In this What's It Worth? For Everyone episode, we're asking: Are we waiting too long for new treatments?

If you've ever heard about a promising new medication, peptide, or breakthrough therapy and wondered, "If it works so well, why isn't everyone using it yet?"—you're not alone.

It can feel frustrating to hear about exciting discoveries while waiting years before they become part of routine healthcare.

In this episode, we take you behind the scenes of the scientific process to explore what happens between an exciting idea and a treatment that is recommended for patients. Along the way, we use recent blood thinner research as a real-world example of why asking the right questions—and taking the time to answer them—matters.

• A promising scientific idea is not the same as a proven treatment.

• Clinical trials help researchers answer two critical questions: Does it work? and Is it safe?

• Many exciting discoveries change as they are studied in larger groups of people.

• The goal of the scientific process is not to slow innovation—it is to help ensure new treatments provide meaningful benefits while minimizing harm.

• Progress in medicine depends on both curiosity and careful testing.

Use these questions to help guide conversations with your healthcare team when you hear about a new treatment:

• How strong is the evidence supporting this treatment?

• Has it been studied in people, or only in laboratory or animal studies?

• What are the known benefits?

• What are the known risks?

• How does it compare with treatments that are already available?

• Is this treatment appropriate for someone with my medical history?

New discoveries are exciting—and they are how medicine moves forward. But every promising idea deserves careful testing before it becomes routine care.

The goal isn't simply to bring new treatments to patients faster. It's to bring forward treatments that have been shown to make a meaningful difference in people's lives.

This episode is for educational purposes only and is not medical advice. It does not replace care from your own healthcare team.

🎙️Host: Diana Langworthy, PharmD, BCPS | Associate Professor at the University of Minnesota College of Pharmacy | Clinical Pharmacist in Adult Internal Medicine, Fairview East Bank Hospital

📬 Enjoyed this episode? Find more evidence-based content, podcast episodes, social media, and ways to connect at https://beacons.ai/diana.the.pharm.d.etective.

In this What's It Worth? For Everyone episode, we're talking about AFib, blood thinners, and liver disease.

AFib stands for atrial fibrillation. It is a common heart rhythm problem that can increase the risk of stroke. Because of that stroke risk, many people with AFib are prescribed a blood thinner.

But what if someone has AFib and also has liver disease or cirrhosis?

That decision can be more complicated.

In the full What's It Worth? episode, we discussed a systematic review and meta-analysis comparing DOACs with warfarin in people with atrial fibrillation and liver disease. DOACs are a group of blood thinners that include apixaban, also known as Eliquis, and rivaroxaban, also known as Xarelto.

Key Takeaways

• In this study, DOACs appeared to work similarly to warfarin for preventing stroke in people with AFib and liver disease.
• DOACs also appeared to have a more favorable bleeding profile than warfarin in many patients, including patients with cirrhosis.
• This episode explains why blood thinner decisions in liver disease are not one-size-fits-all.
• We talk about how liver function, kidney function, bleeding history, clotting risk, and other medications can all affect which blood thinner may be the safest choice.
• The core takeaway from the review is that DOACs may be reasonable options for many people with AFib and liver disease, but the decision still needs to be individualized.
• Practical takeaway: Bring your full medication list to your appointment and ask your healthcare team how your liver disease, kidney function, age, weight, bleeding risk, and other medicines affect the blood thinner choice.

Questions Worth Asking

Use these questions to help guide a conversation with your healthcare team:

• Why do I need a blood thinner?
• What is my risk of stroke if I do not take one?
• What is my personal risk of bleeding?
• How severe is my liver disease?
• Is this blood thinner safe for my level of liver function?
• How is my kidney function?
• Are any of my medicines raising my bleeding risk?
• Are any of my medicines interacting with this blood thinner?
• What bleeding symptoms should I watch for?
• Who should I call if I notice bleeding or need a procedure?

Bring your full medication list to your appointment. This includes prescription medicines, over-the-counter medicines, pain relievers like ibuprofen or naproxen, aspirin, vitamins, supplements, and medicines you only take once in a while.

