In recent years the medical community has grown increasingly concerned that women with heart attacks may be less likely to receive prompt and effective treatment. The difference between the sexes in the presentation of symptoms is thought to be a major barrier to better treatment for women. But now a new study published in JAMA Internal Medicine finds…
No Support For Broad Screening Of Chronic Kidney Disease
October 21, 2013 by 1 Comment
Although taught in medical school and widely used in clinical practice, broad screening of otherwise healthy people for chronic kidney disease (CKD) is unwarranted, according to new recommendations from the American College of Physicians published in the Annals of Internal Medicine. People with early kidney disease, who are classified as having stages 1 to 3 CKD, usually…
Clear! CPR in the Hospital Is Not Always Good for the Patient
September 9, 2013 by Leave a Comment
On TV it always seems clear and simple. A patient in the hospital goes into cardiac arrest and the medical team springs into action. After a few tense moments of furious activity, and only after all seems lost, the patient is successfully revived. A few scenes later the smiling and now fully healthy patient thanks…
European Heart Guidelines Based On Disgraced Research May Have Caused Thousands Of Deaths
July 31, 2013 by 2 Comments
Despite a 2-year-old scandal discrediting key evidence, current guidelines relying on this evidence have not been revised. As a result of physicians following these guidelines, some researchers say, it is possible that thousands of patients may have died each year in the UK alone. It is unlikely that a true understanding of the damage will…
Paper Raises Hundreds Of Questions About The Integrity Of Stem Cell Research Group
July 2, 2013 by 2 Comments
Serious questions have been raised about the integrity and validity of research performed by a well-established German stem cell research group. A paper published in the International Journal of Cardiology exhaustively details a multitude of discrepancies and contradictions in papers from the researcher’s group. Further, the revelation of such widespread misconduct may lead to broader disturbing questions about…
Unconventional Analysis Finds Threshold For LDL Reduction With Statins
April 29, 2013 by Leave a Comment
Using an unconventional mathematical approach, a group of Japanese researchers say there may be no good reason to reduce LDL cholesterol more than 40 mg/dl. Their research letter has been published online in JAMA Internal Medicine. According to the authors, members of the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group, most meta-analyses use linear models…
More Reasons Why Health Hype Stories Are Bad
April 13, 2013 by Leave a Comment
In response to my post yesterday about why health stories should nearly always be received with caution, I received the following comment from a distinguished cardiovascular researcher: One lost point is the role of the investigators and media in hyping their research. Hazen (principal investigator of the first study) is a bright and thoughtful guy, but through…
The Best Doctor Blog On The Internet
January 25, 2013 by 3 Comments
Let me say it right away: the best blog written by a doctor, at least that I’ve ever read, is by a provincial South African general surgeon who calls himself Bongi. He doesn’t write about complex medical policy, and he doesn’t worry too much about appropriate use criteria or whether a patient who needs anticoagulation…
Becoming Your Own Doctor In The Brave New World Of Personalized Medicine
January 17, 2013 by Leave a Comment
Lately there’s been a lot of talk about personalized medicine. There’s a bold idea going around that people should take control of their own healthcare and manage the flood of new data stemming from a whole bunch of new technologies, including, but hardly limited to, personal genomes, biomarkers, wireless sensors, and iPhone ECGs. … …boutique-style…
FDA Safety Review Finds Small, Nonsignificant Increased Risk With Chantix (Varenicline)
December 12, 2012 by Leave a Comment
The FDA today updated its safety review of the smoking cessation drug varenicline (Chantix, Pfizer). A large meta-analysis, which the FDA had required Pfizer to perform, found a higher rate of major adverse cardiovascular events (MACE) in patients taking varenicline than in patients taking placebo. However, the increase in risk was very small and did not achieve statistical…
Following Earlier Recall, Ranbaxy Halts Manufacturing Atorvastatin
November 29, 2012 by Leave a Comment
Ranbaxy, the often-troubled manufacturer of generic drugs, will temporarily stop manufacturing generic atorvastatin. On November 9, 2012 the company announced a voluntary recall of some lots of atorvastatin because of possible contamination with glass particles. An FDA statement today said that Ranbaxy will discontinue making the drug “until it has thoroughly investigated the cause of the…
Longer Warfarin Therapy After Bioprosthetic Aortic Valve Replacement May Be Beneficial
November 27, 2012 by Leave a Comment
Three months of warfarin is the usual standard of care following bioprosthetic aortic valve replacement (AVR), although the supporting evidence base for this practice is limited. Now a large new registry study published in JAMA suggests that more prolonged warfarin therapy may be beneficial. Danish researchers identified 4,075 patients who underwent bioprosthetic AVR. As expected,…
Expert Consensus Document Offers Advice On Troponin Tests
November 13, 2012 by Leave a Comment
