Zero Calcium Score May Help Many Patients Skip Unwanted Treatment

The precise role of coronary artery calcium )CAC) scans in clinical practice has been the subject of considerable discussion and debate. Passionate advocates have been unable to persuade most physicians that obtaining routine calcium scores can help improve risk prediction and prognosis. No general consensus has yet emerged. Now a new study published in the Journal of the…

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Study Raises New Questions About Perioperative Beta Blockers

A large observational study finds that patients with hypertension who are taking beta blockers have higher rates of cardiovascular complications after noncardiac surgery. The study appears to support current guidelines against using beta blockers in the initial treatment of essential hypertension and may offer a contribution to the ongoing debate over the use of perioperative beta-blockade for noncardiac surgery…

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New Cholesterol Drugs Not Breaking The Bank– Yet

Sales of the new cholesterol-lowering PCSK9 inhibitors have been lower than some had anticipated, the nation’s largest pharmacy benefit manager, Express Scripts, disclosed in a Reuters news story. The majority of prescriptions have been rejected by Express Scripts “because patients did not meet required medical criteria,” Reuters reported. “We’re seeing a lot of patients who either don’t qualify or…

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Double Duty: Academic Leaders, Corporate Boards, And The Harvard Connection

A large and potentially disturbing number of leading academic figures serve on the board of directors of public healthcare companies, according to a new study published in BMJ. “These kind of industry relationships have not been front and center in most debates about conflict of interest (COI),” David Rothman, PhD, a medical historian at Columbia University, noted in…

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DOJ May Soon Announce Settlements With Hundreds Of Hospitals Over ICD Overuse

The US Department of Justice may be getting ready to announce that hundreds of hospitals have settled with the government in response to a lengthy investigation over ICD (implantable cardioverter defibrillator) overuse, according to an article by Lisa Schencker in Modern Healthcare. “The U.S. Justice Department may announce in the coming weeks what may be the largest False Claims Act…

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SPRINT Trial To Be Presented At The American Heart Association Meeting In November

Update: I have now received confirmation that SPRINT will be presented on Monday, November 9 at 2 PM. The SPRINT trial, which provoked a storm of excitement and controversy a few weeks ago, will be presented in November at the American Heart Association meeting in Orlando. The trial is not currently on the list of late-breaking clinical trials but…

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Second Trial Of Controversial Chelation Therapy Gains Crucial Early Support

The National Institutes of Health is giving money to support the planning of a second trial to test the potential role of chelation therapy in treating patients with myocardial infarction. The first Trial to Assess Chelation Therapy (TACT) was extremely controversial. It was funded by the NIH more than a dozen ago as part of an initiative to…

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BMJ Paper Criticizes Proposed US Dietary Guidelines

Once again experts are passionately disagreeing about the proper role of saturated fats and carbohydrates in the diet. The latest volley comes from a full-scale critique  published in the BMJ  of proposed new US dietary guidelines. The author of the critique, Nina Teicholz,  is the author of The Big Fat Surprise: Why Butter, Meat, & Cheese Belong in a Healthy Diet. In both the…

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A Coke, A Smile, And 120 Million Dollars

As I’ve reported in the past Coca-Cola has a long history of giving money to medical organizations and researchers. Now we know just how much. In response to a New York Times story this summer, Coke has disclosed details of its financial support to a great number and broad variety of health organizations and initiatives. Over the past five years, it…

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Study Questions Conventional Wisdom About Trans Fats

Could a little trans fat found naturally in meat and dairy actually be protective? Amid the stormy debate over dietary recommendations regarding saturated fats and carbohydrates, there’s been one area of calm and consensus. Nearly everyone seems to have agreed that trans fats have no place in the diet. The FDA’s recent move to ban trans…

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The Shaky Scientific Edifice: Watching Retracted And Unretracted Papers

The good news is that retracted papers really are worse than papers that have not been retracted. The bad news is that unretracted papers still have plenty of problems. That’s the inevitable conclusion of a fascinating new paper from Darrel Francis’s group in the UK. In the past few years the same group has exposed fraud and…

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Required Reading: Cardiologists Gone Wild

At first glance it might appear that cardiologists are the worst people on earth. In his blog post “Cardiologists and Chinese Robbers“ Scott Alexander lists a long string of horrible misdeeds that might lead you to prefer an encounter in a dark alley with a Mafia henchman instead of a cardiologist: You may have read about one…

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Bankruptcy Judge Approves Sale Of Embattled Diagnostic Lab Company

A federal bankruptcy judge has approved the sale for $37.1 million of the once high-flying Health Diagnostics Laboratory to a new lab company, True Health Diagnostics. True Health has a business model that mimic’s HDL’s and is owned by some of the same players who helped create and who owned HDL. Health Diagnostic Laboratory (HDL) was started in 2009. By 2012 the…

