A Prominent Cardiologist Responds to our last Podcast Conversation with Vinay Prasad
We at Sensible Medicine are delighted to receive comments of this high quality. In fact, this is EXACTLY our goal.
Paul Dorian is an academic electrophysiologist at the University of Toronto. He sent this to me as an email regarding a conversation I had with Vinay this past weekend. We discussed the culture of medical science.
The thing is, whenever Paul writes or speaks, I learn something. I post his comment and Vinay’s response as a gift to our paid subscribers. (The vast amount of content we post is free, but I feel guilty for not offering something extra to those who support our work. Thank you.)
Here is the link to our conversation. JMM
From Professor Paul Dorian…
John, I really enjoyed your recent conversation [with Vinay]. Please feel free to forward this commentary to him.
I understand that part of the purpose of the Substack is to get people to feel less certain and less comfortable in their prejudices, and there’s a certain entertainment quotient that is necessary for this.
However, I hope both of you are at least moderately, if not very, sympathetic to the extraordinary difficulty of actually doing what you suggest is reasonable to advance medical science. It is unbelievably difficult, and as somebody who has been trying to do this for 40 years I don’t think either of you ( maybe particularly Vinay) are sufficiently sympathetic to the enormous Effort and personal cost of doing Clinical Trials.
In most parts of the world, this is done for no compensation, except the small probability that at some point in the distant future, you get to be an author on a paper and have 30 seconds of fame and possibly just possibly contribute a small amount to the sum of knowledge which helps clinicians and patients.
[Re ORBITA 2] Of course, it would be a good idea to do a real clinical trial with proper blinding and masking of drug therapy versus PCI. A trial which somehow controls for the placebo effect, measures quality of life more accurately than has been done in the past, and has a carefully controlled drug choice and escalation for the medical arm—all the while ensuring that the patients are representative of the average patient. Such a trial would ensure that we are able to somehow disassociate true drug side effects from nocebo effects, and it would quantify benefits from placebo effect, in both arms.
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