Questioning Medicine

Part 2 of the top articles of 20201) statins and the nocebo effect2) VA DOD Lipid guidelines- Don't check more than every 10 years!3) blood in the urine and what to do about it per the newest guidelines. 4) SGLT2i, FLOZINS!!! The data and how to use it in practice with really really sick patients

A two part podcast on the top published articles of 2020

SGLT2 inhibitors and GLP1 agonists administered without metformin compared to other glucose‐lowering drugs in patients with type 2 diabetes mellitus to prevent cardiovascular events: A systematic review - Escobar - 2021 - Diabetic Medicine - Wiley Online LibraryYes these fancy new drugs work with and without metformin but that does not mean these drugs should be first line!!Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA | JAMA NetworkYep even 200,000IU of vit D does nothing except raise your vit d level. Diet and acne: review of the evidence from 2009 to 2020 - Dall’Oglio - - International Journal of Dermatology - Wiley Online LibraryWhat you eat does mess with your acne, or at least says this large observational trial.Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials | The BMJThe muscle aches with statins is a common event

Semaglutide works for weight loss but at what co$t? BOARD CHANGER- New gonorrhea guidelinesDiabetes drugs are expensive for our patients and we can't forget that. Children find it hard to tell what facial expression you are giving when you have a mask on!https://www.nejm.org/doi/10.1056/NEJMoa2032183 industry-conducted trial published in the New England Journal of Medicine.Researchers randomized nearly 2000 participants without diabetes who were either overweight with at least one weight-related comorbidity or obese to receive All2.4 mg subcutaneous semaglutide or placebo weekly for 68 weeks. mean bmi 38. weighing at 105 lbs. Mean weight loss was significantly greater with semaglutide than placebo (15% vs. 2%), as was the percentage of patients losing >5% of body weight (86% vs. 32%). difference is 31lbs-- over 68weeks or 16 months.. the drug cost 734$ per month. that is 11,744 for treatment or 379 per pound. not worth it to me twitter and say shouldnt you have the conversation?!? BOARD CHANGER T

Also ask yourself, did this study compare their treatment to the 'gold standard' and if the answer is no they compared it to a straw man, then think big Pharma, or authors that needed publication for their job. We can't treat what we don't know exist and 30-50% of the time COVID19 is asymptomatic. Combined Oral Contraception DO NOT have an increase risk of DVT and long term the risk are very minimal if a DVT does develop while on COC. Speaking of studies that should have never been done- Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study) | Gut (bmj.com) Diagnostic Yield of Colon Capsule Endoscopy vs CT Colonography in a Screening Population | PracticeUpdate The authors of this multicenter, prospective, randomized study compared the diagnostic yield of colon capsule endoscopy (CCE) with that of CT colonography (CTC) for colon cancer screening in an average-risk adult population. First you had e

The Drug Addiction Treatment Act of Under the Act, physicians may apply for a waiver to prescribe buprenorphine for the treatment of opioid addiction or dependence outside of an opioid treatment program (OTP). The Drug Addiction Treatment Act of 2000 was authored by Senator Orrin Hatch (R-UT), Senator Joe Biden (D-DE), and Senator Carl Levin (D-MI). DATA 2000 waiver Why would biden reverse this—it was one of the things I think we all agree upon is a good thing!! I thought it must be the money – its always the money But I found a few reasons reasons why Confirmation bias--- Under the Act, physicians may apply for a waiver to prescribe buprenorphine for the treatment of opioid addiction or dependence outside of an opioid treatment program (OTP)Money== Biden received $6.3m from pharma, compared to $1.6m for Trump,Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383:2603-15. https://pubmed.ncbi.nlm.nih.gov/33301246 Randomized placebo-contro

Autoimmune mothers likely don't actually have more ADHD kids. If you patient is in the hospital we now have a RCT to answer the question about ACEI starting or stopping. Finally, there are problems around COVID we don't even know about and it has nothing to do with contracting COVID19.Association of Maternal Autoimmune Disease With Attention-Deficit/Hyperactivity Disorder in Children | Attention Deficit/Hyperactivity Disorders | JAMA Pediatrics | JAMA Network Doesn't say what the authors think that it says – or perhaps it does and that is the problem with most studies in pregnancy…. The authors conclusions were “In this cohort study, maternal autoimmune diseases were associated with increased ADHD among children.” Wiat autoimmune disorders in mom and boom big time risk of ADHD in children! Better brain has true celiac so this is something I am interested—it sparked my attention! population-based cohort analysis of 831,718 infants and mothers in the end the researchers matched almost 13,000 children whose mo

