Recent Posts


February 18th, 2016

Podcast 195: Pioglitazone for secondary prevention?

(3 votes, average: 4.00 out of 5)

Pioglitazone, long known to increase insulin sensitivity, has been “mostly relegated to use in unusual conditions such as lipodystrophies” after its drug class, the thiazolidinediones, “fell from grace” in the words of our guest.

Dr. Clay Semenkovich has just written an editorial comment on a study in the New England Journal of Medicine. That study showed a benefit from pioglitazone use in the secondary prevention of vascular events among patients with insulin resistance (but not diabetes) who’d had a recent ischemic stroke or TIA.

He discusses the implications of those findings and, given the drug’s side effects, cautions against a rush to prescribing pioglitazone without first discussing the trade-offs with patients.

NEJM editorial (free)

NEJM study (free)

Physician’s First Watch coverage (free)

February 3rd, 2016

Podcast 194: Rising middle-age mortality rates are worrying

(3 votes, average: 3.00 out of 5)

Ever since Anne Case and Angus Deaton published a paper in the Proceedings of the National Academy of Sciences last November there has been a spate of commentary over their major finding: mortality rates among middle-aged whites in the U.S. are rising while everyone else’s are improving.

The Commonwealth Fund has just published an “issue brief” on the topic, and we’ve got the authors — senior researcher David Squires and Fund president David Blumenthal — to talk things over with us.

Commonwealth Fund issue brief (free)

PNAS study (free)

December 20th, 2015

Podcast 193: Glioma survival lengthened

(2 votes, average: 2.50 out of 5)

We usually don’t venture into oncology here, but the approach taken to glioma treatment in a JAMA paper — maintenance therapy with chemotherapy plus alternating electrical fields delivered transdermally via transducers — seems worth reporting to all clinicians. It prolonged patients’ lives significantly, which, according to an editorialist, hasn’t occurred in this disease in at least a decade.

The first-author of the manufacturer-sponsored research, Dr. Roger Stupp, explains the approach and the implications it holds for patients with this rapidly progressing tumor.

Physician’s First Watch coverage (free)

JAMA paper (free)

JAMA editorial (subscription required)

December 10th, 2015

Podcast 192: Are we too sweet on HbA1c testing?

(3 votes, average: 2.33 out of 5)

Over half the patients with Type 2 diabetes have their HbA1c measured too frequently — i.e., at least three times a year. Why is that a bad thing? Dr. Rozalina McCoy, the lead author of a paper in The BMJ explains.

Using claims data, her group followed over 30,000 patients with stable HbA1c levels and found that only 40% had measurements taken within guideline-suggested limits — twice a year.



November 21st, 2015

Podcast 191: The prostate screening conundrum

(2 votes, average: 3.00 out of 5)

[Running time: 13 minutes]

The 2008 and 2012 recommendations from the USPSTF regarding PSA-based prostate screening have been accompanied by drops in both the screening and detection rates of prostate cancer, two studies in JAMA find.

Our guest, Dr. David Penson, wrote an editorial accompanying those studies. It attempts to put these new findings into perspective and to help the patients and physicians caught in the middle of a continuing debate on the wisdom of screening.

Physician’s First Watch coverage of the JAMA studies and editorial (free)

November 19th, 2015

Podcast 190: Last line of antibiotic defense breached

(5 votes, average: 4.20 out of 5)

The Lancet Infectious Diseases has just published a worrying account from China about a dangerous antibiotic resistance factor carried on plasmids. The factor, called MCR-1, confers resistance to colistin — a last line of defense against multi-resistant Gram-negative bacilli.

The co-author of a helpful commentary in that journal, Dr. David L. Paterson of the University of Queensland in Brisbane, is our guest.

Lancet Infectious Diseases article (free abstract)

Lancet Infectious Diseases commentary (free abstract)

Physician’s First Watch coverage (free)

Clinical Conversations

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