Impella, Mammograms and Med School Fails Students
VP fixed the audio 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
Jun 26, 2024•45 min
Sensible Medicine
Common sense and original thinking in bio-medicine
A platform for diverse views and debate
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Episodes
Fear and Opioids in Academic Medicine
Regard for power implies disregard for those without power; part 3 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
Jun 21, 2024•8 min
A discussion with interventional cardiologist Dr David Cohen on medical evidence, TAVR and stroke prevention
David Cohen is one of the smartest docs on Twitter. I learned a bunch talking with him. The procedure called transcatheter aortic valve implantation or TAVR is a damn miracle. In days of old, a heart surgeon would have to saw open the chest and cut out the heavily calcified immobile aortic valve and sew in a new one. I watched a case as a young doctor and came away shocked that patients survive this surgery. TAVR is even more stunning. Doctors place a valve up the aorta, across the diseased valv...
Jun 16, 2024•43 min
Adam and I discuss the week's medical news
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
May 30, 2024•39 min
Cifu, Prasad, Mandrola
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/subscribe
May 27, 2024•45 min
Friday Reflection #39: What to Expect When You Are Aging
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-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. I’ve already written a reflection on four things patients...
May 17, 2024•6 min
A Novel Approach to AF Ablation
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 elimination of AF, but when they are restudied, they have reconnection of PV activity. Observations like these suggest there is something else happening with...
May 16, 2024•40 min
Video version of our podcast
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/subscribe
May 11, 2024•42 min
Cifu, Mandrola, Prasad
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/subscribe
May 10, 2024•42 min
A Discussion with Dr. Dena Zeraatkar regarding analytic flexibility in observational studies
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 McMaster University in the Health Research Methodology graduate program. Following her doctoral training, she pursued postdoctoral training at Harvard...
Apr 30, 2024•23 min
Friday Reflection 38: Yesterday’s Solutions; Today’s Problems
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
Apr 12, 2024•10 min
Yet Another Excellent Explainer About P-Values in Randomized Trials
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 gist of it though is really important when we look at evidence. Erik did an excellent job of explaining P-values, trial power, and, at the end, we dis...
Apr 04, 2024•44 min
Friday Reflection 37: Why I Teach (acceptable and less acceptable reasons)
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
Mar 08, 2024•8 min
Friday Reflection 36: Why Don’t Doctors Want to See Patients?
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/subscribe
Feb 02, 2024•8 min
New Austrian Study Shows Boosters do NOT reduce COVID19 deaths in people who had COVID
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
Jan 25, 2024•8 min
Math Professor Ben Recht and I Discuss P-values and Confidence Intervals
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 paper in NEJM evidence. But we mostly talk basics. Ben writes at his Substack arg min This is a public episode. If you'd like to discuss this with other s...
Jan 18, 2024•49 min
A discussion with the primary investigator of the world's first placebo-controlled AF ablation trial
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 Bartholomew hospital in London UK and primary investigator of the study. They recently published their feasibility study for AF ablation vs placebo. ...
Dec 22, 2023•19 min
Mandrola and Prasad are back
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
Dec 17, 2023•51 min
Mandrola and Prasad are back
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
Dec 17, 2023•50 min
Friday Reflection 35: Four Who Fired Me
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
Dec 15, 2023•9 min
Friday Reflection 32: The Trauma of Not Dying Alone
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/subscribe
Nov 03, 2023•8 min
Soren Diederichsen on Atrial Fibrillation Screening
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 Severity and Etiology of Incident Stroke in Patients Screened for Atrial Fibrillation vs Usual Care and the Impact of Prior Stroke: A Post Hoc Analysis o...
Nov 01, 2023•36 min
Andrew Foy has a Different Conclusion on a Big JAMA paper on CV risk reduction
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 both a person and a population. But paying health systems to do specific things is a policy intervention. Even though a policy, like this one, makes s...
Oct 23, 2023•53 min
Friday Reflection 31: Senses, Memories, and Medicine
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
Oct 20, 2023•6 min
Sudden cardiac death and arrhythmias in athletes
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 Bronny James, son of Lebron James. These high-profile cases have highlighted the issue of sudden cardiac death of athletes. Dr. Dorian has published ext...
Oct 18, 2023•54 min
Prasad's lecture gets cancelled/ Cifu Gets COVID
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
Oct 16, 2023•55 min
New Podcast -- Discussion with Rita Redberg and Angela Lu regarding Their Study on Conflict of Interest
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 products, they mean business. Such decisions have huge implications. You cannot go against them. Think #HighConsequences. CMS studies the evidence a...
Oct 05, 2023•35 min
Foy and Mandrola Talk Coronary Calcium and a New Super-Exciting Approach to Medical Education
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 posts and support our work, consider becoming a free or paid subscriber. The second part of our conversation centers on a big med-ed project Andrew ...
Sep 27, 2023•1 hr 5 min
Foy and Mandrola Discuss AF, AF-Ablation, Sham-controls, Evidence Translation and Heterogenous Treatment Effects
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 no sham control. We referenced this useful review paper on placebo and nocebo effects in cardiology, from Brian Olshansky. Our second topic was the FR...
Sep 19, 2023•40 min
Coumadin beats DOAC, ECMO fails, When RCTs needed, Bad COVID Policy
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
Sep 11, 2023•49 min
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