Sensible Medicine is a shared column featuring the voices of leading physicians, scientists and thinkers. We showcase ideas about all things medicine.
Joined July 2022
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Another great one from @adamcifu on the misguided enthusiasm for cancer screening tests like Grail's Galleri: sensible-med.com/p/having-my…
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We have finished sharing our nine free "How to Not Get Fooled by the Medical Literature."
Today, on @Sensible__Med, we post the first of nine lecture for paid subscribers. Join us. It is a fun set of lectures. You will definitely learn a ton!
sensible-med.com/p/episode-1…
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We've got a Monday/Friday take on Grail this week. Should be interesting. @drjohnm goes first.
A Formal Review of the Grail Cancer Detection Trial sensible-med.com/p/a-formal-…
The Murky World of Conflict of Interest open.substack.com/pub/sensib…
We've got a Monday/Friday take on Grail this week. Should be interesting. @drjohnm goes first.
A Formal Review of the Grail Cancer Detection Trial sensible-med.com/p/a-formal-…
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This is EXACTLY our goal on @Sensible__Med: sensible arguments by sensible people for sensible people
I know both and I know both care about evidence. it is also refreshing to even see a conversation about evidence without political theater of left vs right.
every sensible person should appreciate how low the risks are. current covid hospitalizations are probably an overestimate since covid->pneumonia/hypoxia->hospitalization is a zebra now. so covid hospitalizations are a mix of incidental or mild and unrelated versus the now most common causal path of covid>URI>volume depletion/fatigue> fall or syncope. so if you can mitigate that, that could be helpful
I also don't believe that VA group or their prior work. Have they been right about anything? wrong on long covid, wrong on repeat infections, wrong on glps helping every outcome (cognitive, psychiatric). so I don't have faith in this one as our main evidence
we just ultimately have no idea and people have to make decisions nonetheless. i think the risks are going to be tiny/rare on either side. I personally wouldn't recommend it in 1st, 2nd, or third trimester.
good read nonetheless
Sensible Medicine retweeted
I know both and I know both care about evidence. it is also refreshing to even see a conversation about evidence without political theater of left vs right.
every sensible person should appreciate how low the risks are. current covid hospitalizations are probably an overestimate since covid->pneumonia/hypoxia->hospitalization is a zebra now. so covid hospitalizations are a mix of incidental or mild and unrelated versus the now most common causal path of covid>URI>volume depletion/fatigue> fall or syncope. so if you can mitigate that, that could be helpful
I also don't believe that VA group or their prior work. Have they been right about anything? wrong on long covid, wrong on repeat infections, wrong on glps helping every outcome (cognitive, psychiatric). so I don't have faith in this one as our main evidence
we just ultimately have no idea and people have to make decisions nonetheless. i think the risks are going to be tiny/rare on either side. I personally wouldn't recommend it in 1st, 2nd, or third trimester.
good read nonetheless
@dmrind calls out @VPrasadMDMPH for his answer to a frequently asked question and Dr. Prasad responds. Enjoy!
The COVID Vaccine for Pregnant Women sensible-med.com/p/the-covid…
Sensible Medicine retweeted
A Summary of the Evidence for Left Atrial Appendage Closure vs Oral Anticoagulation via @drjohnm
sensible-med.com/p/a-summary…
Sensible Medicine retweeted
Unbelieveable COVID-19 💉 revelations by BMJ Investigation:
The Bayesian analysis framework to detect safety signals in VAERs did not work, it was mathematically compromised, & officials ignored several warnings about it, while citing the lack of signals as evidence of safety 😱
Sensible Medicine retweeted
I agree with @VPrasadMDMPH : when alpha is allocated across primary endpoints, a nominal 95% CI excluding the null is not enough to declare success. Figures should show CIs compatible with the testing plan or clearly identify nominal intervals and display the applicable significance threshold.
ARRIVE trial illustrates the same issue with interim monitoring: the primary p value was 0.049, but the required threshold was 0.046. The success criterion was not met. Neither the figure nor the headline should imply otherwise but missing that threshold is not proof of no effect.
