Sensible Medicine

The study in question is a randomized clinical trial looking at the Million Hearts Model. This model paid health care organizations to assess and reduce CV risk. Obviously, this is an important goal. Heart disease, specifically, atherosclerotic vascular disease, is a leading killer of humans. Any reduction of heart disease should have a benefit on both a person and a population. But paying health systems to do specific things is a policy intervention.

LT was an 80-year-old woman admitted to our inpatient medical team with gram-negative bacteremia. She came to the hospital with three days of weakness, fever, chills, and anorexia. After briefly interviewing and examining the patient with my team in room 23 of the emergency room, I excused myself while they finished their assessment. Sensible Medicine is a reader-supported publication. If you appreciate our work, please consider becoming a free or paid subscriber.

Discover more from Sensible Medicine Common sense and original thinking in bio-medicine Over 73,000 subscribers A few months ago, a sensational letter came out in JAMA Pediatrics. The authors took California school children out of the classroom, and had them line up in the school yard. Then a dog sniffed them to see if they had COVID19. Students were told not to look backwards at the dog, but inevitably some students must have snuck a peak.

Sudden cardiac death due to ventricular rhythm disturbances are rare but highly public. It’s strange and curious because you don’t expect healthy athletes to suffer serious cardiac issues. Recently three prominent athletes have survived sudden cardiac death. Christian Erikson, a Danish soccer player, Damar Hamlin, an American football player and Bronny James, son of Lebron James. These high-profile cases have highlighted the issue of sudden cardiac death of athletes.

We can all agree that evidence from clinical trials should guide practice. But. But. There are snags. One problem with evidence-based practice is that it’s harder than many experts would admit. Today I will use an example in the heart failure space. Many heart failure experts vigorously advocate for rapid and complete use of the four classes of drugs that have yielded positive results in trials.

Dr. Peter Attia’s longevity book Outlive is interesting and insightful, but readers should know that his muscular brand of primary care results in some very aggressive recommendations. This is a book that should be read and discussed, but not blindly followed. Like many of my patients, I recently read Peter Attia’s Outlive, and I found the book informative and highly motivational. I appreciate his emphasis on good sleep and his rejection of nutritional dogma.

Anything I would write about medicine seems too irrelevant today. It feels like 9/11. I watch the news and Twitter. The stories and images render everything else secondary. My gosh.

SS was a 78-year-old man whose chief concern was simply, “I am dying.” During three visits to his home, I was unable to find anything concerning, or to reassure him that his health was good, or to convince him to come to the office for a more traditional evaluation. Four weeks after our last visit, his wife called me to let me know that he had died in his sleep.

Angela Lu is training to be a physician. She’s interested in public policy. As a third year medical student, she teamed up with established leaders to ask a unique question regarding public disclosure of financial relationships. When the Centers for Medicare & Medicaid Services (CMS) issues National Coverage Determinations (NCDs) for services or products, they mean business. Such decisions have huge implications. You cannot go against them. Think #HighConsequences.