Recent Posts


November 1st, 2015

Podcast 188: Should “deintensification” be a quality-of-care measure?

(1 votes, average: 5.00 out of 5)

The ACCORD trial found dangers in too-strict control of blood pressure and glucose in diabetes. Our guest has just published a study in JAMA Internal Medicine measuring the scope of the problem. Using Veterans Affairs data, his group found that “deintensification” of therapy after targets were met or exceeded was disappointingly rare.

JAMA Internal Medicine study (free abstract)

Physician’s First Watch summary (free)

October 25th, 2015

Podcast 187: Colorectal adenomas not prevented by calcium and/or vitamin D

(No Ratings Yet)

We interview John Baron about his recent New England Journal of Medicine study testing the ability of calcium or vitamin D (or both) to prevent recurrences of colorectal adenomas in a population who had lesions found during colonoscopy. On follow-up after three to five years, the effects of daily calcium and/or vitamin D supplements were the same as for placebo — that is, there was no significant reduction in risk.

The results were surprising, since the same author found a protective effect for calcium in a 1999 publication in NEJM. (In that study, vitamin D wasn’t tested.)


New England Journal of Medicine study (free abstract)

Physician’s First Watch coverage (free)

October 6th, 2015

Podcast 186: Stop supplementing calcium!

(9 votes, average: 3.22 out of 5)

Two analyses in the BMJ show little or no benefit from loading up older patients with calcium — indeed, the bad side effects of doing so (kidney stones and cardiovascular problems, to name two) outweigh the benefits.

Our conversation with Dr. Mark Bolland should offer reassurance to clinicians and their patients that a normal diet will provide enough of the stuff for good health.

BMJ studies (free)

Physician’s First Watch coverage (free)

[Running time: 18 minutes]

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

Clinical Conversations

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