Primary Care Corner with Geoffrey Modest MD: PPIs associated with MIs???

By: Dr. Geoffrey Modest There was a recent article published online and hitting the press regarding a possible association between the use of proton-pump inhibitors (PPIs) and subsequent MIs (see DOI:10.1371/journal.pone.0124653​). The article was unusual in that it used a new technique for medical research: data-mining.  The bottom line is that if there were a real association between PPI use […]

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Primary Care Corner with Geoffrey Modest MD: Tight diabetes control and cardiovasc disease– followup of the VA study

By: Dr. Geoffrey Modest The Veterans Affairs Diabetes Trial (VADT) was one of the triumvirate published around 2009, along with the ACCORD and ADVANCE trials, which looked at intensive glycemic control and cardiovascular outcomes. These trials basically found that intensive control did not help and perhaps hurt: the ACCORD trial achieved an A1c of 6.4% in the […]

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Primary Care Corner with Geoffrey Modest MD: NYTimes – more drug company shenanigans

By: Dr. Geoffrey Modest There was a rather poignant editorial in the NY Times on June 8th, pointing out 2 clever (though, incidentally, illegal) ways the drug companies help boost their profits by preventing/delaying the transition to generics: Buying off the competition — the example of Provigil: the drug company (Cephalon) first sued 4 generic […]

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Primary Care Corner with Geoffrey Modest MD: DPP-4 inhibitors and cardiovascular outcomes

By:  Dr. Geoffrey Modest New Engl J of Med just had a large study on the cardiovascular effects of sitagliptin (see DOI: 10.1056/NEJMoa1501352). Background: sitigliptin is a DPP-4 inhibitor (dipeptidyl peptidase 4 inhibitor), which functions by decreasing the degradation of incretins (and thereby increasing glucose-mediated endogenous insulin secretion and suppressing glucagon levels). But there were concerning […]

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Primary Care Corner with Geoffrey Modest MD: IMPROVE-IT trial ezetimibe

By: Dr. Geoffrey Modest So, at long last, the IMPROVE-IT trial has been published: the one comparing simvastatin plus ezetimibe vs simvastatin alone in high-risk patients (this was the study that came out as the block-buster, high-profile study at the Am Heart Assn meetings last November –7 months ago!!!, but was notably not published simultaneously, for remarkably opaque reasons….. see DOI: […]

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Primary Care Corner with Geoffrey Modest MD: New vs old OCPs and thromboembolism

By: Dr. Geoffrey Modest The BMJ just published a large analysis of the relationship between combined oral contraceptives OCPs and the risk of venous thromboembolism VTE (see BMJ 2015;350:h2135). They analyzed 2 nested case-control studies from 2 different UK databases, with a combined input from 1340 general practices, assessing the first diagnosis of VTE in women aged 15-49 from 2001-2013, and comparing […]

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Primary Care Corner with Geoffrey Modest MD: Melanoma increasing (a lot)

By: Dr. Geoffrey Modest MMWR just released an analysis of melanoma incidence, mortality trends, and projections in the US from 1982-2030 (see here). Melanoma is common (5th most common cancer in men and 7th in women) and is associated with the most skin cancer deaths, with deaths occurring most frequently in younger people (average of 20.4 years of potential life lost). Costs […]

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Primary Care Corner with Geoffrey Modest MD: Mass med society opioid prescription guidelines

By: Dr. Geoffrey Modest The Massachusetts Medical Society just sent out guidelines on opioid therapy prescribing (see here).  A brief summary: –most of the guidelines are pretty self-evident: –for initiation of opiates: screen the female patients for pregnancy (and counsel re: risks) –do some form of screening for risk of opiate abuse [i would add that […]

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