Polypharmacy is a rapidly worsening problem that hits elderly patients particularly hard.  As patients grow older, they need more medications but at the same time become less capable of managing the complexity of drug treatments.  In order to simplify treatment regimens for older patients, it is necessary to consider the evidence supporting treatment of various conditions and when the evidence is not particularly strong, reduce or eliminate medications accordingly.  Diabetes management in the elderly is highlighted in this podcast with specific attention given to deintensifying diabetes treatment in the elderly.

Articles discussed in this episode:

• Polypharmacy in the Aging Patient: Glycemic Control in Older Adults With Type 2 Diabetes: A Review (Kasia J. Lipska, MD, MHS)
• Evaluation and Treatment of Older Patients With Hypercholesterolemia: A Clinical Review (Timo E. Strandberg, MD, PhD)
• Trends in Prescription Drug Use Among Adults in the United States From 1999-2012 (Elizabeth D. Kantor, PhD, MPH)

Interview with Saad B. Omer, MBBS, MPH, PhD, author of Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States A Review of Measles and Pertussis

An opioid abuse epidemic now plagues US healthcare. It was caused, in part, by overzealous advocacy for controlling chronic pain resulting in overuse of narcotics. There are now 2 million Americans addicted to opioids. The approach for treating chronic pain must change. In this podcast, we summarize recent CDC guidelines for the proper use of opioids for treating chronic pain.

Articles discussed in this episode:

• CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016,
• The CDC Guideline on Opioid Prescribing: Rising to the Challenge (Yngvild Olsen, MD, MPH),
• The DSM-V definition for opioid use disorder and 11 point checklist

Interview with Daniel C. Cherkin, PhD, author of Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial

Interview with Wendy C. King, PhD, author of Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity

Interview with William R. Phillips, MD, MPH, author of Screening for Chronic Obstructive Pulmonary Disease: US Preventive Services Task Force Recommendation Statement

Interview with Raj Chetty, PhD, author of The Association Between Income and Life Expectancy in the United States, 2001-2014, and Angus Deaton, PhD, author of On Death and Money: History, Facts, and Explanations

Interview with Kiros Berhane, PhD, author of Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012

Mononucleosis is a common disease of young adults manifested by lethargy, fever, pharyngitis, lymphadenopathy and splenomegaly. In this podcast, we review the clinical features of the disease and how good each of them is at establishing a diagnosis of mononucleosis. We also review how Epstein Barr virus was discovered as the cause of mononucleosis and talk to Mark H. Ebell, MD, MS, author of Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review.

Articles discussed in this episode:

• Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review (2016)
• Acute Lymphatic Leukemia and Infectious Mononucleosis (1931)
• Infectious Mononucleosis: Part I. Clinical Aspects (1935) 
• Infectious Mononucleosis: Clinical Manifestations in Relation to EB Virus Antibodies (1968)

Interview with Antoni Ribas, MD, PhD, author of Association of Pembrolizumab With Tumor Response and Survival Among Patients With Advanced Melanoma

Interview with Céline Vetter, PhD, author of Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women

Christine Curry, MD, PhD, assistant professor of obstetrics and gynecology at the University of Miami, discusses the challenges of keeping pregnant patients and her colleagues well-informed of the facts as Zika virus fears circulate.

Interview with Pascal Hammel, MD, author of Effect of Chemoradiotherapy vs Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial

Attention-Deficit/Hyperactivity Disorder, or ADHD is a very common problem affecting about 10% of all adolescents. Children with ADHD have short attention spans, are hyperactive, talk a great deal, can be disruptive in the classroom etc.-features that are common in many adolescents. However, to have true ADHD, children must be significantly impaired by these problems. An array of medical and behavioral treatments can successfully help manage ADHD. These are reviewed in a series of articles appearing in the May 10, 2016, issue of JAMA. In this podcast, we discuss ADHD with the authors of some of those papers, Eugenia Chan, MD, MPH from Harvard and Philip Shaw, MD, PhD from the National Human Genome Research Institute.

Articles discussed in this episode:

• Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents: A Systematic Review
• Quantifying the Benefits and Risks of Methylphenidate as Treatment for Childhood Attention-Deficit/Hyperactivity Disorder
• Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Interview with Douglas B. White, MD, MAS, author of Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients

Drs Stuart Spechler and Peter Kahrilis discuss GERD and esophagitis--how they occur and how they are treated. Dr Spechler also discusses a new hypothesis regarding how reflux esophagitis is caused that differs from the traditional teaching that acid and pepsin reflux into the esophagus and burn the mucosa layers.

Related articles:
Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes
Turning the Pathogenesis of Acute Peptic Esophagitis Inside Out

Interview with Ann E. Kurth, PhD, RN, MSN, MPH, author of Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement

Interview with Douglas K. Owens, MD, MS, author of Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement

Interview with Jeff D. Williamson, MD, MHS, author of Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial

Interview with Ezekiel J. Emanuel, MD, PhD, author of Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe

Interview with Michael P. Pignone, MD, MPH, author of Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement

Interview with Barbara E. Murray, MD, author of Infectious Disease Expert Sees Threat From Colistin-Resistant Superbug

Interview with Axel Linke, MD, author of Effect of a Cerebral Protection Device on Brain Lesions Following Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis: The CLEAN-TAVI Randomized Clinical Trial

Interview with David Grossman, MD, author of Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

Interview with Dhruv S. Kazi, MD, MSc, MS, author of Cost-effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease

Introducing a new series of JAMA articles on professionalism, discussed from the perspective of how clinicians should address challenging clinical situations and adverse events in their medical practice. In the first episode of the accompanying podcast, JAMA Professionalism: Best Practice, we interview Wendy Levinson, MD, and Jensen Yeung, MD, authors of Disclosure of Medical Error, which appeared in the August 16, 2016 issue of JAMA, as well as Thomas H. Gallagher, MD.

