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Chintan V. Dave, PharmD; Aaron S. Kesselheim, MD, JD, MPH; Erin R. Fox, PharmD; Peihua Qiu, PhD; Abraham Hartzema, PharmD, MSPH, PhD

Substantial price increases for specific generic drugs have received national attention recently. Some factors that may be responsible for these price increases include shortages in the manufacturing supply chain and reductions in the number of generic drug manufacturers. This study examined the relationship between market competition levels and changes in generic drug prices between 2008 and 2013 by using prescription claims data from commercial health plans.

Gene K. Ma, MD; Colleen M. Brensinger, MS; Qufei Wu, MS; James D. Lewis, MD, MSCE

Clostridium difficile infection (CDI), the most common health care–associated infection, differs from most other infections in that it often recurs after treatment. In this retrospective cohort study, the authors analyzed data on nearly 39 million commercially insured patients in the OptumInsight Clinformatics Database to evaluate whether incidence of multiply recurrent CDI (mrCDI) is increasing, to determine whether any such increase is proportional to the increase in CDI, and to identify risk factors for mrCDI among patients with an episode of CDI.

George D. Lundberg, MD

In July 2017, Annals of Internal Medicine celebrates 90 years of continuous publication. Recognizing the occasion, the editorialist provides reflections on the history and future of medical journals.

Sameer D. Saini, MD, MS; Akbar K. Waljee, MD, MSc

Ma and colleagues report a retrospective cohort study to address gaps in our knowledge about multiply recurrent Clostridium difficile infection (mrCDI). The editorialists discuss the findings, the limitations of the study, and why a better understanding of the epidemiology of mrCDI is a critical first step toward developing a sound strategy to address this growing public health challenge.

Darren B. Taichman, MD, PhD; Darilyn V. Moyer, MD; Christine Laine, MD, MPH

This issue includes 2 Annals Graphic Medicine pieces about the beginning of internship. This editorial discusses what residents face during this time.

Franklin J. Canady, BA

Venetta Masson, RN, MA

Brenda Butka, MD

Stanley Cohen, MD

Darren B. Taichman, MD, PhD

Judith Feinberg, MD; Susana Keeshin, MD

Michael Natter, MD

Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.

Jason Bitterman, MD

Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.

Jason L. Vassy, MD, MPH, SM; Kurt D. Christensen, PhD, MPH; Erica F. Schonman, MPH; Carrie L. Blout, MS, CGC; Jill O. Robinson, MA; Joel B. Krier, MD; Pamela M. Diamond, PhD; Matthew Lebo, PhD; Kalotina Machini, PhD; Danielle R. Azzariti, MS, CGC; Dmitry Dukhovny, MD, MPH; David W. Bates, MD, MSc; Calum A. MacRae, MD, PhD; Michael F. Murray, MD; Heidi L. Rehm, PhD; Amy L. McGuire, JD, PhD; Robert C. Green, MD, MPH; for the MedSeq Project

The clinical value of whole-genome sequencing (WGS) in asymptomatic adults is uncertain. This pilot trial describes the effects on care of adding WGS to standardized family history assessment in primary care. The researchers observed that adding WGS to standardized family history in this population revealed new molecular findings of uncertain clinical utility and prompted clinical actions of unclear value.

Derek K. Chu, MD, PhD; Christopher M. Hillis, MD, MSc; Darryl P. Leong, MBBS(Hons), MPH, MBiostat, PhD; Sonia S. Anand, MD, PhD; Deborah M. Siegal, MD, MSc

This systematic review examines current evidence about the benefits and risks of antiplatelet therapy for adults with essential thrombocythemia, a disorder associated with high risk for both thrombosis and hemorrhage.

Michalina Kołodziejczak, MD; Felicita Andreotti, MD, PhD; Mariusz Kowalewski, MD; Antonino Buffon, MD; Marco Matteo Ciccone, MD; Gianfranco Parati, MD; Pietro Scicchitano, MD; Julia M. Umińska, MD; Stefano De Servi, MD; Kevin P. Bliden, MBA; Jacek Kubica, MD, PhD; Alessandro Bortone, MD, PhD; Filippo Crea, MD; Paul Gurbel, MD; Eliano P. Navarese, MD, PhD

This meta-analysis of 11 trials compares implantable cardioverter-defibrillator therapy with conventional care for the primary prevention of death of various causes in adults with ischemic or nonischemic cardiomyopathy.

