Inside Medicine: Five on Friday (April 12, 2024).
This week in medicine, what I'm thinking about, etc. You know, an actual newsletter.
We are back with “Five on Friday", the feature where Inside Medicine behaves like an actual medical/health/science newsletter. Below are top-of-mind things that I’m thinking about right now. And please vote in the poll at the end!
If you value this feature—and Inside Medicine in general…
Here we go…
Item 1. Beta-blockers for heart attacks? New data says “not always.”
When patients have a heart attack (“myocardial infarction,” or “MI”), there are life-saving medicines and procedures that doctors can provide that are time-dependent. The biggies: aspirin and a visit to a cardiac catheter unit, where specialized cardiologists can remove blockages, and prop open crucial coronary arteries. There are also other medications that are given, depending on the situation. One of the options is “Beta-blockers,” which lower blood pressure. For a long time, giving Beta-blockers to patients leaving the hospital after being treated for a heart attack was an almost unquestioned dogma. Over time, this has changed. New data in the New England Journal of Medicine this past week show that giving Beta-blockers to certain patients—those who didn’t have signs of reduced heart pumping efficiency—seemed to make no difference. And it’s even possible that some subgroups were harmed.
What has changed? For one thing, treatment of heart attacks overall is now much better than it was 30 years ago. Today, far more patients go to the “cath lab,” in short order, which means better outcomes. So, given that many post-MI hearts are better off than similarly sick people who had heart attacks in the 1980’s, it seems that long-term Beta-blocker therapy may be superfluous now for patients who did well during their hospitalization. All to say, that yesterday’s best practices are often overruled by new data that reflect different times.
Item 2. Mortality in young Oregonians. Covid-19 vs. Covid-19 vaccines. (Spoiler: vaccines are safer).
New data in the CDC’s Morbidity and Mortality Weekly Report out of Oregon indicate that for people ages 16-30, the rate of death from Covid-19 in 2021-2022 was far greater than the risk of Covid-19 vaccination. This is important because in young people a condition called myocarditis has been found in rare cases (males especially), after Covid-19 mRNA vaccine receipt. Most of these myocarditis cases were mild, but the condition could not simply be shrugged off, especially in a population that has a pretty low risk of death from Covid-19. Back in 2021, I wrote a New York Times essay with Dr. Céline Gounder and Dr. Katie Dickerson Mayes (a stellar graduating ER resident at my program), in which we ran the best math we had at the time. We concluded then that vaccinations for young people were safer than facing Covid-19 unvaccinated. But, we had limited data then, and relied on estimates of worst case scenarios. All to say, it’s good to see more data showing we got the analysis right back then. Still, I’ll be honest and say that that new data from Oregon are not definitive. There are many ways to study this question, and the way the scientists organized this study was not exactly what I would have done, if I had access to the raw data. So, it’d be nice eventually to have something a little better than this new report to support the argument on our side. But, for now, we’ll take it.
Item 3: The future of telehealth depends on DC lawmakers.
When Covid-19 hit, telehealth became a lifeline for many who needed to see a doctor. In March of 2020, the federal government changed its rules overnight and the rest is history. The future, however, is less clear. In a MedPage Today report by Shannon Firth, we get brought up to speed on the issues that must be resolved, including whether remote care can continue over state lines and how much these visits should cost.
We’ve learned a lot about patient and doctor willingness to use telehealth (i.e., it’s a lot higher than we might have thought in 2019), but in the post-Covid-19 emergency phase, some tweaks are probably in order. That said, we do not want to take any steps backwards. Access is a huge issue here, and telehealth can be a part of the solution.
Item 4: Parkinson’s Awareness Month.
April is Parkinson’s Disease (PD) awareness month. Here’s information from the Parkinson’s Foundation. PD affects around 1 million people in the US. Some statistics: While most cases occur in people over age 50, around one in four are diagnosed in younger people. Men are more likely to have PD, but the ratio is basically 70%-30%. While PD progresses to become a very difficult and devastating disease, there are treatments, and advancements have made a tremendous difference in recent years.
Item 5. Poll of the Week results.
Last week, I asked how you felt about Paxlovid, in light of new data.
Item 5a. Poll of the Week for this week! This time, we’ll go a bit less medical. Assuming you were able to…
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That’s it. Your “Friday Five!”
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Love the “Five on Friday!”
You were missing a choice. I saw totality twice and would see it again, but unlikely to go over five hours just to see the eclipse. I don’t fit into any of those categories.