Adam's response to the BMJ article recalls the often useful Upton Sinclair quote: "It is difficult to get a man to understand something when his salary depends on his not understanding it."
Still, much respect for the honesty and authenticity of JM and AC.
Great discussion. I’m no longer in hospital medicine and just doing outpatient but wonder if calling the local AA to get someone to come out and speak with the patient with AUD discharge would be an option. Likely it’s already been done and I don’t know because again I’m outpatient now
A very interesting and useful discussion. As a retired cardiologist, I was most interested in the part on coronary disease and MI. You correctly pointed out that MIs frequently occur in lesions that showed only a small degree of stenosis. Most people fail to differentiate the gradual progression of atherosclerosis which is almost universally present (although with different degrees of progression in different people) with the sudden occurrence of myocardial infarction where the artery is completely occluded by a clot. Preventive treatment is often recommended to retard the rate of increase in the atherosclerosis that is assumed to be the underlying cause despite the lack of any scientifically credible evidence that such treatment is helpful. Great progress has been made in the treatment of acute MI in terms of survival and limitation of quantitative cardiac damage but the seemingly more rational "preventive" of chronic anticoagulant therapy has likewise shown no significant benefit. Recent and ongoing studies have attempted to determine whether newer technologies such as CT scanning or other means can improve the determination of which lesions are most likely to undergo whatever it is that triggers the acute event but, thus far, have not shown much success. I think the paradigm of risk factor causation has merely led to one blind alley of research after another. Doctors should stick to their areas of expertise---the diagnosis and treatment of disease. We don't know enough to provide any scientifically credible advice to prevent it.
My question would be (regarding the naltrexone study) did they provide incentives to the subjects? I am a bit of a cynic and think that if they were incentivized they would gladly give you a name any name and number any number of a real or fictious person to comply w the study design. I am very familiar w Boston Medical and suspect the patients did it for the money! There are SO many variables among what passes for research. Great discussion
Adam's response to the BMJ article recalls the often useful Upton Sinclair quote: "It is difficult to get a man to understand something when his salary depends on his not understanding it."
Still, much respect for the honesty and authenticity of JM and AC.
Great discussion. I’m no longer in hospital medicine and just doing outpatient but wonder if calling the local AA to get someone to come out and speak with the patient with AUD discharge would be an option. Likely it’s already been done and I don’t know because again I’m outpatient now
Thanks again. Just a friend of Bill W.
As an ER doc in a geriatric ER for decades, I can't tell you how many times I see seniors come in after falling due to hypotension from their BPmeds!
A very interesting and useful discussion. As a retired cardiologist, I was most interested in the part on coronary disease and MI. You correctly pointed out that MIs frequently occur in lesions that showed only a small degree of stenosis. Most people fail to differentiate the gradual progression of atherosclerosis which is almost universally present (although with different degrees of progression in different people) with the sudden occurrence of myocardial infarction where the artery is completely occluded by a clot. Preventive treatment is often recommended to retard the rate of increase in the atherosclerosis that is assumed to be the underlying cause despite the lack of any scientifically credible evidence that such treatment is helpful. Great progress has been made in the treatment of acute MI in terms of survival and limitation of quantitative cardiac damage but the seemingly more rational "preventive" of chronic anticoagulant therapy has likewise shown no significant benefit. Recent and ongoing studies have attempted to determine whether newer technologies such as CT scanning or other means can improve the determination of which lesions are most likely to undergo whatever it is that triggers the acute event but, thus far, have not shown much success. I think the paradigm of risk factor causation has merely led to one blind alley of research after another. Doctors should stick to their areas of expertise---the diagnosis and treatment of disease. We don't know enough to provide any scientifically credible advice to prevent it.
My question would be (regarding the naltrexone study) did they provide incentives to the subjects? I am a bit of a cynic and think that if they were incentivized they would gladly give you a name any name and number any number of a real or fictious person to comply w the study design. I am very familiar w Boston Medical and suspect the patients did it for the money! There are SO many variables among what passes for research. Great discussion
The three most-trusted names in medicine: Cifu, Mandrola & Cochrane. Am I wrong?