Recent Posts


September 27th, 2015

Podcast 185: A Spirited Discussion on Medicare’s ‘Doc Fix’ Fix for Reimbursement

(2 votes, average: 3.00 out of 5)

A group of physicians, economists, and medical students gathered on Medstro to talk about Medicare’s solution to the decades-old “doc fix” problem — it’s how you get paid for caring for Medicare patients.

The chat was occasioned by an essay in the New England Journal of Medicine by Meredith Rosenthal, an economist and a close observer of Medicare policy and reimbursement in general. She joins the discussion and helps sort things out. You’ll want to listen, but we warn you: it’s contentious!

[Running time: 29 minutes]

NEJM essay (free)

September 22nd, 2015

Podcast 184: Ruling out pulmonary embolism in primary care

(3 votes, average: 3.33 out of 5)

Pulmonary embolism is a vexing problem in primary care: Does this patient have it? Can I send them home with reassurance? Should I refer them for further testing?

A Dutch group has evaluated the tests most likely to be available in the primary care setting — the various flavors of the Wells rules and the Geneva scores — against a panel of some 600 patients with suspected PE and known outcomes after referral and three months’ follow-up. They come down in favor of the Wells rule and simple D-dimer testing, but an editorialist in the BMJ offers a note of dissent.

Our interview with one of the study authors, Dr. Geert-Jan Geersing, sorts this all out.

[Running time: 13 minutes]

BMJ study (free)

BMJ editorial (subscription required)


August 21st, 2015

Podcast 183: An Obesity ‘Switch’ in the Genome Described

(6 votes, average: 4.33 out of 5)

There’s a kind of “wall switch” in the human genome that’s been newly described. It seems to be able to turn on and off genes controlling the efficiency with which we burn fat.

The study describing the finding in the New England Journal of Medicine reads like a genetic research tour-de-force, showing how the whole circuit is controlled by a single variation in a nucleotide sequence.

The study’s senior author, MIT’s Manolis Kellis, examines the switch and its implications.

[running time: 26 minutes]

NEJM study (free)

NEJM editorial (free)

Physician’s First Watch coverage

August 16th, 2015

Podcast 182: Dietary fat studies meta-analyzed — trans fat still a bad bet

(4 votes, average: 3.25 out of 5)

The BMJ’s meta-analysis of several large cohorts finds no association of saturated fat with all-cause and cardiovascular mortality or total coronary disease. Trans fat, on the other hand, increased risk in all those categories.

The first author on the paper, Dr. Russell de Sousza, isn’t ready to give a free pass to saturated fat, though. Listen in as he explains.

BMJ meta-analysis (free)

Physician’s First Watch coverage (free)

[Running time: 19 minutes]


August 7th, 2015

Podcast 181: Oral Contraceptives’ Role in Reducing Endometrial Cancers

(1 votes, average: 5.00 out of 5)

(Running time: 15 minutes)

A study in the Lancet Oncology gathered information from dozens of epidemiological studies to estimate that over 200,000 cases of endometrial cancer have been prevented in the past 10 years as a result of oral contraceptive use.

A commentary in the journal offers a remarkable look at weighing the benefits and harms of OCs. We talk with a co-author of that commentary, Dr. Nicolas Wentzensen of the National Cancer Institute.

Lancet Oncology study

Lancet Oncology comment

July 18th, 2015

Podcast 180: A sketch of community-acquired pneumonia

(5 votes, average: 4.00 out of 5)
How Webster defined it 90 years ago.

How Webster defined it 90 years ago.

The CDC’s Seema Jain is our guest, talking about a study she did with her team to characterize the causes of community-acquired pneumonia in U.S. adults. (They don’t mention finding Webster’s Micrococcus lanceolatus.) Medicine has come a long way since 1925, but Dr. Jain says that clinicians still need better diagnostic tools to pinpoint the causes of CAP in individual patients.

Using five hospitals in Chicago and Nashville, Jain’s team surveyed over 2000 adult patients admitted with radiographic evidence of CAP during a 30-month period. Also included is discussion of her February paper that sought to characterize CAP in children.

NEJM abstract of study in adults

NEJM abstract of study in children


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