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A VIDEO RECORDING OF THIS INTERVIEW WILL BE AVAILABLE WITHIN A FEW DAYS. [display podcast] In treating most exacerbations of chronic obstructive pulmonary disease (COPD) the usual regimen consists of prednisone plus 5- to 7-days of antibiotics. But what if a shorter course of antibiotic therapy would do? That would be both convenient for patients and less […] The post Podcast 298: COPD exacerbations — 7 days of antibiotics versus 2 first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. This time, we look to New York for guidance on recognizing and treating monkeypox. Dr. Eric Meyerowitz of Montefiore and Dr. Stephen Baum of Einstein will lead you through the monkeypox thicket in a 17-minute chat. Included below is information for patients as well as links to some key […] The post Podcast 301: Monkeypox — what to look for, how to treat first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. We're back with another interview from this year's IASLC conference. This time, Christine Sadlowski and Dr. Julia Rotow interview Dr. Mariano Provencio about the survival outcomes from the NADIM II trial. In that trial, patients with resectable stage III AB non-small cell lung cancer received nivolumab plus chemotherapy […] The post Podcast 300: NADIM II trial offers “quite exciting” results in lung cancer first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. Interim results on overall survival in phase 3 of the IMpower010 trial were presented at this year's meeting of the International Assosciation for the Study of Lung Cancer (IASLC). As part of the NEJM Group's coverage of the conference, Christine Sadlowski interviewed the presenter, Dr. Enriqueta Felip. […] The post Podcast 299: Lung cancer and atezolizumab — results from the IMpower010 trial first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW WILL BE AVAILABLE HERE SHORTLY. THE USUAL AUDIO FILE IS AVAILABLE BELOW Steven Cummings has co-written a take-no-prisoners editorial in the New England Journal of Medicine. The topic? Vitamin D supplements. The conclusion? “…providers should stop screening for 25-hydroxyvitamin D levels or recommending vitamin D supplements, and people should stop taking […] The post Podcast 297: Forget about all that vitamin D testing! first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS ROUNDTABLE IS AVAILABLE HERE. Your host is old enough to remember when hospital corridors featured physicians with little black bags, scurrying around to see their patients. That's no longer true, of course. Most of the physicians seen in those corridors these days are white-coated employees. The Annals of Internal Medicine reported a few […] The post Podcast 296: A roundtable on the question, Why are young internists flocking to the hospitalist practice style? first appeared on Clinical Conversations.

CREST-2's results are probably more than a year away. In the meantime, what to do about diagnosed severe (but asymptomatic) carotid stenosis? Recent results suggest that medical management compares favorably with the surgical approach. In this edition, we address the question with a conversation between Dr. Allan Brett, NEJM Journal Watch‘s editor-in-chief, and Dr. Seemant Chaturvedi, […] The post Podcast 295: How should clinicians manage severe (but asymptomatic) carotid artery stenosis while awaiting CREST-2's results? first appeared on Clinical Conversations.

Locally advanced rectal cancer usually receives a three-part treatment: chemotherapy followed by radiotherapy and then surgery. In a small-cohort study presented at this year's ASCO conference researchers used a PD-1 inhibitor — dostarlimab — every three weeks for 6 months against the disease. All patients had mismatch repair deficient tumors. No other treatments were needed however, […] The post Podcast 294: PD-1 blockade in locally advanced rectal cancer first appeared on Clinical Conversations.

Patients with metastatic breast cancer whose tumors express low levels of HER2 are generally classified and treated as having HER2-negative disease. However, Dr. Shanu Modi of the Memorial Sloan Kettering Cancer Center and a group of international collaborators explored the use of a monoclonal antibody–drug conjugate (trastuzumab–deruxtecan) in patients with disease they classify as HER2-“low.” Compared […] The post Podcast 293: HER2-“low” breast cancer and its reponse to an antibody-drug conjugate first appeared on Clinical Conversations.

Apnea testing is part of the protocol used to determine whether a patient is dead according to neurologic criteria. The question is, do clinicians need to obtain consent to proceed? In a fascinating 15-minute chat, two intensivists, Drs. Patricia Kritek and Robert Truog, discuss that question and another, larger one: what is death, anyway? Their back-and-forth […] The post Podcast 292: Informed consent and apnea testing for death — or — What is death, anyway? first appeared on Clinical Conversations.

In the early waves of the Covid-19 pandemic why did patients in unionized nursing homes, have a roughly 10% lower rate of mortality than those in non-unionized ones? A report in Health Affairs tries to sort out the possible reasons. Listen to our 13-minute interview, which raises the question: Should you send your patients to non-unionized facilities? […] The post Podcast 291: Unionized nursing homes had lower mortality during Covid-19 first appeared on Clinical Conversations.

