June 26th, 2012
Podcast 157: Of parking lots, low back pain, the Yankees, writing, and — oh yes — clinical medicine
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A chat with clinician-essayist Cameron Page, whose essay “They Paved Paradise and Put Up a Parking Lot” appears in this month’s Health Affairs.
Our conversation explores the connections in medicine that link outside the clinic walls, with stops along the way at William Carlos Williams, Richard Seltzer, the Yankees, and more.
We get around to low back pain, eventually. Join us for a summer kick-off conversation
Health Affairs essay (free)
May 20th, 2012
Podcast 156: Using low-dose CT screening for lung cancer in defined populations — a conversation with Peter Bach
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Dr. Peter Bach is the first author on a new JAMA analysis of the benefits and harms of using low-dose CT screening for lung cancer. The American College of Chest Physicians and the American Society of Clinical Oncology requested the systematic review to assist them in drawing up a clinical guideline.
Join us in discussing who might most benefit from being offered such screening, and what work remains to be done.
Links:
JAMA article (free)
Physician’s First Watch coverage of recent guidelines from the American Lung Assoc. (free)
May 14th, 2012
Podcast 155: What’s wrong with U.S. healthcare and what will save it?
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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)
May 2nd, 2012
Podcast 154: Treating heart failure’s hypercoagulable state — warfarin or aspirin?
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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:
April 30th, 2012
Podcast 153: Type 2 diabetes in young people — tough going on the treatment front
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About 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)
April 18th, 2012
Podcast 152: Gum disease and atherosclerosis — evidence for an association, but not for a cause-and-effect
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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.
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