Systemic Racism and Health Disparities: A Statement from Editors of Family Medicine Journals

The year 2020 has been marked by historic protests across the United States and the globe sparked by the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, and so many other Black people. The protests heightened awareness of racism as a public health crisis and triggered an antiracism movement. The editors of several North American family medicine publications have come together to address this call to action and share resources on racism across our readerships.http://deepblue.lib.umich.edu/bitstream/2027.42/163331/1/Final Statement on Systemic Racism- with acknowledgements.pdf-1Description of Final Statement on Systemic Racism- with acknowledgements.pdf : Main ArticleSEL

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Family Practice Triumphs by the Year 2020: What Will We Have Done Right?

For family practice in the United States to be considered a success in the year 2020, several things will need to be done right between now and then. These include (1) an emphasis on quality of care, (2) a dependence on new technologies to enhance quality, (3) availability of and access to primary care for the entire US population, (4) increased political power for the specialty of family practice, (5) enhanced research and research funding, and (6) learning to work with patients so that they are the masters of their own care. If successful in 2020, family physicians will be perceived as quality physicians who use technology that everyone wants and who use their political power to advocate for patients’ rights to quality health care and the research important to the discipline and quality health care. Family physicians will have become the “go-to doctors” who put patients in charge

Risk Management and Medical Malpractice

Medical malpractice claims are common and may be emotionally difficult for physicians. Most malpractice suits claim negligence. The most frequent types of claims include failure or delay in diagnosis, negligent treatment with drugs, failure to obtain consultation, failure to obtain informed consent, and negligent management of procedures. The most important risk-management strategy is the provision of good medical care. If a claim is filed, physicians should cooperate fully with the malpractice insurance carrier and refrain from discussing the case with colleagues

The Blues: Now and Forever More?

WE FAMILY PHYSICIANS are recurrently told that we underdiagnose and undertreat depression. I am sure it is true. Some of it is our fault, but there are many other complexities involving physicians, patients, society, and medications that contribute to how we recognize and treat depression. The studies of Simon and VonKorff1 and Schulberg et al2 provide new insights on aspects of this underrecognition and undertreatment

Gmenac Revisited: Medical Manpower in the Late 80s

The Graduate Medical Education National Advisory Committee Report is now almost half a decade old. Many of the recommendations have been implemented partially or completely, but many have not. This article recounts the major recommendations, what has happened with them, and the impact of the changes that have occurred. Graduate medical education, physician supply and requirements, specialty and geographical distribution, foreign medical graduates, and nonphysician providers are areas that need ongoing attention and should be the focus of further study and monitoring

Interspecialty Communication: Overcoming Philosophies and Disincentives

INTERSPECIALTY COMMUNICATION can probably thwart unneeded visits, improve the selection of testing, provide a better estimate of the urgency of the visit from the perspective of the consultant, and improve communication on sensitive issues. The family physician may also learn more from an interaction such as a phone call than from a one-way referral letter at a later date, because of both the immediacy and the opportunity to ask questions. If this communication can do so much, why is there not more