Podcasts about nejm

This week, we explore new evidence comparing oral anticoagulants for acute venous thromboembolism, treatment for chemotherapy-induced thrombocytopenia, and early results of gene therapy for inherited deafness. We also examine evolving strategies for chronic lymphocytic leukemia, review the management of polymyalgia rheumatica, and present a case discussion of a woman with chest pain, dyspnea, and syncope. We explore gastric cancer prevention, competency-based billing, the health consequences of immigration enforcement, access to high-cost gene therapies, and we present a Perspective on good compressions.

Abbas Hassan is a plastic surgery resident at the Indiana University School of Medicine. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A.M. Hassan and J.F. Waljee. Valuing Care Provided by Residents and Fellows — Toward Competency-Based Billing. N Engl J Med 2026;394:1041-1043.

Send a textYou read everywhere that you “should” cut salt—especially if your blood pressure is up. But salt also makes food enjoyable. In this episode, I walk through the human evidence (not animal studies) and frame salt as a risk–benefit tradeoff: when does sodium meaningfully matter, for whom, and how can you test your sensitivity?Big questions we answerIf you have high blood pressure: does lowering salt always help?If your BP is normal but you have heart/kidney risk: does salt matter?If you're basically healthy: how worried should you be?Key takeawaysSodium is essential (nerves, muscles, fluid balance)—the issue is dose and individual response.Most sodium comes from packaged/restaurant foods (not your salt shaker).Salt restriction lowers BP, but the average effect is modest compared with typical BP meds (context matters).Salt sensitivity varies: roughly ~30% of healthy people and ~40–50% of people with hypertension may be “salt-sensitive” (with higher rates in older adults, women, and some ancestry groups).If you're salt-sensitive—especially with hypertension—being mindful of sodium is likely worth it. If you're not, the “must be low-salt for everyone” story is less clear.Practical: Do an N-of-1 salt sensitivity testMeasure home BP daily (or a few times/day) for a weekGo lower-sodium for 1–2+ weeks (at least within guidelines, possibly lower)Track BP changeAdd salt back and watch what happensOptional: repeat the low-salt phase for confirmation If BP shifts meaningfully (often ~3–5 mmHg+), you may be salt-sensitive.Food reality check (why sodium adds up fast)~10% of a 2,300 mg/day sodium “budget”: 2 slices bread, 1 Tbsp ketchup, or a pinch of salt~1/3: 1 cup canned soup, 1 slice pizza, or a Big Mac~1/2: frozen lasagna, a few deli slices, or a 6” cold-cut sub Cooking mostly from whole foods makes staying lower-sodium much easier.Studies & resources mentioned (links embedded)CDC hypertension awareness/treatment/control stats: https://www.cdc.gov/nchs/products/databriefs/db511.htmHypertension outcomes review (risk of events/death): https://pmc.ncbi.nlm.nih.gov/articles/PMC8292050/Population sodium/BP overview (JACC): https://www.jacc.org/doi/10.1016/j.jacc.2019.11.055DASH-Sodium trial (NEJM): https://www.nejm.org/doi/full/10.1056/NEJM200101043440101Sodium restriction meta-analysis (BP/outcomes): https://pmc.ncbi.nlm.nih.gov/articles/PMC12624901/Salt sensitivity overview (AHA/Hypertension): https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.17959Heart failure trials/meta (salt restriction): https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.122.009879Salt substitute trial (NEJM): https://www.nejm.org/doi/full/10.1056/NEJMoa2105675Call to action Are you going to run your own N-of-1 salt test? If you do, I'd love to hear what you learn.Reminder: I'm an educational resource, no

O panorama da saúde de hoje traz os principais tópicos do 2º Fórum da Mulher Médica, abordando como a maioria feminina na profissão está a redefinir liderança, jornadas de trabalho e a cultura dos serviços de saúde. Analisamos também a discussão recente do NEJM sobre a individualização das metas de pressão arterial, reforçando a importância de equilibrar os benefícios cardiovasculares com os riscos, especialmente em pacientes idosos e frágeis. Por fim, acompanhamos o movimento de consolidação da saúde digital com a aquisição da Talkspace por uma grande rede hospitalar, sinalizando uma integração mais profunda entre o teleatendimento em saúde mental e o cuidado presencial. Afya News. Informação médica confiável e atualizada no seu tempo.Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/10-03-2026

This week, we explore a phase 3 trial of finerenone in type 1 diabetes and chronic kidney disease and guidance on timing of nonculprit-lesion PCI after STEMI. We cover an investigational therapy for Dravet syndrome and neoadjuvant treatment for high-risk intrahepatic cholangiocarcinoma. We review the effects of radiotherapy on normal tissue, a puzzling case of progressive neurologic decline after suspected foodborne illness, and Perspectives on private equity, the AHEAD model, and medical credit cards.

Ruqaiijah Yearby is a professor at the Temple University Beasley School of Law. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. R. Yearby and M. Alsan. Private Equity's Transformation of American Medicine — Implications for Health Equity. N Engl J Med 2026;394:937-940.

Přestože vláda Andreje Babiše (ANO) označuje obranu za prioritu, vyčlenila na ni méně peněz a Česku hrozí, že nedosáhne ani na hranici dvou procent HDP. „Pokud by k tomu došlo, budeme v zásadě jedinou členskou zemí NATO, která v době zhoršující se bezpečnostní situace ve světě i v Evropě snižuje investice do obrany. Zvlášť ostře by to vyniklo v našem regionu,“ říká v Interview Plus Jan Jireš, analytik CEVRO Institutu a poradce Sekce obranného průmyslu Hospodářské komory.

Přestože vláda Andreje Babiše (ANO) označuje obranu za prioritu, vyčlenila na ni méně peněz a Česku hrozí, že nedosáhne ani na hranici dvou procent HDP. „Pokud by k tomu došlo, budeme v zásadě jedinou členskou zemí NATO, která v době zhoršující se bezpečnostní situace ve světě i v Evropě snižuje investice do obrany. Zvlášť ostře by to vyniklo v našem regionu,“ říká v Interview Plus Jan Jireš, analytik CEVRO Institutu a poradce Sekce obranného průmyslu Hospodářské komory.Všechny díly podcastu Interview Plus můžete pohodlně poslouchat v mobilní aplikaci mujRozhlas pro Android a iOS nebo na webu mujRozhlas.cz.

