New column and podcast up:

Last week, I wrote a column on one of the most controversial clinical trials in cardiology.

The EXCEL trial pitted stents vs bypass surgery for people who have left main coronary artery disease. The trial has been beset with controversy.

The three areas of debate surround the definition of MI (or heart attack), the increased risk of death in the stent arm, and selective publishing of data.

Here is the column: Latest EXCEL MI Analysis Settles Nothing; Flaws Remain

You should study this one because it hints at how precarious medical evidence can be.


On the This Week in Cardiology podcast, I discuss EXCEL, but also the issue of trust in science.

This includes a few words on the matter of silly studies that still garner media attention. I’ve come to name these studies, howlers.

One of the reasons behind this is the business model of medical publishing. Medical journals, like any media outlet, need attention. Coffee studies bring attention; statistics studies not so much.

The pandemic has brought oodles of silly studies.

A classic example is the broken study on cardiac MRI in recovered COVID patients. This one had to be corrected due to a slew of errors and now shows no concerning signal of cardiac harm from COVID. But it has hundreds of thousands of page views and will surely bump up the impact factor of the journal that published it.

I discussed CMR, COVID and sports participation a few weeks ago.

The problem with howlers is that they hurt public trust in science. One week coffee is good, the next it is not. Don’t wear masks, do wear masks.

I also discuss the Vitamin D and COVID19 issue. Teaser: it’s folly.

Science leaders, I think, ought to be more candid about the limits of science, the uncertainty. Let the public in on the truth.

You know, a Karl Popper-like message.

Finally, there was big news in nutrition science: a group at the UCSF actually did a randomized controlled trial. This is huge because most nutrition science stems from flawed observational studies.

Here is the pod link: https://podcasts.apple.com/us/podcast/this-week-in-cardiology/id991125169

Let me know what you think. Remember, if you like the pod, give it a good rating so others can find it.

JMM

1 comment

  1. love your podcast. would love it if you addressed the recent clinical trials for Mavacamten for obstructive HCM? As a patient, I read good things and then a critical column, so your take on the trial and the data would be very welcome. Thanks for considering it.

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