This placebo-controlled study compared the effect of amiodarone and an implantable cardioverter–defibrillator (ICD) on mortality in patients with New York Heart Association class II or III congestive heart failure (CHF). Amiodarone had no benefit overall and slightly increased mortality among patients with class III CHF. ICD therapy reduced mortality overall, but the benefit appeared to be restricted to patients with class II CHF. These important results will broaden the use of ICD therapy.

In this randomized trial in patients who had ulcer bleeding while taking aspirin for prevention of vascular disease, clopidogrel was associated with a much higher rate of recurrent bleeding than the combination of aspirin and a proton-pump inhibitor (8.6 percent vs. 0.7 percent).

Clopidogrel therapy alone is not a safe alternative to aspirin for patients who have a history of ulcer bleeding while taking aspirin.

The adverse effects of excess alcohol intake on cognitive function are well established, but the effect of moderate alcohol consumption is uncertain. This study assessed cognitive function in relation to alcohol intake among women in the Nurses' Health Study who were 70 to 81 years of age and then reassessed it two years later.

The data suggest that up to one drink per day does not impair cognitive function and may actually decrease cognitive decline.

This study of bone marrow specimens from patients with acute myelogenous leukemia (AML) found that nucleophosmin (NPM), a nuclear protein, was displaced into the cytoplasm in about 60 percent of patients with a normal karyotype. These patients had a mutated NPM gene. Their disease may constitute a distinct subtype of AML.

One of the functions of NPM is to stabilize p53 in the nucleus when DNA is damaged. Sequestration of mutant NPM in the cytoplasm could nullify its influence on p53, a principal protector of DNA against damage.

Dr. William H. Frist is the majority leader of the U.S. Senate and a cardiac-transplantation surgeon. He is the fifth cardiac surgeon and the first U.S. senator to deliver the Shattuck Lecture, the 114th in this series. Dr. Frist outlines his vision for the U.S. health care system in the year 2015.

A 39-year-old woman who had recently emigrated from Greece had multiple episodes of headache, neck pain, photophobia, and fever over a three-month period. The cerebrospinal fluid contained predominantly lymphocytes and monocytes. The results of a tuberculin skin test and antibody titers for brucella were positive. All cultures and viral tests were negative. Peripheral-blood monocytosis with rare immature myeloid cells developed. The differential diagnosis and management are discussed.

In 1992, the passage of the Food and Drug Administration (FDA) Prescription Drug User Fee Act and, in 1997, the FDA Modernization Act resulted in an 85 percent increase in the number of employees at the FDA and in more efficient processes for the approval of drugs. In this article, the author identifies the remaining challenges facing the FDA. She contends that the FDA should improve its post-marketing surveillance, facilitate communication of information about the risks of drugs and devices, and contribute to efforts to control the cost of drugs.