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Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Liver Lineup: Progress, Policy, and Barriers in Hepatitis C Elimination

Liver Lineup: Updates & Unfiltered Insights

, hosts Kimberly Brown, MD, a professor of Medicine at Michigan State University and Wayne State University, associate medical director of the Henry Ford Hospital Transplant Institute, and medical director of Transplant Outreach Services at Henry Ford Hospital, and Nancy Reau, MD, a professor of internal medicine, the Richard B. Capps Chair of Hepatology, associate director of solid organ transplantation, and the section chief of hepatology at Rush University Medical Center, discuss the progress and persistent challenges in eliminating 

With highly effective, short-course oral therapies now available, Brown and Reau emphasize that curing HCV is more achievable than ever. The discussion explores the major policy, clinical, and structural milestones enabling this effort—and the critical gaps in diagnosis, treatment access, and health policy that still impede progress.

Reau opens by emphasizing the revolutionary nature of curative HCV therapies, which not only improve individual health outcomes but also reduce transmission, presenting a rare opportunity for public health impact on a global scale. She and Brown discuss how national and international efforts, including World Health Organization goals and US legislation, have aligned to prioritize viral hepatitis elimination.

Specifically, the hosts discuss the role of the US Preventive Services Task Force and the Affordable Care Act in establishing HCV screening as a covered preventive service. Outlining the evolution from birth cohort screening to universal screening for adults 18 and over, Reau and Brown discuss a recent legal challenge to the Affordable Care Act’s preventive service mandate that threatened access to HCV screening. The Supreme Court’s 6–3 decision to uphold this provision was, in their view, a critical win for public health and HCV elimination.

Despite these advances, both experts acknowledge major challenges remain in the HCV care cascade. Many patients are lost between screening and cure, often due to provider restrictions, system fragmentation, and lack of prioritization. They emphasize the need for government-backed elimination efforts, drawing lessons from successful national programs in countries like Egypt and Georgia.

The conversation also underscores the role of grassroots advocacy, emphasizing the critical role clinicians and patients alike can play in supporting federal hepatitis elimination legislation. Most importantly, they encourage patients to share their stories with legislators—a strategy proven effective in other public health movements, including HIV.

Reau additionally calls upon listeners to write to their local senators to support bipartisan legislation from senators Bill Cassidy (R-LA) and Chris Van Hollen (D-MD) to eliminate hepatitis C using the following link: 

Ask Senators to Cosponsor the Cure Hepatitis C Act

Editors’ note: Relevant Disclosures for 

 include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for 

 include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

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Hosts Kimberly Brown and Nancy Reau discuss policy, clinical, and structural milestones enabling HCV elimination efforts and critical gaps impeding progress.

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Introducing Liver Lineup: Updates & Unfiltered Insights — an exciting new podcast delivering timely, candid perspectives on the most pressing topics in the fast-moving world of hepatology. Created by Nancy Reau, MD, and Kimberly Brown, MD, and hosted by HCPLive, this series dives into the cutting edge of liver disease research, clinical care, and real-world practice.

Hepatology

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Hepatitis C page, resources on the topics of medical news and expert insight into HCV can be found. Content includes articles, interviews, videos, podcasts, and breaking news on hepatitis C virus research, treatment, and drug development.

Jonathan Meyer, MD, is a clinical professor of Psychiatry at UC San Diego and nationally recognized psychopharmacology educator.

At the 2025 Southern California Psychiatry Conference at Huntington Beach, CA, from July 11 – 12, Jonathan Meyer, MD, presented on muscarinics and 

, a brand under MJH Life Sciences, Meyer, a voluntary clinical professor at the University of California, San Diego, discussed what’s new in tardive dyskinesia, when to switch medications, and how the only effective treatment for this condition is VMAT2 inhibitors.

In this Q&A, Meyer emphasized the importance of making sure you diagnose tardive dyskinesia correctly, not mixing up tardive dyskinesia with Parkinsonism. Medications for Parkinsonism worsen tardive dyskinesia symptoms, and vice versa. Only 2 FDA-approved medications for tardive dyskinesia sit on the market—tetrabenazine and valbenazine—both vesicular monoamine transporter 2 (VMAT2) inhibitors.

