geoffrey modest medical blogs

  A recent study documented a significant ethical violation by drug companies, finding that for low income countries that were involved in drug testing studies, the successful drugs were not   subsequently  available to the participants (see   clinical trials countries involved not get meds later JAMAIntMed2025  in dropbox, or doi:10.1001/jamainternmed.2025.6060)   Details: -- they identified all novel drugs and biologics approved by the FDA from 2015 through 2018, along with their approved indication, as well as all phase 2 and 3 clinical trials supporting their FDA approval from 2015 to 2018, with data from the Drugs@FDA database, ClinicalTrials.gov website, and drug regulatory agency websites, in this retrospective analysis -- countries were categorized into 4 income groups (high, upper middle, lower middle, and low) using the World Bank's historical classification of economies, and by the geographic regions using the United Nations regional groupings of...

  a recent randomized control trial found that in patients with stable coronary artery disease and atrial fibrillation (AF), monotherapy with the anticoagulant edoxaban was better than dual antithrombotic therapy with an added antiplatelet drug (see afib and stable CAD NEJM2024  in dropbox, or DOI: 10.1056/NEJMoa2407362)   Details : -- 1040 patients were enrolled in a multicenter, open-label, adjudicator-masked, randomized trial comparing edoxaban monotherapy with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) in patients with atrial fibrillation and stable coronary artery disease, in 18 sites in South Korea, with recruitment from  2019-2022     -- coronary artery disease (CAD) was defined as being previously treated with revascularization or managed medically         -- stable CAD was defined as having had a percutaneous coronary intervention (PCI) or CABG at least 6 months before enrollment or an...

  A recent article appeared in the New York Times about the potential harms of the high potency marijuana currently widespread and well-distributed, refuting that this is nonaddictive and safe (see https://www.nytimes.com/2024/10/04/us/cannabis-marijuana-risks-addiction.html?smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb  or https://www.nytimes.com/2024/10/04/us/cannabis-marijuana-risks-addiction.html  ).   A few general comments: -- there are many reports of patients being treated for extremely large amounts of marijuana intake daily, with the following problems associated with that:   “ cannabinoid hyperemesis syndrome ”, or CHS: severe vomiting, with patients “writhing around in pain” at times, and associated with severe dehydration, seizures, kidney failure, cardiac arrest, and at least eight attributable deaths     -- it is hard to get accurate data on CHS since it is not consistently recorded in the medic...