John Mandrola, MD
@drjohnm
Heart rhythm doc, writer for @Medscape, host of This Week in Cardiology podcast, cyclist, #MedicalConservative. The more you see, the harder medicine gets
ID:139173680
https://johnmandrola.substack.com/ 01-05-2010 19:49:37
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John Mandrola, MD It's great to be an optimist when you're running a clinical trial. But during the design phase you need to be a pessimist, or have a flexible budget and use a sequential design that doesn't pretend to know N.
An important observation👇🏻 The majority of *major* cardiology trials are under powered to sort signal from noise. Just as Frank Harrell points out nearly every week. This is bad for our field.
I’m not an oncologist and a lot these studies are intimidating due to the hard names of drugs. But. If I’m diagnosed with cancer, and a doc recommends a Rx, I’m googling it along with “Vinay Prasad”. Incredibly important work for patients and society. Kudos John Arnold
Darren Dahly - on Bluesky and Substack I shudder whenever I read “clinical trial emulation”. How do you emulate blinding or guarantee that all confounders are measured? How do you start the clock at the same time for every patient?
I really enjoyed this piece. Perhaps Walter Kirn approaches a modern-day Mark Twain. And gosh do we ever need that now.
Agree completely with John Mandrola, MD. Additional issues:
1) DEDICATE-DZHK6 1 year events are too high !!! TAVR= 5.4% (1% in PARTNER 3) and SAVR= 10% (2.9% in P3). Data from Germany seems to do worse than other RCT (remember GARY registry?)
You lost me at Cochran review. COVID confirms all guideline writing groups to have significant biases. Some are good, some are bad. Very hard for patients to do this themselves (see Alex Berenson and spine surgery.)
Find a doctor you relate to and trust, get second opinions for…
You have to liste to the last episode of TWIC from John Mandrola, MD talking about Complete trial
nejm.org/doi/full/10.10…