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Why can’t the U.S. control prescription drug pricing as they do in the U.K., where per-capita spending is less than half our level? In a capitalist democracy, many parties — the drug companies, medical associations, consumer groups — get to lobby their points of view. Is the problem intractable, or just an exercise in chaos? Our three guests have written a book about the problem, “The Right Price: A value-based prescription for drug costs.” And although they don’t have a definitive answer, they do offer recommendations, interesting observations, and a way forward. Listen in and let us know what you think. [Running time: 26 minutes] “The Right Price” (Amazon link) TRANSCRIPT Joe Elia: The US has the highest drug prices around, right? And it threatens household as well as governmental budgets. Who sets those prices? What is their basis? You’re listening to Clinical Conversations from the NEJM Group. I’m Joe Elia and I’m here with the authors of a book that came out last year titled, “The Right Price: A Value-

Multisystem inflammatory syndrome in children (or MIS-C) is a serious complication of Covid-19 infection, usually showing up about a month after infection. CDC worked with several hospitals around the U.S. to discern whether vaccination in adolescents would lessen the likelihood of this outcome. A vaccine hadn’t yet been approved, as it now is, for kids between 5 and 11). The bottom line is that vaccination with BNT162b2 (colloquially known as Pfizer-BioNTech) proved over 90% effective in preventing MIS-C. Listen in as we discuss the work with CDC’s Laura Zambrano. The interview runs about 15 minutes. The article in MMWR (free) TRANSCRIPT Joe Elia: Multisystem Inflammatory Syndrome in Children or MIS-C is a troubling complication of COVID-19 infection. Does vaccination lower the risk? You’re listening to Clinical Conversations from the NEJM Group. I’m Joe Elia, and I’m here with a principal co-author of a paper in MMWR published last week. Dr. Laura Zambrano, the senior epidemiologist in the [Multisystem Infl

Kiarri Kershaw has written a simple letter in JACC — the Journal of the American College of Cardiology. The letter conveys a strong message: health inequities don’t act uniformly across one’s lifetime. Her examination of Black versus white mortality from all causes and from cardiovascular causes with the use of age-specific data shows places in the life of a population where health interventions could lower mortality risks. Using age-adjusted data to examine an entire population is too coarse an approach. She and her colleagues found that older Black people (age 85+) show a survival advantage over whites, despite the fact that whites hold the advantage at every other age interval. There are several possible reasons for this, and Dr. Kershaw and my co-host Dr. Karol Watson offer a few. This is probably the shortest Clinical Conversation ever, coming in at under 7 minutes. And it’s well worth your listening time. Dr. Kershaw’s letter in JACC. The post Podcast 279: Age-specific data do better than age-adjusted

An internist at Massachusetts General Hospital, Dr. Joseph Betancourt also runs their program on equity and community health. In this, the final entry in our four-interview exploration of race and clinical equity, Betancourt talks about the need for medical institutions to pay attention to what’s happening in their patients’ communities. To that end, MGH has a “bodega makeover” initiative to bring healthy food choices to local stores. (His grandfather’s bodega in Spanish Harlem likely served as an inspiration.) Running time: 17 minutes The post Podcast 278: Where equity and community health intersect — a conversation with Joseph Betancourt first appeared on Clinical Conversations.

Dr. Sheares talks about her experience with inequities. She believes that clinicians should aspire to be students of their patients as well as of the pathophysiology of the diseases their patients present with. Listen in. Running time: 20 minutes The post Podcast 277: Race and clinical equity — know your patients — a conversation with Karen Dorsey Sheares first appeared on Clinical Conversations.

In this, our second conversation on race and clinical equity, Dr. Karol Watson of UCLA offers her observations on what she’s observed as a cardiologist trying to deal with treatment plans for patients who’ve lost their health insurance or have had to go to a plan that doesn’t cover what’s needed. She reminds us that tagging people as “non-compliant” would often be better expressed as “unable to afford.” Let me know what you think, please, at jelia@nejm.org Running time: 10 minutes The post Podcast 276: Pay attention to the structural barriers that contribute to clinical inequity — Karol Watson first appeared on Clinical Conversations.

