I find this study to mirror some other studies I’ve seen lately. The pay they might get for this “simple procedure” may be telling as to why they keep pushing its use to continue
As a famous president once said: "my views are evolving".
One of the things I've learned from the pandemic is that it's often smarter to keep a certain flexibility of mind and not fall prey to dogmatism (irrespective of direction). I've come to admire people such as Zvi, Zeynep or Alex Tabarrok.
In the case of RDN, we should of course differentiate the questions of "does it work?", if yes "how good is it in reducing BP?" and "should it be done on a large scale/reimbursed?" (with nuances depending on your healthcare system).
Focusing on the first question: After SYMPLICITY HTN 3 I thought the answer was quite clear "no, it doesn't work". So I ignored the "yeah, but the new technology might work", "yeah, but now we know to target the more distal/smaller branches as well", "yeah, but something about the methods were slightly off" comments etc.
After seeing all the other sham-controlled RCTs, it now seems that the answer is "it does indeed work". Even in Andrew Foy's meta-analysis there's a paragraph on the newer gen devices appearing to work better. (perhaps a reviewer pushed for it?).
I've learned my lesson in humility facing uncertainty. I've adjusted my priors.
Other questions to ask - Is it safe? Are there long-term side effects from the nerve ablation that might outweigh the benefits. And does artificially reducing blood pressure (a surrogate endpoint) in a population with blood pressure elevated in response to their clinical condition have an impact on long-term cardiac and survival endpoints? Finally, we need to shift focus from pharmaceutical and surgical interventions, and rather address the clinical state driving the elevated blood pressure in the first place.
Excellent example of design biased to get the answer one wants. Great presentation of the studies.
I find this study to mirror some other studies I’ve seen lately. The pay they might get for this “simple procedure” may be telling as to why they keep pushing its use to continue
loved this the placebo affect in full force thaks dr. foy
As a famous president once said: "my views are evolving".
One of the things I've learned from the pandemic is that it's often smarter to keep a certain flexibility of mind and not fall prey to dogmatism (irrespective of direction). I've come to admire people such as Zvi, Zeynep or Alex Tabarrok.
In the case of RDN, we should of course differentiate the questions of "does it work?", if yes "how good is it in reducing BP?" and "should it be done on a large scale/reimbursed?" (with nuances depending on your healthcare system).
Focusing on the first question: After SYMPLICITY HTN 3 I thought the answer was quite clear "no, it doesn't work". So I ignored the "yeah, but the new technology might work", "yeah, but now we know to target the more distal/smaller branches as well", "yeah, but something about the methods were slightly off" comments etc.
After seeing all the other sham-controlled RCTs, it now seems that the answer is "it does indeed work". Even in Andrew Foy's meta-analysis there's a paragraph on the newer gen devices appearing to work better. (perhaps a reviewer pushed for it?).
I've learned my lesson in humility facing uncertainty. I've adjusted my priors.
Other questions to ask - Is it safe? Are there long-term side effects from the nerve ablation that might outweigh the benefits. And does artificially reducing blood pressure (a surrogate endpoint) in a population with blood pressure elevated in response to their clinical condition have an impact on long-term cardiac and survival endpoints? Finally, we need to shift focus from pharmaceutical and surgical interventions, and rather address the clinical state driving the elevated blood pressure in the first place.
Excellent Dr. Foy. Thanks so much.
Excellent analysis.
My first question would be .... who funded the trials??
Interesting that he Pfizer Covid vax studies were unblinded and crossover before endpoint.... hmmm
Same thought! There is often a funding tie when a trial design is biased like this to ensure a certain outcome. A device manufacturer, maybe?
There have been several trials that involved ivermectin that the funding was “obscured” and eventually lead back to gates.