Drug prices continue to rise in the US. Many solutions have been proposed but few have been implemented. Drs. Janet Woodcock from the FDA and Aaron Kesselheim, author of The High Cost of Prescription Drugs in the United States from the Harvard Medical School discuss the role of brand name drugs and generics and how they influence the cost of pharmaceuticals.

Also see The Cost of US Pharmaceutical Price Reductions: A Financial Simulation Model of R&D Decisions by Thomas A. Abbott and John A. Vernon.

Interview with Francisco A.R. García, MD, MPH, author of Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement

Interview with Joel G. Ray, MD, MSc, FRCPC, author of Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes

Patrick Soon-Shiong, MD, physician-scientist and entrepreneur, talks about the National MoonShot Initiative, his MoonShot 2020 Program, as well as promising approaches in cancer immunotherapy. This podcast was originally recorded on June 3, 2016

Interview with Vivian S. Lee, MD, PhD, MBA;, author of Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes: Association With Reduced Cost and Improved Quality, and Michael E. Porter, PhD, author of From Volume to Value in Health Care: The Work Begins

Interview with John M. Jakicic, PhD, author of Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial

What to do when the wrong procedure is performed? In this first installment of JAMA Performance Improvement: Do No Harm we explore the options for dealing with this very difficult problem with Tami Minnier, RN, MSN, Paul Phrampus, MD, Linda Waddell, RN, MSN, and David Baker, MD, MPH, FACP. Air traffic audio courtesy of LiveATC.net, used with permission.

Interview with Jeffrey L Saver, M.D., author of Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis

When managing septic shock, passive leg raising is the best test to determine if a patient is likely to respond to a fluid bolus, better than CVP lines or even bedside ultrasound. Dr Najib Ayas, Associate professor of Critical Care Medicine at the University of British Columbia, discusses shock management from the context of his Rational Clinical examination article in the September 27, 2016 issue of JAMA, entitled “Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?”

Nearly all women experience some element of nausea and vomiting during their pregnancies. In this podcast we review the entire spectrum of disease all the way up to hyperemesis gravidarum and how to provide care for women experiencing these problems.

Article discussed in this episode:

Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy

This Medical News podcast features a Q&A with CDC Director Tom Frieden, MD, commemorating the agency’s historic 70th anniversary. The interview was recorded on August 8th, 2016.

In this episode of JAMA Professionalism: Best Practice, Edward H. Livingston, MD looks at the case of a physician requesting prescription medication from a colleague to examine professional boundaries between physicians and options for managing those boundaries. Shiphra Ginsburg, MD and Wendy Levinson, MD, authors of the related article, join Dr Livingston to discuss the best options for handling this challenging situation. Arthur S. Hengerer, MD, chair of the Federation of State Medical Boards discusses the legal and licensure ramifications of physicians prescribing for other clinicians and Kate E. Engelhardt, MD, and D. Brock Hewitt, MD, MPH, practicing physicians, relate their experience with other clinicians asking them to prescribe medications.

Interview with Ann E. Kurth, PhD, RN, MSN, MPH, Task Force member and co-author of Primary Care Interventions to Support Breastfeeding: US Preventive Services Task Force Recommendation Statement

This Medical News podcast discusses the Human Genome Project-write with Harvard geneticist, George Church, PhD.

Medicare recently developed a star rating system to help consumers determine the quality of care delivered at various hospitals. This rating system was considered controversial by many. In this podcast we discuss the rating system with one of its critics, Karl Y. Bilimoria, MD, MS, and with Kate Goodrich, MD, the Director of the Center for Clinical Standards and Quality at Medicare.

Article discussed in this episode:

The New CMS Hospital Quality Star Ratings: The Stars Are Not Aligned

Interview with Douglas K. Owens, MD, MS, USPSTF Task Force member and coauthor of Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement

Approximately one-third of all medical school graduates report having been abused as students. Medical student and resident abuse has long been considered unacceptable behavior but still persists in the teaching environment. In this podcast we discuss how students and residents might respond to these events. We interview Geoffrey Young, MD, from the Association of American Medical Colleges and Thomas J. Nasca, MD, from the Accreditation Council for Graduate Medical Education, who discuss how they expect medical schools to respond to abusive behaviors and what resources are available to students and residents who have been abused to report those experiences without fearing retribution.

Article discussed in this episode:

Medical Student Mistreatment

Interview with Christopher JL. Murray, MD, DPhil, author of US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014

Interview with Jennifer Abbasi, author of NIH Charts a Path for Nutrition Science

Interview with Roger L. Zemek, MD, author of Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents

Interview with Ann E. Kurth, PhD, RN, MSN, MPH, author of Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Recommendation Statement

Between 8% and 10% of the population will have a seizure at one point in life. It's important to distinguish seizures from other entities that can look like them and, once a diagnosis of a seizure is established, know how to treat them. In this JAMA Clinical Review podcast, we discuss seizures and epilepsy with Jay Gavvala, MD, author of New-Onset Seizure in Adults and Adolescents: A Review.

Article discussed in this episode:

New-Onset Seizure in Adults and Adolescents: A Review

Interview with Alex R. Kemper, MD, MPH, MS, Task Force member and co-author of Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive Services Task Force Recommendation Statement

Interview with Alex H. Krist, MD, MPH, Task Force member and co-author of Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement