vo2maxer

Here is an interesting thread expanding on your point. It starts with,

“if you find the death of 500,000,000 mammals, birds and reptiles in weeks of australia wildfires mind blowing and horrifying, note that more were killed worldwide for food in the same period of time - and these facts are not unlinked”

https://twitter.com/mbeisen/status/1212959832522625024?s=21

I agree with your annoyance at these types of threads. The contrast in this chain is the animated discussion between the originator and various scientists including neuroscientists, primatologists, etc.

Zed’s follow up to initial thread on bootcamps:

https://twitter.com/lzsthw/status/1212808427468185600?s=21

From the author of the article, Dr. Heather Ferris, who gave permission for the following points to be shared:

That column in the post is very size constrained and has a very specific format- I would have loved to expand on some areas. Second- this is really written to educate those without diabetes about the disease. A lot of the subtext, which was more explicit but edited out, is that everyone’s diabetes is different. People with diabetes get a lot of blame and unsolicited advice, but each person has their own way of managing their disease and we should accept that.

I thought the article author’s background could be of interest:

https://med.virginia.edu/faculty/faculty-listing/hf4f/

Dr. Freedhoff provides a longer explanation for each of the points he makes where you may check their veracity. I don’t see how this article resembles a Tweet except in the author’s aim to keep the advice list short.

Not quite, in the same way that there are diseases with high prevalence in pediatric populations, similarly in geriatrics. Dementia, cardiovascular and cerebrovascular disease, osteoarthritis, prostatic disease, and many others come to mind.

Sorry, I missed that completely. You’re right on all counts. Thank you for the clarification and your reference :-)

Could you be more specific with what sentences or paragraphs in the article have been debunked? I can’t find where the author questions ketosis is happening or incorrectly defines gluconeogenesis or parrots 1950s AMA talking points. I’m not trying to start a long argument but would be very interested to learn where my own knowledge on the subject may be in error.

How does reading the classics shelter from engaging with ephemeral works?

I know the guidelines well, nevertheless, thank you. But I’m truly curious why such a straightforward comment by kerkeslager would get downvoted, it would honestly satisfy my intellectual curiosity. It also raises the issue with reading speed and its connotations. Examples: Is reading faster better? It depends on the material; Is speed reading as the extreme form of it of any value or just a gimmick? A gimmick of no value to me.

If you already own a computer with the Windows OS, I don’t see a reason why you shouldn’t start learning Python on it. Anaconda is a great open-source distribution with lots of goodies. Also you can set up a VM with whatever Linux distro you fancy and run with it. Windows 10 itself comes with the Windows Subsystem for Linux (WSL). I hope this helps.

I am not sure either why you’re being downvoted on a non-controversial comment. I’m also honestly curious. Is your statement being conflated with ‘speed reading’? A quick search finds plenty of similar recommendations. From one of them:

“The more you read, the more you will be better at it. The better you are at reading, the more you will increase your reading speed.” [1]

[1] https://www.lifehack.org/articles/productivity/10-ways-incre...

From one of the best guides on reading a book:

“....a good book can teach you about the world and about yourself. You learn more than how to read better; you also learn more about life. You become wiser. Not just more knowledgeable - books that provide nothing but information can produce that result. But wiser, in the sense that you are more deeply aware of the great and enduring truths of human life.”

― Mortimer J. Adler, How to Read a Book: The Classic Guide to Intelligent Reading

I would be quite wealthier if my unread list were this short :-)

FDA approved: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?ev...

Thank you for update.

I’m not redirected when I open it in Safari, FF, or Chrome.

Diagnosing an infection is inexact in most outpatient settings. The healthcare provider takes into account a number of factors based on the history and physical exam. A rapid antigen test as is available for streptococcal pharyngitis makes it straightforward. Unfortunately, that’s not the case for many infectious conditions which end up being treated empirically. For example, most upper respiratory infections’ etiology is viral in both adults and children. It’s very reasonable to prescribe medication for symptomatic relief and reassure the patient that should discomfort continue or worsen, antibiotics may be considered. Even though this should be the standard of care, many physicians and extenders still overprescribe antibiotics mostly to move the visit along or satisfy the patient. A good explanation with evidence takes longer than just acquiescing to the demand.

Alternative link: http://introtodeeplearning.com/

The annual physical exam as it is currently understood by most patients and performed by many physicians is actually quite controversial. It has become more of a just-in-case tradition with little evidence for its benefits. The best approach is to consult the U.S. Preventive Services Task Force and follow its screening recommendations: https://www.uspreventiveservicestaskforce.org/

Yes, thank you for pointing it out.

