Questioning Medicine

Episodes

• 
  Episode 439: 446. mRNA flu vaccine? Is it worth the outcome hype? 21.10.2026 19m

  https://www.nejm.org/doi/full/10.1056/NEJMoa2516491https://www.ahajournals.org/doi/10.1161/CIR.0000000000001466
• 
  Episode 438: 445. GLP1 CME 14.10.2026 39m

  OMED GLP1 CME
• 
  Episode 437: 444. Monday Morning Articles 12.10.2026 27m

  Silvain J, et al. Discontinuation of β-blockers in stable patients with previous myocardial infarction, preserved left ventricular ejection fraction, and no heart failure: A pooled analysis of individual patient data. Lancet 2026 Aug 30; [e-pub]. DOI: 10.1016/S0140-6736(26)01426-1. PubMed https://jamanetwork.com/journals/jama/fullarticle/2854257 https://research.ebsco.com/c/536ryc/viewer/pdf/yggxxbydhz https://www.nejm.org/doi/full/10.1056/NEJMoa2601598?query=clinical-medicine Jover R, et al. Colonoscopy intervals and colorectal cancer incidence after adenoma removal. N Engl J Med 2026 Sep 17; 395:1051. DOI: 10.1056/NEJMoa2603816. PubMed https://www.nejm.org/doi/full/10.1056/NEJMoa2607978?query=clinical-medicine
• 
  Episode 436: 443. Fast 5 Medical Article Review 30.09.2026 24m

  Kanwal F, et al. Clinical care pathway for the risk stratification and management of patients with metabolic dysfunction–associated steatotic liver disease. Gastroenterology 2026 Jul; 171:164. DOI: 10.1053/j.gastro.2026.01.047. PubMed   - MASLD screening and treatment recommendations.  CT detected substantially more cardiac thrombi than TTE  Nio SS, et al. Diagnostic yield of cardiac CT to detect cardiac thrombi in patients with acute ischemic stroke (AIS of HEARTS). Stroke 2026 Aug; 57:2408. DOI: 10.1161/STROKEAHA.126.055575. PubMed  Lee KK, et al. Targeted use of computed tomographic coronary angiography in acute chest pain. N Engl J Med 2026 Aug 29; [e-pub]. DOI: 10.1056/NEJMoa2608903. PubMed  CTCA did not reduce MI or cardiac death after MI was ruled out Bundgaard H, et al. Response-tailored or standard-duration antibiotic treatment for infective endocarditis. N Engl J Med 2026 Aug 28; [e-pub]. DOI: 10.1056/NEJMoa2607887. PubMed Relapse of infection was significantly more common when antibiotics stopped early https://www.sciencedirect.com/science/article/pii/S073646792200347X  -- you don’t need magnesium when you replace potassium
• 
  Episode 435: 442. 7 article review 10.09.2026 33m

  we unpack whether rivaroxaban followed by aspirin improves thromboprophylaxis after hip and knee arthroplasty, put oral GLP-1 therapy orforglipron head-to-head with dapagliflozin for type 2 diabetes, and examine new evidence on venous thromboembolism after mechanical restraint in psychiatric hospitals. We also translate updated pediatric functional-constipation guidance, the newest ACG recommendations for colonic diverticulitis, and real-world data on blood-pressure control and mortality among U.S. veterans—then finish with a practical look at whether a lumbar belt can truly ease nonspecific low-back pain.Shivakumar S, et al. Rivaroxaban then aspirin vs. aspirin alone after total hip or knee arthroplasty. N Engl J Med 2026 Jul 12; [e-pub]. DOI: 10.1056/NEJMoa2603649. PubMed https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00800-7/abstract https://pubmed.ncbi.nlm.nih.gov/42393373/ Welch M, et al. Orforglipron compared with dapagliflozin in adults with type 2 diabetes and inadequate glycaemic control with metformin (ACHIEVE-2): A multicentre, randomised, non-inferiority, open-label, phase 3 trial. Lancet 2026 Jul 11; 408:125. DOI: 10.1016/S0140-6736(26)00800-7. PubMed Viuff JH, et al. Venous thromboembolism after mechanical restraint in psychiatric hospitals: Population based cohort and self-controlled case series study. BMJ 2026 Jul 1; 394:e100016. DOI: 10.1136/bmj-2026-100016. PubMed Gordon M, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines for treatment of functional constipation in children aged 0–18 years. J Pediatr Gastroenterol Nutr 2026 May 20; [e-pub]. DOI: 10.1002/jpn3.70447. PubMed Peery AF, et al. ACG clinical guideline: Colonic diverticulitis. Am J Gastroenterol 2026 Jul; 121:1549. DOI: 10.14309/ajg.0000000000004047.  Yamada M, et al. Blood pressure control and mortality among US veterans. Hypertension 2026 Apr 7; [e-pub]. DOI: 10.1161/HYPERTENSIONAHA.125.25787.  Grange L, et al. Lumbar belt for nonspecific low back pain: A randomized clinical trial. JAMA Netw Open 2026 Aug 3; 9:e2629793. DOI: 10.1001/jamanetworkopen.2026.29793. PubMed
• 
  Episode 434: 441. Coronary Artery Calcium (CAC) -- Yacky Yack, the details on CAC 31.08.2026 48m

