By: Dr. Geoffrey Modest -A new article just came out of the Program in Placebo Studies in Boston that link the “placebo effect” to specific genes in the newly-defined “placebome” (see here), also noted in a more popular forum. Background, promoting the concept that placebo effects are legitimate biological responses to environmental cues: –studies on placebos have […]
Primary Care Corner with Geoffrey Modest MD: Sitagliptin — more drug company shenanigans.
By: Dr. Geoffrey Modest The preliminary results of the TECOS trial (Trial Evaluating Cardiovascular Outcomes with Sitagliptin) was just released by the drug company (Merck), though formal release is expected in June at the Am Diabetes Assn meeting (and, I do not have an advanced copy to critique in detail). This issue takes on added importance since […]
Primary Care Corner with Geoffrey Modest MD: MMR vaccination and autism, again
By: Dr. Geoffrey Modest Yet another study on the relationship (or lack thereof) between MMR vaccination and autism. I bring this up since this is a large study but includes kids at higher risk of autism (see JAMA. 2015;313(15):1534-1540). This is a retrospective cohort study from a large health insurer (Optum) database, using claims data (the insurer is […]
Primary Care Corner with Geoffrey Modest MD: Dolutegravir and lipids
By: Dr. Geoffrey Modest Several of the HIV drugs are associated with adverse lipid effects, as well as metabolic (eg, insulin resistance/diabetes) and cardiovascular complications. A recent study looked at the effects of dolutegravir (an integrase strand transfer inhibitor, INSTI) on cholesterol ( see Clin Drug Investig (2015) 35:211–219). In this analysis they looked at 4 clinical trials of Rx-naive patients put on […]
Primary Care Corner with Geoffrey Modest MD: Guideline on treating first seizure
By: Dr. Geoffrey Modest The Am Acad of Neurology and Am Epilepsy Society just released an evidence-based guideline on the management of an unprovoked first seizure in adults (see Neurology. 84;16: 1705-1713). Background: in the US, there are 150K adults annually who have a first unprovoked seizure, defined as a seizure (sz) of unknown etiology, or a […]
Primary Care Corner with Geoffrey Modest MD: USPSTF breast cancer screening recommendations
By: Dr. Geoffrey Modest The US Preventive Services Task Task Force just published a draft recommendation for breast cancer screening in women after age 50 (see here), as follows. For women 50-74 years old, screening mammography every 2 years, grade B recommendation (moderate certainty that there is net benefit): –meta-analysis suggests that screening 10,000 women age […]
Primary Care Corner with Geoffrey Modest MD: E-cigarettes
By: Dr. Geoffrey Modest So, no great surprise. E-cigarettes are taking over our youth… The latest MMWR reviewed tobacco use in middle and high school students in the US, from 2011-2014, revealing profound changes (see here for full MMWR report). In brief: –the CDC and FDA reviewed data of trends in current tobacco use (defined as: use […]
Primary Care Corner with Geoffrey Modest MD: PCSK9 inhibitors and general observations
PCSK9 inhibitors and general observations […]
Primary Care Corner with Geoffrey Modest MD: Sinusitis guidelines
Sinusitis guideline […]
Primary Care Corner with Geoffrey Modest MD: Too low blood pressure and cognitive decline in elderly
By: Dr. Geoffrey Modest An Italian prospective cohort study of elderly patients (>65 yo) with baseline cognitive impairment assessed the association between achieved blood pressure in those who were hypertensive and the rate of cognitive decline (see JAMA Intern Med. 2015;175(4):578-585). Details: –172 patients followed in 2 outpatient memory clinics, mean age 79, 63.4% female, mean mini-mental status exam (MMSE) baseline score […]