(Running time: 15 minutes)

A study in the Lancet Oncology gathered information from dozens of epidemiological studies to estimate that over 200,000 cases of endometrial cancer have been prevented in the past 10 years as a result of oral contraceptive use.

A commentary in the journal offers a remarkable look at weighing the benefits and harms of OCs. We talk with a co-author of that commentary, Dr. Nicolas Wentzensen of the National Cancer Institute.

Lancet Oncology study

Lancet Oncology comment

How Webster defined it 90 years ago.

The CDC’s Seema Jain is our guest, talking about a study she did with her team to characterize the causes of community-acquired pneumonia in U.S. adults. (They don’t mention finding Webster’s Micrococcus lanceolatus.) Medicine has come a long way since 1925, but Dr. Jain says that clinicians still need better diagnostic tools to pinpoint the causes of CAP in individual patients.

Using five hospitals in Chicago and Nashville, Jain’s team surveyed over 2000 adult patients admitted with radiographic evidence of CAP during a 30-month period. Also included is discussion of her February paper that sought to characterize CAP in children.

NEJM abstract of study in adults

NEJM abstract of study in children

Running time: 20 minutes

The anticoagulant dabigatran, marketed in the U.S. as Pradaxa, has always had the problem that, although it’s more convenient to use, there’s no sure way to stop its effect if the patient has a major bleed.

Now, a monoclonal antibody fragment called idarucizumab (pronounced i-DARE-you-scis-ooh-mab) shows promise as a reversal agent. In an interim analysis of the first 90 of a planned 300 patients, the fragment was quite effective in stopping bleeds.

The analysis was published in the New England Journal of Medicine, and we talk with the paper’s first author, Charles V. Pollack, Jr.

Link to NEJM article (free)

Neel Shah wrote a Perspective essay in the New England Journal of Medicine earlier this month on the U.K.’s NICE recommendation that encourages wider acceptance of home delivery and midwifery. The question is, could it work in the U.S.?

For the audio-oriented Clin Con audience we’ve adapted a video conversation that took place on Medstro (https://medstro.com/groups/nejm-group-open-forum/discussions/112). There, Dr. Shah and other clinicians discuss the problems U.S. obstetricians and U.S. mothers-to-be face. The Medstro forum is now finished, but the discussions back and forth over the course of its 10-day run are still available at the URL above.

Running time: 32 minutes

Running time: 19 minutes

We talk with Dr. Cosette Wheeler about a new Lancet Oncology paper that offers follow-up on two major trials of HPV-16/18 vaccines.

The analysis adds more data to the suspicion that although three doses of vaccine are optimal, two or even one may offer substantial protection. Wheeler is very cautious on this point, however, and insists that the goal must be to deliver three doses to every recipient. In the U.S., HPV vaccine courses are completed less than half the time.

Lancet Oncology abstract

Running time: 26 minutes

“Understanding Value-Based Healthcare,” published in April by McGraw-Hill is today’s focus.

Drs. Christopher Moriates, of the University of California, San Francisco; Vineet Arora, of the University of Chicago; and Neel Shah of Harvard Medical — the book’s authors — discuss its straightforward approach to valuing patient outcomes foremost.

The discussion ranges over their reasons for writing the book, their attempt to reach the broader audience concerned with healthcare costs, and their recommendations for taking action locally.

Here’s a link to the authors’ Costs-of-Care website, where you will find information on ordering the book.