August 3rd, 2011
Podcast 127: Why QALYs matter
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This time we talk with Dr. Katia Noyes, first author on a study of the cost-effectiveness of disease-modifying drugs in multiple sclerosis. If you don’t treat MS, don’t think that the topic is irrelevant. Noyes brings the issues of cost-effectiveness and the dreaded QALY into focus for clinicians who see patients.
After all, medical costs will undoubtedly become centerpieces of political debate over the next year and beyond. We’d all be better off being able to evaluate the arguments made.
July 16th, 2011
Podcast 126: Placebos and Medical ‘Meaning’
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Last week’s New England Journal of Medicine paper on the placebo effect in evaluating asthma treatments was fascinating in itself. The editorial that accompanied it, however, was a delight. It asks clinicians to think less about laboratory measures of cure, and more about the patient’s satisfaction with treatment — whether the treatment was “real” or not.
This week’s guest, Dr. Daniel Moerman, wrote that editorial. His training in anthropology adds a refreshing viewpoint to his observations on clinical medicine. Let us know what you think by leaving a comment.
Relevant links:
- Physician’s First Watch coverage of the NEJM paper
- Two acupuncture papers mentioned by Moerman in his interview (and cited in his editorial):
July 8th, 2011
Podcast 125: The smoking-cessation drug varenicline poses some difficult tradeoffs.
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There is a new meta-analysis from the Canadian Medical Association Journal that finds increased risks among smokers trying to quit and taking varenicline (Chantix). Among smokers with stable cardiovascular disease, the number needed to treat to cause an adverse cardiovascular event is about 30, yet the number needed to treat to achieve smoking cessation is 10.
Our guest, Dr. Sonal Singh, is the first author of this meta-analysis. As you’ll hear, he has strong feelings about his team’s findings.
Related links:
CMAJ paper (free)
CMAJ commentary (sorry, but it’s not free)
June 25th, 2011
Podcast 124: Getting more accuracy into blood pressure measurements
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Patients’ systolic pressures vary by about 10%, regardless of whether they are measured at home or under the duress of a visit to the doctor. That variation is troubling when deciding whether to put a patient on an antihypertensive regimen: how reliable are the measurements that will form the basis of your decision? How do you get the data you need to really make an informed decision?
This edition of Clinical Conversations is all about those questions. It’s with the first author of a June 23 Annals of Internal Medicine paper that reports a striking variation, not only among measurements made with highly calibrated machines, but also between measurements made in the clinic, at home, or — most carefully — in research settings.
We hope you’ll enjoy listening in and that you’ll leave some comments with us.
Related link:
June 3rd, 2011
Podcast 123: Calcium’s benefits seem to peak out at about 800 mg daily
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On the basis of evidence from a Swedish cohort, calcium intakes much above that country’s recommended 800 mg daily don’t have added protective value against fracture and osteoporosis.
The authors of this BMJ paper suggest we’d be better off making sure those at the low end of the calcium-intake spectrum get their 800 mg, rather than trying to overinsure “protection” with too much of the stuff.
We have an interview with first-author Eva Warensjö.
Links:
- BMJ article (free)
- Physician’s First Watch coverage (free)
May 19th, 2011
Podcast 122: Most newer antiepileptics apparently safer in early pregnancy — but not all.
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A paper from Denmark looks at five newer-generation antiepileptics and finds no strong birth-defects signal associated with their use in the first trimester. However, as the senior author points out in a statement to Clinical Conversations, one of the drugs — topiramate — has only recently been cited by the FDA as carrying a risk for cleft lip and palate, and the JAMA study did not look specifically for that complication.
Dr. Danielle Scheurer and Joe Elia talk about the study and read the author’s statement, sent via email (the authors — epidemiologists — respectfully declined an interview regarding clinical matters).
Links:
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