Clinical Conversations

(Running time: 15 minutes)
A study in the Lancet Oncology gathered information from dozens of epidemiological studies to estimate that over 200,000 cases of endometrial cancer have been prevented in the past 10 years as a result of oral contraceptive use.
A commentary in the journal offers a remarkable look at weighing the benefits and harms of OCs. We talk with a co-author of that commentary, Dr. Nicolas Wentzensen of the National Cancer Institute.
Lancet Oncology study
Lancet Oncology comment
The post Podcast 181: Oral Contraceptives’ Role in Reducing Endometrial Cancers first appeared on Clinical Conversations.

How Webster defined it 90 years ago.
The CDC’s Seema Jain is our guest, talking about a study she did with her team to characterize the causes of community-acquired pneumonia in U.S. adults. (They don’t mention finding Webster’s Micrococcus lanceolatus.) Medicine has come a long way since 1925, but Dr. Jain says that clinicians still need better diagnostic tools to pinpoint the causes of CAP in individual patients.
Using five hospitals in Chicago and Nashville, Jain’s team surveyed over 2000 adult patients admitted with radiographic evidence of CAP during a 30-month period. Also included is discussion of her February paper that sought to characterize CAP in children.
NEJM abstract of study in adults
NEJM abstract of study in children
The post Podcast 180: A sketch of community-acquired pneumonia first appeared on Clinical Conversations.

Running time: 20 minutes
The anticoagulant dabigatran, marketed in the U.S. as Pradaxa, has always had the problem that, although it’s more convenient to use, there’s no sure way to stop its effect if the patient has a major bleed.
Now, a monoclonal antibody fragment called idarucizumab (pronounced i-DARE-you-scis-ooh-mab) shows promise as a reversal agent. In an interim analysis of the first 90 of a planned 300 patients, the fragment was quite effective in stopping bleeds.
The analysis was published in the New England Journal of Medicine, and we talk with the paper’s first author, Charles V. Pollack, Jr.
Link to NEJM article (free)
The post Podcast 179: Pradaxa (dabigatran) reversal near? first appeared on Clinical Conversations.

Dr. Scott Allen of Physicians for Human Rights talks about the lessons evident in the complicity of clinicians — physicians, PAs, and psychologists at the very least — in the torture of prisoners.
His group published an analysis under the title “Doing Harm: Health professionals’ central role in the CIA torture program,” and that’s the focus of this discussion. Allen says that the lesson for all clinicians is to remember the importance of their professions’ commitments to patients, which were badly eroded in these episodes.
Running time: 20 minutes
Doing Harm report from PHR
The post Podcast 178: Why Should Clinicians’ Complicity in CIA Torture Matter to You? first appeared on Clinical Conversations.

Neel Shah wrote a Perspective essay in the New England Journal of Medicine earlier this month on the U.K.’s NICE recommendation that encourages wider acceptance of home delivery and midwifery. The question is, could it work in the U.S.?
For the audio-oriented Clin Con audience we’ve adapted a video conversation that took place on Medstro (https://medstro.com/groups/nejm-group-open-forum/discussions/112). There, Dr. Shah and other clinicians discuss the problems U.S. obstetricians and U.S. mothers-to-be face. The Medstro forum is now finished, but the discussions back and forth over the course of its 10-day run are still available at the URL above.
Running time: 32 minutes
The post Clinical Conversation 177: Can We Deliver NICEly? first appeared on Clinical Conversations.

Running time: 19 minutes
We talk with Dr. Cosette Wheeler about a new Lancet Oncology paper that offers follow-up on two major trials of HPV-16/18 vaccines.
The analysis adds more data to the suspicion that although three doses of vaccine are optimal, two or even one may offer substantial protection. Wheeler is very cautious on this point, however, and insists that the goal must be to deliver three doses to every recipient. In the U.S., HPV vaccine courses are completed less than half the time.
Lancet Oncology abstract
The post Podcast 176: HPV Vaccine — How many doses are needed to confer protection? first appeared on Clinical Conversations.

Running time: 26 minutes
“Understanding Value-Based Healthcare,” published in April by McGraw-Hill is today’s focus.
Drs. Christopher Moriates, of the University of California, San Francisco; Vineet Arora, of the University of Chicago; and Neel Shah of Harvard Medical — the book’s authors — discuss its straightforward approach to valuing patient outcomes foremost.
The discussion ranges over their reasons for writing the book, their attempt to reach the broader audience concerned with healthcare costs, and their recommendations for taking action locally.
Here’s a link to the authors’ Costs-of-Care website, where you will find information on ordering the book.
The post Podcast 175: “Understanding Value-Based Healthcare” — A Discussion with the Authors of an Important New Book first appeared on Clinical Conversations.

The PARADIGM-HF trial of LCZ696 — a novel compound that both blocks the renin-angiotensin system with an ARB component and blocks neprilysin’s degradation of natriuretic peptides — increased survival in heart failure by some 20% relative to enalapril. It seems to be a big deal, and the trial’s two principal authors have agreed to talk about their work and its larger meaning.
Running time: 15 minutes
Other links:
The study in the New England Journal of Medicine (free)
NEJM Journal Watch coverage of the study (free)
The post Podcast 174: PARADIGM and Heart Failure first appeared on Clinical Conversations.

Running time: 9 minutes
In the light of the New England Journal of Medicine‘s recent publication three papers on sodium intake and its implications for cardiovascular disease, blood pressure, and excess mortality, we thought we’d speak again with Dr. Jan Staessen, who surprised a lot of people 3 years ago with a paper in JAMA warning against population-wide sodium reductions. His research showed that cutting sodium intakes to levels recommended by the U.S. Dept. of Agriculture was associated in his cohort with an increase in cardiovascular risk.
Dr. Staessen kindly agreed to serve as our guide through the new NEJM research.
LINKS:
The 2011 Staessen interview
Physician’s First Watch coverage of the new NEJM studies
The post Podcast 173: Sensible Sodium Levels in View at Last first appeared on Clinical Conversations.

Running time: 15 minutes
Dr. Danielle Ofri, author and internist (as well as an aspiring cellist), is writing a book about how patients and clinicians hear each other. Our discussion centers on that, and on her request that you contact her if you can put her in touch with great diagnosticians (and maybe even their patients).
If you have any suggestions about this or other matters, please contact me here: jelia@nejm.org.
Dr. Ofri may be contacted at her website: http://danielleofri.com
 Here’s a link to our 2009 interview with Ofri.
The post Podcast 172: Listening for the Diagnosis, a Conversation with Danielle Ofri first appeared on Clinical Conversations.