Federal Practitioner

Given the expansive contemporary role of statins for primary cardiovascular disease (CVD) prevention, the language in the new U.S. Preventive Services Task Force draft guidance on their use in that setting may seem conservative. Even so, the proposed recommendations, open to public comment until March 21, take more recent data into account but don’t substantially vary from the 2016 USPSTF document they are intended to replace.

The task force concluded “with moderate certainty” that a statin prescription will clinically benefit adults aged 40-75 years without CVD but with at least one of several risk factors, such as dyslipidemia or diabetes, who have a 10-year CVD risk of at least 7.5%.

AndrewSoundarajan/Thinkstock

The net benefit of statin therapy is “at least small” for individuals in whom the 10-year CVD risk is 7.5% up to 10.0%, the new report states. That, says an accompanying USPSTF press release, means such people “may benefit from statin use and should decide with their clinician if taking a statin is right for them.”

Also, notes the report, the net benefit of statin therapy is “at least moderate” for individuals with a 10% or greater CVD risk over the next decade who, the press release states, “should take a statin to prevent a first heart attack or stroke.”

The evidence review on which the task force based the guidance, the report says, lacked sufficient basis for determining statin benefit versus risk in adults older than 75 years without a history of CVD. “In the absence of this evidence, clinicians should use their judgment as to whether to offer a statin to a patient in this age group,” according to the press release.

The review focused on 22 clinical trials for data on the statin benefits and saw significantly decreased associated risks for death from any cause, fatal or nonfatal stroke, and fatal or nonfatal myocardial infarction with treatment. The combined trial populations exceeded 85,000 for assessing all-cause mortality and 76,000 for each of the other two endpoints.

To assess any potential statin therapy harms, the evidence review covered 19 clinical trials with a combined enrollment of about 75,000 – two more trials than considered in the 2016 document – plus three observational studies with more than 400,000 participants. Statins were found not to be associated with an increased risk for study withdrawal because of adverse events, nor were there signs of greater risk for myalgia or new-onset diabetes, compared with placebo.

“A majority of the trials reviewed by the USPSTF used moderate-intensity statin therapy,” the report states. “Based on available evidence, use of moderate-intensity statin therapy seems reasonable for the primary prevention of CVD in most persons.”

A version of this article first appeared on Medscape.com.

Given the expansive contemporary role of statins for primary cardiovascular disease (CVD) prevention, the language in the new U.S. Preventive Services Task Force draft guidance on their use in that setting may seem conservative. Even so, the proposed recommendations, open to public comment until March 21, take more recent data into account but don’t substantially vary from the 2016 USPSTF document they are intended to replace.

The task force concluded “with moderate certainty” that a statin prescription will clinically benefit adults aged 40-75 years without CVD but with at least one of several risk factors, such as dyslipidemia or diabetes, who have a 10-year CVD risk of at least 7.5%.

AndrewSoundarajan/Thinkstock

The net benefit of statin therapy is “at least small” for individuals in whom the 10-year CVD risk is 7.5% up to 10.0%, the new report states. That, says an accompanying USPSTF press release, means such people “may benefit from statin use and should decide with their clinician if taking a statin is right for them.”

Also, notes the report, the net benefit of statin therapy is “at least moderate” for individuals with a 10% or greater CVD risk over the next decade who, the press release states, “should take a statin to prevent a first heart attack or stroke.”

The evidence review on which the task force based the guidance, the report says, lacked sufficient basis for determining statin benefit versus risk in adults older than 75 years without a history of CVD. “In the absence of this evidence, clinicians should use their judgment as to whether to offer a statin to a patient in this age group,” according to the press release.

The review focused on 22 clinical trials for data on the statin benefits and saw significantly decreased associated risks for death from any cause, fatal or nonfatal stroke, and fatal or nonfatal myocardial infarction with treatment. The combined trial populations exceeded 85,000 for assessing all-cause mortality and 76,000 for each of the other two endpoints.

To assess any potential statin therapy harms, the evidence review covered 19 clinical trials with a combined enrollment of about 75,000 – two more trials than considered in the 2016 document – plus three observational studies with more than 400,000 participants. Statins were found not to be associated with an increased risk for study withdrawal because of adverse events, nor were there signs of greater risk for myalgia or new-onset diabetes, compared with placebo.

“A majority of the trials reviewed by the USPSTF used moderate-intensity statin therapy,” the report states. “Based on available evidence, use of moderate-intensity statin therapy seems reasonable for the primary prevention of CVD in most persons.”

A version of this article first appeared on Medscape.com.

Given the expansive contemporary role of statins for primary cardiovascular disease (CVD) prevention, the language in the new U.S. Preventive Services Task Force draft guidance on their use in that setting may seem conservative. Even so, the proposed recommendations, open to public comment until March 21, take more recent data into account but don’t substantially vary from the 2016 USPSTF document they are intended to replace.

The task force concluded “with moderate certainty” that a statin prescription will clinically benefit adults aged 40-75 years without CVD but with at least one of several risk factors, such as dyslipidemia or diabetes, who have a 10-year CVD risk of at least 7.5%.

AndrewSoundarajan/Thinkstock

The net benefit of statin therapy is “at least small” for individuals in whom the 10-year CVD risk is 7.5% up to 10.0%, the new report states. That, says an accompanying USPSTF press release, means such people “may benefit from statin use and should decide with their clinician if taking a statin is right for them.”

Also, notes the report, the net benefit of statin therapy is “at least moderate” for individuals with a 10% or greater CVD risk over the next decade who, the press release states, “should take a statin to prevent a first heart attack or stroke.”

The evidence review on which the task force based the guidance, the report says, lacked sufficient basis for determining statin benefit versus risk in adults older than 75 years without a history of CVD. “In the absence of this evidence, clinicians should use their judgment as to whether to offer a statin to a patient in this age group,” according to the press release.

The review focused on 22 clinical trials for data on the statin benefits and saw significantly decreased associated risks for death from any cause, fatal or nonfatal stroke, and fatal or nonfatal myocardial infarction with treatment. The combined trial populations exceeded 85,000 for assessing all-cause mortality and 76,000 for each of the other two endpoints.

To assess any potential statin therapy harms, the evidence review covered 19 clinical trials with a combined enrollment of about 75,000 – two more trials than considered in the 2016 document – plus three observational studies with more than 400,000 participants. Statins were found not to be associated with an increased risk for study withdrawal because of adverse events, nor were there signs of greater risk for myalgia or new-onset diabetes, compared with placebo.

“A majority of the trials reviewed by the USPSTF used moderate-intensity statin therapy,” the report states. “Based on available evidence, use of moderate-intensity statin therapy seems reasonable for the primary prevention of CVD in most persons.”

A version of this article first appeared on Medscape.com.

Renowned infectious disease specialist, humanitarian, and healthcare champion for many of the world’s most vulnerable patient populations, Paul Edward Farmer, MD, died suddenly in his sleep from an acute cardiac event on Feb. 21 in Rwanda, where he had been teaching. He was 62.

Dr. Farmer cofounded the Boston-based global nonprofit Partners In Health and spent decades providing healthcare to impoverished communities worldwide, fighting on the frontline to protect underserved communities against deadly pandemics.

Dr. Farmer was the Kolokotrones University Professor and chair of the department of global health and social medicine in the Blavatnik Institute at Harvard Medical School, Boston. He served as chief of the division of global health equity at Brigham and Women’s Hospital, also in Boston. 

“Paul dedicated his life to improving human health and advocating for health equity and social justice on a global scale,” said HMS dean George Q. Daley in a letter to the HMS community. “I am particularly shaken by his passing because he was not only a consummate colleague and a beloved mentor, but a close friend. To me, Paul represented the heart and soul of Harvard Medical School.”

He was also chancellor and cofounder of the University of Global Health Equity in Kigali, Rwanda. Before his death, he spent several weeks teaching at the university.

“Paul Farmer’s loss is devastating, but his vision for the world will live on through Partners In Health,” said Partners In Health CEO Sheila Davis in a statement. “Paul taught all those around him the power of accompaniment, love for one another, and solidarity. Our deepest sympathies are with his family.”

Dr. Farmer was born in North Adams, Mass., and grew up in Florida with his parents and five siblings. He attended Duke University on a Benjamin N. Duke Scholarship and received his medical degree in 1988, followed by his PhD in 1990 from Harvard University.

His humanitarian work began when he was a college student volunteering in Haiti in 1983 working with dispossessed farmers. In 1987, he cofounded Partners In Health with the goal of helping patients in poverty-stricken corners of the world.

Under Dr. Farmer’s leadership, the nonprofit tackled major public health crises: Haiti’s devastating 2010 earthquake, drug-resistant tuberculosis in Peru and other countries, and an Ebola outbreak that tore through West Africa.

Dr. Farmer documented his 2014-2015 experience treating Africa’s Ebola patients in a book called “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.”

He wrote that by the time he arrived, “western Sierra Leone was ground zero of the epidemic, and Upper West Africa was just about the worst place in the world to be critically ill or injured.”

