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Answer: Osteoarthritis. Two are nostrums and the other is a disease, but the nostrums have no appreciable effect — on osteoarthritis at least. We discuss a BMJ meta-analysis that uses novel methods to prove the point. The good news is that neither chondroitin nor glucosamine is dangerous, but the bad news is that we spend so much hoping that this is the right combination to alleviate arthritic pain. Interview related link: BMJ meta-analysis News-related links: PSA screening overdiagnoses prostate cancer and doesn’t lower mortality A distinct phenotype of chronic obstructive pulmonary disease New resistance factor, NDM-1, shows up in North America The post Podcast 101: Osteoarthritis, chondroitin, and glucosamine — one of these things doesn’t belong. first appeared on Clinical Conversations.

We’re not talking about philosophy here, but practical clinical approaches to making sure your patients understand what they’re agreeing to, and have the information to ask the right questions before they sign that form. It’s podcast 100. I’m always looking for ways to make this useful, and if you have any reactions, please drop a line to jelia@jwatch.org. Thank you! Interview-related links: Dr. Fernandez’s editorial Annals study abstract Link to an organization providing patient decision aids News-related links: American Academy of Pediatrics proposal on mandatory flu shots for health workers Lancet abstract for the carotid stenosis study Lancet abstract on intimate-partner violence The post Podcast 100: Practical informed consent first appeared on Clinical Conversations.

It was thought that the increased risk among blacks undergoing stenting had to do with factors such as comorbid conditions and socioeconomics. But in a study in Circulation, their rate of stent thrombosis was higher than non-blacks, even after adjusting for those factors (and despite the fact that as a group, black were more adherent to their clopidogrel regimens). We discuss things with the paper’s senior author, Dr. Ron Waksman. Interview-related links: Circulation abstract Physician’s First Watch summary News-related links: Sibutramine abstract in NEJM ASCO guidelines on genetic screening JAMA article on risk-reducing surgeries PNAS article on chronic fatigue link to virus The post Podcast 99: Blacks’ higher rate of stent thrombosis apparently has a genetic basis. first appeared on Clinical Conversations.

Our interview this week is with a research nutritionist whose BMJ meta-analysis found a 14% reduction in risk for type 2 diabetes among those with the highest intake (versus those with the lowest) of leafy green vegetables. It’s a meta-analysis, and not a randomized controlled trial, and it’s interesting. Listen in. We’re off next week, so I’ll see you again in early September. Interview-related links: Phyician’s First Watch summary BMJ article News-related links: Label information for “ella” 5-days-after emergency contraception FDA announcement of intent to withdraw approval from midodrine Neurology abstract on headaches in teens and possible lifestyle triggers The post Podcast 98: Leafy green vegetables apparently lower one’s risks for type 2 diabetes first appeared on Clinical Conversations.

Vena cava filters, often meant to be permanent, can actually lose a strut or two. And it’s not as rare an occurrence as you might think. Our conversationalist found it happens about 15% of the time with a certain brand of filter. The FDA has announced that it’s starting its own studies of the problem. Listen in. If you see something during the week that you’d like me to devote an interview to, please let me know. My email is jelia@jwatch.org. I’d love to have your suggestions. Interview-related links: FDA’s announcement on MedWatch Physician’s First Watch coverage of the vena cava filter research Study posted on the Bard website News-related links: Abstract of study linking acetaminophen use to asthma in adolescents Lancet Infectious Diseases report on new resistance factor in enterobacteria Archives of Neurology report on protein signature of Alzheimer’s in spinal fluid The post Podcast 97: What happens when vena cava filters break? first appeared on Clinical Conversations.

What becomes of children who survive cancer treatment and enter their reproductive years? Would their attempts to have children end in a higher-than-normal rate of stillbirths and miscarriages? Apparently not. It turns out the major concern is with women who’ve undergone pelvic irradiation before menarche. That treatment seems to hobble uterine development, but not irretrievably. For their part, boys who’ve had gonadal irradiation seem not to place their offspring at higher risk for adverse birth outcomes. Our conversation is with the senior author on a Lancet paper from last week investigating these effects. Interview-related links: Physician’s First Watch summary Abstract of Lancet article News-related links: Background material on FDA advisory committee vote New York Times article on GlaxoSmithKline Compression-only CPR Caffeine in pregnancy Mayo Clinic’s caffeine table The post Podcast 96: Survivors of childhood cancer face manageable reproductive risks. first appeared on Clinical Conversations.

This week’s interview is with the editorialist commenting on an exciting Lancet paper. The writer, Dr. Gbenga Ogedegbe, says that the work, in which patients with uncontrolled hypertension titrated their own medications according to prespecified rules, could change how clinicians manage uncomplicated hypertension. From his base at New York University School of Medicine, Dr. Ogedegbe sees promise — if the costs are right. Listen in. Interview-related link: Lancet paper (free abstract) Dr. Ogedegbe’s editorial (you’ll need a Lancet subscription) News-related links: New VA rules on PTSD compensation Back pain and glucosamine Tight BP control in diabetics with coronary disease The post Podcast 95: What if hypertensive patients titrated their own drug dosages? first appeared on Clinical Conversations.

