In her commentary this month, Dr Myerson equates the US healthcare system to a horse that is tied to the back of a cart, offering sharp criticism on the skewed priorities of health insurance companies and therefore the entire healthcare system.

While study after study continues to show how important it is for physicians to counsel their patients on prevention strategies, few doctors can take the time to do more than offer patient handouts from (one hopes) a reliable website. "Getting reimbursed for prevention services" is the culprit, according to Dr Myerson.

This is also likely the reason why so many hypertensive patients are not following the DASH diet (a lifestyle strategy that has been shown to reduce dependence on antihypertensives), as was reported at the annual meeting of the American Society of Hypertension. "Dietary counseling is not allowed for in the reimbursement structure," says Dr Mellen in this issue.

The irony of this state of affairs is highlighted by findings from a new study (N Engl J Med. 2007;357:370-379), which received wide coverage in the lay media, showing that the etiology of obesity is tied to one's social milieu, or "network," as much as to one's biology or behavioral pattern.

The authors found that obesity often occurs in clusters: having an obese friend, sibling, or spouse (but not a neighbor) increases the risk of becoming obese by as much as 57%. The authors suggest that this may offer a partial explanation to the spread of obesity.

And what "works" for obesity could also apply to the spread of diabetes (and probably heart disease and many other diseases). It is, therefore, not surprising that the incidence of diabetes is accelerating among young Americans, and not only type 1 but also type 2 as discussed in this issue.

In the sense that our health is to a large extent a byproduct of our lifestyle, geography, and culture, our diseases are also a byproduct of the times we live in—a simple idea, with far-reaching clinical implications.

This is a clear indictment of our lifestyle—the unhealthy nature of our eating habits (overprocessed food, excessive eating) and lack of physical exertion ("walking"?) are but 2 obvious examples. Physicians are well aware of the impact that lifestyle has on health and disease, but the same can't be said for the rest of the US population.

Perhaps the uncovering of the "boomerang effect" of our "social diseases" will be the wake-up call for medical schools and insurance companies to begin emphasizing the role of patient education in rooting out the social aspects of disease. If "keeping up with the Joneses" now has medical implications, the definition of infectious diseases may have to be expanded (back to our forefathers' individualism?).

Finally, the 2 articles on Medicare in this issue provide up-to-date information on NPI and PQRI, which will help expedite your claims (I wonder why acronyms have become so important to the care of older Americans?). And lots of new, practical information in this issue comes from a host of annual national meetings, discussing hypertension, diabetes, geriatrics, and digestive diseases, to name a few. We hope you find it all useful.

Dalia Buffery, Group Editor