One of his greatest qualities was his ability to connect with patients – to treat them “not like ones who suffered, but like a pal you’d joke with,” said Pardis Sabeti, MD, PhD, a Harvard University geneticist who also spent time in Africa and famously sequenced samples of the Ebola virus’ genome.

Dr. Sabeti and Dr. Farmer bonded over their love for Sierra Leone, and their grief over losing a close colleague to Ebola, Sheik Humarr Khan, who was one of the area’s leading infectious disease experts.

Dr. Sabeti first met Dr. Farmer years earlier as a first-year Harvard medical student when she enrolled in one of his courses. She said students introduced themselves, one by one, each veering into heartfelt testimonies about what Dr. Farmer’s work had meant to them.

Dr. Farmer and Dr. Sabeti were just texting on Feb. 19, and the two were “goofing around in our usual way, and scheming about how to make the world better, as we always did.”

Dr. Farmer was funny, mischievous, and above all, exactly what you would expect upon meeting him, Dr. Sabeti said.

“It’s cliché, but the energetic kick you get from just being in his presence, it’s almost otherworldly,” she said. “It’s not even otherworldly in the sense of: ‘I just came across – greatness.’ It’s more: ‘I just came across kindness.’ ”

Dr. Farmer’s work has been widely distributed in publications including Bulletin of the World Health Organization, The Lancet, the New England Journal of Medicine, Clinical Infectious Diseases, and Social Science & Medicine.

He was awarded the 2020 Berggruen Prize for Philosophy & Culture, the Margaret Mead Award from the American Anthropological Association, the American Medical Association’s Outstanding International Physician (Nathan Davis) Award, and, with his Partners In Health colleagues, the Hilton Humanitarian Prize.

He is survived by his wife, Didi Bertrand Farmer, and their three children.

A verison of this article first appeared on Medscape.com.

Renowned infectious disease specialist, humanitarian, and healthcare champion for many of the world’s most vulnerable patient populations, Paul Edward Farmer, MD, died suddenly in his sleep from an acute cardiac event on Feb. 21 in Rwanda, where he had been teaching. He was 62.

Dr. Farmer cofounded the Boston-based global nonprofit Partners In Health and spent decades providing healthcare to impoverished communities worldwide, fighting on the frontline to protect underserved communities against deadly pandemics.

Dr. Farmer was the Kolokotrones University Professor and chair of the department of global health and social medicine in the Blavatnik Institute at Harvard Medical School, Boston. He served as chief of the division of global health equity at Brigham and Women’s Hospital, also in Boston. 

“Paul dedicated his life to improving human health and advocating for health equity and social justice on a global scale,” said HMS dean George Q. Daley in a letter to the HMS community. “I am particularly shaken by his passing because he was not only a consummate colleague and a beloved mentor, but a close friend. To me, Paul represented the heart and soul of Harvard Medical School.”

He was also chancellor and cofounder of the University of Global Health Equity in Kigali, Rwanda. Before his death, he spent several weeks teaching at the university.

“Paul Farmer’s loss is devastating, but his vision for the world will live on through Partners In Health,” said Partners In Health CEO Sheila Davis in a statement. “Paul taught all those around him the power of accompaniment, love for one another, and solidarity. Our deepest sympathies are with his family.”

Dr. Farmer was born in North Adams, Mass., and grew up in Florida with his parents and five siblings. He attended Duke University on a Benjamin N. Duke Scholarship and received his medical degree in 1988, followed by his PhD in 1990 from Harvard University.

His humanitarian work began when he was a college student volunteering in Haiti in 1983 working with dispossessed farmers. In 1987, he cofounded Partners In Health with the goal of helping patients in poverty-stricken corners of the world.

Under Dr. Farmer’s leadership, the nonprofit tackled major public health crises: Haiti’s devastating 2010 earthquake, drug-resistant tuberculosis in Peru and other countries, and an Ebola outbreak that tore through West Africa.

Dr. Farmer documented his 2014-2015 experience treating Africa’s Ebola patients in a book called “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.”

He wrote that by the time he arrived, “western Sierra Leone was ground zero of the epidemic, and Upper West Africa was just about the worst place in the world to be critically ill or injured.”

One of his greatest qualities was his ability to connect with patients – to treat them “not like ones who suffered, but like a pal you’d joke with,” said Pardis Sabeti, MD, PhD, a Harvard University geneticist who also spent time in Africa and famously sequenced samples of the Ebola virus’ genome.

Dr. Sabeti and Dr. Farmer bonded over their love for Sierra Leone, and their grief over losing a close colleague to Ebola, Sheik Humarr Khan, who was one of the area’s leading infectious disease experts.

Dr. Sabeti first met Dr. Farmer years earlier as a first-year Harvard medical student when she enrolled in one of his courses. She said students introduced themselves, one by one, each veering into heartfelt testimonies about what Dr. Farmer’s work had meant to them.

Dr. Farmer and Dr. Sabeti were just texting on Feb. 19, and the two were “goofing around in our usual way, and scheming about how to make the world better, as we always did.”

Dr. Farmer was funny, mischievous, and above all, exactly what you would expect upon meeting him, Dr. Sabeti said.

“It’s cliché, but the energetic kick you get from just being in his presence, it’s almost otherworldly,” she said. “It’s not even otherworldly in the sense of: ‘I just came across – greatness.’ It’s more: ‘I just came across kindness.’ ”

Dr. Farmer’s work has been widely distributed in publications including Bulletin of the World Health Organization, The Lancet, the New England Journal of Medicine, Clinical Infectious Diseases, and Social Science & Medicine.

He was awarded the 2020 Berggruen Prize for Philosophy & Culture, the Margaret Mead Award from the American Anthropological Association, the American Medical Association’s Outstanding International Physician (Nathan Davis) Award, and, with his Partners In Health colleagues, the Hilton Humanitarian Prize.

He is survived by his wife, Didi Bertrand Farmer, and their three children.

A verison of this article first appeared on Medscape.com.

Renowned infectious disease specialist, humanitarian, and healthcare champion for many of the world’s most vulnerable patient populations, Paul Edward Farmer, MD, died suddenly in his sleep from an acute cardiac event on Feb. 21 in Rwanda, where he had been teaching. He was 62.

Dr. Farmer cofounded the Boston-based global nonprofit Partners In Health and spent decades providing healthcare to impoverished communities worldwide, fighting on the frontline to protect underserved communities against deadly pandemics.

Dr. Farmer was the Kolokotrones University Professor and chair of the department of global health and social medicine in the Blavatnik Institute at Harvard Medical School, Boston. He served as chief of the division of global health equity at Brigham and Women’s Hospital, also in Boston. 

“Paul dedicated his life to improving human health and advocating for health equity and social justice on a global scale,” said HMS dean George Q. Daley in a letter to the HMS community. “I am particularly shaken by his passing because he was not only a consummate colleague and a beloved mentor, but a close friend. To me, Paul represented the heart and soul of Harvard Medical School.”

He was also chancellor and cofounder of the University of Global Health Equity in Kigali, Rwanda. Before his death, he spent several weeks teaching at the university.

“Paul Farmer’s loss is devastating, but his vision for the world will live on through Partners In Health,” said Partners In Health CEO Sheila Davis in a statement. “Paul taught all those around him the power of accompaniment, love for one another, and solidarity. Our deepest sympathies are with his family.”

Dr. Farmer was born in North Adams, Mass., and grew up in Florida with his parents and five siblings. He attended Duke University on a Benjamin N. Duke Scholarship and received his medical degree in 1988, followed by his PhD in 1990 from Harvard University.

His humanitarian work began when he was a college student volunteering in Haiti in 1983 working with dispossessed farmers. In 1987, he cofounded Partners In Health with the goal of helping patients in poverty-stricken corners of the world.

Under Dr. Farmer’s leadership, the nonprofit tackled major public health crises: Haiti’s devastating 2010 earthquake, drug-resistant tuberculosis in Peru and other countries, and an Ebola outbreak that tore through West Africa.

Dr. Farmer documented his 2014-2015 experience treating Africa’s Ebola patients in a book called “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.”

He wrote that by the time he arrived, “western Sierra Leone was ground zero of the epidemic, and Upper West Africa was just about the worst place in the world to be critically ill or injured.”

One of his greatest qualities was his ability to connect with patients – to treat them “not like ones who suffered, but like a pal you’d joke with,” said Pardis Sabeti, MD, PhD, a Harvard University geneticist who also spent time in Africa and famously sequenced samples of the Ebola virus’ genome.

Dr. Sabeti and Dr. Farmer bonded over their love for Sierra Leone, and their grief over losing a close colleague to Ebola, Sheik Humarr Khan, who was one of the area’s leading infectious disease experts.

Dr. Sabeti first met Dr. Farmer years earlier as a first-year Harvard medical student when she enrolled in one of his courses. She said students introduced themselves, one by one, each veering into heartfelt testimonies about what Dr. Farmer’s work had meant to them.

Dr. Farmer and Dr. Sabeti were just texting on Feb. 19, and the two were “goofing around in our usual way, and scheming about how to make the world better, as we always did.”

