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The New England Journal of Medicine Downloaded from nejm.org on May 16, 2022. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine Downloaded from nejm.org on May 16, 2022. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine Downloaded from nejm.org on May 16, 2022. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine Downloaded from nejm.org on May 16, 2022. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine Downloaded from nejm.org on May 16, 2022. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine Downloaded from nejm.org on May 16, 2022. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts Medical Society. All rights reserved.