Healthcare researchers and providers are coming to a crossroad on the issue of pharmaceuticals. On the one hand, newspaper articles (eg, Washington Post, January 29, 2003, Medicine redefines cancer: Many cancer patients are not cured but leading normal lives) are highlighting the often miraculous, life-prolonging benefits that newer medications offer. At the same time, the costs of these medications forced this physician last week to "borrow" medications for one of his patients who was diabetic and had lost his Medicaid or poverty insurance for his insulin or antihypertensive medication as the threshold for poverty had been lowered. In addition, many of the newer pharmaceuticals raise ethical questions that move beyond issues of allocation of scarce resources. Lastly, the just passed Medicare legislation provides "some" relief for the extraordinary cost of pharmaceuticals that the elderly are incurring.

This issue of the journal highlights the responses of European countries, particularly Italy, to the issues that the pharmaceutical agenda, as it pertains to ambulatory services, poses to health professionals and citizenry alike. Unlike their American counterparts, Europeans have acted on popular demand for access to pharmaceuticals for all citizens at a "reasonable price." How have they done that from both a political and economic perspective? What challenges are they facing as they seek to continue this overall policy? What are the cultural and social differences between our 2 broad societies (pace-I realize that Europeans are not all alike; parenthetically, the same goes for Americans) that can lead to a better understanding of policies that could be experimented on in the American setting?

We have an ambitious agenda on a topic that is constantly in the news-primarily in the form of the just passed Medicare "overhaul" bill. This issue of the journal aims, in a small way, to stimulate that debate.

The next 2 articles continue our series of articles on the development and use of health status measures in the VA population, a set of articles that will surely have reverberations throughout the healthcare industry.

Lastly and very importantly, we continue with our regular column from Physicians for Human Rights.