This is a long one! 83 minutes. This is the second podcast in which we answer questions from a our “ask us anything” post. We recorded this one before our most recent podcast — kind of like Abbey Road and Let it Be — so we were still graced by Vinay’s presence. In fact, we recorded it in his studio. We still have about a half dozen questions to ans…

John and Adam discuss our hopes for Vinay’s tenure at the FDA and how we intend to keep Sensible Medicine a vibrant place on Substack, a place where we will continue to showcase a range of ideas and opinions about all things bio-medicine. We also answer some of the questions from our recent “ask us anything” post. This is a public episode. If you'd…

FH is a 66-year-old woman who comes in for an urgent visit because she has been feeling woozy for two days. She is very anxious, almost distraught, because she thinks these symptoms are the same as the ones that her sister had before she died of a hemorrhagic stroke. Sensible Medicine is a reader-supported publication. If you appreciate our work, c…

Professor Jeffrey Flier is a distinguished service professor and Higginson Professor of Physiology and Medicine at Harvard Medical School. He is the former dean of Harvard Medical School. We talked about the recent (and sudden) change in NIH funding. First a note on Professor Flier. He is not a normal medical school dean. He is active online. He sp…

We are back with a riveting discussion 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

I recently recorded a conversation with Michael Easter from the TWO/PERCENT, a Substack and podcast. Michael offers “practical, accurate, and useful health, performance, and mindset information,” and in a space where there is a lot of drive, I find him remarkably thoughtful. Our conversation is on the podcast feed. Below are my notes for our conver…

Doctors often get credit (or blame) for having to make difficult, life-and-death decisions. But really, it is all of us, when we are patients, who make the bravest decisions that carry the highest stakes. 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/subscr…

I have long followed the work of Dr. Margaret McCartney. She is a general practitioner in Glasgow, Scotland, writer, public speaker, and now PhD. She is a fierce advocate for evidence-based medicine. She holds highly skeptical views of screening for disease—which, to my surprise is quite common in the UK. Her recently finished PhD sought empirical …

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

I had the pleasure of being interviewed by Michael Easter. Michael is behind the TWO/PERCENT Substack where he offers “practical, accurate, and useful health, performance, and mindset information.” I’ve listened to, and read, a bunch of Michael’s content. Not only is it enjoyable but it seems, well, sensible. Our conversation was inspired by my Com…

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

What does our philosophy have to do with RFK Jr and MAHA? 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, John Mandrola, and Andrew J Foy

4 mistakes people make in systematic reviews 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

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

The woman with palpitations. The man with whom you used to joke and trade barbs who now sits silently, absent, while you talk to his wife. The woman whose depression dominates every visit; her depression being the one problem she refuses to address. The man whose joy and charisma makes every visit an absolute pleasure, despite his painful disabilit…

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 podcast is one of three we will be posting to answer the questions that came to us in response to this post. We had a nice set of questions so we will certainly be doing it again. 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…

I learned a lot from Elizabeth Fama’s multipart series on the back-to-sleep recommendation for infants. She agreed to put the entire series into an audio file. Here you go. JMM Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. This is a public episode. If you…

Ask general internists what they love about their field, and they are likely to talk about long-term relationships with patients and the pleasure of solving clinical puzzles. 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…

My lecture to the cancer care staff at a county hospital. 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

Even when a decision is clear, and things turn out badly, the lack of a counterfactual allows endless second guessing. 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

I discuss how medical students are selected, and perhaps how they should be selected. 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

Remarks about a model clinician. 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

It would be foolish to argue that doctors are unaffected by how they are treated by patients. Their treatment may not affect the care they deliver and only affect how they feel at the end of the day. It is probably impossible to know. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, vis…

When I type the words coronary artery disease I bet that you picture angiograms with stenotic lesions—blockages in colloquial language. Indeed a high grade plaque from atherosclerosis in the inside of a coronary artery can limit flow to the heart muscle. But. But. Not as much as you think. You know why? Because there is something called the coronar…

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/subscribeBy Vinay Prasad, Adam Cifu, MD, and John Mandrola

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/subscribeBy Stefan G. Kertesz, MD, MSc

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 doc…

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…