The Internal Medicine Insider
Q2 2025: Three Breakthroughs You Need to Know
AI just outperformed doctors in clinical decision-making. And that's not even the biggest story from the past three months.
While you were managing the usual chaos of clinic and consults, researchers dropped bombshell after bombshell that will fundamentally change how we practice internal medicine. We're talking first-ever proven therapies for conditions we've been managing symptomatically for decades.
Let me walk you through what actually matters from the research avalanche—the stuff that will change your practice, not just fill journal pages.
The Big Three Game-Changers
1. We Finally Have a Drug That Works for HFpEF + Obesity
Remember all those HFpEF patients with obesity you've been managing with "lifestyle modifications" and prayer? Tirzepatide just changed the game completely.
The SUMMIT trial results are stunning: 46% reduction in heart failure events (8.0% vs 14.2%). We're talking about the first medication ever proven to actually help these patients instead of just managing their symptoms.
The mechanism isn't just weight loss—though the average 15% weight reduction is impressive. We're seeing real cardiovascular protection: 5 mmHg drop in systolic BP, significant reduction in estimated blood volume, and a 37% decrease in inflammatory markers.
Bottom line: That HFpEF patient with BMI >30 sitting in your clinic tomorrow? You finally have something evidence-based to offer beyond dietary counseling.
2. MASH Has Its First Real Treatment
Semaglutide's ESSENCE trial just delivered what hepatologists have been dreaming about: 62.9% of patients achieved steatohepatitis resolution versus 34.3% with placebo.
Even better? 32.7% achieved both resolution AND fibrosis improvement. We're not just talking about marginal benefits here—this is disease modification for a condition that affects millions of your diabetic patients.
Clinical reality check: Start thinking about which of your T2DM patients with elevated ALT might benefit. This is likely heading for FDA approval soon.
3. AI Actually Beat Doctors (In a Head-to-Head Study)
Here's the one that's going to spark heated discussions at your next department meeting. In virtual urgent care settings, AI recommendations were rated superior to physicians by expert reviewers. When AI and doctors disagreed, AI was rated better nearly twice as often.
This isn't theoretical anymore. AI tools are already being integrated into clinical workflows, and the performance data is getting harder to ignore.
What this means: Start paying attention to AI-assisted diagnostic tools. Your patients probably already are.
The Clinical Pearls That Matter
Thoracentesis in acute heart failure? The TAP-IT trial says hold your horses. Upfront thoracentesis showed no benefit over medical therapy alone. Sometimes our clinical intuition doesn't match the data. TAP-IT trial results
Weekly insulin is here. Efsitora alfa delivers comparable A1C reduction to daily degludec while cutting injections from 365 to 52 per year. Your insulin-resistant patients might actually stay compliant. QWINT-2 weekly insulin trial
Lung nodule biopsies just got safer. Navigational bronchoscopy achieved 79% diagnostic accuracy with only 3.3% pneumothorax rate versus 28.3% for transthoracic biopsy. Time to rethink your referral patterns. VERITAS trial - navigational bronchoscopy
What You Need to Do Monday Morning
Review your HFpEF patients with obesity—identify candidates for tirzepatide if/when it gets approved for this indication
Look at your diabetic patients with elevated liver enzymes—consider which ones might benefit from semaglutide for MASH
Talk to your pulmonologist colleagues about navigational bronchoscopy for the next lung nodule referral
Start familiarizing yourself with AI diagnostic tools your institution might be implementing
The Smart Summary: 5 Bullet Points for Rounds
• Tirzepatide reduces heart failure events by 46% in HFpEF patients with obesity—the first evidence-based therapy for this population
• Semaglutide resolves MASH in 63% of patients—potentially the first FDA-approved treatment for this condition
• AI outperformed physicians in clinical decision-making studies—no longer theoretical, this is happening now
• Navigational bronchoscopy beats transthoracic biopsy for lung nodules—79% accuracy with dramatically fewer complications
• Multiple first-in-class therapies are entering practice simultaneously—internal medicine is evolving faster than ever
Before You Go...
This quarter delivered more practice-changing research than most entire years. The convergence of breakthrough therapies with advanced diagnostic technologies means we're entering a new era of precision, technology-augmented internal medicine.
Found this useful? Share it with a colleague who needs to know about these developments. And if you want to stay ahead of the curve on research that actually matters for your practice, make sure you're subscribed for our next quarterly roundup.
The landscape of internal medicine is changing rapidly. The question isn't whether these innovations will affect your practice—it's whether you'll be ready when they do.
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Essential Reading for Deep Dives
Cardiovascular Breakthroughs: • SUMMIT Trial - Tirzepatide for HFpEF • TAP-IT Trial - Thoracentesis in Heart Failure
Metabolic Medicine Revolution: • ESSENCE Trial - Semaglutide for MASH • QWINT-2 - Weekly Insulin
Diagnostic Innovation: • AI vs Physicians Clinical Study • AI in Medicine - Harvard Analysis
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