@richard-lehman.bsky.social I have learned so much from your words, spoken and written. I am sad we wont have any future conversations, but I am grateful for the ones we had. Medicine is better because of your efforts. Richard, thank you for everything.

Sad to hear of the loss of Richard Lehman. Grateful to him and @raj-mehta.bsky.social for recording this podcast - an excellent teaching resource: creators.spotify.com/pod/profile/...

This is basically why, at least in medicine, I think it's a fool's errand to pretend like we are estimating effects. I think it's much more realistic to frame it as evaluating claims, and accepting that at some point residual uncertainty will have to be left to clinical judgement.

Worth a read. But.. 😜 - All statistical methods rely on assumptions and thought exercises. - The good advice here about the importance of context and assumptions, and moving away from resting everything on "a calculation", is widely applicable to sample size evaluation.

We finally have randomized, controlled clinical trial results from ambient AI scribes. But what do these RCTs actually tell us? Look at the below chart. Time savings are often low, but doctors give the technology rave reviews, esp in anecdotes that people tend to believe more than data 👀 🧵 🖥️🩺

The long-awaited SURPASS-CVOT is here, just in time for the holidays #T2D #CVD #Tirzepatide www.nejm.org/doi/full/10....

In Clinical Scholars- literally one of the first 5 things Rod talked about. cc: @jeremysussman.bsky.social @iwashyna.bsky.social

The creation of a medical reversal.

Listen in as @richard-lehman.bsky.social and @raj-mehta.bsky.social explore why it took so long for fair tests of treatments to develop, and the transition from anecdotal and authority-based decisions to empirical methodologies in the 18th and 19th centuries. www.jameslindlibrary.org/blogs/the-fi...

The new ⌚️ will have hypertensive notifications This doesn’t seem like a cuffless BP - but more like a notification ‘you may have hypertension, go check your BP’ ? From www.apple.com/newsroom/202... @jordybc.bsky.social @drwanpen.bsky.social @spjuraschek.bsky.social @daichishimbo.bsky.social?

Some key changes that stood out to me (got the opportunity to help w writing these!): 1) Stronger recs for single pill combos 2) Broader recs for screening for primary aldo (now consider in anyone with stage 2 HTN — i.e., BP >=140/90) 3) Just. Say. No… to cuffless BP devices… and to EtOH 2/

should we screen for CKD in the general population? Finally, flozins, finerenone and GLP1s allow a good cost-effectiveness case www.nephjc.com/news/2025/7/... for #NephJC shorts Time to stop just being dialysis-ologists and flozinate, glipinate! #NephSky

Heard from #AHRQ that the entire grants staff has been let go! They are unable to issue funds for grants already funded, let alone fund new grants. This is outrageous and will make Americans poorer and sicker. Why? A brief thread about just some recent AHRQ-funded research: #MedSky #HealthPolicy

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%! Practice changing investigator-initiated RCT. #ISTH2025

Is generative #AI capable of clinical reasoning? Our new piece @thelancet.bsky.social open-access @adamrodmanmd.bsky.social www.thelancet.com/journals/lan...

Rubio terminated 5800 USAID contracts – more than 90% of its foreign aid programs – in defiance of the courts. Here’s a list of just some of the lifesaving awards that were terminated. Nearly all were Congressionally mandated. They’ve saved millions of lives. 🧵

A randomized trial of tailored A.I.-guided ablation of atrial fibrillation vs standard-of-care, anatomical ablation demonstrated superiority of AI guidance www.nature.com/articles/s41...

I wrote a book The Creative Destruction of Medicine (2013, title adopted after Schumpeter). This title of the book for what we are now seeing in the U.S. is just The Destruction of Medicine.

Indirects support infrastructure for translational research and clinical trials. Look for clinical trials to be paused or halted because universities will no longer have funds to keep them open. This will be devastating for cancer patients at NCI-designated comprehensive cancer centers, for example.

A randomized trial of GPT-4 vs 92 physicians with or without this #AI LLM for performance on patient care tasks. AI improved physician performance, on par with AI alone (based on 5 clinical vignettes) nature.com/articles/s41...

