the standard of care in depressive disorders, however, is highly debated. many professional associations today are not recommending SSRI for moderate depressions. SSRI use in general is highly debatable. So placebo is a valid comparator. maybe look into Kirsch, the emperors new clothes, if you want to dive into it.
Really glad you are addressing the concerns with the new PPD med Zuranolone, in my little piece of the health world our initial concern was that exposure during lactation was not part of the safety profile, yet 83% or so of women start breastfeeding?
Re orbita-2: so I get stented so I’m not taking imdur or prn ntg but likely still continued on Coreg or other beta blocker but instead of anti-anginal I’m taking Plavix or other. It’s still a trade-off and I’m still probably going to be carrying around the prn ntg. Patients can’t be expected to make this decision. They will choose stenting every time because they cannot see everything involved with that stent and its risks.
I respectfully disagree. In my experience, most patients understand in stent thrombosis (“your stent may clog off, and the risk is higher if you dont take plavix”). Antiplatelet agents can be expensive.
I Agree that you are trading one or two medicines (beta blocker and imdur) for another (plavix or brilinta). However, if you stop taking your imdur you probably will get chest pain. If you stop your plavix, the consequences may be higher.
You don’t need to go beyond use of “Harrison Scale,” since it alone is unadulterated bullshit-- as is the entire bamboozle “specialty” of psychiatry in fact the bambozzle factor rivals that of “virology/sequencing/immunology / Team Fauci idiocy
What a ridiculous comment. You undoubtedly would have said the same thing about the surgeons who questioned whether radical mastectomy was actually better than lumpectomy for early stage breast cancer. Why should we do a study of that when "clinical decision making" dictates that we disfigure every woman who walks in the door with a 7mm breast nodule? Anyone who thinks chopping off the entire pectoralis muscle and leaving someone disabled for the rest of their life MIGHT be a tad excessive is just a politically motivated grifter.
"All these grifters with their rigid requirements for evidence want to preserve this woman's ability to use her right arm, can you believe this shit?! What a bunch of one-trick ponies" 😂😂😂
You've missed the point. If everyone had the same attitude that you expressed in your comment, we would still be doing radical mastectomies instead of lumpectomies and many women would have been needlessly subjected to the morbidity of that procedure. Of course we can't "deny the efficacy of any therapy" that doesn't have RCT evidence. If we did that, it would not just be an "entirely unreasonable way to practice medicine," there would hardly be any practice of medicine. In many fields, most of the commonly used therapies fall in that category. That is precisely the problem. People insisting, as you seem to be, that evidence generation is simply too hard so we should just be content with never actually proving if what we do is helpful or not.
Alright sir, it seems like we have very different interpretations of what VP is saying. You keep talking about making clinical decisions today for the patient who comes into your office/ward this afternoon. I think we can all agree (you, me, VP, JM, etc.) that for that patient, the job of the physician is to make the best decisions you can with the available evidence. When the evidence does not give clear guidance, then we must use our best clinical judgment to decide what to do, knowing that maybe another clinician might do something different. That is just a fact of life as a physician.
My understanding of what VP is saying on this podcast is that the lack of good evidence for what to do in common clinical scenarios reflects a problem with the culture of medicine, which does not value evidence generation as much as VP thinks it ought to be valued. I'm in full agreement with that. No one is denying that uncertainty is inevitable for physicians. VP is saying that it's a deep problem in medicine that we (at an institutional and system-wide level) don't make REDUCING that uncertainty a higher priority.
The Pharma companies have more than enough resources, as does the government. In the Covid realm, the gov't shouldn't have undertaken lockdowns and mandates without at least starting the appropriate studies.
Giving advice based on available data that is speculative/provisional but NOT making mandates is appropriate. Interesting that one of the best studies of masking came from Bangladesh of all places. Did they have no mortality and morbidity? And note I said 'starting studies'. Yes it does say something - that I believe making mandates that so hurt the youngest among us with no data was reprehensible. Most of Europe didn't do that.
Again, I'm not faulting them for not knowing the correct answers up front, but for their totalitarian attitude and apparent antipathy to uncovering the correct answer.
Well dang it. Your comment shut me right up. The fact that he’s critical of the system is why I like him. My criticism is the opposite extreme. I want him to be more critical because I don’t know how Doctors prescribe medication with known harmful side effects. What more science do we need when they already tell you it’s dangerous? I think we (Doctors and patients alike) should stop consuming dangerous medications so that pharmaceutical companies would be forced to raise their standards and create better medications. But I suppose I prevailed as the opposite extreme to your criticism , which would put Vinay in the middle, which is the balanced and likely accurate perspective. (Even though I’m holding on to mine)
"we have this culture of certainty rather than uncertainty" -Mandrola's comment/framing is so elegant.
this was real fire! (also, playback has gotten betr on here) =)
gr8 stuff. _JC
nice episode, thanks!
the standard of care in depressive disorders, however, is highly debated. many professional associations today are not recommending SSRI for moderate depressions. SSRI use in general is highly debatable. So placebo is a valid comparator. maybe look into Kirsch, the emperors new clothes, if you want to dive into it.
