Questioning Medicine12 Heinä 2023

Episode 211: 211. Pharmacogenomics Testing, PHASER,

(https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf) clearly state there is insufficient evidence to support this activity and testing. This is mainly because of low quality evidence and concern of bias given commercially funded studies.

(https://www.aafp.org/pubs/afp/issues/2023/0100/poems-pharmacogenic-testing-antidepressants.html)

American Psychiatric Association Psychiatry.org - Genetic Testing to Improve Psychiatric Medication Choice

Harvard https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964

First prime

As I mention in my response email PRIME the primary outcomes per clinnicaltrials.gov were depression remission at 24 weeks, which was not statically significant. And then a use of fewer medications that have a potential gene-drug interaction which from what I can find was a ‘theoretical’ interaction not an actual increase in adverse events. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial | Depressive Disorders | JAMA | JAMA Network

“The PREPARE Study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113234/#:~:text=Open%2Dlabel%20placebo%20reduced%20minimum,0.02%25%20in%20the%20TAU%20arm. When patients were told they were getting placebo for back pain and it helped their back pain!

The current VA/DoD guidelines clearly state, “For patients who cannot tolerate a statin, we suggest a washout period followed by a rechallenge with the same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing”.

https://www.healthquality.va.gov/guidelines/CD/lipids/VADoDDyslipidemiaCPG5087212020.pdf (full disclosure and bias I helped write them)

N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects | NEJM was published in the NEJM and then a few weeks later Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials (bmj.com) was published in the BMJ.

Around that same time a publication in JAMA https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773490 showed that using pharmacogenetic testing resulted in no worse LDL levels (soft endpoint) at one year but also no better

Kokeile Premiumia

Nauti 14 päivää ilmaiseksi

Tilaa Premium

Jaksot(385)

Episode 423: 430. Hormone Replacement Therapy and the Black Box Warning

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 In...

24 Maalis 12min

Episode 422: 429. Rivaroxaban vs Apixaban = The Battle of the Blood Thinners!

— 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 ...

20 Maalis 9min

Episode 421: 428. Asthma and Stroke --- A breathless combination

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 eith...

13 Maalis 16min

Episode 420: 427. Kawasaki disease-no, not the motorcycle company

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 aspi...

11 Maalis 7min

Episode 419: 426. Go Big or Go Partial? The Knee Replacement Showdown

Setting the stagePicture this: your knee is like a three-room apartment. You've got a medial room, a lateral room, and a patellofemoral room. In isolated anteromedial osteoarthritis, just one room is ...

10 Maalis 11min

Episode 418: 425. Triptan initiation and cerebrovascular events

Kalapura C, et al. Triptan initiation and cerebrovascular events in patients with migraine: A nationwide cohort study. J Am Heart Assoc 2026 Feb 17; 15:e043409. DOI: 10.1161/JAHA.125.043409. Today, w...

6 Maalis 6min

Episode 417: 424. GLP1 and NAION

Li H-Y, et al. GLP-1 receptor agonists and risk of optic nerve or vision-threatening events in patients with type 2 diabetes or cardiometabolic diseases: A meta-analysis of randomized controlled trial...

5 Maalis 8min

Episode 416: 423. CME-- Discharge Questions Answered in 2025

CME-- Discharge Questions Answered in 2025

3 Maalis 45min

Kaikki yhdessä sovelluksessa

Kuuntele kaikki suosikkipodcastisi ja -äänikirjasi yhdessä paikassa.

Sinulle valikoitua sisältöä

Podme-sovelluksessa kokoat suosikkisi helposti omaan kirjastoosi. Saat meiltä myös kuuntelusuosituksia!

Jatka kuuntelua koska tahansa

Voit jatkaa siitä mihin jäit, myös offline-tilassa.

Premium

9,99 €/kk

Kaikki premium-podcastit
Ei mainoksia
Ei sitoutumista, peruuta koska tahansa

Aloita 14 päivän kokeilu

Premium

13,99 €/kk

Kaikki premium-podcastit
Ei mainoksia
Ei sitoutumista, peruuta koska tahansa
Yksi lisäkäyttäjä

Kokeile 14 päivää maksutta

Suosittua kategoriassa Terveys ja hyvinvointi

vakeva-elama-viisaampi-mieli-vahvempi-keho

Tarinat ja äänet, joita rakastat kuunnella

Kuuntele kaikki suosikkipodcastisi ja -äänikirjasi

Lue lisää