Questioning Medicine

Covid infohttps://melwy.com/blog/lancet-paper-on-chloroquine-is-overhyped-real-world-data-should-not-be-a-black-box So I couldn’t miss the largest observational study published to date on the effects of (hydroxy-)chloroquine, in 96 032 hospitalised Covid-19 patients, from an international registry comprising 671 hospitals in six continents:Surgisphere is the company that put it all together is in the end it showed not only no benefit with hydroxychloriquine but also possible harm!No transparency- they dont really say how they got their data and wont release how they got there data and no review. Lancet being this all great academic journal wont mention or say who did peer review on this article. WHAT! one of the beliefs is Lancet editor-in-chief Richard Horton. Let it slip through the cracks cause he doesnt like trump. This is well known he doesnt like trump but then to intentionally release a bad or falsified study that disagrees with a drug that president trump has openly supported is just crazy!https:/

Prostate Cancer Incidence 5 Years After US Preventive Services Task Force Recommendations Against Screening JNCI: Journal of the National Cancer Institute, djaa068,——Published: 20 May 2020https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2762575?guestAccessKey=1c75486d-f2a4-4e1b-ac99-25ca247be690&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=etoc&utm_term=050420Sex Differences in Salaries of Department Chairs at Public Medical Schools

Fox MT et al. Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis. JAMA Netw vOpen 2020 May 1; 3:e203951. (https://doi.org/10.1001/jamanetworkopen.2020.3951) Rates of treatment failure did not differ significantly between the short and prolonged courses (11.2% and 9.4%). https://jamanetwork.com/journals/jama/fullarticle/2765729?guestAccessKey=2169ba8b-43fc-4360-bed7-acf7a31b1c9d&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=051220Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical TrialIn jama may 12 – look to see if special biomechanical footwear could help osteoarthirits knee pain-At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, −1.3 [95% CI, −1.8 to

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2762699Association Between Renin-Angiotensin System Blockade Discontinuation and All-Cause Mortality Among Persons With Low Estimated Glomerular Filtration RateThe answer was no; In a 5-year follow-up, ACE-I/ARB discontinuation was associated with an increased risk of both mortality (hazard ratio, 1.39; 95% CI, 1.20-1.60) and major adverse cardiovascular events (hazard ratio, 1.37; 95% CI, 1.20-1.56).https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2762509Lobbying Expenditures and Campaign Contributions by the Pharmaceutical and Health Product Industry in the United States, 1999-2018pharma makes a lot of money—how do they spend ithttps://www.ncbi.nlm.nih.gov/pubmed/31801739With the best way to treat gout according to his article in annals rheumatology disease titled the contact trial-“comparing naproxen and low-dose colchicine for treatment of gout flares in primary care ““electric scooter injuries and hospital admissions

https://science.sciencemag.org/content/early/2020/04/24/science.abb5793read an interesting paper title- Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 14 Apr 2020.First, some basics but still things that I learned: • The two corona virus currently in cirulation are HKU1 and OC43 and they are seasonal- mainly the winter months with peaks around oct, nov, dec. ; • HCoV-OC43 and HCoV-HKU1 infections, are the common circulating coronavirus and may be asymptomatic or are associated with mild to moderate upper respiratory tract illness” -- rarely do these kill you while obviously SARS-CoV-2 has been shown to be deadly even though the fast majority of people have been shown to be asymptomatic or with mild symptoms that can be controlled at home • Immunity to HKU1 and OC43 wanes fairly rapidly, over the course of about a year;https://www.ncbi.nlm.nih.gov/pubmed/2170159?dopt=AbstractEpidemiol Infect. 1990 Oct;105(2):435-46.“the time course of immune response to experimen

https://covid19treatmentguidelines.nih.gov/A National Institutes of Health panel has released new guidelinesagainst use of hydroxychloroquine plus azithromycin outside of clinical trials https://www.ncbi.nlm.nih.gov/pubmed/32001253Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysisEpinephrine is the cornerstone of anaphylaxis management but continues to be underutilized ANTIBODY—https://jamanetwork.com/journals/jama/fullarticle/2764954 “Yet, according to Theel, several companies are marketing lateral flow assays as rapid point-of-care tests to identify active COVID-19, something the FDA announced it will take action against. “We do not really know how well these assays work at this point,” Theel said in a follow-up email.” https://www.sccgov.org/sites/covid19/Pages/press-release-04-21-20-early.aspxThey say the Santa Clara Medical Examiner identified two individuals who died at home on February 6, 2020 and Feb

