Sensible Medicine Newsletter

1 week ago | sensible-med.com | Adam Cifu

This is an updated version of an article I posted on Sensible Medicine last year. On Monday, I’ll be starting a stint attending on our inpatient general medicine service with a couple of our brand-spanking-new interns. It seemed like a good time to bring out this column. I came up with this list by reflecting on what did and did not work for me during my training, at least when viewed from the proverbial retrospectoscope. This Substack is reader-supported.

1 week ago | sensible-med.com | John Mandrola

One of the most common and valid criticisms of a randomized clinical trial is external validity—or generalizability. The point of any RCT is that we can apply the results to a patient we see in the office. A trial that recruits highly selected (perfect) patients is hard to apply to the “regular” everyday patient. A classic example is the DanGer-Shock trial of the microaxial flow pump in patients with cardiogenic shock.

2 weeks ago | sensible-med.com | Adam Cifu

A few months ago, I wrote about how a study that purported to show that an older version of the Shingrix vaccine prevented dementia was covered in the news. I argued that although people should get the current vaccine, I did not think the study proved that vaccinating against shingles prevents dementia. As is often the case -- which is what I love about this site -- I got some feedback. Some people congratulated me on my wisdom, while others explained why I was wrong.

2 weeks ago | sensible-med.com | Vinay Prasad |John Mandrola |Adam Cifu

The most common question we get asked is: is there a course on how to become better at critically reading medical research. Here it is!This is the fourth of 9 videos that we recorded as part of a course on clinical appraisal, and there will be many more to come. This and future videos will be made available as a thank you to paid subscribers.

2 weeks ago | sensible-med.com | John Mandrola

Kidney disease does not get the attention it deserves. Heart disease and cancer suck up most of the attention. The kidney is complex (without a simple clogged-pipe frame). Kidney disease progresses slowly, often with overlap from heart disease. But end-stage kidney disease requiring dialysis affects more than 2 million people, and patients on dialysis have 5-year survival rates of only 50%. Chronic kidney disease (CKD) if left untreated may progress to ESKD.