Category Archives: NEJM

Estimated Lifetime Gained With Cancer Screening Tests

The title of this piece is that of a paper published by JAMA Internal Medicine. It is available at the end of this article. If you are a long-time reader of this site, you will appreciate that I have long been skeptical about the utility of screening for cancer. This view may seem odd to…


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Thrombotic Thrombocytopenia Associated With the AstraZeneca Vaccine

The COVID-19 vaccine developed by AstraZeneca (AZ) has been widely used in Europe, but not in the US. Its technical nomenclature is a recombinant adenoviral vector encoding the spike protein antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (ChAdOx1 nCov-19. Not long after the introduction of this vaccine cases of clots associated with low…


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Brief Medical Updates

Three recent medical reports. The first is from Science. A conference held by Biogen in February of this year was a superspreader event. Phylogenetic analysis of SARS-CoV-2 in Boston highlights the impact of superspreading events reports the spread of SARS-CoV-2 following an international business conference in at the Marriott Long Wharf on Feb 26-27. By…


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Einstein, Insanity, and Models

“Insanity is doing the same thing over and over and expecting different results.” This quotation attributed to Einstein, was said by him (if he really said it) in the context of quantum mechanics, where doing the same experiment repeatedly does give different results. But in the macro world the same experiment properly performed does give…


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Mammography Screening in Switzerland

The May 22, 2014 issue of the New England Journal of Medicine has a perspective piece that is even more instructive than its authors and the journal’s editors realized: ‘Abolishing Mammography Screening Programs? A View from the Swiss Medical Board’. It describes the process that the Swiss used to evaluate the scientific foundation for the…


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Osmolality and Brain Injury

The August 23rd issue of the New England Journal of Medicine has a review article about the treatment of raised intracranial pressure. A patient with head trauma is the index case. Patients who are known to have increased intracranial pressure or more commonly thought to have it are typically treated with agents that increase serum…


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Unreasonable Health Insurance Premiums

New York Times columnist and Nobel prize winner in economics Paul Krugman is famous for his dedication to fiscal stimulus as an escape from our current economic woes. No matter how much money the government pumps into the economy he wants more if the result is not what is desired. Thus he is indulging in…


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Hepatorenal Syndrome

The September 24th issue of the New England Journal of Medicine has an excellent review article by Ginès and Schrier on Renal Failure in Cirrhosis. It reviews the pathogenesis of the circulatory events by which severe liver disease compromises renal function. Surprisingly, the authors omit a key step in the pathophysiology of compensated cirrhosis. Look…


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Screening for Prostate Cancer – Yet Again

It seems to be impossible to drive a stake through the heart of this issue. The current New England Journal of Medicine has two more studies and an editorial on the subject. One (Mortality Results from a Randomized Prostate-Cancer Screening Trial) concludes “that prostate-cancer screening provided no reduction in death rates at 7 years and…


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Medicare's Payment of Physicians

Every year Congress goes through a Medicare ritual. The law as written requires about a 20% reduction in payments to doctors. Medicare’s rates are already low causing many physicians to refuse new Medicare patients who don’t have supplemental insurance.These physicians usually are the best in each locale; it’s the weakest that stay in the system…


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