Chung-wah Cheng, MPH; Tai-xiang Wu, MPH; Hong-cai Shang, MD, PhD; You-ping Li, MPH; Douglas G. Altman, PhD; David Moher, PhD; Zhao-xiang Bian, MD, PhD; for the CONSORT-CHM Formulas 2017 Group

This article is the simplified Chinese version of the CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration.

Chung-wah Cheng, MPH; Tai-xiang Wu, MPH; Hong-cai Shang, MD, PhD; You-ping Li, MPH; Douglas G. Altman, PhD; David Moher, PhD; Zhao-xiang Bian, MD, PhD; for the CONSORT-CHM Formulas 2017 Group

This article is the traditional Chinese version of the CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration.

Chung-wah Cheng, MPH; Tai-xiang Wu, MPH; Hong-cai Shang, MD, PhD; You-ping Li, MPH; Douglas G. Altman, PhD; David Moher, PhD; Zhao-xiang Bian, MD, PhD; for the CONSORT-CHM Formulas 2017 Group

Chinese herbal medicine (CHM) formulas are the major components of traditional Chinese medicine (TCM) interventions. A group of TCM clinical experts, methodologists, epidemiologists, and editors has developed this CONSORT Extension for CHM Formulas (CONSORT-CHM Formulas 2017). The group hopes that the extension can improve the reporting quality of randomized trials of CHM formulas.

Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD

About 28 million Americans are currently uninsured and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for a national health insurance system that would cover every American. In 2002, an Institute of Medicine (IOM) review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality.

Joel S. Bennett, MD

Chu and colleagues report a systematic review to determine the benefits and risks of treating patients with essential thrombocythemia with antiplatelet agents. The editorialist discusses the uncertainty the review uncovers and the need for high-quality trials to definitively address this important clinical question.

Teri A. Manolio, MD, PhD

Vassy and colleagues report a pilot study of the effect of adding whole-genome sequencing (WGS) to a standardized family history assessment in primary care. The editorialist notes that the findings demonstrate that primary care physicians are capable of managing WGS findings, healthy patients tolerate this information well, and use and costs seem to increase. The unanswered question remains whether WGS will truly improve patient outcomes.

Klaus Linde, MD; Benno Brinkhaus, MD

This issue includes an extension of the CONSORT Statement that presents and explains recommendations for the better description of randomized trials of Chinese herbal medicine. The editorialists discuss the extension and how it will help to improve the quality, trustworthiness, and clinical relevance of trials of Chinese herbal therapies.

Robert B. Saper, MD, MPH; Chelsey Lemaster, MS, MPH; Anthony Delitto, PhD, PT; Karen J. Sherman, PhD, MPH; Patricia M. Herman, ND, PhD; Ekaterina Sadikova, MPH; Joel Stevans, PhD, DC; Julia E. Keosaian, MPH; Christian J. Cerrada, BS; Alexandra L. Femia, MS; Eric J. Roseen, DC; Paula Gardiner, MD, MPH; Katherine Gergen Barnett, MD; Carol Faulkner, BS; Janice Weinberg, ScD

Several clinical trials indicate that yoga is an effective treatment for chronic low back pain. It is uncertain how the efficacy of yoga compares to that of standard therapies for low back pain. In this trial, yoga was compared to a standardized program of physical therapy and education in a group of low income, racially diverse patients with chronic low back pain symptoms.

Douglas G. Chang, MD, PhD; Stefan G. Kertesz, MD, MSc

A randomized trial by Saper and colleagues examines whether yoga is noninferior to physical therapy for treating patients with low back pain. The editorialists discuss the findings and highlight the importance of recognizing both the varying pathophysiology of low back pain and the modesty of treatment benefits when studying the effectiveness of interventions.

