Having a substack column is like a commercial retail operation and it is always the case that sometimes the public does not show up or buy anything. There are likely more factors in play than whether it is good news or bad. You put the information out there to inform, and those who read it were informed. Just keep writing; what you do is still valuable.
Not a doc and definitely don't understand much beyond the high level basic summary you provide but that's good enough for me. Too many in our world have become too lazy to read more than click bait headlines. I'm thankful for the information you and other docs on substack provide. Keep writing
Please don’t do audience capture. Please continue to do your thing, which is unflinching critical appraisal of cardiology studies from a medical conservative/ constrained perspective.
As for this particular study and your readership’s response, it’s a very expensive device that very few clinicians will ever see or manage, and even fewer (relatively) will experience as a patient. It SHOULD be a niche product used in only a highly selected population (as indicated by the strict inclusion criteria and the slow enrolment, as you noted). It may simply be a product and condition that lacks broad appeal among your readers.
Or…it may simply be the opposite of “if it bleeds, it leads”. Maybe good news doesn’t excite people to comment….but I wonder about page loads and how much your readers consumed it all the same.
Or maybe you had a lot of interested readers like me who just wanted to get out for a bike ride and get off the internet. :) I'm a lay reader of your posts and know a lot of the information goes right by me (100% can never remember the names of any of these trials) but two things here stuck in my head-taking 11 years to enroll patients and the 26% reduced chance of dying in relative terms. I even stopped reading for a minute to think about an 11-year-long focus and what an effort that must have been. Pretty cool! But, sometimes you gotta put the computer away and go outside.
And then there's just the inertial resistance to tapping the email to like and comment on the post. Substack is great in so many respects, but not so great in this one.
Excellent points. I have also for some time questioned the value of all the Impella devices I saw implanted in patients with shock. I'm really happy it works in MI related cariogenic shock. But the vast majority I saw implanted were not for that indication and/or would not have met the entry criteria in the study.
As to your reader's lack of interest, I think it is because your audience has been self-selected for having a generally skeptical outlook on medical devices, procedures, and drugs. This is the right attitude to start with but we must also know when to get enthusiastic about a medical device, procedure or drug.
Ok I like the thoughtful article.Well done indeed. It seems number needed to treat for most of cardiology treatments are designed to remind me why some of us become surgeons. You guys must spend a lot of time being wined and dined .
The "influencers" all know there are strategic times to post which will get more attention and engagement, and I would imagine for many readers Monday is the busiest day of the week so fewer have time to ponder and comment. I was glad to see a study done which showed true relative risk reduction in a certain patient/scenario, should be useful going forward. However, it also saddens me to imagine how many patients it has been used for inappropriately until now, at harm or futility to them and their families, and great cost to the healthcare system. These studies need to be done prior to devices being approved. Thank you for bringing these important trials to a wider audience.
How does the incentive benefit people when the cart is in front of the horse?
There's no benefit to continually allowing people to push products. Just because one device happened to work among thousands of essentially snake oil products that medical companies develop and use to artificially inflate value without demonstration, doesn't prove that incentives are beneficial.
You need to prove that medical products work. Medicine and profit, especially in our current system, are just not compatible. You cannot rationalize your way out of that no matter how much you try. Yes, maybe there are small benefits, but the overall picture is profoundly clear.
Having a substack column is like a commercial retail operation and it is always the case that sometimes the public does not show up or buy anything. There are likely more factors in play than whether it is good news or bad. You put the information out there to inform, and those who read it were informed. Just keep writing; what you do is still valuable.
Not a doc and definitely don't understand much beyond the high level basic summary you provide but that's good enough for me. Too many in our world have become too lazy to read more than click bait headlines. I'm thankful for the information you and other docs on substack provide. Keep writing
Please don’t do audience capture. Please continue to do your thing, which is unflinching critical appraisal of cardiology studies from a medical conservative/ constrained perspective.
As for this particular study and your readership’s response, it’s a very expensive device that very few clinicians will ever see or manage, and even fewer (relatively) will experience as a patient. It SHOULD be a niche product used in only a highly selected population (as indicated by the strict inclusion criteria and the slow enrolment, as you noted). It may simply be a product and condition that lacks broad appeal among your readers.
Or…it may simply be the opposite of “if it bleeds, it leads”. Maybe good news doesn’t excite people to comment….but I wonder about page loads and how much your readers consumed it all the same.
Or maybe you had a lot of interested readers like me who just wanted to get out for a bike ride and get off the internet. :) I'm a lay reader of your posts and know a lot of the information goes right by me (100% can never remember the names of any of these trials) but two things here stuck in my head-taking 11 years to enroll patients and the 26% reduced chance of dying in relative terms. I even stopped reading for a minute to think about an 11-year-long focus and what an effort that must have been. Pretty cool! But, sometimes you gotta put the computer away and go outside.
And then there's just the inertial resistance to tapping the email to like and comment on the post. Substack is great in so many respects, but not so great in this one.
Excellent points. I have also for some time questioned the value of all the Impella devices I saw implanted in patients with shock. I'm really happy it works in MI related cariogenic shock. But the vast majority I saw implanted were not for that indication and/or would not have met the entry criteria in the study.
As to your reader's lack of interest, I think it is because your audience has been self-selected for having a generally skeptical outlook on medical devices, procedures, and drugs. This is the right attitude to start with but we must also know when to get enthusiastic about a medical device, procedure or drug.
AP
Ok I like the thoughtful article.Well done indeed. It seems number needed to treat for most of cardiology treatments are designed to remind me why some of us become surgeons. You guys must spend a lot of time being wined and dined .
The "influencers" all know there are strategic times to post which will get more attention and engagement, and I would imagine for many readers Monday is the busiest day of the week so fewer have time to ponder and comment. I was glad to see a study done which showed true relative risk reduction in a certain patient/scenario, should be useful going forward. However, it also saddens me to imagine how many patients it has been used for inappropriately until now, at harm or futility to them and their families, and great cost to the healthcare system. These studies need to be done prior to devices being approved. Thank you for bringing these important trials to a wider audience.
Thank you John - great finding you here and keep going!
Skepticism always leads to truthism.
Thx
How does the incentive benefit people when the cart is in front of the horse?
There's no benefit to continually allowing people to push products. Just because one device happened to work among thousands of essentially snake oil products that medical companies develop and use to artificially inflate value without demonstration, doesn't prove that incentives are beneficial.
You need to prove that medical products work. Medicine and profit, especially in our current system, are just not compatible. You cannot rationalize your way out of that no matter how much you try. Yes, maybe there are small benefits, but the overall picture is profoundly clear.