Dr. Farmer was funny, mischievous, and above all, exactly what you would expect upon meeting him, Dr. Sabeti said.

“It’s cliché, but the energetic kick you get from just being in his presence, it’s almost otherworldly,” she said. “It’s not even otherworldly in the sense of: ‘I just came across – greatness.’ It’s more: ‘I just came across kindness.’ ”

Dr. Farmer’s work has been widely distributed in publications including Bulletin of the World Health Organization, The Lancet, the New England Journal of Medicine, Clinical Infectious Diseases, and Social Science & Medicine.

He was awarded the 2020 Berggruen Prize for Philosophy & Culture, the Margaret Mead Award from the American Anthropological Association, the American Medical Association’s Outstanding International Physician (Nathan Davis) Award, and, with his Partners In Health colleagues, the Hilton Humanitarian Prize.

He is survived by his wife, Didi Bertrand Farmer, and their three children.

A verison of this article first appeared on Medscape.com.

The lingering effects of the COVID-19 pandemic continue to take a toll on the happiness, well-being, and lifestyles of many segments of the population, especially those in the health care field, including psychiatrists.

The newly released Medscape Psychiatrist Lifestyle, Happiness & Burnout Report 2022 explores psychiatrists’ happiness in their personal and professional lives and how they are maintaining mental and physical health.

Prior to the global pandemic, 79% of psychiatrists said they were “very” or “somewhat” happy outside of work, like physicians overall (81%).

But as the pandemic has worn on, feelings have shifted, and there are clear signs of stress and strain on those in the health care field. 

Now, the percentage of psychiatrists who say they are currently “very” or “somewhat” happy outside of work has fallen to 62%, similar to physicians overall (59%).
 

Higher in women

In last year’s report, overall 42% of psychiatrists reported burnout; that’s risen to 47% this year.

When it comes to burnout, psychiatrists are in the lower range of burned-out physicians. Perhaps not surprising, given the challenges of the COVID-19 pandemic, burnout rates are highest in emergency medicine and critical care specialists.

About half of psychiatrists (52%) reported that they were more burned out now than during the initial quarantine months of the pandemic, similar to physicians overall (55%). About one-third said their burnout was the same.

Female psychiatrists reported being burned out at a greater rate than their male colleagues (46% vs. 30%).

“There’s no question that women have reported far more role strain during the pandemic than men,” said Carol A. Bernstein, MD, psychiatrist at Montefiore Health System and professor and vice chair for faculty development and well-being at Albert Einstein College of Medicine, New York.

Courtesy Dr. Carol A. Bernstein

Work-life balance

More than half of psychiatrists (53%) report they are willing to take a cut in pay in order to achieve a better work-life balance or have more free time. This is similar among physicians overall (55%).

More than one-third (39%) of psychiatrists reported clinical depression (severe depression lasting some time and not caused by grief), while 44% reported colloquial depression (feeling down, blue, sad).

About half of depressed psychiatrists said their depression does not have an impact on relationships with patients. Of those who saw an impact, the major behaviors they reported were being easily exasperated with patients and feeling less motivated to take patient notes carefully.

To maintain happiness and mental health, psychiatrists choose to spend time with loved ones, do the things they enjoy, exercise, and get plenty of sleep.

Perhaps not surprisingly, more psychiatrists were happy with their work-life balance before the pandemic (68% vs. 54%). The same holds for physicians overall.

Before the pandemic, 17% of psychiatrists reported being unhappy with their work-life balance. That has risen to 29% this year.

The vast majority of psychiatrists are currently in a committed relationship, with 76% either married or living with a partner. A somewhat higher percentage (83%) of physicians overall report being in a committed relationship.

About eight in 10 psychiatrists (81%) describe their marriage as good or very good – the same as last year.

A little more than half of psychiatrists have life partners who do not work in medicine. This is similar to the proportion among all physicians (56%).

Among psychiatrists balancing parenthood and a medical career, female psychiatrists noted feeling conflicted more often than their male counterparts (36% vs. 22% were “very conflicted” or “conflicted”).

This general attitude is reflected in almost all occupations, according to a Pew Research survey, which found that larger shares of mothers than fathers struggled with childcare responsibilities during the pandemic.

Findings from Medscape’s latest happiness, wellness, and lifestyle survey are based on 13,069 Medscape member physicians (61% male) practicing in the United States who completed an online survey conducted between June 29 and Sept. 26, 2021. Most respondents were between 35 and 64 years old.

A version of this article first appeared on Medscape.com.

The lingering effects of the COVID-19 pandemic continue to take a toll on the happiness, well-being, and lifestyles of many segments of the population, especially those in the health care field, including psychiatrists.

The newly released Medscape Psychiatrist Lifestyle, Happiness & Burnout Report 2022 explores psychiatrists’ happiness in their personal and professional lives and how they are maintaining mental and physical health.

Prior to the global pandemic, 79% of psychiatrists said they were “very” or “somewhat” happy outside of work, like physicians overall (81%).

But as the pandemic has worn on, feelings have shifted, and there are clear signs of stress and strain on those in the health care field. 

Now, the percentage of psychiatrists who say they are currently “very” or “somewhat” happy outside of work has fallen to 62%, similar to physicians overall (59%).
 

Higher in women

In last year’s report, overall 42% of psychiatrists reported burnout; that’s risen to 47% this year.

When it comes to burnout, psychiatrists are in the lower range of burned-out physicians. Perhaps not surprising, given the challenges of the COVID-19 pandemic, burnout rates are highest in emergency medicine and critical care specialists.

About half of psychiatrists (52%) reported that they were more burned out now than during the initial quarantine months of the pandemic, similar to physicians overall (55%). About one-third said their burnout was the same.

Female psychiatrists reported being burned out at a greater rate than their male colleagues (46% vs. 30%).

“There’s no question that women have reported far more role strain during the pandemic than men,” said Carol A. Bernstein, MD, psychiatrist at Montefiore Health System and professor and vice chair for faculty development and well-being at Albert Einstein College of Medicine, New York.

Courtesy Dr. Carol A. Bernstein

Work-life balance

More than half of psychiatrists (53%) report they are willing to take a cut in pay in order to achieve a better work-life balance or have more free time. This is similar among physicians overall (55%).

More than one-third (39%) of psychiatrists reported clinical depression (severe depression lasting some time and not caused by grief), while 44% reported colloquial depression (feeling down, blue, sad).

About half of depressed psychiatrists said their depression does not have an impact on relationships with patients. Of those who saw an impact, the major behaviors they reported were being easily exasperated with patients and feeling less motivated to take patient notes carefully.

To maintain happiness and mental health, psychiatrists choose to spend time with loved ones, do the things they enjoy, exercise, and get plenty of sleep.

Perhaps not surprisingly, more psychiatrists were happy with their work-life balance before the pandemic (68% vs. 54%). The same holds for physicians overall.

Before the pandemic, 17% of psychiatrists reported being unhappy with their work-life balance. That has risen to 29% this year.

The vast majority of psychiatrists are currently in a committed relationship, with 76% either married or living with a partner. A somewhat higher percentage (83%) of physicians overall report being in a committed relationship.

About eight in 10 psychiatrists (81%) describe their marriage as good or very good – the same as last year.

A little more than half of psychiatrists have life partners who do not work in medicine. This is similar to the proportion among all physicians (56%).

Among psychiatrists balancing parenthood and a medical career, female psychiatrists noted feeling conflicted more often than their male counterparts (36% vs. 22% were “very conflicted” or “conflicted”).

This general attitude is reflected in almost all occupations, according to a Pew Research survey, which found that larger shares of mothers than fathers struggled with childcare responsibilities during the pandemic.

Findings from Medscape’s latest happiness, wellness, and lifestyle survey are based on 13,069 Medscape member physicians (61% male) practicing in the United States who completed an online survey conducted between June 29 and Sept. 26, 2021. Most respondents were between 35 and 64 years old.

A version of this article first appeared on Medscape.com.

The lingering effects of the COVID-19 pandemic continue to take a toll on the happiness, well-being, and lifestyles of many segments of the population, especially those in the health care field, including psychiatrists.

The newly released Medscape Psychiatrist Lifestyle, Happiness & Burnout Report 2022 explores psychiatrists’ happiness in their personal and professional lives and how they are maintaining mental and physical health.

Prior to the global pandemic, 79% of psychiatrists said they were “very” or “somewhat” happy outside of work, like physicians overall (81%).

But as the pandemic has worn on, feelings have shifted, and there are clear signs of stress and strain on those in the health care field. 

Now, the percentage of psychiatrists who say they are currently “very” or “somewhat” happy outside of work has fallen to 62%, similar to physicians overall (59%).
 

Higher in women

In last year’s report, overall 42% of psychiatrists reported burnout; that’s risen to 47% this year.

When it comes to burnout, psychiatrists are in the lower range of burned-out physicians. Perhaps not surprising, given the challenges of the COVID-19 pandemic, burnout rates are highest in emergency medicine and critical care specialists.

