Questioning Medicine

There was a paper to start the year that got a lot of hype saying that just maybe we should target an LDL but that is not what the study actually showed and I will tell you why I think it is wrong.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757311?widget=personalizedcontent&previousarticle=2757307 Prior authorization requirements increased from 8% to approximately 24% of covered drugs on Medicare Part D plans between 2007 and 2019. Solutions-First, focus prior authorization on its intended purpose. Health plans should eliminate prior authorization requirements for medications that have very low final denial rates… this should only be for people that are outliersprotect continuity of patient care. For patients who are stable with chronic treatment, insurers should offer protections to minimize disruptions and inefficiencies—get a drug forever shouldn’t need to go off the drug or switch insurance than try a new drug on their formulary when you have already failed it on the other insuranceThird, promote transparency, efficiency, and fairness. Technology exists to enable prescribers to view the formulary status, prior authorization requirements, and cost sharing for medications

https://annals.org/aim/fullarticle/2760034/disclosure-form-work-submitted-medical-journals-proposal-from-international-committee. disclose everything for the papers that you keep..or writePatient comprehension of common orthopedic terminology Cosic F, Kimmel L, Edwards E. Heal Lit Res Pract. 2019;3(3):e187-e193. patients don't understand all that we sayhttps://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32700one article is good to go for HPV (maybe)https://jamanetwork.com/journals/jama/fullarticle/2759002sunscreen gets into the blood but so whatand uptodate says use Tamiflu past 48hrs but look at the study and what do we find???https://www.ncbi.nlm.nih.gov/pubmed/31839279clinical trials regisitery told it allhttps://www.clinicaltrialsregister.eu/ctr-search/trial/2014-004471-23/results

Try not to read these all at once!!https://www.ncbi.nlm.nih.gov/pubmed/30715088 https://www.bmj.com/content/365/bmj.l2006 https://www.ncbi.nlm.nih.gov/pubmed/30359476 https://www.ncbi.nlm.nih.gov/pubmed/30964526 https://www.ncbi.nlm.nih.gov/pubmed/30415629 https://www.ncbi.nlm.nih.gov/pubmed/31454046https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723523 https://ginasthma.org/ https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Guidelines/2019/2019-Afib-Guidelines-Made-Simple-Tool.pdf https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext https://www.ncbi.nlm.nih.gov/pubmed/30782340 https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1 https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxishttps://journals.lww.com/greenjournal/Fulltext/2019/10000/Over

No summary YET! I promise it is coming, but here are a few more articles I think were pretty impressive from 2019.

It is that time of year again-- Top articles of 2019 part 1. This is my opinion, but I think it is a pretty good opinion.

https://jamanetwork.com/journals/jama/fullarticle/2751726 uspstf now grade B for asymptomatic urine in preggohttps://pediatrics.aappublications.org/content/144/6/e20192739kids do shoot their eye out!https://www.nejm.org/doi/full/10.1056/NEJMoa1908142Metoprolol does not treat COPDhttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754809?guestAccessKey=d3ef4800-287b-43aa-9d58-fd3c1e8359c2&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=111819HIV and social media!! 

https://www.nejm.org/doi/full/10.1056/NEJMoa1806515-- IVC filter after a severe injury = it is ok to wait 7 dayshttps://www.nejm.org/doi/full/10.1056/NEJMoa1904143antithrombotic therapy with afib after a pci and 1 year == just the DOAChttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31791-X/fulltextpolypill for primary prevention just might work but likely need more researchhttps://www.bmj.com/content/366/bmj.l4570the more you exercise the more you live-- seems like a basic concept and it is easy to understand but sadly hard to follow for manyhttps://www.ncbi.nlm.nih.gov/pubmed/31189511dulaglutide can save non-fatal strokes and for just 20million dollars you can help the industry make a killing in this very flawed study

https://www.ncbi.nlm.nih.gov/pubmed/31550435 mono and athletes -- stick with 21 dayshttps://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.32738 Hair Dye does not cause breast cancerhttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753986?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110619mailing the HPV kit is better because it increases screening rates

https://jamanetwork.com/journals/jama/article-abstract/2753909?guestAccessKey=03d877eb-6d48-476f-9487-aa6fbbd8a8d5&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=103019https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753986?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110619  mailing hpv gets more people screened! Shocking!https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32135-X/fulltext?rss%3Dyes patiromer might work but 70% of people don't need it cause they don't get hyperkalemia! https://www.acc.org/latest-in-cardiology/journal-scans/2019/09/04/14/45/sleep-duration-and-myocardial-infarction sleep 6-9 hours-- its good for your heart! https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30366-9/fulltext sertraline does not work for depression but it works for anxiety-- likely best to just hold off on the meds for most PCP depressionhttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2753318 cutting medications makes people happy https://annals.org/aim/article-abstract/2751453/blood-culture-results-before-after-antimicrobial-administration-patients-severe-manifestati

https://insights.ovid.com/crossref?an=00006396-900000000-98602https://jamanetwork.com/journals/jama/article-abstract/2751887?guestAccessKey=8fa2f772-1ba4-40ff-9015-4fcb46d6829e&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=091819https://www.ncbi.nlm.nih.gov/pubmed/14604741https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749268?widget=personalizedcontent&previousarticle=0https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749265https://www.jwatch.org/na44775/2017/08/10/nonsteroidal-anti-inflammatory-drugs-back-pain-andhttps://www.ncbi.nlm.nih.gov/pubmed/28153830

