geoffrey modest medical blogs

  the NY Times had another article by Rebecca Robbins on drug company shenanigans, this one on the delayed release of a superior form of tenofovir in the pursuit of profit (see  https://www.nytimes.com/2023/07/22/business/gilead-hiv-drug-tenofovir.html?smid=nytcore-ios-share&referringSource=articleShare  ).   Details : -- Gilead Sciences developed tenofovir disoproxyl fumarate (TDF), which became available in 2001 and was a game-changer for HIV treatment, the single best med at that time. it also was an excellent treatment for chronic hepatitis B infection -- unfortunately, there were a few important adverse effects well-known at the time: kidney failure and osteoporosis -- tenofovir alafenamide (TAF) was initially approved in 2016, as an upgrade, with similar benefits to TDF but significantly fewer renal or bone problems (TAF has much lower plasma concentrations than TDF)     But: -- in 2004, Gilead was developing a "next generation prodrug of ten...

  A recent real-world effectiveness study compared ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) in the treatment of hypertension, suggesting that ARBs should be the first choice given their better safety profile, and that we should not have an equipoise approach of either being equally appropriate (See  htn ARB over ACE htn2021  in dropbox, or  DOI: 10.1161/HYPERTENSIONAHA.120.16667 ). Thanks to Jon Pincus for bringing this to my attention    Details:  -- retrospective, new-user comparative cohort design study using statistical techniques to  minimize confounding:     -- a few different approaches to propensity scoring to match the groups, involving tens of thousands of measured baseline covariates, including demographics, diagnoses, drug exposures, drug groups, procedures, comorbidities, risk scores     -- including 76 negative control outcomes (these are outcomes that should not be associated with any of th...