 The big thing that's new is not the medications. We've had two FDA-approved treatments in 2017, but in the early days when they're just approved, I think the focus was more on detecting tardive dyskinesia. We've come to appreciate that it's not just the movements, it's the functional impact, the impact on the person's well-being, the impact on psychosocial functioning.

A big aspect of what I'll be covering today is really how to use some of these newer instruments that have been developed to help you figure out for your patients with TD, how it interferes with what they do on a day-to-day basis, not just physically, but psychologically and socially.

If you have a patient and you're giving the medication for TD, and you don't see that they're improving, what are some of the things that clinicians should be thinking about?

 Well, for one thing, you want to make sure that you have the right diagnosis. There are sometimes movements [that] can happen to people on psychotropic [medications], which may lead the clinician to think they have tardive dyskinesia.

A classic example is a form of Parkinsonism, in which the person has jaw tremors, because it's in this area, we often would assume it's tardive dyskinesia, and most of the time, you're right…if they've been exposed to a D2 blocker, but in this case, it's actually a form of Parkinsonism. The medicines [that] make Parkinsonism better tend to make TD worse. Conversely, for people with Parkinsonism, the medicines for TD tend to make those symptoms worse.

If you assume, though, that you have the correct diagnosis, the most important thing is making sure the person's taking the medication and that you've maximized the dose. If there is no response whatsoever on the maximal dose of one medication, there's really no harm in trying the other one. We only have 2 options right now, which are FDA-approved, but there are a subset of people with TD who don't get adequate improvement with either of the 2 FDA-licensed medications. Those are the types of people who you may refer to a neurologist for further evaluation and treatment.

Between the two, how should a clinician decide which one they're going to start trying? Is there a rhyme or reason to it?

 There really often isn't. One of them has a bit more of a titration schedule, which is tetrabenazine. Does that always cause a problem? Not necessarily. There are actually some people who prefer a lower initiation schedule.

Valbenazine is easier to initiate. 40 milligrams is the starting dose, and it's actually a very effective dose. I say to clinicians: you need to know how to use both, simply because insurance, more than anything, may dictate what you have access to. They are both effective.

We don't have any head-to-head data. There's inferential data from imaging studies that maybe you might get more VMAT2 occupancy, perhaps at the maximal dose of valbenazine versus the maximal dose of tetrabenazine. I can't promise there's always a clinical correlate for that, but it emphasizes a point of [knowing] how to use both. Maybe somebody will respond better, or perhaps a differential tolerability to one or the other.

Any closing thoughts that you want to share with clinicians?

 The only effective treatments for tardive dyskinesia are the VMAT2 inhibitors. In the old days, people used to throw medicines like benztropine against all movement disorders with the D2 blockade. We now know that they're not effective for TD, and in fact, they tend to make it worse.

The only thing I'll say about that is, if you have people on anticholinergics at some point in their treatment, if they have TD, you want to slowly taper them off to allow the VMAT2 inhibitor to give you your maximum benefit for their movements, most importantly, to improve their quality of life related to their tardive dyskinesia.

Articles

Jonathan Meyer, MD, presented insights on tardive dyskinesia (TD) at the 2025 Southern California Psychiatry Conference. He emphasized the importance of accurate diagnosis, distinguishing TD from Parkinsonism, as treatments for one can exacerbate the other. The only FDA-approved treatments for TD are VMAT2 inhibitors, tetrabenazine and valbenazine. Meyer highlighted the need to assess the functional impact of TD on patients' lives and suggested trying both medications if one proves ineffective. He advised tapering off anticholinergics to maximize the benefits of VMAT2 inhibitors.

Discover the latest insights on tardive dyskinesia treatment, diagnosis, and the role of VMAT2 inhibitors in enhancing patient well-being.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

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 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

What’s New in Tardive Dyskinesia, With Jonathan Meyer, MD

Hypercortisolism in Patients with Treatment-Resistant Type 2 Diabetes, with Richard Auchus, MD, PhD

, Richard Auchus, MD, PhD, presented the results of his deeper examination of the participants of the CATALYST trial for management of 

CATALYST was a phase 4, 2-part, multicenter trial; part 1 examined the prevalence of hypercortisolism in a population of roughly 1000 patients over 36 sites across the US. Each patient had hemoglobin A1c >7.5%, despite using several glucose-lowering therapies such as glucagon-like peptide-1 receptor agonists (GPL-1 RAs). Investigators administered a 1 mg dexamethasone suppression test, the results of which indicated 24% of participants had hypercortisolism.

