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)

Brief thread on that "masks in schools" article in @nejm. It's a very well done article that I think many people have not actually read...
1/N The setup is starightforward. Cowger et al have access to data on 300,000+ students and teachers COVID tests in 70+ Eastern Mass public school districts. (2/N)

When does the pandemic end?
I think ending isolation requirements for those infected with COVID is a necessary and sufficient requirement to declare the end of the pandemic. To be clear, we can't do this yet. But it might not be that far off. 🧵 medscape.com/viewarticle/96… 2. I've had a few goalposts for the end of the pandemic. I abandoned covid eradication when I saw the data on animal reservoirs. Elimination seems increasingly unlikely given the vaccine breakthrough rate with omicron.

I need to tell you a story from the early days of the pandemic.

April 2020. COVID was spiking in CT. 450 out of the 1000 beds in our hospital were COVID patients. The ICUs were full - and two extra floors were converted to ICUs to make room. I was seeing kidney consults. There was a lot of them. We learned early on that COVID ramped up the risk of acute kidney injury. (We also knew early that clotting was a problem since our dialysis membranes kept failing).

With the #DeltaVariant, the equation on opening schools has changed. Masks and ventilation may not be enough to protect our kids and prevent community spread. We have a new weapon this school year, though - antigen tests.
(1/7) Antigen tests are cheap, fast, and - critically - don't need a central lab to run.
But you've heard that they aren't as sensitive as PCR tests, and that is true...
(2/7)

How can we be most rational about rare adverse events after vaccination? I discussed the risk of #GuillainBarre syndrome after the @JNJNews #vaccine with @ShyannMalone this morning. Some thoughts in this thread (1/n)
2. I have been speaking with several "on the fence" people. Not yet vaccinated, not fully opposed to vaccination. They are all intelligent, thoughtful individuals. They can quote me the numbers in terms of risk, and acknowledge the very low risk of adverse events post-vaccine.

Do we need a third dose of @pfizer #vaccine? I spoke with @ShyannMalone about the data (and lack thereof). Key point to remember: antibodies are *supposed* to decline with time. Not a compelling indication for booster. Show us B/T cell data please. Not enough time to discuss "why not?" - as vaccines are safe, effective, and plentiful. They are definitely NOT plentiful outside of the US - extra stockpiles could potentially be shared to reduce cases elsewhere (and the variants that arise from them).