Richard M. Bergenstal, MD; Robin L. Gal, MSPH; Crystal G. Connor, MS, MPH; Rose Gubitosi-Klug, MD, PhD; Davida Kruger, MSN, APRN-BC, BC-ADM; Beth A. Olson, BAN, RN, CDE; Steven M. Willi, MD; Grazia Aleppo, MD; Ruth S. Weinstock, MD, PhD; Jamie Wood, MD; Michael Rickels, MD, MS; Linda A. DiMeglio, MD, MPH; Kathleen E. Bethin, MD, PhD; Santica Marcovina, PhD; Andreana Tassopoulos, BS; Sooji Lee, MS, MSPH; Elaine Massaro, MS; Suzan Bzdick, RN, CCRC; Brian Ichihara, BA; Eileen Markmann, BSN; Paul McGuigan, BSN; Stephanie Woerner; Michelle Ecker, RD, CDN, CDE; Roy W. Beck, MD, PhD; for the T1D Exchange Racial Differences Study Group

Interpreting observed differences between hemoglobin A_1c values in black and white patients may have important implications for population health as well as the care of individual patients. This study used continuous glucose monitoring to assess whether higher hemoglobin A_1c levels among black patients reflects worse glycemic control or biological differences in the glycation of hemoglobin.

Brian J. Hemens, BScPhm, MSc, RPh; Alfonso Iorio, MD, PhD

Shekelle and colleagues describe important refinements to machine-learning software designed to reduce the need for human activity to identify relevant studies for a systematic review update. The editorialists discuss their findings and call on reviewers to evaluate these efficiency-boosting methods and reevaluate their approach to updating reviews.

Elizabeth Selvin, PhD, MPH; David B. Sacks, MBChB

Bergenstal and colleagues report a study that contributes to our understanding of racial differences in hemoglobin A_1c (HbA_1c). The editorialists discuss the findings, explain why they do not suggest limited utility of HbA_1c in blacks, and call for studies that enable better understanding of populations that may be prone to discordant HbA_1c and glucose measures.

Julia Wynn, MS; Wendy K. Chung, MD, PhD

In April 2017, the U.S. Food and Drug Administration authorized 23andMe's direct-to-consumer (DTC) genetic test. This commentary discusses its limited clinical utility and raises concerns that its approval creates a pathway that could lead to expansive DTC genetic testing of similarly low clinical utility that the public will misunderstand and misuse.

Jean P. Hall, PhD

High-risk pools are included as a state option in the American Health Care Act recently passed by the U.S. House of Representatives. These plans segregate persons with preexisting conditions from the broader insurance pool to a much smaller pool with others who have potentially high costs. This commentary discusses what we know about the past performance of high-risk pools and why reinstituting them would constitute a huge step backward for American health care policy.

Emily P. Hyle, MD, MSc; Sowmya R. Rao, PhD; Emily S. Jentes, PhD, MPH; Amy Parker Fiebelkorn, MSN, MPH; Stefan H.F. Hagmann, MD, MSc; Allison Taylor Walker, PhD, MPH; Rochelle P. Walensky, MD, MPH; Edward T. Ryan, MD; Regina C. LaRocque, MD, MPH

Measles outbreaks in the United States are mostly due to index infections occurring in returning U.S. travelers. In a study of more than 40 000 travelers presenting to U.S. pretravel clinics, the authors assessed why those eligible for measles vaccination were not offered it or, if it was offered, why they refused it.

J. Michael McWilliams, MD, PhD

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) aims to improve health care by rewarding clinicians providing higher-quality and lower-cost care who would receive increases in their Medicare reimbursement rates. Poorer performers would receive reductions in their rates. The author discusses how the design of MACRA will, however, result in unintended consequences and incentives that will increase health care disparities without reducing costs.

Lori K. Handy, MD, MSCE; Paul A. Offit, MD

In this issue, Hyle and colleagues report that only 47% of adults eligible for measles vaccine at a pretravel clinic visit were vaccinated. The editorialists note that efforts to increase measles immunization rates are focused mainly on young children and that the need to immunize unvaccinated travelers at risk for transmitting measles within the United States after international travel often is overlooked. They argue that vigilance is needed to ensure that travelers do not bring the virus back from overseas.