Rank #1: Podcast 240: Overuse of statins for primary prevention of cardiovascular events
Running time: 23 minutes
Paula Byrne set out to understand what the available data tell us about how many people are taking statins for primary prevention — and how much good is it likely doing them?
Also, how do you discuss their possible harms and benefits with patients?
Nov 01 2019
Rank #2: Podcast 223: What are the implications of the BP guidelines?
If adopted, last December’s ACC/AHA guidelines on what pressure levels signal hypertension would label almost two thirds of the U.S. population between ages 45 and 75 as having the condition. The number of people who would be candidates for treatment would almost double — from 8 million to about 15 million.
What are the implications of this for clinicians?
Harlan Krumholz, senior author of an analysis in The BMJ, talks about the problems and the opportunities for collaboration with patients.
Aug 14 2018
Rank #3: Podcast 221: Pertussis makes a comeback — kids have an outsize role
What’s causing this resurgence, and what’s to be done? Pejman Rohani talks about his Science Translational Medicine study that used “gold standard” historical data to examine possible causes.
He and his colleagues conclude that, as with mumps, slowly waning vaccine protection is at play. However, they identify the “core transmission group” as schoolchildren, who have a greater frequency of contacts. Adults, they find, have “at most a minor role.”
Apr 10 2018
Rank #4: Podcast 222: Growing prominence of NPs in primary care
This time we talk with Dr. Hilary Barnes, first author of a Health Affairs paper: “Rural and Nonrural Primary Care Physician Practices Increasingly Rely on Nurse Practitioners.”
I thought listeners might want to know more about the dramatic change in the way primary care is acquiring, in Barnes’s words, an “increasing interdisciplinary character.”
Jul 20 2018
Rank #5: Podcast 242: Tranexamic acid saves lives after traumatic bleeds
Tranexamic acid, which frustrates clot dissolution, has been shown to reduce death from intracranial bleeding in a large international placebo-controlled trial — “CRASH-3.”
Ali Raja and Joe Elia host a lively chat with Ian Roberts, the co-chair of the trial’s writing committee, who, in addition to chastising the hosts’ seeming fascination with P-values, recounts a story from early in his training that first stirred his devotion to preventing bleeding-related death after trauma.
Ian Roberts explains CRASH-3 on YouTube to collaborators in Malaysia
Running time: 23 minutes
Nov 15 2019
Rank #6: Podcast 239: Talking with veterans
Running Time: 18 minutes
Veterans Day will be here soon, and this episode introduces you to Patrick Tripp, a writer and radiation oncologist. He’s taken conversations with some of his patients and published thumbnail profiles of several in a remarkable essay in the London Review of Books (that’s right, it’s not a medical journal).
The patients all happened to be veterans of the war in Vietnam. There are no biomedical insights here — or are there? At the very least, you are reminded that the people in the exam room all have stories to tell, and if you have the luxury of listening to them you may just learn more about their true chief complaint.
Oct 25 2019
Rank #7: Podcast 241: Talking about guns with patients
Running time: 18 minutes
In California, Garen Wintemute and his group find evidence that people are willing to discuss gun safety with their clinicians, especially when there may be danger of harm present. That willingness extends across gun owners and non-owners. So why aren’t more clinicians doing it?
The findings appear in Health Affairs.
Links to the article & further resources:
Nov 07 2019
Rank #8: Podcast 232: Basic organic chem and drug pricing
You surely remember “O-chem” — those late-night undergraduate hours spent grappling with benzene rings and alkanes and all the rest. Well, it turns out that drug makers were paying close attention to things like racemic mixtures and enantiomers. The manufacturers usually release their products as racemic mixtures and then, when patents are about to expire, an enantiomer appears. Voila! New drug, new price!
Dr. Joseph Ross and his crew looked at the implications to Medicare spending of all this. They published an interesting letter in the Annals of Internal Medicine detailing how much money the system could save if we stuck with the racemic mixtures. How much? Well, on the order of $15 billion over 5 to 6 years.
Sep 06 2019
Rank #9: Podcast 229: Simplifying perioperative anticoagulation in AF
Patients with atrial fibrillation who undergo surgical procedures need special attention because their anticoagulant medications, if not adjusted, increase their risk for bleeding. Those on direct-acting oral anticoagulants — or “DOACs” — face special problems because assays for the amount of drug on-board before surgery are not routinely available.
Dr. James Douketis and international colleagues have a simpler approach in their PAUSE study. On the basis of the known pharmacokinetics of DOACs, they dispense with coagulation testing and heparin bridging. Their approach involves assessing the likelihood of the procedure to cause bleeding. For low-risk procedures, DOACs are suspended a day before and resumed a day after; for riskier procedures, like resections, it’s two days before and two after.
The drugs under study were apixaban, dabigatran, and rivaroxaban.
We discuss the PAUSE results with Dr. Douketis.
Aug 16 2019
Rank #10: Podcast 228: Hematuria — should the workup include imaging?
Matthew Nielsen and colleagues found almost 80 diagnostic algorithms for working up a finding of hematuria. From these, they chose five representative approaches, ranging from those based on the patients’ risk factors to more aggressive ones that stress CT imaging for all.
Using a 100,000-patient simulated cohort, Nielsen’s group found that more intensive imaging found more cancers than the other approaches. However, radiation-induced cancers from CT wiped out that advantage.
Join us as Dr. Nielsen walks through his findings and their clinical implications. The work appeared in JAMA Internal Medicine.
Aug 08 2019