Clinical Conversations

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 appeared on Clinical Conversations.

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.