  Does a Coronary Artery Calcium (CAC) scan still earn its place in modern cardiovascular prevention? This podcast cuts through the headlines to examine the recent research, challenge overconfident conclusions, and put CAC testing under the microscope alongside the PREVENT risk equation.Each episode brings a sharp, evidence-first look at what calcium scoring can—and cannot—tell us about heart-attack risk. We unpack study methods, question the assumptions behind new publications, and ask the practical questions clinicians and patients actually need answered: When does CAC meaningfully change care? Who benefits most? And in an era of PREVENT, does a scan add actionable information beyond the numbers?Clear-eyed, clinically grounded, and never afraid to interrogate the data, this is the podcast for anyone who wants the real value of CAC—not just the latest claim.
• 
  Episode 433: 440. CME Understanding Medical Stats 21.08.2026 33m

  OMED lecture on how to understand medical stats
• 
  Episode 432: 439. 6 articles in 2026 24.07.2026 25m

  CME
• 
  Episode 431: 438. CME- What To Do AFTER PE Diagnosis 21.07.2026 26m

  OMED lecture
• 
  Episode 430: edit fix 437. A Brief Review of the Medical Literature! 08.07.2026 32m

  Xin X, et al. Optimal exercise modalities and dosages for blood pressure reduction in adults with prehypertension and established hypertension: A network meta-analysis and dose–response relationship study. J Am Heart Assoc 2026 May 14; 15:e044003. DOI: 10.1161/JAHA.125.044003. Vosooney A, et al. Screening for Cervical Cancer: A Recommendation From the Women’s Preventive Services Initiative. Obstet Gynecol 2026 Jul; 148:e3. DOI: 10.1097/AOG.0000000000006315. Castells A, et al. Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): A pragmatic, randomised, controlled, non-inferiority trial. Lancet 2025 Apr 12; 405:1231. DOI: 10.1016/S0140-6736(25)00145-X.Castells A, et al. Colonoscopy versus biennial FIT screening: A post hoc sustained-strategy analysis of the COLONPREV Trial. Gut 2026 Jun 10; [e-pub]. DOI: 10.1136/gutjnl-2026-338896.  Diercks D, et al. Evaluation and management of chest pain from cardiovascular causes in female patients. BMJ 2026 Jan 30; 392:e086177. DOI: 10.1136/bmj-2025-086177.  https://www.sciencedirect.com/science/article/pii/S0140673626008767?via%3Dihub   Lancet. 2026 May 23;407(10543):2015-2026. Yanik EL, et al. Associations of sleep and shift work with osteoarthritis risk. Arthritis Care Res (Hoboken) 2026 Jan 22; [e-pub]. DOI: 10.1002/acr.70040.  Noma H, et al. Angiotensin receptor blockers versus calcium channel blockers for first-line antihypertensive therapy and survival in adults aged 75 years or older. J Am Geriatr Soc 2026 Apr 26; [e-pub]. DOI: 10.1111/jgs.70463. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s029lbl.pdf
• 
  Episode 429: 436. postpartum burnout., asundexian, semaglutide and ETOH, neck infection, varenicline 15.06.2026 31m

