It has recently been shown that after an initial period of reduced muscle protein synthesis a longer phase of increased catabolism predominates.3 Our group has previously found increased IGF-1 mRNA in COPD-related muscle wasting,13 but other groups have found decreased IGF-1 mRNA in human and animal muscle in response to local infection and injury.32, 33 Our patients had been critically ill for a median of 20 days, while the studies mentioned examined shorter terms. The gene discussed is IGF1; the disease is chronic obstructive pulmonary disease.