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
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.
Prior authorization requirements increased from 8% to approximately 24% of covered drugs on Medicare Part D plans between 2007 and 2019.
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
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
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.
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).
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.
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—
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
one article is good to go for HPV (maybe)
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???
clinical trials regisitery told it all
Try not to read these all at once!!
https://jamanetwork.com/journals/jama/fullarticle/2751726 uspstf now grade B for asymptomatic urine in preggo
https://pediatrics.aappublications.org/content/144/6/e20192739kids do shoot their eye out!
https://www.nejm.org/doi/full/10.1056/NEJMoa1908142Metoprolol does not treat COPD
HIV and social media!!