NEJM 9 October 2014 Vol 371 1381 With blood transfusion, it seems that less is usually better. This has been shown in renal patients and palliative care, and is now reconfirmed in septic shock. Fifteen years ago, the Canadian Critical Care Trial Group study showed that transfusing critically ill patients at threshold of 10 G/dl […]
NEJM 2 October 2014 Vol 371 1285 Here is a trial which had me taking my glasses off and scratching my bald patch. Why on earth should a drug company—in this case Boehringer Ingelheim— want to pay for a trial of taking patients OFF a drug? And why in particular should it want to take people […]
NEJM 25 September 2014 Vol 371 1189 This week we start with mepolizumab. Before we know it, we encounter losmapimod. Enough is enough. I think the World Health Organization should convene an extraordinary meeting of the International Nonproprietary Names Committee with the sole purpose of Stopping Silly Names. Medical practitioners are serious people and they […]
NEJM 18 September 2014 Vol 371 1100 The way I have ureteric colic is so classical that just watching me sweat and groan is enough for anyone to make the diagnosis, even without the haematuria on the dipstick. I see the same thing all the time in out of hours primary care patients, and generally […]
NEJM 11 September 2014 Vol 371 1016 Ticagrelor has had mixed fortunes since it was introduced as a new thienopyridine platelet aggregation inhibitor a few years ago. The PLATO trial left lingering doubts whether it is better than the much cheaper clopidogrel when used in acute coronary syndromes. Rather than attempting to resolve these, the […]
NEJM 4 Sep 2014 Vol 371 892 A terrific piece by Rita Redberg discusses sham controls in medical device trials. Whenever sham procedures are used in the control arms of such trials (or in surgical trials generally) they reveal a huge placebo effect. For example, renal denervation therapy produced huge sustained falls in recorded blood […]
NEJM 21-28 August 2014 Vol 371 711 I have a new little grandson called Timothy. He is lucky being born in August because respiratory syncytial virus generally lies low at this time of the year. Most babies get RSV at some stage of their first year, and the earlier they get it the worse it […]
NEJM 14 August 2014 Vol 371 601 The usual wisdom about sodium chloride is that the more you take, the higher your blood pressure and hence your cardiovascular risk. We’ll begin, like the NEJM, with the PURE study. This was a massive undertaking. They recruited 102 216 adults from 18 countries and measured their 24 […]
NEJM 7 August 2014 Vol 371 497 A new gene for breast cancer susceptibility? The PALB2 gene locus has been known about for several years, but this study puts it firmly on the map by intensively investigating 362 members of 154 affected families. The risk for female PALB2 mutation carriers, as compared with the general […]
NEJM 31 July 2014 Vol 371 397 Set aside half an hour to enjoy this week’s New England Journal. The key articles are all about malaria, and they are free. You might expect an account of The Origins of Anti-Malarial Drug Resistance to be both boring and depressing, but this one by Randall Packard is […]