My colleague has an interesting idea on vax persuasion
But... Scott Alexander IDs a problem. All 4 folks he suggests are super smart & competent but they aren't optimized only for being correct, they are also optimized for keeping power.
I discussed my experience in clinic with vaccine hesitant patients on This Week in Cardiology podcast podcasts.apple.com/us/podcast/jul…
Point 1: ... patients don't make decisions like odds-ratio-calculating robots. People feel risk.
Some feel more risk from the vaccine than COVID
Point 2: I don't think the average cardiac patient should feel that way and I do my best to persuade them that the clear benefit-harm choice is to get vaccinated.
Yet I make the same argument for anticoagulants, tobacco cessation etc and still many pts don't heed my advice.
The specific message is obviously that based on this study, sac/val has no role over ACE/ARB in post-MI patients with heart failure and LV dysfunction.
We cannot ignore costs of care. And low BP was worse in the ARNI group.
The larger message--there is nearly always a larger message--is that we may have over-estimated this drug class.
It missed significance now in 2 of 3 outcome trials.
In PARAGON-HF of HFpEF and now PARADISE-MI.
Re PARADIGM, we know large effect sizes often don't replicate
This principles in this podcast are so darn important for critical appraisal
@youyanggu lack of prior infectious disease knowledge is a feature not a bug.
It allows a dispassionate interpretation of evidence.
Say it w me: **content expertise is over-rated!**
2/
I’m all about Bayes, but the novel-ness of COVID-19, and the fact that it’s a once-in-a-lifetime pandemic, should reduce (or eliminate) any prior beliefs.
I dare say the frequentist-like approach may have been better for Covid.
4/
NEJM published 2 RCTs of #AFib ablation vs AF drugs.
The rub was that the ablation was done EARLY in the course.
Practice had been to try drugs first then do ablation.
EARLY AF and STOP AF studied the procedure early. #AHA20 Thread and my column >>
Both trials used the Medtronic cryoballoon system.
Medtronic participated in funding both trials.
STOP AF was 100% an industry trial. See pic.
Early AF had funding from many other sources
Background -- numerous trials have shown that AF ablation using different techniques (freezing or burning) can reduce AF episodes relative to meds.
In CABANA -- the largest outcome trial, AF ablation reduced AF but had no sig effect on clinical outcomes like stroke or death.