Accupuncture for knee pain (and two other articles)

In the Annals of Internal Medicine due out on December 21 are three “alternative medicine” articles. The lead article, effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee, randomized 570 patients with osteoarthritis of the knee to one of three interventions: a 26 week tapering schedule of acupuncture, sham acupuncture, or six 2-hour […]

MRI for breast imaging

Last week’s JAMA had an article on magnetic resonance imaging of the breast prior to biopsy, which evaluated the performance of MRI imaging in evaluating patients with breast abnormalities. This study found that MRI had good sensitivity but only moderate specificity for detecting cancer. The negative predictive value of MRI was only about 85%, not […]

Defibrillators post-MI — a note of caution

The use of implantable cardioverter-defibrillators for the prevention of sudden death in patients who are at high risk for but have not yet had cardiac arrest (primary prevention) is gradually expanding. A number of trials have shown mortality benefit in different populations: MADIT: benefit in patients with coronary disease, ejection fraction less than 35%, spontaneous […]

D-dimer for the diagnosis of recurrent DVT

Diagnosing recurrent venous thromboembolic disease of the legs is more difficult than diagnosing a first episode of DVT. Patients who have had an initial DVT are often left with some degree of post-phlebitic syndrome, which can mimic the symptoms of recurrent disease. Duplex ultrasound often remains abnormal after a DVT, making the distinction between recurrent […]

Better living through electricity?

Atrial fibrillation is associated with increased morbidity and mortality, in part because AF is a marker for other cardiovascular risk factors such as hypertension, valvular disease and left ventricular dysfunction. AF is also deleterious in its own right, due to the rapid, irregular heart rate, loss of atrial systole and atrial thromboembolism. Thus, there is […]

Authors’ replies

Dr. Lucy Yardley, corresponding author for the paper on vestibular rehabilitation, has posted comments directly addressing my critiques. Dr. Robert Belshe, corresponding author of the first of the two NEJM articles on intradermal flu vaccination, emailed several corrections to statements I had made. These are important points. Dr. Mathew Hotopf, corresponding author of the article […]