Really glad you are addressing the concerns with the new PPD med Zuranolone, in my little piece of the health world our initial concern was that exposure during lactation was not part of the safety profile, yet 83% or so of women start breastfeeding?
Re orbita-2: so I get stented so I’m not taking imdur or prn ntg but likely still continued on Coreg or other beta blocker but instead of anti-anginal I’m taking Plavix or other. It’s still a trade-off and I’m still probably going to be carrying around the prn ntg. Patients can’t be expected to make this decision. They will choose stenting every time because they cannot see everything involved with that stent and its risks.
I respectfully disagree. In my experience, most patients understand in stent thrombosis (“your stent may clog off, and the risk is higher if you dont take plavix”). Antiplatelet agents can be expensive.
I Agree that you are trading one or two medicines (beta blocker and imdur) for another (plavix or brilinta). However, if you stop taking your imdur you probably will get chest pain. If you stop your plavix, the consequences may be higher.
You don’t need to go beyond use of “Harrison Scale,” since it alone is unadulterated bullshit-- as is the entire bamboozle “specialty” of psychiatry in fact the bambozzle factor rivals that of “virology/sequencing/immunology / Team Fauci idiocy
combo one-two punch is back! let’s have it!
What a ridiculous comment. You undoubtedly would have said the same thing about the surgeons who questioned whether radical mastectomy was actually better than lumpectomy for early stage breast cancer. Why should we do a study of that when "clinical decision making" dictates that we disfigure every woman who walks in the door with a 7mm breast nodule? Anyone who thinks chopping off the entire pectoralis muscle and leaving someone disabled for the rest of their life MIGHT be a tad excessive is just a politically motivated grifter.
"All these grifters with their rigid requirements for evidence want to preserve this woman's ability to use her right arm, can you believe this shit?! What a bunch of one-trick ponies" 😂😂😂
You've missed the point. If everyone had the same attitude that you expressed in your comment, we would still be doing radical mastectomies instead of lumpectomies and many women would have been needlessly subjected to the morbidity of that procedure. Of course we can't "deny the efficacy of any therapy" that doesn't have RCT evidence. If we did that, it would not just be an "entirely unreasonable way to practice medicine," there would hardly be any practice of medicine. In many fields, most of the commonly used therapies fall in that category. That is precisely the problem. People insisting, as you seem to be, that evidence generation is simply too hard so we should just be content with never actually proving if what we do is helpful or not.
Alright sir, it seems like we have very different interpretations of what VP is saying. You keep talking about making clinical decisions today for the patient who comes into your office/ward this afternoon. I think we can all agree (you, me, VP, JM, etc.) that for that patient, the job of the physician is to make the best decisions you can with the available evidence. When the evidence does not give clear guidance, then we must use our best clinical judgment to decide what to do, knowing that maybe another clinician might do something different. That is just a fact of life as a physician.
My understanding of what VP is saying on this podcast is that the lack of good evidence for what to do in common clinical scenarios reflects a problem with the culture of medicine, which does not value evidence generation as much as VP thinks it ought to be valued. I'm in full agreement with that. No one is denying that uncertainty is inevitable for physicians. VP is saying that it's a deep problem in medicine that we (at an institutional and system-wide level) don't make REDUCING that uncertainty a higher priority.
The Pharma companies have more than enough resources, as does the government. In the Covid realm, the gov't shouldn't have undertaken lockdowns and mandates without at least starting the appropriate studies.
Giving advice based on available data that is speculative/provisional but NOT making mandates is appropriate. Interesting that one of the best studies of masking came from Bangladesh of all places. Did they have no mortality and morbidity? And note I said 'starting studies'. Yes it does say something - that I believe making mandates that so hurt the youngest among us with no data was reprehensible. Most of Europe didn't do that.
Again, I'm not faulting them for not knowing the correct answers up front, but for their totalitarian attitude and apparent antipathy to uncovering the correct answer.
Well dang it. Your comment shut me right up. The fact that he’s critical of the system is why I like him. My criticism is the opposite extreme. I want him to be more critical because I don’t know how Doctors prescribe medication with known harmful side effects. What more science do we need when they already tell you it’s dangerous? I think we (Doctors and patients alike) should stop consuming dangerous medications so that pharmaceutical companies would be forced to raise their standards and create better medications. But I suppose I prevailed as the opposite extreme to your criticism , which would put Vinay in the middle, which is the balanced and likely accurate perspective. (Even though I’m holding on to mine)
Thank you for responding but this is where I run for my life out of the office
Troll alert. Nothing to see here.