Having liver disease or cirrhosis does not automatically mean a person with AFib can never take a blood thinner. But it does mean the decision needs extra care.

The goal is thoughtful, personalized care.

This episode is for educational purposes only and is not medical advice. It does not replace care from your own healthcare team.

Welcome to What's It Worth? For Everyone — a shorter, everyone-friendly version of What's It Worth? focused on making health evidence clearer, calmer, and easier to use.

In this episode, Dr. Diana Langworthy revisits the recent What's It Worth? long-form discussion with Dr. Tory Pressman and Dr. Alexis Quade about Tylenol — also known as acetaminophen or paracetamol — during pregnancy and concerns about autism, ADHD, and other neurodevelopmental disorders.

The full episode breaks down a 2026 systematic review and meta-analysis in more detail. This companion episode pulls out the big-picture takeaways: what the study asked, why this question is hard to answer, what makes the evidence reassuring, and what we still cannot say with 100% certainty.

If you've seen headlines about Tylenol and autism and wondered what to do with that information, this episode is designed to help you slow down the claim, understand the evidence, and ask better questions with your healthcare team.

Key Points

• Tylenol, acetaminophen, and paracetamol refer to the same medication, which is commonly used during pregnancy for fever and pain.

• Questions about autism, ADHD, and neurodevelopmental disorders can feel deeply personal for parents and pregnant people, which is why clear and careful communication matters.

• The episode explains why observational studies can be tricky, especially when people take a medication because of fever, pain, infection, or another condition.

• We unpack the idea of confounding by indication — the possibility that the reason someone took the medication may also be part of the story.

• The 2026 systematic review and meta-analysis is reassuring because its stronger analyses, including sibling-comparison studies, did not show a meaningful association between prenatal acetaminophen exposure and autism, ADHD, or intellectual disability.

• The practical takeaway is not "take it whenever, however, forever," but rather: use medications thoughtfully, talk with your healthcare team, and do not let scary headlines become a source of blame.

Questions Worth Asking

• What are the risks of not treating fever or pain during pregnancy?

• If I need acetaminophen, what dose and timing make sense for me?

• How often is too often to need it?

• Are there non-medication options that fit my symptoms?

• Is there anything about my pregnancy or health history that changes the risk-benefit balance?

This episode is for informational and educational purposes only and is not intended to replace advice from a licensed healthcare professional.

Host Information

Diana Langworthy, PharmD, BCPS
Associate Professor, University of Minnesota College of Pharmacy
Clinical Pharmacist, Adult Inpatient Internal Medicine

LinkedIn: Diana (Mack) Langworthy
www.linkedin.com/in/diana-langworthy-4a765957

TikTok: Diana The Pharm.D.etective (@whatsitworthrx)

References

1. [Episode Study] D'Antonio F, Flacco ME, Della Valle L, Prasad S, Manzoli L, Samara A, Khalil A. Prenatal paracetamol exposure and child neurodevelopment: a systematic review and meta-analysis. Lancet Obstet Gynaecol Womens Health. Published online January 16, 2026. doi:10.1016/S3050-5038(25)00211-0
2. Prada D, Ritz B, Bauer AZ, Baccarelli AA. Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology. Environmental Health. 2025;24:56. doi:10.1186/s12940-025-01208-0
3. American College of Obstetricians and Gynecologists. Acetaminophen Use in Pregnancy and Neurodevelopmental Outcomes. Practice Advisory. Published September 22, 2025. Accessed April 13, 2026.
4. Bérard A, Cottin J, Leal LF, et al. Systematic Review and Meta-Analysis: Acetaminophen Use During Pregnancy and the Risk of Neurodevelopmental Disorders in Childhood. J Am Acad Child Adolesc Psychiatry. 2026;65(4):484-504.
5. Sheikh J, Allotey J, Khashan AS, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141.
6. Lee PC, Chen CY, Pan ML, et al. Maternal Acetaminophen Use and Child Neurodevelopment. JAMA Pediatr. Published online March 9, 2026. doi:10.1001/jamapediatrics.2026.0071.

