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An overdose of second opinions
The patient printed out information on all these regimens and sought guidance. Each ‘expert’ was adamant. What should she do?
The answer was, of course, every ‘expert’ was making shit up. There was no right answer. Among all these options, we only have a few large randomized studies to provide lamplight in the darkness.
Why Top Olympic Athletes Use Baking Soda to Boost Performance
The 14 cyclists in the study did three 40-kilometer time trials: one for practice, one with Maurten baking soda, and one with a placebo that was designed to look and taste like Maurten but didn’t contain any baking soda. The data shows that, as expected, blood pH was increased in the baking soda condition (meaning it became less acidic). Most of the other variables were unchanged: heart rate was the same, perceived effort was the same, the pacing pattern was the same. But they could tolerate higher levels of lactate throughout the test—and, most importantly, they were faster.
Why Top Olympic Athletes Use Baking Soda to Boost Performance
The problem is that straight baking soda is also famously hard on the digestive system, causing bloating, cramps, diarrhea, and other performance-harming effects. For decades, that was the deal with the devil that athletes had to contemplate: a possible edge in return for a possible bout of the runs. Some found they could handle it; most opted not to chance it. Maurten’s solution involves encasing micro-pills of baking soda in a soup-like hydrogel that shepherds the active ingredient straight through the sensitive stomach into the intestine before releasing it, avoiding gut upset.
Nighttime Exercise Breaks May Extend Sleep by 27 Minutes - Neuroscience News
The results, which are based on 28 participants, show that after the activity breaks, participants slept for an additional 27 minutes on average, compared with prolonged sitting.
First systematic review and meta-analysis suggests artificial intelligence may be as effective as health professionals at diagnosing disease -- ScienceDaily
"We reviewed over 20,500 articles, but less than 1% of these were sufficiently robust in their design and reporting that independent reviewers had high confidence in their claims. What's more, only 25 studies validated the AI models externally (using medical images from a different population), and just 14 studies actually compared the performance of AI and health professionals using the same test sample," explains Professor Alastair Denniston from University Hospitals Birmingham NHS Foundation Trust, UK, who led the research.
"Within those handful of high-quality studies, we found that deep learning could indeed detect diseases ranging from cancers to eye diseases as accurately as health professionals. But it's important to note that AI did not substantially out-perform human diagnosis."
Pragmatic trials revisited: applicability is about individualization - Journal of Clinical Epidemiology
Classically, clinical research has centered on studying groups of individuals to extrapolate the findings to the general population. It is time to walk back from the population (the average patient) to the individual patient, understanding that population-oriented research is actually exploratory and individual-oriented research is confirmatory [24].
Cost savings due to n-of-1
Omeprazole was the appropriate treatment in only 52% of these chronic users of acid-suppressing drugs. Eleven of 27 trials (41%) indicated that ranitidine was the preferred treatment. The SPT method proved acceptable to patients, feasible to administer, and reproducible. It can statistically discriminate effectiveness and adverse events and serve as a useful, prognostic tool in community practice by determining the least costly, evidence-based, appropriate treatment.
Labeling Accuracy of Cannabidiol Extracts Sold Online | Substance Use and Addiction | JAMA | JAMA Network
Eighty-four products were purchased and analyzed (from 31 companies). Observed CBD concentration ranged between 0.10 mg/mL and 655.27 mg/mL (median, 9.45 mg/mL). Median labeled concentration was 15.00 mg/mL (range, 1.33-800.00). With respect to CBD, 42.85% (95% CI, 32.82%-53.53%) of products were underlabeled (n = 36), 26.19% (95% CI, 17.98%-36.48%) were overlabeled (n = 22), and 30.95% (95% CI, 22.08%-41.49%) were accurately labeled (n = 26) (Table 1).
Can CBD Really Do All That? - The New York Times
Realm of Caring, still run by Heather Jackson, is already doing this in partnership with academic researchers, sharing data from a 55,000-person registry that includes information on what people are using cannabis for and what side effects and benefits they see.
Industrial n-of-1
The N-of-1 trials propose replacing large-scale trials of whole groups with methodical study of individual patients. However, the requirement to provide specific treatment to different subgroups of patients will make clinical trials more complex, so the industry needs to redesign how it interacts with patients. CROs will need to establish expert teams to structure and run precision-medicine-oriented trials for their sponsor clients.
No evidence of added benefit for most new drugs entering German healthcare system: International drug development processes and policies are responsible and must be reformed -- ScienceDaily
And for 125 drugs (58%), the available evidence did not prove an added benefit over standard care in the approved patient population.
The situation is particularly shocking in some specialties, they add. For example, in psychiatry/neurology and diabetes, added benefit was shown in just 6% (1/18) and 17% (4/24) of assessments, respectively.
N-of-1 Clinical Trials: Removing the Hay to Find the Needle | Clinical Chemistry
an observed lack of universality in response to interventions and a greater focus on the individual with the emergence of precision medicine. A strong focus on the uniqueness of each individual has led to many discoveries in cancer diagnostics and drug efficacy and has prompted the US Food and Drug Administration to relabel numerous approved drugs to include pharmacogenomics information.
Evaluation of person-level heterogeneity of treatment effects in published multiperson N-of-1 studies: systematic review and reanalysis | BMJ Open
person-level HTE is common and often substantial
Use of evidence-based therapies for youth psychiatric treatment is slow to catch on: Intensive training and practices with 'proficient culture' are critical to evidence-based therapy use -- ScienceDaily
"Evidenced-based therapies are effective for treating a wide range of psychiatric conditions, but there is still a gap in widespread use," said the study's lead author Rinad S. Beidas, PhD, an associate professor of Psychiatry and Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania, and founding director of the Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI). "While findings showed a modest increase in use, the data point to a clear need for finding better ways to support clinicians and organizations in using EBP therapies. This research-to-practice gap is a historically intractable problem, which exists not only in behavioral health but all across health care specialties."
My health: Consumers empowered by sharing medical 'selfies' -- ScienceDaily
"The first study asked a range of people what they think about the role of this kind of consumer-generated data, and the second study was to see how people engage with it, as there can be a difference between what people say they will do and what they will do," she said.
"But these two studies largely confirmed each other. Consumers feel this data is valuable, it helps them have a sense of autonomy in their care, improves their view of the service they are being provided, and it enhances the relationship between doctor and patient because there is a sense of mutual respect and communication.
Cholesterol medication could invite diabetes, study suggests: Patient data shows association between statins and type 2 diabetes -- ScienceDaily
Statins are a class of drugs that can lower cholesterol and blood pressure, reducing the risk of heart attack and stroke. More than a quarter of middle-aged adults use a cholesterol-lowering drug, according to recent federal estimates.
Researchers found that statin users had more than double the risk of a diabetes diagnosis compared to those who didn't take the drugs. Those who took the cholesterol-lowering drugs for more than two years had more than three times the risk of diabetes.
"The fact that increased duration of statin use was associated with an increased risk of diabetes -- something we call a dose-dependent relationship -- makes us think that this is likely a causal relationship," Zigmont said.
