NEJM 23 Jul 2015 Vol 373 307 Four summers ago I found myself dabbling in the early history of outcomes research. I was astonished to find that surgeons over a century ago were reflecting on much the same issues as they do today. In cancer, for example, there was lively debate about the place and […]
NEJM 16 July 2015 Vol 373 209 I’ll say it again: “Cancer boasts the worst trials in medicine. Also the worst drug regulation. Also the worst cost/benefit ratio for new treatments. And also the worst drug toxicities. Plus the highest levels of public and charitable funding. My forehead hits the desk when I read about […]
NEJM 9 July 2015 Vol 373 111 First they defined a new disease category. Then they promoted a mechanistic explanation. Then they made everyone focus on the pathway that matched the latest drugs. Then they made billions of dollars selling the drugs. By the time the whole edifice started to look shaky, everybody was complicit […]
NEJM 2 July 2015 Vol 373 11 Liraglutide for weight loss. Like the second Iraq war, we knew for years that it was coming. The propaganda was laid out well in advance. “Obesity is a chronic disease with serious health consequences,” say the NovoNordisk authors. No it’s not, it’s a measure of body weight that […]
NEJM 25 June 2015 Vol 372 2533 The research articles in this week’s print NEJM are all about arcane stuff I’ve covered previously. The Clinical Practice article takes us back to the real world—the one we’d rather not think about, where there is a smell of urine and random cries from rooms down the corridor. […]
NEJM 18 June 2015 Vol 372 2387 For the first time in years, I actually handled a new printed copy of the NEJM last night. What a suave production it is! Flicking though its stylish pages with their subtle sheen, I came across the IMPROVE-IT study once again. It’s a telling reminder of how credulous […]
NEJM 11 June 2015 Vol 372 2307 Here at last is a study that shows some benefit from out of hospital cardiopulmonary resuscitation. It’s not a randomised trial, since that would be considered unethical, or at least heretical. Instead it comes from interrogating a big Swedish database of outcomes following cardiac arrests outside hospitals. “CPR […]
NEJM 4 Jun 2015 Vol 372 2185 If you are the sort of exciting doctor who looks after adults with acute hypoxaemic respiratory failure, here is just the article you need. It’s a French trial comparing the effect of high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The […]
NEJM 28 May 2015 Vol 372 2087 Now that the NEJM has flagged up its position on conflicts of interest, it’s definitely a case of caveat lector—looking hard at what it decides to publish. First in this week’s issue is a GSK-funded trial of its new herpes zoster vaccine (HZ/su) aimed at preventing shingles in […]
NEJM 21 May 2015 Vol 372 2064 The NEJM has the highest reputation of any medical journal, so it’s impossible not to feel dismay when it lets its standards slip towards the near-nonsensical. When the first part of Lisa Rosenbaum’s three-part series on conflicts of interest appeared, I wondered if it might be some kind […]