Anil
11.8K posts
Anil
@AlphaBetaAnil
🫀 🩺 Physician | Trader | Performance Optimizer Tracking stocks, glucose, and gains — data-driven in life and markets.
United States Katılım Mart 2014
168 Takip Edilen8.8K Takipçiler
@AlphaBetaAnil a bargain - probably will advise against "seed oils"
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Yes my Crestor costs less than a buck a month, and I'm the first of my family not to have a heart attack in their 50's - yes, they are effective and I don't have to pay $800 to see a "doctor" who doesn't keep up with the literature
Dr. Ammous@AmmousMD
Maybe statins are ineffective but too profitable for the ones pushing them?
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The 2026 US Lipid Guidelines: A Paradigm Shift for... bishnusubedi.blogspot.com/2026/03/the-20…
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How many cusps does this aortic valve have?
1️⃣ Unicuspid
2️⃣ Bicuspid
3️⃣ Quadricuspid
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@HoustonHrtDoc Funny how inpatient notes at big-name centers read: ‘Seen previously by community cardiologist’, as if that’s a downgrade. I’ve seen far sharper clinical thinking in ‘community’ hospitals than in many ivory towers.
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@AlphaBetaAnil Anil- this problem is pervasive in academia- while constantly shunning communal practice, often times preaching from ivory Towers, talking about equality while their actions often times counter everything that they preach
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@DrSiyabMD Is Topol still working off 2011 CAC data? Citing a 2011 book in 2026 to argue against CAC makes it sound like nothing has changed in 15 years, despite multiple updated guidelines and risk‑stratification data since then.
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My most controversial opinion remains that all this is silly mental gymnastics… We should just put statins in the drinking water and CAD will become a solved problem in a few decades.
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This discussion on CAC on Twitter this weekend has really illustrated the massive differences in perspective between ivory tower academia and real world community medicine.
Eric Topol@EricTopol
@drjohnm I have been outspoken on the massive misuse of CAC testing for a long time (excerpt from my book in 2011) and have never ordered one.
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@MichaelAlbertMD I use CTa which cost around 550 dollars out of pocket in our institution after open discussion with the patients about risk of cta that incudes contrast allergies and possibility of incidental findings. Instead of cac.
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I would add that I use CAC screening for intermediate-to-high risk individuals who are LDL skeptical (thanks, keto people). While I don't know the true impact on my decision-making, I take solace in the fact that many agree on the value of LDL-lowering therapy after a positive CAC scan (non-zero).
Michael Albert, MD@MichaelAlbertMD
This is the best version of John — the apolitical one. Initial thoughts: I agree. We still do not have a randomized controlled trial showing that coronary artery calcium (CAC) screening leads to a survival benefit or a reduction in major adverse cardiovascular events (MACE). As someone who has published on CAC screening in obesity, I think it’s important to acknowledge that much of the support for screening comes from observational data or randomized trials where CAC was used in secondary analyses rather than as a hard clinical endpoint. I may have more to say once I review the studies informing this new guideline.
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@khurramn1 I have discomfort with biology of atherosclerosis treated as threshold in general. Biology doesn’t obey threshold! cac is not be all end all. Have seen nontrivial number of patients with high lesions/ plaque with zero calcium score on ct angiography.
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Don't understand the dichotomy on this issue in the cholesterol management guidelines.
1. CAC>100: Class 1 rec intensive LLT management, LDL target <70 (AGREE)
2. Moderate to severe incidental CAC on non gated , where almost exclusively you will have close to create than >100 on gated: Class II for same LDL goals <70 (DISAGREE WITH CLASS REC)
Any thoughts on this?
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@dvasishtha @operationdanish @MichaelAlbertMD If AI gives wrong answer then we should able to sue hell out of them. Let’s be real. You should be not asking your customers to sign waivers
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@operationdanish @MichaelAlbertMD Not blaming physicians per se.
But when it comes to patient use of AI I'm asking is the correct move to ban AI from offering medical advice and then ask patients to solve systemic issues while they face access crunches?
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If you think physicians are the problem, then it tells me you don't understand the issue. The same people who made this delay possible would love to replace physicians with robots so they can charge you twice as much and give you half the time.
Dhruv Vasishtha@dvasishtha
My wife asked to schedule an appointment with her PCP and got a slot in March...2027.
