Sensible Medicine

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

No association between preprocedural fasting and witnessed pulmonary aspiration: A systematic review and meta-analysis Here are a couple of other older articles to give you the history of preprocedural fasting. Reducing the Risk of Acid Aspirations During Cesarean Section Fasting from midnight — the history behind the dogma CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy This i...

This Substack is reader-supported. If you appreciate our work, consider becoming a free or paid subscriber. Clinical Validation of a Circulating Tumor DNA–Based Blood Test to Screen for Colorectal Cancer If you want a deeper dive into cancer screening, we have covered the topic a lot on Sensible Medicine. There is a video debate Vinay, John, and Adam had about colon cancer screening. We also poste...

We are beginning a new series today. John and Adam will discuss a couple of articles we found interesting. Please let us know your thoughts. This week: Phase 3 Trial of Semaglutide in Metabolic Dysfunction–Associated Steatohepatitis Tiotropium Initiation and Dementia Risk in Chronic Obstructive Pulmonary Disease This is a public episode. If you'd like to discuss this with other subscribers or get...

This is a long one! 83 minutes. This is the second podcast in which we answer questions from a our “ask us anything” post. We recorded this one before our most recent podcast — kind of like Abbey Road and Let it Be — so we were still graced by Vinay’s presence. In fact, we recorded it in his studio. We still have about a half dozen questions to answer; we will cover those on an upcoming podcast. E...

John and Adam discuss our hopes for Vinay’s tenure at the FDA and how we intend to keep Sensible Medicine a vibrant place on Substack, a place where we will continue to showcase a range of ideas and opinions about all things bio-medicine. We also answer some of the questions from our recent “ask us anything” post. This is a public episode. If you'd like to discuss this with other subscribers or ge...

FH is a 66-year-old woman who comes in for an urgent visit because she has been feeling woozy for two days. She is very anxious, almost distraught, because she thinks these symptoms are the same as the ones that her sister had before she died of a hemorrhagic stroke. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. A few...

Professor Jeffrey Flier is a distinguished service professor and Higginson Professor of Physiology and Medicine at Harvard Medical School. He is the former dean of Harvard Medical School. We talked about the recent (and sudden) change in NIH funding. First a note on Professor Flier. He is not a normal medical school dean. He is active online. He speaks candidly, often critically. He and Vinay wrot...

We are back with a riveting discussion 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 recently recorded a conversation with Michael Easter from the TWO/PERCENT , a Substack and podcast. Michael offers “practical, accurate, and useful health, performance, and mindset information,” and in a space where there is a lot of drive, I find him remarkably thoughtful. Our conversation is on the podcast feed. Below are my notes for our conversation with links to many of the things we discus...

Doctors often get credit (or blame) for having to make difficult, life-and-death decisions. But really, it is all of us, when we are patients, who make the bravest decisions that carry the highest stakes. 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 have long followed the work of Dr. Margaret McCartney. She is a general practitioner in Glasgow, Scotland, writer, public speaker, and now PhD. She is a fierce advocate for evidence-based medicine. She holds highly skeptical views of screening for disease—which, to my surprise is quite common in the UK. Her recently finished PhD sought empirical evidence regarding declaration of conflicts of int...

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I had the pleasure of being interviewed by Michael Easter. Michael is behind the TWO/PERCENT Substack where he offers “practical, accurate, and useful health, performance, and mindset information.” I’ve listened to, and read, a bunch of Michael’s content. Not only is it enjoyable but it seems, well, sensible. Our conversation was inspired by my Coming Out Against the Healthy Lifestyle post. I hope...

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What does our philosophy have to do with RFK Jr and MAHA? 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