August 7th, 2015
Podcast 181: Oral Contraceptives’ Role in Reducing Endometrial Cancers
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(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.
July 18th, 2015
Podcast 180: A sketch of community-acquired pneumonia
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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
July 11th, 2015
Podcast 179: Pradaxa (dabigatran) reversal near?
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Running time: 20 minutes
The anticoagulant dabigatran, marketed in the U.S. as Pradaxa, has always had the problem that, although it’s more convenient to use, there’s no sure way to stop its effect if the patient has a major bleed.
Now, a monoclonal antibody fragment called idarucizumab (pronounced i-DARE-you-scis-ooh-mab) shows promise as a reversal agent. In an interim analysis of the first 90 of a planned 300 patients, the fragment was quite effective in stopping bleeds.
The analysis was published in the New England Journal of Medicine, and we talk with the paper’s first author, Charles V. Pollack, Jr.
July 4th, 2015
Podcast 178: Why Should Clinicians’ Complicity in CIA Torture Matter to You?
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Dr. Scott Allen of Physicians for Human Rights talks about the lessons evident in the complicity of clinicians — physicians, PAs, and psychologists at the very least — in the torture of prisoners.
His group published an analysis under the title “Doing Harm: Health professionals’ central role in the CIA torture program,” and that’s the focus of this discussion. Allen says that the lesson for all clinicians is to remember the importance of their professions’ commitments to patients, which were badly eroded in these episodes.
Running time: 20 minutes
June 22nd, 2015
Clinical Conversation 177: Can We Deliver NICEly?
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Neel Shah wrote a Perspective essay in the New England Journal of Medicine earlier this month on the U.K.’s NICE recommendation that encourages wider acceptance of home delivery and midwifery. The question is, could it work in the U.S.?
For the audio-oriented Clin Con audience we’ve adapted a video conversation that took place on Medstro (https://medstro.com/groups/nejm-group-open-forum/discussions/112). There, Dr. Shah and other clinicians discuss the problems U.S. obstetricians and U.S. mothers-to-be face. The Medstro forum is now finished, but the discussions back and forth over the course of its 10-day run are still available at the URL above.
Running time: 32 minutes
June 12th, 2015
Podcast 176: HPV Vaccine — How many doses are needed to confer protection?
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Running time: 19 minutes
We talk with Dr. Cosette Wheeler about a new Lancet Oncology paper that offers follow-up on two major trials of HPV-16/18 vaccines.
The analysis adds more data to the suspicion that although three doses of vaccine are optimal, two or even one may offer substantial protection. Wheeler is very cautious on this point, however, and insists that the goal must be to deliver three doses to every recipient. In the U.S., HPV vaccine courses are completed less than half the time.
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