HHS Expands Access to Treatment for Opioid Use Disorder | HHS.govU.S. Department of Health and Human Services Announcement of practice guidelines for the administration of Buprenorphine for treating opioid use disordersJan 12- 20221 -physicians with a DEA license- only not all providers -you can only treat patients located in the state you have a medical license in (basically no tele) -Physicians utilizing this exemption will be limited to treating no more than 30 patients with buprenorphine for opioid use disorder at any one time (note: the 30 patient cap does not apply to hospital-based physicians, such as Emergency Department physicians). -ONLY buprenorphine- does not apply to methadone for the treatment of OUD. - Physicians utilizing this exemption shall place an "X" on the prescription and clearly identify that the prescription is being written for opioid use disorders

They say every dog has its day and IT think every drug has its place Anyone who says ‘that drug is bad’ or that test is bad or that anything is bad is just being closed minded or not aware of the evidence because evidence and medicine comes down to numbers.The real statement should be I don’t think that drug is beneficial enough for the harm. However that is an opinion statement, it is what you think and that is when shared decision making comes into play because maybe your patient does think it is beneficialNo more clearly see than in this viewpoint in Jama titled Balancing the Risks and Benefits of Benzodiazepineshttps://jamanetwork.com/journals/jama/fullarticle/2775180?guestAccessKey=fe7dd94f-653f-4da0-ad1f-21fb8c60e420&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=010821 Which talks about the risk and benefits of benzos. A drug that I often here so many providers dis on with no real evidence to back it up—how do I know there is no real

Dr sprouse-- Endo saying that Vit D below 30 leads to 2nd hyperparathyroidism due to calcium absorption deficiency and downstream consequences of that condition leads to poor bone health. He agreed all the other outcomes don’t have good evidence. I think 30 is the recommendation from the endo society. MY RESPONSE Well just to be clear they are right and they are wrong Yes it MAY, key word is MAY (it’s a not a universal truth), cause a secondary hyperparathyroid. HOWEVER, as I am sure you have already thought, this is a lab value. WE DON’T CARE ABOUT LAB VALUES, we care about patients. We treat patients, not lab values. So realistically who cares!?!?!? They will say well we care because it leads to broken bones and fractures!?!?! Then say really?? Based on what data because in this trial of almost 700 women who underwent BMD testing at baseline and 2 years later there was no difference between vitamin d and placebo https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3958 And they will say yes but th

NEW covid19 vaccine I am sure many of you have heard it is the first of its kind. It uses mRNA technology. I am not going to discuss what that means ebcasue so many people already have on other podcasts and publications but the question is should you get the vaccine. I have read many opinons on this from experts for exampleDr. Michal Elovitz, a preterm labor researcher and obstetrician at the University of Pennsylvania. Said its possible the mRNA and the bubble it travels in, made of lipid nanoparticles, could cross the placenta, and This might, in theory, cause inflammation in utero that could be harmful to the developing fetal brain” she went on to say, “It’s also possible the new vaccines could be totally safe in pregnancy, like the flu shot.” No pregnant patients were enrolled in the accessible trials, although some people got pregnant during the course of the study. Researchers are monitoring them to see how they do. We have not even tested this on pregnant animals—we have no idea if this is safe for pre

What you see is what you get- no more clearly seen then inThis paper titled Nutritional Analysis of Foods and Beverages Depicted in Top-Grossing US Movies, 1994-2018 In JAMA internal medicine which looked at the nutritional quality of foods and beverages depicted inthe 250 top-grossing US movies from 1994 to 2018these 250 movies sold 10 billion box office tickets and grossed $164 billion in theatersworldwide. These are popular movies we all watch or are aware ofand what they put on the screen as a societal “norm”in this study-Two trained researchers viewed movies in their entirety and listed allfoods and beverages depicted in each scene.they used the Nutrient Profile Index (NPI) to classify foods and beverages as healthy or notpenalizes components that should be limited likesugar, sodium, and saturated fat and rewards fiber, protein, and fruit and vegetableNow I understand this is not a one size fits all and the authors admit there is not portion controlon this so if the movie had a thimble full of high sugar

Get the best evidence because you want to know what they are looking at and occasionally people send me articles I was not aware of. Plus I ate spending my time sending them all the information then people say well ya but you are looking at the wrong evidence just right off the bat say “I will explain but tell me the evidence you are looking at”So he sent me 5 articles and I going to break them down in hopefully a rapid fire dissectionAnd before we get started there is a very important piece of information that we all need to be clear on, low vitamin d DOES not mean that replacing the vitamin d then fixes the problem. We knew for a while that high HDL seem to have a protective cardiovascular effect but when we looked at the data it didn’t appear raising the HDL with a drug called niacin had an effect on cardiovascular events. This is the ultimate association and correlation connection. Sure it appears more popsicles consumed are associated with higher rates of drowning but getting rid of popsicles will not ge