The U.S. Preventive Services Task Force recently issued its sixth set of guidelines on using daily aspirin to prevent cardiovascular disease. The guidelines appeared in JAMA — whose editors asked our guest, Dr. Allan Brett, to write an editorial evaluation. This edition carries Brett's advice on using the new guidelines in daily clinical practice. Brett's JAMA editorial USPSTF […] The post Podcast 290: USPSTF's new take on aspirin and primary prevention of CVD first appeared on Clinical Conversations.

Saline or balanced crystalloids? The question of which resuscitation fluid to use in clinical practice seems to have been settled by recent research findings — or at least settled in favor of balanced crystalloids. But wait, our guests see slight differences that may affect your choice. Patricia Kritek practices critical care medicine at the University of […] The post Podcast 289: Saline versus balanced crystalloids — what to choose first appeared on Clinical Conversations.

Spend 15 minutes with Dr. Natalia Shevchuk, whom we interviewed by candlelight last month. She is sheltering in the Odessa region now, having left the Donetsk area. This time, she relates how she lost a colleague in Russia's attack on the Kramatorsk railway station and found another she'd feared lost in Mariupol. She told us that […] The post Podcast 288: Following up with a Ukrainian narcologist first appeared on Clinical Conversations.

During the American Academy of Neurology's 2022 meeting in Seattle, Dr. Richard Lipton of Albert Einstein College of Medicine took questions from Dr. Teshamae Monteith (U. Miami) and Joe Elia. Lipton's group sought to characterize the impact of patients' monthly headache days on their quality of life, especially the role of depression, allodynia, and anxiety. (Read […] The post Podcast 287: Thinking about quality-of-life in migraine first appeared on Clinical Conversations.

Dr. Natalia Shevchuk (pictured above) treats substance use disorders in Ukraine's Donetsk region. Her face is candlelit because her town is under curfew, and people aren't allowed to put on their room lights (if they have electricity) in the hours of darkness, lest Russian bombardments use the lights as guides. She talked with Dr. Ali Raja […] The post Podcast 286: Talking about addiction treatment by candlelight from Ukraine's Donetsk region first appeared on Clinical Conversations.

Gastroesophageal reflux, or GERD, was the focus of a revised set of guidelines issued in January in the American Journal of Gastroenterology. Given the frequency of that condition in primary care clinics, internist and NEJM Journal Watch editor-in-chief Allan Brett proposed a discussion about the practical application of these guidelines with David Bjorkman. Dr. Bjorkman, […] The post Podcast 285: GERD's revised guidelines — an internist and a gastroenterologist discuss them. first appeared on Clinical Conversations.

Some 85 years ago Guernica was bombed, and after that came Dresden, Coventry, Hiroshima, Bach Mai, and the rest. This episode of Clinical Conversations asks how it might be possible to help clinicians under bombardment in Ukraine. As you will hear, one hospital in Chernihiv keeps all but essential staff away from its buildings when […] The post Podcast 284: The clinical situation in Ukraine first appeared on Clinical Conversations.

You want more evidence that post-recovery vaccination against Covid-19 reinfection helps? Here is a careful study from the U.K. that followed some 35,000 health care workers — initially without symptoms — in over 100 institutions there. Starting in June 2020 the SIREN study tested these people regularly, with blood sampling every month and nasal swabs […] The post Podcast 283: More data — this time from the U.K. — about post-Covid vaccination first appeared on Clinical Conversations.

Governments' directives about how and when to vaccinate people who've recovered from Covid-19 vary widely. But, according to this episode's guest, Dr. Ronen Arbel, they all say they don't have enough evidence to set firm policy. So, Arbel and his colleagues set out to collect evidence from some 150,000 patients' records in Israel who'd recovered […] The post Podcast 282: Vaccination after Covid-19 recovery prolongs natural immunity to reinfection first appeared on Clinical Conversations.

Why can't the U.S. control prescription drug pricing as they do in the U.K., where per-capita spending is less than half our level? In a capitalist democracy, many parties — the drug companies, medical associations, consumer groups — get to lobby their points of view. Is the problem intractable, or just an exercise in chaos? Our three […] The post Podcast 281: Drug Costs — What's “The Right Price” for prescription pharmaceuticals? first appeared on Clinical Conversations.

Multisystem inflammatory syndrome in children (or MIS-C) is a serious complication of Covid-19 infection, usually showing up about a month after infection. CDC worked with several hospitals around the U.S. to discern whether vaccination in adolescents would lessen the likelihood of this outcome. A vaccine hadn't yet been approved, as it now is, for kids between […] The post Podcast 280: MIS-C after Covid-19 in adolescents — can vaccination prevent it? first appeared on Clinical Conversations.

