the future of Medicare

Healthcare for the elderly in the United States is in an untenable financial situation. This is the result of a convergence of factors: an aging population with increasing life expectancy; the pharmaceutical and device industries devising new and very costly techniques and applying them to this population; the sophistication of patients, demanding them. All of […]

Check out this Journal Club

My attention was drawn to this recently launched website, that aims to act as an online journal club. It is just getting rolling and has some bugs, but is quite interesting. Rather than try to describe it, I suggest checking it out: Journal Review

The zoster vaccine

The lead article in yesterday’s NEJM, A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults, presents the results of a VA Cooperative Study looking at the efficacy of a high potency, live attenuated VZV vaccine developed by Merck from the Oka/Merck strain. The results are encouraging, with a reduction in the incidence […]

Why don’t we just put statins in the water supply and be done with it?

Statins and the risk of colorectal cancer in last week’s NEJM is a case-control study from Israel that looked at about 2000 patients with colorectal cancer and a similar number of controls, and found that “the use of statins for at least five years (vs. the nonuse of statins) was associated with a significantly reduced […]

Multidetector spiral CT for PE

Last week’s NEJM has an article, from Switzerland and France, on multidetector-row computed tomography in suspected pulmonary embolism. Rationale The authors state that first-generation, single-detector, spiral CT scanning is quite specific (90%) but not very sensitive (70%) for detecting pulmonary emboli. In two previous studies by their group, negative CT scans were contradicted by positive […]

Cardiac resynchronization in heart failure

Patients with heart failure often have intraventricular conduction delays (such as bundle branch blocks), which cause the ventricles to contract dyssynchronously, in an inefficient manner. This is the rationale behind the implantation of biventricular pacing devices to restore synchrony. The effect of cardiac resynchronization on morbidity and mortality in heart failure, in this week’s NEJM, […]

Intensive lipid-lowering therapy

[Back after a two-month hiatus, due to busy practice, vacation, and time spent/wasted playing with video editing software and a new camcorder…] In this week’s NEJM, Intensive lipid lowering with atorvastatin in patients with stable coronary disease makes an argument in favor of reducing LDL cholesterol levels for secondary prevention to lower than the current […]

Take two ximelegatran and call me in the morning

[Addendum, 2/14/05: as has been pointed out by commenters, ximelagatran was turned down for approval by an FDA panel in September, 2004, because of concerns about hepato-toxicity. Whether it will ever be marketed in the US is very much in doubt. The following post has been slightly edited with this in mind.] Coumadin is such […]