“Oral anticoagulation reduces thromboembolic events in patients with nonvalvular atrial fibrillation (AF); however, underuse of anticoagulation is a major issue in treating patients with nonvalvular AF at high stroke risk. Prior data from the American College of Cardiology’s (ACC) Practice Innovation and Clinical Excellence Registry (PINNACLE Registry) has found approximately 40% of patients are not receiving anticoagulants, with little change over time, despite the availability of the nonvitamin K antagonists. Studies examining the reasons for nonuse are sparse. Because underuse may relate to both physician prescribing and patient factors, some studies have looked at physician assessment of the risk of bleeding … Read More
All posts by Anupam
“Was my brain hijacked by drugs — or was I willfully choosing to risk it all for a few hours of selfish pleasure? What makes people continue taking drugs like street fentanyl, which put them at daily risk of death? These questions are at the heart of drug policy and the way we view and treat addiction. But simplistic answers have stymied efforts to ameliorate drug use disorders and reduce stigma. Research now shows that addiction doesn’t mean either being completely subject to irresistible impulses, or making totally free choices. Addiction’s effects on decision-making are complex. Understanding them can help … Read More
“Cigarette smoking remains the leading preventable cause of illness and death in the United States. One in eight U.S. adults smoke, with the highest prevalence among some of the groups that are affected by the greatest health inequities. Although most people who smoke are aware of the associated health risks and want to quit, many are unable to do so because of nicotine dependence. [..] Although studies show higher rates of successful quitting among people who use a medication approved for smoking cessation by the Food and Drug Administration (FDA), only one third of people use evidence-based cessation treatments when … Read More
“I have attempted suicide more than 10 times in my life, and the desire to kill myself is among my earliest memories. My adult life has been an ongoing struggle with addiction, depression, anxiety, chronic suicidal ideation, and suicide attempts. And yet in Bir [a small village in the Himalayan foothills], despite the fretful uncertainty of our time there, I never thought seriously about suicide. I was scared, but I was not depressed. I was panicking about the outside world, but my inside world—so often a source of misery—was relatively calm. My next serious bout of depression didn’t come until … Read More
“A new study from researchers at the Kenya Medical Research Institute (KEMRI) and Massachusetts General Hospital (MGH) showed a single dose of human papillomavirus virus (HPV) vaccine was highly efficacious in preventing HPV, the virus that causes cervical cancer, in girls and women ages 15 to 20. The study results were announced at the 35th International Papillomavirus Conference in Washington, DC, this week. Researchers described the findings from their randomized, multicenter, double-blind, controlled trial, which included 2,275 participants in Kenya between the ages of 15 and 20. The women were randomly assigned to receive either a single dose of the bivalent … Read More
“Well intentioned as the [proposed menthol-flavored cigarette] ban may be, it has angered some Black leaders, including a group of ministers who have rallied against Ms. Hochul’s proposal because they worry it could increase encounters between Black people and the police if menthol cigarettes were to go underground and authorities crack down on sellers. Other Black opponents of the ban suggest it may be discriminatory, a heavy-handed crackdown on the preferred nicotine fix of Black smokers, even if African American men have the highest rates of lung cancer, according to the Centers for Disease Control and Prevention. Some smokers said that if the … Read More
“The effects of social determinants of health (SDOH) on health outcomes have been extensively evaluated and described. Efforts to elucidate the impact of specific unmet health-related social needs (HRSN), such as food insecurity and lack of transportation, on specific outcome measures can help pinpoint necessary interventions and policy changes. [..] In recent years, the Centers for Medicare &Medicaid Services (CMS) have placed higher priority on addressing health equity, including directly addressing unmet HRSN and accounting for social risk in Medicare payments. For payments, a growing body of literature has demonstrated that health care systems caring for patients with higher social … Read More
“While I’m often a patient who hates the experience of talking to my doctor through a laptop, I’m also a researcher who has devoted a large part of his career to better understanding what happens when new technologies are added to clinical spaces. From this perspective, I see three major challenges that have to be overcome before large language models can really serve as clinical scribes. The truth challenge. [..] There are two major chokepoints where hands-free AI could lead to inaccurate medical records. The first is in the speech-to-text technology. When the university where I teach pivoted online for … Read More
“Online prescribing rules for controlled drugs were relaxed three years ago under emergency waivers to ensure critical medications remained available during the COVID-19 pandemic. Now, the U.S. Drug Enforcement Agency has proposed a rule that would reinstate most previously longstanding requirements that doctors see patients in person before prescribing narcotic drugs such as Oxycontin, amphetamines such as Adderall, and a host of other potentially dangerous drugs. The aim is to reduce improper prescribing of these drugs by telehealth companies that boomed during the pandemic. Given the ongoing opioid epidemic, allowing continued broad use of telemedicine prescribing “would pose too great … Read More
“Herpes care providers and advocates have a variety of concerns, including vaccines and drugs. Although there have been antivirals available for 40 years, they only temporarily suppress the virus. And there are no vaccines; the last major effort to develop one, from GSK, failed in 2010, and there have been few efforts since, though BioNTech and Moderna have recently shown interest in deploying mRNA to that effect. More basically, though, advocates lament that it is difficult for them to even find out if they have the virus. The Centers for Disease Control and Prevention does not recommend that standard STI panels include … Read More