Insights are brief stories about NEJM content, written by contributors appointed by NEJM editorial staff. While the posts often include quotes from editors, and are approved by editors, these blog posts about NEJM content are not published in NEJM, and should not be considered NEJM editorials or commentary. They are intended to provide insight into the clinical significance of interesting content found on NEJM.org, and where it may lead us in practice and research. Questions are included at the end to stimulate thinking and discussion.
Posts in the ‘Insights’ Category
Reproductive Technologies and the Birth Defect Risk
Posted by Lisa Rosenbaum • May 9th, 2012
The constant publication of clinical trials may give the impression that for every question, there is an answer. The reality, however, is that many clinical questions do not lend themselves to investigation in a randomized, controlled fashion. Whether assisted reproductive technology causes an increased rate of birth defects is one such question. Although for some… Read More…
When Less is Enough: Rethinking Thyroid Cancer Treatment
Posted by Rena Xu • May 3rd, 2012
Many patients with thyroid cancer who have undergone thyroid gland resection are treated with radioiodine ablation. This practice is thought to reduce the rate of cancer recurrence and death – but it does so at a price. Exposure to radioactive substances increases the risk of developing a second radiation-induced primary cancer. Treatment with radioiodine is… Read More…
Cold Steel or Caged Balloon? The ASCERT Study Adds to the Revascularization Rivalry
Posted by John Staples • April 18th, 2012
Mac versus PC, Republicans versus Democrats, chocolate versus vanilla … life is full of rivalries, and the world of medicine is no exception. Take cardiology and cardiac surgery, for example. Who’s better at mending a particular group of blood-starved hearts? The answer depends on the group of hearts – and perhaps on the group you… Read More…
CT Angiography for Safe Discharge of Patients
Posted by Lisa Rosenbaum • April 11th, 2012
Chest pain is the second most common reason for Emergency Room visits in this country, and although only 10-15% of patients admitted with chest pain are ultimately diagnosed with an acute coronary syndrome, the majority of patients get admitted. So common, in fact, is this admission diagnosis, that during cardiology rounds the other week, when… Read More…
Life after PE: Can Rivaroxaban Be the New Warfarin?
Posted by Rena Xu • April 4th, 2012
Most patients who are found to have a pulmonary embolism are started on a medication to prevent future clots. For years, the drug of choice has been warfarin, a vitamin K antagonist that decreases the level of clotting factors. This medication works well but is notoriously complicated to use, requiring frequent monitoring with blood draws… Read More…
Anti–Interleukin-17–Receptor Antibody for Psoriasis
Posted by Daniela Lamas • March 28th, 2012
The 45-year old woman in your office is discouraged. For years now, she’s suffered from psoriasis; thick, red skin with flaky silver patches leaving her self-conscious and, often, in pain. She feels like she’s tried everything. First it was topical treatments, then phototherapy, salt-water baths and now systemic therapy with immune suppression. She’s considered newer… Read More…
Tenecteplase vs. Alteplase for Ischemic Stroke
Posted by Lisa Rosenbaum • March 21st, 2012
Though, for clinicians, ordering a drug these days is as simple as a click of a button, for the drug, getting to within reach of our fingertips is no easy feat. Most drugs fail in early phases of testing, and those that eventually reach our clinical armamentarium have spent years getting there. Rarely do we… Read More…
More Screening Scrutiny: An Update on Screening for Prostate Cancer
Posted by Rena Xu • March 14th, 2012
Last year, the U.S. Preventive Services Task Force (USPSTF) issued a controversial draft recommendation against routine screening for prostate cancer. The rationale was that for asymptomatic men, prostate-specific antigen (PSA)-based screening offered unclear survival benefit while posing at least a small risk. In this week’s NEJM, an article by Schröder et al. report updated data… Read More…
Donepezil and Memantine for Alzheimer’s Disease
Posted by Lisa Rosenbaum • March 7th, 2012
All of us who have completed an internship are well-familiar with the poly-pharmacy-discharge challenge. The patient comes in on eight medications. Now it’s time to go home, and you’ve gone and added another four. Surely the patient doesn’t need all of these, but as you review her list, it’s not clear that any can be… Read More…