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Sanjay Kaul On The Empa-Reg Outcome Study

The really big medical news today is the publication of the highly anticipated Empa-Reg Outcome study in the New England Journal of Medicine. It is the first large clinical trial with a diabetes drug (empagliflozin, Jardiance) to demonstrate a significant reduction in cardiovascular outcomes. The trial even resulted in a surprising, statistically significant reduction in mortality. I asked Sanjay Kaul for…

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Why Rob Califf Running The FDA May Be Like Nixon In China

(Updated)– There’s a widespread belief that only a conservative like Nixon could have opened up US relations with China. Any attempt by a Democrat to do the same would have been political suicide, but for Nixon it was politically feasible, and today it is recognized as one of his very few untarnished genuine achievements. I want to suggest that…

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President Obama Nominates Cardiologist Rob Califf To Lead FDA

The White House announced on Tuesday that it was going to nominate Duke University cardiologist Rob Califf to serve as the next Commissioner of the FDA. The nomination had been widely expected since his appointment in January as the FDA Deputy Commissioner for Medical Products and Tobacco. Before going to the FDA Califf had most…

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On Empathy: “The Only Time I Remember Seeing A Physician Touch My Father”

You can’t reduce empathy to a formula. Read this Lancet perspective by Caleb Gardner. It’s about what he learned while a medical student from his father’s death from heart failure. A few excerpts: I attended a lecture on breaking bad news and having goals-of-care discussions with families in the critical care setting. The presentation was like many…

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Survey: Yearly Pay For Cardiologists Hits $542,000

A newly-released survey finds that compensation for cardiologists grew to $542,000 in 2014. This represents a $30,000 increase from 2013 and brings the total close to the previous high of $548,000 in 2012. The increase may reflect an over-representation of private physicians in the survey released by MedAxiom Consulting, which bills itself as the nation’s top cardiovascular service…

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The Dirty Little Secret About Electronic Health Records

When it comes to electronic health records mum’s the word. Earlier this year I wrote a post, Two Dirty Little Secrets About Electronic Health Records [reprinted below], in which I reported that Epic Systems and other  EHR companies  require hospitals to sign a non-dispargement agreement, or “gag” clause. In fact, I reported, Epic doesn’t even allow its hospitals and…

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John Markoff On The End of Moore’s Law and Closing The Door on The Terminator

This is completely off topic (or is it?) but if you have any interest in technology you should read this fascinating Edge interview with John Markoff, the pioneering technology reporter for the New York Times. I am simply shocked that I have not heard more about the possible end to Moore’s Law (which states that computing power doubles…

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Cost Effectiveness Of Entresto And CardioMEMS Evaluated

The new Novartis heart failure drug Entresto  (the combination of sacubitril and valsartan, formerly known as LCZ696) is cost effective but the CardioMEMS monitoring system (St. Jude Medical) is not, according to draft reports issued last week by the Institute for Clinical and Economic Review (ICER). The same organization released a widely discussed report about the cost…

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A Premature SPRINT To The Finish Line

On Friday the NHLBI declared victory in the SPRINT trial. As was widely reported here and elsewhere, the NHLBI announced that the trial had been stopped early after significant reductions in cardiovascular events and mortality had occurred in the group of hypertensive patients randomized to a  more aggressive blood pressure target than is currently recommended today. But there was a…

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NIH Trial, Stopped Early, Supports More Intensive Blood Pressure Targets

More stringent blood pressure targets could save lives and reduce cardiovascular events, according to preliminary results from a large NIH clinical trial that was stopped early. The SPRINT (Systolic Blood Pressure Intervention Trial) trial randomized 9,361 hypertensive patients 50 years of age or older to the standard systolic blood pressure target (when the trial began) of 140…

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Amarin Begins Legal Off-Label Promotion Of Vascepa

Barely a month after a big victory in a federal court over the FDA, Amarin Pharma has started off-label promotion of Vascepa, its much-disputed prescription fish-oil product, Medical Marketing & Media reports. Vascepa was first approved by the FDA in 2012 as as an adjunct to diet to reduce triglyceride (TG) levels in adult patients with severe hypertriglyceridemia (TG > 500mg/dL),…

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Don’t Believe The Hype

What is the most common flaw in health journalism? “Conveying certainty that doesn’t exist.” That’s Gary Schwitzer’s terrific response to this important question. At last week’s Presenting Overdiagnosis 2015 conference in Washington, DC Schwitzer, the publisher of HealthNewsReview.Org, listed the most common mistakes journalists make: Exaggerating effect size– relative not absolute data Using causal language to describe observational studies Idolatry…

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