Recent Posts

RSS

October 10th, 2019

Podcast 237: U.S. health spending — where is the outrage?

(3 votes, average: 3.67 out of 5)

Running time: 18 minutes

JAMA has just published an analysis of the latest findings regarding waste in the nation’s $3.5 trillion annual health “co-pay.” And with 25% of that — some eight hundred billion dollars — characterized as wasted, you’d think there would be stacks of competing cost-saving proposals to consider, especially regarding administrative costs. There aren’t.

An editorial comment on all this by our guest, Don Berwick, reminds us that one person’s wasteful spending is another’s lavish income. The question is, with all that money left on the table, what are we foregoing as a country?

Dr. Berwick has thoughts, and he kindly agreed to share them with us.

JAMA article by Shrank et al.

JAMA editorial by Berwick

 

October 4th, 2019

Podcast 236: Is an AI better at diagnosis?

(2 votes, average: 3.00 out of 5)

Running time: 20 min.

Recently, Lancet Digital Health ran a meta-analysis concluding — if cautiously — that “deep learning” (more familiarly known as artificial intelligence) can be considered “equivalent to healthcare professionals” in image-based diagnoses.

In an editorial commentary on the analysis, Tessa Cook says, in effect, “not so fast!” And she discusses the reasons behind that caution with us in this episode.

Dr. Cook’s commentary in Lancet Digital Health

The meta-analysis on which she was commenting

 

September 26th, 2019

Podcast 235: Forced sexual initiation and its clinical aftermath

(1 votes, average: 5.00 out of 5)

Running time: 18 min.

Laura Hawks and colleagues undertook a study of forced sexual initiation — that is, a woman’s first episode of vaginal intercourse (and it’s forced when it wasn’t voluntary on her part).

Using government survey data on some 13,000 women of reproductive age, Hawks compared the women whose sexual initiation was voluntary with those whose wasn’t. It turns out that there were longer-term medical consequences apparently associated with the circumstance. Listen in.

Links:

JAMA Internal Medicine article

JAMA Internal Medicine editorial

September 19th, 2019

Podcast 234: Pay for women pediatricians lags

(2 votes, average: 4.50 out of 5)

Running time: 21 minutes

A national sample of early- to midcareer pediatricians shows that women are lagging behind men in compensation, and another study from the sample shows that they’re not getting much help with the housework, either.

We talk with two of the authors of these studies and get their advice on what to do next — besides emptying the dishwasher and folding some laundry, gentlemen.

Links:

Pediatrics article on earnings

Pediatrics article on housework help

Pediatrics editorial on the two articles

September 11th, 2019

Podcast 233: Antipsychotics are no solution to delirium during hospitalization

(2 votes, average: 3.50 out of 5)

Using “Vitamin H” (haloperidol) or newer antipsychotics to treat delirium in hospitalized patients should be off the menu, writes Edward Marcantonio in an Annals of Internal Medicine editorial.

Dr. Marcantonio agrees with the authors of a systematic review who conclude that “current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.” In his commentary entitled “Old Habits Die Hard,” he writes “the findings presented are sufficient to stop this clinical practice.”

Links:

Annals of Internal Medicine editorial

Marcantonio’s “Clinical Practice” article in NEJM in 2017

September 6th, 2019

Podcast 232: Basic organic chem and drug pricing

(1 votes, average: 4.00 out of 5)

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.

Links:

Annals of Internal Medicine letter

NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of albuterol vs. levalbuterol

 

Clinical Conversations

About the Podcast

To subscribe:

Comments, suggestions, and story ideas welcome. Learn more about Clinical Conversations.