Anil Makam

A meta-analysis of 5 contemporary trials found no improvement in outcomes with beta blocker therapy after myocardial infarction with normal EF (≥50%)

Conservative dialysis strategy shows promise for AKI-D

The LIBERATE-D trial found that this approach led to better renal recovery at discharge vs thrice-weekly dialysis (64% vs 50%)

Although adjusted CIs were nonsignificant and deaths were numerically higher

ICIs for NSCLC illustrates caution in broadening trial eligibility

In ECOG 0-1, trials show overall survival gain (65% vs 50% alive at 18 mos w/ chemo)

In ECOG 2+, excluded in trials & typical of hospitalized adults, survival is just ~4 mos

x.com/EvidenceRounds...

Many FDA-approved drugs receive indications broader than pivotal clinical trials, most notably for patient fitness

While broader labels can extend access, absolute benefits may be smaller or absent altogether, especially for sicker & more impaired hospitalized patients

The rise in early-onset cancer in the US, including colon cancer, is less an epidemic of disease & more an epidemic of diagnosis

The lack of a substantial rise in deaths, despite significant rising incidence strongly suggests increased diagnostic scrutiny & overdiagnosis

Routine use of gabapentin for postoperative pain is not supported by evidence

In a large multicenter double-blind RCT of patients undergoing major surgery, gabapentin did NOT improve pain, opioid use, length of stay, or quality of life

confirms a prior meta-analysis

Following the topline SNAP trial results, a new multicenter trial found cefazolin noninferior to cloxacillin for MSSA bacteremia, with fewer adverse events

Given its safety, convenience, and lower cost, cefazolin should be considered first-line therapy for MSSA bacteremia

You're gonna wanna follow this

Will be the single best way to have your finger on the pulse of what matters in hospital medicine and inpatient medicine more broadly

You misspelled clueless

This study seems riddled with selection and detection biases and I can't see how any knowledgeable expert could just take the results at face value and conclude a doubling of risk of long-covid with reinfection.

link to apply

careers.sgim.org/job/academic...

We had our first OFF site Division retreat last week!

Incredible energy, connection & culture building

Plus iconic SF views & food :)

UCSF DHM based at ZSFG is becoming the best academic Division of Hospital Medicine in the country

And not just for a safety-net

We're hiring btw

The Pros and Cons of the Latest FDA Actions on COVID Vaccines In case you missed it, last week the FDA granted full approval for the Novavax COVID-19 vaccine. This vaccine, which uses a more traditional protein-plus-adjuvant strategy instead of the mRNA approach...

Recent FDA actions on Covid vaccines:
1. Novavax approved (👏)
2. Narrowed indications for all (pros and cons)
3. Called for clinical trials (👍)
No doubt we're relying too much on old data to inform clinical practice. Some thoughts on what we gain… and what we risk. blogs.jwatch.org/hiv-id-obser...

Medicaid Patients with Type 2 Diabetes Face Hurdles Getting Cardioprotective Meds Medicaid Patients with Type 2 Diabetes Face Hurdles Getting Cardioprotective Meds sciprian@crf.org Fri, 04/25/2025 - 16:56 Michael O'Riordan SGLT2 inhibitors and GLP-1 agonists are class 1 medications, but many Medicaid patients have challenges with access.

Medicaid Patients with Type 2 Diabetes Face Hurdles Getting Cardioprotective Meds

Agree for commercial insurance or Medicare

Too expensive within Medicaid

If there is one clinical driver of practice and it's not accounted for in any analysis I can't in any confidence trust the observational comparative effectiveness

Other than the rate of ODS is very very low which is most important part of evidence base

No, it does

It's just pseudo random but may correlate with other practice patterns and serve as a marker

FWIW I do fast correction for most

And if they live in low 120s from chronic badness I don't bother fixing it unless underlying issues fixable

Remains the sole clinical driver of speed

Rest is practice variation

Can't omit it and trust evidence at all

None of these adjust for chronicity

It's the major confounded here between an acute episodic thing vs chronic badness

Availability of Cardioprotective Medications for Type 2 Diabetes in the Medicaid Program | Annals of Internal Medicine Background: Sodium–glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the only type 2 diabetes medications that reduce cardiovascular disease an...

🚨New Study in Annals🚨

GLP1ra & SGLT2i are the only diabetes meds that reduce heart attacks & death

But can't work if can't prescribe

TLDR

40% Medicaid enrollees have restricted access to GLP1 & 25% to SGLT2i

much state/plan variability

GLP access plateaued in '22

bit.ly/3Y72K2z

Copied from my Twitter thread:

NOW WHAT?

removing restrictions would improve access w/o step therapy (which makes no sense here) or prior auth

But $$$ is a real concern

Here is our pitch why may be less of an issue in Medicaid

AND

Restricting DPP4i instead of GLP/SGLT can offset some costs

Availability of Cardioprotective Medications for Type 2 Diabetes in the Medicaid Program | Annals of Internal Medicine Background: Sodium–glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the only type 2 diabetes medications that reduce cardiovascular disease an...

🚨New Study in Annals🚨

GLP1ra & SGLT2i are the only diabetes meds that reduce heart attacks & death

But can't work if can't prescribe

TLDR

40% Medicaid enrollees have restricted access to GLP1 & 25% to SGLT2i

much state/plan variability

GLP access plateaued in '22

bit.ly/3Y72K2z

Shared without comment.

This was inspired by an amazing study that I did a very popular Twitter thread on

x.com/AnilMakam/st...

Text in pictures

Link here
papers.ssrn.com/sol3/papers....

This matters because different skills translates to different probabilities for the same patient

A key take home is that Doctors are unique diagnosticians

There is NO single 'doctor' with fixed abilities

What this means is that doctors can be the "master of their ROC" and strive for diagnostic excellence in both ruling in AND ruling out badness

I've been thinking more and more about evidence-based diagnosis

Penned this piece with Gurpreet & Oanh on the SSRN preprint server titled:

Striving for Diagnostic Excellence: "The Median Is Not the Message"

Tell me what you think

Agree. Not enjoyable so far. Place is great if you like echo chambers, especially ones that celebrate an assassination because of the industry. Thought the selling point was more sanity and compassion? Will lurk time to time to see if gets better, but find me at the other place