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									               CMAJ                                                                           Highlights
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             Marijuana and chronic obstructive                                       National Pharmaceutical Strategy
             pulmonary disease
                                                                                     The need for a national strategy on pharmaceuticals is greater
                                             Smoking marijuana and to-               in 2009 than it was in 2004, say MacKinnon and Ip in their
                                             bacco concurrently may have a           evaluation of the limited progress made by the strategy. See
                                             synergistic effect on the de-           Commentary, page 801
                                             velopment of chronic obstruc-
                                             tive pulmonary disease, find
                                             Tan and colleagues in their             Orange palms
                                             cross-sectional, population-
                                             based study of 878 adults.              A 40-year-old woman
                                             However, smoking marijuana              presented to the emer-
                                             alone was not associated with           gency department with
                                             respiratory disease in their            orange discoloration of

                                             study. See Research, page 814           her palms of several
                                                Other studies suggest that           days’ duration. A dietary
                                             smoking marijuana probably              history helped to deter-
             leads to respiratory symptoms, says Tashkin. However, any               mine the cause. See Clin-
             association between smoking marijuana and declining lung                ical images, page 895
             function is unclear, he adds. See Commentary, page 797

                                                                                     Hereditary hemorrhagic telangiectasia
             Intensive insulin therapy in intensive
                                                                                     Recurrent epistaxis, multiple telangiectasias and visceral ar-
             care units                                                              teriovenous malformations are suggestive of hereditary hem-
                                                                                     orrhagic telangiectasia. Four related articles highlight the
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