Sensible Medicine retweeted
What do you think about 95% CI presented for many endpoints/ particularly when alpha is split
Full video on ZD's Youtube
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Some folks continue to repeat the claim that covid shots "saved 3.2 million lives" in the US alone, an estimate based on a modeling study published in a non-peer reviewed blog. The counterfactual that one would have to believe to get to this number is so absurd that it is hard to understand how anyone calling himself a scientist could cite it.
Sensible Medicine retweeted
@VPrasadMDMPH calls masking the MAGA hat for doctors.
"There were randomized data pre-pandemic where they showed that cloth masks absolutely don't work or maybe even increase the rate of transmission."
"Fauci went on 60 Minutes in March and he said, no, they don't work. Eight weeks later he said, actually, I was wrong about that. He was lying the second time. The first time he was telling the truth."
"I think masking is the MAGA hat for doctors. It's a political ornament."
@mayamshahh pushes back:
"The data does show that surgical masks are effective to some extent."
His answer on the one big randomized Bangladesh study:
"They got 10% more participants [in one of the two groups of] their own study. It's statistically imbalanced."
Sensible Medicine retweeted
Russ Vought is right. The NIH has been corrupted by racial-ideological capture and the Administration should have the power to make sure that it no longer sends billions out to left-wing ideological programs under the guise of “healthy equity” or other pseudo-science.
New:
Officials battled over NIH in the Oval Office today, per ppl familiar.
RUSS VOUGHT criticized NIH "woke" spending and floated exec order to review grants.
JAY BHATTACHARYA defended his agency.
TRUMP appeared to side with Vought.
w @rbeggin
washingtonpost.com/politics/…
Sensible Medicine retweeted
"Conditional recommendation based on low quality evidence"
These thresholds are also not based on evidence that matters! Lots of indirect speculation
What you'd want: Two populations randomized, one treated at ferritin <15 and another treated at <30. Look at fatigue, QoL, transfusions, mortality
Doubt the higher threshold wins. What it does with certainty is create more "diseased"
The aphorism told to me in residency rings true -"patients lie about sex, drugs, and taking their iron pills"
🔇 What is new in Hematology ??
The recent American Society of Hematology's 2026 guidelines on the diagnosis of iron deficiency is out!!
For years we've anchored to ferritin ≤12–15 ng/mL as the diagnostic line. The panel reviewed the evidence and concluded those thresholds were never evidence-based to begin with they were inherited. Here's what changes:
🔹 Children 9 months–4 years: ferritin ≤20 ng/mL (up from ≤12)
🔹 Adults: ≤30 ng/mL (up from ≤15) — and ≤50 ng/mL if there are symptoms or ongoing risk factors
🔹 Menstruating individuals: ≤30 ng/mL, with ≤50 ng/mL where there is heavy menstrual bleeding, planned surgery, or pregnancy being planned
🔹 Pregnancy: ≤30 ng/mL — and a strong recommendation against using ≤15 ng/mL, the only strong recommendation in the document
🔹 Anemia of inflammation: ferritin alone is not enough. Pair it with a fasting TSAT. Consider iron deficiency if TSAT <20% or ferritin <100 ng/mL
For India, where iron deficiency is near-endemic in women and young children, the practical implication is simple: a ferritin in the teens or twenties in a symptomatic menstruating woman is not reassurance. It is a diagnosis.
Worth a read, and worth a conversation with our lab colleagues about the reference ranges printed on our reports.
📄 Powers JM, et al. ASH 2026 guidelines for diagnosis of iron deficiency. Blood Advances. doi:10.1182/bloodadvances.2025015950
#Hematology #IronDeficiency #Anemia #WomensHealth #ASH2026 #EvidenceBasedMedicine
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New members on the USPSTF
Congrats @venkmurthy
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Confounding in clinical practice
open.substack.com/pub/sensib… via @adamcifu
Sensible Medicine retweeted
Another L for public health establishment and Peter Marks. Myocarditis signal was clear from Israel data in nejm in 2021. Knowing what to look for they still couldn't figure it out!
This is a new investigation in @bmj_latest, one of the most reputable medical journals: US officials knew covid vaccine safety system was flawed—but turned aside the FDA doctor who alerted them
bmj.com/content/394/bmj-2026…