In this week's podcast episode in the Nutrition After Breast Cancer: Just the Facts series, I bring up the study that sparked that concern. I don't ignore things like this. I don't pretend they don't exist. If there's research being talked about, I want you to know about it. But here are the actual facts. The study was done in mice. The mice were made to consume about 40% of their diet in olive oil. And the rest of their diet was an obesogenic, high-carbohydrate diet designed to promote weight gain and metabolic dysfunction. That is not a Mediterranean diet. That is not olive oil drizzled over vegetables and salmon. That is not real life. It was a laboratory model designed to stress metabolism. Context matters. Deeply.   Resources Mentioned: Guide to Essential Fatty Acids: https://www.thebreastcancerrecoverycoach.com/oil Episode #326 Simplifying Seed Oils and Fatty Acids After Breast Cancer https://www.thebreastcancerrecoverycoach.com/326   Work with Laura: https://www.thebreastcancerrecoverycoach.com/health      REFERENCES: Obesity and Low-Fat Diet History Trends in Obesity Among Adults in the United States, 2005 to 2014 (CDC) https://www.cdc.gov/mmwr/preview/mmwrhtml/su6001a15.htm Documents obesity prevalence: 15.0% (1976-1980), 23.3% (1988-1994) Adult Obesity Prevalence Maps (CDC) https://pmc.ncbi.nlm.nih.gov/articles/PMC9611578/ 30.9% obesity prevalence (1999-2000) Adult Obesity Prevalence, 2021-2023 (CDC) https://www.cdc.gov/nchs/products/databriefs/db508.htm Current obesity prevalence: 40.3% How the Ideology of Low Fat Conquered America https://pubmed.ncbi.nlm.nih.gov/18296750/ Historical analysis of the low-fat movement Heart Disease Mortality Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000 (Ford et al., NEJM 2007) https://www.nejm.org/doi/full/10.1056/NEJMsa053935 ~51% decline in men, ~49% decline in women 47% from medical treatments, 44% from risk factor changes Obesity and diabetes offset gains by 8% and 10% Heart Disease Mortality in the United States, 1970 to 2022 https://www.ahajournals.org/doi/10.1161/JAHA.124.038644 89% decrease in heart attack deaths 81% increase in heart failure and other heart disease deaths Omega-3s, Inflammation, and Cancer Omega-6/Omega-3 Ratios and Modern Diets Ancestral ratios: 1:1 to 4:1 Modern Western diet: 15:1 to 20:1 Impact on eicosanoid metabolism and cellular inflammation DHA and Triple Negative Breast Cancer (Journal of Nutritional Biochemistry, 2019) DHA induced cell death in TNBC cells Mechanism: altered membrane composition, increased oxidative stress in cancer cells High-Fat Diets and TNBC Metastasis (Preclinical Studies) CD36-mediated fatty acid uptake in TNBC Oleic acid-rich diets promoting metastasis in mouse models Importance of tumor phenotype and metabolic flexibility   Let's Connect! If this episode helped you breathe a little easier, please share it with a friend or leave a review. Every share helps spread this message of hope, healing, and whole-person wellness.

Philippe Pinel remarked in 1800 that "It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them." This insight remains profoundly relevant today, especially in hospice care, where inappropriate prescribing is a common issue. Studies show that 20%–70% of hospice patients receive at least one unnecessary medication near the end of life, including drugs like antihypertensives, statins, and vitamins. In this episode of the GeriPal Podcast, we tackle the pressing topic of deprescribing at the end of life with expert guests Jennifer Tjia, Jon Furuno, and Simon Mooijaart. The conversation focuses on identifying medications that should almost always be discontinued—such as statins, osteoporosis meds, finasteride, and vitamins, which offer minimal benefit for patients with limited life expectancy. We also delve into more nuanced cases, such as antithrombotics, which present complex decisions that challenge clinicians, particularly when prognosis spans the many weeks to months range. Finally, we explore practical strategies for engaging patients and families in deprescribing conversations. Our guests highlight tools such as the FRAME mnemonic (Focus on the goals of care, Review current medications, Assess each medication's risk/benefit, Minimize the medication burden, and Evaluate regularly) and the Goal Concurrent Prescribing tool, which helps ensure medication decisions align with patients' values and end-of-life priorities. By: Eric Widera Other resources discussed in the podcast Prevalence and Factors Associated With Receiving a Prescription for Antithrombotic Therapy on Hospice Admission," JAGS. 2025 Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease. 2025 Effects of the discontinuation of antihypertensive treatment on neuropsychiatric symptoms and quality of life in nursing home residents with dementia (DANTON): a multicentre, open-label, blinded-outcome, randomised controlled trial. 2024 Perspectives on deprescribing in palliative care. Expert Review of Clinical Pharmacology. 2023 Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study. Thrombosis Research. 2025 Human-Centered Design Development and Acceptability Testing of a Goal Concordant Prescribing Program in Hospice. JPM 2025 Reduction of Antihypertensive Treatment in Nursing Home Residents. NEJM 2025  

This week, we explore a new standard of care for high-risk HER2-positive early breast cancer, long-acting therapy for people with HIV facing adherence challenges, a first-in-class trial of a p53 reactivator, and tecovirimat for mpox. We review group B streptococcal disease and a revealing case of prosthetic joint infection. Perspectives examine the role of folate therapy, Medicare drug-price negotiation, AI in medical education, and incidental findings.

Bruce Chabner is a professor of medicine at Harvard Medical School and clinical director emeritus of the Massachusetts General Hospital Cancer Center. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. I.D. Goldman and B.A. Chabner. Cerebral Folate Deficiency, Autism, and the Role of Leucovorin. N Engl J Med 2026;394:833-835.

AtualizarO que era impensável virou pauta de governo: estabelecer uma idade mínima para o acesso de menores a redes sociais. Neste episódio, exploramos os sérios riscos (violência sexual online, danos à saúde mental, prejuízo à atenção) e os benefícios (ativismo, conexão) da vida digital.Com Sheylli Caleffi e Rodrigo Nejm, analisamos a abordagem radical da Austrália e a chegada do Estatuto Digital da Criança e do Adolescente (ECA Digital) no Brasil, que exige autorização dos pais para menores de 16 anos e responsabiliza as plataformas.Aprenda sobre os sinais de desequilíbrio e as dicas práticas para famílias, como a importância da conversa aberta e a criação do "Acordo de Geladeira". Uma discussão essencial para entender o caminho mais realista e efetivo para proteger crianças e adolescentes. Vamos juntos!

