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Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets.
Professionals in virtually every industry have been buzzing about Chat-GPT ever since it debuted in November of last year. The AI-powered chatbot can generate all kinds of text from stories and poems to computer code. It uses language models to produce text that mimics the style of human beings. And now doctors are using it to answer routine clinical questions.
Three recent events tell us that US healthcare is doomed. First, health care premiums have risen to new heights. Second, Medicare has agreed to pay for GRAIL cancer screening as part of coverage with evidence development and third, many doctors protested Cigna’s denial of coverage for a double lung transplant for stage IV lung cancer, leading the insurer to agree to cover it.
The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.
Vinay started with this: Professor Frank Harrell responded As has often been the case, hyperbole limits the value of some of your opinions Vinay. To say that the FDA is a rubber stamp is ludicrous. Sure there are shortcomings as with any organization but sponsors know they can't get approval without a heck of a lot of work. I don’t know. The laxity of the FDA has lately surprised me—especially for devices.
Years ago, I was late to a dinner party at a new, trendy downtown restaurant. I had been working as an attending on the bone marrow transplant service, and the day got away from me. I had to take care of a patient who had a serious adverse reaction when she received her stem cell infusion. Another patient was suffering from a catastrophic fungal infection, and graft versus host disease threatened the life of a third.
I want to begin this post by saying: I wish the nothing but the best to the patient, Carol, who has a diagnosis of lung cancer. I hope that our medicines are able to give her a long and rich life, and that a new discovery can eliminate this disease. This is a post about her doctors at Vanderbilt. I also want to say that I am confident insurers can behave poorly, peer to peer is an insult, and prior auth is a broken system, but medicine has to be careful not to offer unproven and costly things to
I want to begin this post by saying: I wish the nothing but the best to the patient, Carol, who has a diagnosis of lung cancer. I hope that our medicines are able to give her a long and rich life, and that a new discovery can eliminate this disease. This is a post about her doctors at Vanderbilt. I also want to say that I am confident insurers can behave poorly, peer to peer is an insult, and prior auth is a broken system, but medicine has to be careful not to offer unproven and costly things to
California’s mask mandate for all healthcare settings came to end on Monday. Patients and staff are no longer required to wear face masks in hospitals and long-term care facilities, but it is still highly recommended. Nurses say the move puts their health at risk at a time when some 139,991 Americans are getting infected with COVID-19 every week. Members of the California Nurses Association recently voiced their opposition to the move, which they say puts their health at risk. “We know tha
A nurse has finally been laid to rest after her remains were found in the trash in Huber Heights, Ohio. Shianne Richardson and her wife were dumpster diving in the neighborhood when they happened upon an urn filled with the nurse’s cremated remains. Both women knew they had to give this woman the final sendoff she deserved. “We sometimes stop at dumpsters because a lot of places throw away food,” Richardson explained.
For someone like me who only knew Matthew Perry from occasional glimpses of Friends during my “lost decade” of medical training, I was surprised by the attention paid to his death. After reading a few articles, however, I realized the impact that his disease, and his writing and speaking about it, had. Stefan Kertesz is Professor of Medicine at the Heersink School of Medicine at the University of Alabama at Birmingham where his work includes leading VA and non-VA supported research f
I started it all by claiming on Twitter that the FDA was a rubber stamp. From boosters for 6 month old babies (no data), to postpartum depression drugs that are basically Xanax , to bad cancer drug approvals, in my mind, the FDA is failing the American people. In a recent post, John Mandrola reviewed 5 cardiology devices approved by the FDA with questionable data.
Let’s do a thought experiment about the tricuspid valve. The TCV controls blood flow from the right atrium to the right ventricle. Background : A common TCV problem occurs when the leaflets don’t close properly during systole and there is too much regurgitation of blood back to the right atrium. We call this TR or tricuspid regurgitation.
Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. The reason for less bleeding is that patients with proper occlusion can often be taken off anticoagulant drugs. These are nice ideas.
Investigators from Leipzig Germany called the trial ECLS-SHOCK. It studied the use of extracorporeal life support in patients with cardiogenic shock due to acute myocardial infarction. ECLS-SHOCK delivered shocking results. First some background. Cardiogenic shock is medical jargon to describe the really bad situation when the heart cannot deliver enough blood to the body.
A few months ago, a sensational letter came out in JAMA Pediatrics. The authors took California school children out of the classroom, and had them line up in the school yard. Then a dog sniffed them to see if they had COVID19. Students were told not to look backwards at the dog, but inevitably some students must have snuck a peak. The dog sat down next to suspected COVID19 kids, indicating they might have COVID19 (towards their peers).
A few years ago, Dr. Richard T. Bosshardt waded into a minefield. He had been a Fellow of the American College of Surgeons (ACS) for over thirty years when he expressed his opinion that the ACS’s diversity, equity, and inclusion initiatives were threatening their dedication to excellence. Dr. Bosshardt has garnered support for his objections and has published his opinions in The Wall Street Journal, City Journal, and National Review.