Conclusions:

Preclinical studies and clinical trials have shown that intermittent fasting has broad-spectrum benefits for many health conditions, such as obesity, diabetes mellitus, cardiovascular disease, cancers, and neurologic disorders. Animal models show that intermittent fasting improves health throughout the life span, whereas clinical studies have mainly involved relatively short-term interventions, over a period of months. It remains to be determined whether people can maintain intermittent fasting for years and potentially accrue the benefits seen in animal models. Furthermore, clinical studies have focused mainly on overweight young and middle-age adults, and we cannot generalize to other age groups the benefits and safety of intermittent fasting that have been observed in these studies.

Although we do not fully understand the specific mechanisms, the beneficial effects of intermittent fasting involve metabolic switching and cellular stress resistance. However, some people are unable or unwilling to adhere to an intermittent-fasting regimen. By further understanding the processes that link intermittent fasting with broad health benefits, we may be able to develop targeted pharmacologic therapies that mimic the effects of intermittent fasting without the need to substantially alter feeding habits.

Studies of the mechanisms of caloric restriction and intermittent fasting in animal models have led to the development and testing of pharmacologic interventions that mimic the health and disease-modifying benefits of intermittent fasting. Examples include agents that impose a mild metabolic challenge (2-deoxyglucose, metformin, and mitochondrial-uncoupling agents), bolster mitochondrial bioenergetics (ketone ester or nicotinamide riboside), or inhibit the mTOR pathway (sirolimus). However, the available data from animal models suggest that the safety and efficacy of such pharmacologic approaches are likely to be inferior to those of intermittent fasting.

The Apple Watch used a sensor to intermittently measure changes in blood flow as long as the user carried the device. The signals then generated pulse intervals over one minute which ran through an algorithm to infer the presence of an irregular ventricular rhythm. Further evaluation was conducted for the group with abnormal results. On the other hand, a 12-lead electrocardiogram measures electrical activity over a very short period of time. It’s just one quick snapshot of the heart, therefore, episodic atrial fibrillation can occur outside that quick peek.

Please, explain to me how I deformed it when they label “all doctor talk” of the “inversion of the relationship between patients and physicians” as quackery without any reasoned argument to support such “humble opinion.” The position in the original submission is straight forward: The study was funded by Apple to drive sales by people who generally don’t suffer with atrial fibrillation. Consequently, this will create unnecessary alarm in the worried well, who will undergo needless testing and possibly harmful therapy. There is already plenty of superfluous medical evaluations and treatments at a huge cost. Are we supposed to encourage this when it is clearly industry driven with little evidence in how it advances healthcare. If this is my ax to grind, so be it, but as a physician, shouldn’t I be cynically happy that more business will be coming my way?

In regards to your observation, Husten’s review notes that the study [1] included subjects where the incidence and prevalence of atrial fibrillation (AF) is low [2], and given the study’s design flaws, its findings turned out to be largely irrelevant except as a marketing tool with relatively negligible costs for Apple [3].

I don’t know if Mr. Husten is an Apple hater, but it would be more interesting if you challenged his actual arguments including those in the study’s accompanying opinion piece: “The uncomfortable fact is that our personal health data have considerable financial value to those who want to use them in the myriad marketplaces connected to our $3.7 trillion health economy.” [4]

[1] https://www.nejm.org/doi/full/10.1056/NEJMoa1901183

[2] https://www.ajconline.org/article/S0002-91491301288-5/fullte...

[3] http://www.cardiobrief.org/2019/11/13/what-can-we-learn-from...

[4] https://www.nejm.org/doi/full/10.1056/NEJMe1913980

What you’re saying is that evidence should not drive decisions in health care but rather industry marketing. And if this what you mean, how is it quackery to suggest that more studies are needed or that users need to be given more information on devices with such a significant rate of false-positives?

The review by Dr. Marcus, a cardiologist [1], refers to a study funded by Apple and published in The New England Journal of Medicine [2]. His main point is that “insufficient evidence exists to recommend atrial fibrillation (AF) screening in asymptomatic adults.” [3] There would be a significant number of alarmed users with false-positive results who would undergo costly additional evaluation and treatment where there may be of little benefit. It is troublesome, in his view, that “private industry has bypassed expert consensus to initiate screening for AF in the general population.” He adds that “this is an industry instigated inversion of the relationship between patients and physicians...” [4] Larry Husten at the Cardiobrief blog gives a good overview of some of the pitfalls [5].

[1] https://profiles.ucsf.edu/gregory.marcus

[2] https://www.nejm.org/doi/full/10.1056/NEJMoa1901183

[3] https://jamanetwork.com/journals/jama/fullarticle/2695678

[4] https://www.nature.com/articles/s41569-019-0330-y

[5] http://www.cardiobrief.org/2019/11/13/what-can-we-learn-from...