About half of psychiatrists (52%) reported that they were more burned out now than during the initial quarantine months of the pandemic, similar to physicians overall (55%). About one-third said their burnout was the same.

Female psychiatrists reported being burned out at a greater rate than their male colleagues (46% vs. 30%).

“There’s no question that women have reported far more role strain during the pandemic than men,” said Carol A. Bernstein, MD, psychiatrist at Montefiore Health System and professor and vice chair for faculty development and well-being at Albert Einstein College of Medicine, New York.

Courtesy Dr. Carol A. Bernstein

Work-life balance

More than half of psychiatrists (53%) report they are willing to take a cut in pay in order to achieve a better work-life balance or have more free time. This is similar among physicians overall (55%).

More than one-third (39%) of psychiatrists reported clinical depression (severe depression lasting some time and not caused by grief), while 44% reported colloquial depression (feeling down, blue, sad).

About half of depressed psychiatrists said their depression does not have an impact on relationships with patients. Of those who saw an impact, the major behaviors they reported were being easily exasperated with patients and feeling less motivated to take patient notes carefully.

To maintain happiness and mental health, psychiatrists choose to spend time with loved ones, do the things they enjoy, exercise, and get plenty of sleep.

Perhaps not surprisingly, more psychiatrists were happy with their work-life balance before the pandemic (68% vs. 54%). The same holds for physicians overall.

Before the pandemic, 17% of psychiatrists reported being unhappy with their work-life balance. That has risen to 29% this year.

The vast majority of psychiatrists are currently in a committed relationship, with 76% either married or living with a partner. A somewhat higher percentage (83%) of physicians overall report being in a committed relationship.

About eight in 10 psychiatrists (81%) describe their marriage as good or very good – the same as last year.

A little more than half of psychiatrists have life partners who do not work in medicine. This is similar to the proportion among all physicians (56%).

Among psychiatrists balancing parenthood and a medical career, female psychiatrists noted feeling conflicted more often than their male counterparts (36% vs. 22% were “very conflicted” or “conflicted”).

This general attitude is reflected in almost all occupations, according to a Pew Research survey, which found that larger shares of mothers than fathers struggled with childcare responsibilities during the pandemic.

Findings from Medscape’s latest happiness, wellness, and lifestyle survey are based on 13,069 Medscape member physicians (61% male) practicing in the United States who completed an online survey conducted between June 29 and Sept. 26, 2021. Most respondents were between 35 and 64 years old.

A version of this article first appeared on Medscape.com.

A healthy, diverse gut microbiome is associated with better cognitive function in middle age, new research suggests.

Investigators conducted cognitive testing and analyzed stool samples in close to 600 adults and found that beta-diversity, which is a between-person measure of gut microbial community composition, was significantly associated with cognitive scores.

Three specific bacterial genera showed a positive association with performance on at least one cognitive test, while one showed a negative association.

“Data from our study support an association between the gut microbial community and measure of cognitive function – results that are consistent with findings from other human and animal research,” study investigator Katie Meyer, ScD, assistant professor, department of nutrition, UNC Gillings School of Public Health, Chapel Hill, N.C., told this news organization.

“However, it is also important to recognize that we are still learning about how to characterize the role of this dynamic ecological community and delineate mechanistic pathways,” she said.

The study was published online Feb 8 in JAMA Network Open.
 

‘Novel’ research

“Communication pathways between gut bacteria and neurologic function (referred to as the ‘gut-brain axis’) have emerged as a novel area of research into potential mechanisms regulating brain health through immunologic, metabolic, and endocrine pathways,” the authors wrote.

A number of studies have “shown associations between gut microbial measures and neurological outcomes, including cognitive function and dementia,” but mechanisms underlying these associations “have not been fully established.”

Animal and small-scale human studies have suggested that reduced microbial diversity is associated with poorer cognition, but studies have not been conducted in community-based large and diverse populations.

The researchers therefore examined cross-sectional associations of gut microbial diversity and taxonomic composition with cognitive status in a large group of community-dwelling, sociodemographically diverse Black and White adults living in four metropolitan areas who were participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

They hypothesized that microbial diversity would be positively associated with global as well as domain-specific cognitive status and that higher cognitive status would be associated with specific taxonomic groups involved in short-chain fatty acid production.

The CARDIA’s year 30 follow-up examination took place during 2015-2016, when the original participants ranged in age from 48 to 60 years. During that examination, participants took a battery of cognitive assessments, and 615 also provided a stool sample for a microbiome substudy; of these, 597 (mean [SD] age, 55.2 [3.5] years, 44.7% Black, 45.2% White) had both stool DNA available for sequencing and a complete complement of cognitive tests and were included in the current study.

The cognitive tests included the Digit Symbol Substitution Test (DSST); Rey-Auditory Verbal Learning Test (RAVLT); the timed Stroop test; letter fluency and category fluency; and the Montreal Cognitive Assessment (MoCA).

Covariates that might confound associations between microbial and cognitive measures, including body mass index, diabetes, age, sex, race, field center, education, physical activity, current smoking, diet quality, number of medications, and hypertension, were included in the analyses.

The investigators conducted three standard microbial analyses: within-person alpha-diversity; between-person beta-diversity; and individual taxa.
 

Potential pathways

The strongest associations in the variance tests for beta-diversity, which were significant for all cognition measures in multivariable-adjusted principal coordinates analysis (all Ps = .001 except for the Stroop, which was .007). However, the association with letter fluency was not deemed significant (P = .07).

After fully adjusting for sociodemographic variables, health behaviors, and clinical covariates, the researchers found that three genera were positively associated, while one was negatively associated with cognitive measures.

Starting point

Commenting for this news organization, Timothy Dinan, MD, PhD, professor of psychiatry and an investigator, APC Microbiome Institute, University College Cork, Ireland, said, “This is an important study, adding to the growing body of evidence that gut microbes influence brain function.”

Dr. Dinan, who was not involved with the study, continued: “In an impressively large sample, an association between cognition and gut microbiota architecture was demonstrated.”

He cautioned that the study “is limited by the fact that it is cross-sectional, and the relationships are correlational.” Nevertheless, “despite these obvious caveats, the paper undoubtedly advances the field.”

Dr. Meyer agreed, noting that there is “a paucity of biomarkers that can be used to predict cognitive decline and dementia,” but because their study was cross-sectional, “we cannot assess temporality (i.e., whether gut microbiota predicts cognitive decline); but, as a start, we can assess associations.”

She added that “at this point, we know far more about modifiable risk factors that have been shown to be positively associated with cognitive function,” including eating a Mediterranean diet and engaging in physical activity.

“It is possible that protective effects of diet and activity may, in part, operate thorough the gut microbiota,” Dr. Meyer suggested.

The CARDIA study is supported by the National Heart, Lung, and Blood Institute, the Intramural Research Program of the National Institute on Aging, and the University of North Carolina Nutrition Research Institute. Dr. Meyer and coauthors and Dr. Dinan report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A healthy, diverse gut microbiome is associated with better cognitive function in middle age, new research suggests.

Investigators conducted cognitive testing and analyzed stool samples in close to 600 adults and found that beta-diversity, which is a between-person measure of gut microbial community composition, was significantly associated with cognitive scores.

Three specific bacterial genera showed a positive association with performance on at least one cognitive test, while one showed a negative association.

“Data from our study support an association between the gut microbial community and measure of cognitive function – results that are consistent with findings from other human and animal research,” study investigator Katie Meyer, ScD, assistant professor, department of nutrition, UNC Gillings School of Public Health, Chapel Hill, N.C., told this news organization.

“However, it is also important to recognize that we are still learning about how to characterize the role of this dynamic ecological community and delineate mechanistic pathways,” she said.

The study was published online Feb 8 in JAMA Network Open.
 

‘Novel’ research

“Communication pathways between gut bacteria and neurologic function (referred to as the ‘gut-brain axis’) have emerged as a novel area of research into potential mechanisms regulating brain health through immunologic, metabolic, and endocrine pathways,” the authors wrote.

A number of studies have “shown associations between gut microbial measures and neurological outcomes, including cognitive function and dementia,” but mechanisms underlying these associations “have not been fully established.”

Animal and small-scale human studies have suggested that reduced microbial diversity is associated with poorer cognition, but studies have not been conducted in community-based large and diverse populations.

The researchers therefore examined cross-sectional associations of gut microbial diversity and taxonomic composition with cognitive status in a large group of community-dwelling, sociodemographically diverse Black and White adults living in four metropolitan areas who were participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

They hypothesized that microbial diversity would be positively associated with global as well as domain-specific cognitive status and that higher cognitive status would be associated with specific taxonomic groups involved in short-chain fatty acid production.

The CARDIA’s year 30 follow-up examination took place during 2015-2016, when the original participants ranged in age from 48 to 60 years. During that examination, participants took a battery of cognitive assessments, and 615 also provided a stool sample for a microbiome substudy; of these, 597 (mean [SD] age, 55.2 [3.5] years, 44.7% Black, 45.2% White) had both stool DNA available for sequencing and a complete complement of cognitive tests and were included in the current study.

