Questioning Medicine

Donanemab doesn't work for alzheimers if you actually read the study. Mammograms should be done every other year and starting at age 50. Blue-blockers don't prevent eye strain on the computerand sleep varies but at this time the evidence doesnt suggest it causes obesityhttps://www.nejm.org/doi/full/10.1056/NEJMoa2100708new drug donanemab vs placebo = 257-patient double-blind randomised TRAILBLAZER-ALZ trial. the authors say “In patients with early Alzheimer’s disease, donanemab resulted in a better composite score for cognition and for the ability to perform activities of daily living than placebo at 76 weeks, although results for secondary outcomes were mixed. “ but lets review individuals with a Mini-Mental State Examination (MMSE) score of 20-28 were included in the study The primary outcome was the change in the Integrated Alzheimer’s Disease Rating Scale at 76 weeks. (iADRS; range, 0 to 144, with lower scores indicating greater cognitive and functional impairment) the change in the iADRS score at 76 wee

CirculationBariatric Surgery and Cardiovascular Outcomes in Patients With Obesity and Cardiovascular Disease: A Population-Based Retrospective Cohort StudyCirculation 2021 Apr 13;143(15)1468-1480, AG Doumouras, JA Wong, JM Paterson, Y Lee, B Sivapathasundaram, JE Tarride, L Thabane, D Hong, S Yusuf, M Anvari Patients with CVD who underwent bariatric surgery were matched 1:1 with similar CVD patients who did not undergo bariatric surgery. primary outcome was major adverse cardiovascular events (MACE) (first occurrence of all-cause mortality, myocardial infarction, coronary revascularization, cerebrovascular events, and heart failure hospitalization)n follow-up of 4.6 years, the primary outcome was lower in the surgery group compared with the control group occurred in 11.5% (151/1319) of the surgery group and 19.6% (259/1319) of the controls that is roughly a NNT of 12. But enough with the observational trials- do what we want to see or don’t do it. And while observation studies

Compression stocking to prevent cellulitis? NOT SO FAST! Vitamin D still doesn't work even for depression. Hip fractures are on teh decline and it is not because of drugs. A scribe cost money, but how much? What about doing an LP with anticoagulants, it is probably safer than you think. What do you do with kidney stones? Finally, there is a lot of medical waste, so stop ordering MRIs for low back pain! https://pubmed.ncbi.nlm.nih.gov/33058700/https://pubmed.ncbi.nlm.nih.gov/32989711/https://www.auajournals.org/doi/10.1097/JU.0000000000001318https://jamanetwork.com/journals/jama/fullarticle/2771609https://www.acpjournals.org/doi/10.7326/M20-0428https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768887https://jamanetwork.com/journals/jama/fullarticle/2768978https://www.nejm.org/doi/10.1056/NEJMoa1917197

1- make sure pts follow up on positive FIT test2. symptom severity — driven particularly by catching/locking and clicking/popping — correlated significantly with the burden of cartilage damage. CARTILAGE DAMAGE!!3. U.S. Food and Drug Administration announced it is allowing the use of the Binx Health Assay for point-of-care testing for Chlamydia trachomatis and Neisseria gonorrhoeae4. In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin5. ADHD- “results favored using methylphenidate in children and adolescents, and amphetamines in adults as first-line, short-term (12 weeks or under) treatment.”6. when it comes to PAD it is true what they say! no pain no gain- but maybe they should say no walking pain less loss and more walking pain much bigger gains in 6minute walking distanceThe Push for Timely Follow-up After Abnormal At-home Colon Cancer Screening Results | Cancer Screening, Prevention, Control | JAMA | JAMA Network The pandemic has brough on way mor

DOAC are just as safe if not safer for warfarin for valvular afib (NOT valve replacement but moderate to severe mitral stenosis). Please, just give normal lovenox for covid patients. Stop DM drugs in the elderly cause no-glycemia is more dangerous than hyperglycemia. semaglutide works as along as you keep taking it. gestational diabetes screening should be a two stop process. Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation: A Population-Based Cohort Study: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org) researchers did a New-user retrospective propensity score–matched cohort study matching roughly 28,000 new users of DOACs with new users of warfarin. During a median follow-up of roughly 130 days,primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of intracranial or gastrointestinal bleeding. the rate of stroke or systemic embolism was significantly lower

Uterine Fibroid and heavy bleeding might have a new drug if your normal drug was giving placebo. HPV Vaccine is still awesome and very very safe. Copper IUD has a new kid in town when it comes to emergency contraception and Colchicine should not be used for secondary prevention (at least not when I read the trial)HTTPS://WWW.NEJM.ORG/DOI/FULL/10.1056/NEJMOA2008283 Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy international, double-blind, 24-week, phase 3 trials involving women with fibroid-associated heavy menstrual bleeding.Participants were randomly assigned in a 1:1:1 ratio to receive once-daily placebo, relugolix combination therapy (40 mg of relugolix, 1 mg of estradiol, and 0.5 mg of norethindrone acetate), or delayed relugolix combination therapy (40 mg of relugolix monotherapy, followed by relugolix combination therapy, each for 12 weeks). The primary efficacy end point in each trial was the percentage of participants with a response (volume of menstrual blood loss <80 ml

