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Graphic on the right just about sums up 2020 research wouldn’t you say? @venkmurthy @VPrasadMDMPH
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Michael Cunningham, MD, FACC, FSCAI
1.8K posts
Michael Cunningham, MD, FACC, FSCAI
@OSHeartDoc
Dad, husband, interventional cardiologist. Director of Cardiology at SRHS. Tweets my own.
Ocean Springs, MS Beigetreten Kasım 2019
1.3K Folgt913 Follower
Michael Cunningham, MD, FACC, FSCAI retweetet
@CoffeeBlackMD @drmikehart Yeah, but that study sucks in all kinds of ways... any imaging-based study with no core lab adjudication of imaging findings is trash. Also, what would the mechanism be for a blood thinner to decrease plaque? Doesn't even pass the smell test.
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@drmikehart Best I can tell the thinning as it exists at the effective doses is still less than your typical baby aspirin. But still important to point out.
And I’d love more studies myself.
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Effective Nattokinase dose = 10,800 FU/day.
Studies with lower doses show no effect.
Taking it with Vitamin K2 & Aspirin 81mg = best effect.
But chat with your doctor first.
Too much blood thinning can lead to a hemorrhagic stroke.
Also, we need more studies on NK.
Patrick Sullivan Jr.@realPatrickJr
Joe Rogan recently discussed a study where 1,062 people took nattokinase for a year. Ultrasound results showed their arterial plaque actually shrank by 36%. This enzyme stops new blockages AND helps reverse the ones you already have. Let's look at the data and dosing: (1/12)
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@BrentAWilliams2 "I wasn't seeing any patients getting better."
Maybe you're just a bad doctor? 🤣
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If anyone believes that 1/3 of all hospital deaths a year are attributable to medical errors doesn’t have an IQ high enough to have a discussion about the topic.
Jamie Andrews@JamieAA_Again
No no... distrust in medicine is definitely for a reason.
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Because he’s not a serious person. His “coward” trope is all he has. You knew he wasn’t serious the moment he said “yeah, yeah, you’re very talented”. No reason to respond after a comment like that. It’s a waste of my time. His tune would change mighty quick if he was on my Cath table or in your OR, but he’s safe behind the keyboard. Who’s the real coward?
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@Diplomatt42 @KaiRedOak1 @OSHeartDoc @sdixitmd That's not how economics works. I don't actually get to set my own price in an open market. People have to be willing to pay.
There's nothing cowardly about that. Why don't you answer what you'd be willing to pay to save a loved one's life?
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Hot take:
I make more than that and I’m underpaid for what I do.
Shades of @DrDiGiorgio.
Richard Hanania@RichardHanania
Average income of physicians US: $458,100 Canada: $194,700 Netherlands: $185,700 Sweden: $115,200 nber.org/papers/w34956
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@anish_koka He gave a ref link at the end of his thread... so, there's that.🙄
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Single arm ? Given issues with CIMT would have to see a control arm.
And if the mechanism for plaque regression is blood thinning? Why should that regress plaque ?
Patrick Sullivan Jr.@realPatrickJr
At 10,800 FU, carotid artery plaque shrank by up to 36%. The arterial wall thickness decreased by 21.7% on average. These are physical, structural changes that doctors measured and confirmed on ultrasound.
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@TXMCtrades @Cernovich Yeah, when someone proposes banning short selling, they have declared their IQ to be sub 110, minimum.
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@JonMFleetwood @jathorpmfm But it’s not… so there’s that.
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Medical care is the third leading cause of death in the U.S., per Johns Hopkins.
hub.jhu.edu/2016/05/03/med…
Jeffrey A Tucker@jeffreytucker
Not sure why this is supposed to be funny these days. wsj.com/opinion/pepper…
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@just_mindy Yeah, the ones who don’t match are generally too picky with the places they select.
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but won’t that likely be in their second, third or fourth choice or by putting off grad for a year and reapplying? Sincerely asking. I’m just trying to learn from TT Match Day videos
Pradheep J. Shanker, M.D.@neoavatara
Almost every single one of them will get a residency if they want one. Again, I already proved she is 100% wrong on this.
