Dan retweeted
The most contentious issue of the latest NHSE guidance is the explicit mention about looking back at an episode of care one was previously involved in to see how things developed for professional "curiosity".
Curiosity is a very poor word to use for multiple reasons not least because professional curiosity is the bedrock of holistic medicine and their phrasing comes across as a loaded word to diminish care, reflection, and professional development.
Many have argued that "it is just common sense" however one of the problems that is inextricable from the concept of common sense is the trust placed in those who judge how the language used in guidance is interpreted.
If no one trusts NHSE or regulators then everyone will naturally lurch to being overly risk-averse which will create inefficiencies, unforced errors, and damage morale.
It should be uncontroversial to say that those who were never involved in patient care and yet go on to access patient information should be disciplined, if not sacked.
But those who were previously involved in episodes of care should be given the professional latitude to follow up.
Surely the professional who remembers a patient and cares enough about them to follow up, reflect, and learn is a legitimate and valid reason.
@NHSEngland must come out and clarify this urgently or they risk either undermining professional development or some newfound unintended consequence like institutions getting patients to sign away all rights and protections in new waivers (hello website cookie disclaimers)
Dan retweeted
MICROSOFT BUILT A TOOL THAT CONVERTS LITERALLY ANYTHING INTO CLEAN MARKDOWN FOR YOUR LLM
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just clean, structured markdown your LLM can actually read
github.com/microsoft/markitd…
Dan retweeted
Introducing Project Glasswing: an urgent initiative to help secure the world’s most critical software.
It’s powered by our newest frontier model, Claude Mythos Preview, which can find software vulnerabilities better than all but the most skilled humans.
anthropic.com/glasswing
Dan retweeted
"Just stop taking it and keep the weight off."
That's not how chronic disease works.
I just published the most comprehensive breakdown of what actually happens — hormonally, metabolically, neurologically — when you stop GLP-1 therapy.
48 studies. 9,000+ patients. 3 meta-analyses.
Here's what the data show:
→ 60% of lost weight returns within 1 year
→ Regain starts within weeks — not months
→ Your hormones fight you for YEARS after weight loss
→ But the regain curve decelerates. ~25% of the benefit may persist.
→ And reduced-dose maintenance strategies are showing real promise.
This isn't a willpower problem. It's a biology problem. And the science is not ambiguous.
Full article:
substance-over-noise.beehiiv…
↪️ michaelalbertmd.com
#SubstanceOverNoise #GLP1 #ObesityMedicine
Dan retweeted
In your 40s, your statin number need to treat (NNT) might be 500.
To prevent an event over 4-5 years.
But your NNT after 40 years (at 80) drops to about 4.
Some people spend their whole lives arguing about the 4-year number
And never live to understand the 40-year one.
Dan retweeted
Yes. All these physicians are ‘sensible’ and ‘pragmatic’ and ‘evidence-based’ until it comes to weight loss and then something happens to them all….it’s actually a very simple and human thing…
…they let their own biases and experiences override their limited understanding of metabolism
Everyone has lost and gained weight. Or had someone close to them that has. It’s an almost universal experience. We all know what worked for us and what didn’t.
Many HCPs believe in “pull your socks up, where’s your willpower and discipline” “when I was naughty I gained 5kg but then I was strict and lost it, you can do it too”
Those lean also believe that they’re thin because they live their life in discipline. That maybe partly true but there are so many other factors.
They believe patients who live with obesity and its consequences are weak-willed or feckless.
And this underpins weight-related stigma which is perpetuated throughout the medical profession.
Which is why you see ridiculous PowerPoints “GLP-1 undermines lifestyle efforts”
Do some CME/ CPD and FFS learn about biology of weight and appetite and then talk to your patients.
Things have moved on from “eat less and move more”
Just wondering why otherwise scientific and evidence informed physicians that brand themselves as “sensible” can confidently hold ignorant and harmful attitudes about obesity? (Rhetorical question.)
This bias irritates me to no end because during a consult, I often ask if they have ever experienced harm or judgement from a physician or health care provider about their weight.
