Sensible Medicine

Sudden cardiac death due to ventricular rhythm disturbances are rare but highly public. It’s strange and curious because you don’t expect healthy athletes to suffer serious cardiac issues. Recently three prominent athletes have survived sudden cardiac death. Christian Erikson, a Danish soccer player, Damar Hamlin, an American football player and Bronny James, son of Lebron James. These high-profile cases have highlighted the issue of sudden cardiac death of athletes. Dr. Dorian has published extensively on this topic. We had a great conversation. I learned a lot and hope you will too. JMM Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Here are three pertinent articles he has published—note the first is from NEJM. Landry CH, Allan KS, Connelly KA, Cunningham K, Morrison LJ, Dorian P; Rescu Investigators. Sudden Cardiac Arrest during Participation in Competitive Sports. N Engl J Med. 2017 Nov 16;377(20):1943-1953. doi: 10.1056/NEJMoa1615710. PMID: 29141175; PMCID: PMC5726886.Weissler Snir A, Connelly KA, Goodman JM, Dorian D, Dorian P. Exercise in hypertrophic cardiomyopathy: restrict or rethink. Am J Physiol Heart Circ Physiol. 2021 May 1;320(5):H2101-H2111. doi: 10.1152/ajpheart.00850.2020. Epub 2021 Mar 26. PMID: 33769918.Weissler-Snir A, Allan K, Cunningham K, Connelly KA, Lee DS, Spears DA, Rakowski H, Dorian P. Hypertrophic Cardiomyopathy-Related Sudden Cardiac Death in Young People in Ontario. Circulation. 2019 Nov 19;140(21):1706-1716. doi: 10.1161/CIRCULATIONAHA.119.040271. Epub 2019 Oct 21. PMID: 31630535. 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 podcast discusses the disinvitation of Dr. Prasad from a conference and Dr. Sifu's experience with COVID. They explore the importance of academic freedom, controversy over lecture cancellation, tension within academia, Adam's encounter with COVID-19, and the culture of medicine.

Angela Lu is training to be a physician. She’s interested in public policy. As a third year medical student, she teamed up with established leaders to ask a unique question regarding public disclosure of financial relationships. When the Centers for Medicare & Medicaid Services (CMS) issues National Coverage Determinations (NCDs) for services or products, they mean business. Such decisions have huge implications. You cannot go against them. Think #HighConsequences.CMS studies the evidence and publishes a proposed decision. It then allows public comments. People care. The idea behind their study, which made it into the Journal of the American Medical Association, was to study how many commenters disclosed their financial conflicts. Dr. Lu went through more than 680 comments submitted on 4 NCDs—all of which were high cost invasive procedures. I won’t spoil the conversation, but they found a very high percentages of comments asking to expand indications for these procedures and very very low percentages of people who disclosed their relevant relationships. This study was made possible by the Open Payments database. One important note: disclosure of relationships was voluntary. Enjoy the conversation. Thanks for listening. JMM 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

Andrew Foy rejoins the Sensible Medicine podcast. We talk first about coronary artery calcium. Andrew is an expert in this area. We have co-written our case against CAC scoring for any cause in the American Family Physician. It’s had little effect as CAC scoring is running rampant. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The second part of our conversation centers on a big med-ed project Andrew is co-leading at Penn State. He calls it Argue-to-Learn. The idea is to expose pre-clinical students to the value of civil debate. Here is their paper: Student Perceptions of a New Course Using Argumentation in Medical EducationHere is a quote: The absence of argumentation (i.e., a productive exchange of opposing views aimed at improved understanding of a given issue) in medical education may leave physicians susceptible to medical marketing, and incapable of both resolving industry claims and adapting to changing paradigms.Gosh. Gosh. Double Gosh, this is an exciting effort. Listen to Andrew explain. JMM 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

This week, I talk with Andrew Foy, who is an academic cardiologist at Penn State University in Hershey, PA. Andrew is one of the smartest voices in medicine today. We start with the REMEDIAL trial, published recently in JAMA. Ablation vs Meds. Primary endpoint—depression and anxiety. One of the main issues was the control arm—namely that there was no sham control. We referenced this useful review paper on placebo and nocebo effects in cardiology, from Brian Olshansky. Our second topic was the FRAIL AF trial. This was frail, elderly patients who had AF and were stable on Vitamin K antagonists (similar to warfarin) were randomized to remain on the VKA or switch to a direct acting oral anticoagulant. Primary endpoint—major bleeding. FRAIL AF is in Andrew’s wheelhouse as one of his primary academic areas of study is the role of multi-morbidity in translating medical evidence. He mentions a term called heterogenous treatment effects or HTE. I don’t love the term because it’s heavy into jargon. But HTE is super important for using evidence in the clinic. Andrew explains it well.Here is the editorial Andrew co-authored regarding another important trial in elderly patients who were having NSTEMI. I have written about FRAIL AF on Medscape and Sensible Medicine. We were going to talk about coronary artery calcium screening, but we had talked enough and will do a separate podcast on CAC. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.As always, let us know what you think. We appreciate the support. Thank you. JMM 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 harmful medical treatments discovered through randomized controlled trials, risks and benefits of COVID boosters, changes in COVID-19 vaccine eligibility criteria, critical analysis of ECMO and viral swab tests, and the importance of randomized studies and cultivating a culture of curiousness.

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

Tracy and Christine discuss the US and Danish COVID-19 response, child vaccination policies, controversial research areas, living with the virus, disease severity, lockdowns, COVID-19 transmission in schools, challenges in publishing research, interpreting and choosing vaccination programs, and the importance of honest and transparent discussions surrounding vaccines.

Although it is unoriginal to point out that doctors learn from our patients, here are a few lessons so powerful, so extrapolatable, that I forever associate them with an individual. 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

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