A meta-analysis of 11 studies encompassing more than 60,000 subjects finds that statins don’t lower all-cause mortality in people without cardiovascular disease. One editorialist calls the study, just published in the Archives of Internal Medicine, “the cleanest and most complete meta-analysis of pharmacological lipid lowering for primary prevention.” One of the study’s principal authors, Kausik K. Ray, talked with us from London. I think you’ll find that listening in is worth your time. Interview-related links: Physician’s First Watch coverage of the Archives‘s statin papers Ray et al.‘s meta-analysis News-related links: Starting dialysis early doesn’t improve mortality Digoxin’s dangers in dialysis Rosiglitazone’s bad week Tight glucose control in diabetes brings some benefits, but at the cost of “imprudent” risks PSA testing for prostate cancer lowers mortality, but mostly in low-screening regions The post Podcast 94: What does a new meta-analysis tell us about statins and primary prevention? first ap

That’s the question asked in an intriguing essay — by a radiologist — released online in the New England Journal of Medicine. We have her as our guest this week. Feedback, please! You can comment here or by emailing me at jelia@jwatch.org — or better still, call 1-617-440-4374. Interview-related links: Rebecca Smith-Bindman’s essay Radiation doses from common CT exams News-related links: California’s pertussis epidemic Life in utero near a cell tower doesn’t lead to childhood cancer Homocysteine-lowering again fails as secondary CVD prevention FDA approves test that can detect both HIV antibodies as well as antigen The post Podcast 93: Is computed tomography safe? Yes, but … first appeared on Clinical Conversations.

A JAMA paper suggests that in all but the most severe exacerbations of COPD, it’s best to start off with low-dose oral corticosteroids rather than the higher-dose intravenous treatment that, contrary to guideline recommendations, almost everyone now gets. Our conversation this week is with the study’s first author, Dr. Peter Lindenauer. Visit the Journal Watch website at http://jwatch.org for a comprehensive look at new medical research, with comments from our experts. Interview-related links: COPD guidelines from the Global Initiative for Chronic Obstructive Lung Disease JAMA article abstract News-related links: Increased cancer risk with ARBs Diabetes, its treatments, and cancer risks FDA announces review of olmesartan FDA’s MedWatch reporting site The post Podcast 92: Corticosteroids in COPD exacerbations — high-dose intravenous or low-dose oral? first appeared on Clinical Conversations.

We talk with a Danish researcher, Emil Fosbøl, whose team estimated the risks of cardiovascular events caused by NSAID use in healthy people. Your feedback is always welcomed and encouraged. Please drop me a note (jelia@jwatch.org) or call in a comment to 1-617-440-4374. I’m eager to act on your suggestions. The interview-related link: First Watch coverage of the NSAIDs article News-related links: Distracted driving Valproic acid The post Podcast 91: What risks do NSAIDs hold for healthy people? They’re not trivial. first appeared on Clinical Conversations.

Here’s a question wrapped in mist: How to prevent diabetes? Well, lifestyle changes for sure, but that’s hard. Drug therapy? Easier, but side effects can take away that advantage pretty quickly. Rosiglitazone offers some benefits, but its side effects — most notably increased risks for heart failure and death — have some people wondering whether it should stay on the market. Canadian researchers took the approach of using low doses of rosiglitazone and metformin in combination. They compared that treatment with placebo in a small group of 200 patients with impaired glucose tolerance. Those receiving treatment had a much lower risk of developing type 2 diabetes over the ensuing 4 years of follow-up. The results aren’t anywhere near ready for allowing clinical use, but they at least move us a bit through the fog. Our conversation this week is with Bernard Zinman, the principal author of the study, just published in the Lancet. News-related link: First Watch coverage of BMJ study on hormone-replacement thera

Glasses — when did you start wearing them? They serve to help us do more than just read the newspaper, according to our conversational guest today. Prof. Stephen Lord of Sydney’s Prince of Wales Medical Research Institute and his coauthors write in BMJ this week about trying to encourage elderly wearers of multifocal lenses to use single-focus lenses when they walk outside, where the terrain is unfamiliar. The results are practical, and the discussion about them (Prof. Lord’s side of it, that is) enlightening. Give us a call at 617-440-4374. This week’s conversation-related link: Physician’s First Watch coverage of the BMJ study This week’s news-related links: AAP statement on pool and swimming safety Beta-blockers and COPD CREST: carotid endarterectomy vs. stenting HIV-1 transmission drops after start of antiretroviral therapy The post Podcast 89: Glasses aren’t just for reading any more. Listen in to how they can help the elderly avoid falls. first appeared on Clinical Conversations.