We’ve conducted a set of four interviews with physicians on the topic of race and clinical equity. The conversations center not so much on their published research, but on the roles that these physicians take in their organizations and, in addition, the stories they tell about their own experiences. Our first is with Dr. Kimberly Manning, who’s a professor of medicine at Emory. Let us know what you think. Write to me at jelia@nejm.org. Running time: 20 minutes The post Podcast 275: Race and Clinical Equity — a Conversation with Dr. Kimberly Manning first appeared on Clinical Conversations.

Apologies for the long silence. We have been off doing other things — one of which has been figuring out how to cover conferences. Last month, after much preparation, we covered the American Society of Hematology (ASH) annual conference; our second foray consists of brief coverage of the American Society of Clinical Oncology (ASCO) gastrointestinal cancer symposium. We present a brief, pre-conference chat in this edition. It was conducted just before the ASCO conference began, to get a sense of our guides’ expectations. Those guides — David Ilson, Ghassan Abou=Alfa, and Axel Grothey — are interviewed here and will be interviewed again at the end of the conference. The are expert, respectively, in cancers of the esophagus; stomach, liver, and pancreas; and the colon and rectum. In forthcoming interviews, I will share several of the interviews done with hematologists for ASH. I hope you will find them as fascinating as I have. Running time: 19 minutes The post Podcast 274: Preliminary Thoughts on the 2021 ASCO

Eric Rubin is editor-in-chief of the New England Journal of Medicine. I asked him how COVID-19 has affected that journal, which has been around since the War of 1812 and seen its share of pandemics. Listen in — it’s the first in a planned series of interviews with the editors of the principal clinical journals. Running time: 19 minutes NEJM’s Covid-19 resources page TRANSCRIPT Joe Elia: Welcome to Clinical Conversations. I’m your host, Joe Elia. Dr. Eric Rubin, a specialist in infectious diseases, took over the reins of the New England Journal of Medicine as its editor-in-chief about a year ago. He had just enough time to settle in before — you know — the biggest pandemic in a century arrived. He’s kindly agreed to take part in what’s planned as a conversational survey of the editors of the principal medical journals about their takes on COVID-19. These chats won’t focus so much on the clinical science of the pandemic as much as its broader effects. In addition to editing the Journal, Dr. Rubin is an associat

Dr. Paul Sax writes the closest thing that the NEJM Group has to humor. He’s serious, of course, since his blog “HIV and ID Observations” concerns all things infectious . But he sprinkles in the odd cartoon or links to … dog videos, fer cryin’ out loud. He scours the ID literature (and we must include the social-media literature in that category) for interesting stuff to write about, seems to have a knack for summarizing whole conferences in 750 words, and often manages to give his readers a reason to smile in these fretful times. We decided to catch up with him and ask him about his inspirations and for his advice. He doesn’t disappoint. Running time: 10 minutes Paul Sax’s latest “HIV and ID Observations” blog: “Carbapenems and Pseudomonas, Lyme and Syphilis Testing, a Bonus Point for Doxycycline, and Some Other ID Stuff We’ve Been Talking About on Rounds” TRANSCRIPT: Joe Elia: This is Clinical Conversations. I’m your host, Joe Elia. The current pandemic is leaving its mark all over the place, and one obviou

Back in late March (people often tell me that, these days, 4 months ago might as well be 4 years ago) we talked with emergency physician Julian Flores, who was working out of Broward County. Covid-19 cases were modest in number but threatening to get worse, and indeed they did. The county’s cases jumped 100-fold, from about 600 to over 50,000. Just south of Broward, Miami-Dade has double that caseload. We revisit Dr. Flores (who was sheltering from the rains of a coastal near-hurricane in his car). He confesses bewilderment and counsels skepticism — especially of one’s biases — in evaluating this thing we’re facing. Running time: 16 minutes Other interviews on Covid-19 in this series: Dr. Anthony Fauci (NIAID, Bethesda, MD) Dr. Susan Sadoughi (Boston, MA) Dr. Matthew Young (suburban Delaware) Dr. Julian Flores (Broward County, FL) Dr. Kristi Koenig (San Diego, CA) Dr. Renee Salas (Boston, MA) Drs. Andre Sofair and William Chavey (New Haven, CT, and Ann Arbor, MI) Dr. Comilla Sasson (volunteering in New Y

