This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad

A spirited discussion of craziness in medicine This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, Adam Cifu, MD, and John Mandrola

MM is 94 years old. Her only active medical issues are hypertension and vitamin D deficiency. She takes only 20 mg of lisinopril and 1000 units of vitamin D3 each day. She has no cognitive decline and gardens every day if the Chicago weather allows. Her Friday afternoon appointment is the doctor’s last of the week. Sensible Medicine is a reader-sup…

A few short words about our conversation: Two decades have passed and electrophysiologists have learned little about how to ablate atrial fibrillation. Now, and then, we simply ablate circles around the orifices of the pulmonary veins. This works reasonably well. But we don’t—exactly—know why it works. For instance, some patients have total elimina…

We discuss the state of medical education, Harvard music video, causal language at JAMA and more This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, Adam Cifu, MD, and John Mandrola

Video will be available to paid subscribers This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, Adam Cifu, MD, and John Mandrola

Gosh was this a great conversation about her recent paper on specification curve analysis of nutritional observational studies. Here is Dr. Zeraatkar’s bio: Dena Zeraatkar, PhD is an Assistant Professor in the Departments of Anesthesia and Health Research Methods, Evidence, and Impact (HEI) at McMaster University. She earned her doctoral degree at …

The Thomas Sowell quote, “On closer scrutiny, it turns out that many of today's problems are a result of yesterday's solutions” has been ringing in my head a lot lately. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe…

Gosh was I lucky to speak with Professor Erik Van Zwet from Leiden University in the Netherlands. He is the first author on a recent NEJM Evidence paper looking at more than 23,000 trials in the Cochrane Database. (I linked to an URL that should get by the paywall.) There are technical aspects of this paper. We hit on some (not a lot) of them. The …

Why have I been committed to medical education? Some of the reasons are admirable but not terribly novel. Others are a bit hard to admit, but just as true. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe…

Friday Reflection 35: Why Don’t Doctors Want to See Patients? I was asked “Why is it that doctors don’t want to see patients?” and I could not answer the question. Fourteen months later, here is my response. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/sub…

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad

Ben Recht is a professor at UC Berkeley. You know, the place that has all those parking spaces for the Nobel laureates. He understands the innards of math. And that is exactly why he explained that doctors who use evidence don’t have to get bogged down in technicalities. I reached out to Ben to discuss a complicated but provocative statistical pape…

As many of you know, I have long argued (unsuccessfully until now) for a placebo-controlled trial of AF ablation. One group gets the ablation; the other gets a placebo or sham procedure. This way we can sort out the placebo-resistant effect of the ablation. Finally, here is the first report of one. Dr. Malcolm Finlay is an electrophysiologist at St…

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad and John Mandrola

These patients did the right thing leaving my care. We were wrong for each other, or I had given what I had to offer (at the time) and it was not enough. That does not lessen the feeling that I failed. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe…

They say dying alone is sad. They also say we all die alone. There is trauma to not dying alone as well. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

If you care about AF you will love this conversation. Soren has some interesting ideas about what AF is now vs what AF was in the past. Here are some links:The LOOP Study (which was non-significant). Effects of Atrial Fibrillation Screening According to N-Terminal Pro-B-Type Natriuretic Peptide: A Secondary Analysis of the Randomized LOOP Study Sev…

The study in question is a randomized clinical trial looking at the Million Hearts Model. This model paid health care organizations to assess and reduce CV risk. Obviously, this is an important goal. Heart disease, specifically, atherosclerotic vascular disease, is a leading killer of humans. Any reduction of heart disease should have a benefit on …

Friday Reflection 31: Senses, Memories, and Medicine Medical training introduced me to a whole menu of smells -- both diagnostic tools and reminders of times in my career. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe…

Sudden cardiac death due to ventricular rhythm disturbances are rare but highly public. It’s strange and curious because you don’t expect healthy athletes to suffer serious cardiac issues. Recently three prominent athletes have survived sudden cardiac death. Christian Erikson, a Danish soccer player, Damar Hamlin, an American football player and Br…

