The recent release of the American College of Emergency Physicians guideline recommending the use of tPA for ischemic stroke is remarkable. While it is unsurprising that a professional guideline flouts science, the publication is striking for its casual tone and its methodologically inexplicable review of evidence. Scientific thinking is absent. Below, therefore, is a brief description of the relevant data, through the lens of science.
Heart Diets, Hard Numbers, and Truth That Lasts
It’s not every day that a heart diet controversy is truly settled. But earlier this month a report in the British Medical Journal solved the cold case of a nearly 50-year old heart study with a hidden, and crucial, finding. Better still, a landmark study published this week sharpens the point.
Results of the largest and arguably most important trial ever of thrombolytics (clot-busting drugs) for acute stroke were published last week in The Lancet, and the study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad.
Last week The Lancet published a meta-analysis of 27 statin trials, an attempt to determine whether patients with no history of heart problems benefit from the drugs—true story. The topic is controversial, and no less than six conflicting meta-analyses have been performed—also a true story. But last week’s study claims to show, once and for all, that for these very low risk patients, statins save lives—true story.
At Albany Medical College, the master of physical examination was Dr. Beebe. The son and grandson of country doctors, Richard Beebe was an internist who made house calls. He earned his degree in the 1920’s at Johns Hopkins in the wake of giants like Osler, Cushing, and Halsted, and for six decades he roamed the hallways of my alma mater with a doctor’s bag in hand. I once saw a history and physical he had written. Penned in a small, looping cursive that slanted elegantly, the document was four full pages, a masterpiece.
I dropped my wife’s new iPad. Dropping things is one of the many curses of oafdom, a defining condition for me. And this promised to be costly: The impact cracked the corner of the glass surface leaving the screen portion unaffected, but marring the machine’s techno-loveliness, and sending my better half into a funk.