in terms of coverage, costs, access to care, and the health of the population.
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November 18, 2009 (DOI: 10.1056/NEJMp0910138)
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Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform
The Senate Finance Committee’s health care reform bill would mandate industry involvement in the oversight of comparative-effectiveness research. Drs. Harry Selker and Alastair Wood make a case for the independence of the scientific process.
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November 18, 2009 (DOI: 10.1056/NEJMp0910747)
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Lobbying, Campaign Contributions, and Health Care Reform
If current trends continue, the health sector is likely to spend more than a half billion dollars on lobbying of Congress and federal agencies in 2009. Dr. Robert Steinbrook reports on industry’s efforts to influence health care reform.
Free Full Text
 November 18, 2009 (DOI: 10.1056/NEJMp0910879)
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The Supreme Court, Process Patents, and Medical Innovation
Dr. Aaron Kesselheim explores the implications of a current Supreme Court case for future patents on medical processes for treating patients and engaging in research.
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November 18, 2009 (DOI: 10.1056/NEJMp0909658)
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Medicaid and National Health Care Reform
Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health care reform. Sara Rosenbaum examines Medicaid under the House and Senate health care reform proposals.
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Published Online October 14, 2009 (DOI: 10.1056/NEJMp0909449)
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Massachusetts Health Care Reform — Near-Universal Coverage at What Cost?
Under the microscope of the national health care reform debate, questions have been raised about the appropriateness of the Massachusetts model for the country as a whole, given the costs of the program. Joel Weissman and Dr. JudyAnn Bigby discuss the financing of the Massachusetts system.
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Published Online October 21, 2009 (DOI: 10.1056/NEJMp0909295)
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Mandatory Vaccination of Health Care Workers
Alexandra Stewart writes that mandatory vaccination of health care workers raises important questions about a state’s power to compel individuals to engage in particular activities in order to protect the public.
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Published Online November 4, 2009 (DOI: 10.1056/NEJMp0910151)
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Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans
Rapid antigen tests, as compared with RT-PCR assays, had poor sensitivity to the 2009 influenza A (H1N1) virus in 21 patients with severe infection and acute lung injury that required mechanical ventilation.
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November 18, 2009 (DOI: 10.1056/NEJMc0909049)
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A Crisis in Late Pregnancy
A 31-year-old woman in the 37th
week of pregnancy presents
with severe bitemporal headache
and shortness of breath…
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