NEJM 19 Jan 2017 Vol 376 Transmission of drug resistant TB Tuberculosis in Europe used to be known as the White Death, and that is the title of the best book about its history. But in parts of South Africa extensively drug resistant (XDR) tuberculosis might be called the New Black Death, because there it […]
NEJM 12 Jan 2017 Vol 376 PROMS and PROs I first went to the Proms in 1966. I enjoyed the queuing, the atmosphere, and the music: young Barenboim playing Beethoven with Boulez, Kertesz conducting Dvorak, Heather Harper singing something English and so forth. So long ago. Now the word prom seems to mean a passing-out […]
NEJM 5 Jan 2017 Vol 376 The trials of big pharma As a fan of Ben Goldacre’s Bad Pharma and Peter Gøtzsche’s Deadly Medicines and Organised Crime, I was not expecting to think highly of a piece called “The Large Pharmaceutical Company Perspective” in the NEJM series called “The Changing Face of Clinical Trials.” It […]
NEJM 22-29 Dec 2016 Vol 375 Co-amoxiclav for OM in under-twos This trial firmly establishes the superiority of a ten day over a five day course of co-amoxiclav for babies and toddlers with acute otitis media. The figures are clear: with only five days treatment, failure of resolution at ten days is 34%, whereas if […]
NEJM 8-15 Dec 2016 Vol 375 Geographical variation in trials This review article on geographical subgroup variation is a master class in how to think about and analyze randomised controlled trials. Salim Yusuf and Janet Wittes have been leading figures in the design and interpretation of RCTs for the last thirty years, and that shines through […]
NEJM 1 Dec 2016 Vol 375 Can genes prove how drugs work? Medicine is the application of neat science to a messy world. We love it when it works simply: for example, when a single gene controls a single biochemical process, which we can then block with a single chemical. Statins are often cited as […]
NEJM 24 Nov 2016 Vol 375 AAA in UK & USA It grieves me to say it, but there are certain things that American medicine does better than British medicine. Repairing abdominal aortic aneurysms seems to be one of them. It’s not that men on the whole live longer over there, but only a third […]
NEJM 17 Nov 2016 Vol 375 Diabetes kills in Mexico City “Overall, between 35 and 74 years of age, the excess risk of death associated with diabetes accounted for approximately one third of all deaths from vascular causes and one third of all other deaths.” That is a shocking statistic and it applies to the largest […]
NEJM 10 Nov 2016 Vol 375 Reinventing connected medicine A 1300 word Viewpoint article can hardly do justice to a theme as grand as “Meaning and the Nature of Physicians’ Work”, and a lot of this piece is taken up with describing the current realities of American hospital medicine for those at its coalface. But […]
NEJM 3 Nov 2016 Vol 375 Tolerating uncertainty “At once it struck me what quality went to form a Man of Achievement . . . when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason.” John Keats, December 1817 This quotation heads a wonderful short essay […]