Part 2 of CATALYST was a randomized, double-blind, placebo-controlled study of mifepristone (Korlym) in select patients from part 1. Patients were randomized to either mifepristone or placebo; the former cohort exhibited a salutary response on glucose, with A1c lowering by roughly 1.5% and roughly 1.3% relative to placebo.

Auchus and colleagues conducted a deeper examination of the patient characteristics highlighted in CATALYST, who had an A1c between 7.5% and 11.5%. Investigating the results from the dexamethasone suppression test, the team stratified patients into 3 major categories: cortisol <1.2, cortisol 1.2-1.8, and cortisol >1.8 after dexamethasone. Auchus and colleagues found substantial worsening of disease, disease control, and comorbidities associated with greater amounts of cortisol after dexamethasone.

“We found that 25% of them failed the dexamethasone suppression test, indicating some form of hypercortisolemia,” Auchus said. “And ‘failed’ conventionally is 1.8 mcg/dL or higher of serum cortisol after the 1mg test. But if you take truly normal people, their cortisol normally suppresses to zero. A couple of groups have looked at what the normal range is for dexamethasone suppression tests in people who are at low suspicion of hypercortisolism, and it turns out that the +2 standard deviation is about 1.2 mcg/dL.”

“Now, we didn’t test the 1.2 to 1.8 people,” Auchus told 

. “So what would happen if we treated those people? And you could also take this one step further and say, ‘What would happen if we treated the people who were less than 1.2?’ I think these are the sort of questions that we need to address.”

Auchus spoke to the lack of variance in response between cohorts. He addressed the alternative approach taken when studying mifepristone and hypercortisolism’s impact on T2D.

“I think it’s comforting but vexing in that the test is an easy way to find people who should respond well, but the reason they respond and the underlying reason that their cortisol doesn’t suppress completely doesn’t seem to matter,” Auchus said. “And it’s a little different than the way we’ve normally thought about it.”

Auchus also mentioned barriers to implementation, chiefly the lack of comfort in drugs like mifepristone and cortisol-directed therapy at large.

“They’ve generally been boutique drugs that only a few endocrinologists use, who specialize in Cushing’s and pituitary centers, adrenal centers,” Auchus said. “I think a barrier to implementation is the comfort level of the average endocrinologist in using cortisol-directed therapy.”

Auchus advised clinicians to keep the possibility of secondary causes in mind when investigating a patient’s treatment-resistant diabetes or high blood pressure. He encouraged broader screening and earlier consideration of alternative causes.

“When the usual things don’t work, don’t keep banging your head against the wall,” Auchus said. “Think about secondary causes. Cortisol and aldosterone are two of the first things you should be thinking of.”

DeFronzo RA, Auchus RJ, Bancos I, et al. Study protocol for a prospective, multicentre study of hypercortisolism in patients with difficult-to-control type 2 diabetes (CATALYST): prevalence and treatment with mifepristone. BMJ Open. 2024;14(7):e081121. Published 2024 Jul 16. doi:10.1136/bmjopen-2023-081121

Diabetes Care Publishes Results from Prevalence Phase of Corcept’s CATALYST Trial in People with Difficult-to-Control Type 2 Diabetes. Corcept Therapeutics. April 21, 2025. Accessed July 14, 2025. https://ir.corcept.com/news-releases/news-release-details/diabetes-care-publishes-results-prevalence-phase-corcepts

Videos

Auchus discusses his recent presentation on the CATALYST trial, investigating the characteristics of patients with difficult-to-treat T2D because of hypercortisolism.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 2 Diabetes

nt Understanding Indolent Systemic Mastocytosis (ISM): Symptoms and Impact

Understanding Indolent Systemic Mastocytosis: A Chronic Mast Cell Disorder

Indolent systemic mastocytosis (ISM) is a lifelong chronic disease characterized by the clonal expansion of aberrant mast cells in the bone marrow, skin, and other tissues. This condition is driven by the 

 D816V mutation, which occurs somatically in more than 90% of cases. The disease fundamentally alters the normal function of mast cells, leading to widespread tissue infiltration and dysfunction that affects multiple organ systems throughout the body.

