In this brief 2026 season opener, host Diana Langworthy, PharmD, BCPS pauses to acknowledge the weight of the moment—particularly here in Minnesota—where uncertainty, fear, and harm are being felt in very real ways across communities.

This episode is not about policy analysis or debate. It's a reflection on what it means to hold space for thinking, teaching, and care when the world feels unstable—and why asking good questions, slowing down our reasoning, and practicing intellectual humility still matter in healthcare education and clinical practice.

Diana also shares how What's It Worth? will move forward this season, and how the podcast, Substack (whatsitworthpodcast.substack.com), and future TikTok (Diana the Pharm.D.etective - @whatsitworthrx) content will work together as connected—but distinct—spaces for evidence critique, reflection, and public-facing curiosity.

Welcome back What's it Worth? listeners.

This episode steps away from traditional trial critique. It's a year-end reflection on what it means to practice evidence-based healthcare at a moment when trust in science, institutions, and clinicians is eroding—and when evidence itself is increasingly being misused to create fear rather than understanding.

This episode is for frontline healthcare professionals and future providers who feel the weight of that shift and are asking how to respond without becoming part of a polarized conversation.

The answer, I believe, is not louder certainty—but better questions.

As we move into the next year, evidence-based practice will require more than knowing the literature. It will require clinicians who are willing to defend evidence with transparent communication, clarity, humility, and compassion—and who can help patients ask not just "Is there a study?" but "What's it worth?"

Learn more and continue the conversation:
Substack: https://whatsitworthpodcast.substack.com/
Email: whatsitworthpodcast@gmail.com

Secondary prophylaxis after spontaneous bacterial peritonitis (SBP) has long been considered standard of care—but how strong is the evidence behind it?

In this episode, host Dr. Diana Langworthy is joined by Dr. Ben Webber (hospital medicine physician) and Danielle Luettel (PharmD Candidate 2026) to unpack a contemporary observational study examining outcomes associated with SBP prophylaxis. Together, they explore how historical trials, modern resistance patterns, and guideline recommendations intersect—and where uncertainty still remains.

As care evolves over time, it is important to revisit standard practices to ensure they still make sense. How we revisit them is important and strong internal validity is still what we need to make practice changing claims.

• Secondary SBP prophylaxis is rooted in strong historical evidence but largely based on older trials.
• Contemporary observational data raise important questions about mortality benefit and patient selection.
• Guideline recommendations still support prophylaxis, but resistance patterns and evolving microbiology matter.
• Association does not equal causation—especially in retrospective database studies.
• Does this retrospective cohort study rise above the rest? ---> Tune in to find out!

Silvey S, Patel NR, Tsai, SY, et al. Higher Rate of Spontaneous Bacterial Peritonitis Recurrence With Secondary Spontaneous Bacterial Peritonitis Prophylaxis Compared With No Prophylaxis in 2 National Cirrhosis Cohorts. The American Journal of Gastroenterology 120(5):p 1066-1075, May 2025. | DOI: 10.14309/ajg.0000000000003075

Diana Langworthy, PharmD, BCPS
Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist, Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Ben Webber, MD
Associate Professor, Division of Hospital Medicine
Senior Medical Director, Adult Med/Surg
University of Minnesota Medical Center – East Bank

Danielle Luetell
PharmD Candidate, Class of 2026

Subscribe to the What's it Worth? Podcast on Substack

If you want to get new episode alerts, bonus content, and continue reflecting on what studies like this mean for real clinicians and real patients—head over to the What's it Worth? substack.

Have a study you'd like us to decode on a future episode?
Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty.

Additional References & Guidelines

• American Association for the Study of Liver Diseases (AASLD)
  • Biggins, Scott W.*,1; Angeli, Paulo2; Garcia‐Tsao, Guadalupe3,4; et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 74(2):p 1014-1048, August 2021. | DOI: 10.1002/hep.31884
• European Associate for the Study of the Liver
  • EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis Journal of Hepatology, Volume 53, Issue 3, 397 - 417
• Foundational Trial for Secondary Prophylaxis
  • Ginés P, Rimola A, Planas R, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990 Oct;12(4 Pt 1):716–724. doi:10.1002/hep.1840120416. PMID:2210673.