The cognitive tests included the Digit Symbol Substitution Test (DSST); Rey-Auditory Verbal Learning Test (RAVLT); the timed Stroop test; letter fluency and category fluency; and the Montreal Cognitive Assessment (MoCA).

Covariates that might confound associations between microbial and cognitive measures, including body mass index, diabetes, age, sex, race, field center, education, physical activity, current smoking, diet quality, number of medications, and hypertension, were included in the analyses.

The investigators conducted three standard microbial analyses: within-person alpha-diversity; between-person beta-diversity; and individual taxa.
 

Potential pathways

The strongest associations in the variance tests for beta-diversity, which were significant for all cognition measures in multivariable-adjusted principal coordinates analysis (all Ps = .001 except for the Stroop, which was .007). However, the association with letter fluency was not deemed significant (P = .07).

After fully adjusting for sociodemographic variables, health behaviors, and clinical covariates, the researchers found that three genera were positively associated, while one was negatively associated with cognitive measures.

Starting point

Commenting for this news organization, Timothy Dinan, MD, PhD, professor of psychiatry and an investigator, APC Microbiome Institute, University College Cork, Ireland, said, “This is an important study, adding to the growing body of evidence that gut microbes influence brain function.”

Dr. Dinan, who was not involved with the study, continued: “In an impressively large sample, an association between cognition and gut microbiota architecture was demonstrated.”

He cautioned that the study “is limited by the fact that it is cross-sectional, and the relationships are correlational.” Nevertheless, “despite these obvious caveats, the paper undoubtedly advances the field.”

Dr. Meyer agreed, noting that there is “a paucity of biomarkers that can be used to predict cognitive decline and dementia,” but because their study was cross-sectional, “we cannot assess temporality (i.e., whether gut microbiota predicts cognitive decline); but, as a start, we can assess associations.”

She added that “at this point, we know far more about modifiable risk factors that have been shown to be positively associated with cognitive function,” including eating a Mediterranean diet and engaging in physical activity.

“It is possible that protective effects of diet and activity may, in part, operate thorough the gut microbiota,” Dr. Meyer suggested.

The CARDIA study is supported by the National Heart, Lung, and Blood Institute, the Intramural Research Program of the National Institute on Aging, and the University of North Carolina Nutrition Research Institute. Dr. Meyer and coauthors and Dr. Dinan report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A healthy, diverse gut microbiome is associated with better cognitive function in middle age, new research suggests.

Investigators conducted cognitive testing and analyzed stool samples in close to 600 adults and found that beta-diversity, which is a between-person measure of gut microbial community composition, was significantly associated with cognitive scores.

Three specific bacterial genera showed a positive association with performance on at least one cognitive test, while one showed a negative association.

“Data from our study support an association between the gut microbial community and measure of cognitive function – results that are consistent with findings from other human and animal research,” study investigator Katie Meyer, ScD, assistant professor, department of nutrition, UNC Gillings School of Public Health, Chapel Hill, N.C., told this news organization.

“However, it is also important to recognize that we are still learning about how to characterize the role of this dynamic ecological community and delineate mechanistic pathways,” she said.

The study was published online Feb 8 in JAMA Network Open.
 

‘Novel’ research

“Communication pathways between gut bacteria and neurologic function (referred to as the ‘gut-brain axis’) have emerged as a novel area of research into potential mechanisms regulating brain health through immunologic, metabolic, and endocrine pathways,” the authors wrote.

A number of studies have “shown associations between gut microbial measures and neurological outcomes, including cognitive function and dementia,” but mechanisms underlying these associations “have not been fully established.”

Animal and small-scale human studies have suggested that reduced microbial diversity is associated with poorer cognition, but studies have not been conducted in community-based large and diverse populations.

The researchers therefore examined cross-sectional associations of gut microbial diversity and taxonomic composition with cognitive status in a large group of community-dwelling, sociodemographically diverse Black and White adults living in four metropolitan areas who were participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

They hypothesized that microbial diversity would be positively associated with global as well as domain-specific cognitive status and that higher cognitive status would be associated with specific taxonomic groups involved in short-chain fatty acid production.

The CARDIA’s year 30 follow-up examination took place during 2015-2016, when the original participants ranged in age from 48 to 60 years. During that examination, participants took a battery of cognitive assessments, and 615 also provided a stool sample for a microbiome substudy; of these, 597 (mean [SD] age, 55.2 [3.5] years, 44.7% Black, 45.2% White) had both stool DNA available for sequencing and a complete complement of cognitive tests and were included in the current study.

The cognitive tests included the Digit Symbol Substitution Test (DSST); Rey-Auditory Verbal Learning Test (RAVLT); the timed Stroop test; letter fluency and category fluency; and the Montreal Cognitive Assessment (MoCA).

Covariates that might confound associations between microbial and cognitive measures, including body mass index, diabetes, age, sex, race, field center, education, physical activity, current smoking, diet quality, number of medications, and hypertension, were included in the analyses.

The investigators conducted three standard microbial analyses: within-person alpha-diversity; between-person beta-diversity; and individual taxa.
 

Potential pathways

The strongest associations in the variance tests for beta-diversity, which were significant for all cognition measures in multivariable-adjusted principal coordinates analysis (all Ps = .001 except for the Stroop, which was .007). However, the association with letter fluency was not deemed significant (P = .07).

After fully adjusting for sociodemographic variables, health behaviors, and clinical covariates, the researchers found that three genera were positively associated, while one was negatively associated with cognitive measures.

Starting point

Commenting for this news organization, Timothy Dinan, MD, PhD, professor of psychiatry and an investigator, APC Microbiome Institute, University College Cork, Ireland, said, “This is an important study, adding to the growing body of evidence that gut microbes influence brain function.”

Dr. Dinan, who was not involved with the study, continued: “In an impressively large sample, an association between cognition and gut microbiota architecture was demonstrated.”

He cautioned that the study “is limited by the fact that it is cross-sectional, and the relationships are correlational.” Nevertheless, “despite these obvious caveats, the paper undoubtedly advances the field.”

Dr. Meyer agreed, noting that there is “a paucity of biomarkers that can be used to predict cognitive decline and dementia,” but because their study was cross-sectional, “we cannot assess temporality (i.e., whether gut microbiota predicts cognitive decline); but, as a start, we can assess associations.”

She added that “at this point, we know far more about modifiable risk factors that have been shown to be positively associated with cognitive function,” including eating a Mediterranean diet and engaging in physical activity.

“It is possible that protective effects of diet and activity may, in part, operate thorough the gut microbiota,” Dr. Meyer suggested.

The CARDIA study is supported by the National Heart, Lung, and Blood Institute, the Intramural Research Program of the National Institute on Aging, and the University of North Carolina Nutrition Research Institute. Dr. Meyer and coauthors and Dr. Dinan report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Twitter was all abuzz over an exchange that occurred Feb. 17 during the question-and-answer discussion that followed oral abstract presentations at the ASCO Genitourinary Cancers Symposium, held in San Francisco and also online. One of the panelists was accused of being less than professional in handling questions from the floor.

It began with a tweet from Sumanta Pal, MD, of the City of Hope, when he called out the behavior, although he did not identify the perpetrator.

“Yesterday we saw some reprehensible behavior emanating from the @ASCO #GU22 podium, with a well known investigator insulting (in a manner deeply imbued w microaggressions) an esteemed colleague at the mic. It’s a teachable moment & the lesson is simple: be kind to ur colleagues.”

It was not immediately clear what had occurred, and several people asked him to identify the people involved. One physician responded, “If it was bad enough to infer and share on Twitter, name the name.”

But even without details, the post provoked a reaction.

Erika Hamilton, MD, wrote, “I am not aware of this incident, but I always wonder ... if someone would do that from the podium, what would they/have they done and said when they didn’t think everyone was watching?”

Another tweet questioned why there were no codes of conduct in place, so that situations like this one wouldn’t happen.

“[It is] about time professional societies had codes of conduct in place for invited speakers, moderators of sessions etc,” wrote Deborah Verran, MD. “Then if it is breached the individual concerned is not invited back. This kind of incident also needs to be mentioned as part of the conference feedback process.”

As the number of clinicians chiming in increased, it soon became apparent that others were aware of the incident, and one posted a video clip, putting the mystery to rest.
 

Moderator quips, ‘Behave ... children’

The exchange occurred immediately following the oral abstract presentations on prostate cancer on Feb. 17. Two of these abstracts featured new data from large clinical trials investigating the use of PARP inhibitors in metastatic prostate cancer, which had slightly different results, leading to some debate. The PROpel trial with olaparib showed a benefit in all patients, irrespective of gene mutation status, but the MAGNITUDE trial with niraparib showed a benefit only in patients with gene alterations, and especially in those with BRCA1/2 mutations.

The invited discussant, Celestia Higano, MD, from the University of British Columbia, Vancouver, compared and contrasted the two trials and the differing results.

