There are many studies that are ground breaking but nobody pays attention to them because they do not sell medical care or drugs.
For instance, it was established before the 1930s that high cholesterol results from low thyroid activity. It is completely ignored in order to sell statins.
Other studies show stents rarely prolong life. But nobody pays attention because they want to sell stents.
I could go on and on and on, Dr. Mandrola. I’m seeing studies that make the CAST event look like small beer.
And don’t get me started on the so-called evidence for the Covid “vaccine”.
As a prospective patient, I do not believe in medicine as you guys preach, practice and dictate it. Therefore, I refuse to enter the medical maze of lunacy and trickery.
Great column. And fantastic talk at UBC cardiology grand rounds last week. I know many of my colleagues consider this newsletter and TWIC to be mandatory reading. It gives voice to aspiring, budding, and closet medical conservatives.
The power of a quality newsletter like this one is the democratization of information that diverges from named journals, societies, and associations, who are beholden to industry interests and varying degrees of industry capture, and who collectively fuel the “therapeutic fashion” you speak of. The study discussed here is a good example thereof.
You have performed a very valuable service in revisiting this important study. It should be an effective cautionary example because the logic behind the decision to use anti-arrhythmic drugs in that setting seemed so obvious. Hopefully, it will cause some of the more "proactive" doctors to exercise a little more caution with medications and interventions intended to be "preventive" measures. I wonder what would have happened had the results merely shown that there was little or no difference between the drug and placebo groups. I suspect the practice would have continued and spurred on further research to find "better" drugs.
I don't understand the Nottingham researchers' vague guesses about the significance of the treatment group's 9-fold increase in death. Did no one think to calculate the P value?
Relative to your note of surprise about the degree to which Sensible Medicine is appreciated -- you're not just being read by physicians. I'm a patient-centered care PhD type working in Rehab Medicine and you guys are a breath of fresh air. I was red-pilled about how problematic many studies are a few years back in the course of a psychosocial research fellowship where my brilliant mentor INSISTED I go hang out with the Measurement and Stats folks for a while. Many investigators are still deer-in-the-headlights about what their data can and can't demonstrate.
It's been a long time since I got used to reading and enjoying John Mandrola's comments. He is a true scientist, one of the few who from a scientific point of view interprets the results of medical trials. And I say this with the certainty of someone who is over seventy years old and has spent his life researching and publishing.
J. Mandrola's attitude is all the more commendable as current Medicine has almost been transformed into a religion dominated by non-scientific interests.
Is there a word missing in your last sentence? “But due to my age, I can testify that we quite sure that ventricular arrhythmias needed to be suppressed after an MI.” It doesn’t make sense!
"Some things will surely hold up: PCI for MI, fixing displaced fractures, antibiotics for bacterial infection, and of course, caring and empathy." Antibiotics for infections? They certainly can be effective, but with so many organisms becoming resistant to them, not to mention their effect on the gut biome, maybe there is a better therapy out there.
Unfortunately, “fashion based medicine” or “opinion based medicine” makes the problem seem more benign than it actually is. Studies don’t just go unpublished randomly according to individual reviewers whims and opinions. There are very clear financial incentives for publishing journals to bias in favor of industry products, resulting in an artificial abundance of visible data favoring industry products and scant evidence against them. Evidence based medicine feels like it’s really just becoming sponsored medicine.
well the whole crazy covid episode is a glaring (and shocking) example of fashionable medicine... really eye opening how 80%+ of public health all behaved as a herd, darting from issue to issue on masks, vax, bat origins, etc... who can forget "it's safe to protest" but not safe to go out for other reasons
I'd love someone at Sensible Medicine to do a dive into involuntary hospitalisation and treatment for suicidal ideation /attempt... It's a totally non evidenced based practice yet society denies people their basic human rights... For no reason (no good reason that is). The reality is we have virtually no evidence for the interventions done at an individual level in the suicide prevention space (evidence is for things like reducing access to means and minimising media reporting which happens on a societal level) yet there's a massive industry that's been created to meet the needs of distressed individuals... Nobody is willing to acknowledge the emperor has no clothes. Let alone acknowledge that we have very little to offer suicidal individuals... My local ED offers a 48hr crisis containment hospitalisation in which nothing therapeutic happens bar they're in hospital, plus 4 follow up phonecalls... It bemuses me that that's going to make a significant difference to anyone with deep seated problems. But suicide is so rare and suicidal ideation is so ubiquitous that there's no political will for anything but a show that looks like the government is doing something. Eg evidence is suicide helplines reduce attempts, but not numbers of successfully completed suicides - yet they're advertised as a suicide prevention service, when in reality they're an unsuccessful attempt prevention service.
The “fashion” at the time when Ronnie Reagan was in office, was that keeping people in mental institutions “against their will” was a violation of their individual rights and freedoms. Maybe that will revert back when enough backlash occurs from the meth tent cities (who coulda predicted that the meth industry could produce a product so “good” that it would drive one to insanity and homelessness in a matter of months, as opposed to the years it took for that to happen with the old meth.
Here’s a question for you: if everyone has a “right” to something but there is not enough of the “things that provide for this right (caregivers and someone else’s money), how is this even a “right”??
You didn't even mention the moracizine arm, where they had to stop the trial after a mere 2 weeks because the treatment group did so much worse! https://www.nejm.org/doi/full/10.1056/NEJM199207233270403
There are many studies that are ground breaking but nobody pays attention to them because they do not sell medical care or drugs.