Patients with ISM experience a constellation of debilitating symptoms caused by mast cell mediator release, including flushing, itching, tachycardia, lightheadedness, abdominal pain, diarrhea, and brain fog. These chronic symptoms can escalate to severe, acute episodes known as anaphylaxis, which pose serious medical risks. Most patients develop a characteristic chronic skin rash called urticaria pigmentosa, while approximately one-third suffer from osteoporosis, significantly increasing their fracture risk. The unpredictable nature of these symptoms creates substantial anxiety and further compromises patient well-being.

The quality of life for ISM patients is severely impacted due to the chronic nature of the disease and the current lack of curative treatment options. First-line symptom management relies on anti–mast cell mediator drugs, including H1 and H2 antihistamines, but these medications often provide inadequate relief. Many patients continue to experience residual symptoms or develop adverse effects from their medications, contributing to ongoing disability. The unpredictability of symptom flares creates a cycle of anxiety and reduced quality of life, making ISM a particularly challenging condition to manage from both medical and psychological perspectives.

A panelist discusses how indolent systemic mastocytosis presents with chronic, mast cell–mediated symptoms that significantly reduce quality of life, often persist despite treatment, and may lead to serious complications like anaphylaxis and osteoporosis.

Video Series

Understanding Indolent Systemic Mastocytosis (ISM): Symptoms and Impact

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Image Credit: US Food and Drug Administration

 has approved an update to the VARIPULSE Platform’s irrigation flow rate, which is designed to optimize irrigation and support consistent successful operations with low adverse event rates.

Announced on July 14, 2025, by parent company Johnson & Johnson MedTech, the approval follows the significant milestone of >10,000 VARIPULSE procedures across all approved countries. The platform has also maintained a neurovascular adverse event rate of <.5% - although the release notes this statistic is calculated from internal customer reported data/complaints rather than a prospective clinical investigation. The rate reported is preliminary and pending publication.

More than 8 million people in the US and 50 million globally experience 

; 1 in 4 adults ≥40 years of age are at risk of development. However, 1 in 3 are unaware of the condition. Catheter ablation is a safe and effective method of restoring incorrect electrical signals in the heart when traditional therapies are incapable of generating change.

“With a growing prevalence of atrial fibrillation around the world, innovative solutions are critical in expanding options for patients and helping electrophysiologists treat AFib effectively and efficiently,” said Andrea Natale, MD, executive medical director, Texas Cardiac Arrythmia Institute, St. David’s Medical Center. “The VARIPULSE Platform enables efficient procedures with a favorable safety profile, allowing me to treat more patients and get them back to their normal lives.”

The VARIPULSE device is a Pulsed Field Ablation (PFA) system which was initially approved for drug refractory paroxysmal atrial fibrillation on November 7, 2024. It combines PFA therapy with the CARTO 3 system, the world’s leading 3D electroanatomical cardiac mapping system. The device provides real-time visualization of catheter positioning while delivering treatment confidence through tissue proximity indication and lesion tagging.

As treatment is delivered through tissue proximity and lesion tagging, electrophysiologists receive critical feedback for lesion durability and long-term outcomes with the platform. VARIPULSE could provide a comprehensive solution to address both routine and complex AF ablations, according to Johnson & Johnson MedTech.

The VARIPULSE Platform’s initial approval in 2024 was based on 12-month outcome data from the prospective, non-randomized, multi-center admIRE trial, which consisted of 291 patients from 30 US healthcare centers. By week 12, all patients achieved acute procedural success, including 98% with first-pass isolation recorded per vein. Roughly 85% of patients reached peak primary effectiveness when 73-96 applications were given per vein with few adverse events observed.

“By learning from real-world experience and working closely with clinicians, we are continuously enhancing our technologies to improve patient care,” said Michael Bodner, company group chair, electrophysiology and neurovascular, Johnson & Johnson MedTech. “This update to the VARIPULSE Platform reflects our ongoing commitment to lead the evolution of PFA through meaningful, data-driven improvements that advance product performance and build procedural confidence.”

