My editorsÂ at Medscape warned me years ago that many people, especially younger ones, read a lot less. This saddened me because I’ve spent a great deal of time learning to write.
One of America’s most accomplished writers, Malcolm Gladwell, began his podcast because he worried about not reaching younger people.
Each week, I spend a great deal of time putting together thoughts on the top 4-5 cardiology stories of the week. Most of the ‘stories’ are studies, but not always.Â I have been doing this podcast for a couple of years now, but haven’t promoted it because I was not sure it would stick. It looks like it has–lots of young doctors have told me they listen.
I call the podcast This Week in Cardiology.
It’s available here on iTunes.Â https://itunes.apple.com/us/podcast/this-week-in-cardiology/id991125169?mt=2
It lasts about 10-15 minutes. Some of it is technical, but not all of it.
This last two weeks, I discussed the retraction of the PREDIMED trial. Gosh this is a big deal as PREDIMED was a randomized controlled trial (RCT), and most nutrition studies are observational. The differences in the two types of studies are significant.
Observational studies are tough to sort out–because of confounding.Â Confounding means there are many reasons the two groups could have had different outcomes.
Since PREDIMED was an RCT, the randomization of the two groups balance the confounding factors, and one can tell if the treatments causes a difference. I put causes in italics because good randomization allows one to make causal claims. This differs from observational studies, in which we can only say differences in the two groups associate with each other.
Association does not equal causation.
Specifically, PREDIMED studied use of the Mediterranean diet + Olive oil vs Mediterranean diet + nuts vs low-fat diet. In the original trial, the two versions of the Med diets led to fewer major adverse cardiac events. That was big. The trial was cited more than a thousand times.
But then a single doc, named John Carlisle, working on his own, figured out that there were irregularities in the randomization, not only in PREDIMED but up to 90 major papers.
Carlisle’s revelations prompted PREDIMED authors and the NEJM editors to look further, and indeed, they found irregularities. They republished the paper and the same results stood, but now the trial was considered mostly on observational study.
I discuss these issues on the podcast.
Other topics this week included comments on the massive overuse of tests for heart disease, such as stress tests, and the uncertainties of moderate alcohol intake for healthy and stroke care for the elderly, and the rise of genetic testing.
Perhaps you might find this weekly review useful. If you do, could you give it a rating on iTunes. It helps other find it.