Adam Cifu+

Turning Three Pet Peeves into Unsolicited Advice

For Journalists, Researchers, and Editors

How investigators, journalists, and editors contribute to mistrust in science

The key players in the system should reflect on their own behavior if we are to restore faith in science.

This Fortnight in Medicine XXIX

Treating MSSA and a new way to treat HFrEF (not really)

When Normal Isn’t Normal: Non-anemic Iron Deficiency

A response

A Medical Reversal You May not Have Heard Of

Things are pretty quiet in the summer so let's go back to an old-school medical reversal in electrophysiology. One I lived through. If you like trials you will like this story

Do not Relegate Palliation

Adam’s post yesterday stirred me to write about the words and intentions doctors use.

Friday Reflection 62: The Ethics of Telling Patients We Have Nothing Left to Offer

We no longer conceal bad diagnoses from patients; we consider this unethical. It is time that we consider it unethical to conceal that we have nothing to offer beyond palliation.

Can you trust your doctor?

A first, second, and third opinion

The SNAP Trial Exemplifies What EBM Should Look Like

It's always worth showing properly designed and conducted trials--though it's bad for pageviews. Nonetheless, SNAP authors show the way to answering questions in biomedicine

Why has trust in medicine declined?

A recent California op Ed misses the point

Advice for Internship

The calendar has turned to June, another class of medical students has graduated, and they will soon begin their residency training. What better time to dish out some unsought advice.

Genetic Screening of Newborn Babies

Universal newborn screening with whole genome sequencing (WGS) is coming to the UK - at least on paper.

This Fortnight in Medicine XXVIII

How to treat sinusitis (maybe), and do GLP-1s prevent cancer?

Closing the loop on Hantavirus

Sensible medicine - 1; Media - 0

For Hospital Medicine, the Answer Should Always be: Randomize

I call them therapeutic fashions, things that we do because it's fashionable and popular. This week three of these were busted by...what else...the RCT

The American Diabetes Association Threw Out Researchers for Passing Out Their Editorial

A Sensible Medicine 1st, 2nd, and 3rd opinion

Clinical Trial Prediction Markets: Forecasting Evidence or Distorting It?

Will prediction markets influence clinical trials?

I'm healthy. I'm a little overweight. Should I start a GLP-1?

A first, second, and third opinion

Behind Every Dad Bod is a Dad Brain?

Does having kids improve your brain, or are people with "better brains" more likely to have kids?

Do not assume beneficial interventions apply to higher-baseline risk patients

The TRACK trial of low-dose rivaroxaban in patients with kidney disease teaches an important lesson in EBM

Should evidence come with an expiration date?

An empirical analysis

Treating (or not treating) the Sick, the At-risk, the Well, and the Hobbyists

My father graduated from medical school in 1955.

Ferritin Levels – Redefining Normality in Women

Medicine must improve because we want to treat the sick better and because we need to keep up with the new diagnoses being created that turn healthy people into patients.

This Fortnight in Medicine XXVII

An RCT of sunscreen and melanoma prevention and an observational study analyzing the risk of NAION with SGLT2-I

Good Ideas Need to Pass Muster in the RCT

The implantable loop recorder is pretty amazing little tool. It provides a lot of data. But data are not outcomes. And, as it turns out, reducing outcomes is not so easy.

How to Keep up with the Medical Literature

The only real truism is that you learn best when you are reading about a topic that is directly related to the care of an actual patient.

ChatCPR: AI’s Answer to the Question ‘When Will It Save Lives?’

In the US, fewer than 1 in 10 people who have cardiac arrest outside the hospital survive. Read this summary of a research team's attempt to use AI to save lives.

Affirmative Action in Medical Education

Does affirmative action still have a role in medical school admissions? A Sensible Medicine Debate

When Sponsors Stop Trials Everyone Loses

The ANTHEM HFrEF trial of vagal nerve stimulation was proceeding well when the sponsor stopped the trial. The story...and some thoughts about the research enterprise

Friday Reflection 60: The Brockton

A critical rotation, the details of which could not exist today.