Giant bladder cancer paper in NEJM this week with the highly anticipated results of the perioperative EV-Pembro trial (EV-303 / KN-905). Already we can say this is a landmark publicaion in bladder cancer that will change practice and even challenge the role of cystectomy (maybe)! Declan Murphy and Renu Eapen caught up with first author Christof Vulsteke (Integrated Cancer Centre, Ghent, BEL) when we were at ESMO Asia recently and had a chat about this work and how it will change practice. This is a Themed Podcast supported by our Platinum Partner, Astellas. Even better on our YouTube channelLinks:EV-303 in NEJM 

Andrew Humberman BioSnap a weekly updated Biography.Andrew Huberman, the Stanford neuroscientist and podcast powerhouse, has been buzzing in the health optimization scene over the past week with fresh podcast drops and ripple effects across media. On February 18, his Huberman Lab episode featuring Dr. Lauren Colenso-Semple dissected whether women should train differently from men, challenging fitness industry hype with PhD-level exercise physiology insights, as detailed on Podcast Notes. Just days earlier, on February 17, a teaser for mastering brain performance and longevity highlighted top neuroscience takeaways from his ongoing series. And on February 11, he unpacked the science of love, desire, and attachment, tying childhood styles to adult bonds in a must-listen essential.Rapamycin News spotlighted a recent transcript where Huberman hyped peptides like Epitalon as game-changers for sleep and longevity, blending conservative tips like social media lockboxes with edgier endorsements of Tadalafil for men over 40 and next-gen obesity drugs like Retatrutide, though he slightly overstated Phase 2 trial losses at one-third body weight per NEJM data. Fast Life Hacks updated his supplement stack in February 2026, confirming daily staples like 400mg Tongkat Ali, Fadogia Agrestis, and omega-3s that boosted his testosterone from 600 to the high 700s ng/dL.Off-podcast, a Minneapolis news piece from February 15 credited Huberman's YouTube sobriety talks alongside Joe Rogan for inspiring a man's Damp January success, quoting his takedown of alcohol's cultural stranglehold. PsyPost nodded to his chat with Kathryn Paige Harden on genetics fueling the seven deadly sins from the womb, while Mueller Memorial invoked his wisdom on movement as the quickest mind-changer for grief. No public appearances or business moves popped, but his premium podcast model funds research sans early episode access. Social mentions lean inspirational, no scandals—just Huberman fueling the self-optimizers. Word on the street: he's the unlikely sobriety guru for coastal liberals.Get the best deals https://amzn.to/3ODvOtaThis content was created in partnership and with the help of Artificial Intelligence AI

On this week's episode, Eric Schmidt, Paul Matteis, Sam Fazeli, Graig Suvannavejh, and Luba Greenwood kick off with a discussion on the surge in out licensing deals and growing drug development momentum in China -- a trend they expect will continue. The conversation then shifts to market sentiment, touching on biotech outlook and M&A. in policy news, the group highlights that the FDA reversed its refusal to file a letter for Moderna's flu vaccine after President Trump met with Dr. Marty Makary. They also discuss the FDA's recent regulatory unpredictability, particularly in vaccines and rare diseases. Next, the co-hosts highlight Denali Therapeutics' upcoming PDUFA date for its Hunter syndrome therapy as another test of the FDA's flexibility. The group notes the agency's paper published in NEJM announcing approval of certain drugs based on a single clinical trial, with some viewing it positively for biotech innovation while others caution it may be meaningless, especially with leadership changes. The co-hosts close the discussion on regulatory news by reflecting on positives that have emerged during the Dr. Makary/Dr. Prasad era. In company news, the co-hosts discuss an analysis on the Keytruda patent landscape J&J's investment in a new cell therapy manufacturing plant and data updates from Roche in kidney disease and Compass Pathways' latest psilocybin results. *This episode aired on February 20, 2026.

The EV-303 trial that led to the FDA approval of perioperative enfortumab vedotin + pembrolizumab in cisplatin-ineligible bladder cancer patients in now published in NEJM. We discuss the results and ponder potential future changes to treating bladder cancer in the future. Urinary diversion surgeries: https://jamanetwork.com/journals/jamaoncology/fullarticle/2842595

Nejméně pět evropských zemí v čele s Británií je přesvědčeno, že ruský opoziční lídr Alexej Navalnyj byl před dvěma lety v lágru na Sibiři otráven vzácným smrtícím jedem, a nezemřel tedy přirozenou smrtí, jak prohlašuje Kreml. Z útoku je přitom viněn právě ruský stát. V sobotu, tedy druhý den Mnichovské bezpečnostní konference, o tom informovaly tiskové agentury.

Nejméně pět evropských zemí v čele s Británií je přesvědčeno, že ruský opoziční lídr Alexej Navalnyj byl před dvěma lety v lágru na Sibiři otráven vzácným smrtícím jedem, a nezemřel tedy přirozenou smrtí, jak prohlašuje Kreml. Z útoku je přitom viněn právě ruský stát. V sobotu, tedy druhý den Mnichovské bezpečnostní konference, o tom informovaly tiskové agentury.Všechny díly podcastu Názory a argumenty můžete pohodlně poslouchat v mobilní aplikaci mujRozhlas pro Android a iOS nebo na webu mujRozhlas.cz.

This week, we highlight major advances in multiple myeloma, gene therapy for cystinosis, and experimental treatments for myotonic dystrophy. We review long-term outcomes of aortic-valve replacement, strategies for secondary stroke prevention, and a revealing diagnostic case of eosinophilic disease in an older adult. A Sounding Board explores FDA approval standards. Perspectives delve into tobacco cessation, influenza evolution, and the uncertainty patients and clinicians share when facing life-altering diagnoses.

Sonja Rasmussen is a professor in the Department of Genetic Medicine at Johns Hopkins School of Medicine. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S.A. Rasmussen and D.B. Jernigan. Antigenic Drift and Antivaccine Shift in the 2025–2026 Influenza Season. N Engl J Med 2026;394:732-735.

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker.Three new pieces of research to talk about in today's podcast. First, in the NEJM - could patients stop anti-coagulation after ablation for AF? Conventional practice says no. Does this paper change that?Second, in JAMA - can spinal manipulation, or clinician-guided self-management, or both help with low back pain? This paper is a good crack.Finally, in the BJGP - what do our patients think about advance care planning? Should we be talking about this more, and, if so, in whom and how?ReferencesNEJM Anti-coags after ablation in AFNEJM EditorialJAMA Low back painBJGP Advance care planningwww.nbmedical.com/podcast

Chronic diseases like heart disease, diabetes, and obesity are killing more people than ever before. Could your diet be the biggest driver of this risk? Today, Dr Mark Hyman explains why food matters more than genetics for long-term health, and how one diet change can make the biggest difference.  Alongside Professor Tim Spector, Mark, a 15-times New York Times bestselling author and a practising family doctor, explores how modern eating is linked to chronic disease and what the science says reduces risk. We break down how food is designed to make us eat more, how this affects metabolism, insulin and inflammation, and why this matters more than your genes. By the end of the episode, you'll understand the single most important dietary change Mark believes can lower chronic disease risk, based on clinical experience. If the modern world is driving these conditions, what's one small change you can make to take back control of your future health?