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, Adam Cifu, MD, and John Mandrola

Angela Lu is training to be a physician. She’s interested in public policy. As a third year medical student, she teamed up with established leaders to ask a unique question regarding public disclosure of financial relationships. When the Centers for Medicare & Medicaid Services (CMS) issues National Coverage Determinations (NCDs) for services or pr…

Andrew Foy rejoins the Sensible Medicine podcast. We talk first about coronary artery calcium. Andrew is an expert in this area. We have co-written our case against CAC scoring for any cause in the American Family Physician. It’s had little effect as CAC scoring is running rampant. Sensible Medicine is a reader-supported publication. To receive new…

This week, I talk with Andrew Foy, who is an academic cardiologist at Penn State University in Hershey, PA. Andrew is one of the smartest voices in medicine today. We start with the REMEDIAL trial, published recently in JAMA. Ablation vs Meds. Primary endpoint—depression and anxiety. One of the main issues was the control arm—namely that there was …

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad and John Mandrola

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

Sensible Medicine Sensible Medicine x Vaccine Curious Cross Podcast on the USA vs Denmark, vaccines, etc: Show notes by Dovid Y Rimmer, Tracy Beth Høeg and Christine Stabell Benn * Benn, Høeg. Regarding becoming a medical skeptic. Hoeg: anonymous blog - exercise during pregnancy. Benn: Vitamins, sex differences, and vaccines. * Differences in pande…

Although it is unoriginal to point out that doctors learn from our patients, here are a few lessons so powerful, so extrapolatable, that I forever associate them with an individual. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe…

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad

Here is the profile for Harvard Professor Robert (Bobby) Yeh. His most recent Circulation paper: Bringing the Credibility Revolution to Observational Research in Cardiology. We referenced a paper by Professor Miguel Hernan: The C-Word: Scientific Euphemisms Do Not Improve Causal Inference From Observational Data Paper referenced on left ventricular…

BW was a 66-year-old woman who presented for an urgent visit to the general medicine clinic. She reported that she had been having dizziness for the last four days. When pressed, she said it occurred intermittently, being present more than absent. She could not identify any palliative or provocative features, and when asked about associated symptom…

There is something valuable about learning to adapt old skills to novel situations. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

Adam and I discuss three topics I) The MIND Trial published in NEJM. Does a special diet reduce the future risk of cognitive decline? II) HFpEF — I am speaking at a congress on heart failure with preserved ejection fraction this week, and Adam helps me out with some pointers. III) NYT published a Sunday front page story on potential overuse of proc…

Four pieces of advice nobody asked for. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

KW was a 58-year-old man with long standing type 1 diabetes mellitus and hypertension. He came to an appointment one Friday afternoon with chest pain. The pain had been present intermittently for 10 days. It was on the left side of his chest and beneath his sternum. It did not radiate anywhere, it was not related to exertion, nor was it associated …

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, Adam Cifu, MD, and John Mandrola

This ghost panel is made up of people who used to be my patients but no longer are — people who left my practice without telling me. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

Links The Case for Being a Medical Conservative https://www.amjmed.com/article/S0002-9343(19)30167-6/fulltext ELAN Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2303048 Mandrola on NYC Residents’ Strike https://www.medscape.com/viewarticle/992607 This is a public episode. If you’d like to discuss this with other subscribers or get access to bon…

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad and John Mandrola

I visit the binder to pay my respects, to learn, to reminisce, and to trace the arc of my career. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

Medicine in America will be better, more humane, and more affordable with more good, smart, dedicated primary care physicians. Be part of the solution. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, John Mandrola, and Adam Cifu, MD

Why did it take years for me to reach a time in my career when I am comfortable admitting knowledge gaps? This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad and John Mandrola

When patients meet a new doctor, both patient and doctor should be aware of each other’s philosophy. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Vinay Prasad, John Mandrola, Tracy Beth Høeg, MD, PhD, and Adam Cifu, MD

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy John Mandrola, Adam Cifu, MD, and Vinay Prasad

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribeBy Adam Cifu, MD