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This is the nature of observational studies. Biases that come to mind:
• Immortal time bias (CABG wait)
• Selection bias (non-shared populations)
• Chronological bias (2001–2017 vs 2018–2021)
• Ascertainment bias (MI definition differs)
• Design heterogeneity (RCT vs registry pooled)
• Unmeasured confounding (SYNTAX, DM severity,.......)
3/
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IVI use being associated with such benefit in the very early period (first 3-5 days) is clinically implausible.
In addition to your points, I would add the following:
- Key claim: IVI-PCI ≈ CABG
- But the data come from 3 very different sources, and the mixing creates serious bias concerns.
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Salman Arain@realarainmd
PCI vs. PCI - More reflections on the study by Gim et al The sticking point for me (and others like @aymanka, @ihtanboga, @GreggWStone) is the immediate separation of the curves bet. the PCI arms. It is difficult to see how immortal time bias alone accounts for this. doi: 10.1016/j.jcin.2025.11.036
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@Diplomatt42 @KaiRedOak1 @OSHeartDoc @sdixitmd The more economically appropriate question is: if you or your loved one were having a heart attack, how much would you pay for his services?
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@realarainmd @aymanka @ihtanboga @GreggWStone Sal, there is no way these can be compared and not expect massive confounders and biases that are unaccounted for.
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PCI vs. PCI - More reflections on the study by Gim et al
The sticking point for me (and others like @aymanka, @ihtanboga, @GreggWStone) is the immediate separation of the curves bet. the PCI arms.
It is difficult to see how immortal time bias alone accounts for this.
doi: 10.1016/j.jcin.2025.11.036
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@SBakerMD My Kerry Blue Terrier is awesome.
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It seems Doctors getting a lot of flake on here recently. Not sure why.
I trust @CoffeeBlackMD . But more importantly in any profession there’s always going to be people who are better than their peers.
Stop lumping them all together. Shows low IQ.
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@independentMDs @BrentAWilliams2 Mildly protective. But it’s not some big advantage. Could become obsolete as AI progresses.
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The fact that med students think these skills are protective, and even may serve as a most against replacement by AI....is detached from the reality of American healthcare in so many ways.
Max Jordan Nguemeni@MaxJordan_N
Unlike AI we can do a physical exam. Listen to your heart and lungs. Trigger reflexes to assess them. Rotate/flex/extend your joints. Check for rebound or guarding. Appreciate allodynia. Yall say what you want about AI vs doctors but AI is far from being able to replace us.
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@JanMusuta @RichardHanania Doctors are 8% of healthcare costs. We are not the problem.
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@RichardHanania Don't know if it supposed to be a good thing or a bad one.
Depends on the perspective. But the Netherlands is providing similar services for lower cost so that's that.
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Average income of physicians
US: $458,100
Canada: $194,700
Netherlands: $185,700
Sweden: $115,200 nber.org/papers/w34956
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@RichardHanania Looooooooonnnngggg right tail. Very long. Now do median. Then do years of training and debt accrued during said training. Then do wait times. Useless paper. The amount of garbage printed to vilify physicians in this country is becoming ridiculous.
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@BrentAWilliams2 They just want to put us in permanent public servitude. Aka, slavery. You can’t convince me otherwise.
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No country provides “universal health care” for it’s citizens because there is no such thing as universal health care.
Kyle Blomquist for U.S. Congress@BlomquistForMI
The U.S. is the only developed nation in the world that does not provide universal healthcare to its citizens. Public options aren't it. ACA subsidy expansion isn't it. Anything less than Medicare for All is an obstacle between you and the care you deserve.
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Michael Cunningham, MD, FACC, FSCAI retweetet
William Faulkner once said, “To understand the world, you must first understand a place like Mississippi.” This week I had a chance to test that principle for myself, including a visit to Faulkner’s home in Oxford, Mississippi. jonathanturley.org/2026/03/21/hot…
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