Kiarri Kershaw has written a simple letter in JACC — the Journal of the American College of Cardiology. The letter conveys a strong message: health inequities don't act uniformly across one's lifetime. Her examination of Black versus white mortality from all causes and from cardiovascular causes with the use of age-specific data shows places in […] The post Podcast 279: Age-specific data do better than age-adjusted data in revealing health inequities first appeared on Clinical Conversations.

An internist at Massachuetts General Hospital, Dr. Joseph Betancourt also runs their program on equity and community health. In this, the final entry in our four-interview exploration of race and clinical equity, Betancourt talks about the need for medical institutions to pay attention to what’s happening in their patients’ communities. To that end, MGH has a […] The post Podcast 278: Where equity and community health intersect — a conversation with Joseph Betancourt first appeared on Clinical Conversations.

Dr. Sheares talks about her experience with inequities. She believes that clinicians should aspire to be students of their patients as well as of the pathophysiology of the diseases their patients present with. Listen in. Running time: 20 minutes The post Podcast 277: Race and clinical equity — know your patients — a conversation with Karen Dorsey Sheares first appeared on Clinical Conversations.

In this, our second conversation on race and clinical equity, Dr. Karol Watson of UCLA offers her observations on what she’s observed as a cardiologist trying to deal with treatment plans for patients who’ve lost their health insurance or have had to go to a plan that doesn’t cover what’s needed. She reminds us that tagging […] The post Podcast 276: Pay attention to the structural barriers that contribute to clinical inequity — Karol Watson first appeared on Clinical Conversations.

We’ve conducted a set of four interviews with physicians on the topic of race and clinical equity. The conversations center not so much on their published research, but on the roles that these physicians take in their organizations and, in addition, the stories they tell about their own experiences. Our first is with Dr. Kimberly Manning, who’s […] The post Podcast 275: Race and Clinical Equity — a Conversation with Dr. Kimberly Manning first appeared on Clinical Conversations.

Apologies for the long silence. We have been off doing other things — one of which has been figuring out how to cover conferences. Last month, after much preparation, we covered the American Society of Hematology (ASH) annual conference; our second foray consists of brief coverage of the American Society of Clinical Oncology (ASCO) gastrointestinal […] The post Podcast 274: Preliminary Thoughts on the 2021 ASCO Gastrointestinal Cancer Conference first appeared on Clinical Conversations.

Eric Rubin is editor-in-chief of the New England Journal of Medicine. I asked him how Covid-19 has affected that journal, which has been around since the War of 1812 and seen its share of pandemics. Listen in — it’s the first in a planned series of interviews with the editors of the principal clinical journals. Running time: 19 minutes […]

Dr. Paul Sax writes the closest thing that the NEJM Group has to humor. He’s serious, of course, since his blog “HIV and ID Observations” concerns all things infectious . But he sprinkles in the odd cartoon or links to … dog videos, fer cryin’ out loud. He scours the ID literature (and we must include […]

Back in late March (people often tell me that, these days, 4 months ago might as well be 4 years ago) we talked with emergency physician Julian Flores, who was working out of Broward County. Covid-19 cases were modest in number but threatening to get worse, and indeed they did. The county’s cases jumped 100-fold, from […]

Don’t expect HIPAA regulations to protect your “digital health footprint” from prying eyes. Every time you swipe your card to buy goodies at the supermarket (are you risking diabetes with all that ice cream?), or binge-watch that kinky series (how’s your mental health these days, really?), or let your step-tracker show you’ve fallen off the pace […]

We interview Dr. Michael Gonzalez, a Houston-based emergency physician, who describes the situation there as “an ongoing, slow-rolling, level 6 hurricane that just isn’t gonna go away and, more importantly, isn’t gonna tell us when landfall is coming and when it’s gonna be over.” How are his patients reacting to this surge? What does he do […]

This time Dr. Ali Raja and Joe Elia talk with two authors of a study that found disparate effects on traffic deaths from the legalization of recreational cannabis. The two states under study, Colorado and Washington, were compared, not with each other, but with a composite of states that most closely resembled what Colorado and […]

The novel coronavirus obviously has devastating effects on the lungs, but other, less immediately visible attacks occur — notably to the kidneys. Dr. Steven Fishbane (a nephrologist) and his colleagues have just published their findings based on a survey of some 5500 patients with COVID-19 admitted to a metropolitan New York health system. Acute kidney injury […]

A combination of three antivirals — Kaletra (which is lopinavir plus ritonavir) and ribavirin — when given early and with interferon significantly reduces viral shedding, disease symptoms, and hospital stay in  patients with COVID-19 when compared with a control regimen of Kaletra alone. The drugs are active against other coronaviruses, but the key factors seem […]

