Gregory Schmidt

@CoffeeBlackMD I find most useful in finding the patient who has far more age/sex adjusted plaque than would otherwise have expected. Turns the previously throught low or intermediate risk patient into someone worth targeting more intensive ascvd risk reduction targets

Coronary calcium scores have some parallel problems as the full body elective MRI but not to the same extent. They are great in the right hands of a cardiologist (or a good internist/FP) that can parse the nuance in intermediate risk patients. Perhaps helping in a decision to start a statin given all the contexts. Negative results are clearly reassuring but the problem comes when you have significant old, hard disease and then what to do about it. In asymptomatic patients should you really be doing any further work up? Including catheterization? We know treatment of asymptomatic lesions isn’t beneficial. The study hasn’t ever shown any serious end of line kind of benefits. It’s never had a good randomized trial. In low risk, affluent worried well patients the study can act as a cash machine. In high risk patients especially the symptomatic, it’s irrelevant. I have a few cardiology followers. They may want to weigh in on how they use and see it. But from my perspective you shouldn’t be spending money just looking to look and this should be a test your treating physician should use in context to help them make decisions.

@drgarymcgowan @NIPCIRELAND @uniofgalway Great work !

✅ MSc Preventive Cardiology — First Class Honours. 🔬 Also delighted to receive an award for research excellence, with no small thanks to the outstanding support from my supervisors. Another small step to the dream of becoming a Cardiologist 🫀 @NIPCIRELAND @uniofgalway

100% I am generally never disappointed to order imaging in context of severe infection without clear cause or of suspected abdominal source. Number of findings on imaging that change management far outweigh small number of studies return negative. Renal stones. Stercoral colitis. Pyomyositis

Note to intensivists: A rule that I’ve kept with and seems to work very well in working with patients in the intensive care unit is that if somebody is admitted to the intensive care unit with urosepsis requiring vasopressors it’s always a good idea to image the urinary drainage system for obstructions and stones. Source control. This self imposed rule has served me very well .

@NutritionMadeS3 Well done cascade screening!

I was the 1st in my family to ever measure lp(a) High. Pushed for cascade screening. Mother, sister also high. Dozens of family members now measuring Mom has calcium score=850. Always lean, active, no tobacco or alcohol. Now on LLT, ApoB cut in half Knowledge saves lives.

@adamcifu Thanks for suggestion. Just purchased.

One of my favorite books since 1991. Just got the 5th edition. I’ve also owned the 1st and 3rd.

@david_perell Highly recommend this similar restaurant in Paris. Only Q when you dine there is rare or medium: relaisentrecote.fr

If I could bring one restaurant chain to America, it’d be Flat Iron in London: solid steaks, fairly affordable, simple menu, insanely quick, comfy enough decor, nice enough for a work lunch but casual enough to eat with friends. Asked the waitress about the business and she said there’s ~20 locations in England, ~45 minute waits on the weekend, and the economics work out because they move people in and out so much faster than traditional steakhouses.

@AdamRodmanMD @morgancheatham Yourself?

@morgancheatham Do you think that in the near- and medium-term, this shifts the locus of importance towards generalist knowledge or towards specialist knowledge? (something I think a lot about re: medical education reform)

prediction: AI will collapse traditional medical specialties as we know them. medical specialties emerged out of necessity. as medicine became more complex, no single physician could master its full scope. we began dividing care by organ systems, technologies, and life stages — structures that mirrored both biology and the way symptoms typically presented. over time, hospitals, licensing bodies, and reimbursement systems ossified these divisions. we learned to think this way not just because it made biological sense, but because it was the only way we could manage complexity.

@AdamRodmanMD @morgancheatham I’ve leant more towards specialist over the years.

@drgarymcgowan Do you have a preferred approach to calculate 40-year risk?

10-year CVD risk scores in people in their 30s are grossly misleading. People are constantly reassured by such scores, delaying preventive efforts. It's 40-year risk that matters in your 30s... Don't wait for the disease. Get ahead of it!

@drgarymcgowan Something along fibre / colorectal cancer risks

If you’re eating for health & longevity, ideal outcomes [for most] would include: - weight reduction / leanness - muscle gain / maintenance - lower blood pressure - insulin sensitivity & glycaemic control - lower LDL-C / ApoB & triglycerides What would you add? 🍎

@drgarymcgowan Enjoying what you eat

@DrNadolsky Patient last month told me she wasn’t sure what to do with all her free time now that she isn’t thinking about food all day. She seemed confused that this was how people normally live. And was considering what hobby she’d pick up with all the extra time.

“I feeling like I’m eating to live instead of living to eat now.” “I’m finally free from all the food thoughts.” - patient who started a GLP-1 med last month

@drgarymcgowan @NutritionDanny This was a great episode, thanks for recording it.

When we recorded the LMHR ep on Sigma (@NutritionDanny & Dr Alan Flanagan), one of the focal points was misleading science communication among the LMHR authors. Amidst the KETO-CTA fiasco, it should be clear why this was such a focus. sigmanutrition.com/episode541/

@DrNadolsky Exactly. In a group of people exposed to a lot of smoking. Those who have the worst coronaries to start with, did the worst overall.

Even better - the lowest amount of smoking was 2 packs per day. Highest was 5 packs per day.

@AdamRodmanMD @mkurman88 I agree, although often directionally right, it seems too often mis out on some critical landmark studies about the question asked. I’m not sure if this issue is related in part to data available in its brain vs its search and selection strategy

@mkurman88 Hope that helps! Like I said, not a very tough question, and I know the literature very well. It gets a C+. Maybe a B-.

I have it, guys! What should I ask? Give me some challenging topics to compare with OpenAI Deep Research, preferably tough medical questions.

@sama Don’t like it

an idea for paid plans: your $20 plus subscription converts to credits you can use across features like deep research, o1, gpt-4.5, sora, etc. no fixed limits per feature and you choose what you want; if you run out of credits you can buy more. what do you think? good/bad?

@levie @gdb Please share!

@gdb Deep Research did what took about ~5+ doctor visits and dozens hours of research to make progress on in about 10 minutes.

Deep Research for helping navigate a medical issue:

@adamcifu @DarrellWhite Wonderfully written. Thank you.

@DarrellWhite Yes. @adamcifu/p-145850596" target="_blank" rel="nofollow noopener">substack.com/@adamcifu/p-14…

What makes me crazy about so much "longevity medicine" is that it is lives in a clinical data free zone. It is based on theory and extrapolation and never considers public costs. Grrrr. That is my complaint for the day.

@StuartBlitz Broaden your expansion mmr with selling the doctor report templates to save time Have you considered using AI?

@StuartBlitz 10x that market cap by adding a paid patient portal 100x it with a "second opinion" option for patients

I’m pretty excited about my new angel investment. Tech friend said he had to manually take his data on a CD from one doctor to another. He had this amazing insight to create a cloud-based solution so data can just flow EMR to EMR. Seems like a $100B company. Anyone interested?