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Such a lack of understanding and intellect. Statins are some of the most well tolerated medications, with very minimal side effects, and incredible outcomes data that cost pennies a day. You can't make money off them. At least not as much as selling supplements.
Dr. Ammous@AmmousMD
@mdawese11 If you call poisoning people with statins healing, I want nothing to do with it.
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@DrSiyabMD He could have critiqued the paper itself like he does for other papers. That specific paper excluded 9 statin meta-analysis papers because they didn’t have survival curves. Sounds like analysis of analysis paper. Contrarian is always contrarian.
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A greatly under-appreciated side effect of niche academic debate on twitter is that everyone else (aka gen public) can see it too.
While other docs rightly call out obvious misinformation, John comes out and says well actuallyyyyyy, if you look at the data, he’s not *actually* wrong! See?!
What others see: hmm Aseem Malhotra is making sense… hey look an esteemed cardiologist using papers to support Aseem Malhotra’s claim, looks legit! 🤔
Do you think people realize the nuance that the actual problem (the “fuss”) is not that data itself but the fact that it is being intentionally misused to push a dangerous and misleading narrative that might influence people who actually need their statin the most, to stop taking them? No. Why should they either?
John could have used this opportunity to really highlight that, but he didn’t. Interesting.
The problem is not the data, it is the messaging and narrative.
John Mandrola, MD@drjohnm
You can fuss about the framing but this is NOT misinformation. See bmjopen.bmj.com/content/5/9/e0… AM is really close to correct. Survival (on average) is smaller than you think Even the ICD vs amio for sustained VT is months not years. In the old days authors stated it clearly
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@AppleHelix Equivalence/noninferiority designs typically rely on active comparators, not placebo. Equivalent or non inferior to placebo is absurd.
The ethical justification for placebo is a separate question from the statistical framework.
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I hope Venk doesn’t think head-to-head trial design = superiority. And that non-inferiority trial design = placebo controlled.
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@MichaelAlbertMD Prasad is wearing his physician hat while he should be wearing regulator's hat.
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Ben has the best take I've read thus far.
Benjamin Mazer@BenMazer
The legal standard is “safe and effective” — not most effective. Vinay has certainly set himself up for lawsuits with his Moderna decision. He has always been right that inferior controls are a serious threat to medical knowledge and ethics. But FDA can’t do much to stop it.
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@FBIDirectorKash This person's height is around 5'8'' and weight is around 70-80 kg if that helps.
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Additional recovered images from the same camera at Nancy Guthrie’s front door the morning of her disappearance, including two videos of the individual.
Anyone with information, please contact 1-800-CALL-FBI or visit tips.fbi.gov
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New images in the search for Nancy Guthrie:
Over the last eight days, the FBI and Pima County Sheriff’s Department have been working closely with our private sector partners to continue to recover any images or video footage from Nancy Guthrie’s home that may have been lost, corrupted, or inaccessible due to a variety of factors - including the removal of recording devices. The video was recovered from residual data located in backend systems.
Working with our partners - as of this morning, law enforcement has uncovered these previously inaccessible new images showing an armed individual appearing to have tampered with the camera at Nancy Guthrie's front door the morning of her disappearance.
Anyone with information, please contact 1-800-CALL-FBI or visit tips.fbi.gov
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25% discontinued trial-related therapy, most often because of intolerance,
Such non-random discontinuation can produce informative censoring, in which censored patients differ systematically in risk from those who remain under observation .
NEJM@NEJM
Our latest video in our partnership with @DGlaucomflecken summarizes the POTCAST trial, which assessed a strategy of actively increasing plasma potassium levels to the high-normal range in patients at high risk for ventricular arrhythmias. Read the full study for free: nej.md/DrG35
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Dr Bhattachary is implying:
Let parents refuse vaccines.
Let kids suffer the consequences.
Then say, “See? Now do you trust us?”
That’s not trust-building.
That’s coercion by harm.
Aaron Rupar@atrupar
BHATTACHARYA: We have to reestablish trust in public health. If you just double down on what let to the loss of trust, we're not gonna change it CASSIDY: Now we have a measles outbreak among those who did not trust. To further cast doubt upon the measles vaccine for no scientific reason -- that's not gonna increase trust
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