Highlights
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**Marijuana and chronic obstructive pulmonary disease** 

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/8/789/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/180/8/789/F1)

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Smoking marijuana and tobacco concurrently may have a synergistic effect on the development of chronic obstructive pulmonary disease, find Tan and colleagues in their cross-sectional, population-based study of 878 adults. However, smoking marijuana alone was not associated with respiratory disease in their study. **See Research, page** [814](http://www.cmaj.ca/lookup/volpage/180/814?iss=8)

Other studies suggest that smoking marijuana probably leads to respiratory symptoms, says Tashkin. However, any association between smoking marijuana and declining lung function is unclear, he adds. **See Commentary, page** [797](http://www.cmaj.ca/lookup/volpage/180/797?iss=8)

**Intensive insulin therapy in intensive care units** 

Intensive insulin therapy, compared with conventional glucose management, may not lower the risk of mortality for critically ill patients, but the risk of hypoglycemia is increased 6-fold. This is what Griesdale and colleagues found in their meta-analysis of 26 randomized trials. Their research also suggests that patients in surgical intensive care units may have a mortality benefit with intensive insulin therapy. **See Research, page** [821](http://www.cmaj.ca/lookup/volpage/180/821?iss=8)

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/8/789/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/180/8/789/F2)

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Patients in medical intensive care units have more chronic illness than those in surgical intensive care units and are less able to benefit from intensive insulin treatment, say Van den Berghe and colleagues. They also say that surgical intensive care units have more effective protocols for implementing intensive insulin therapy. **See Commentary, page** [799](http://www.cmaj.ca/lookup/volpage/180/799?iss=8)

**National Pharmaceutical Strategy** 

The need for a national strategy on pharmaceuticals is greater in 2009 than it was in 2004, say MacKinnon and Ip in their evaluation of the limited progress made by the strategy. **See Commentary, page** [801](http://www.cmaj.ca/lookup/volpage/180/801?iss=8)

**Orange palms** 

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/8/789/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/180/8/789/F3)

FIGURE. No caption available.

A 40-year-old woman presented to the emergency department with orange discoloration of her palms of several days’ duration. A dietary history helped to determine the cause. **See Clinical images, page** [895](http://www.cmaj.ca/lookup/volpage/180/895?iss=8)

**Hereditary hemorrhagic telangiectasia** 

Recurrent epistaxis, multiple telangiectasias and visceral arteriovenous malformations are suggestive of hereditary hemorrhagic telangiectasia. Four related articles highlight the challenges in diagnosing and managing this genetic disorder. **See Practice, page [833](http://www.cmaj.ca/lookup/volpage/180/833?iss=8), page [836](http://www.cmaj.ca/lookup/volpage/180/836?iss=8), page [838](http://www.cmaj.ca/lookup/volpage/180/838?iss=8), page [839](http://www.cmaj.ca/lookup/volpage/180/839?iss=8)**

**E-prescribing** 

United States President Barack Obama unveils a multibillion dollar electronic record-keeping initiative that includes incentives for paperless prescriptions. **See News, page** [806](http://www.cmaj.ca/lookup/volpage/180/806?iss=8)

**Weather-health management** 

A new online service offers a free, subscriber-based alert system that notifies users of weather patterns that might aggravate 5 medical conditions: arthritis, asthma, diabetes, heart disease and migraine. **See News, page** [809](http://www.cmaj.ca/lookup/volpage/180/809?iss=8)

![Figure4](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/8/789/F4.medium.gif)

[Figure4](http://www.cmaj.ca/content/180/8/789/F4)

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