Sensible Medicine

A lively review of two debated medical studies. First, the discussion examines whether coronary calcium scoring meaningfully improves cardiovascular risk prediction, and the downstream testing it can trigger. Then, a trial of continuous glucose monitoring in non-insulin-treated type 2 diabetes raises questions about patient selection, medication changes, industry influence, and whether better glucose numbers reflect the device or intensified treatment.

Andrew Foy, a cardiologist and medical commentator focused on clinical evidence, joins a lively review of two major studies. They examine why vitamin D failed to prevent fractures in healthy adults and whether catheter ablation offers meaningful quality-of-life benefits beyond a sham procedure for atrial fibrillation. The conversation also explores anticoagulation, monitoring, and why conservative management can preserve future options.

A critical look at trial design, from the POLO pancreatic cancer study and its controversial control arm to the limits of progression-free survival. The discussion then explores multiplicity, showing how flexible analyses, subgroup mining, nutritional research, and conflicting headlines can produce unstable findings. Examples involving Avastin, immunotherapy, preregistration, replication, and underpowered trials reveal why medical evidence can be so difficult to interpret.

Andrew Foy, a physician and evidence-based medicine researcher, joins John Mandrola, a cardiac electrophysiologist and medical commentator. They examine colorectal cancer screening after 75, competing causes of death, and how to discuss stopping low-value testing. They also scrutinize blood P-tau217 tests for Alzheimer’s risk, ambiguous cognitive endpoints, research hype, and the crucial data often buried in supplementary materials.

A critical look at cancer mortality research among pilots and flight attendants, including radiation exposure, confounding, screening differences, and uncertain classifications. The discussion then turns to shorter antibiotic courses for infective endocarditis, examining relapse risk, questionable trial design, and whether stewardship should outweigh proven treatment duration.

A critical appraisal of clinical trial endpoints, from mortality and myocardial infarction to composite measures driven by hospitalizations. The discussion examines heart failure drugs, TAVR trials, surrogate outcomes, placebo comparisons, indication drift, and how multimorbidity can change the balance of treatment benefits and harms.

A sharp tour of how medical evidence can be bent by commercial interests. The discussion examines drug trials, observational studies, adolescent weight-loss treatments, Tamiflu research, cardiac devices, ablation procedures, and oncology trials. Along the way, it explores how comparator choices, composite endpoints, survey timing, and long-term safety concerns can shape conclusions.

A puzzling case of unexplained syncope opens a reflection on how generalists and specialists think, read, and care for very different patient populations. The discussion explores medicine as a team sport, the fox-and-hedgehog divide between broad and deep expertise, referral decisions, and the risks of practicing beyond one’s scope. The case ultimately points toward a temporal infarct and seizure.

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A practical tour of Kaplan-Meier curves, censoring, and progression-free survival. The discussion explores how scheduled scans, toxic treatments, withdrawals, weak control arms, and skewed randomization can distort oncology trial results. It also examines the disconnect between progression-free and overall survival, and why critical appraisal requires reading beyond headline statistics to the full trial design.