The fact that GLP-1 receptor agonists (like Ozempic and Mounjaro) are the most powerful weight loss drugs ever is NOT the most interesting thing about them. More stuff keeps coming out - and the effects are just wild. This week? A reduction in dementia risk. Breakdown below. This week, for @medscape, I reviewed this article, appearing in @jamaneurology. It's the first real meta-analysis of the effect of glucose-lowering drugs on dementia focusing solely on randomized trials. buff.ly/J5PXkL8

The GLP-1 receptor agonists (like Ozempic and Mounjaro) are wildly effective weight-loss agents. But are they COST-effective? That's a trickier question. And a new study just out in JAMA Health Forum provides an answer. A resounding "no."
(Thread) For those of you who like reading articles in the traditional way, please check out my weekly column @Medscape. Good comments there too.
buff.ly/4IhGleH

If you were on social media during the pandemic, you came across #DiedSuddenly.
Stories of young people, healthy, suffering fatal cardiac arrest out of nowhere. The implication? Those evil vaccines.
It was all bullshit. But I want to talk about why it was so effective.
🧵 Before we dive in, I have a bit longer version of this thread @medscape: buff.ly/4keHNvW

NIH has announced a cut in the "indirect rate" to 15% across the board, in a move that appears to be retroactive to even existing grants. This is a bloodbath for research institutions throughout the country.
Brief explainer for those not in this world:

buff.ly/3EtML7D If I am awarded a grant for the NIH, it covers my budget for the research study. It ALSO awards a percentage of that budget (over what I need for the study) to Yale, my institution. That overage is called the indirect rate.

This thing keeps happening with ultra-processed food research and it's very confusing to me. People seem to be searching for a link with bad health outcomes that is *independent* of caloric intake. Like... folks... that's the link. (brief 🧵) I think I got on this kick with the JFK hearings. There was... a lot there. His thoughts about UPF actually come close to the mark though. Except he did this thing that a lot of people do - he blamed the health outcomes of UPF intake on the chemicals and additives and stuff.

Every week, I see a new study talking about this or that effect of GLP-1 receptor agonists like #ozempic. FINALLY, we have a study evaluating all the outcomes (good and bad) in one dataset. There are some... surprises. 🧵 Kudos to @zalaly for this analysis, appearing in @NatureMedicine.
You can find the primary source here: buff.ly/4jm6iqC
And my (more in depth) @medscape column here: buff.ly/4gZtbyu

(Or stick with me on this thread).

Data keeps emerging that suggests GLP-1RAs like #Ozempic curb all sorts of appetites... not just appetite for food. Brief thread on some new findings... They aren't the splashiest articles, but studies keep suggesting Ozempic has these "off-target" effects. Here's one showing the drug reduces alcohol intake...
nature.com/articles/s4159…

Well we finally got an Ozempic vs. Mounjaro head-to-head (kind of)... Brief thread to break down the weight-loss-drug showdown... Appearing today @JAMAInternalMed, we have this study, which is probably the closest we'll get to a semaglutide (Ozempic), tirzepatide (Mounjaro) randomized trial. (See my article @medscape for why we almost never get real trials of competitor drugs).
medscape.com/viewarticle/mo…

This week, we have an interesting article in @JAMA_current which finds that adding three biomarkers that are clearly associated with cardiovascular disease to an existing risk equation does NOT improve the predictive ability of that equation. How does this happen?
🧵 I want to take a minute to try to break our intuition that strength of association and strength of prediction are the same thing (or even necessarily related). An an example, I made up some fake data.
We have 10,000 people, followed for 10 years. 2000 Die. (Yikes).

I've definitely noticed this phenomenon in American diet culture of late.
But high-protein diets may not be all they are cracked up to be. Why? A new study in Nature Metabolism puts the blame squarely on a single amino acid: leucine.
🧵 OK there are three macronutrients. Your caloric intake will be comprised of some combination thereof, and basically all of the diet wars of the last 40 years can be cast in terms of macro content.

