Sensible Medicine This Fortnight in Medicine XVIII
Jan 28, 2026
They debate a new flu antiviral, covering trial results, timing of treatment, household transmission, costs, and comparisons with older drugs. They dig into a heart failure trial about rapid medication up-titration, questioning follow-up intensity, patient selection, and real-world applicability. The conversation centers on tradeoffs between pragmatic trials and individualized clinical care.
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Start Antivirals Within 48 Hours
- Give oseltamivir or baloxavir within 48 hours of symptom onset to get meaningful benefit.
- Beyond 48 hours, trials show little to no symptomatic improvement.
Willingness To Pay For Shorter Flu
- Andrew said he would have paid $120 to shorten a miserable few days of flu.
- John and Andrew both describe a minimalist attitude toward medicating routine influenza.
STRONG-HF Cut Readmissions, Not Mortality
- The STRONG-HF trial accelerated GDMT titration and reduced 180-day HF readmission or death (15.2% vs 23.3%).
- Most of the benefit came from fewer readmissions rather than lower mortality.