We (Dr. Danielle Bowen Scheurer and Joe Elia) talk with Dr. John Jernigan of the CDC COVID-19 Investigation Team, which recently published its findings on the spread of COVID-19 in a Seattle-area skilled nursing facility. Most intriguingly, over half the patients who tested positive were asymptomatic at the time of their first testing, and a few […]

Cardiovascular consults are way down. Is the threat of COVID-19 infection scaring people away from EDs? We caught up with Dr. Comilla Sasson, the American Heart Association’s VP for science and innovation. She’s an emergency physician who teaches at the University of Colorado. She’d traveled to New York City to “help with the response,” and she […]

This week’s guests, Dr. Andre Sofair and Dr. William (“Rusty”) Chavey are physician-editors on the daily clinical news alert called Physician’s First Watch. I went back through the recent issues and found this January 10 entry, which began “The CDC is requesting that clinicians ask their patients with severe respiratory disease about any travel to Wuhan […]

Four weeks ago — in early March — I interviewed Dr. Renee Salas about climate change and clinical medicine. Back in those halcyon days, COVID-19 was very much a gathering storm, but it had not yet slammed into the United States. Here we are, over 10,000 U.S. deaths later in early April, not having heard of much […]

We talk with Colleen Farrell who’s doing her third year of an internal medicine residency in New York City. Fortunately, we caught her during a one-week vacation (she was supposed to be taking two), and she chatted with us about how she and her colleagues are coping. We asked her what she thought COVID-19’s larger lessons would […]

San Diego County has Dr. Kristi Koenig as medical director of its emergency medical services. That’s fortunate for the county, because she’s co-edited a definitive textbook, “Koenig and Schultz’s Disaster Medicine: Comprehensive principles and practices.” We’re fortunate to have her as our guest. She’s full of sound advice on organizing a community’s response (for example, setting […]

This time we talk with Dr. Julian Flores, who works in a Broward County, Florida, emergency room. When he was interviewed, the count of Covid-19 cases stood at 412, less than 12 hours later, the new number was 505, as of this posting — on Friday near noon Eastern — it’s at 614. Flores is expecting […]

Dr. Matt Young is a first-year resident in obstetrics and gynecology in suburban Delaware. Between the day I invited him to be interviewed and the interview itself (a 36-hour span) things had changed a lot for him. Anxiety levels are up among his colleagues, and everyone in his hospital must wear a mask all the time. […]

We talk with Susan Sadoughi, an internist at Brigham & Women’s Hospital in Boston, about how quickly things have changed over the past week. Last week, I introduced the Fauci interview by saying that I’d heard a clinician complain that she’d spent half her time answering questions about COVID-19. This week, she’s our guest, and she’s […]

We have Dr. Anthony Fauci of NIAID to talk with us about COVID-19, the disease caused by the 2019 novel coronavirus (also known as SARS-CoV-2). He’s full of sound advice in the midst of a rapidly changing epidemic. We wanted to know, How do you talk with patients about this rapidly spreading infection? How do you […]

Here we have an interview with Prof. Feng He, whose English is much better than my Mandarin. Thus, I’ve attached a transcript to make her ideas on salt intake (no level is too low) and blood pressure (there’s a dose-response relation with salt) more immediately available than it might be to your ears alone. She’s coauthor […]

JAMA recently published a review of some 40 papers examining the relation between malpractice liability strategies — tort reform, increased insurance premiums, etc. — and the quality of care. Apparently the efforts had no discernible effect on mortality rates, length of hospital stays, and the like. An editorial accompanying the paper sketches out a vision of […]

With human papillomavirus vaccine in short supply around, moving from a three- or two-dose regimen to one dose would immediately double or treble supplies, cut costs, and simplify logistics. A careful study in Cancer by this week’s guest, Ana Rodriguez, and her colleagues adds to the evidence that single-dosing is possible and protective against pre-cancerous cervical lesions. […]

Back in November, Ali Raja and Joe Elia talked with Garen Wintemute about his Health Affairs paper regarding addressing the topic of guns with patients. Having encountered another of those weeks in which interviewees were either on vacation (richly deserved, we’re certain) or too busy to respond to Joe’s requests (get some sleep!), we’re going to […]

Intermittent fasting has salutary effects. Listen how Dr. Mark P. Mattson, co-author of a recent NEJM review on the topic, assesses the practice — and how he’s managed to skip breakfast for the past 30 years or so. Dr. Ali Raja joins Joe as co-host again this time. Links: de Cabo and Mattson’s review in the New […]