Clinical Conversations

A large-scale computer simulation based on NHANES data plotted the most cost-effective strategy, which turns out to be to start screening before middle age and to repeat every 3 to 5 years. We talk with the first author of a Lancet paper that details the findings.
Interview-related link:
Physician’s First Watch summary of the Lancet paper
News-related links:
2009 H1N1 makes an unwelcome comeback
Health care workers are undervaccinated against 2009 H1N1
Checklists lower hospitals’ mortality rates in U.K.
Dutasteride doesn’t prevent high-grade prostate tumors
Is it reasonable to spend $638,000 to prevent a single MI?
The post Podcast 81: When should you start screening for type 2 diabetes? first appeared on Clinical Conversations.

We talk with three of the academic authors of a New England Journal of Medicine study that pooled data from a few studies in an attempt to examine the possible link between use of bisphosphonates and femoral-shaft fractures.
Interview-related links:
Physician’s First Watch coverage
NEJM paper
NEJM editorial
FDA statement
News-related links:
Aspirin ineffective in preventing miscarriage
BNP-guided therapy for heart failure
Have kids at risk carry two epi-pens
Rotarix contamination
The post Podcast 80: Bisphosphonates and atypical hip fractures — how large is the risk? first appeared on Clinical Conversations.

Patients who consult urologists only are more likely to get radical prostatectomy, and those who consult both urologists and radiation oncologists are more likely to get radiation. Those who see internists are more likely to receive watchful waiting. What are all these facts trying to tell us?
Our conversation is with the principal authors of a study of Medicare data that examines this issue.
This weeks interview-related link:
First Watch coverage of the prostate cancer study
This week’s news-related links:
What’s in that health-reform bill?
High-chair hazard prompts recall
ACCORD study summary
NAVIGATOR study summary
Rabies shots lowered to a total of five
American Academy of Neurology recommendations on Parkinson’s
The Journal Watch website
The post Podcast 79: Prostate cancer, patients’ consultations, and the treatments they receive first appeared on Clinical Conversations.

This week, a conversation with Michael Hochman on his examination of what the major general journals publish in the way of comparative effectiveness studies. He talks about what they are and how to think about that reprint that the drug rep has just dropped off for you.
Reach us at 617-440-4374, or write to jelia@jwatch.org.
This week’s interview links:
Michael Hochman’s JAMA study
The accompanying editorial
This week’s news links:
Blood pressure variability and CVD risk
Elective coronary angiography’s low yield
Prostate cancer treatments after consultations
The post Podcast 78: Just what are “comparative effectiveness” studies anyway? first appeared on Clinical Conversations.

Our attempts to get an interview with a researcher were unavailing, so we’ve  gone to plan B and repeat a useful look at treating community-acquired pneumonia according to guideline recommendations.
Please leave comments and complaints at jelia@jwatch.org. You can call and voice these at 1-617-440-4374.
Interview-related links:
Community-Acquired Pneumonia: Guideline-Compliant Treatment Is Better
IDSA/ATS guidelines
News-related links:
Evaluating long-term risk via glycated hemoglobin
Usefulness of aspirin in lowering risk in patients with abnormal ankle-brachial ratios
Carotid endarterectomy versus stenting in patients at high risk
Kapidex changes its name to Dexilant
The post Podcast 77: We revisit a conversation on treating community-acquired pneumonia according to the guidelines (and we’ve got current news). first appeared on Clinical Conversations.

A conversation with the authors of an Archives of Internal Medicine study that examines the best tactics for saying “No” to inappropriate requests.
Contact me at 1-617-440-4374 or at jelia@jwatch.org.
Interview-related links:
Archives of Internal Medicine abstract
Atul Gawande’s New Yorker article
News-related links:
The rosiglitazone (Avandia) controversy
Advisory on thiazolidinediones
Physicians’ work hours
13-valent pneumococcal vaccine
Influenza-vaccination expansion
Group CBT for low-back pain
The post Podcast 76: On saying “No” to patients’ requests. first appeared on Clinical Conversations.

Patients with hypertension at risk for cardiovascular events have done better with an ACE inhibitor-calcium channel blocker combination than with the ACE inhibitor plus hydrochlorothiazide. The ACCOMPLISH investigators have now reported on their analysis of progression-of-nephropathy outcomes in their trial. We interview the first author of the analysis, Dr. George Bakris of the University of Chicago’s Pritzker School of Medicine.
Interview-related links:
NHLBI guidelines on managing hypertension
Physician’s First Watch coverage of ACCOMPLISH analysis
News-related links:
FDA warning on long-acting beta agonists
Pipe- and cigar-smoking and COPD risk
Metformin’s sometimes-offputting aroma
Health statistics on the U.S.
The post Podcast 75: Which regimen for hypertension? first appeared on Clinical Conversations.

We talk with Dr. Catherine Kelly about her study in  BMJ showing serious interference of some SSRIs with tamoxifen therapy in breast cancer. The study was conducted using Canadian provincial databases.
Reach us at 1-617-440-4374 or by email to jelia@jwatch.org.
Interview article:
BMJ study
Physician’s First Watch coverage
Medical news links:
Back pain guidelines
Inflammatory bowel disease and venous thromboembolism
Automated calling systems
The post Podcast 74: How two SSRIs apparently interfere with tamoxifen therapy. first appeared on Clinical Conversations.

A panel of the American Heart Association, the American Cancer Society, and the American Urological Association issued a statement on androgen-deprivation therapy and cardiovascular risk. We’ve got an interview with the chair of the writing committee, Dr. Glenn Levine.
Interview-related links:
Physician’s First Watch coverage of the statement
Link to the statement, as published in Circulation
News-related links:
Lancet retracts 1998 paper linking MMR vaccination and autism
Use prefilled Sanofi Pasteur N1N1 vaccines before mid-February
JAMA study on proteinuria
If you’d like to contact Clinical Conversations, call 1-617-440-4374 or write to jelia@jwatch.org
The post Podcast 73: How best to monitor patients on androgen-deprivation therapy for cardiovascular risks? first appeared on Clinical Conversations.

We’ve got Dr. William Carroll this week — we tried last week, but the 13-hour time difference between Boston and Perth just stymied me. Dr. Carroll speaks about his NEJM editorial concerning two new drugs for multiple sclerosis. Both are oral therapies that work to keep lymphocytes at bay in this disease.
Interview-story link:
MS Treatments Said to Offer ‘New Horizon’
News links:
New York Times series on radiation safety
Lancet study on glycated hemoglobin levels
FDA approval of diabetes drug
JNCI study on ovarian cancer symptoms
The post Podcast 72: A conversation about two new drugs for multiple sclerosis. first appeared on Clinical Conversations.