During the question-and-answer session that followed, Neeraj Agarwal, MD, from the Huntsman Cancer Institute, University of Utah, directed a question to Fred Saad, MD, who had presented the results of the PROpel trial.*

“As a practicing oncologist, I am very intrigued by the different results of the MAGNITUDE and PROpel trials. I am trying to figure out what do I do in my practice,” Dr. Agarwal began.

He continued on, explaining that he didn’t think that olaparib and niraparib were that different from one another for the two studies to have such differing results, when both of the drugs were given in combination with abiraterone.

The inclusion criteria for PROpel stipulated that patients undergo testing by ctDNA to determine if they were biomarker positive or not, but he pointed out that it is possible for testing to miss patients who might otherwise be positive for homologous recombination repair (HRR) gene alterations. He posed the question, could some of the patients deemed biomarker negative in fact have been positive but whose status was not detected by ctDNA testing?

At that point, Dr. Higano interrupted him before he had completed his question and asked, “Can I make a comment? Were you listening to my discussion?”

She then continued, pointing out that “you can’t talk about comparing olaparib and niraparib – these two trials had two very different populations.”

She emphasized that this was about the combinations in the populations being studied and not about olaparib and niraparib. “I clearly wasn’t very clear,” she said.

Dr. Agarwal then repeated that he wanted to know what to do with his patients and asked again about the accuracy of ctDNA testing.

“That’s a good question,” Dr. Higano said, “But the other comments you made weren’t.”

At that point, the moderator chimed in. “Let’s all calm down ... children.”

After a brief applause following the moderator’s comment, Dr. Saad then addressed the question.

When the video clip of this exchange was posted, a flood of tweets poured in, supporting Dr. Pal’s initial summation of the situation.

Alison Birtle, MD, tweeted, “I’m even more appalled having seen this exchange. Unacceptable. You don’t humiliate either the speaker or the delegate and the questions were entirely valid in my opinion. Basically what do I do tomorrow with these data so why ask were you listening. That’s just rude.”

Jason Kovac, MD, tweeted: “It’s absolutely not a proper way to behave. Whether it’s behind the scenes or to your face. You can hear the arrogance from everyone including the moderator with his children comment. This is the true face of medicine.”

Jarey Wang, MD, PhD, however, liked the moderator’s input. “Love it. ‘Let’s all calm down children.’ Good for the moderator.”

Several of the physicians who commented thought that the issue should have been addressed at the time it happened. Don S. Dizon, MD, wrote, “Calling out microagressions as they occur is so important. And very difficult. Agree, the teachable moment must be met with bravery. But it should happen in real time too.”

After 2 days of bantering on Twitter, with the thread growing increasingly longer and with the vast majority of posts supporting Dr. Pal’s initial assessment, Dr. Higano finally entered the discussion and defended her comments: “What you do not know is that the questioner and I are good colleagues,” she tweeted. “I have been involved in two of his academic promotions. My main concern was his comment re: how the two trials could have ‘so different results with the same combination.’ I sought to rectify wrong message.”

There were no direct replies to Dr. Higano’s tweet.

Perhaps the line to draw under this affair is the tweet from Simon Kim, MD, MPH, who wrote: “We can do better!”

A version of this article first appeared on Medscape.com.

Correction, 2/24/22: Dr. Fred Saad's name was misstated in an earlier version of this article.

Twitter was all abuzz over an exchange that occurred Feb. 17 during the question-and-answer discussion that followed oral abstract presentations at the ASCO Genitourinary Cancers Symposium, held in San Francisco and also online. One of the panelists was accused of being less than professional in handling questions from the floor.

It began with a tweet from Sumanta Pal, MD, of the City of Hope, when he called out the behavior, although he did not identify the perpetrator.

“Yesterday we saw some reprehensible behavior emanating from the @ASCO #GU22 podium, with a well known investigator insulting (in a manner deeply imbued w microaggressions) an esteemed colleague at the mic. It’s a teachable moment & the lesson is simple: be kind to ur colleagues.”

It was not immediately clear what had occurred, and several people asked him to identify the people involved. One physician responded, “If it was bad enough to infer and share on Twitter, name the name.”

But even without details, the post provoked a reaction.

Erika Hamilton, MD, wrote, “I am not aware of this incident, but I always wonder ... if someone would do that from the podium, what would they/have they done and said when they didn’t think everyone was watching?”

Another tweet questioned why there were no codes of conduct in place, so that situations like this one wouldn’t happen.

“[It is] about time professional societies had codes of conduct in place for invited speakers, moderators of sessions etc,” wrote Deborah Verran, MD. “Then if it is breached the individual concerned is not invited back. This kind of incident also needs to be mentioned as part of the conference feedback process.”

As the number of clinicians chiming in increased, it soon became apparent that others were aware of the incident, and one posted a video clip, putting the mystery to rest.
 

Moderator quips, ‘Behave ... children’

The exchange occurred immediately following the oral abstract presentations on prostate cancer on Feb. 17. Two of these abstracts featured new data from large clinical trials investigating the use of PARP inhibitors in metastatic prostate cancer, which had slightly different results, leading to some debate. The PROpel trial with olaparib showed a benefit in all patients, irrespective of gene mutation status, but the MAGNITUDE trial with niraparib showed a benefit only in patients with gene alterations, and especially in those with BRCA1/2 mutations.

The invited discussant, Celestia Higano, MD, from the University of British Columbia, Vancouver, compared and contrasted the two trials and the differing results.

During the question-and-answer session that followed, Neeraj Agarwal, MD, from the Huntsman Cancer Institute, University of Utah, directed a question to Fred Saad, MD, who had presented the results of the PROpel trial.*

“As a practicing oncologist, I am very intrigued by the different results of the MAGNITUDE and PROpel trials. I am trying to figure out what do I do in my practice,” Dr. Agarwal began.

He continued on, explaining that he didn’t think that olaparib and niraparib were that different from one another for the two studies to have such differing results, when both of the drugs were given in combination with abiraterone.

The inclusion criteria for PROpel stipulated that patients undergo testing by ctDNA to determine if they were biomarker positive or not, but he pointed out that it is possible for testing to miss patients who might otherwise be positive for homologous recombination repair (HRR) gene alterations. He posed the question, could some of the patients deemed biomarker negative in fact have been positive but whose status was not detected by ctDNA testing?

At that point, Dr. Higano interrupted him before he had completed his question and asked, “Can I make a comment? Were you listening to my discussion?”

She then continued, pointing out that “you can’t talk about comparing olaparib and niraparib – these two trials had two very different populations.”

She emphasized that this was about the combinations in the populations being studied and not about olaparib and niraparib. “I clearly wasn’t very clear,” she said.

Dr. Agarwal then repeated that he wanted to know what to do with his patients and asked again about the accuracy of ctDNA testing.

“That’s a good question,” Dr. Higano said, “But the other comments you made weren’t.”

At that point, the moderator chimed in. “Let’s all calm down ... children.”

After a brief applause following the moderator’s comment, Dr. Saad then addressed the question.

When the video clip of this exchange was posted, a flood of tweets poured in, supporting Dr. Pal’s initial summation of the situation.

Alison Birtle, MD, tweeted, “I’m even more appalled having seen this exchange. Unacceptable. You don’t humiliate either the speaker or the delegate and the questions were entirely valid in my opinion. Basically what do I do tomorrow with these data so why ask were you listening. That’s just rude.”

Jason Kovac, MD, tweeted: “It’s absolutely not a proper way to behave. Whether it’s behind the scenes or to your face. You can hear the arrogance from everyone including the moderator with his children comment. This is the true face of medicine.”

Jarey Wang, MD, PhD, however, liked the moderator’s input. “Love it. ‘Let’s all calm down children.’ Good for the moderator.”

Several of the physicians who commented thought that the issue should have been addressed at the time it happened. Don S. Dizon, MD, wrote, “Calling out microagressions as they occur is so important. And very difficult. Agree, the teachable moment must be met with bravery. But it should happen in real time too.”

After 2 days of bantering on Twitter, with the thread growing increasingly longer and with the vast majority of posts supporting Dr. Pal’s initial assessment, Dr. Higano finally entered the discussion and defended her comments: “What you do not know is that the questioner and I are good colleagues,” she tweeted. “I have been involved in two of his academic promotions. My main concern was his comment re: how the two trials could have ‘so different results with the same combination.’ I sought to rectify wrong message.”

There were no direct replies to Dr. Higano’s tweet.

Perhaps the line to draw under this affair is the tweet from Simon Kim, MD, MPH, who wrote: “We can do better!”

A version of this article first appeared on Medscape.com.

Correction, 2/24/22: Dr. Fred Saad's name was misstated in an earlier version of this article.

Twitter was all abuzz over an exchange that occurred Feb. 17 during the question-and-answer discussion that followed oral abstract presentations at the ASCO Genitourinary Cancers Symposium, held in San Francisco and also online. One of the panelists was accused of being less than professional in handling questions from the floor.

It began with a tweet from Sumanta Pal, MD, of the City of Hope, when he called out the behavior, although he did not identify the perpetrator.

“Yesterday we saw some reprehensible behavior emanating from the @ASCO #GU22 podium, with a well known investigator insulting (in a manner deeply imbued w microaggressions) an esteemed colleague at the mic. It’s a teachable moment & the lesson is simple: be kind to ur colleagues.”