More cover 19 information based on antibody testing, pregnancy and pre-symptomatic spreadhttps://www.medrxiv.org/content/10.1101/2020.03.30.20047365v1.full.pdfhttps://www.nejm.org/doi/full/10.1056/NEJMc2009316?utm_source=The+Scope&utm_campaign=86f20fbd35-Weekly_Scope_Jan_12_2018_COPY_01&utm_medium=email&utm_term=0_809ad7d22b-86f20fbd35-180869057

Remdesivir for compassionate use?? Recently published in the New England Journal of Medicine- Is this the COVID19 treatment we have all be hoping for.https://www.nejm.org/doi/full/10.1056/NEJMoa2007016https://jamanetwork.com/journals/jama/fullarticle/2764727?guestAccessKey=72e8a5f3-3754-4bf8-bb17-8c2f1cf358b0&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=041320

Treatment that works-- MASK!https://annals.org/aim/fullarticle/2764367/effectiveness-surgical-cotton-masks-blocking-sars-cov-2-controlled-comparisonHigh Velocity Nasal Insufflation (HVNI) Therapy Application in Management ofCOVID-19 Have patients wear a surgical mask—in this computer study it showed that mask do help but not necessarily mask on you but mask on the pt.

Id be happy to send you links to any of the articles talked about in this podcast but I cover the new test on the corona virus that claims to be great but the devil in the details as well as talk about more hear-say medicine and the ever popular ACE inhibitor debate

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v1.full.pdf https://www.sciencedirect.com/science/article/pii/S0399077X20300858 https://first10em.com/chloroquine-for-covid-no-good-evidence-yet/

https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-000890-25/FRhttps://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub

Question Everything-- EBM not hear-say medicine

A listener wrote in with a question about a drug, this is my response. Let me know your thoughts? Would you prescribe this drug? Andrewbuelt@gmail.comhttps://www.nejm.org/doi/pdf/10.1056/NEJMoa1705848

There was a paper to start the year that got a lot of hype saying that just maybe we should target an LDL but that is not what the study actually showed and I will tell you why I think it is wrong.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757311?widget=personalizedcontent&previousarticle=2757307 Prior authorization requirements increased from 8% to approximately 24% of covered drugs on Medicare Part D plans between 2007 and 2019. Solutions-First, focus prior authorization on its intended purpose. Health plans should eliminate prior authorization requirements for medications that have very low final denial rates… this should only be for people that are outliersprotect continuity of patient care. For patients who are stable with chronic treatment, insurers should offer protections to minimize disruptions and inefficiencies—get a drug forever shouldn’t need to go off the drug or switch insurance than try a new drug on their formulary when you have already failed it on the other insuranceThird, promote transparency, efficiency, and fairness. Technology exists to enable prescribers to view the formulary status, prior authorization requirements, and cost sharing for medications

https://annals.org/aim/fullarticle/2760034/disclosure-form-work-submitted-medical-journals-proposal-from-international-committee. disclose everything for the papers that you keep..or writePatient comprehension of common orthopedic terminology Cosic F, Kimmel L, Edwards E. Heal Lit Res Pract. 2019;3(3):e187-e193. patients don't understand all that we sayhttps://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32700one article is good to go for HPV (maybe)https://jamanetwork.com/journals/jama/fullarticle/2759002sunscreen gets into the blood but so whatand uptodate says use Tamiflu past 48hrs but look at the study and what do we find???https://www.ncbi.nlm.nih.gov/pubmed/31839279clinical trials regisitery told it allhttps://www.clinicaltrialsregister.eu/ctr-search/trial/2014-004471-23/results

Try not to read these all at once!!https://www.ncbi.nlm.nih.gov/pubmed/30715088 https://www.bmj.com/content/365/bmj.l2006 https://www.ncbi.nlm.nih.gov/pubmed/30359476 https://www.ncbi.nlm.nih.gov/pubmed/30964526 https://www.ncbi.nlm.nih.gov/pubmed/30415629 https://www.ncbi.nlm.nih.gov/pubmed/31454046https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723523 https://ginasthma.org/ https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Guidelines/2019/2019-Afib-Guidelines-Made-Simple-Tool.pdf https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext https://www.ncbi.nlm.nih.gov/pubmed/30782340 https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1 https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxishttps://journals.lww.com/greenjournal/Fulltext/2019/10000/Over

No summary YET! I promise it is coming, but here are a few more articles I think were pretty impressive from 2019.

It is that time of year again-- Top articles of 2019 part 1. This is my opinion, but I think it is a pretty good opinion.