Does Hope Hurt? Predicting Death at the End of Life

“There’s always hope”.

This is a statement I have used many times when discussing the care of a patient with a terminal illness, but I have to admit it always felt a bit pablum. I think it ends up being short hand for “none of us are ready to accept reality so here we are”. A few years ago I stopped saying that when I believe a patient is terminally ill.  Instead I state that the patient has reached the end of his or her life, and its time to plan for that.

For the video version of this post, click here.

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Amyotrophic Lateral Sclerosis and Environmental Toxins: A New Link?

An article appearing in JAMA Neurology links exposure to certain environmental toxins, like pesticides to Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease). While I could spend these 150 seconds talking about whether or not we should run home and clean all the Round-Up out of our garage, I’d like to take this chance to talk about 3 methodologic issues a study like this brings to the fore.

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“Price Transparency” Doesn’t Curb Spending In Medicine

I love price transparency. When I book an airline seat, I will base my entire decision around the fact that one flight is $3 cheaper. Leg room be damned. But does price transparency work in the healthcare industry? A study appearing in the Journal of the American Medical Association may be telling us something important: Healthcare isn’t like other industries.

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Arsenic in the Baby Food – Time to Panic?

Giving a baby their first bite of real food – it’s an indelible memory. That breathless moment as you wait to see whether it will be swallowed or unceremoniously rejected, the look of astonishment on their little face. For many of us, that first bite was rice cereal – gentle on the stomach, easy to mix with breast milk or formula, safe, trusted, traditional.

Well it turns out we’ve been poisoning our children all along.  Well, at least that’s what a paper appearing in JAMA Pediatrics would have you believe.

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New Drugs Hold Real Promise for Metastatic Melanoma

I’m going to show you a survival curve for metastatic melanoma.

Survival rate in metastatic melanoma

Survival Rate in Metastatic Melanoma

This data was analyzed in 2001, but sadly, even current 5 year-survival for metastatic melanoma sits around 15%. But some new drugs might change this.

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Peanuts, Peanut Avoidance, and the Development of Allergy

I love a nice clinical trial that answers an important question and one of my favorites from the recent past was the “Learning Early About Peanut allergy” or LEAP trial, published in February of 2015 in the New England Journal.  I probably don’t need to reiterate the results of this truly landmark study, but basically, it upended about two decades worth of advice to parents to avoid exposing their infants to food containing potential allergens, such as peanuts.

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Huge Chinese Study Suggests 20% of Heart Disease due to Low Fruit Consumption

A 柚子 a day keeps the doctor away?

Appearing in the New England Journal this week is a juicy study  that suggests that consuming fresh fruit once daily can substantially lower your risk of cardiovascular disease. In fact, the study suggests that 16% of cardiovascular death can be attributed to low fruit consumption. For those of you keeping score, that’s pretty similar to the 17% of cardiovascular deaths that could be prevented if older people stopped smoking.

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Naltrexone to Prevent Opioid Relapse: A New Weapon in the Fight

There are a few experiences nearly every physician remembers. Delivering that first baby, running that first code, a stranger showing you a rash at a dinner party. Some things are universal. Likewise the first time you injected naloxone into someone suffering from an opioid overdose. For the non-medical folks, naloxone blocks the receptor in the brain that gives opiates their punch. Injecting someone with the stuff essentially puts them into immediate, full-blown withdrawal. It’s lifesaving, but rough. Think that scene from Trainspotting.

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Rosacea linked to Parkinson disease: Is this remotely plausible?

The title of the manuscript is:

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Titles like that remind me of the time I was in South Africa and ran into an evangelical Christian basketball team. I know what both of those things are, but I’d never thought of putting them together. Nevertheless that’s the study that appears in JAMA Neurology. So are we playing epidemiology roulette, or is this a real finding? Should your patients with rosacea be concerned?

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Are IUDs dangerous for teenage girls?

In the past 5 years both the American Academy of Pediatrics and the American College of Obstetrics and Gynecology have come out in support of Long-acting reversible contraceptives (LARCs) as highly effective options for adolescent girls. LARCs, which include IUDs and implants, are undoubtedly superior to oral contraceptives and condoms when it comes to preventing pregnancy.

Of course IUDs don’t prevent sexually transmitted infections. The question, then, is whether use of IUDs will commensurately decrease condom usage, and, according to an article appearing in JAMA pediatrics, the answer is yes. But as usual, the devil is in the details.

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