This week includes studies on promising new therapies for IgA nephropathy, evolving antithrombotic strategies after coronary stenting, and the inciting antigen in rare vaccine-related clotting syndromes. We review the urgent challenge of mucormycosis and follow the case of a young woman with headaches and hypertension. We discuss human-subjects research. Perspectives examine rural health, data interoperability, drug labels in the courts, and a pediatrician's dilemma.

Carmel Shacharis an assistant clinical professor of law and faculty director of the Health Law and Policy Clinic at Harvard Law School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. H. Howard and C. Shachar. The Rural Health Transformation Program — An Avenue for Promoting Administrative Policies. N Engl J Med 2026;394:625-627.

(featured photo shows David, his wife Yvonne, and son, Joey, when young) Meet the Incredible Dr. David Antonuccio, Part 2 of 2 Shrink, Songwriter, and Hero Today we continue our conversation with my dear friend and esteemed colleague, Dr. David Antonuccio, a true scholar, clinician, researcher, musician, and champion of scientific transparency. The Nicotine Patch Study David revisited his landmark research on the nicotine patch, a costly trial involving roughly 600 participants who were randomly assigned to receive either a real nicotine patch or a sham patch. The goals were to assess safety and efficacy. The safety data looked reassuring. However, the efficacy findings were unexpected: the placebo patch worked just as well as the active nicotine patch in reducing smoking. The sponsoring company published the safety data but refused to publish—and refused David access to—the efficacy findings, which showed no advantage for the nicotine patch. You can check the link to the NEJM article here.  David writes: "Notice the 48 week follow-up data were excluded in this paper despite the fact that they were available. That really annoyed me. I also now believe that the original version of the paper was ghostwritten and ghost analyzed by the industry folks.in other words.  I'm not sure that the authors ever had access to the "raw" data before they were analyzed." This was important because there was a decrease in smoking DURING the study among those wearing the patch, and getting their "fix" of nicotine that way. . . but what happened AFTER the study?  David writes: "Here is the link to the follow up paper that emphasized efficacy and included the 48 week follow-up data." Notice that this paper was not published until three years later, when the Nicotine Patch had already been heavily advertised and sold on the market. This early experience in his career revealed the tension between marketing interests which focus on sales, and scientific interests which focus on truth and transparency—a daunting and frustrating pattern that would emerge again and again in his career. Expert Testimony in a Tragic Criminal Case David then described expert testimony he provided in a deeply troubling legal case. A 72-year-old woman, happily married for 50 years and a respected kindergarten teacher, had recently been prescribed Paxil, along with Ambien and Ativan. She abruptly, and without memory, woke up in the middle of the night and stabbed her husband 200 times and was subsequently arrested for homicide. There was no jury trial; instead, a plea bargain was used to determine sentencing. Dr. David Antonuccio was called as an expert witness in her defense. He described Dr. David Healy's research documenting a significant increase in both suicidal and violent urges among some patients taking SSRIs, especially Paxil. He argued that this woman's bizarre behavior was consistent with a drug-induced dissociative or fugue state. Based in part on David's testimony, the charge was reduced to manslaughter, and the judge sentenced her to time served, allowing her to return home to her children. For more on this topic: David Healy's Research on SSRIs and Homicidal Urge SSRIs Called on Carpet Over Violence Claims Black Box Warnings and Patient Rights David also emphasized the urgent need to revise Black Box warnings to reflect the full range of possible toxic or dissociative effects of psychiatric medications—not just suicidality. He has long advocated for a Patient Bill of Rights to ensure scientific transparency and informed consent. A Surprising Conversation with Dr. John Nash David shared a fascinating personal story about calling Dr. John Nash, whose life inspired the award-winning film A Beautiful Mind. In the movie, Nash's recovery from schizophrenia  is portrayed as medication-dependent. However, Nash told David directly that this was not true—the medication narrative was added to the script, possibly out of concern that portraying his recovery without meds might discourage viewers from taking prescribed medications. Nash said: "What saved me was the support of family and friends." Music, Truth, and "Buzz" David is also a talented songwriter. One of his songs, "Buzz," addresses the emotional and ethical issues surrounding electroconvulsive therapy (ECT). The inspiration came from a man in the Midwest who was legally ordered to undergo ECT against his will. A widespread public outcry ultimately convinced the judge to rescind the order. Forgiveness and "In the Air Tonight" One of David's favorite songs is Phil Collins' "In the Air Tonight," which he sees as a deeply spiritual musical meditation on forgiveness—a theme David considers one of the most powerful psychological forces we possess. David explains that the Phil Collin's song is about forgiveness, but more indirectly and specifically about the songwriter's inability to forgive. And yes—David sang it live for us on the podcast! You might be interested in this chapter that David coauthored on the science of forgiveness Thank you for joining us today. And heartfelt thanks to you, Dr. David Antonuccio, for your gifts of enlightened skepticism, ethical courage, incisive scientific thinking, and soulful musical talent. David, Rhonda, and David

Meniscus tears are common in the older population but is physical therapy a good treatment? Listen to our latest podcast as we discuss the findings of the recent NEJM article, "A Randomized Trial of Physical Therapy for Meniscal Tear and Knee Pain" with Dr. Carlin Senter.

This week, we look at new evidence on oral cholesterol-lowering therapy, the evolving role of beta-blockers after myocardial infarction, and advances in breast and prostate cancer treatment. We review the inherited risk of coronary disease. We also work through a revealing diagnostic case in a young woman and reflect on science under pressure, corporatized insurance, the reach of FDA law, and what it means to live with life-sustaining technology.

Leemore Dafny is a professor of business administration at Harvard Business School and a professor of public policy at the Harvard Kennedy School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. L. Dafny. Health Insurance after Corporatization — What Next? N Engl J Med 2026;394:521-523.

This week, we explore new therapies to reduce pancreatitis risk in severe hypertriglyceridemia, advances in breast cancer treatment, and long-term results of gene therapy for hemophilia B. We discuss vision-threatening vascular emergencies, the mental health effects of firearm injury on families, and care for peripheral artery disease. We also follow a revealing diagnostic case in an older woman with respiratory failure. Perspectives reflect on hypertension control, immunization access, chronic disease policy, and on the inherited risk of disease.

Robert Kocher is an adjunct professor at the Stanford University School of Medicine, a nonresident senior scholar at the University of Southern California Schaeffer Institute, and a partner at Venrock. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S.P. Kishore and R. Kocher. The Hypertension Control Paradox — Why Is America Stuck? N Engl J Med 2026;394:417-420.

