Discover and read the best of Twitter Threads about #MedicalConservative
Most recents (7)
Excited to share our recently published point-counterpoint paper on halting implantation of the @bostonsci subcutaneous-ICD
The paper is now open access.
A brief thread
The paper is now open access.
A brief thread
Background:
I have used the S-ICD. It has *potential* advantages over the traditional trans-venous ICD system
But it is the newcomer. A #MedicalConservative believes proponents of new stuff must show more than *potential* benefits over the tried and true.
I have used the S-ICD. It has *potential* advantages over the traditional trans-venous ICD system
But it is the newcomer. A #MedicalConservative believes proponents of new stuff must show more than *potential* benefits over the tried and true.
Recent Issues w the S-ICD:
In the first part of the commentary @bogdienache and I focus our argument around:
-Two Class 1 FDA recalls of the S-ICD
-Serious concerns over the PRAETORIAN trial-- the only trial RCT comparing transvenous ICD (standard) to S-ICD
In the first part of the commentary @bogdienache and I focus our argument around:
-Two Class 1 FDA recalls of the S-ICD
-Serious concerns over the PRAETORIAN trial-- the only trial RCT comparing transvenous ICD (standard) to S-ICD
Giving talks in which you don't have a slide deck already made is illuminating. Look what I found out about publication bias>
It was "discovered" in 1979 by Rosenthal content.apa.org/record/1979-27…
How did he do this?
Thread ...
It was "discovered" in 1979 by Rosenthal content.apa.org/record/1979-27…
How did he do this?
Thread ...
He used a variant of ...sit down for this...the Fragility Index, which we reported on in cardiology
ahajournals.org/doi/10.1161/CI…
The criticism was fierce. But I liked it. @ShahzebKhanMD
ahajournals.org/doi/10.1161/CI…
The criticism was fierce. But I liked it. @ShahzebKhanMD
Here's Rosenthal's explanation
I am no stats person but this looks a lot like a fragility concept applied to all studies.
I am no stats person but this looks a lot like a fragility concept applied to all studies.
1/n On peut tirer une leçon importante de ce durcissement de la FDA: c'est que contrairement au discours général qui prétend qu'il faut arrêter d'embêter les firmes pharmas avec des évaluations rigoureuses pour favoriser l'innovation, c'est le contraire qui est vrai>
2/n >si on veut des produits efficaces et utiles il faut, au contraire, accroître les exigences. Il vaut mieux avoir un seul bon produit que 100 produits inutiles. Innovation est un mot valise, un mot symbole du dévoiement de la médecine, du hype et du spin >
3/n Car c'est un mot mal défini qui a une fonction purement marketing. Or, depuis des années, nous surfons sur une idéologie et des pratiques de dérégulation et de détérioration des normes d'évaluation des médicaments au nom de l'innovation.
After a few days to go over the #EXCEL 5 year results published in @NEJM and thinking hard about @DrMoritzWvB tweet on IC and cardiac surgery seeing things quite differently, here are a few thoughts. Glad to hear your thoughts
@tssmn @ctsnetorg @EACTS
1/30
@tssmn @ctsnetorg @EACTS
1/30
2/ Congratulations to the investigators for an outstanding RCT! Important question and results, which will have an impact on guidelines. The protocol was powered for non-inferiority of the composite outcome at 3 years, and congratulations for following these patients to 5 years
3/ why were p-values for secondary outcomes reported selectively? e.g. for revascularization, but not others?
A few words on #prevention.
When I rail against prevention, some assume I am not interested in preventing disease.
This is not true. I am.
I found this paper from @JuanGrvas et al that helps explain my tension about prevention.
cadernos.ensp.fiocruz.br/csp/public_sit…
When I rail against prevention, some assume I am not interested in preventing disease.
This is not true. I am.
I found this paper from @JuanGrvas et al that helps explain my tension about prevention.
cadernos.ensp.fiocruz.br/csp/public_sit…
This article discusses the precautionary principle as it relates to screening and prevention of disease. Here you have 2 concepts--additive preventive measures and reductive preventive measures--taken from G Rose.
I love reductive measures. Avoidance of bad stuff--smoking, donuts, French fries, driving a car too much etc. @nntaleb calls this via negativa artofmanliness.com/articles/via-n…
Thread 1/n Le hype autour de l#Applewatch et de son dispositif de détection des fibrillations atriales (FA) est en train de s'étendre très vite et nous donne un avant-goût des dégâts de l'apporche Big data de la santé. En tant que #medicalconservative je vais tempérer ce hype.
2/n Le hype repose sur trois piliers, à mon avis, des piliers non explicites mais qui jouent un rôle majeur dans l'argumentaire et qui sont de l'ordre des représentations: 1- la technologie c'est merveilleux 2- la technologie "sauve des vies"
3/n 3- le consommateur A LE DROIT d'accéder à tout ce qui peut être consommé et qui suscite son désir.
Twitter thread coming on what @adamcifu @VPrasadMDMPH @AndrewFoy82 and I think is the BEST approach to pt care. This is ...
The Case for Being a Medical Conservative.
amjmed.com/article/S0002-…
Thanks to the @amjmed for publishing this.
The Case for Being a Medical Conservative.
amjmed.com/article/S0002-…
Thanks to the @amjmed for publishing this.
This started when @AndrewFoy82 wrote me a rough sketch of the medical conservative's approach after a journalist criticized those of us who are too skeptical of new therapies.
We begin by stating that the #medicalconservative is not a hater, non-believer or nihilist.
