Tag Archives: NEJM

Health Studies: High Milk & Dairy Consumption Not Related To Lower Heart Disease, Diabetes (NEJM)

From the New England Journal of Medicine (February 13, 2020):

Milk and Dairy Product Health NEJMIn our opinion, the current recommendation to greatly increase consumption of dairy foods to 3 or more servings per day does not appear to be justified…When consumption of milk is low, the two nutrients of primary concern, calcium and vitamin D (which is of particular concern at higher latitudes), be obtained from other foods or supplements without the potential negative consequences of dairy foods.

For calcium, alternative dietary sources include kale, broccoli, tofu, nuts, beans, and fortified orange juice for vitamin D, supplements can provide adequate intake at far lower cost than fortified milk. Pending additional research, guidelines for milk and equivalent dairy foods ideally should designate an acceptable intake (such as 0 to 2 servings per day for adults), deemphasize reduced-fat milk as preferable to whole milk, and discourage consumption of sugar-sweetened dairy foods in populations with high rates of overweight and obesity.

For adults, the overall evidence does not support high dairy consumption for reduction of fractures, which has been a primary justification for current U.S. recommendations. Moreover, total dairy consumption has not been clearly related to weight control or to risks of diabetes and cardiovascular disease. High consumption of dairy foods is likely to increase the risks of prostate cancer and possibly endometrial cancer but reduce the risk of colorectal cancer.

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Podcast: “Intermittent Fasting” Study Author Mark P. Mattson MD On Diet’s Health Benefits

NEJM Journal WatchIntermittent fasting has salutary effects. Listen how Dr. Mark P. Mattson, co-author of a recent NEJM review on the topic, assesses the practice — and how he’s managed to skip breakfast for the past 30 years or so.

Evidence is accumulating that eating in a 6-hour period and fasting for 18 hours can trigger a metabolic switch from glucose-based to ketone-based energy, with increased stress resistance, increased longevity, and a decreased incidence of diseases, including cancer and obesity.

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Medical Podcasts: The Time Physicians Spend On Patient’s Electronic Health Records (NEJM)

New England Journal of Medicine Podcast logoListen to a chat with Julia Adler-Milstein, the author of an editorial that comments on a recent Annals of Internal Medicine study detailing the amount of time clinicians typically spend hunched over their EHRs during a patient visit.

Why aren’t you able to navigate your electronic health record (EHR) as easily as you can find a recipe on, say, Google?

And, what about those requirements for documenting everything?

Links:

Annals of Internal Medicine editorial

Annals paper on the time clinicians spend

Running time: 17 minutes

Aortic Stenosis: Early Aortic-Valve Replacement Surgery Lowers Mortality

Early Surgery or Conservative Care for Aortic Stenosis New England Journal of Medicine January 8 2020 Infographic

CONCLUSIONS

Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care.

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Heart Studies: Alcohol Abstinence For Atrial Fibrillation Reduces Arrhythmia (NEJM)

Alcohol Abstinence for Atrial Fibrillation New England Journal of Medicine January 1 2020

Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. 

New England Journal of Medicine

January 2, 2020 Atrial fibrillation is the most common sustained arrhythmia,1 and alcohol is consumed by a majority of U.S. adults.2 The current study showed that among regular drinkers, a substantial reduction in alcohol consumption by patients with symptomatic atrial fibrillation was associated with a reduction in recurrence of atrial fibrillation and a reduced proportion of time spent in atrial fibrillation. Earlier meta-analyses showed that alcohol was associated with a dose-related increased risk of incident atrial fibrillation, with increased risk observed even among drinkers who consumed as few as 7 drinks per week.8 Current trends show a rise in alcohol consumption among adults older than 60 years of age,2coupled with greater prevalence of atrial fibrillation in this age group. The present study, with participants having an average intake of approximately 17 drinks per week at baseline, suggests that consumption at these levels may contribute to atrial fibrillation.

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Health Podcasts: Which Drug Prices Should Medicare Negotiate? (NE Journal Of Medicine)

From a New England Journal of Medicine article:

New England Journal of Medicine podcastMedicare negotiation of prescription-drug prices would bring U.S. government policies in line with those of other high-income countries, and the idea is popular with both the public and policy analysts. But it would represent a sea change for pharmaceutical firms, which will maintain that any threat to their pricing power will slow innovation. 

Negotiating prices of 10 too-little drugs and 10 too-late drugs to levels currently paid in the United Kingdom would produce about $26.8 billion in savings in 2019 alone, most of which ($25.9 billion) would come from savings on drugs in the latter category. Over time, the drugs included could change. For instance, in 2020 this category might include Revlimid (lenalidomide), which generated $6.5 billion in 2018 U.S. sales; its price in the United Kingdom is 32% of that in the United States.

Americans all along the political spectrum favor allowing Medicare to negotiate the prices it pays for prescription drugs.1 In September, House Speaker Nancy Pelosi (D-CA) introduced what is now called the Elijah E. Cummings Lower Drug Costs Now Act of 2019 (H.R. 3), and the bill would have Medicare do just that.

Although there are draft pieces of legislation and regulation that take aim at the rising cost of drugs, H.R. 3 is the legislative tip of the spear for price negotiation. If it became law, Medicare would target drugs that claim the largest share of the health care budget and that face limited competition from generics or biosimilars. I propose an alternative set of drugs for price negotiation: those that have too little evidence to support full approval or are too late in their life cycle to justify continued high prices.

To read more: https://www.nejm.org/doi/full/10.1056/NEJMp1912736?query=recirc_inIssue_bottom_article