Welcome back to What's it Worth! Join your host, Dr. Diana Langworthy, and guests Dr. Alexis Quade and Dr. Tory Pressman, as they break down a 2026 systematic review and meta-analysis evaluating prenatal paracetamol exposure and child neurodevelopmental outcomes, including autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability.

After renewed public attention in 2025 around Tylenol use in pregnancy and neurodevelopmental disorders, clinicians and patients are left asking how much weight to give observational medication safety signals. This episode explores how study design, confounding, outcome definitions, and risk-benefit thinking shape what we can — and cannot — conclude from the evidence. Let's dive in and see what it's worth!

Key Points

• We explore why Tylenol, pregnancy, autism, ADHD, and neurodevelopmental disorders became such a high-profile medication safety conversation.

• The episode critiques a 2026 systematic review and meta-analysis, with a focus on study design choices like sibling comparisons, adjusted observational data, validated outcomes, and risk-of-bias assessment.

• We discuss why confounding by indication matters when the exposure is a medication used for fever, pain, or illness during pregnancy.

• We contrast the 2026 systematic review with the 2025 Navigation Guide paper and ask whether environmental health methods can be directly applied to pregnancy medication safety questions.

• Drs. Quade and Pressman help translate the evidence into real-world counseling about uncertainty, risk, benefit, and trust.

• When headlines move faster than evidence, how should clinicians and patients decide what's actually worth changing? ------> Tune in to find out!

References

1. [Episode Study] D'Antonio F, Flacco ME, Della Valle L, Prasad S, Manzoli L, Samara A, Khalil A. Prenatal paracetamol exposure and child neurodevelopment: a systematic review and meta-analysis. Lancet Obstet Gynaecol Womens Health. Published online January 16, 2026. doi:10.1016/S3050-5038(25)00211-0
2. Prada D, Ritz B, Bauer AZ, Baccarelli AA. Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology. Environmental Health. 2025;24:56. doi:10.1186/s12940-025-01208-0
3. American College of Obstetricians and Gynecologists. Acetaminophen Use in Pregnancy and Neurodevelopmental Outcomes. Practice Advisory. Published September 22, 2025. Accessed April 13, 2026.
4. Bérard A, Cottin J, Leal LF, et al. Systematic Review and Meta-Analysis: Acetaminophen Use During Pregnancy and the Risk of Neurodevelopmental Disorders in Childhood. J Am Acad Child Adolesc Psychiatry. 2026;65(4):484-504.
5. Sheikh J, Allotey J, Khashan AS, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141.
6. Lee PC, Chen CY, Pan ML, et al. Maternal Acetaminophen Use and Child Neurodevelopment. JAMA Pediatr. Published online March 9, 2026. doi:10.1001/jamapediatrics.2026.0071.

Welcome back to What's it Worth! Join your host, Dr. Diana Langworthy, and guest host Tim Haas, PharmD Candidate 2028, as they break down the COBRRA trial — a head-to-head comparison of apixaban vs. rivaroxaban for the treatment of acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).

For years, clinicians have debated whether one DOAC may carry a lower bleeding risk than another, despite both apixaban and rivaroxaban being widely used first-line therapies for acute VTE. Did the COBRRA trial finally give us a clearer answer? Let's dive in and see what it's worth!

• COBRRA was a randomized trial comparing apixaban vs. rivaroxaban in patients with acute symptomatic DVT and PE, with a primary focus on clinically relevant bleeding risk.
• The trial included a broad real-world VTE population, including patients with both provoked and unprovoked thromboembolism, pulmonary embolism, and deep vein thrombosis.
• We break down the Kaplan-Meier curve for clinically relevant bleeding and discuss what the timing of events may tell us about differences between these DOAC regimens.
• The study used a prospective randomized open-label blinded endpoint (PROBE) design, giving us an opportunity to discuss pragmatic trial methodology and real-world applicability.
• Which patients with acute VTE might benefit most from apixaban over rivaroxaban from a bleeding risk perspective? ------> Tune in to find out!