A newly published document provides practical advice on the use of the popular and potent troponin tests. The Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations was developed by the American College of Cardiology Foundation in collaboration with several other societies to help address the many complex issues raised by the introduction…
L.A. Confidential: Preview Of AHA Scientific Sessions 2012
October 29, 2012 by Leave a Comment
The American Heart Association scientific sessions, which start next weekend in Los Angeles, will be bigger than ever, with 853 separate sessions– 111 more than last year– and 27 late-breaking clinical trials– 6 more than last year. Elliott Antman, chair of the scientific sessions program committee, provided a preview of some of the highlights of this…
Research And Denial At St Jude Medical
October 26, 2012 by 2 Comments
Research and development is the cornerstone of medical progress, but sometimes R&D turns into its evil twin brother, research and denial. Yesterday I reported on the the RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment) trial presented at the TCT meeting in Miami. The trial missed its primary…
FDA Panel Recommends Approval Of Mipomersen For Familial Hypercholesterolemia
October 18, 2012 by 1 Comment
The FDA’s Endocrinologic and Metabolic Drugs Advisory Committee gave a weak endorsement to mipomersen, an antisense oligonucleotide inhibitor manufactured by Genzyme, for use in homozygous familial hypercholesterolemia (FH). With its relatively close 9-6 vote, and with its comments, the committee expressed concerns about both the efficacy and safety of the drug, but ultimately the severity of…
UK Study Casts Doubts On Value Of Type 2 Diabetes Screening
October 4, 2012 by Leave a Comment
The dramatic growth in type 2 diabetes has resulted in increased interest in screening programs. Now a new study published in the Lancet raises concerns that screening programs may not result in long-term improvement in outcomes. In the ADDITION-Cambridge study, investigators in the UK randomized general practices to either screening or no screening. The practices allocated to…
Stem Cell Therapy Company Hypes Preliminary Results
July 5, 2012 by 3 Comments
Update (July 6)– I have heard from several investigators in the trial that the Osiris press release was issued without any input or consultation from the site investigators. In fact, the site investigators, including several who are extremely experienced clinical trialists, have expressed frustration and disappointment because their input has not been sought at any point…
One Reader’s Negative View Of Mark Midei
July 3, 2012 by Leave a Comment
A few months ago I posted a lengthy piece about Mark Midei, the interventional cardiologist from Maryland who had his medical license suspended last year following a lengthy scandal in which he became the poster-boy (or scapegoat, depending on whom you ask) for all that’s wrong with interventional cardiology in the US. Although I was highly critical…
Many CHF Patients Not Receiving– Or Getting Benefits From– High Dose ACE Inhibitors And ARBs
July 3, 2012 by Leave a Comment
Although current guidelines recommend that ACE inhibitors and angiotensin-receptor blockers (ARBs) be used in high doses in patients with congestive heart failure, many CHF patients currently receive lower than recommended doses of these drugs. In a research letter published online in Archives of Internal Medicine, investigators in Montreal analyzed data from 43,405 patients with a first…
Good Science/Bad Science: Contrasting Papers On Dietary Compositon In JAMA And BMJ
June 27, 2012 by 3 Comments
Two studies published on Tuesday on dietary composition offer a striking contrast. One tackles the interesting question of whether different diets producing the same amount of weight loss might have different effects on energy expenditure. The investigators performed a rigorous, carefully designed experiment that advances our knowledge about diets and metabolism. The second tackled an…
Is Chronic Kidney Disease A CHD Risk Equivalent?
June 19, 2012 by 1 Comment
A new study published in the Lancet provides new data about whether chronic kidney disease (CKD) should, like diabetes, be considered a coronary heart disease (CHD) risk equivalent. Marcello Tonelli and colleagues analyzed data from a population of 1.25 million people in Alberta, Canada. During a median followup of 4 years, 11,340 people were admitted to…
Real World Bleeding Risk Of Aspirin In Primary Prevention Examined
June 6, 2012 by Leave a Comment
A new study published in JAMA provides substantial new evidence about the real world effects of aspirin, including the risk of bleeding, in a broad population. The study also sheds important new light on the effects of aspirin in a diabetic population. Giorgia De Berardis and colleagues analyzed data from more than 4 million people in…
This Week In Medicine: Stop Exercising and Eat Chocolate!
May 31, 2012 by 5 Comments
It’s been a terrific few days of medical news for lazy people and chocoholics. First, a study in PLoS One provided ammunition to the exercise-averse crowd by claiming that exercise can actually be bad for some healthy people. As an added bonus, a story about the study was carried on the front page of the…
You Know Nothing, Dr. Snow: Why Medicine Can’t Be More Like Facebook
May 18, 2012 by 3 Comments
Medicine can never be like Facebook, despite what Matt Herper argues over at Forbes. Perhaps he was just trolling for hits on a day when everyone is thinking about the Facebook IPO, but Herper proposed, with apparently seriousness, that medicine needs to model itself on the tech world in order to match the kind of…
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