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2748452    -- come one come all unless you are a kidney https://www.ncbi.nlm.nih.gov/pubmed/31054907   SURPRISE!! Women prefer to do self swab rather than clinician swabhttps://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-c-screening1  If the pt. is breathing then you test for Hep Chttps://jamanetwork.com/journals/jama/article-abstract/2748796  high dose vit d. might be harmfulhttps://www.nejm.org/doi/full/10.1056/NEJMoa1811744 Canagliflozin is here and so are the SGLT2 inhibitors--IMPRESSIVE

https://www.ncbi.nlm.nih.gov/pubmed/30347032  Terbinafine adverse effects are rarehttps://www.ncbi.nlm.nih.gov/pubmed/31189511 Dulaglutide prevents MACE but at a high price taghttps://www.ncbi.nlm.nih.gov/pubmed/30853124   If you punch your buddy then get some buddy tapehttps://www.ncbi.nlm.nih.gov/pubmed/31076416 prediabetes gibes me a headache  https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Access-to-Hormonal-Contraception    Over the counter birthcontrol!! 

Let's look at the numbers behind CAC! The best evidence is found here https://jamanetwork.com/journals/jama/fullarticle/2687224 but the largest study is found here https://www.sciencedirect.com/science/article/pii/S0735109715072253?via%3Dihub but in the end they use this https://en.wikipedia.org/wiki/Net_reclassification_improvement which might trick many people but I know it won't trick the smart people that listen to questioning medicine

https://www.ncbi.nlm.nih.gov/pubmed/30874755 - ACC/AHA and ESC are still not evidence basedhttp://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.939.1670&rep=rep1&type=pdf -- only need to check every ten years-- it is the other risk factors that matter!https://www.ncbi.nlm.nih.gov/pubmed/26680162 Signal to noise is around 1 in 10 yrs

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2739056 not all guidelines are equal, think for yourself. Some guidelines even do harm when you actually look at the evidence. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740207 doacs and surgery what do you do-- low risk surgery stop one day prior and start one day after surgery. with high risk surgery you stop two days prior and start two days after https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871?guestAccessKey=90abe76b-3a15-4b95-9b42-4f751c5fbe64&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=etoc&utm_term=081919 Pt in the hospital for a non-cardiac condition and they have a high bp== don't worry about it- no evidence for what one week of high bp will do but we do have evidence that starting medications while in an acute state will cause harm. just let it be!!https://ginasthma.org/wp-content/uploads/20

https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 even when we dont know where the stroke is coming from- aspirin is still king all these years later https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30840-2/fulltext Aspirin is such a king that is doesn't matter if you have a spontaneous brain bleed or intracerebral hemorrhage it does appear safe to restart aspirin after a 2-3 month breakhttps://jamanetwork.com/journals/jama/article-abstract/2736564 smart-choice trial looked 3 months compared to 12 months of DAPT and https://jamanetwork.com/journals/jama/article-abstract/2736563 STOPDAPT-2 trial looked at 1 months followed by monotherapy clopidogrel compaed to 12 months of DAPT and BOOM 1 month is winner winner chicken dinnerhttps://www.ncbi.nlm.nih.gov/pubmed/31063082 all of medicine has variation- some pcp will give an antibiotic for otitis media. some will not. Some radiologist will say follow up is needed and some will nothttps://ginasthma.org/pocket-guide-for-asthma-management

https://www.cdc.gov/mmwr/volumes/68/wr/mm6825a2.htm we are not testing people for HIV even though guidelines https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1 since 2006 have recommended that everyone be tested! 13yrs later!! Time to do it!!https://www.ncbi.nlm.nih.gov/pubmed/30658933 The self swab is as good if not better than provider or clinician testing- it is time to educate the population and move to at home cancer screening- save the office visits for important things- like what to do in the 7% of women that are hpv positive. https://www.fda.gov/drugs/medication-health-fraud/public-notification-big-penis-contains-hidden-drug-ingredient?utm_campaign=CDER%20New%2007%2F17%2F2019&utm_medium=email&utm_source=Eloqua&elqTrackId=6371f8c053574a478fea3a734e8041ed&elq=1631be58825d49e3803c4b92a2cb8553&elqaid=8776&elqat=1&elqCampaignId=7246 Big Penis is a drug that has the drug Viagra in it- over t

https://www.ncbi.nlm.nih.gov/pubmed/30608562 A1C level low is not good and high is not good cause both seem to wind up have you the pt. in the hospital for hypoglycemia- the low point of the U curve is around 7-8% which ironically seems to fit perfectly with recent guidelineshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735985 pts don't take the medications and if they have hypertension at least in this candania study 1/3 were magically curred of their hypertension one they were monitoredhttps://www.ncbi.nlm.nih.gov/pubmed/31147311 PPI are still a drug with real side effects and should not be given out like candy but if your patient needs them they lets make no mistake about it they do work really really well http://cancerpreventionresearch.aacrjournals.org/content/12/5/305 smoking puts you at 2-3 times risk of bladder cancer-- peeing blood is not for me so I choose not to smoke https://www.ncbi.nlm.nih.gov/pubmed/31112386 no more PRN albuterol -- instead when you want to write fo