1. [Episode Trial] Castellucci LA, Chen VM, Kovacs MJ, et al. Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. N Engl J Med. 2026;394(11):1051-1060. doi:10.1056/NEJMoa2510703
2. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):e545-e608.
3. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism. Circulation. 2026. doi:10.1161/CIR.0000000000001415.
4. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism. Blood Adv. 2020;4(19):4693-4738.
5. Agnelli G, Buller HR, Cohen A, et al. Oral Apixaban for the Treatment of Acute Venous Thromboembolism. N Engl J Med. 2013;369:799-808.
6. The EINSTEIN Investigators. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med. 2010;363:2499-2510.
7. Beyer-Westendorf J, Lensing AWA, Arya R, et al. Choosing wisely: the impact of patient selection on efficacy and safety outcomes in the EINSTEIN-DVT/PE and AMPLIFY trials. Thromb Res. 2017;149:29-37.

Welcome back to What's it Worth! For over 70 years, the treatment of schizophrenia has been synonymous with dopamine D2 receptor blockade—until now. Join your host, Dr. Diana Langworthy, and guest Dr. Alexandra Rola (Psychiatry Clinical Pharmacist and Assistant Professor at Binghamton University) as they dive into the EMERGENT-3 trial. We're dissecting the efficacy and safety of xanomeline-trospium, a first-in-class muscarinic agonist that targets psychosis without the traditional side effects of dopamine antagonists. Is this the breakthrough psychiatry has been waiting for? Let's dive in and see what it's worth!

Key Points

• Unlike traditional antipsychotics, xanomeline is a dual M1/M4-preferring muscarinic receptor agonist. By pairing it with trospium (a peripheral muscarinic antagonist), the "KarXT" combination aims to deliver CNS antipsychotic effects while minimizing peripheral side effects like nausea and vomiting.
• In this 5-week, Phase 3 trial of 256 adults with acute psychosis, xanomeline-trospium demonstrated a statistically significant and clinically meaningful 9.4-point greater reduction in the PANSS total score compared to placebo by week 5.
• The study showed significant improvements in both the Positive Syndrome Scale (hallucinations/delusions) and the Negative Syndrome Scale (social withdrawal/apathy), suggesting a more holistic impact on schizophrenia symptoms.
• While it avoids dopamine-related side effects, KarXT is associated with cholinergic-driven GI issues; nausea, dyspepsia, and vomiting were the most frequently reported adverse events.
• What are the ethics of a placebo controlled trial in acute psychosis when we have proven medications for treatment? Join us for an important conversation about equity and ethics in clinical trials.
• Can we treat psychosis without touching a single dopamine receptor? ------> Tune in to find out!

References

1. [EPISODE TRIAL] Kaul I, Sawchak S, Walling DP, et al. Efficacy and Safety of Xanomeline-Trospium Chloride in Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry. 2024;81(8):749-756. doi:10.1001/jamapsychiatry.2024.0785
2. World Medical Association. WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants. Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the 75th WMA General Assembly, Helsinki, Finland, October 2024.
3. Waltz JA, Pujji SD, Colloca L. Placebo and nocebo phenomena in schizophrenia spectrum disorders: a narrative review on current knowledge and potential future directions. Psychol Med. 2025 Jul 18;55:e199. doi: 10.1017/S0033291725100901. Erratum in: Psychol Med. 2026 Feb 02;56:e37. doi: 10.1017/S0033291726103493.
4. Gara MA, Vega WA, Arndt S, et al. Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry. 2012 Jun;69(6):593-600. doi: 10.1001/archgenpsychiatry.2011.2040.
5. Lawrence RE, Appelbaum PS. Ethics in placebo-controlled, acute treatment trials in schizophrenia: Two rival ethical frameworks. Schizophrenia Research 264 (2024) 372-377.

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

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

Guest Information

Alexandra Rola, PharmD

Clinical Assistant Professor, Pharmacy Practice, Binghamton University

Psychiatry Clinical Pharmacist