In this episode, we explore evolving evidence on anticoagulation after atrial fibrillation ablation, long-term outcomes with immunotherapy for melanoma, and promising new treatments for hepatitis D and triple-negative breast cancer. We review advances in physiologic pacing for heart failure and work through a challenging case involving fever, rash, and neurologic symptoms. An article considers fairness for late-career physicians, and Perspectives discuss misconceptions about autism, access to contraception, and the financial pressures shaping health care.

Tara Eicher is a postdoctoral research fellow in the Department of Biostatistics at the Harvard T.H. Chan School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. T. Eicher, J. Quackenbush, and A. Ne'eman. Challenging Claims of an Autism Epidemic — Misconceptions and a Path Forward. N Engl J Med 2026;394:313-315.

Firearm ownership has surged in the U.S., yet safety discussions remain uncommon in clinical care. An NEJM article supports routine, nonpolitical firearm counseling using the “3 A's” (Ask, Advise, Assist) to reduce risks such as suicide and unintentional injury. Separately, a BMJ meta-analysis shows that patients stopping GLP-1 weight-loss medications typically regain weight within 1.5–2 years, reinforcing obesity as a chronic condition requiring long-term planning. Finally, a large sham-controlled trial found no meaningful benefit of trigeminal nerve stimulation for pediatric ADHD, suggesting prior perceived effects were placebo-driven.

Date: January 17, 2026 Reference:  Casey et al. RSI Investigators and the Pragmatic Critical Care Research Group. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. NEJM. 2025 Dec The podcast is not uploading correctly. Please use this LINK to listen to Episode #500 until I resolve the issue. Guest Skeptic: Dr. Scott Weingart […] The post SGEM#500: Don't You Want Me – Etomidate or Ketamine for Induction of Critically Ill Patients first appeared on The Skeptics Guide to Emergency Medicine.

This week, we explore new evidence on managing asymptomatic carotid stenosis, restoring vision in advanced macular degeneration, and preventing migraine in children. We discuss innovative cellular therapy for autoimmune disease, review sudden cardiac arrest in athletes, and describe a case of severe systemic infection with vision loss. Perspectives examine global tobacco risks, the future of telehealth payment, Medicare coverage of new technologies, and the things physicians carry.

Tara Sklar is the faculty director of the Health Law and Policy Program at the University of Arizona James E. Rogers College of Law and associate director of telehealth law and policy at the University of Arizona College of Medicine–Tucson Arizona Telemedicine Program. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. T. Sklar and B. Richman. Financing Telehealth — Moving Beyond Payment Parity. N Engl J Med 2026;394:211-213.

Luke Hedrick, Dave Furfaro, and recurrent RFJC guest Robert Wharton are joined again today by Nicole Ng to discuss the FIBRONEER-IPF trial investigating Nerandomilast in patients with IPF. This trial was published in NEJM in 2025 and looked at Neradomilast vs placebo for treating patients with IPF, on or off background anti-fibrotic therapy. This agents is now FDA approved for pulmonary fibrosis, and understanding the trial results is essential for any pulmonary physician treating patients with IPF or progressive pulmonary fibrosis. Article and Reference Today’s episode discusses the FIBRONEER-IPF trial published in NEJM in 2025. Richeldi L, Azuma A, Cottin V, Kreuter M, Maher TM, Martinez FJ, Oldham JM, Valenzuela C, Clerisme-Beaty E, Gordat M, Wachtlin D, Liu Y, Schlecker C, Stowasser S, Zoz DF, Wijsenbeek MS; FIBRONEER-IPF Trial Investigators. Nerandomilast in Patients with Idiopathic Pulmonary Fibrosis. N Engl J Med. 2025 Jun 12;392(22):2193-2202. doi: 10.1056/NEJMoa2414108. Epub 2025 May 18. PMID: 40387033. https://www.nejm.org/doi/abs/10.1056/NEJMoa2414108 Meet Our Guests Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a pulmonary and critical care fellow at Johns Hopkins. Dr. Nicole Ng is an Assistant Profess of Medicine at Mount Sinai Hospital, and is the Associate Director of the Interstitial Lung Disease Program for the Mount Sinai National Jewish Health Respiratory Institute. Infographic Key Learning Points Why this trial mattered IPF therapies remain limited: nintedanib and pirfenidone slow (but do not stop) decline and often cause GI side effects. Nerandomilast is a newer agent (a preferential PDE4B inhibitor) with antifibrotic + immunomodulatory effects. Phase 2 data (NEJM 2022) looked very promising (suggesting near-“halt” of FVC decline), so this phase 3 trial was a big test of that signal. Trial design essentials Industry-sponsored, randomized, double-blind, placebo-controlled, large multinational study (332 sites, 36 countries). Population: IPF diagnosed via guideline-aligned criteria with central imaging review and multidisciplinary diagnostic confirmation. Intervention: nerandomilast 18 mg BID, 9 mg BID, or placebo; stratified by background antifibrotic use. Primary endpoint: change in FVC at 52 weeks, analyzed with a mixed model for repeated measures. Key secondary endpoint: time to first acute exacerbation, respiratory hospitalization, or death (composite). Who was enrolled Typical IPF trial demographics: ~80% male, mean age ~70, many former smokers. Many were already on background therapy (~45% nintedanib, ~30–33% pirfenidone). Notable exclusions included significant liver disease, advanced CKD, recent major cardiovascular events, and psychiatric risk (suicidality/severe depression), reflecting class concerns seen with other PDE4 inhibitors. Efficacy: what the primary endpoint showed Nerandomilast produced a statistically significant but modest reduction in annual FVC decline vs placebo (roughly 60–70 mL difference). Importantly, it did not halt FVC decline the way the phase 2 data suggested; patients still progressed. Important nuance: interaction with pirfenidone Patients on pirfenidone had ~50% lower nerandomilast trough levels. Clinically: 9 mg BID looked ineffective with pirfenidone, so 18 mg BID is needed if used together. In those not on background therapy or on nintedanib, 9 mg and 18 mg looked similar—suggesting the apparent “dose-response” might be partly driven by the pirfenidone drug interaction Secondary and patient-centered outcomes were neutral No demonstrated benefit in the composite outcome (exacerbation/resp hospitalization/death) or its components. Quality of life measures were neutral and declined in all groups, emphasizing that slowing FVC alone may not translate into felt improvement without a disease-reversing therapy. The discussants noted this may reflect limited power/duration for these outcomes and mentioned signals from other datasets/pooling that might suggest mortality benefit—but in this specific trial, the key secondary endpoint was not positive. Safety and tolerability Diarrhea was the main adverse event: Higher overall with the 18 mg dose, and highest when combined with nintedanib (up to ~62%). Mostly mild/manageable; discontinuation due to diarrhea was relatively uncommon (but higher in those on nintedanib). Reassuringly, there was no signal for increased depression/suicidality/vasculitis despite psychiatric exclusions and theoretical class risk. How to interpret “modest FVC benefit” clinically The group framed nerandomilast as another tool that adds incremental slowing of progression. They emphasized that comparing absolute FVC differences across trials (ASCEND/INPULSIS vs this trial) is tricky because populations and “natural history” in placebo arms have changed over time (earlier diagnosis, improved supportive care, etc.). They highlighted channeling bias: patients already on antifibrotics may be sicker (longer disease duration, lower PFTs, more oxygen), complicating subgroup comparisons. Practical takeaways for real-world use All three antifibrotics are “fair game”; choice should be shared decision-making based on goals, tolerability, dosing preferences, and logistics. Reasons they favored nerandomilast in practice: No routine lab monitoring (major convenience advantage vs traditional antifibrotics). Generally better GI tolerability than nintedanib. BID dosing (vs pirfenidone TID). Approach to combination therapy: They generally favor add-on rather than immediate combination to reduce confusion about side effects—while acknowledging it may slow reaching “maximal therapy.” Dosing guidance emphasized: Start 18 mg BID for IPF, especially if combined with pirfenidone (since dose reduction may make it ineffective). 9 mg BID may be considered if dose reduction is needed and the patient is not on pirfenidone (e.g., monotherapy or with nintedanib).