The Platform includes the VARIPULSE Catheter, TRUPULSE Generator, and CARTO 3D Mapping System VARIPULSE Software. It is available for use in the US and several other nations including Europe, China, and Canada.

Johnson & Johnson Receives FDA Approval for Updated VARIPULSE Platform Irrigation Rate. J&J MedTech. July 14, 2025. Accessed July 14, 2025. 

https://www.jnjmedtech.com/en-US/news-events/johnson-johnson-receives-fda-approval-updated-varipulse-platform-irrigation-rate

MedTech J & J. Johnson & Johnson Medtech receives FDA approval for the VARIPULSETM pulsed field ablation platform for the treatment of atrial fibrillation. PR Newswire. November 7, 2024. Accessed July 14, 2025. 

https://www.prnewswire.com/news-releases/johnson--johnson-medtech-receives-fda-approval-for-the-varipulse-pulsed-field-ablation-platform-for-the-treatment-of-atrial-fibrillation-302298232

Iapoce C. FDA Approves VARIPULSE Platform for Treatment of Atrial Fibrillation. 

. November 7, 2024. Accessed July 14, 2025. 

https://www.hcplive.com/view/fda-approves-varipulse-platform-for-treatment-of-atrial-fibrillation

The FDA has approved an update to the VARIPULSE Platform's irrigation flow rate, enhancing its operational consistency and safety profile. This follows over 10,000 procedures performed globally, with a neurovascular adverse event rate of less than 0.5%. The VARIPULSE Platform, a Pulsed Field Ablation system, is used for treating atrial fibrillation, a condition affecting millions worldwide. It integrates with the CARTO 3 system for real-time visualization and feedback, supporting both routine and complex ablations. The platform's initial approval was based on successful outcomes from the admIRE trial.

The previously approved technology has already accomplished over 10,000 procedures for patients with various heart diseases, primarily including atrial fibrillation.

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FDA News

FDA Approves Updated VARIPULSE Platform Irrigation Flow Rate for Heart Disease

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

These data resulted from a sub-study of the open-label extension (OLE) of the randomized, placebo-controlled phase 3 ‘Balance’ analysis.

Plaque Psoriasis

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Psoriasis Flare Associated with Withdrawal from Biologics Prior to Pregnancy

Stay updated with the latest healthcare breakthroughs, including FDA news, clinical trial data, and regulatory submissions, in this week's essential news roundup.

Allergy

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The HCPFive: Top News for Healthcare Providers from the Week of 07/06

In this video, the last in a 6-part series, panelists discuss recent advancements in PsO management.

Advocating for Patients With Psoriasis: Securing Access to Nonsteroidal Topicals Like Roflumilast

In this video, the fifth in a 6-part series, panelists discuss recent advancements in PsO management.

Bridging and Enhancing Biologic Response With Targeted Topicals for Scalp Psoriasis

In this video, the fourth in a 6-part series, panelists discuss recent advancements in PsO management.

Counseling Patients With Psoriasis on Roflumilast and Nonsteroidal Topicals

In this video, the third in a 6-part series, panelists discuss recent advancements in PsO management.

The Role of Roflumilast in Long-Term Psoriasis Management

In this video, the second in a 6-part series, panelists discuss recent advancements in PsO management.

Formulation Matters: Managing Scalp Psoriasis Across Hair Types

In this video, the first in a 6-part series, panelists discuss recent advancements in PsO management.

Tackling Real-World Barriers in Scalp Psoriasis Treatment Delivery

Discover cutting-edge insights on schizophrenia, mood disorders, and digital therapeutics at the 2025 Southern California Psychiatry Conference.

Muscarinic Agonists, Mood Disorders, and More: Highlights from So Cal Psych 2025

Majcher discusses innovations in ocular imaging and the importance of educating patients on early warning signs of myopia to halt disease progression.

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Latest News

Liver Lineup: Progress, Policy, and Barriers in Hepatitis C Elimination

What’s New in Tardive Dyskinesia, With Jonathan Meyer, MD

Hypercortisolism in Patients with Treatment-Resistant Type 2 Diabetes, with Richard Auchus, MD, PhD

Understanding Indolent Systemic Mastocytosis (ISM): Symptoms and Impact

FDA Approves Updated VARIPULSE Platform Irrigation Flow Rate for Heart Disease