Marijuana use and brain function in middle age

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The public attitude towards marijuana is changing. Though some continue to view the agent as a dangerous gateway to harder drugs like cocaine and heroin, increasing use of the drug for medical purposes, and outright legalization in a few states will increase the number of recreational pot users. Its high time we had some solid data on the long-term effects of pot smoking, and a piece of the puzzle was published today in JAMA internal medicine.

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Chantix goes to bat against the nicotine patch for quitting smoking. The winner? No one.

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Quitting smoking is really hard. It’s frustrating for smokers and for their doctors. And I need to come clean and admit that when varenicline (Chantix) came out I was excited to have one more weapon in my anti-smoking armamentarium. After all, the gums, lozenges, and patches didn’t seem to work very well, but here was this new drug – a pill – that initially boasted quit rates as high as 40%. Compare that to 8% with placebos.

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The US spends an appropriate amount on end of life care, if you massage the numbers a bit.

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I think it’s fair to say that there is a certain narrative regarding costs of health care in the United States. It goes like this:  “The US spends more on healthcare than any other nation, and gets less for it”.

Is that really true?

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Being a woman versus being womanly: the implications after heart attack

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There are two elements you can expect to see in almost any study: the first is some effect size – a measure of association between an exposure and outcome. The second is a subgroup analysis – a report of how that effect size differs among different groups. Sex is an extremely common subgroup to analyze – lots of things differ between men and women. But a really unique study appearing in the Journal of the American College of Cardiology suggests that sex might not matter when it comes to coronary disease. What really matters is gender.

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The diagnosis: Cancer. Should you blame your genes?

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The prevailing wisdom about almost all types of cancer is that the disease occurs due to a combination of genetic susceptibility and environmental exposures. For different types of cancers, the relative weight of each of these components may differ. But teasing out how much contribution to cancer incidence can be attributed to genetics versus environment is tricky. Unless, that is, you have access to a register of over 100,000 pairs of twins.

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Antidepressants, pregnancy, and autism: the real story

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If you’re a researcher trying to grab some headlines, pick any two of the following concepts and do a study that links them: depression, autism, pregnancy, Mediterranean diet, coffee-drinking, or vaccines.  While I have yet to see a study tying all of the big 6 together, waves were made when a study appearing in JAMA pediatrics linked antidepressant use during pregnancy to autism in children.

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Miserable? Happy? You’ll live just as long either way.

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We’ve been doing these 150 second analyses for about 6 months now, so I feel I can ask you this:  Are you happy? Really happy?

Well it turns out it doesn’t matter.

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Med Students: The best 4.6 minutes in your day.

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Whenever I have a new med student on a rotation with me, I tell them the same thing.  Your med student rotations will be the worst experience in your medical training. OK, so I might not be the best preceptor.

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Should the worldwide c-section rate be 15%?

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Every pregnant woman should get a c-section.

Wait, no. No pregnant women should get c-sections.

Hmm, that doesn’t seem right either.

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A blood test to avoid a spinal tap in an infant? Yes please.

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Here’s a secret for any non-clinicians watching this. Docs are terrified of fevers in very young infants – not because they turn out so horribly – most are benign viral infections – but because fever in an infant of less than 4 weeks requires a spinal tap to rule out meningitis. It would be great to have a test that could reliably and quickly tell us if a baby’s fever was due to a bacterial infection that needs prompt and aggressive treatment, or a virus, that can be managed at home.

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