The New England Journal of Medicine carries several studies comparing the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysms. Tying all those studies together is an editorial by Dr. K. Craig Kent of the University of Wisconsin. We’ve got him as our guest this week. Have a listen. Interview-related links: K. Craig Kent’s editorial EVAR trial abstract DREAM study abstract News-related links Swapping in a reassembled-from-scratch genome Dengue now originates in Florida Antibiotic use has consequences The post Podcast 88: Weighing the benefits of endovascular versus open repair in abdominal aortic aneurysm. first appeared on Clinical Conversations.

Dr. Robert Centor of the University of Alabama at Birmingham believes that the paradigm for treating pharyngitis in adolescents and young adults must change. Listen to our conversation and hear why. Here are this week’s links: Interview-related links: Commentary Urges ‘Expanding the Diagnostic Paradigm of Pharyngitis’ in Young People Robert Centor’s blog — “Medrants” News-related links: PPI article in Archives of Internal Medicine FDA’s “Bad Ad” Program website Annual doses of vitamin D lead to increased falls Cord-blood pH article from BMJ The post Podcast 87: After this week’s news, we reprise an interview from last December on pharyngitis in adolescents and young adults. first appeared on Clinical Conversations.

Why wouldn’t you want your hospital to lower its rate of early readmissions for heart failure by 15%? We talk with Dr. Adrian Hernandez about his examination of Medicare data from over 200 hospitals, how the hospitals vary widely in the rates at which their patients are followed up within a week of discharge for heart failure, and what that means for readmission rates. Hint: hospitals with more efficient follow-up have lower readmission rates. Listen in to our conversation. Interview-related link: Physician’s First Watch summary of Hernandez’s JAMA article News-related links: ACIP guidelines on MMRV vaccine Herpes zoster vaccine underuse Breast-cancer screening’s numbers for women just under 40 The post Podcast 86: Prompt follow-up after discharge for heart failure reduces early-readmission rates. first appeared on Clinical Conversations.

A surprise finding: homocysteine is supposed to be a factor in vascular inflammation, but lowering hyperhomocysteinemia in patients with diabetic nephropathy actually accelerated the decline of  their GFRs. What gives? We have a conversation with Dr. J. David Spence, whose results were just published in JAMA. Interview-related link: JAMA paper on the effect of B vitamins on diabetic nephropathy News-related links: Clopidogrel suffers possible class-effect interference from PPIs BMJ paper on hyperemesis gravidarum across generations High-test flu vaccine guidance from ACIP Brain games and the lack of data supporting their effectiveness The post Podcast 85: B vitamins lower homocysteine levels, so why don’t they retard the progression of diabetic nephropathy? first appeared on Clinical Conversations.

I’d forgotten that it’s only been a year since 2009 H1N1 (remember when we called it “swine flu”?) struck, but then I saw Richard Wenzel’s op-ed essay in the New York Times. Dr. Wenzel kindly agreed to a conversation, and that’s our offering this week. Interview-related links: Wenzel’s op-ed piece in the New York Times CDC’s estimates of flu-attributable illness News-related links: PTU gets a boxed warning False-positives in screening for lung cancer Hospitalizations for MI have declined If you’d like to leave a comment, we’d love to have it. Give voice to more expressive messages at 1-617-440-4374. The post Podcast 84: One year later, what have we learned from 2009 H1N1? A conversation with Richard Wenzel. first appeared on Clinical Conversations.

This week’s conversation introduces you to CardioExchange, a joint effort by Journal Watch and the New England Journal of Medicine to create an online community of clinicians interested in cardiovascular diseases. Two of CardioExchange’s editors, Dr. Richard Lange and Dr. L. David Hillis, interview Dr. William Boden of the COURAGE study, and Dr. Gregg Stone, an interventionalist. The exchange of views is interesting. Interview-related links: The COURAGE study as it appeared in NEJM The COURAGE “Nuclear Substudy” as it appeared in Circulation Signing up for CardioExchange News-related links: White House orders change to hospital visitation policies AHRQ’s report on the state of U.S. healthcare Flu vaccines’ non-effect on vitamin-K antagonists Driving with dementia The post Podcast 83: An interview by CardioExchange’s editors on the COURAGE study first appeared on Clinical Conversations.

Repetitive tasks, like making sure to wash your hands after seeing each patient, may seem like drudgery, but they save patients’ lives. This week we talk with Prof. Elizabeth Robb and Sir Brian Jarman about their success at chopping hospital mortality rates with simple checklists. Sir Brian has offered to monitor your hospital’s stats for free. So give a listen. Comments to 1-617-440-4374 or to jelia@jwatch.org. Interview-related links: BMJ article Links to the checklists used Physician’s First Watch summary Prof. Robb’s You-Tube video Dr Foster Intelligence unit at Imperial College, London News-related links: Fruit-and-veggie intake Chlamydia screening Generic losartan (Cozaar) Childhood cancer’s aftereffects Back-surgery conflicts The post Podcast 82: Checklists save lives — lots of lives. Becoming a clinical automaton. first appeared on Clinical Conversations.