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Questioning Medicine
Questioning Medicine
Category: Medicine
Location: Florida
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March 23, 2020 05:09 PM PDT
March 12, 2020 06:58 PM PDT

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.com

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1705848

March 08, 2020 03:41 PM PDT

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.

March 01, 2020 10:21 AM PST

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 outliers
protect 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 insurance
Third, promote transparency, efficiency, and fairness. Technology exists to enable prescribers to view the formulary status, prior authorization requirements, and cost sharing for medications and alternatives in electronic health records (EHRs



https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757311?widget=personalizedcontent&previousarticle=2757307

FDA updated its gadolinium warning in 2010, specifying that 3 agents (gadopentetate dimeglumine, gadodiamide, and gadoversetamide)- the FDA stated that other GBCAs could be used cautiously under certain circumstances
We needed a solution so BOOM newer agents, termed group II agents (gadobenate dimeglumine, gadobutrol, gadoteridol, and gadoterate meglumine),
In this study – almost 5k pts. stage 4 and 5 CKD receiving group II GBCAs, including patients undergoing dialysis. They report a 0% pooled incidence of unconfounded NSF



https://www.bmj.com/content/368/bmj.l6669

Sticking to a healthy lifestyle including not smoking, not being overweight, and exercising regularly, is associated with a longer life expectancy at age 50 free of major diseases such as cancer, cardiovascular diseases, and diabetes,
The number of extra disease-free years is around 7.6 for men and 10 for women, compared with participants with no low risk lifestyle factors.


https://jamanetwork.com/journals/jama/article-abstract/2758598

prostate cancer and diet
Time to progression did not differ significantly between the groups (unadjusted hazard ratio, 0.96 [95 percent confidence interval, 0.75 to 1.24]; adjusted hazard ratio, 0.97 [95 percent confidence interval, 0.76 to 1.25]). For the intervention and control groups, the 24-month Kaplan-Meier progression-free percentages were 43.5 and 41.4 percent, respectively (difference, 2.1 percent; 95 percent confidence interval, −8.1 to 12.2 percent).



https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2759737?guestAccessKey=dc41fd4e-5c0c-46bb-9353-ceca16f96b25&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=020320


just read the summary- These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality.


SUMMARY
This study revealed approximately 3% to 7% higher relative risks and less than 2% higher absolute risks of incident CVD and all-cause mortality over the 30 years of follow-up. People who consume more servings per week would have greater risks.
Why they are wrong and the big problem
Furthermore, risks of CVD and mortality are determined by a range of factors, including but not limited to genetic predisposition, demographic factors, socioeconomic status, weight, lifestyle factors (eg, smoking, sleep, physical activity, and diet), and the built environment
Overall looked at 6 studies total- large heterogeneity- people could eat all sorts or amounts of meat
Food preparation methods were not consistently and universally assessed across the cohorts in this study. Therefore, separating fried chicken from poultry intake was not possible
They used questionnaires- we know people lie to be healthier on questionnaires
Only baseline diet data was analyzed from the 6 studies in this cohort. – 19 years of follow up but only used one questionnaire for each study!!!!!!!!!!!!!!!!!!!!!! only 1 dietary measurement was used—

February 24, 2020 07:19 PM PST

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 write

Patient 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 say

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32700

one article is good to go for HPV (maybe)

https://jamanetwork.com/journals/jama/fullarticle/2759002

sunscreen gets into the blood but so what

and uptodate says use Tamiflu past 48hrs but look at the study and what do we find???

https://www.ncbi.nlm.nih.gov/pubmed/31839279

clinical trials regisitery told it all

https://www.clinicaltrialsregister.eu/ctr-search/trial/2014-004471-23/results

February 03, 2020 06:08 PM PST

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

January 23, 2020 08:09 PM PST

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.

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