Melatonin Dietary Supplements for Children

When The Medical Letter discusses dietary supplements of one sort or another, we often end by urging our readers to tell their patients not to take them because we really don’t know what’s in them. A Research Letter in a recent issue of JAMA on the quantity of melatonin in melatonin gummies gives us an […]

Underuse of Paxlovid

The combination of the oral antiviral nirmatrelvir and the protease inhibitor ritonavir (Paxlovid – Pfizer) has been available in the US since late December, 2021.  In the clinical trial that led to the Emergency Use Authorization for Paxlovid, the drug decreased hospitalization or death, compared to placebo, by 88%.1 US COVID-19 deaths in 2022 averaged […]

USPSTF Indications for Statins for Primary Prevention of CV Disease

Statins are recommended for virtually all patients who have atherosclerotic cardiovascular disease (ASCVD), but the indications for prevention of ASCVD are less clear. The US Preventive Services Task Force (USPSTF) recommendation statement on statin use for primary prevention of cardiovascular disease was recently published in the Journal of the American Medical Association.1 The USPSTF lists […]

Vitamin D Supplements

The July 28th issue of The New England Journal of Medicine included results from a large, randomized, placebo-controlled trial of vitamin D supplementation to lower the risk of fractures in middle-aged and older adults who were not selected based on gender, vitamin D deficiency, low bone mass, or osteoporosis. Supplementation with vitamin D3 2000IU/day did […]

Whither COVID-19?

Or, in modern English, where is this pandemic going? The answer is clear: we don’t know. In Shanghai 26 million people have been locked down in their homes, while in Florida the governor is imploring children to take off their masks. CDC.gov tells us that more than 982,000 Americans have died from COVID-19, more than […]

Oral Antivirals for COVID-19: Supply and Demand

In December, the FDA granted Emergency Use Authorizations (EUAs) to 2 oral antiviral drugs for treatment of mild to moderate COVID-19 in outpatients at high risk of progressing to severe disease, including hospitalization or death. The long list of conditions that qualifies infected patients for a prescription for one of these agents includes age >65 […]

Remdesivir for Outpatients, At Last

An article in last Sunday’s New York Times described the 7-hour search of a Times reporter who lives in Washington state for Paxlovid, the new Pfizer drug for oral treatment of COVID-19. Her elderly mother with risk factors living in northern California had just developed early symptoms of the disease and a positive at-home coronavirus […]