Robert A. Klosa

This is no different from case reports for vegan diets showing plaque reversal. Interesting but not applicable at a population level. At an individual level the fact my grandfather smoked like a chimney and lived to 90 doesn’t invalidate the conclusion that smoking causes cancer only that some people are resistant to its effects. What I do agree with is that there is not enough research to understand why some are resistant. I wish that was the point Nick was making.

The external validity can’t be estimated from his case report. It almost certain isn’t zero. And it’s very hard estimate external validity of trials. If his case is better characterized we can start to establish external validity. How is he genetically different from people for whom this is not true? How is he similar or different from other people in the LMHR phenotype?

I can't say I've ever encountered someone who conflates elevated LDL with heart disease. Most operate, rightly so, from the standpoint that heart disease is a probabilistic outcome influenced by numerous factors, one of which is circulating LDL / apoB concentrations. This is entirely compatible with Nick's personal experience. Since his anecdote has zero external validity, it can rightly be ignored in favor of population-level data and mechanistic inferences when dealing with literally any person other than Nick himself. Most importantly, is there any health benefit from maintaining higher vs lower levels? What, exactly, is the point of keeping LDL extremely elevated when it probabilistically increases disease risk?

@PeterJAnderson_ @MohammedAlo How do I interpret this chart. Is the decrease in PAV an average? So while there was progression in some individuals on average PAV decreased?

Hi Dr Alo, “Below 60 mg/dL we don’t see ASCVD” Did you mean generally we shouldn’t or mostly shouldn’t? ( or are you meaning in primary prevention more so than secondary treatment) This paper on polytherapy LLT of high dose statins and PCSK9i for 18 months with an average LDL of mid 30 mg/dL interestingly still shows plaque progression in 35.7% of cohorts. Authors believe unaddressed risk factors may be responsible jacc.org/doi/10.1016/j.…

Below 60 mg/dL and we don't see ASCVD. Add if we can drive it lower, you can see send regression in fresh soft plaque and remodeling of older plaque.

@WarMonitor3 Mostly left.

Ministers are resigning left right and centre today Kier Starmer is under huge pressure...

@ronmortgageguy It’s a tear down. Makes no sense to renovate.

When He's Right He's Right: Fix The Prime Minister's Damn HOUSE Every PM is afraid to spend the $75M to fix 24 Sussex Dr. people will scream it's too much money for a place the PM will live But Carney's right it's a rat & mold riddled disgrace & it needs to be fixed NOW

@MarkMcGrathCFP You get penalized if you pay off your mortgage or if you have high credit usage. So some guy carrying $30k rotating to collect points with 50k total credit is worse off than someone carrying $60k with $200k outstanding credit. All else equal. It’s directionally correct. Maybe.

Credit score competition let's go

@Mbakaza4L @AmberWoods100 So if we can’t afford these ‘entitlements’ how does he expect to fund the UBI needed to offset the AI job-pocalypse.

And there it is. Elon Musk just said he wants to cut Social Security and Medicare, calling them “entitlements”: “That’s the big one to eliminate.”

@alexandrmitr2 @_JakubJanda Can someone start a gofumdme so Fico can get a suit that fits.

Fico v Kremlu. Vyvrcholení.

@grok @DoctorTro @IanCopeland5 @grok consider drugs currently available over the counter and assess if it would make sense to allow ivermectin to be purchased over the counter. Specifically consider safety profile, drug interactions, how common the diseases are for which it is a treatment.

Yes, ivermectin 1% cream is FDA-approved for papulopustular rosacea (inflammatory lesions). Two pivotal RCTs showed strong efficacy: ~75-76% lesion reduction vs ~50% for vehicle, with superior IGA "clear/almost clear" rates (38-40% vs 12-19%). For other helminths (e.g., ascariasis, trichuriasis), some RCTs show moderate efficacy, often as add-on therapy, but not primary FDA indication or as robust as the listed parasites. Recent cluster-RCTs (e.g., BOHEMIA) found monthly MDA reduced malaria incidence ~26% via vector control, but not direct cure. Evidence is strongest for approved parasitic/skin uses. Consult a doctor and primary sources like FDA labels/PubMed.

Explain why with data. Support with RANDOMIZED CONTROL TRIALS why Ivermectin should be sold over the counter. You can't...

@DoctorTro @johnarnold Only if it comes with a wick.

@johnarnold 99%

The best chocolate is indisputably 72%.

"Intellectuals are naturally seduced by the idea of a planned society, because they think they will be in charge of it." --Philosopher Roger Scruton

Harvard, apparently, is about to adopt a new policy to combat grade inflation. I devised my own anti–grade inflation policy 25 years ago. I’ve shared it with provosts and deans, to no avail. Here it is: The Muñoz Plan Against Grade Inflation The plan has three key components:

Healthy user bias. Should have been called 'Smoking & Drinking and Coronary Artery Calcium progression'. "Participants with lower energy from carbohydrate intake were more likely to be men, current smokers; ... to drink more ... [and] tended to have higher intake of total energy" See table 2. Not subtle differences.

