Clinical Conversations

Latest Episodes:

Podcast 101: Osteoarthritis, chondroitin, and glucosamine — one of these things doesn’t belong. Sep 17, 2010

Show notes

Answer: Osteoarthritis. Two are nostrums and the other is a disease, but the nostrums have no appreciable effect — on osteoarthritis at least. We discuss a BMJ meta-analysis that uses novel methods to prove the point.

The good news is that neither chondroitin nor glucosamine is dangerous, but the bad news is that we spend so much hoping that this is the right combination to alleviate arthritic pain.

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BMJ meta-analysis

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Podcast 100: Practical informed consent Sep 10, 2010

Show notes

We’re not talking about philosophy here, but practical clinical approaches to making sure your patients understand what they’re agreeing to, and have the information to ask the right questions before they sign that form.

It’s podcast 100. I’m always looking for ways to make this useful, and if you have any reactions, please drop a line to jelia@jwatch.org. Thank you!

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Podcast 99: Blacks’ higher rate of stent thrombosis apparently has a genetic basis. Sep 03, 2010

Show notes

It was thought that the increased risk among blacks undergoing stenting had to do with factors such as comorbid conditions and socioeconomics. But in a study in Circulation, their rate of stent thrombosis was higher than non-blacks, even after adjusting for those factors (and despite the fact that as a group, black were more adherent to their clopidogrel regimens).

We discuss things with the paper’s senior author, Dr. Ron Waksman.

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Podcast 98: Leafy green vegetables apparently lower one’s risks for type 2 diabetes Aug 20, 2010

Show notes

Our interview this week is with a research nutritionist whose BMJ meta-analysis found a 14% reduction in risk for type 2 diabetes among those with the highest intake (versus those with the lowest) of leafy green vegetables. It’s a meta-analysis, and not a randomized controlled trial, and it’s interesting. Listen in.

We’re off next week, so I’ll see you again in early September.

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Podcast 97: What happens when vena cava filters break? Aug 14, 2010

Show notes

Vena cava filters, often meant to be permanent, can actually lose a strut or two. And it’s not as rare an occurrence as you might think. Our conversationalist found it happens about 15% of the time with a certain brand of filter. The FDA has announced that it’s starting its own studies of the problem. Listen in.

If you see something during the week that you’d like me to devote an interview to, please let me know. My email is jelia@jwatch.org. I’d love to have your suggestions.

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Podcast 96: Survivors of childhood cancer face manageable reproductive risks. Jul 30, 2010

Show notes

What becomes of children who survive cancer treatment and enter their reproductive years? Would their attempts to have children end in a higher-than-normal rate of stillbirths and miscarriages? Apparently not.

It turns out the major concern is with women who’ve undergone pelvic irradiation before menarche. That treatment seems to hobble uterine development, but not irretrievably. For their part, boys who’ve had gonadal irradiation seem not to place their offspring at higher risk for adverse birth outcomes.

Our conversation is with the senior author on a Lancet paper from last week investigating these effects.

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Podcast 95: What if hypertensive patients titrated their own drug dosages? Jul 09, 2010

Show notes

This week’s interview is with the editorialist commenting on an exciting Lancet paper. The writer, Dr. Gbenga Ogedegbe, says that the work, in which patients with uncontrolled hypertension titrated their own medications according to prespecified rules, could change how clinicians manage uncomplicated hypertension. From his base at New York University School of Medicine, Dr. Ogedegbe sees promise — if the costs are right. Listen in.

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Podcast 94: What does a new meta-analysis tell us about statins and primary prevention? Jul 01, 2010

Show notes

A meta-analysis of 11 studies encompassing more than 60,000 subjects finds that statins don’t lower all-cause mortality in people without cardiovascular disease. One editorialist calls the study, just published in the Archives of Internal Medicine, “the cleanest and most complete meta-analysis of pharmacological lipid lowering for primary prevention.”

One of the study’s principal authors, Kausik K. Ray, talked with us from London. I think you’ll find that listening in is worth your time.

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Podcast 93: Is computed tomography safe? Yes, but … Jun 25, 2010

Show notes

That’s the question asked in an intriguing essay — by a radiologist — released online in the New England Journal of Medicine. We have her as our guest this week.

Feedback, please! You can comment here or by emailing me at jelia@jwatch.org — or better still, call 1-617-440-4374.

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Podcast 92: Corticosteroids in COPD exacerbations — high-dose intravenous or low-dose oral? Jun 18, 2010

Show notes

A JAMA paper suggests that in all but the most severe exacerbations of COPD, it’s best to start off with low-dose oral corticosteroids rather than the higher-dose intravenous treatment that, contrary to guideline recommendations, almost everyone now gets. Our conversation this week is with the study’s first author, Dr. Peter Lindenauer.

Visit the Journal Watch website at http://jwatch.org for a comprehensive look at new medical research, with comments from our experts.

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