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Gosh was this a great conversation about her recent paper on specification curve analysis of nutritional observational studies. Here is Dr. Zeraatkar’s bio:Dena Zeraatkar, PhD is an Assistant Professor in the Departments of Anesthesia and Health Research Methods, Evidence, and Impact (HEI) at McMaster University. She earned her doctoral degree at McMaster University in the Health Research Methodology graduate program. Following her doctoral training, she pursued postdoctoral training at Harvard Medical School, for which she was awarded a Banting scholarship.Her research centers on evidence synthesis and evaluation—identifying and appraising research to optimally inform healthcare and public health decisions. She often works in areas in which the evidence is complex or conflicting, examples of which include nutrition and COVID-19 therapeutics. For her research, in 2023, she was awarded a Gairdner Early Career Investigator Award.First, it would help to read my comments yesterday on the paper. Dr. Zeraatkar is well-spoken, clear and she explains a complicated topic in simple terms. Her work is exactly the type we love at Sensible Medicine. Stay for her final comment. It made me so happy. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

The Thomas Sowell quote, “On closer scrutiny, it turns out that many of today's problems are a result of yesterday's solutions” has been ringing in my head a lot lately. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Professor Erik Van Zwet from Leiden University discusses P-values in randomized trials, trial power, and trial replication. They explore the significance of P-values in interpreting study outcomes, the challenges of sample size, and understanding effect size. The conversation clarifies the unexpectedness of results and emphasizes the importance of historical data for comprehensive analysis in clinical settings.

Why have I been committed to medical education? Some of the reasons are admirable but not terribly novel. Others are a bit hard to admit, but just as true. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Friday Reflection 35: Why Don’t Doctors Want to See Patients?I was asked “Why is it that doctors don’t want to see patients?” and I could not answer the question. Fourteen months later, here is my response. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Examining the bias in observational studies and the findings of a new Austrian study on the effectiveness of boosters in individuals who have recovered from COVID-19. Discussion on the Effectiveness of Booster Vaccinations and COVID-19 Death Rates: critique of a study from Austria that examines the impact of booster vaccinations on testing positive for COVID-19 and argues against boosters for temporary reduction in cases. Lack of Effectiveness of Booster Shots in Individuals with Previous COVID-19 Infection: study showing no reduction in COVID-19 deaths from booster shots in individuals with prior COVID-19 infection, highlighting durable natural immunity and critiquing US policy and FDA approval of boosters.

Math Professor Ben Recht from UC Berkeley simplifies stats for doctors, discussing P-values in clinical trials, statistical significance, sample size influence, navigating statistical power, deciphering data in research papers, dangers of subgroup analyses, treatment effects in medicine, and patient selection in cancer trials.

As many of you know, I have long argued (unsuccessfully until now) for a placebo-controlled trial of AF ablation. One group gets the ablation; the other gets a placebo or sham procedure. This way we can sort out the placebo-resistant effect of the ablation. Finally, here is the first report of one. Dr. Malcolm Finlay is an electrophysiologist at St Bartholomew hospital in London UK and primary investigator of the study. They recently published their feasibility study for AF ablation vs placebo. The American Heart Journal published the pilot study of 20 patients. Finlay and colleagues call it the ORBITA AF trial. But it’s important to note that this was done separate from the ORBITA investigators at Imperial College. The larger study will have a different name. Here is a copy and paste:Twenty patients with PersAF (duration <2years) were recruited, representing 10% of the proposed larger trial as determined by a power calculation. The patients were randomized in a 1:1 ratio to receive either PVI±DCCV(PVI group) or DCCV+Placebo(DCCV group). The primary endpoint was to evaluate the blinding of the patients. The good news is that it mostly worked. Blinding was successful in most patients. Recurrence of AF was less in the ablation vs cardioversion arm. But the numbers were too small to say much. Same with quality of life measures, which were mostly similar until 12 months. The authors concluded that This feasibility study establishes the potential for conducting a blinded, placebo-controlled trial to evaluate the efficacy of PVI versus DCCV in patients with PersAF.I hope you enjoy the conversation. This is darn exciting for the field. And I am delighted to publish this conversation on Sensible Medicine. (I also tried to include the un-edited transcript of the conversation.)Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Topics discussed include the approval of a drug for postpartum depression, effectiveness of drug classes in treating various conditions, critique of FDA's regulatory process, examining the role of stenting and medication in angina treatment, challenges in pragmatic trials and the detection of gravitational waves, the cultural difference between medicine and physics, and the failure of ECMO trials.