  Jafari K, et al. Risk factors for pediatric deep neck infection revisit after emergency department discharge for pharyngitis or localized neck symptoms. Ann Emerg Med 2026 May; 87:605. DOI: 10.1016/j.annemergmed.2025.10.007.In a “look-back” analysis of some 800 children admitted with deep neck infection, 18% had at least one ED discharge before admission. The most common discharge diagnoses were fever, pharyngitis/tonsillitis, and localized neck symptoms.In a “look-forward” analysis, 0.01% of about 400,000 children diagnosed with pharyngitis/tonsillitis and 0.07% of almost 60,000 children presenting with nontraumatic neck symptoms were subsequently admitted with a deep neck infection. Klausen MK, et al. Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: A randomised, double-blind, placebo-controlled trial. Lancet 2026 May 2; 407:1687.Heavy drinking decreased from 17 days per month at baseline to 13 with placebo and 10 with semaglutide — a significant 3-day difference.Days without any alcohol use in the past month increased from 9 at baseline to 11 with placebo and 12 with semaglutide, though this difference was not significant (P=0.051). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2848777Conclusions and Relevance  In this RCT of 651 AWS, varenicline sampling was efficacious, with potentially superior outcomes compared with NRT.    https://jamanetwork.com/journals/jama/fullarticle/2848997Conclusions and Relevance  Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout. https://pubmed.ncbi.nlm.nih.gov/42120723/. These data demonstrate orforglipron's potential as a globally scalable option for minimizing weight changes after injectable therapy. Trial limitations include the absence of a comparator arm involving continued use of injectable obesity-management medications and the trial's 1-year duration. https://pubmed.ncbi.nlm.nih.gov/42104164/mong 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17).  https://www.nejm.org/do/10.1056/NEJMdo008444/full/Among patients with noncardioembolic ischemic stroke or high-risk TIA treated with antiplatelet therapy, asundexian at a daily dose of 50 mg resulted in lower risks of ischemic stroke and major cardiovascular events than placebo, without a higher risk of major bleeding.
• 
  Episode 428: 435. Evolocumab, Statin and CKD, PCN allergy, MRI vs Rotator Cuff 08.05.2026 17m

  https://pubmed.ncbi.nlm.nih.gov/41903215/  Evolocumab to Reduce First Major Cardiovascular Events in Patients Without Known Significant Atherosclerosis and With Diabetes: Results From the VESALIUS-CV Trial https://pubmed.ncbi.nlm.nih.gov/41769754/  Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications https://pubmed.ncbi.nlm.nih.gov/41921035/  Direct Oral Challenge for Penicillin Allergy: The International Network of Antibiotic Allergy Nations (iNAAN) Study https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844659  Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging  https://www.acpjournals.org/doi/10.7326/ANNALS-25-02772   Rapid Evaluation of Artificial Intelligence Technology Used for Ambient Dictation in Primary Care: Comparing the Quality of Documentation of Artificial Intelligence–Generated and Human-Produced Clinical Notes
• 
  Episode 427: 434. 6 Articles From Arb to Patient Perspective to Cervical Cancer Screening 04.05.2026 25m

  https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70463  Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First-Line Antihypertensive Therapy and Survival in Adults Aged 75Years or Older  https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673626003673?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673626003673%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis  https://pubmed.ncbi.nlm.nih.gov/42033454/   Overdiagnosis in atrial fibrillation screening with wearables  https://pubmed.ncbi.nlm.nih.gov/41766353/   Patients' perspectives on deprescribing in swedish primary care: an exploratory survey study  https://pubmed.ncbi.nlm.nih.gov/41627785/   Reducing short-acting beta-agonist overprescribing in general practice: Evaluation of a quality improvement programme in East London  https://pubmed.ncbi.nlm.nih.gov/42024880/   Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative
• 
  Episode 426: 433. Salt, Statins, and Stents 21.04.2026 16m

  Donato J, et al. Things We Do For No Reason™: Low salt diets for patients with acute heart failure. J Hosp Med 2026 Feb 4; [e-pub]. DOI: 10.1002/jhm.70278.Some guidelines now recommend "normal sodium intake" for patients with acute and chronic HF, which means avoiding excessive sodium intake and staying under 4 to 5 g daily.https://academic.oup.com/eurjhf/article-abstract/26/4/730/8328801?redirectedFrom=fulltext&login=trueLuo Y, et al. Measuring public preferences for statin therapy: Using the smallest worthwhile difference. JAMA Intern Med 2026 Feb 16; [e-pub]. DOI: 10.1001/jamainternmed.2025.7958. It's honestly kind of beautiful - and a little frustrating. But it's also a reminder that medicine isn't math; it's human. People don't just want statistics; they want clarity, control, and context. A one-percent drop means one thing on paper, and something very different when you're trying to remember if you already took today's pill. Kang J, et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention: 10-year follow-up of the HOST-EXAM trial. Lancet 2026 Apr 11; 407:1439. DOI: 10.1016/S0140-6736(26)00422-8.Over ten years, about 25 out of 100 patients on clopidogrel had one of these events, compared to about 29 out of 100 on aspirin. Statistically, that’s a hazard ratio of 0.86, with a p value of 0.005, and it translates into an absolute risk reduction of just over 3 percent and a number needed to treat of about 33. In other words, if you treat 33 stable post‑PCI patients with clopidogrel rather than aspirin for ten years, you prevent one net adverse event.Looking only at thrombotic events—cardiovascular death, non‑fatal MI, ischemic stroke, ACS readmission, or stent thrombosis—clopidogrel again came out ahead: roughly 17 percent vs 20 percent, hazard ratio 0.82, p around 0.002. This difference was largely driven by fewer strokes and fewer rehospitalizations for acute coronary syndromes.Now for bleeding. You might worry that better antithrombotic protection would mean more bleeding. In fact, the opposite happened. Any clinically relevant bleeding, BARC type 2 or higher, occurred in about 9 percent of clopidogrel patients versus almost 11 percent on aspirin, with a hazard ratio of 0.81. Major bleeding—BARC type 3, including haemorrhagic stroke—was also lower on clopidogrel: about 5.6 percent vs 7.7 percent. Haemorrhagic stroke itself was cut roughly in half.
• 
  Episode 425: 432. CME LECTURE- Under Pressure, Blood Pressure 18.04.2026 34m