I received a text message from a colleague last night during dinner that a trial we were part of, called OCEANIC AF , was being terminated early by the data safety monitoring board. This morning, the makers of asundexian had a press release up on its site. This is huge news in cardiology. But it is also worthy of a column here because we at Sensible Medicine are interested in how new therapies are tested.
When I look back on these reflections, it is surprising to me how much I’ve written about death. I am not a palliative care physician or even a geriatrician. Even though my practice is made up of about 750, overwhelmingly older people, mostly with chronic medical conditions, I only attend to the death of a patient a few times a month. Let’s contrast that to the thirty or so cases of hypertension I manage each week.
My father was an avid reader of obituaries. Once, when I was a teenager, I told him that his habit of reading them every morning with his cappuccino was weird. At the time, I considered anything I didn’t understand weird, and the word “morbid” wasn’t part of my lexicon. My father, never one to take the bait from his occasionally irksome son, explained that reading obituaries was an excellent way to learn recent history.
Over the last week, a debate has simmered between the pages of my Substack , Sensible Medicine, and the Sensible Medicine podcast, which you can watch here. Sensible Medicine Mandrola and Prasad are back Listen now 4 days ago · 60 likes · 18 comments · Vinay Prasad and John Mandrola Briefly put the argument is: Yes, of course, medicine would benefit from more large, well done randomized studies, and better epidemiologic evidence, but this is expensive, costly, requires coordinatio
Black Americans continue to suffer from health inequalities that can reduce their quality of life. They face higher rates of illness and death due to conditions that can be prevented through regular screenings and checkups compared to White people. Black people are also more likely to experience discrimination or face barriers when accessing healthcare services.
Student nurses need to complete at least 400 hours of clinical training before they can take the National Council Licensure Exam, but more states are allowing students to practice their skills in simulated labs instead of on real patients. A new bill in New York State would allow nursing students to substitute up to 30% of their clinical training with “high-quality simulation education.
Here is an odd take on a Friday Reflection but hey, it’s the holidays, and I have been on vacation. A few pithy images (if images can be pithy). It is a bit of a reprise from last year but with a bunch of new ones. For those who read from the email, you might not be able to see them all — just view them on the Substack site. Sensible Medicine is a reader-supported publication.
Angel McCullough is the director of nursing at Thomas Jefferson University Hospital in Philadelphia, but she recently got a new assignment. Every Tuesday, she visits around a dozen elementary schools in the city to give a lesson on nursing and basic human medicine. It’s part of a new program called the “Mini Nurse Academy,” which is designed to get young students interested in nursing.
The iconic pit bull isn’t exactly America’s favorite breed of dog. In fact, it’s one of the most reviled. Pit bulls are known to bite humans more than other breeds, which makes it difficult for them to find a home. These dogs deserve to live a happy, healthy life just like any other animal, but they need to be sheltered in a way that reduces their threat to the public.
This one hits at the heart of my field—the ablation of atrial fibrillation. Current thinking holds that the way to ablate AF is to electrically isolate the muscle bundles going in and out of the pulmonary veins. Think of it as building an electric fence around the pulmonary veins. We use different energy sources to ablate the tissue. This is a picture I made in 2012.
When the primary investigator showed the main results slide of the SELECT trial here at the American Heart Association meeting, there was applause. I am not sure how I feel about clinicians clapping for positive results, but the fact remains that the SELECT trial is a big deal. In SELECT, the injectable glucagon-like peptide 1 (GLP-1) agonist semaglutide was studied against placebo in more than 17,000 obese or overweight patients who had atherosclerotic disease.
You had two choices in the lottery for senior science class. Mr. Flexner taught science in the old way. As a reductionist, he had his students learn basic physiology as that would explain human disease. If you did the work, which was hard, you got a good grade. Mrs. Onderdonk focused on the mechanics of science. Her students actually did science. They thought about questions; designed experiments to answer these questions, and assessed the results.
I’ve been hearing a lot about intermittent fasting as an approach to weight loss lately. This comes from physicians, patients, and celebrities. I never pay attention to this kind of chatter because, as I have written , I think weight loss advice (outside of GLP-1s and bariatric surgery) arises from a data free zone. However, I’ve realized that intermittent fasting serves as a good example from which to discuss the complexities of actually practicing medicine according to evidence-bas
PW is a 35-year-old man with chronic, primary insomnia. During our first visit, we discussed sleep hygiene and planned a trial of sleep-restriction therapy. At our second visit, we discussed pharmacologic therapy, and I started a medication. During our third visit we adjusted the medical regimen. About a month after that visit, PW left a message on my voicemail.
Some one million nurses with active RN licenses are not working due to unsafe working conditions, according to National Nurses United, the largest nursing union in the country. Nurses have been organizing to get federal lawmakers to pass a bill that would set minimum nurse-patient ratios for every department in every hospital in the country. The bill, known as The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, was authored by Sen.
Shariya Small wasn’t ready to be a single mom when she gave birth to triplets earlier this year. The 14-year-old resented having to wake up at all hours of the night to change diapers and feed her babies. It was all a little too much for a teenager to handle. All three of her children were born prematurely at 26 weeks, which only complicated the situation.
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