🧭 REBEL Rundown 📌 Key Points 💀 Mortality: No statistically significant difference in 28-day mortality between ketamine vs etomidate for intubation in critically ill patients, though there was a ~1% absolute difference favoring ketamine. 📉🫀⚠️ Hemodynamics: Ketamine induction was associated with more cardiovascular collapse, mainly driven by new/increased vasopressor use (dose escalation or addition of a vasoactive agent). 💉⬆️ Click here for Direct Download of the Podcast. 📝 Introduction Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of adrenal suppression. Additionally, recent data points towards improved mortality when ketamine was selected over etomidate (Kotani 2023). High quality randomized controlled trials are needed to further elucidate which agent should be selected in critically ill patients. 🧾 Paper Casey JD et al. Ketamine or etomidate for tracheal intubation of critically ill adults. NEJM 2025. PMID: 41369227 🔙Previously Covered On REBEL REBEL EM: The EvK Trial: Ketamine vs Etomidate for Rapid Sequence IntubationREBEL EM: From Debate to Data: Emerging Insights into RSI Induction with Ketamine vs Etomidate ️ What They Did CLINICAL QUESTION In critically ill adults undergoing tracheal intubation, does the use of ketamine instead of etomidate result in improved 28 day mortality? STUDY DESIGN Multicenter, randomized, open-label trial in both emergency departments and ICUs. POPULATION Inclusion Criteria:Critically ill patients > 18 years of age undergoing tracheal intubation with the use of an induction agentExclusion Criteria:Known pregnancyPrisonersPrimary diagnosis of traumaNeed for immediate intubation precluding randomizationClinicians determined that the use of ketamine or etomidate was either necessary or contraindicated INTERVENTION & COMPARATOR Intervention (HFNC Group):Ketamine administered based on a provided nomogram: full dose (2.0 mg/kg), intermediate dose (1.5 mg/kg) or reduced dose (1.0 mg/kg)Comparator (BPAP Group):Etomidate administered based on a provided nomogram: full dose (0.3 mg/kg), intermediate dose (0.25 mg/kg) or reduced dose (0.2 mg/kg) OUTCOMES Primary: In-hospital death from any cause by day 28.Secondary:Cardiovascular collapse during intubation defined as SBP < 65 mm Hg, receipt of new or increased dose of vasopressors or cardiac arrest.Exploratory Procedural:Lowest systolic blood pressureLowest systolic blood pressure below 80 mmHgHighest systolic blood pressure above 180 mmHgLowest oxygen saturationLowest oxygen saturation below 80%Successful first attempt intubationTime from induction to intubationExploratory Clinical:Number of ventilator free daysVasopressor-free daysICU free days Safety: Systolic blood pressure at 24 hours after enrollmentOngoing receipt of vasopressors at 24 hours 📈 Results: 2365 patients were randomizedKetamine: 1176Etomidate: 1189> 99% of patients received the drug they were randomized to receiveNMBA: 69% of patients in both groups received rocuronium~ 95% of patients had video laryngoscopy for the primary intubation attempt 💥 Critical Results 💪 Strengths Multicenter ED + ICU cohort of critically ill patients → improves external validityStrong randomization → balanced baseline characteristicsRight population for the question → appropriately focused on a sick cohort where induction choice matters mostHigh protocol adherence → most patients received the agent they were randomized toExcellent follow-up → minimal loss to follow-up / outcome capture ⚠️ Limitations No blinding → potential performance/resuscitation biasTrauma excluded → limits applicability to peri-intubation trauma careCase-mix skewed toward septic shock → may reduce generalizability to other shock etiologiesPower assumptions → designed to detect a 5% mortality difference (possibly overly ambitious)Equipoise-only enrollment → excluded patients with clear indication/contraindication → selection bias + reduced real-world applicabilityComposite secondary outcome with non-equivalent endpoints (e.g., cardiac arrest vs vasopressor titration)Ketamine dosing by actual body weight (vs ideal) → may have increased dose/exposure in some patients 🗣️ Discussion The increase in cardiovascular collapse seen with ketamine was driven by the “new or increased vasopressor use” piece of the composite outcome not by the more clinically relevant severe hypotension (SBP < 65 mm Hg) or cardiac arrest.The increase in CV collapse is a secondary outcome and hypothesis generating onlyCare beyond induction agent isn’t clearly delineated and may have varied between groupsReasons why there was more CV collapse in the ketamine group:Patients in the etomidate group were more likely to be on pressors or have pressor increases prior to induction agent administrationKetamine has analgesic properties which may affect hemodynamics (etomidate does not have analgesic effects)The standard ketamine dose of 2 mg/kg is higher than the induction dose used by most (1-1.5 mg/kg)Ketamine dosing was based on actual body weight though ideal body weight dosing is more accepted. This may have resulted in unnecessarily large ketamine doses that may have had a greater effect on hemodynamics.This is a study of patients with clinical equipoisePatients who the clinician determined would clearly benefit from one agent or the other or in whom one agent or the other was contraindicated were excluded from the study.This may add a selection bias to the results.Clinicians were not blinded to the induction agent administeredThe absence of blinding can introduce bias.For instance, knowledge of the agent the patient was randomized to may result in different resuscitative treatment prior to intubation.An induction agent nomorgram was provided to allow clinicians to choose their induction dose depending on patient stability.A 5% difference in mortality may be overly ambitious. As Josh Farkas points out in his post on this article, PCI for STEMI only has a 3% absolute difference in mortality versus standard care.The 1% absolute difference in mortality while not statistically significant would be clinically significant if it was real. The study would have to be much larger to show a statistically significant 1% difference.About 2% of patients in each group received additional medications during induction (propofol, benzodiazepines, opiates). It is unclear why these agents were selected in specific cases and how they may have affected the outcomes in question. 📘 Author's Conclusion “Among critically ill adults undergoing tracheal intubation, the use of ketamine to induce anesthesia did not result in a significantly lower incidence of in-hospital death by day 28 than etomidate.“ 💬 Our Conclusion In this well done RCT, induction with ketamine did not result in a lower 28-day mortality when compared to induction with etomidate in critically ill adults. The secondary outcome of an increase in cardiovascular collapse is interesting and should be studied more in the future. 🚨 Clinical Bottom Line This data should not drive clinicians to abandon the use of ketamine in RSI. To the contrary, the study leaves open the possibility of a clinically meaningful difference in mortality favoring ketamine that may be borne out in a larger study. However, etomidate can be considered as a first-line option for RSI and may be the superior drug in patients at high-risk for cardiovascular decompensation. Post Peer Reviewed By: Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO), Frank Lodeserto, MD and Anand Swaminathan, MD (X: @EMSwami) 📚 References Kotani Y et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: a meta-analysis of randomized trials J Crit Care 2023;77:154317. PMID: 37127020 👤Associate Author Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence ... Resuscitation Read More REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of ... Procedures and Skills Read More The post The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation appeared first on REBEL EM - Emergency Medicine Blog.