  432.  CME LECTURE-  Under Pressure, Blood Pressure
• 
  Episode 424: 431. Gout should we treat to a number? Is Co-testing needed? 14.04.2026 18m

  https://www.sciencedirect.com/science/article/abs/pii/S2665991326000342?via%3Dihublancet rheumatology A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial  The question on the table: Is chasing a serum urate level below six milligrams per deciliter worth the effort? Or are we just torturing our patients with more lab draws and dose titrations than they actually need? What’s the Real Takeaway?So — is it worth chasing six? Probably yes, but let's keep expectations realistic.Think of it like aiming for LDL targets in dyslipidemia — specific numbers keep us intentional,The bottom line: when your gout patient agrees to start urate-lowering therapy,  don’t expect miracles overnight. Lower urate just tilts the odds for fewer flares — it doesn’t guarantee smooth sailing for every patient.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846208 HPV, Cytology, and Cotest Cervical Cancer Screening and the Risk of Precancer  Let’s start with the basics. For years the Pap test, or cytology, has been the main tool for catching early changes on the cervix. More recently, we’ve added tests that look directly for HPV, the virus that actually causes most cervical cancers. Some places now do both at the same time, called “cotesting.” It sounds like more must be better, right?A big study out of British Columbia followed over eight thousand women for up to ten years after they had both tests done at the same visit. The researchers wanted to know: if your HPV test is negative, does adding that extra Pap result actually help keep you safer in the long run?Here’s what they found. If a woman’s HPV test was positive and her Pap looked abnormal, her chance of developing a significant precancer over time was pretty high, more than 40%. If the HPV test was positive but the Pap looked normal, the risk was lower, but still real—over 20%. Those are the folks we definitely want to follow closely.But once the HPV test was negative, the story changed. Whether the Pap looked normal or a bit off, the risk of serious precancer over the following years stayed very low—well under 5%, and for most women under 1%. In fact, women who were HPV‑negative had almost the same low risk as women whose HPV and Pap were both negative, but adding that Pap test made screening more complicated and more expensive for very little extra benefit.So what does this mean in plain language? If your HPV test is negative, you’re in a very low‑risk group for cervical precancer for many years, even if your Pap result isn’t perfectly pristine. Doing both tests on everyone, every time, doesn’t buy much extra safety, but it does add cost and can lead to more follow‑up procedures that many women don’t actually need.
• 
  Episode 423: 430. Hormone Replacement Therapy and the Black Box Warning 24.03.2026 12m

  Let’s rewind to the early 2000s. Flip phones were cool, low-rise jeans were a crime, and the Women’s Health Initiative—WHI—dropped what became the medical equivalent of a headline: “Hormone Therapy Increases Risk!” The study looked at one very specific regimen: an oral pill with conjugated equine estrogens—yes, horse estrogens—and medroxyprogesterone acetate, or MPA, taken every day by women with an average age of 63.Now, 63 is not “just hit menopause.” That’s about 12 years past menopause for most women. So we were basically taking a therapy usually started around 50, testing it in women in their early 60s, and then pretending that result applied to everyone, at every age, on every dose, with every type of hormone, in every form—patch, pill, gel, ring, cream, you name it.Imagine testing one fast-food burger in 63-year-olds and then announcing: “All food is dangerous. Consider only lettuce, and maybe not too much of that either.”Let’s do a quick myth-versus-reality lightning round.Myth: “All hormone therapy causes breast cancer.”Reality: The best current data do not support a blanket statement like that. In many analyses, especially for women who start near menopause, breast cancer risk is small, nuanced, and depends on the specific regimen and individual risk factors. Estrogen alone has even been associated with lower breast cancer mortality compared to placebo in long-term WHI follow‑up.Myth: “You should take as little as possible for as short as possible, no matter what.”Reality: Your dose and duration should match your symptoms, your risk profile, and your goals. There is no magical stopwatch at 5 years where your body alarms go off. It’s a conversation, not a countdown.Myth: “Vaginal estrogen is as risky as full-body hormone therapy.”Reality: Local vaginal therapies were unfairly swept under the same warning umbrella, despite very different absorption and risk profiles. The new product-specific approach is meant to fix that.
• 
  Episode 422: 429. Rivaroxaban vs Apixaban = The Battle of the Blood Thinners! 20.03.2026 9m

