To subscribe:
To have your comment included in a future podcast, call 617-440-4374. Please leave your name, number, and the podcast ID number.
(6 votes, average: 3.33 out of 5)Dr. Arnold Relman, longtime observer of the U.S. healthcare system and editor emeritus of the New England Journal of Medicine, proposes two major reforms: First, private insurance companies should leave the healthcare field, and second, physicians should organize into multispecialty practices.
His proposals, just published in BMJ, grow out of his alarmed observation — some 30 years ago in the NEJM — of the rise of the “new medical-industrial complex.”
Links:
BMJ essay (free abstract)
NEJM 1980 article (free abstract)
(9 votes, average: 3.11 out of 5)Heart failure brings problems associated with hypercoagulation, such as stroke and sudden death.
An international study followed some 2300 patients with heart failure (ejection fractions of 35% or less) and in stable sinus rhythm for a mean of 3.5 years, randomizing them to treatment with either warfarin or aspirin.
The two treatment groups showed about the same risks for stroke and overall mortality, but warfarin was associated with more major bleeding episodes.
Our guest is the first author on the report, released online by the New England Journal of Medicine.
Links:
(4 votes, average: 2.50 out of 5)
Type 2 diabetes in young people -- tough going on the treatment front [ 12:59 ] Play Now | Play in Popup | DownloadAbout half of adolescents with type 2 diabetes fail treatment with metformin alone within a few years. Things go somewhat better with metformin plus an intensive lifestyle intervention, and better still with the addition of rosiglitazone to metformin — however even the addition of the second drug leads to treatment failure about 40% of the time.
What’s to be done? On the basis of the evidence collected by the TODAY investigators, the problem has as many metabolic as social dimensions. Clearly, drugs alone are not the answer here.
Dr. Phil Zeitler, the TODAY study chair talks with Clinical Conversations about his surprise at the higher rate of failure with metformin monotherapy among adolescents than among adults, and what lessons this study holds.
Links:
Physician’s First Watch summary (free)
New England Journal of Medicine article (free)
New England Journal of Medicine editorial (free)
(2 votes, average: 3.00 out of 5)The American Heart Association’s scientific statement on “Periodontal Disease and Atherosclerotic Vascular Disease” is likely to raise hackles among those offering treatments for gum disease as a way to lower risk for heart disease — or even to ameliorate it. The association’s writing committee, after a 4-year review of the evidence, finds no support for such treatments and calls any assertions to the contrary “unwarranted.”
We interview the Dr. Peter Lockhart, co-chair of the AHA’s committee.
Links:
American Heart Association statement (free)
(2 votes, average: 1.00 out of 5)Influenza A (H3N2)v — a novel flu virus that emerged last summer and shows signs of being able to transmit itself from person to person — is our topic this week.
The virus carries genes from swine and avian flu viruses, and the few cases found in the U.S. all made complete recovery.
We talk with CDC epidemiologists involved in assessing the threat, and they’re reassuring on two fronts: first of all, most of the population shows at least some cross-reactive antibody to the virus; and second, they’ve isolated a candidate vaccine virus that they would use in the event that A (H3N2)v started showing increased ability for person-to-person transmission.
Links:
(5 votes, average: 4.00 out of 5)After stroke or transient ischemic attack, depression is more common than among the general population, and the risk for depression extends beyond the early time period after the event.
More alarmingly, less than a third of those with persistent depression — defined as depression detected both at 3 and 12 months after the cerebrovascular event — receive antidepressant medication.
We offer an interview with Dr. Nada El Husseini, first author of a study published online in Stroke that presents the data supporting those observations.
Link:
Stroke abstract (free)
Physician’s First Watch summary (free)