Don’t expect HIPAA regulations to protect your “digital health footprint” from prying eyes. Every time you swipe your card to buy goodies at the supermarket (are you risking diabetes with all that ice cream?), or binge-watch that kinky series (how’s your mental health these days, really?), or let your step-tracker show you’ve fallen off the pace (can you afford those extra pounds?), there’s another little distinguishing feature added to your footprint. This weeks’s guest, Dr. David Grande, and his associates asked a group of experts what they thought about all this accumulating personal data that’s outside HIPAA’s purview. Listen in. (Running time: 20 minutes) Dr. Grande’s paper in JAMA Network Open Franklin Foer’s Atlantic essay on the downside of Big Data’s help in the pandemic New York Times‘s privacy project TRANSCRIPT: Joe Elia:  You’re listening to Clinical Conversations. I’m your host Joe Elia. This week’s chat isn’t about COVID-19 (or maybe it is really, but we’ll get back to that). What we’re pursuin

We interview Dr. Michael Gonzalez, a Houston-based emergency physician, who describes the situation there as “an ongoing, slow-rolling, level 6 hurricane that just isn’t gonna go away and, more importantly, isn’t gonna tell us when landfall is coming and when it’s gonna be over.” How are his patients reacting to this surge? What does he do to prepare himself for a shift in the emergency department? Is there enough PPE to go around? Listen in. Running time: 25 minutes Other interviews on Covid-19 in this series: Dr. Anthony Fauci Dr. Susan Sadoughi Dr. Matthew Young Dr. Julian Flores Dr. Kristi Koenig Dr. Renee Salas Drs. Andre Sofair and William Chavey Dr. Comilla Sasson Dr. John Jernigan Dr. Ivan Hung Dr. Steven Fishbane TRANSCRIPT  Joe Elia: You’re listening to Clinical Conversations. I’m your host Joe Elia. Here we are still swimming in the sea of numbers generated by the COVID-19 pandemic: numbers of confirmed cases, numbers of tests, fatality rates per 100,000 population, et cetera. With so many nu

This time Dr. Ali Raja and Joe Elia talk with two authors of a study that found disparate effects on traffic deaths from the legalization of recreational cannabis. The two states under study, Colorado and Washington, were compared, not with each other, but with a composite of states that most closely resembled what Colorado and Washington would be if they hadn’t passed legalization. The states were thus compared against their “doppelgangers.” Colorado showed an increase of roughly 75 additional traffic deaths per year, while Washington didn’t show any substantial effect. How can this be so, and what are the implications for states with legalization already in place or contemplating it? Links: JAMA Internal Medicine study JAMA Internal Medicine editorial Running time: 20 minutes  Transcript: Joe Elia: You’re listening to Clinical Conversations. I’m your host, Joe Elia. Earlier this week, JAMA Internal Medicine published two reports and an editorial about the association of legalized recreational marijuana and

The novel coronavirus obviously has devastating effects on the lungs, but other, less immediately visible attacks occur — notably to the kidneys. Dr. Steven Fishbane (a nephrologist) and his colleagues have just published their findings based on a survey of some 5500 patients with COVID-19 admitted to a metropolitan New York health system. Acute kidney injury developed in about one third of the group, and it was very common (almost 90%) among those requiring mechanical ventilation. But beyond these clinical features, I wanted to ask Dr. Fishbane about how he and his staff prepared for the viral onslaught, and especially what lessons he takes from the experience. Running time: 21 minutes Links: Kidney International study Other interviews in this series on COVID-19 Dr. Anthony Fauci Dr. Susan Sadoughi Dr. Matthew Young Dr. Julian Flores Dr. Kristi Koenig Dr. Renee Salas Drs. Andre Sofair and William Chavey Dr. Comilla Sasson Dr. John Jernigan Dr. Ivan Hung TRANSCRIPT Joe Elia: You’re listening to Clinical Con