It was not immediately clear what had occurred, and several people asked him to identify the people involved. One physician responded, “If it was bad enough to infer and share on Twitter, name the name.”

But even without details, the post provoked a reaction.

Erika Hamilton, MD, wrote, “I am not aware of this incident, but I always wonder ... if someone would do that from the podium, what would they/have they done and said when they didn’t think everyone was watching?”

Another tweet questioned why there were no codes of conduct in place, so that situations like this one wouldn’t happen.

“[It is] about time professional societies had codes of conduct in place for invited speakers, moderators of sessions etc,” wrote Deborah Verran, MD. “Then if it is breached the individual concerned is not invited back. This kind of incident also needs to be mentioned as part of the conference feedback process.”

As the number of clinicians chiming in increased, it soon became apparent that others were aware of the incident, and one posted a video clip, putting the mystery to rest.
 

Moderator quips, ‘Behave ... children’

The exchange occurred immediately following the oral abstract presentations on prostate cancer on Feb. 17. Two of these abstracts featured new data from large clinical trials investigating the use of PARP inhibitors in metastatic prostate cancer, which had slightly different results, leading to some debate. The PROpel trial with olaparib showed a benefit in all patients, irrespective of gene mutation status, but the MAGNITUDE trial with niraparib showed a benefit only in patients with gene alterations, and especially in those with BRCA1/2 mutations.

The invited discussant, Celestia Higano, MD, from the University of British Columbia, Vancouver, compared and contrasted the two trials and the differing results.

During the question-and-answer session that followed, Neeraj Agarwal, MD, from the Huntsman Cancer Institute, University of Utah, directed a question to Fred Saad, MD, who had presented the results of the PROpel trial.*

“As a practicing oncologist, I am very intrigued by the different results of the MAGNITUDE and PROpel trials. I am trying to figure out what do I do in my practice,” Dr. Agarwal began.

He continued on, explaining that he didn’t think that olaparib and niraparib were that different from one another for the two studies to have such differing results, when both of the drugs were given in combination with abiraterone.

The inclusion criteria for PROpel stipulated that patients undergo testing by ctDNA to determine if they were biomarker positive or not, but he pointed out that it is possible for testing to miss patients who might otherwise be positive for homologous recombination repair (HRR) gene alterations. He posed the question, could some of the patients deemed biomarker negative in fact have been positive but whose status was not detected by ctDNA testing?

At that point, Dr. Higano interrupted him before he had completed his question and asked, “Can I make a comment? Were you listening to my discussion?”

She then continued, pointing out that “you can’t talk about comparing olaparib and niraparib – these two trials had two very different populations.”

She emphasized that this was about the combinations in the populations being studied and not about olaparib and niraparib. “I clearly wasn’t very clear,” she said.

Dr. Agarwal then repeated that he wanted to know what to do with his patients and asked again about the accuracy of ctDNA testing.

“That’s a good question,” Dr. Higano said, “But the other comments you made weren’t.”

At that point, the moderator chimed in. “Let’s all calm down ... children.”

After a brief applause following the moderator’s comment, Dr. Saad then addressed the question.

When the video clip of this exchange was posted, a flood of tweets poured in, supporting Dr. Pal’s initial summation of the situation.

Alison Birtle, MD, tweeted, “I’m even more appalled having seen this exchange. Unacceptable. You don’t humiliate either the speaker or the delegate and the questions were entirely valid in my opinion. Basically what do I do tomorrow with these data so why ask were you listening. That’s just rude.”

Jason Kovac, MD, tweeted: “It’s absolutely not a proper way to behave. Whether it’s behind the scenes or to your face. You can hear the arrogance from everyone including the moderator with his children comment. This is the true face of medicine.”

Jarey Wang, MD, PhD, however, liked the moderator’s input. “Love it. ‘Let’s all calm down children.’ Good for the moderator.”

Several of the physicians who commented thought that the issue should have been addressed at the time it happened. Don S. Dizon, MD, wrote, “Calling out microagressions as they occur is so important. And very difficult. Agree, the teachable moment must be met with bravery. But it should happen in real time too.”

After 2 days of bantering on Twitter, with the thread growing increasingly longer and with the vast majority of posts supporting Dr. Pal’s initial assessment, Dr. Higano finally entered the discussion and defended her comments: “What you do not know is that the questioner and I are good colleagues,” she tweeted. “I have been involved in two of his academic promotions. My main concern was his comment re: how the two trials could have ‘so different results with the same combination.’ I sought to rectify wrong message.”

There were no direct replies to Dr. Higano’s tweet.

Perhaps the line to draw under this affair is the tweet from Simon Kim, MD, MPH, who wrote: “We can do better!”

A version of this article first appeared on Medscape.com.

Correction, 2/24/22: Dr. Fred Saad's name was misstated in an earlier version of this article.

Key clinical point: Advanced age and liver stiffness measurement (LSM) on transient elastography, both pretreatment and at 24-week sustained virological response (SVR24), may aid in predicting the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved SVR to interferon (IFN)-free direct-acting antivirals (DAA).

Main finding: Multivariate analysis revealed age ≥71 years (adjusted hazard ratio [aHR] 3.402; P = .005) and LSM ≥9.2 kPa (aHR 6.328; P < .001) to be the significant predictive factors at pretreatment and age ≥71 years (aHR 2.689; P = .014) and LSM ≥8.4 kPa (aHR 6.642; P < .001) at SVR24.

Study details: This was a multicenter retrospective study including 567 patients with no history of HCC but with HCV infection treated with DAAs and who achieved SVR24.

Disclosures: The study was sponsored by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; Japan Society for the Promotion of Science; Japan Agency for Medical Research and Development; and Ministry of Health, Labor, and Welfare of Japan. Some authors declared receiving speaker fees/research grants from various pharmaceutical companies.

Source: Nakai M et al. Sci Rep. 2022;12:1449 (Jan 27). Doi: 10.1038/s41598-022-05492-5.

Key clinical point: Advanced age and liver stiffness measurement (LSM) on transient elastography, both pretreatment and at 24-week sustained virological response (SVR24), may aid in predicting the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved SVR to interferon (IFN)-free direct-acting antivirals (DAA).

Main finding: Multivariate analysis revealed age ≥71 years (adjusted hazard ratio [aHR] 3.402; P = .005) and LSM ≥9.2 kPa (aHR 6.328; P < .001) to be the significant predictive factors at pretreatment and age ≥71 years (aHR 2.689; P = .014) and LSM ≥8.4 kPa (aHR 6.642; P < .001) at SVR24.

Study details: This was a multicenter retrospective study including 567 patients with no history of HCC but with HCV infection treated with DAAs and who achieved SVR24.

Disclosures: The study was sponsored by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; Japan Society for the Promotion of Science; Japan Agency for Medical Research and Development; and Ministry of Health, Labor, and Welfare of Japan. Some authors declared receiving speaker fees/research grants from various pharmaceutical companies.

Source: Nakai M et al. Sci Rep. 2022;12:1449 (Jan 27). Doi: 10.1038/s41598-022-05492-5.

Key clinical point: Advanced age and liver stiffness measurement (LSM) on transient elastography, both pretreatment and at 24-week sustained virological response (SVR24), may aid in predicting the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved SVR to interferon (IFN)-free direct-acting antivirals (DAA).

Main finding: Multivariate analysis revealed age ≥71 years (adjusted hazard ratio [aHR] 3.402; P = .005) and LSM ≥9.2 kPa (aHR 6.328; P < .001) to be the significant predictive factors at pretreatment and age ≥71 years (aHR 2.689; P = .014) and LSM ≥8.4 kPa (aHR 6.642; P < .001) at SVR24.

Study details: This was a multicenter retrospective study including 567 patients with no history of HCC but with HCV infection treated with DAAs and who achieved SVR24.

Disclosures: The study was sponsored by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; Japan Society for the Promotion of Science; Japan Agency for Medical Research and Development; and Ministry of Health, Labor, and Welfare of Japan. Some authors declared receiving speaker fees/research grants from various pharmaceutical companies.

Source: Nakai M et al. Sci Rep. 2022;12:1449 (Jan 27). Doi: 10.1038/s41598-022-05492-5.

Key clinical point: Robot-assisted liver resection (RALR) and laparoscopic liver resection (LLR) show similar long-term oncological outcomes to open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC) along with allowing faster patient recovery.

Main finding: OLR, LLR, and RALR achieved 5-year overall survival rates of 78.6%, 76.8%, and 74.4% (P = .90) and 5-year disease-free survival rates of 57.9%, 51.3%, and 51.8% (P = .64), respectively. Patients undergoing LLR (6 days) or RALR (8 days) vs. OLR (12 days) recovered faster (both P < .001).

Study details: The data come from a single-center prospective study that compared 3 propensity score-matched cohorts of 56 patients each who were aged 14-75 years and received no previous treatment before undergoing either ALR, LLR, or OLR due to BCLC stage 0-A HCC.

