The risk of beta blockers

There’s more evidence that beta blockers given before surgery increase patients’ risk of stroke, according to research out of Montefiore Medical Center.

Looking at the records of almost 206,000 patients over 16 years, they found that using beta blockers for the first time in the month before surgery increased stroke risk by 25%, while patients already using them had a 17% increased risk.

A couple of notes: This doesn’t apply to cardiac surgery (beta-blockers did help protect against myocardial infarction and cardiac revascularizations). And Black and Hispanic patients seemed to be prescribed beta blockers more often, even though they weren’t sicker.

RSV vax works

A big new study (230 hospitals and 245 emergency departments across the country) found that the RSV vaccine works well in the real world — it was “80% effective in protecting against hospitalizations and deaths during the 2023-2024 RSV season.”

You might think “Wait, they’re just now looking at how effective it is?” The idea is that this is a real-world study, as opposed to the study-based ones the approval was based on.

Short Takes

USA Today discovers pharmacy deserts

To be fair, the deserts are growing as more and more independent pharmacies close, and chains start cutting back on their locations.

The X for Y Files

Radicava (aka edaravone), which was approved to treat ALS, seems to stop brain-tumor stem cells from proliferating. That means — Canadian researchers say — “repurposing the drug may prove to be a potent weapon against glioblastoma.”

In a sad irony, despite that approval, edaravone may not even provide a “clinically relevant benefit” to ALS patients.

When seven days is enough

Patients with blood infections only need a 7-day course of antibiotics — not the 14 days that’s often prescribed. Only a week is not only just as good, it actually might be slightly better, according to the study out of the University of Toronto.

Among patients with bloodstream infections who received 7 days of antibiotics, 14.5% had died at 90 days, versus 16.1% of those who received 14 days of antibiotics.

The data held true, they said, regardless of whether patients were in the regular hospital or the ICU, and no matter the severity or type of the infection.

What’s better than GLP-1s?

With all the hubbub about GLP-1 drugs, it turns out they’re not really cost-effective for weight loss — at least not compared to surgery. A Northwestern University study found that bariatric surgery is the way to go if money is an issue (e.g., if you’re an insurance company), “delivering two more healthy years of life and saving patients about $9,000 a year.”

Of course GLP-1s will eventually be less expensive, but they still have to be taken for life while surgery is once-and-done, although you might have to take some extra supplements to make up for the GI changes.

ICYMI: Part D changes

There are big changes afoot for Medicare Part D plans next year, making it important for recipients not to just keep doin’ what they’ve been doin’. Notably, there’s good news — with a caveat. The good news is that, thanks to provisions in the IRA…

• Out-of-pocket costs for beneficiaries are capped at $2,000 per year.
• The deductible is capped at $590.
• Low-income folks may be eligible for subsidies to help pay for it.

The downside is that about 70% of insurers have raised their premiums (although there’s an incentive for insurers to keep that premium increase to $35), and some may reduce coverage of certain drugs in favor of less expensive options. They may also “eliminate pharmacies, doctors, or other services from the provider networks beneficiaries must use.”

Bottom line: Recipients really need to read the details of plans before choosing one — it’s the biggest change in coverage since 2003.

You know it’s 2024 when someone has to write this opinion piece

“Doctors, Not AI, Should Authorize Treatments”