Questioning Medicine

https://jamanetwork.com/journals/jama/fullarticle/2751726 uspstf now grade B for asymptomatic urine in preggohttps://pediatrics.aappublications.org/content/144/6/e20192739kids do shoot their eye out!https://www.nejm.org/doi/full/10.1056/NEJMoa1908142Metoprolol does not treat COPDhttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754809?guestAccessKey=d3ef4800-287b-43aa-9d58-fd3c1e8359c2&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=111819HIV and social media!! 

https://www.nejm.org/doi/full/10.1056/NEJMoa1806515-- IVC filter after a severe injury = it is ok to wait 7 dayshttps://www.nejm.org/doi/full/10.1056/NEJMoa1904143antithrombotic therapy with afib after a pci and 1 year == just the DOAChttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31791-X/fulltextpolypill for primary prevention just might work but likely need more researchhttps://www.bmj.com/content/366/bmj.l4570the more you exercise the more you live-- seems like a basic concept and it is easy to understand but sadly hard to follow for manyhttps://www.ncbi.nlm.nih.gov/pubmed/31189511dulaglutide can save non-fatal strokes and for just 20million dollars you can help the industry make a killing in this very flawed study

https://www.ncbi.nlm.nih.gov/pubmed/31550435 mono and athletes -- stick with 21 dayshttps://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.32738 Hair Dye does not cause breast cancerhttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753986?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110619mailing the HPV kit is better because it increases screening rates

https://jamanetwork.com/journals/jama/article-abstract/2753909?guestAccessKey=03d877eb-6d48-476f-9487-aa6fbbd8a8d5&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=103019https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753986?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110619  mailing hpv gets more people screened! Shocking!https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32135-X/fulltext?rss%3Dyes patiromer might work but 70% of people don't need it cause they don't get hyperkalemia! https://www.acc.org/latest-in-cardiology/journal-scans/2019/09/04/14/45/sleep-duration-and-myocardial-infarction sleep 6-9 hours-- its good for your heart! https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30366-9/fulltext sertraline does not work for depression but it works for anxiety-- likely best to just hold off on the meds for most PCP depressionhttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2753318 cutting medications makes people happy https://annals.org/aim/article-abstract/2751453/blood-culture-results-before-after-antimicrobial-administration-patients-severe-manifestati

https://insights.ovid.com/crossref?an=00006396-900000000-98602https://jamanetwork.com/journals/jama/article-abstract/2751887?guestAccessKey=8fa2f772-1ba4-40ff-9015-4fcb46d6829e&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=091819https://www.ncbi.nlm.nih.gov/pubmed/14604741https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749268?widget=personalizedcontent&previousarticle=0https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749265https://www.jwatch.org/na44775/2017/08/10/nonsteroidal-anti-inflammatory-drugs-back-pain-andhttps://www.ncbi.nlm.nih.gov/pubmed/28153830

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2748452    -- come one come all unless you are a kidney https://www.ncbi.nlm.nih.gov/pubmed/31054907   SURPRISE!! Women prefer to do self swab rather than clinician swabhttps://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-c-screening1  If the pt. is breathing then you test for Hep Chttps://jamanetwork.com/journals/jama/article-abstract/2748796  high dose vit d. might be harmfulhttps://www.nejm.org/doi/full/10.1056/NEJMoa1811744 Canagliflozin is here and so are the SGLT2 inhibitors--IMPRESSIVE

https://www.ncbi.nlm.nih.gov/pubmed/30347032  Terbinafine adverse effects are rarehttps://www.ncbi.nlm.nih.gov/pubmed/31189511 Dulaglutide prevents MACE but at a high price taghttps://www.ncbi.nlm.nih.gov/pubmed/30853124   If you punch your buddy then get some buddy tapehttps://www.ncbi.nlm.nih.gov/pubmed/31076416 prediabetes gibes me a headache  https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Access-to-Hormonal-Contraception    Over the counter birthcontrol!! 

Let's look at the numbers behind CAC! The best evidence is found here https://jamanetwork.com/journals/jama/fullarticle/2687224 but the largest study is found here https://www.sciencedirect.com/science/article/pii/S0735109715072253?via%3Dihub but in the end they use this https://en.wikipedia.org/wiki/Net_reclassification_improvement which might trick many people but I know it won't trick the smart people that listen to questioning medicine

https://www.ncbi.nlm.nih.gov/pubmed/30874755 - ACC/AHA and ESC are still not evidence basedhttp://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.939.1670&rep=rep1&type=pdf -- only need to check every ten years-- it is the other risk factors that matter!https://www.ncbi.nlm.nih.gov/pubmed/26680162 Signal to noise is around 1 in 10 yrs

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2739056 not all guidelines are equal, think for yourself. Some guidelines even do harm when you actually look at the evidence. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740207 doacs and surgery what do you do-- low risk surgery stop one day prior and start one day after surgery. with high risk surgery you stop two days prior and start two days after https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871?guestAccessKey=90abe76b-3a15-4b95-9b42-4f751c5fbe64&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=etoc&utm_term=081919 Pt in the hospital for a non-cardiac condition and they have a high bp== don't worry about it- no evidence for what one week of high bp will do but we do have evidence that starting medications while in an acute state will cause harm. just let it be!!https://ginasthma.org/wp-content/uploads/20

https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 even when we dont know where the stroke is coming from- aspirin is still king all these years later https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30840-2/fulltext Aspirin is such a king that is doesn't matter if you have a spontaneous brain bleed or intracerebral hemorrhage it does appear safe to restart aspirin after a 2-3 month breakhttps://jamanetwork.com/journals/jama/article-abstract/2736564 smart-choice trial looked 3 months compared to 12 months of DAPT and https://jamanetwork.com/journals/jama/article-abstract/2736563 STOPDAPT-2 trial looked at 1 months followed by monotherapy clopidogrel compaed to 12 months of DAPT and BOOM 1 month is winner winner chicken dinnerhttps://www.ncbi.nlm.nih.gov/pubmed/31063082 all of medicine has variation- some pcp will give an antibiotic for otitis media. some will not. Some radiologist will say follow up is needed and some will nothttps://ginasthma.org/pocket-guide-for-asthma-management

https://www.cdc.gov/mmwr/volumes/68/wr/mm6825a2.htm we are not testing people for HIV even though guidelines https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1 since 2006 have recommended that everyone be tested! 13yrs later!! Time to do it!!https://www.ncbi.nlm.nih.gov/pubmed/30658933 The self swab is as good if not better than provider or clinician testing- it is time to educate the population and move to at home cancer screening- save the office visits for important things- like what to do in the 7% of women that are hpv positive. https://www.fda.gov/drugs/medication-health-fraud/public-notification-big-penis-contains-hidden-drug-ingredient?utm_campaign=CDER%20New%2007%2F17%2F2019&utm_medium=email&utm_source=Eloqua&elqTrackId=6371f8c053574a478fea3a734e8041ed&elq=1631be58825d49e3803c4b92a2cb8553&elqaid=8776&elqat=1&elqCampaignId=7246 Big Penis is a drug that has the drug Viagra in it- over t

https://www.ncbi.nlm.nih.gov/pubmed/30608562 A1C level low is not good and high is not good cause both seem to wind up have you the pt. in the hospital for hypoglycemia- the low point of the U curve is around 7-8% which ironically seems to fit perfectly with recent guidelineshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735985 pts don't take the medications and if they have hypertension at least in this candania study 1/3 were magically curred of their hypertension one they were monitoredhttps://www.ncbi.nlm.nih.gov/pubmed/31147311 PPI are still a drug with real side effects and should not be given out like candy but if your patient needs them they lets make no mistake about it they do work really really well http://cancerpreventionresearch.aacrjournals.org/content/12/5/305 smoking puts you at 2-3 times risk of bladder cancer-- peeing blood is not for me so I choose not to smoke https://www.ncbi.nlm.nih.gov/pubmed/31112386 no more PRN albuterol -- instead when you want to write fo

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext If you are over 70 or 75 and primary prevention then likely no benefit in statins and secondary benefit is very small https://www.nejm.org/doi/full/10.1056/NEJMoa1806802 Get the glucose down! After you max out other risk factors as intensive control doesn't have a legacy effect https://www.nejm.org/doi/full/10.1056/NEJMoa1809944 vit d doesnt beat placebo for anything- ever. Except for the vit d lab number https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-hypoactive-sexual-desire-disorder-premenopausal-women Vyleesi (bremelanotide) will make you have more sexual desire on a sexual desire scale but not more sex-

https://www.ahajournals.org/doi/10.1161/JAHA.118.011318 energy drinks prolong the QT just ever so slightly in healthy 22yr olds so if you are thinking of telling grandma to slam 32ounces of energy drink and she is on QT prolonging medication then you probably shouldnt https://www.nejm.org/doi/full/10.1056/NEJMoa1808082 zolendranae is not a magic drug that cures osteopenia they just have magic trial makers the rigged the trial to show benefit https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2734709 in a study that looked at 7 days of step for 70 plus year old women it seemed that over 2000 seem to have a cardiac benefit and the benefit significantly leveled off around 4000 steps https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734798 if going to the dentist and you have a fake heart or fake heart valve or previous endocarditis then you need antibiotics else you dont https://jamanetwork.com/journals/jama/fullarticle/2717474 give a ppi with anticoag to prevent GI bleed

vitamin d- if you cant give up on it then give up on checking the lab value- fire and forget. https://www.nejm.org/doi/full/10.1056/NEJMoa1800566 induction at 39 weeks is okay with me https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2698631 cardio test and all test have varibilityhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/fulltext our evaluation of you prior to surgery is basically worthless based on current evaluation or stress test https://annals.org/aim/article-abstract/2708163/kidney-damage-biomarkers-incident-chronic-kidney-disease-during-blood-pressure kidney disease from lower bp doesnt seem to be actual damage just hemodynaic effect https://www.ncbi.nlm.nih.gov/pubmed/30688979 lower that bp and doesnt seem to have an effect on dement and might even be protective https://www.gastrojournal.org/article/S0016-5085(18)35193-X/fulltext pt going for elective colonoscopy- keep the clopidogril

afib- new guidelines! https://www.google.com/search?q=2019+American+Heart+Association%2C+American+College+of+Cardiology+and+the+American+Rhythm+Society+focused+update+from+their+2014+guidelines+for+the+management+of+patients+with+atrial+fibrillation&rlz=1C1CHFX_enUS708US708&oq=2019+American+Heart+Association%2C+American+College+of+Cardiology+and+the+American+Rhythm+Society+focused+update+from+their+2014+guidelines+for+the+management+of+patients+with+atrial+fibrillation&aqs=chrome..69i57.1079j0j7&sourceid=chrome&ie=UTF-8 FIT test has high sensitivity and specificity for crc and it gets more people to do colon cancer screening and lets be honest it is only a good test or a good drug if people actually do it https://www.ncbi.nlm.nih.gov/pubmed/30802902 afib can wait to be converted and over 50% of the time will convert on its ownhttps://www.nejm.org/doi/full/10.1056/NEJMoa1900353 good news for you lazy people listening to this on the couch you can still inprove your all cause mortality

https://www.bmj.com/content/364/bmj.l42 skip breakfast- it doesn't help you 'lose weight' https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723074 Automated BP cuffs are the new rage and for good reason they are about equal to awake ambulatory blood pressure https://www.ncbi.nlm.nih.gov/pubmed/30653040 if you have a pt. going to surgery for their knee because of osteoarthritis-- let it be and DONT do an injection. https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(18)30191-1/fulltext if you have a choice-- give apixaban https://jamanetwork.com/journals/jama/article-abstract/2719307 you can not pay physicians for readmission but then they will try and game the system and in the pt. misses out and dies more often-- oops https://jamanetwork.com/journals/jama/article-abstract/2727448 tramadol increase mortality! WOW shocker-- maybe this isn't real but it is really is worthing making us stop to think.

shared decision making for lung cancer rarely happens in the community and when it does happen 2/5 said no thanks to cancer screeninghttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2720126 vit d. - does not work on a bus it doesn't work with white women or black women anyonehttps://www.ncbi.nlm.nih.gov/pubmed/29905969 achilles tendon rupture- if you go to surgery NNT for rerupture of 1 and 66 but risk of infection 1/33https://www.bmj.com/content/364/bmj.k5120 Topical pain creams dont work for chronic pain- BUT low risk of side effects and still getting almost 2 point decrease on 10 point scale-- I will take it!https://annals.org/aim/article-abstract/2724041/compounded-topical-pain-creams-treat-localized-chronic-pain-randomized-controlled Alirocumab is still way too expensivehttps://www.ncbi.nlm.nih.gov/pubmed/30597485 concussion in an athlete-- get them to the sub-symptom heart rate https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723523