Disclosures: The study was supported by the Key Project of Science and Technology in Hubei Province, General Project of Natural Science Foundation of Hubei Province, and General Project of Health Commission of Hubei Province. No conflicts of interest were disclosed.

Source: Zhu P et al. Ann Surg. 2022 (Jan 25). Doi: 10.1097/SLA.0000000000005380.

Key clinical point: Robot-assisted liver resection (RALR) and laparoscopic liver resection (LLR) show similar long-term oncological outcomes to open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC) along with allowing faster patient recovery.

Main finding: OLR, LLR, and RALR achieved 5-year overall survival rates of 78.6%, 76.8%, and 74.4% (P = .90) and 5-year disease-free survival rates of 57.9%, 51.3%, and 51.8% (P = .64), respectively. Patients undergoing LLR (6 days) or RALR (8 days) vs. OLR (12 days) recovered faster (both P < .001).

Study details: The data come from a single-center prospective study that compared 3 propensity score-matched cohorts of 56 patients each who were aged 14-75 years and received no previous treatment before undergoing either ALR, LLR, or OLR due to BCLC stage 0-A HCC.

Disclosures: The study was supported by the Key Project of Science and Technology in Hubei Province, General Project of Natural Science Foundation of Hubei Province, and General Project of Health Commission of Hubei Province. No conflicts of interest were disclosed.

Source: Zhu P et al. Ann Surg. 2022 (Jan 25). Doi: 10.1097/SLA.0000000000005380.

Key clinical point: Robot-assisted liver resection (RALR) and laparoscopic liver resection (LLR) show similar long-term oncological outcomes to open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC) along with allowing faster patient recovery.

Main finding: OLR, LLR, and RALR achieved 5-year overall survival rates of 78.6%, 76.8%, and 74.4% (P = .90) and 5-year disease-free survival rates of 57.9%, 51.3%, and 51.8% (P = .64), respectively. Patients undergoing LLR (6 days) or RALR (8 days) vs. OLR (12 days) recovered faster (both P < .001).

Study details: The data come from a single-center prospective study that compared 3 propensity score-matched cohorts of 56 patients each who were aged 14-75 years and received no previous treatment before undergoing either ALR, LLR, or OLR due to BCLC stage 0-A HCC.

Disclosures: The study was supported by the Key Project of Science and Technology in Hubei Province, General Project of Natural Science Foundation of Hubei Province, and General Project of Health Commission of Hubei Province. No conflicts of interest were disclosed.

Source: Zhu P et al. Ann Surg. 2022 (Jan 25). Doi: 10.1097/SLA.0000000000005380.

Key clinical point: In treatment-naive patients with chronic hepatitis B, therapy with tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) is associated with a lower risk of developing hepatocellular carcinoma (HCC) in the future.

Main finding: During the follow-up, patients receiving TDF showed a lower crude HCC incidence rate than those receiving ETV (0.30 vs. 0.62 per 100 person-years). TDF vs. ETV was associated with a significantly reduced risk of HCC occurrence (adjusted subdistribution hazard ratio 0.58; P = .01).

Study details: The data come from a retrospective cohort study including 10,061 adult treatment-naive patients with chronic hepatitis B but no evidence of HCC and who initiated therapy with ETV (n = 3,934) or TDF (n = 6,127).

Disclosures: The study was sponsored by Gilead Sciences. WR Kim, M Lu, and S Gordon declared serving as an advisory board member and consultant for or receiving research funding from Gilead Sciences. The rest of the authors are current or former employees and stockholders of Gilead Sciences.

Source: Kim WR et al. Aliment Pharmacol Ther. 2022 (Feb 8). Doi: 10.1111/apt.16786.

Key clinical point: In treatment-naive patients with chronic hepatitis B, therapy with tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) is associated with a lower risk of developing hepatocellular carcinoma (HCC) in the future.

Main finding: During the follow-up, patients receiving TDF showed a lower crude HCC incidence rate than those receiving ETV (0.30 vs. 0.62 per 100 person-years). TDF vs. ETV was associated with a significantly reduced risk of HCC occurrence (adjusted subdistribution hazard ratio 0.58; P = .01).

Study details: The data come from a retrospective cohort study including 10,061 adult treatment-naive patients with chronic hepatitis B but no evidence of HCC and who initiated therapy with ETV (n = 3,934) or TDF (n = 6,127).

Disclosures: The study was sponsored by Gilead Sciences. WR Kim, M Lu, and S Gordon declared serving as an advisory board member and consultant for or receiving research funding from Gilead Sciences. The rest of the authors are current or former employees and stockholders of Gilead Sciences.

Source: Kim WR et al. Aliment Pharmacol Ther. 2022 (Feb 8). Doi: 10.1111/apt.16786.

Key clinical point: In treatment-naive patients with chronic hepatitis B, therapy with tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) is associated with a lower risk of developing hepatocellular carcinoma (HCC) in the future.

Main finding: During the follow-up, patients receiving TDF showed a lower crude HCC incidence rate than those receiving ETV (0.30 vs. 0.62 per 100 person-years). TDF vs. ETV was associated with a significantly reduced risk of HCC occurrence (adjusted subdistribution hazard ratio 0.58; P = .01).

Study details: The data come from a retrospective cohort study including 10,061 adult treatment-naive patients with chronic hepatitis B but no evidence of HCC and who initiated therapy with ETV (n = 3,934) or TDF (n = 6,127).

Disclosures: The study was sponsored by Gilead Sciences. WR Kim, M Lu, and S Gordon declared serving as an advisory board member and consultant for or receiving research funding from Gilead Sciences. The rest of the authors are current or former employees and stockholders of Gilead Sciences.

Source: Kim WR et al. Aliment Pharmacol Ther. 2022 (Feb 8). Doi: 10.1111/apt.16786.

Key clinical point: Compared with sorafenib alone, its combination with 3cir-OFF hepatic arterial infusion chemotherapy (HAIC) offers significantly prolonged survival and an acceptable safety profile in patients with advanced hepatocellular carcinoma (HCC) and major portal vein tumor thrombosis (PVTT).

Main finding: Sorafenib plus HAIC vs. sorafenib alone led to a longer median overall survival (16.3 months vs. 6.5 months; hazard ratio [HR] 0.28; P < .001) and progression-free survival (9.0 months vs. 2.5 months; HR 0.26; P < .001) but more frequent grade 3/4 adverse events.

Study details: This was a phase 2 study involving adult, systemic treatment-naive patients with inoperable advanced primary HCC and major PVTT who were randomly assigned to receive either sorafenib plus HAIC (n = 32) or sorafenib alone (n = 32).

Disclosures: The study was sponsored by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, Beijing Natural Science Foundation, and National Natural Science Foundation of China. None of the authors reported any conflicts of interest.

Source: Zheng K et al. Radiology. 2022 (Feb 1). Doi: 10.1148/radiol.211545.

Key clinical point: Compared with sorafenib alone, its combination with 3cir-OFF hepatic arterial infusion chemotherapy (HAIC) offers significantly prolonged survival and an acceptable safety profile in patients with advanced hepatocellular carcinoma (HCC) and major portal vein tumor thrombosis (PVTT).

Main finding: Sorafenib plus HAIC vs. sorafenib alone led to a longer median overall survival (16.3 months vs. 6.5 months; hazard ratio [HR] 0.28; P < .001) and progression-free survival (9.0 months vs. 2.5 months; HR 0.26; P < .001) but more frequent grade 3/4 adverse events.

Study details: This was a phase 2 study involving adult, systemic treatment-naive patients with inoperable advanced primary HCC and major PVTT who were randomly assigned to receive either sorafenib plus HAIC (n = 32) or sorafenib alone (n = 32).

Disclosures: The study was sponsored by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, Beijing Natural Science Foundation, and National Natural Science Foundation of China. None of the authors reported any conflicts of interest.

Source: Zheng K et al. Radiology. 2022 (Feb 1). Doi: 10.1148/radiol.211545.

Key clinical point: Compared with sorafenib alone, its combination with 3cir-OFF hepatic arterial infusion chemotherapy (HAIC) offers significantly prolonged survival and an acceptable safety profile in patients with advanced hepatocellular carcinoma (HCC) and major portal vein tumor thrombosis (PVTT).

Main finding: Sorafenib plus HAIC vs. sorafenib alone led to a longer median overall survival (16.3 months vs. 6.5 months; hazard ratio [HR] 0.28; P < .001) and progression-free survival (9.0 months vs. 2.5 months; HR 0.26; P < .001) but more frequent grade 3/4 adverse events.

Study details: This was a phase 2 study involving adult, systemic treatment-naive patients with inoperable advanced primary HCC and major PVTT who were randomly assigned to receive either sorafenib plus HAIC (n = 32) or sorafenib alone (n = 32).

Disclosures: The study was sponsored by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, Beijing Natural Science Foundation, and National Natural Science Foundation of China. None of the authors reported any conflicts of interest.

Source: Zheng K et al. Radiology. 2022 (Feb 1). Doi: 10.1148/radiol.211545.