Does it seem like your hospital patients are getting more... complicated? They are!
🧵 Just went through this paper from @JAMAInternalMed which, like all good papers, comports with my prior beliefs ;-). No but seriously, I definitely feel like hospital complexity is rising.

I believe that RNA therapeutics will completely transform medicine. Imagine a future where, instead of taking medications daily, you take a shot maybe once a year. That future is, basically, here.
🧵 Currently, this is more or less how our drugs work. They do something to a protein. Inhibit it, cleave it, block its binding to some receptor, speed its degradation, etc.

AI in Medicine is suffering from what I would like to call "The Cassandra Problem"
🧵(1/17) I am thinking about this issues this week thanks to this study, appearing in @JAMANetworkOpen, which examines the utility of a model that predicts blood clots in hospitalized kids. (2/17)

Absolutely fascinating @JAMA_current paper this week suggesting that Cerebral Amyloid Angiopathy may actually be infectious. (Thread) The background here is that CAA is the second most common cause of intracerebral hemorrhage (brain bleed) after hypertension. There are some genetic causes, but most are thought to be idiopathic. Just amyloid getting deposited for no clear reason.

37 degrees Celsius, 98.6 Fahrenheit. That's normal body temperature, right?
Wrong.
New data suggests true "normal" is 98.0 degrees. (thread) We get 98.6 degrees from this guy Karl Wunderlich, who measured 1,000,000 temperatures from 25,000 Germans in the mid 1800s. He was really the first to realize that "fever" was not itself a disease, but a symptom of a disease.

A million tweets echoing the headline "#sucralose is toxic to your DNA" but, like, has anyone read the actual study this is based on? Let's dig in. (thread/) This is the study that the articles are based on, appearing in the Journal of Toxicology and Environmental Health.
tandfonline.com/doi/full/10.10…

This week - in my ongoing series "Is That Thing You Eat Everyday Secretly Killing You?!" - #Erythritol!

I want to dig into a nice @NatureMedicine paper that suggests the sugar substitute might increase the risk of cardiovascular disease. (Thread/) Erythritol is a non-nutritive sweetener used in all sort of products - toothpaste, gum, especially "keto friendly" stuff. Also monkfruit sweetener. It does NOT need to be labeled "artificial" since it can be found (in small quantities) in nature.

You have probably heard that CBD "mellows" the effects of THC in edibles. That is takes the edge off, decreases anxiety, etc.
According to this study in @JAMANetworkOpen, CBD makes THC much stronger. Thread/
jamanetwork.com/journals/jaman… I wrote about this in more detail in my @medscape column here, but briefly this is a small, but cleanly designed, randomized pharmacokinetic study.
medscape.com/viewarticle/98…

Two years ago, I started writing "How Medicine Works and When It Doesn't" to help people understand the insidious nature of medical misinformation.
That's how it started. It's not where I ended up. (thread)
grandcentralpublishing.com/titles/f-perry… To be sure, we live in the disinformation age. We are awash in facts - some true, some false. We can literally pick and choose which we want to believe. I open the book with a chapter on motivated reasoning for just this reason.

Very nice, systematic study of WHY covid mRNA vaccines (rarely) cause myocarditis from @LaelYonker in @CircAHA.
Points the finger squarely at "free spike protein". Here's a brief thread (1/N).
ahajournals.org/doi/abs/10.116… This is a case-control study looking at 16 kids with post-vaccine myocarditis and 45 kids who had no adverse reaction to vaccine. Match was ok, though more boys in myocarditis group (2/N).

Excited to share our new study in the Journal of Hypertension examining the effect of IV antihypertensives on hospitalized patients with severe htn. Outstanding work from @lama_ghazi on this.
Brief thread (1/N) Over a four-year period, we identified 20,383 inpatients who were NOT admitted for hypertensive urgency / emergency and were not in the ICU but had SBP>180 or DBP>110.
(2/N)