For instance, it was established before the 1930s that high cholesterol results from low thyroid activity. It is completely ignored in order to sell statins.
Other studies show stents rarely prolong life. But nobody pays attention because they want to sell stents.
I could go on and on and on, Dr. Mandrola. I’m seeing studies that make the CAST event look like small beer.
And don’t get me started on the so-called evidence for the Covid “vaccine”.
As a prospective patient, I do not believe in medicine as you guys preach, practice and dictate it. Therefore, I refuse to enter the medical maze of lunacy and trickery.
Great column. And fantastic talk at UBC cardiology grand rounds last week. I know many of my colleagues consider this newsletter and TWIC to be mandatory reading. It gives voice to aspiring, budding, and closet medical conservatives.
The power of a quality newsletter like this one is the democratization of information that diverges from named journals, societies, and associations, who are beholden to industry interests and varying degrees of industry capture, and who collectively fuel the “therapeutic fashion” you speak of. The study discussed here is a good example thereof.
Thanks Steve and great to meet in Vancouver!
oh you were in Vancouver last week!!! Next time, drinks on me.
You have performed a very valuable service in revisiting this important study. It should be an effective cautionary example because the logic behind the decision to use anti-arrhythmic drugs in that setting seemed so obvious. Hopefully, it will cause some of the more "proactive" doctors to exercise a little more caution with medications and interventions intended to be "preventive" measures. I wonder what would have happened had the results merely shown that there was little or no difference between the drug and placebo groups. I suspect the practice would have continued and spurred on further research to find "better" drugs.
I don't understand the Nottingham researchers' vague guesses about the significance of the treatment group's 9-fold increase in death. Did no one think to calculate the P value?
“industry-free thinking” didn’t play out well for Semmelweis
Relative to your note of surprise about the degree to which Sensible Medicine is appreciated -- you're not just being read by physicians. I'm a patient-centered care PhD type working in Rehab Medicine and you guys are a breath of fresh air. I was red-pilled about how problematic many studies are a few years back in the course of a psychosocial research fellowship where my brilliant mentor INSISTED I go hang out with the Measurement and Stats folks for a while. Many investigators are still deer-in-the-headlights about what their data can and can't demonstrate.
It's been a long time since I got used to reading and enjoying John Mandrola's comments. He is a true scientist, one of the few who from a scientific point of view interprets the results of medical trials. And I say this with the certainty of someone who is over seventy years old and has spent his life researching and publishing.
J. Mandrola's attitude is all the more commendable as current Medicine has almost been transformed into a religion dominated by non-scientific interests.
Someone should start a journal called: The Journal of Negativity and Non-Significance
It could be a home for high-quality studies that can't get published elsewhere due to publication bias
Is there a word missing in your last sentence? “But due to my age, I can testify that we quite sure that ventricular arrhythmias needed to be suppressed after an MI.” It doesn’t make sense!
Yes. Gosh darn it. Thanks. I fixed it.
I think Dr. Prasad would be shocked by the salty language here!
"Some things will surely hold up: PCI for MI, fixing displaced fractures, antibiotics for bacterial infection, and of course, caring and empathy." Antibiotics for infections? They certainly can be effective, but with so many organisms becoming resistant to them, not to mention their effect on the gut biome, maybe there is a better therapy out there.
Unfortunately, “fashion based medicine” or “opinion based medicine” makes the problem seem more benign than it actually is. Studies don’t just go unpublished randomly according to individual reviewers whims and opinions. There are very clear financial incentives for publishing journals to bias in favor of industry products, resulting in an artificial abundance of visible data favoring industry products and scant evidence against them. Evidence based medicine feels like it’s really just becoming sponsored medicine.
well the whole crazy covid episode is a glaring (and shocking) example of fashionable medicine... really eye opening how 80%+ of public health all behaved as a herd, darting from issue to issue on masks, vax, bat origins, etc... who can forget "it's safe to protest" but not safe to go out for other reasons
I'd love someone at Sensible Medicine to do a dive into involuntary hospitalisation and treatment for suicidal ideation /attempt... It's a totally non evidenced based practice yet society denies people their basic human rights... For no reason (no good reason that is). The reality is we have virtually no evidence for the interventions done at an individual level in the suicide prevention space (evidence is for things like reducing access to means and minimising media reporting which happens on a societal level) yet there's a massive industry that's been created to meet the needs of distressed individuals... Nobody is willing to acknowledge the emperor has no clothes. Let alone acknowledge that we have very little to offer suicidal individuals... My local ED offers a 48hr crisis containment hospitalisation in which nothing therapeutic happens bar they're in hospital, plus 4 follow up phonecalls... It bemuses me that that's going to make a significant difference to anyone with deep seated problems. But suicide is so rare and suicidal ideation is so ubiquitous that there's no political will for anything but a show that looks like the government is doing something. Eg evidence is suicide helplines reduce attempts, but not numbers of successfully completed suicides - yet they're advertised as a suicide prevention service, when in reality they're an unsuccessful attempt prevention service.
The “fashion” at the time when Ronnie Reagan was in office, was that keeping people in mental institutions “against their will” was a violation of their individual rights and freedoms. Maybe that will revert back when enough backlash occurs from the meth tent cities (who coulda predicted that the meth industry could produce a product so “good” that it would drive one to insanity and homelessness in a matter of months, as opposed to the years it took for that to happen with the old meth.
Here’s a question for you: if everyone has a “right” to something but there is not enough of the “things that provide for this right (caregivers and someone else’s money), how is this even a “right”??