THC, even at low doses, impaired driving ability. CBD did not, but the dose may not have been realistic.

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This week — we consider a question that has plagued humankind for ages: why am I spending my time running clinical trials of digital health technologies when I could be smoking people up in Denmark and setting them on the highway to see how straight they drive?

I have been beaten to the punch, unfortunately, by this study which is really an elegant approach to quantifying how much driving is impaired by marijuana.

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The thing that makes marijuana tricky to study, aside from the fact that the controlled substances act still ridiculously has it as a schedule 1 agent — is that it’s not just one thing. …


Should our Thanksgiving advice be like it is for safe sex or drunk driving?

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Photo by Element5 Digital on Unsplash

If you got called by a friend or family member asking what advice you have for staying safe while driving drunk, what would you say to them? Would you talk about wearing a seatbelt, or might you tell them to throw their keys in the nearest river?

As the holidays loom and the coronavirus pandemic surges, more and more health professionals are being asked a version of this question — how can I stay safe while still celebrating a large family thanksgiving?

How should we respond to that? There’s a good argument, as pointed out by Vinay Prasad that demanding abstinence hasn’t worked for other health conditions, why should we expect it to work now? …


Pre-print servers are exploding amidst a tidal wave of coronavirus papers. Not all of them are particularly good.

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When we look back on 2020, what will we call it? The year of the pandemic? The year of democracy? From a medical publishing standpoint it’s clear — 2020 is the year of the preprint.

Preprints. Medical manuscripts published for all to see, prior to peer review.

The promise of preprint servers is nothing less than the democratization of medical science. Free, open publishing so researchers and readers of research can come together and make science better. But like all good ideas, it’s about the execution.

While preprint servers like Arxiv have been running for decades servicing the math and physics community, the medical research world has only more recently embraced biorxiv — often for basic science papers — and the newcomer to the scene MedRxiv — for the clinical sciences. …


Some physicians pulling in hundreds of thousands of dollars a year, and it’s all documented online.

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How much money did your doctor make from industry last year?

If they’re like me, that answer is $0 but it’s not exactly uncommon for docs to get something of value from industry. Of around 900,000 physicians in the US, about 400,000–45% — received a payment from a pharmaceutical or device manufacturer last year.

We know this because of the Open Payments system, established by the Center for Medicare and Medicaid services in 2013 which requires disclosure of all non-research payments, whether in the form of cash, or lunches, or trips to exotic locales to physicians from these industries.

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And this week, in JAMA, we finally get to see how the existence of the Open Payments system — the transparency — has affected payments to physicians. …


A new study finds that both vaccine characteristics and personal factors dictate acceptance rates.

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So… are you going to get it? The COVID vaccine, I mean. It has been said many times before, but it bears repeating. The fact that we are even talking about mass vaccination for a disease that was unknown a year ago is mind-blowing. Vaccine development takes decades. But through really unprecedented work here we are.

Of course, the speed that we got here has led to some uncertainty. Recent surveys suggest that somewhere between 50 to 70% of US adults said they will get a COVID vaccine when it is developed.

That may not be enough to squelch the pandemic. The vaunted “herd immunity” threshold for SARS-CoV-2 suggests we’ll need about 70% of the population to be vaccinated, or, you know, become infected naturally. But importantly, characteristics of the vaccine may affect uptake. It turns out this matters a lot, as this study, appearing in JAMA Network Open shows us. …


The “lifestyle vitamin” has burned us before. Is Vitamin D supplementation smart in COVID-19?

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I have a bit of a love-hate relationship with Vitamin D.

A brief search of my blog has shown me questioning the link between Vitamin D and multiple sclerosis, kidney disease, schizophrenia, falls, and childhood educational attainment.

So it’s no surprise, in the COVID-era, that Vitamin D comes up again. I was intrigued when Dr. Anthony Fauci, a sober and responsible voice if ever there was one during this pandemic reported his personal use of Vitamin D. Vitamin D was also part of the presidential cocktail that Trump received during his stay at Walter Reed.

I decided to dig into the data here, but before we do I want to tell you why I am inherently skeptical of Vitamin D studies. …


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Overall excess deaths captures the real impact of the pandemic, and isn’t dependent on testing or death certificate information.

I remember the first time I filled out a death certificate. Hospital of the University of Pennsylvania, Medical ICU, 2006.

I’d been following the patient for about a week — he was an older man with heart disease and diabetes. He’d come in with pneumonia, developed severe sepsis, and finally had a cardiac arrest. It was the first time I ran a code, and obviously, we didn’t get him back. When it was over, my resident at the time handed me a bunch of papers. The death certificate paperwork.

I had to list the cause of death. Was it the sepsis? The pneumonia? Or maybe the diabetes that predisposed him to it all? In the end, it felt somewhat arbitrary. A death is a death. I filled out the form, took a moment to process, and admitted the next patient. …


The best care is standard of care.

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“Washington On His Deathbed” — Junius Brutus Stearns — 1851

At the time of this writing— October 5th, the president of the United States is still hospitalized at Walter Reed Medical Center for COVID-19. According to press releases, he is doing relatively well despite some transient hypoxemia.

Despite that, according to his personal physician he has received the following medications:

-Remdesivir

-Melatonin

-Zinc

-Famotidine

-Aspirin

-Vitamin D

-A monoclonal antibody cocktail from Regeneron under compassionate use

-And most recently dexamethasone

If you looked at this treatment regimen, not knowing the patient, you’d assume this was someone on the brink of death — ventilated. Last ditch effort time.

Of course, the president does not seem to be particularly sick. So, let’s face it — if you or I had COVID and were as sick as the president, there is no way we would be getting this kind of treatment. And here’s the thing — we’re probably better off. …


It’s a symptom of the broken way we pay for medical care.

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In the United States, women make less money than men in similar jobs. This is a fact that is really not contested. What is contested, though, is why. Because there’s more to a job than the title.

We aren’t going to untangle the systemic differences in gender pay writ large today, but we can take a pretty deep dive into the discrepancy seen among primary care docs thanks to this study, published in the New England Journal of Medicine.

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This is a pretty special analysis, thanks to a level of granular detail that I’ve really never seen before when people have tried to dig into these questions. …


Data from a new randomized trial

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Here in Connecticut a sweltering summer has given way to a surprisingly brisk fall, and, with COVID-19 still keeping many indoor recreation spots shuttered, outdoor activities remain the go-to for those of us with cabin fever.

If you’re like me, you enjoy a nice walk, and a new study appearing in the journal Emotion suggests there’s a better way to do it. No, it has nothing to do with shoes or posture. It’s about attitude.

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We need to walk for awe.

Awe is a positive emotion that people feel when they are in the presence of something bigger than themselves that they can not immediately understand. Awe can be inspired by nature, art, music, collective action, even the courage of others. …

About

F. Perry Wilson, MD MSCE

Writing about medicine, science, statistics, and the abuses thereof. Commentator at Medscape. Associate Professor of Medicine at Yale University.

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