NEJM 24 July 2014 Vol 371 371 Long ago I had a patient who kept having odd things happen to her. She infarcted part of her cerebellum, and then did the same to two fingers on her right hand. She was full of pains, her kidneys were failing, and her erythrocyte sedimentation rate (ESR) stayed […]
NEJM 17 July 2014 Vol 371 203 Niacin is an abundant natural B vitamin, which lowers bad cholesterol and raises good cholesterol. What’s not to like? Well, niacin, unfortunately. In doses that make any difference to lipid levels, it is very likely to make you feel sick, get flushes and/or rashes, and/or feel muscle pains. So […]
NEJM 10 July 2014 Vol 371 107 I was very confused by this paper. It describes two trials of three drugs for premenopausal breast cancer with various permutations, and the bottom line is that all the interventions give the same result. Or, if you are a sponsor of the trial, you can report: “In premenopausal […]
NEJM 3 July 2014 Vol 371 11 I don’t envy anyone with central lumbar spinal stenosis. The odds of benefit from surgery are slight. The pain can be there all the time and always gets worse on walking, which can limit activity severely. No wonder epidural steroid injections have proved popular. In this study, they […]
NEJM 26 Jun 2014 Vol 370 2478 Cryptogenic is a good word. It’s up there with “idiopathic” and “pleiotropic” and “diathesis” for covering gross ignorance with a smattering of Greek. “Cryptogenic” sounds as if it was first used to describe the odd symptoms that Superman experienced when exposed to kryptonite. However, its first use was recorded […]
NEJM 19 Jun 2014 Vol 370 2387 If you have a patient who is taking an opioid for chronic, non-cancer pain and gets constipated as a result, what do you do? Prescribe a laxative. Well done. And advise them that for most people with chronic pain, opioid analgesics don’t work and are best weaned off. […]
NEJM 12 June 2014 Vol 370 2265 Obstructive sleep apnoea is often a result of weight gain, and unfortunately, once it is established, losing weight does not reduce it. But losing weight has benefits of its own (he sighs wistfully), as this trial of weight reduction, continuous positive airways pressure, or both for OSA demonstrates. I […]
NEJM 5 Jun 2014 Vol 370 2169 There is a story that when new antibiotics were arriving every few weeks in the late 1950s, drug companies had a hard time thinking up new names for them, all ending in mycin. So they started using a word generating machine, but stopped when it came up with […]
NEJM 29 May 2014 Vol 370 2071 This week’s New England Journal is dominated by three papers on idiopathic pulmonary fibrosis. The editorial on them begins “I suspect that many of my patients have picked up on more than a hint of frustration in my voice when I tell them that the cause of their […]
NEJM 15-22 May 2014 Vol 370 1944 The introduction of pay for performance in the NHS attracted great interest in the USA, which is still trying to come up with similar schemes of its own. Martin Roland and Stephen Campbell both helped the UK government to set up the Quality and Outcomes Framework for primary […]