https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771670 trials are not real life. We know that. Realistically if your drug just barely hits 0.05 in a clinical trial then in the imperfect setting of the clinic of every day life the drug likely wont work. In this next study, in jama internal medicine titled Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice The authors used a prognostic study and took 3074 patients and wanted to see the difference between BPs obtained in routine clinical practice and the bp obtained during a clinical trial. Which trial you ask?? The sprint trial!! This is brilliant they basically took 3000 patients who were in the SPRINT trial, and as a reminder the sprint trial is the land mark trial of 2015 that showed- In patients at high risk for CVD but who do not have a history of stroke or diabetes, intensive BP control (target SBP <120 mm Hg) improved CV outcomes and overall survival compared to standard therapy (target SBP 135-139 mm Hg), And compared the blood pressure that was taken for measurement and calculation during the trial and compared it with the bp that was calculated during the normal office pcp visit outside of the trial setting. Ideally these should be the same! Right?? If you are going to the study center and getting your bp taken or you are going to your normal doctor and getting your bp taken the results should be the same. You are taking the same meds you should get the same results?!?? But they found those in the intensive arm had a SBP that was 7mm hg higher in the doctors office compared to the SBP measured in the SPRINT trial. those in the standard of care arm had a SBP that was 5mm hg higher in the doctors office compared to the SBP measured in the SPRINT trial. What does this mean?? It means in the doctos office we don’t measure bp the same way they do in trials. I am not sure it means more MACE but if we extrapolate from other date we can say likely an error in bp reading of 6mm hg does make a difference. Moral of the story. Studies are far from perfect. And often we overlook the methods and jump straight to the results but if you are going ot use a trial in practice the methods is maybe one of the most important parts of the paper if you want to get the same results else you can expect you clinical results to vary from the study results just like was shown in this paper. topically applied corticosteroids and emollients are the mainstay of therapy for atopic dermatitis or that is at least the opening line on uptodate but what if we question medicine as done in this paper titled The Effects of Common Over-the-Counter Moisturizers on Skin Barrier Function: A Randomized, Observer-Blind, Within-Patient, Controlled Study https://journals.lww.com/dermatitis/Fulltext/2020/09000/The_Effects_of_Common_Over_the_Counter.7.aspx which look sough to look a little deeper into this standard of care for atopic dermatitis. They took 20 points and randomized them to 1 of 4 moisturizers (Cetaphil Cream, Aveeno Eczema Therapy Moisturizing Cream, CeraVe Moisturizing Cream, Vaseline) on one arm but then NO moisturizers on the other arm. The patients were acting as their control. The right arm gets treatment the left arm gets no treatment. They did this for 4 weeks and then they accessed for Transepidermal water loss (TEWL), capacitance, pH, via tape stripping of stratum corneum. The results showed that after 4 weeks of treatment there was no significant change in pH or in Transepidermal water loss. But the treated side did show an improvement in capacitance.. so basically the arm you put moisturizer on was more ‘hydrated’…shocking. The authors conclude “The effects of moisturizers on nonlesional AD skin were small and need to be addressed when powering future studies.” Which really means that we give moisturizers for atopic dermiatitis with(continued)