From JAMA Cardiology: South African regulations limiting sodium in processed foods were associated with reductions in sodium consumption and blood pressure among rural adults aged 40 years or older. ja.ma/4hMWyUW #CardioSky

In @ajkd.bsky.social www.ajkd.org/article/S027... Revisiting protein restriction: did they get it wrong? Yes they did it wrong. But they don’t admit that in this commentary, sadly 😕

Finally! Antibiotics are not non-inferior to appendectomy despite a generous 20% non-inferiority margin They are actually inferior: www.thelancet.com/journals/lan... in the @thelancet.bsky.social #MedSky

The potential importance of reactivation of herpes simplex virus type 1 (HSV-1) as a contributing factor to developing Alzheimer's disease www.science.org/doi/10.1126/...

Published an opinion piece in @bmj.com with @raj-mehta.bsky.social. I bet no one has opinions about the topic. www.bmj.com/content/388/...

A protein intake of 1.5 g/kg/day enhances net protein balance in older adults on a two-meal eating pattern. by Church DD, Hirsch KR (...) Ferrando AA et 5 al. in J Nutr #MedSky 📖 read the article:

We need some of these phrases for nephrology! Kidney failure = Filter futility Peritoneal dialysis = Abdominal cleaning Hyponatremia = Salt shortage

THREAD This Is The Story Of The The Pernicious Rise of AI-Generated Papers and their Online Impact An Incomplete History Told In The Voice of Documentarian Adam Curtis 1/31

🚨New in Nature Computational Science! 🚨 Do large language models (LLMs) exhibit social identity biases like humans? (co-lead by @tiancheng.bsky.social, together with @steverathje.bsky.social, Nigel Collier, @profsanderlinden.bsky.social, and Jon Roozenbeek) 1/ www.nature.com/articles/s43...

The data speaks for itself

#MedSky #NephSky 🛣️ BPROAD takes the known path of ACCORD trial, minus glycemic control 🎯Question to address: should we aim for a BP of 120 or 140 in patients with diabetes? #NephJC summary by @shahsonride.bsky.social and @madihaaziz.bsky.social www.nephjc.com/news/bproad

An incredible review by @richard-lehman.bsky.social bjgplife.com/the-art-of-u...

A book that needs to be part of every doctor's lifelong learning. Huge riches hinted at in my little review, which is mostly about uncertainty in general practice: bjgplife.com/the-art-of-u... @marydixonwoods.bsky.social @johnlauner.bsky.social

This should be a pretty good indication to any medical journal out there that Bluesky is the ideal platform to post your publications. Unlike Threads and X, pub links aren’t throttled by the algorithm here. #Medsky

For the 1st time on #BlueSky, we release a FULL issue of Annals of Family Medicine! The November/December 2024 issue is AVAILABLE NOW! Our video preview has an exclusive glimpse into our latest issue and the newest research in #PrimaryCare #Medsky #FMsky www.annfammed.org/content/22/6...

Does #randomization ensures balance of risk factors between groups? Consider this: In Denmark 860 individuals were randomly allocated to either intervention or control. Individuals were unaware of their allocation. No intervention took place. Mortality was higher in the intervention group (p=0.003)

New today - @thelancet.bsky.social DM/Endo GLP1RAs and kidney/CV outcomes - SR from @sunilbadve.bsky.social Tuttle, Perkovic et al www.thelancet.com/journals/lan... ($🔒) - with/out DM - kidney outcomes (not albuminuria)

I don’t want to quote dunk on that person, but GLP-1ra drugs are so effective that the FDA is literally allowing compounding pharmacies to defy patent law because so many people can benefit from them and can’t get them due to low supply

Good one! I liked this network MA (I generally don't like these), but the idea of more meds being better is worth considering. www.annfammed.org/content/21/4...

Did you read this great paper? It’s a messy, messy diagnosis in the hospital, also. www.acpjournals.org/doi/10.7326/...

AI for medical transcription - in this case Whisper sneaks in its own hallucinatory phrases apnews.com/article/ai-a... though i wish the AI did invent ‘hyperactivated antibiotics’ we are going to need them soon 😏 h/t @placentadoc.bsky.social #MedSky

FDA Commissioner Robert Califf speaks with JAMA+ AI Editor in Chief Roy Perlis about the challenges of regulating AI in health care. ja.ma/3B4SFux

When insulin was first patented in 1923, the discoverers declined to put their names on it as they felt that insulin belonged to the public. 101 years later, insulin is inaccessible to thousands of Americans because of price gouging by near-monopoly private insurance corporations and their PBMs.

Zerlasiran, a small-interfering RNA, reduced time-averaged lipoprotein(a) concentrations by more than 80% during 36 weeks of treatment in patients with atherosclerotic cardiovascular disease. #AHA24 https://ja.ma/4fSsXYX