  — rivaroxaban versus apixaban.Yes, folks, this is The Battle of the Blood Thinners!And spoiler alert — one of them came out looking like the overachiever in a safety class... while the other probably needs a little extra padding on its report card.The SetupSo here’s the story. For years, observational studies hinted that apixaban — we’ll call it “Api” because we’re friendly like that — might be gentler when it comes to bleeding compared to rivaroxaban — or “Riva,” who sounds like she’d stir drama on a reality show.But now, for the first time ever, we’ve got a head-to-head trial. Picture a randomized cage match… but with 2,800 patients who probably just wanted their deep vein thrombosis or pulmonary embolism treated quietly.These brave participants, average age 58, were split—half got apixaban, half got rivaroxaban. Researchers then followed them for three suspense-filled months.The Results (and the Punchline)Here’s the headline:Clinically relevant bleeding was twice as likely with rivaroxaban compared to apixaban.Yup—7.1% versus 3.3%. That’s a difference big enough to make any hematologist clutch their coffee mug a little tighter.And if you love a good number — the number needed to harm here is 26. That means for every 26 patients you put on rivaroxaban instead of apixaban, one extra person might have a bleeding episode you wish hadn’t happened.Major bleeding? Rivaroxaban also took home that dubious award — 2.4% versus 0.4%.Ouch. That’s like comparing a paper cut to an artery leak.Why the Difference?The researchers think rivaroxaban’s longer initial high-dose period may explain the extra bleeding drama early in treatment.
• 
  Episode 421: 428. Asthma and Stroke --- A breathless combination 13.03.2026 16m

  Minocycline in Acute Ischemic Stroke (EMPHASIS trial)A multicenter, double-blind RCT in China studied 1,724 patients with acute ischemic stroke treated within 72 hours of onset. Patients received either a 4.5-day course of oral minocycline or placebo. Minocycline works by inhibiting microglial activation, which contributes to post-stroke inflammation.Primary outcome: 52.6% of minocycline patients vs. 47.4% of placebo patients achieved good functional recovery (mRS 0–1) at 90 days (p=0.0061).Safety: No difference in adverse events.Practice impact: Clinicians are cautiously optimistic; further positive trials could lead to selective use of minocycline in AIS patients.2. Tenecteplase for Basilar Artery Stroke (TRACE-5 trial)This phase 3 RCT in China tested IV tenecteplase given within 24 hours of ischemic basilar artery occlusion against standard medical care (both groups could undergo thrombectomy).Results: At 90 days, 38% of tenecteplase patients vs. 29% of controls had no or minimal disability (mRS 0–1 or baseline).Safety: Similar rates of intracranial hemorrhage (2–3%) and mortality (29–31%).Practice impact: Promising expansion of the thrombolytic window for severe posterior strokes; more evidence needed before routine use outside research settings.
• 
  Episode 420: 427. Kawasaki disease-no, not the motorcycle company 11.03.2026 7m

  Today, we're talking about Kawasaki disease-no, not the motorcycle company, though sometimes treating it does feel like trying to ride one at full speed through uncertainty.For decades, high-dose aspirin was basically the holy water of Kawasaki treatment. Eighty to a hundred milligrams per kilogram per day-because apparently, kids with vasculitis also needed a little side of tinnitus. But here's the twist: new research says... maybe we didn't need all that aspirin after all.Researchers at one hospital decided to mix things up. First, they treated 300 kids with the traditional high-dose aspirin. Then they switched the policy and gave the next 200 kids low-dose aspirin-3 to 5 mg/kg/day. Everyone got IVIG, because we're not completely reckless. And the results? Drumroll please-no difference. That's right. About 20% of kids in both groups needed IVIG a second time, and their coronary arteries looked... equally fine. The median max Z-score was 1.6 in both groups. (For the non-cardiologists out there, that's comfortably under aneurysm territory, which starts at 2.0.) Basically, the low-dose kids did just as well-and none of them had to choke down near-toxic amounts of aspirin. So, high-dose: meet low benefit. Low-dose: meet my new best friend.