Sensible Medicine

Most conversations about “AI in Medicine” bore me. I think this is because either we lack the imagination to consider how AI will change medicine in the next decade, or we are not being specific enough about how small parts of medicine could be productively affected. Dr. Shantanu Nundy, MD, MBA, is a practicing physician whom I like to think of as a serial innovator. He is currently an advisor on...

High-Dose Influenza Vaccine Effectiveness against Hospitalization in Older Adults * High-Dose Influenza Vaccine to Reduce Hospitalizations * Efficacy of high-dose versus standard-dose influenza vaccine in older adults Beta-blockers after myocardial infarction: effects according to sex in the REBOOT trial This is a public episode. If you'd like to discuss this with other subscribers or get access t...

Today on the podcast, I am joined by Dr. Jennifer Rusiecki. Dr. Rusiecki is an Associate Professor of Medicine at the University of Chicago. She is the Director of Women’s Health and Gender-Based Care in the internal medicine residency program and the assistant clinic director overseeing gender-based care. Dr. Rusiecki and I discussed the article appraised in the other post today, and also discuss...

A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury: The Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction * Should Evidence Come with an Expiration Date? This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus...

No video this week — we had a bit of a computer meltdown — but two interesting articles. As always, thanks for listening. If you have articles you would like us to cover, please send us a suggestion at sensiblemedicine2022@gmail.com. This Substack is reader-supported. If you appreciate our work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this wi...

In a lifetime of possible memories, only some are accessible. There are a few comments — made by mentors, co-residents, and patients — that have lingered and shaped my medical practice. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

I was shocked at the comments on this post . Many people, some of them I know to be smart, thought I was nuts for suggesting two middle-aged women who had isolated high LDL-C needn’t take meds because their calculated 10-year risk was less than 3% What shocked me is that our guidelines suggest treatment with statins when 10-year risk is ≥ 7.5%. You may not know this but clinicians are supposed to...

Medical Management and Revascularization for Asymptomatic Carotid Stenosis Vagus nerve-mediated neuroimmune modulation for rheumatoid arthritis: a pivotal randomized controlled trial We spent quite a bit of time talking about blinding. This is the table on the adequacy of blinding from the supplement. It does seem like blinding was less than perfect. This is a public episode. If you'd like to disc...

We try to answer the remainder of your AUA questions. We will be back in the new year with more article discussions! Here are a few of the things we referenced. GDMT Bugs Me: A bit of a rant against the standard of care A Plan to Refocus Primary Care Sacrificing patient care for prevention: distortion of the role of general practice The Great Colonoscopy Debate Arthroscopic Partial Meniscectomy ve...

We cover questions from Amy J, Benjamin Hourani, Diana Stiles Friou, Chris Costas, Errol Laurie, Jim Healthy, Elizabeth Fama, Never Dull, Rod Rodriguez, Ellison Burns, David Araujo, and George. We have more to come! One nice reference I found while looking into some of the topics: DMSO Is Not a Cure-All. But the FDA’s Panic Over It Birthed a Myth This is a public episode. If you'd like to discuss...

Vascular and inflammatory diseases after COVID-19 infection and vaccination in children and young people in England: a retrospective, population-based cohort study using linked electronic health records Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease: The PRECISE Randomized Clinical Trial This is a public e...

European Study of Prostate Cancer Screening — 23-Year Follow-up Association Between Baseline Diastolic Blood Pressure and the Efficacy of Intensive vs Standard Blood Pressure–Lowering Therapy Further Reading * Effects of intensive blood-pressure control in type 2 diabetes mellitus * A Randomized Trial of Intensive versus Standard Blood-Pressure Control Sensible Medicine is 100% reader-supported. I...

Effects of Intensive Blood Pressure Control in Patients With Frailty: A Post Hoc Analysis From ESPRIT * Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial * Reduction of Antihypertensive Treatment in Nursing Home Residents Polysacc...

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults * The Ideal Cholesterol Level ... Depends...And Cannot Be Determined From Observational Studies Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive Function: The US POINTER Randomized Clinical Trial * Can We Please Stop Asking if Crossword Puzzles Prevent De...

Two papers this week, with a bunch of articles that we referenced in the conversation. Also, the last Fortnight podcast was accidentally posted behind a paywall. It is now up and free to listen to. My apologies. Sensible Medicine is reader-supported. If you appreciate our work, consider becoming a free or paid subscriber. Folinic acid improves verbal communication in children with autism and langu...

We go all observational this week. A look at data suggesting the safety of GLP-1s and a re-examination of data on patient/doctor race concordance/discordance (a topic Adam said we should not study , and then John forces him to). GLP-1 Receptor Agonists and Cancer Risk in Adults With Obesity Physician–patient racial concordance and newborn mortality Original, 2020 article: Physician–patient racial...

NT is a 55-year-old man admitted to the general medicine service with cellulitis of his left leg. When the attending sees him the morning after admission, he notices the patient’s “Medical Center Trustee” hospital ID on his bedside table. After gathering a history and examining the leg, the attending leaves the room. In the hallway, he crosses paths with the hospital president, who is there to mak...

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Last week, John was at the European Society of Cardiology conference in Madrid, and Adam was at the Preventing Overdiagnosis 2025 International Conference in Oxford. A conversation about what we learned. Digitoxin in Patients with Heart Failure and Reduced Ejection Fraction Beta-Blockers Post-MI: A Clear Clinical Message Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagula...

Metformin for Treatment of Knee Osteoarthritis in Patients With Overweight or Obesity Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis Semaglutide or Tirzepatide and Optic Nerve and Visual Pathway Disorders in Type 2 Diabetes This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

TR is a 72-year-old woman, a retired executive, who had been in excellent health until she began experiencing exertional dyspnea and palpitations. After waiting out the symptoms for about a month, she called and made an appointment to see her primary care doctor. The day before her appointment, she awoke unable to move her entire right side. With difficulty, she reached for her phone and called he...

A “manel” reviewing trials and studies that explore the benefits and harms of hormone replacement therapy. The Women’s Health Initiative * Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial * The Women's Health Initiative Randomized Trials and Clinical Practice: A Review * The Women’s Healt...

Primary Articles * As-Needed Albuterol–Budesonide in Mild Asthma * Early versus Later Anticoagulation for Stroke with Atrial Fibrillation Referenced Articles * Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma * Stopping Randomized Trials Early for Benefit and Estimation of Treatment Effects: Systematic Review and Meta-regression Analysis This is a public episode. If you'd like...

Primary articles discussed: * First myocardial infarction: risk factors, symptoms, and medical therapy * Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use DisorderA Randomized Clinical Trial Articles referenced: * Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis * General health checks in adults for reducing morbidity and morta...

A visit brings back the memories of patients and the lessons they taught. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe