David Dobies, MD, FACC, FESC @DavidDobiesMD
Interventional cardiologist with an interest in statistics and evidence based medicine. My opinions are not medical advice. Joined August 2011-
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Latest evidence of utter failure of non-inferiority trials to set appropriate non-inferiority margins. Clinicians should ignore these margins & statistical claims of non-inferiority & instead think how their patients would balance benefits/harms/burdens. pubmed.ncbi.nlm.nih.gov/37421996/
Absolutely
You won't believe this. A team of researchers, led by Sanket Dhruva (UCSF) have found...sit down for this... An association b/w $$ received and Impella's implanted. In @JAMA_current There's even a dose-response curve. Of course. jamanetwork.com/journals/jama/…
DanGer Shock is a positive trial, but not ECLS Shock. Is it because of the device, or the selected Population?. Let ´s discuss it…. 🧵
The p value was 0.04 with a confidence interval of 0.55 to 0.99. A couple of patients could have changed the conclusion. In general a p value of 0.04 is suggestive.
The p value was 0.04 with a confidence interval of 0.55 to 0.99. A couple of patients could have changed the conclusion. In general a p value of 0.04 is suggestive.
I’m very happy to see community care veterans.
I’m very happy to see community care veterans.
Great point.
FULL REVASC trial Is it time to abandon the use of FFR-guided revascularization in ACS? Maybe not! Trial sample reduced & f/u truncated; final power 74% for HR 0.74 (delta) PEP: 19% vs 20.4%, HR 0.93, 0.74-1.17, p=0.53 Inconclusive result, low power nejm.org/doi/full/10.10…
Great observation
@RichardAFerraro @BakhshiHooman @baileyannRN @SABOURETCardio @gbiondizoccai Implausibly large effect sizes with sparse events are seldom replicable.
The confidence interval is 0.55-0.99 with a p value of 0.04. A couple of patients could have changed the conclusions.
The confidence interval is 0.55-0.99 with a p value of 0.04. A couple of patients could have changed the conclusions.
Surrogate endpoints are nice. We need outcomes data. Do the authors plan to data share?
Surrogate endpoints are nice. We need outcomes data. Do the authors plan to data share?
Please read the BMJ article reporting a mismatch between the data presented and the case report forms. Your initial publication is problematic. Please data share.
Please read the BMJ article reporting a mismatch between the data presented and the case report forms. Your initial publication is problematic. Please data share.
What happens when MOC points and fees are more important to your job than voluntary CME: empty seats 👇
What happens when MOC points and fees are more important to your job than voluntary CME: empty seats 👇
Another neutral #heartattack trial: Apolipoprotein A1 Infusions did not reduce myocardial infarction, stroke, or death from cardiovascular causes. 🤔, current treatment (in RCT recruiting hospitals) is too good for novel interventions to change outcomes. nejm.org/doi/full/10.10…
10 doctors on @US_FDA panel for @AbbottNews heart device had financial ties to the company: The FDA didn’t disclose the payments. nbcnews.com/health/health-… via @DavidHilzenrath et al @mmamas1973 @susan_bewley @dr_benoy_n_shah
EMPACT-MI #Empagliflozin within 14 days of #heartattack with features of #heartfailure did not reduce the primary endpoint of a first heart failure hospitalisation or death from any cause compared with placebo. But did ⬇️ heart failure hospitalisation. nejm.org/doi/full/10.10…
Your eight thousandth reminder that HFpEF is not one disease….
According to a 3-year follow-up appraisal of requests of conflicts of interest declarations from the European Medicines Agency, received information only partly addressed formal requests. It is recommended that EMA improve transparency by publishing author names and…
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NBPAS PRESS RELEASE : "We urge every physician who has been harmed by ABMS MOC to speak now, speak loudly, and spread the word to every physician you know." - Dr. Paul Teirstein businesswire.com/news/home/2024… @doctorwes @AaronGoodman33 @MartyMakary @VPrasadMDMPH @VincentRK
Louisiana let's oil companies do what every university lets Pharma do. 👇
"For $5m, Louisiana’s flagship university will let an oil company weigh in on faculty research activities. Or, for $100,000, a corporation can participate in a research study, with “robust” reviewing powers & access to all resulting intellectual property." theguardian.com/us-news/2024/a…
Thank you @guvenguvenh! This is excellent!
@InfoNbpas @doctorwes @AaronGoodman33 @chadinabhan @MartyMakary @VPrasadMDMPH Done. Here is a part of it…
beckershospitalreview.com/hospital-physi… A new Virginia law requires the presence of a physician in the ER and not merely on call. It takes effect 7/25. This law should be in effect yesterday and why is ever allowed to have an ER without a physician? I am shocked that JCAHO is ok with no doc in…
Fully agree. I still do not understand the 60% mortality in control. This is the highest ever reported mortality rate in contemporary PCI era. We did this analysis for all our RCTs and mortality is <50% for the DanGer eligible cohort!
@GreggWStone Great to have hope - but it’s a fragile result and we’ve seen too many times small trial findings reversed. Recover is needed to confirm/refute
Good grief. When you see a mountain of B.S. like this (“Aligning with psychologist George Miller’s Pyramid of Clinical Competence…”), run far, far, away. What fresh hell is this @ACCinTouch ? cvboard.org/pressreleases/…
It’s time for change! We agree @ERDocBrown. Thank you for speaking out. Thank you @medpagetoday Opinion | Let's Fix Maintenance of Certification medpagetoday.com/opinion/prescr…
Latest evidence of utter failure of non-inferiority trials to set appropriate non-inferiority margins. Clinicians should ignore these margins & statistical claims of non-inferiority & instead think how their patients would balance benefits/harms/burdens. pubmed.ncbi.nlm.nih.gov/37421996/
@DavidDobiesMD @bmorecardiology @VPrasadMDMPH @drjohnm And JUPITER was stopped early right as kidney problems and liver problems were nearing statistical significance. A small ARR in a composite endpoint over a short period of time does not equal net benefit from lifelong therapy.
@bmorecardiology @VPrasadMDMPH @drjohnm Look at Jupiter. 0.1% increase in A1C over 20.6 months isn’t really going to cause CV. 5.8% vs 5.9% won’t move the needle. Take it for 10 years and your A1C rises 0.5% and we’re in trouble b/c A1C predicts CV better than LDL.
The business guys want you to think that you can't run a practice without them. In reality, they can't run a medical practice without the physicians. We are the secret sauce; these PE guys are clowns.
@realdocspeaks TBH most doctors don’t know business well enough to own or run their own practices, nor does the current generation actually want to do in their own practice. Private practice will eventually find its nadir and stay there
For me practicing medicine has been a very personal-spiritual/not in religious way-job since I graduated I feel the responsibility&honor of patients trust. When someone comes to lecture me using terms like “added value” or “patient centric approach” i listen politely,am polite.
Very pleased and proud to be reappointed to @SCAI Quality improvement committee for 3 more years, and still a member of the international committee till 2026, working closely with @FaisalLatifMD @timir_paul Dr Debabrata Mukhergee @RameshDaggubati and the president @mirvatalasnag
Dr. Barrett Rollins, the chief integrity officer, needs to step down. He has clearly failed in this job and needs to be replaced. Dana-Farber Cancer Institute needs an outside investigation, as all of its top researchers are involved in this scandal. Research fraud has many…
Prestigious cancer research institute has retracted 7 studies amid controversy over errors @evanbush writes @NBCNews nbcnews.com/science/scienc…
#ACC24 IVUS versus angiography-guided PCI for ACS SIGNIFICANT difference in target-vessel failure between groups Question for the IC experts: When would you NOT use IVUS?
Please I urge everyone to email your administration to break ties with ABIM. They changed the rules again after backlash. Why do our hospitals work with ABIM and force us to maintain our certificates?? It’s a scam and they don’t give a sh*t about physician burnout.
This is definitely a conflict of interest to have an insurance executive and attorney as head of the Health and Human Resources. This position should be held by a physician and not an attorney. Maybe we need to have physicians appointed as the Attorney General of Virginia!
Everyone, meet John Littel AKA Darth Littel. John here is responsible for killing a budget amendment that would save Virginians at least $32 million, increase patient access, and save independent pharmacies from closing their doors. John, as secretary of Health and Human…
Not surprised. Many of the staunchest @ABIMcert pro-MOC supporters hail from Mayo (and most are hypocritical “grandfathers”) 👇
Wow. A major academic medical center has just argued in court that academic freedom is just an illusion. “The clinic argues in court documents its academic freedom policy is not a binding contract with … the plaintiff… The clinic states the policy “expressly reserves to Mayo…
Wow. A major academic medical center has just argued in court that academic freedom is just an illusion. “The clinic argues in court documents its academic freedom policy is not a binding contract with … the plaintiff… The clinic states the policy “expressly reserves to Mayo…
To its great shame, and at a tremendous loss of credibility, @MayoClinic argues it has legal right to punish professors for voicing their medical opinions. How can anyone believe that Mayo doctors actually believe what they say any more? thecollegefix.com/mayo-clinic-ar…
You won't believe this. A team of researchers, led by Sanket Dhruva (UCSF) have found...sit down for this... An association b/w $$ received and Impella's implanted. In @JAMA_current There's even a dose-response curve. Of course. jamanetwork.com/journals/jama/…
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