This week, we explore new options in cardiovascular prevention, fish-oil supplementation in dialysis patients, RSV vaccination, and cutting-edge cellular therapy for leukemia. We discuss advances in lung cancer treatment, approaches to functional dyspepsia, and a complex case of severe infection after travel. Perspectives examine access to and cost of weight-loss drugs, the promise and risks of AI in clinical care, and what it means to care for others while carrying personal loss.

Rachel Sachs is a professor of law at Washington University in St. Louis. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S.B. Dusetzina and R.E. Sachs. Insurance Coverage and Pricing of Weight-Loss Drugs in the United States. N Engl J Med 2026;394:105-107. S. Gondi, A.S. Kesselheim, and B.N. Rome. Generic Liraglutide — Overlooked but Not Forgotten. N Engl J Med. DOI: 10.1056/NEJMp2515668.

 Join hosts Raj, Ashwin, and Eddie in this episode of Blood Cancer Talks as they welcome Dr. Luciano Costa, the first author of the NEJM manuscript on the MajesTEC-3 RCT, which was presented at ASH 2025. This episode dives deep into the trial's topline findings, capturing the nuances of the patient population, efficacy and safety data, and the future implications for treatment. The episode also examines the comparative efficacy of bispecific T-cell engagers versus CAR-T therapies, along with spirited discussion on the potential for fixed-duration treatment in myeloma care. Episode Highlights Main Topics Covered MajesTEC-3 Trial: Teclistamab-Daratumumab vs. Standard of Care Trial design and patient populationPrimary endpoint: Progression-free survival (PFS)MRD negativity rates and depth of responseOverall survival and safety profileClinical implications for treatment selectionTreatment Selection in Early Relapse Comparing MajesTEC-3 and CARTITUDE-4 patient populationsFramework for choosing between bispecific antibodies vs. CAR T-cell therapyManaging anti-CD38 exposed patientsLink to the NEJM paper: https://www.nejm.org/doi/abs/10.1056/NEJMoa2514663  

This week, we share advances in treatment for EGFR-mutated lung cancer, a brain-penetrant enzyme therapy for a rare pediatric disorder, and dual targeting of extramedullary myeloma. We review cardiogenic shock, work through a challenging diagnostic puzzle in a young woman with recurrent illness, and explore Perspectives on corporatized care, vaccine policy, AI in medicine, and where clinicians carry grief.

Ambar La Forgia is an assistant professor in the Management of Organizations group at the University of California, Berkeley Haas School of Business. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A. La Forgia. From Patients to Consumers — The Corporatization of Ambulatory Care. N Engl J Med 2026;394:1-3.