Part 2 of the top articles of 20201) statins and the nocebo effect2) VA DOD Lipid guidelines- Don't check more than every 10 years!3) blood in the urine and what to do about it per the newest guidelines. 4) SGLT2i, FLOZINS!!! The data and how to use it in practice with really really sick patients

A two part podcast on the top published articles of 2020

SGLT2 inhibitors and GLP1 agonists administered without metformin compared to other glucose‐lowering drugs in patients with type 2 diabetes mellitus to prevent cardiovascular events: A systematic review - Escobar - 2021 - Diabetic Medicine - Wiley Online LibraryYes these fancy new drugs work with and without metformin but that does not mean these drugs should be first line!!Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA | JAMA NetworkYep even 200,000IU of vit D does nothing except raise your vit d level. Diet and acne: review of the evidence from 2009 to 2020 - Dall’Oglio - - International Journal of Dermatology - Wiley Online LibraryWhat you eat does mess with your acne, or at least says this large observational trial.Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials | The BMJThe muscle aches with statins is a common event

Semaglutide works for weight loss but at what co$t? BOARD CHANGER- New gonorrhea guidelinesDiabetes drugs are expensive for our patients and we can't forget that. Children find it hard to tell what facial expression you are giving when you have a mask on!https://www.nejm.org/doi/10.1056/NEJMoa2032183 industry-conducted trial published in the New England Journal of Medicine.Researchers randomized nearly 2000 participants without diabetes who were either overweight with at least one weight-related comorbidity or obese to receive All2.4 mg subcutaneous semaglutide or placebo weekly for 68 weeks. mean bmi 38. weighing at 105 lbs. Mean weight loss was significantly greater with semaglutide than placebo (15% vs. 2%), as was the percentage of patients losing >5% of body weight (86% vs. 32%). difference is 31lbs-- over 68weeks or 16 months.. the drug cost 734$ per month. that is 11,744 for treatment or 379 per pound. not worth it to me twitter and say shouldnt you have the conversation?!? BOARD CHANGER T

Also ask yourself, did this study compare their treatment to the 'gold standard' and if the answer is no they compared it to a straw man, then think big Pharma, or authors that needed publication for their job. We can't treat what we don't know exist and 30-50% of the time COVID19 is asymptomatic. Combined Oral Contraception DO NOT have an increase risk of DVT and long term the risk are very minimal if a DVT does develop while on COC. Speaking of studies that should have never been done- Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study) | Gut (bmj.com) Diagnostic Yield of Colon Capsule Endoscopy vs CT Colonography in a Screening Population | PracticeUpdate The authors of this multicenter, prospective, randomized study compared the diagnostic yield of colon capsule endoscopy (CCE) with that of CT colonography (CTC) for colon cancer screening in an average-risk adult population. First you had e

The Drug Addiction Treatment Act of Under the Act, physicians may apply for a waiver to prescribe buprenorphine for the treatment of opioid addiction or dependence outside of an opioid treatment program (OTP). The Drug Addiction Treatment Act of 2000 was authored by Senator Orrin Hatch (R-UT), Senator Joe Biden (D-DE), and Senator Carl Levin (D-MI). DATA 2000 waiver Why would biden reverse this—it was one of the things I think we all agree upon is a good thing!! I thought it must be the money – its always the money But I found a few reasons reasons why Confirmation bias--- Under the Act, physicians may apply for a waiver to prescribe buprenorphine for the treatment of opioid addiction or dependence outside of an opioid treatment program (OTP)Money== Biden received $6.3m from pharma, compared to $1.6m for Trump,Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383:2603-15. https://pubmed.ncbi.nlm.nih.gov/33301246 Randomized placebo-contro

Autoimmune mothers likely don't actually have more ADHD kids. If you patient is in the hospital we now have a RCT to answer the question about ACEI starting or stopping. Finally, there are problems around COVID we don't even know about and it has nothing to do with contracting COVID19.Association of Maternal Autoimmune Disease With Attention-Deficit/Hyperactivity Disorder in Children | Attention Deficit/Hyperactivity Disorders | JAMA Pediatrics | JAMA Network Doesn't say what the authors think that it says – or perhaps it does and that is the problem with most studies in pregnancy…. The authors conclusions were “In this cohort study, maternal autoimmune diseases were associated with increased ADHD among children.” Wiat autoimmune disorders in mom and boom big time risk of ADHD in children! Better brain has true celiac so this is something I am interested—it sparked my attention! population-based cohort analysis of 831,718 infants and mothers in the end the researchers matched almost 13,000 children whose mo

