Barrett’s esophagus no longer carries the promise of esophageal cancer that it seemed to, but it bears watching, especially in the first year after the finding, when most cancers are found.

The first author of this week’s New England Journal of Medicine study tracking the progression of a finding of Barrett’s over a median 5-year period offers some advice on how to proceed.

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A cluster of clear-cell adenocarcinomas of the vagina in young women led to the realization some 40 years ago that almost all their mothers had taken diethylstilbestrol during pregnancy — a drug in wide use in the early 1950s.

In a follow-up to that drug disaster, researchers (including one of the authors of the original reports in the early 1970s) have examined reproductive health in a large cohort of women exposed to DES in utero.  Their results were published last week in the New England Journal of Medicine, and they show that the health effects apparently continue beyond the reproductive years. With that cohort — the baby boomers — now entering the stage of their lives when health visits start to increase, it’s worthwhile for clinicians to be briefed on these long-term effects.

This week, we talk with two authors of the new report.

Links:

Physician’s First Watch coverage (free)

NEJM article (free abstract)

Words really do matter, and for clinicians discussing a child’s overweight with parents, words can hurt, stigmatize, and discourage parents from taking the right actions.

In a brief interview, the author of a Pediatrics study talks about the best approach to take in these discussions. There are no “magic words,” rather the approach should involve asking parents what words they feel most comfortable using in talking about how to address the problem.

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Vaccines work, and here’s more evidence. The quadrivalent rotavirus vaccine introduced in 2006 has dramatically lowered hospitalizations for rotavirus-related diarrhea among children under age 5, among other benefits. Its presence has produced a kind of herd immunity whereby even the unvaccinated are reaping benefits. It bears remembering, though, that vaccinees have about a 90% lower rate of hospitalization for the illness than the unvaccinated. And as to intussusception — a concern with an earlier rotavirus vaccine — that risk is an order-of-magnitude less, according to field data from outside the U.S.

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Health Affairs has a study in which a few simple, but rigorously followed patient-care procedures in a pediatric ICU dropped infection rates, mortality, lengths of hospital stay, and total costs. Sound too good to be true? Well, it wasn’t exactly easy, but the results were real and measurable. Listen in and see whether this could work for you and your institution.

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Last week the Canadian Medical Association Journal published an analysis of data from the Quebec Pregnancy Registry showing that the use of any non-aspirin NSAID during pregnancy was associated with an increased risk for spontaneous abortion before the 20th week of gestation. There was no apparent dose-response effect.

We discuss the research with the paper’s senior author, Dr. Anick Berard of the University of Montreal.

Links:

— Physician’s First Watch coverage of the study (free)

— CMAJ article (free)

An article in Archives of Internal Medicine examines what’s called “diagnostic blood loss” — the loss of blood through phlebotomy and not hemorrhage. The effect is the same, however.

According to a study conducted in 57 medical centers among some 18,000 patients with myocardial infarction, one in five became moderately or severely anemic (hemoglobin level under 11) from their hospital stay. That’s a 20% rate of iatrogenic anemia. Two of the study’s authors discuss the work and their proposed fixes to this problem, which most likely isn’t limited to patients with MIs.

Archives of Internal Medicine article (free)

Physician’s First Watch coverage (free)

This time we talk with Dr. Katia Noyes, first author on a study of the cost-effectiveness of disease-modifying drugs in multiple sclerosis. If you don’t treat MS, don’t think that the topic is irrelevant. Noyes brings the issues of cost-effectiveness and the dreaded QALY into focus for clinicians who see patients.

After all, medical costs will undoubtedly become centerpieces of political debate over the next year and beyond. We’d all be better off being able to evaluate the arguments made.

Last week’s New England Journal of Medicine paper on the placebo effect in evaluating asthma treatments was fascinating in itself. The editorial that accompanied it, however, was a delight. It asks clinicians to think less about laboratory measures of cure, and more about the patient’s satisfaction with treatment — whether the treatment was “real” or not.

This week’s guest, Dr. Daniel Moerman, wrote that editorial. His training in anthropology adds a refreshing viewpoint to his observations on clinical medicine. Let us know what you think by leaving a comment.

Relevant links:

There is a new meta-analysis from the Canadian Medical Association Journal that finds increased risks among smokers trying to quit and taking varenicline (Chantix). Among smokers with stable cardiovascular disease, the number needed to treat to cause an adverse cardiovascular event is about 30, yet the number needed to treat to achieve smoking cessation is 10.

Our guest, Dr. Sonal Singh, is the first author of this meta-analysis. As you’ll hear, he has strong feelings about his team’s findings.

Related links:

CMAJ paper (free)

CMAJ commentary (sorry, but it’s not free)

Physician’s First Watch coverage of the paper (free)