A combination of three antivirals — Kaletra (which is lopinavir plus ritonavir) and ribavirin — when given early and with interferon significantly reduces viral shedding, disease symptoms, and hospital stay in  patients with COVID-19 when compared with a control regimen of Kaletra alone. The drugs are active against other coronaviruses, but the key factors seem to be interferon and promptness of treatment. When the triple-drug combo was administered without interferon 7 days or more after the onset of symptoms, the results were no better than with Kaletra alone. Prof. Ivan Hung, the lead author on the report, explains that the researchers were afraid of prompting a cytokine “storm” if interferon was given after 6 days of symptoms — they’re not sure that that reluctance was well founded now. In any case, no patients died in either group. The study was conducted in Hong Kong and has just been published in The Lancet. (An earlier study by another group published in the New England Journal of Medicine found no sp

We (Dr. Danielle Bowen Scheurer and Joe Elia) talk with Dr. John Jernigan of the CDC COVID-19 Investigation Team, which recently published its findings on the spread of COVID-19 in a Seattle-area skilled nursing facility. Most intriguingly, over half the patients who tested positive were asymptomatic at the time of their first testing, and a few hadn’t developed any symptoms a week after their positive tests. The results are instructive to those working in facilities such as this, whose patients are vulnerable to bad outcomes. Running time: 17 minutes Links: New England Journal of Medicine report MMWR report Links to other interviews in this series: Dr. Anthony Fauci Dr. Susan Sadoughi Dr. Matthew Young Dr. Julian Flores Dr. Kristi Koenig Dr. Renee Salas Drs. Andre Sofair and William Chavey Dr. Comilla Sasson Transcript  TRANSCRIPT Joe Elia:__________You’re listening to Clinical Conversations. I’m Joe Elia. I’m joined this time by Dr. Danielle Bowen Scheurer, a colleague from earlier podcasts. Dr. Scheurer

Cardiovascular consults are way down. Is the threat of COVID-19 infection scaring people away from EDs? We caught up with Dr. Comilla Sasson, the American Heart Association’s VP for science and innovation. She’s an emergency physician who teaches at the University of Colorado. She’d traveled to New York City to “help with the response,” and she talked with us from a field hospital that had been set up on a tennis court in Central Park. She had lots to say about what’s driving patients away from emergency departments these days and what’s likely to happen in medicine (hello, telemedicine!) once the pandemic abates. Running time: 15 minutes Links (courtesy of the American Heart Association): Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19 Oxygenation and Ventilation of COVID-19 Patients New COVID-19 patient data registry will provide insights to care and adverse cardiovascular outcomes COVID-19 Compendium for health care providers Coro

This week’s guests, Dr. Andre Sofair and Dr. William (“Rusty”) Chavey are physician-editors on the daily clinical news alert called Physician’s First Watch. I went back through the recent issues and found this January 10 entry, which began “The CDC is requesting that clinicians ask their patients with severe respiratory disease about any travel to Wuhan City, China. That city has seen at least 59 cases of pneumonia caused by an unknown pathogen since December. Seven of the 59 are critically ill.” How quaint that all seems now — so three months ago! Both our guests are being kept busy by that mysterious pathogen, and I thought I’d check in with them. Running time: 20 minutes Other interviews in this series: Dr. Anthony Fauci Dr. Susan Sadoughi Dr. Matthew Young Dr. Julian Flores Dr. Kristi Koenig Dr. Renee Salas TRANSCRIPT: Joe Elia:     Welcome to Clinical Conversations. I’m your host, Joe Elia. This week’s guests, Andre Sofair and William Chavey are physician-editors on Physician’s First Watch, a daily cli

Four weeks ago — in early March — I interviewed Dr. Renee Salas about climate change and clinical medicine. Back in those halcyon days, COVID-19 was very much a gathering storm, but it had not yet slammed into the United States. Here we are, over 10,000 U.S. deaths later in early April, not having heard of much else but the disease. I thought to use this interview now, both to give listeners a small break from “The Virus” — as President Donald Trump refers to it — and to remind us how quickly things can change on the planet. We make mention during the course of the interview of the need to take the lessons from unanticipated disasters. We can only hope that the lessons the present crisis affords us won’t be lost. Links: Dr. Salas’ Perspective article in NEJM Dr. Salas’ earlier NEJM editorial, written with Drs. Malina and Solomon, on “Prioritizing Health in a Changing Climate” Harvard’s Global Health Institute Running time: 18 minutes TRANSCRIPT OF THE INTERVIEW WITH DR. SALAS Joe Elia: This is Joe Elia. We’ve