2020 Update to The Top Articles of 2019

Alzheimers disease—doesn’t say what you think it says https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.6432?guestAccessKey=807ca0d3-63aa-48f9-8a1d-16df0d828d42&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=113020 Conclusions and Relevance Alzheimer disease and related dementias were associated with adverse financial events years prior to clinical diagnosis that become more prevalent after diagnosis I listen to a podcast and read articles and it seems omg this is great!! Maybe we look to see if people are missing payments or making poor financial decisions and screen them for alzheimers. Currently screening for alzheimers is difficult because we don’t have good treatment to slow or prevent the progression of the disease. Remember a few basic principles of screening are The condition should be an important health problem.There should be a treatment for the condition that can change

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771041#:~:text=Conclusions%20and%20Relevance%20Initiation%20of,effective%20as%20brand%2Dname%20levothyroxine. Comparative Effectiveness of Generic vs Brand-Name Levothyroxine in Achieving Normal Thyrotropin LevelsJAMA Netw Open. 2020;3(9):e2017645. doi:10.1001/jamanetworkopen.2020.17645 Quick history lesson- levothyroxine was cleared and approved for generic use in 2004 – until then Synthroid had enjoyed a huge market share. The only market share. They were it and there is soooo much money when you are the only drug on the market and the most prescribed drug on the market—in 2002 the revenue was estimated at 1 billion dollars. I was alive in 2002 and I can tell you back then 1 billion dollars was a lot of money. But then 2004 there is now competition, a generic drug.! What does the drug company do? Use some of their small fortune to trash the drug, pay of some doctors to write a paper and later in 2004 there was a paper released by The Endocrine S

www.bmj.com/content/368/bmj.m149No one wants to get pregnant two minutes after having a baby. And also agrees that an IUD is most effective form of conception. However placing IUD after delivering a child seems to be a point of debate as the risk of expulsion seems to be significantly higher immediately post pregnancyIn this study titledAverbach SH, Ermias Y, Jeng G, et al. Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis. Am J Obstet Gynecol 2020;223:177-188.They looked at the different rates of IUD expulsion postpartum. As you can imagine the rates vary based on if the IUD was placed within 3 minutes of child delivery or 3 weeks after child delivery. There also seemed to be a difference between hormonal IUD (LNG-IUD) compared with a copper T-shaped IUD. Finally there was a difference whether she had a C-section or a vaginal delivery as you can imagine the vaginal delivery was associated wit

Questioning medicine dailyhttps://www.acpjournals.org/doi/10.7326/M20-7448 https://www.acpjournals.org/doi/10.7326/M20-6817 Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask WearersFREEA Randomized Controlled Trial Masks!!!! Do they prevent COVID19 transmission by preventing spread from infected people to others OR do they work by protecting wearers OR is it both.We now have an answer to the second question, Do the mask work by protecting the wearers and in short the answer is no. Fresh out november 18. The DANMASK-19 trial It a trial designed to examine the masks' protective effect. Spring 2020 in Denmark, Social distancing recommendations were in effect, but masks were not recommended, they were rarely worn outside of hospitals, and the infection rate was modest around 2% per month which is pretty close to what we were seeing because remember we were around 1-3% here in american depending on where you lived with some places much muc

https://www.clinicalkey.com/#!/content/journal/1-s2.0-S0140673620322339?scrollTo=%23hl0000424 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32233-9/fulltext do statins work in old people?? This study in the lancet says- “In a contemporary primary prevention cohort, people aged 70–100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event.’ researchers calculated that 80 adults aged 80–100 years — would need to receive a moderate-intensity statin for 5 years to prevent one MI.and145 adults aged 70–79 years — would need to receive a moderate-intensity statin for 5 years to prevent one MI.and to prevent just one ASCVD event, the numbers needed to treat were 42 and 88, respectively. But anytime you read the results you have to say “how did you come up with that number” what were your methods? In this study they took a sample of people from a large Danish

https://www.acpjournals.org/doi/10.7326/M20-2470 Pharmacologic Approaches to Glycemic Treatment of Type 2 Diabetes: Synopsis of the 2020 American Diabetes Association's Standards of Medical Care in Diabetes Clinical GuidelineFREEWhich is as the artciel suggest in a sypnopsis of the 2020 ADA guidelines metformin is still universal fist line but now the guideline says The choice of agent to add to metformin therapy should be individualized on the basis of patient characteristics, preferences, and drug-specific effects. The big rec from this paper isAmong patients with type 2 diabetes who have established ASCVD or established kidney disease, or heart failure, a sodium–glucose cotransporter-2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with demonstrated cardiovascular disease benefit is recommended (Grade A recommendation). they go on to say maybe one of the key lines--------The addition of these medications should be considered independent from HbA1c level in this patient population