Aggressive Cholesterol Management

A Sensible Medicine Debate

This Fortnight in Medicine XXVI

Vinay, John, and Andrew Address Left Atrial Appendage Closure

The Theatre of Treatment

We cannot assume that treatment effects are observable at the individual patient level.

If not for placebo procedures, you might be getting holes drilled into your heart

Two weeks ago, I wrote about how brave orthopedic surgeons saved many people from needless knee surgery. Yet cardiologists may be the bravest group of doctors when it comes to use of placebo trials

When does shared decision-making mean recommending ineffective therapies?

What is the differential efficacy between a good treatment and a less good treatment that allows a doctor to completely forgo discussion of the inferior treatment?

Hantavirus, What You Need to Know

Public health messaging around the hantavirus cruise ship outbreak has been, ‘there is an extremely low risk to the general public,’ but this is suboptimal.

I Invented a Headache to Test AI. Here’s What I Found.

Putting AI to the test.

Evidence Appraisal Is NOT like a Rorschach Test

Let me take a break from specific study review to tell you about a comment I heard this week

Shortening Medical School Will Not Improve Medical Education

A bit of a rant

This Fortnight in Medicine XXV

Paxlovid and a Polypill

Empathy in the Age of AI

AI’s challenge to the medical profession requires us to think deeply about what it means to care for patients. The machines sound like they care. The question is whether we can help humans care for real.

Bravery (and Humility) is Needed to do Proper Medical Science

Hundreds of thousands of knee arthroscopic meniscus repairs are done. At a cost of $10,000 per surgery. Now let me tell you about the FIDELITY trial follow-up at 10 years.

Welcome Back Vinay Prasad

A reflection on four years of Sensible Medicine and what is ahead for SM 3.0

How to Avoid Giving a Crap Lecture

‘No Way To Prevent This,’ Says Only Nation Where This Regularly Happens

“It’s in the new guidelines” does not always mean it’s time to change practice.

A primary care physician’s case for critical engagement with clinical practice guidelines

Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19

It's mid 2026 and NEJM publishes another decidedly negative Paxlovid trial. A couple of lessons emerge: one about evidence expiration dates and the other about incentives to delay trial publication

“Doc, I got a MyChart alert that I am due for an RSV vaccine, can I get it today?”

How should a doctor respond? An essay and a poll.

This Fortnight in Medicine XXIV

The RSV vaccine and the treatment of intermediate-risk pulmonary embolism

Behind the Magic

When Medical AI Gets the Wrong Answer

The Hubris of Screening for Disease -- Again

JAMA has published an eye-opening analysis of colorectal screening in Veterans. Why doctors cannot see the obvious message continues to surprise me

Long COVID. Alzheimer’s. You Choose.

She had diagnosed herself by the time I saw her.

Private-Mini-Memorials

All that I miss about the lives of my patients

An observational study for left atrial appendage closure supports CLOSURE AF data

Spring weather and travel attacked Sensible Medicine this week.

Reckoning With COVID

Reflections on the Six-Year Anniversary of the COVID Outbreak in New York City

Guidelines, Evidence-based Medicine, and the Practice of Medicine

A meandering meditation on the flaws of guidelines and how evidence often barely affects practice

This Fortnight in Medicine XXIII

Listen now | Dengue Suppression by Male Wolbachia-Infected Mosquitoes

The Illusion of Progression-Free Survival

We want patients to live longer and/or better, and if that’s not the case, keep “First, do no Harm” in mind.

At ACC26, the HI-PEITHO Trial is in a Photo-Finish for Greatest Spin

Pulmonary embolism is a life-threatening condition that often requires more than anticoagulation. Invasive therapies hold promise but must be held to rigorous standards

A Referendum on the Self: On Entering the Medical Profession

I could have been a much better pre-med. But I don’t think it would have made me a better doctor.