HHS Expands Access to Treatment for Opioid Use Disorder | HHS.govU.S. Department of Health and Human Services Announcement of practice guidelines for the administration of Buprenorphine for treating opioid use disordersJan 12- 20221 -physicians with a DEA license- only not all providers -you can only treat patients located in the state you have a medical license in (basically no tele) -Physicians utilizing this exemption will be limited to treating no more than 30 patients with buprenorphine for opioid use disorder at any one time (note: the 30 patient cap does not apply to hospital-based physicians, such as Emergency Department physicians). -ONLY buprenorphine- does not apply to methadone for the treatment of OUD. - Physicians utilizing this exemption shall place an "X" on the prescription and clearly identify that the prescription is being written for opioid use disorders

They say every dog has its day and IT think every drug has its place Anyone who says ‘that drug is bad’ or that test is bad or that anything is bad is just being closed minded or not aware of the evidence because evidence and medicine comes down to numbers.The real statement should be I don’t think that drug is beneficial enough for the harm. However that is an opinion statement, it is what you think and that is when shared decision making comes into play because maybe your patient does think it is beneficialNo more clearly see than in this viewpoint in Jama titled Balancing the Risks and Benefits of Benzodiazepineshttps://jamanetwork.com/journals/jama/fullarticle/2775180?guestAccessKey=fe7dd94f-653f-4da0-ad1f-21fb8c60e420&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=010821 Which talks about the risk and benefits of benzos. A drug that I often here so many providers dis on with no real evidence to back it up—how do I know there is no real

Dr sprouse-- Endo saying that Vit D below 30 leads to 2nd hyperparathyroidism due to calcium absorption deficiency and downstream consequences of that condition leads to poor bone health. He agreed all the other outcomes don’t have good evidence. I think 30 is the recommendation from the endo society. MY RESPONSE Well just to be clear they are right and they are wrong Yes it MAY, key word is MAY (it’s a not a universal truth), cause a secondary hyperparathyroid. HOWEVER, as I am sure you have already thought, this is a lab value. WE DON’T CARE ABOUT LAB VALUES, we care about patients. We treat patients, not lab values. So realistically who cares!?!?!? They will say well we care because it leads to broken bones and fractures!?!?! Then say really?? Based on what data because in this trial of almost 700 women who underwent BMD testing at baseline and 2 years later there was no difference between vitamin d and placebo https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3958 And they will say yes but th

NEW covid19 vaccine I am sure many of you have heard it is the first of its kind. It uses mRNA technology. I am not going to discuss what that means ebcasue so many people already have on other podcasts and publications but the question is should you get the vaccine. I have read many opinons on this from experts for exampleDr. Michal Elovitz, a preterm labor researcher and obstetrician at the University of Pennsylvania. Said its possible the mRNA and the bubble it travels in, made of lipid nanoparticles, could cross the placenta, and This might, in theory, cause inflammation in utero that could be harmful to the developing fetal brain” she went on to say, “It’s also possible the new vaccines could be totally safe in pregnancy, like the flu shot.” No pregnant patients were enrolled in the accessible trials, although some people got pregnant during the course of the study. Researchers are monitoring them to see how they do. We have not even tested this on pregnant animals—we have no idea if this is safe for pre

What you see is what you get- no more clearly seen then inThis paper titled Nutritional Analysis of Foods and Beverages Depicted in Top-Grossing US Movies, 1994-2018 In JAMA internal medicine which looked at the nutritional quality of foods and beverages depicted inthe 250 top-grossing US movies from 1994 to 2018these 250 movies sold 10 billion box office tickets and grossed $164 billion in theatersworldwide. These are popular movies we all watch or are aware ofand what they put on the screen as a societal “norm”in this study-Two trained researchers viewed movies in their entirety and listed allfoods and beverages depicted in each scene.they used the Nutrient Profile Index (NPI) to classify foods and beverages as healthy or notpenalizes components that should be limited likesugar, sodium, and saturated fat and rewards fiber, protein, and fruit and vegetableNow I understand this is not a one size fits all and the authors admit there is not portion controlon this so if the movie had a thimble full of high sugar

Get the best evidence because you want to know what they are looking at and occasionally people send me articles I was not aware of. Plus I ate spending my time sending them all the information then people say well ya but you are looking at the wrong evidence just right off the bat say “I will explain but tell me the evidence you are looking at”So he sent me 5 articles and I going to break them down in hopefully a rapid fire dissectionAnd before we get started there is a very important piece of information that we all need to be clear on, low vitamin d DOES not mean that replacing the vitamin d then fixes the problem. We knew for a while that high HDL seem to have a protective cardiovascular effect but when we looked at the data it didn’t appear raising the HDL with a drug called niacin had an effect on cardiovascular events. This is the ultimate association and correlation connection. Sure it appears more popsicles consumed are associated with higher rates of drowning but getting rid of popsicles will not ge

2020 Update to The Top Articles of 2019