Clinical Conversations

Alasdair Conn, chief of emergency services at Massachusetts General Hospital and an associate professor of surgery at Harvard Medical School continues our series on the aftermath of the Boston Marathon bombings.
Thank you for listening. Do let us know what you think.
Joe Elia
Links:
Dr. Conn’s essay in the Annals of Internal Medicine
Last week’s conversation with Dr. Ron Walls
The post Podcast 161: Boston bombings’ lessons part two first appeared on Clinical Conversations.

Thank you for your questions about the status of Clinical Conversations. We’re edging our way back toward a normal schedule with this, the first of a planned multipart series on the lessons learned in the aftermath of the Boston Marathon bombings.
Ron M. Walls, professor and chair of the department of emergency medicine at Brigham and Women’s Hospital and Harvard Medical School is the guest. Listen in and please let us know what you think.
Joe Elia
Link:
The JAMA “Viewpoint” piece written with Michael Zinner.
The post Podcast 160: The Marathon bombing — lessons learned first appeared on Clinical Conversations.

Running time: 20 min.
In some diseases there are two diagnoses to make: the clinical diagnosis and the diagnosis of what the patient’s treatment preference is. The first is hard enough to make, and the widening choice of treatment choices complicates the second.
Welcome to the task of “preference diagnosis,” which can lead to disappointment and worse if missed in diseases like breast or prostate cancer.
We talk this week with the authors of an essay on the topic in BMJ. They offer some advice and some resources you’ll find useful.
Links:
First Watch coverage (free)
“Option grid” from Cardiff University (free)
BMJ essay (free)
The post Podcast 159: Making the Clinical Diagnosis, But Blowing the Patient’s Treatment Preference first appeared on Clinical Conversations.

Our conversation explores the question that Dr. Marcia Angell poses in a recent essay in the New York Review of Books: May doctors help you to die?
Angell’s is the first name to appear as the sponsor of a November 6 ballot initiative here in Massachusetts, which is modeled on the Oregon law already in place.
I’d expect there to be some disagreement with her arguments, and you’re welcome to leave some feedback at 617-440-4374. I’d like to include them as part of the next podcast.
Here are some links:
1. Angell’s essay in the New York Review of Books
2. Information on the ballot initiative from Ballotpedia
3. The full text of the “Massachusetts Death with Dignity Act”
The post Podcast 158: Physician-assisted dying — a conversation with Dr. Marcia Angell about the Massachusetts ‘Death with Dignity’ ballot question first appeared on Clinical Conversations.

A chat with clinician-essayist Cameron Page, whose essay “They Paved Paradise and Put Up a Parking Lot” appears in this month’s Health Affairs.
Our conversation explores the connections in medicine that link outside the clinic walls, with stops along the way at William Carlos Williams, Richard Seltzer, the Yankees, and more.
We get around to low back pain, eventually. Join us for a summer kick-off conversation
Health Affairs essay (free)
The post Podcast 157: Of parking lots, low back pain, the Yankees, writing, and — oh yes — clinical medicine first appeared on Clinical Conversations.

Dr. Peter Bach is the first author on a new JAMA analysis of the benefits and harms of using low-dose CT screening  for lung cancer. The American College of Chest Physicians and the American Society of Clinical Oncology requested the systematic review to assist them in drawing up a clinical guideline.
Join us in discussing who might most benefit from being offered such screening, and what work remains to be done.
Links:
JAMA article (free)
Physician’s First Watch coverage of recent guidelines from the American Lung Assoc. (free)
The post Podcast 156: Using low-dose CT screening for lung cancer in defined populations — a conversation with Peter Bach first appeared on Clinical Conversations.

Dr. Arnold Relman, longtime observer of the U.S. healthcare system and editor emeritus of the New England Journal of Medicine, proposes two major reforms: First, private insurance companies should leave the healthcare field, and second, physicians should organize into multispecialty practices.
His proposals, just published in BMJ, grow out of his alarmed observation — some 30 years ago in the NEJM — of the rise of the “new medical-industrial complex.”
Links:
BMJ essay (free abstract)
NEJM 1980 article (free abstract)
The post Podcast 155: What’s wrong with U.S. healthcare and what will save it? first appeared on Clinical Conversations.

Heart failure brings problems associated with hypercoagulation, such as stroke and sudden death.
An international study followed some 2300 patients with heart failure (ejection fractions of 35% or less) and in stable sinus rhythm for a mean of 3.5 years, randomizing them to treatment with either warfarin or aspirin.
The two treatment groups showed about the same risks for stroke and overall mortality, but warfarin was associated with more major bleeding episodes.
Our guest is the first author on the report, released online by the New England Journal of Medicine.
Links:
NEJM article
The post Podcast 154: Treating heart failure’s hypercoagulable state — warfarin or aspirin? first appeared on Clinical Conversations.

About half of adolescents with type 2 diabetes fail treatment with metformin alone within a few years. Things go somewhat better with metformin plus an intensive lifestyle intervention, and better still with the addition of rosiglitazone to metformin — however even the addition of the second drug leads to treatment failure about 40% of the time.
What’s to be done? On the basis of the evidence collected by the TODAY investigators, the problem has as many metabolic as social dimensions. Clearly, drugs alone are not the answer here.
Dr. Phil Zeitler, the TODAY study chair talks with Clinical Conversations about his surprise at the higher rate of failure with metformin monotherapy among adolescents than among adults, and what lessons this study holds.
Links:
Physician’s First Watch summary (free)
New England Journal of Medicine article (free)
New England Journal of Medicine editorial (free)
The post Podcast 153: Type 2 diabetes in young people — tough going on the treatment front first appeared on Clinical Conversations.

The American Heart Association’s scientific statement on “Periodontal Disease and Atherosclerotic Vascular Disease” is likely to raise hackles among those offering treatments for gum disease as a way to lower risk for heart disease — or even to ameliorate it. The association’s writing committee, after a 4-year review of the evidence, finds no support for such treatments and calls any assertions to the contrary “unwarranted.”
We interview the Dr. Peter Lockhart, co-chair of the AHA’s committee.
Links:
American Heart Association statement (free)
The post Podcast 152: Gum disease and atherosclerosis — evidence for an association, but not for a cause-and-effect first appeared on Clinical Conversations.