Commentary by Shrujal Baxi MD, NYU Chief Resident

One of the first things you learn about critically analyzing a medical journal piece is to go to the end and see who sponsored the study. Corporate financing is known to have subtle effects on research which can lead to an unconscious bias. Disclosure of funding is paramount for a researcher in order to remain above reproach.

In a recent New York Times article, the impact of such relationships is investigated. In 2006, Dr. Claudia Hensheke, a radiologist at Weill Cornell Medical Center, reported that 80% of deaths due to lung cancer could be prevented through widespread use of screening spiral lung CT scans. Although this claim raised a great deal of debate by those in the field, nothing has been more controversial than the revelation that funding for her research came directly from tobacco giant, Liggett.

Well, “directly funded” is a misnomer. The researchers at Cornell received funding from a little known-charity called the Foundation for Lung Cancer: Early Detection, Prevention & Treatment. This foundation was underwritten almost entirely by Vector, the parent company of the Liggett group, maker of Liggett Select, Eve, Grand Prix, Quest and Pyramid cigarette brands. At a time when universities are turning away tobacco money and journals are actively screening studies completed using such funding, it was surprising to many to hear about this undisclosed contribution. The article goes into detail about the relationship of the faculty involved at Cornell and the foundation funding the research with speculations about intent to hide their financial information.

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Commentary by Rob Donnino MD, NYU Division of Cardiology

The annual meeting of the ACC was held last month in Chicago. A good number of NYU faculty and fellows either presented at or attended the meetings. The cardiology fellows exhibited an impressive balance between exploring the Chicago nightlife and diligent attendance at the meetings. Several of the cardiology fellows presented some of the highlights of the ACC meeting at a recent journal club conference for the Cardiology Division. They will be summarized in a three part weekly series. Part 1 follows below:

Dr. Sohah Iqbal reported the results of the ENHANCE trial. This trial randomized 720 patients with familial hypercholesterolemia to receive either simvastatin alone or in combination with ezetimibe. The primary outcome, change in carotid-artery intima-media thickness (IMT), did not differ between the two groups after 2 years of treatment. This lack of effect was present despite a more significant lowering of LDL (and elevation of HDL) in the combination simvastatin/ezetimibe group. At the end of the study, the LDL in the combination group was 141 mg/dl vs. 192 in the simvastatin alone group.

As many of you know, the ENHANCE trial has generated considerable discussion both in and outside of the medical community, by both the lay press and even by members of the U.S. Congress. Some of the controversy began even before the results were reported when the drug company involved in the study was accused of delaying the reporting of the results. While this matter is currently under Congressional investigation, we will stick with a discussion of the medical results… Read the rest of this entry »

Commentary by Sean Cavanaugh MD, Associate Editor, Clinical Correlations

More strong evidence is popping up in the journals indicating that genes might actually be important in determining disease. Who knew? Now that we are well into the dawning age of genetically determined diagnosis and therapy, this week features a few interesting articles on recently discovered genetic associations with particular disease. Other than that – it’s all about global hypertension…

The Lancet features a type of research increasingly seen in the major journals: combing the genome for single nucleotide polymorphisms (or SNPs) associated with disease, in this case osteoporosis. Association studies identified two suspect SNPs from an initial cohort of 2094 women in the United Kingdom with osteoporosis and then “validated” the Odds Ratios in other cohorts derived from western Europe. The Odds Ratio for the combination of these alleles was independent of bone mineral density but wasn’t too impressive (1.3); however it does compare with known environmental risk factors for fractures and could very likely have a role in the near future as the era of genetic analysis continues to unfold. Read the rest of this entry »

Commentary by David Hatcher, MSIII (reviewed by Neil Shapiro, MD Editor-In-Chief, Clinical Correlations)

C.M. is a 68 year-old retired Caucasian male with a past medical history significant for coronary artery disease, hyperlipidemia, HTN, and a 30 pack year history of smoking. His drug regimen consists of a beta-blocker, an ace inhibitor, a statin, and aspirin.

Patients like C.M. are now more common than ever before. He has already had one heart attack, and he has multiple risk factors for another, many of them preventable. In the United States alone, heart disease and stroke are the first and third leading causes of death. For those like C.M., this means a lifetime on multiple medications; unfortunately, however, not everyone has access to the same resources or is as compliant. Despite the availability of medications proven to be effective for primary and secondary prevention of cardiovascular disease, they often are not used optimally, even in developed countries. A gap currently exists between our knowledge of prevention and its actual practice. Poor drug adherence to multidrug regimens and costly medications are common barriers to treatment, especially in middle and lower income areas. Read the rest of this entry »

Commentary by Joe Philip MD, PGY-2

CORTICUS was the long-awaited trial addressing the use of corticosteroids in sepsis that was published in the NEJM this past January. Months prior to the leading auther Charles Sprung publishing it, the Tisch and Bellevue intensive care units halted corticotropin stimulation testing. Corticosteroids have warranted much publicity since CORTICUS came out—and rightly so as practice across the country has changed because of it. The Survinig Sepsis Campaign has now downgraded the recommendation on the use of corticosteroids in sepsis from C down to 2C based on this trial, which did not show a mortality benefit in those with septic shock. Should practice change as a result? Read the rest of this entry »

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

This week’s ShortCuts begins with a follow up of a story first presented in March, 2008, when the recall of potentially contaminated heparin was reported.

Typical case: 73 year old woman with a complex medical history including end-stage renal disease treated with the use of hemodialysis for 7 years routinely receives heparin intravenously during hemodialysis. In January 2008, during a dialysis session, she develops hypotension with associated nausea and dyspnea and requiring resuscitation with IV fluids. During a subsequent dialysis session, an anaphylactoid reaction is reported, with a sudden drop in blood pressure, dyspnea, nausea, vomiting and constitutional symptoms. Read the rest of this entry »

Case Presentation by Alana Choy-Shan MD, Chief Resident

Please review the posting of our prior CPC here.

When you’re ready you can download the CPC Answer.

Commentary by Vlad Fridman MD, PGY-3

On July 30, 1965, then president Lyndon B. Johnson signed into law an amendment to the Social Security legislation establishing a national health care program for the elderly called Medicare. In fact, at the signing, former president Harry S. Truman was enrolled as the first Medicare beneficiary and received the first Medicare card. Then it was simple. Currently, Medicare is a complicated health insurance program that is comprised of multiple parts, various co-payment and deductible schedules, and also separate plans and additional coverage plans offered by private health insurance companies. In the United States, Medicare is available to US citizens or permanent residents who are in the country for 5 years or more, and who are 65 years or older, those less than 65 years or who have been receiving social security disability benefits, and people with end stage renal disease or ALS.

First, let’s talk about all the parts of Medicare. The original Medicare program had two parts: Part A and Part B. Part A covers hospital stays and skilled nursing facility costs. However, certain criteria must be met for coverage to be valid. The hospital stay needs to be more than 3 days, and if a nursing facility is necessary, it must be as a consequence of the condition diagnosed during the hospitalization. Furthermore, a specific nursing skill need must be present for the nursing home stay to be covered. Nursing home visits due to non-skilled requirements, such as for activities of daily living, are not covered under Medicare A. Part B covers most services that are performed on an outpatient basis. Doctor’s visits, x-rays, laboratory tests, durable medical equipment such as canes and walkers, medications given during doctor visits such as chemotherapy and many similar services are covered under Medicare Part B. Read the rest of this entry »