Letter from the Editor

This month's issue includes articles on new approaches to pain management, use of penicillin, conference coverage from CHEST 2016, and more

While scientific advances continually drive medicine forward, there is the occasional roundabout. This issue focuses on a couple of those. Our cover story looks at how inpatient pain treatment has pulled back from opiate prescribing in response to the current epidemic of addiction. The article gathers advice from experts and guidelines on how to effectively manage inpatients' pain with nonopiate medications and nonpharmaceutical therapies. Of course, some patients will still require opioids, and thus, the experts also explain how to minimize the risks of addiction when prescribing these drugs.

Our feature story focuses on the prescribing of penicillin and how it might be time for this very old drug class to make a comeback. Allergies to penicillin are less of a concern for individuals' health than previously thought, and resistance to other antibiotics is an increasingly big concern for public health, the story reports. Because so many patients outgrow their allergies, it might be worth trying to prescribe penicillin more often, and the experts explain how to do so safely. Safety is also a concern for hospitals dealing with states' legalization of medical marijuana. Our feature story describes different approaches that facilities have taken.

I heard the perspectives of many critical care experts when I attended CHEST 2016 in Los Angeles last fall, and I've tried to summarize an array of them in this issue's conference coverage. There was a lot of debate about sepsis diagnosis and treatment. But amid the uncertainty, there were many positive reports of improvements in sepsis care, including this month's Success Story. That successful sepsis intervention helped rural patients, who are also often the recipients of air medical transport. Another session at the meeting explained the intricacies of these transport systems and why it's important for physicians to understand them. coverage

For a little fun this month, we asked Robert Wachter, MD, FACP, to review a lecture he gave in 2007 predicting what hospital medicine would be like in the far-off year 2017. See what he got right and wrong, and then email us your own predictions (or any other thoughts).

Stacey Butterfield