🫩"LCD in young adults were associated with a higher risk of coronary artery calcium progression in middle age" 🤨"Replacement of carbohydrates with predominantly animal but not plant protein or fat in low-carbohydrate diets has the potential of enhancing CAC progression"

@rblument1 @DrRumberger Many labs don’t use Martin/hopkins. In Canada we’re using Sampson which I believe is somewhere between Friedewald and Martin/Hopkins. Seems easier to train to use APO-B than to unpack the nuances of different equations.

@DrRumberger John, I will vehemently disagree with you on your post. The Dyslipidemia Guideline is definitely not a decade behind the evidence. It was endorsed by 12 societies and represents state of the art science. ApoB is of much less importance in the era of the Martin/Hopkins of NIH eqts

Whatever guidelines come along they are a decade behind the current scientific data. ApoB, which incorporates Lp(a) is the goal and ignorance because doctors are behind their educational times is NOT an excuse

In government hands it wouldn't be worth 5x. It would be mismanaged - albeit certainly cheaper. And that is the 'problem'. Every toll increase would be a political calculation. The failure is that the government didn't capture the real value to a for profit entity at the point of sale or at least introduce some friction or control over toll increases. Personally I think that governments should be required to annuitize the income from the sale of large assets over some reasonable time period to avoid the money being squandered by just one government. It will be squandered for sure - I just want to turn down the volume at the spending orgy.

And Ontarians now have the most EXPENSIVE TOLL ROAD in North America (just Google it) Oh & the 407 is now worth 5X what the government sold it for years ago I have a much better solution: find excellent people to operate our Airports not Dipshits Do NOT be fooled by BS 3/

Sell Off Airports In Canada? How Did That Go With Highway 407? 1) Canada's Airports are run by Fuck-Wits. Hardly any of us who use them like them 2) Just the simple Arithmetic of selling them says the Buyers will charge us alot more later Ontario sold Hwy 407 to business 2/

I work in a governance and control function at a large financial institution. This is not a complicated or even expensive problem. You don't need experts in the field to do basic reviews. It's a misuse of their time and expertise and they're probably not going to be good at it. Hire a few graduate students and train them to review the citations to ensure they exist and are relevant and review images etc. for manipulation. Authors should be required to submit original images and disclose not only the use of AI or image editing but also the how and why they were used. Failure to disclose or previous abuses lands you on a high risk list that is shared among publishers and with agencies providing funding.

New England Journal of Medicine (NEJM) is a top medican journal with a an impact factor of 78.5 And a paper with an AI-generated image (notice the nonsensical ruler) was able to get past NEJM editors and peer reviewers. I've been saying this for the last three years that people forget to use their common sense when it comes to AI.

Cholesterol has a special place in my heart.

More people would be pro datacenter if every one had a beautiful open-to-the-public heated pool.

@StevenMathern @JohnKastelein @Drlipid Rosuvastatin is the generic. Crestor is the brand name manufactured by AstraZeneca.

@JohnKastelein @Drlipid i do not follow. sarcasm? surely crestor is the same as ‘rosuvastatin?

Seems lately I have to do a lot of peer review on these video posts. My guess is that cardiologists and physicians or other "super-smart" docs who require lipid-modulating statins take rosuvastatin and few pay the extra cost to get proprietary Crestor.

@kareem_carr @deedydas Still. At a certain point you run out of unicorns for the other millionaire’s kids to found.

Interesting work but there are a few stats issues to bear in mind. The 50% identified are likely strongly selection biased, since negative outcomes are harder to track down. There's also a base rate question. Reaching an Olympiad requires a school environment capable of mounting an international effort, so the right comparison is peers from similar backgrounds.

What do the smartest kids in the world do when they grow up? I did the largest study of ~18,000 International Olympiad medalists (IMO, IOI and IPhO) over the last 25yrs, arguably the sharpest analytical minds of the world in high school, to see where they ended up and traced ~50% of them. Founders of ~20 unicorns and ~7 decacorns and ~10 billionaires: OpenAI, Cursor, Stripe, Databricks, Perplexity, Ethereum, Cognition, Hyperliquid, Fireworks, Modal, Quora, Parallel, Cartesia, Wispr Most kids went to MIT, a whopping 12% of them, followed by Cambridge (7%) and Sharif (3%)! The career paths they chose (of those who graduated) were: — 36% Academia (professors) — 26% Other — 22% in Software / Tech — 12% in Quant / Finance — 5% Founders! The biggest employer was Google, by far, at 6%. Others interesting tidbits were: — 47 of them work at Jane Street (#3) — 38 at OpenAI (#5) — 15 at Anthropic — 8 at Cognition — 6 at Isomorphic Labs Olympiaders were 1500x more likely to be billionaires and 4000x more likely to be unicorn founders than the average person!