Today, Dave Furfaro, Luke Hedrick, and Robert Wharton discuss the PREDMETH trial published in The New England Journal of Medicine in 2025. This was a non-inferiority trial comparing prednisone to methotrexate for upfront therapy in treatment-naive sarcoidosis patients. Listen in for a break down of the trial, analysis, and clinically applicable pearls. Article and Reference Todays’ episode discusses the PREDMETH trial published in NEJM in 2025. Kahlmann V, Janssen Bonás M, Moor CC, Grutters JC, Mostard RLM, van Rijswijk HNAJ, van der Maten J, Marges ER, Moonen LAA, Overbeek MJ, Koopman B, Loth DW, Nossent EJ, Wagenaar M, Kramer H, Wielders PLML, Bonta PI, Walen S, Bogaarts BAHA, Kerstens R, Overgaauw M, Veltkamp M, Wijsenbeek MS; PREDMETH Collaborators. First-Line Treatment of Pulmonary Sarcoidosis with Prednisone or Methotrexate. N Engl J Med. 2025 Jul 17;393(3):231-242. doi: 10.1056/NEJMoa2501443. Epub 2025 May 18. PMID: 40387020. https://www.nejm.org/doi/full/10.1056/NEJMoa2501443 Meet Our Hosts Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a first year pulmonary and critical care fellow at Johns Hopkins. Key Learning Points Clinical context Prednisone remains the traditional first-line treatment for pulmonary sarcoidosis when treatment is indicated, with evidence for short-term improvements in symptoms, radiographic findings, and pulmonary function—but with substantial, familiar steroid toxicities (weight gain, insomnia, HTN/DM, infection risk, etc.). Despite widespread use, glucocorticoids haven't been robustly tested head-to-head against many alternatives as initial therapy, and evidence for preventing long-term decline (especially in severe disease) is limited. Immunosuppressants (like methotrexate) are often used as steroid-sparing agents, but guideline recommendations are generally conditional/low-quality evidence, and practice varies. Why PREDMETH matters It addresses a real-world question: Can methotrexate be an initial alternative to prednisone in pulmonary sarcoidosis, rather than being reserved only for steroid-sparing later? It also probes a common clinical belief: MTX has slower onset than prednisone (often assumed, not well-proven). Trial design (what to know) Open-label, randomized, noninferiority trial across 17 hospitals in the Netherlands. Included patients with pulmonary sarcoidosis who had a clear pulmonary indication to start systemic therapy (moderate/severe symptoms plus objective risk features like reduced FVC/DLCO or documented decline, plus parenchymal abnormalities). Excluded: non–treatment-naïve patients and those whose primary indication was extrapulmonary disease. Treat-to-tolerability with escalation: both drugs started low and were slowly increased; switch/add-on allowed for inadequate efficacy or unacceptable side effects. Primary endpoint: change in FVC (with the usual caveat that FVC is “objective-ish,” but effort-dependent and not always patient-centered). Noninferiority margin: 5% FVC, justified as within biologic/measurement variation and “not clinically relevant.” Outcomes assessed at weeks 4, 16, 24; powered for ~110 patients to detect the NI margin. Patient population (who this applies to) Mostly middle-aged (~40s) with mild-to-moderate physiologic impairment on average (FVC ~77% predicted; DLCO ~70% predicted). Netherlands-based cohort with limited Black representation (~7%), which matters for generalizability. Would have been helpful to know more about comorbidities (e.g., diabetes), which can strongly influence prednisone risk. Main findings (what happened) Methotrexate was noninferior to prednisone at week 24 for FVC: Between-group difference in least-squares mean change at week 24: −1.17 percentage points (favoring prednisone) with CI −4.27 to +1.93, staying within the 5% NI margin. Timing mattered: Prednisone showed earlier benefit (notably by week 4) in FVC and across quality-of-life measures. By week 24, those early differences largely washed out—possibly because MTX “catches up,” and/or because crossover increased over time. In their reporting, MTX didn't meet noninferiority for FVC until week 24, supporting the practical message that prednisone works faster. Crossover and analysis nuance (important for interpretation) Crossover was fairly high, which complicates noninferiority interpretation: MTX arm: some switched to prednisone for adverse events and others had prednisone added for disease progression/persistent symptoms. Prednisone arm: some had MTX added. In noninferiority trials, heavy crossover can bias intention-to-treat analyses toward finding “no difference” (making noninferiority easier to claim). Per-protocol analyses avoid some of that but introduce other biases. They reported both. Safety signals (what to remember clinically) Adverse events were very common in both arms (almost everyone), mostly mild. Side-effect patterns fit expectations: Prednisone: more insomnia (and classic steroid issues). MTX: more headache/cough/rash, and notably liver enzyme elevations (about 1 in 4), with a small number discontinuing. Serious adverse events were rare; numbers were too small to confidently separate “signal vs noise,” but overall known risk profiles apply. Limitations (why you shouldn't over-read it) Open-label design, and FVC—while objective-ish—is still effort-dependent and can be influenced by expectation/behavior. Small trial, limiting subgroup conclusions (e.g., severity strata, different phenotypes). Generalizability issues (Netherlands demographics; US populations have higher rates of obesity/metabolic syndrome, which may tilt the steroid risk-benefit equation). Crossover reduces precision and interpretability of between-group differences over time. Practice implications (the “so what”) For many patients with pulmonary sarcoidosis needing systemic therapy, MTX is a reasonable initial alternative to prednisone when thinking long-term tolerability and steroid avoidance. Prednisone likely provides faster symptom/QoL relief in the first weeks—so it may be preferable when rapid improvement is important. The trial strengthens the case for a patient-centered discussion: short-term relief vs side-effect tradeoffs, and the possibility of early combination therapy in more severe cases (suggested, not proven).

In this episode, we breakdown the new article and research looking at ketamine and etomidate for intubation. Dr. Mell breaks down the article and what it really means for emergency medicine and airway management. We have this article..."So What" with Dr. Howie Mell

This week, we look at ctDNA-guided immunotherapy for bladder cancer, cardiovascular outcomes with tirzepatide, and evidence that one HPV vaccine dose may be enough. We explore high-dose rifampin for tuberculous meningitis, review measles amid rising outbreaks, and follow a challenging case of gastrointestinal bleeding. Essays examine how clinicians navigate post-Dobbs care, tobacco harm among people with mental illness, congenital syphilis, and sustaining medical research.

Listener discretion is advised. References: Casey, J., Seitz, K., et al. (2025). Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. NEJM. Available: https://www.nejm.org/doi/full/10.1056/NEJMoa2511420?query=featured_home Farkas. (Dec 10, 2025). PulmCrit: Hot take on RSI trial of ketamine vs etomidate. Available: https://emcrit.org/pulmcrit/rsitrial/ Srivatsa S, Chawla M, Hernandez M, et al. Helicopter transport of trauma patients continues to be overutilized: a call for universal transport criterion. Am Surg. Published online September 13, 2025:31348251378910. doi:10.1177/00031348251378910.

In this week's podcast, we sit down with Drs. Sarguni Singh, Christian Furman, and Lynn Flint, three authors of the recent Journal of the American Geriatrics Society article, "Rehab and Death: Improving End-of-Life Care for Medicare Skilled Nursing Facility Beneficiaries."  The authors dive into the challenges facing seriously ill older adults discharged to Skilled Nursing Facilities (SNFs), where fragmented care transitions, misaligned Medicare policies, and inadequate access to palliative care often result in burdensome hospitalizations and goal-discordant care.  The discussion highlights key barriers in Medicare's SNF and hospice benefits, including the inability to access concurrent hospice and SNF care, and explores solutions to improve care. Among the recommendations is leveraging Medicare's Patient Driven Payment Model (PDPM) to reimburse SNFs for providing palliative care, commissioning a Government Accountability Office (GAO) report on SNF utilization at the end of life, and piloting a model that allows time-limited concurrent hospice and rehabilitation care.  Also, check out these two resources if you want a deeper dive: Our past podcast we did, now nearly 6 years ago, on the original NEJM paper, Rehabbed to Death. Joan Carpenter's article titled "Forced to Choose: When Medicare Policy Disrupts End-of-Life Care" in the Journal of Aging & Social Policy  

This week, we look at new studies on high-dose influenza vaccines for older adults, antiplatelet therapy after coronary surgery, and HER2-targeted immunotherapy for advanced bladder cancer. We review complex regional pain syndrome and a pediatric case of fever and rash. We also explore FDA innovation and safety, aspirin's role in metastasis prevention, the meaning of “the good doctor,” smallpox in the Revolution, and how AI may reshape medical science.