The stories they share are immediate, tangible, and relevant - they don’t have to think hard to come up with examples. Their impact can be devastating but talking about them, apologizing on behalf of medicine and our ignorance can be helpful.
Medicine has done a lot of harm to patients - especially with obesity. I have brief conversations with specialists longitudinally over time to try to challenge and correct their bias because bias doesn’t tend to resolve in one meeting. I don’t think they are bad people - it is just a cognitive bias that causes harm and needs to be corrected. I will do my best though to protect patients from them and choose a different specialist for them if I can.
There is irrefutable evidence now and deep understanding of obesity as a biologically driven complex disease that is not simply due to personal choices and behaviour
This is why, when I hear ignorance from physicians on social media, it bothers me and think it needs proper push back.
Dan retweeted
📢Big shift in type 2 diabetes care
NICE now recommends SGLT2 inhibitors first-line for cardio-renal protection from day one.
Evidence suggests 17,000 deaths could be prevented over 3 years, along with £560m in cost savings for the NHS: nice.org.uk/news/articles/ma…
ALT GP smiles towards patient. Overlaid text reads: New type 2 diabetes guidance could save 17,000 lives and £560 million for the NHS over the next three years
Dan retweeted
How do you actually act on a faecal calprotectin result?
We've been refining this in Edinburgh for 20 years.
Here are the three tables from the new Atomic IBD post; starting with the one you can use in clinic tomorrow.
"Monitor, monitor, monitor ... and act on the results of the monitoring."
Different clinical situations need different responses.
• First presentation isn't the same as routine monitoring.
• "Grey zone" results need context.
• And the 250 threshold is a decision point, not a diagnosis.
We taught this to everyone: doctors, nurses, pharmacists, administrators even surgeons.
Dan retweeted
Most people aren’t ghosting you because they don’t like you.
They’re overwhelmed.
Information overload and task pressure drive anxiety and avoidance.
But messages that feel useful cut through and get faster replies.
Dan retweeted
New systematic review and meta-analysis shows that cardiovascular-kidney-metabolic syndrome staging is strongly associated with risks of all-cause and cardiovascular mortality, highlighting the importance of integrated risk assessment in practice.
ow.ly/IVXQ50Y0RzI
Dan retweeted
🫀 Ozempic isn’t just about weight loss — and the data may surprise you.
A landmark clinical trial just showed that semaglutide reduced major heart attacks, strokes, and cardiovascular death by ~20% — even in patients WITHOUT diabetes.
Here’s the twist 👇
🔹 The heart protection was NOT tied to how much weight patients lost
🔹 Benefits were seen regardless of starting weight or BMI
🔹 Only ~⅓ of the heart benefit came from waist reduction
🔹 The rest appears to come from direct cardiovascular effects
So what’s really protecting the heart?
And why does this change how we should think about GLP-1 medications like Ozempic?
👉 I break down the SELECT trial, the mechanisms behind the benefit, and what this means for patients with heart disease in my latest blog.
📖 Read the full analysis here: DrAlo.net/blog
This may change how we define “success” in cardiology and weight-loss medicine.
Please reshare!
#HeartHealth #Ozempic #Semaglutide #SELECTtrial #Cardiology
Dan retweeted
We will need a government inquiry into every single conviction that Amanda was involved in.
We could be looking at Post Office scale wrongful conviction scandal.
#TheTraitors
Dan retweeted
More evidence that an LDL-C of around 60mg is the cutoff for plaque progression vs regression! 💪🏻🫀🩺
Anecdotal Study of 1 -- Me -- I have chronic stable CAD (CAC > 300 15 years ago). With that and other risk factors I had, I easily would have qualified for inclusion in the VESALIUS CV Trial. Fortunately, as soon as PCSK9i came on the market I went on Repatha and now a decade later I am still here - no ischemic events. The day after I got the CAC I had an invasive coronary angiogram which demonstrated wide open lumens: disease was all in arterial wall. Here is data from GLACOV that shows evolocumab not only kept me alive without any CV issues but likely is causing regression. My apoB on Repatha monotherapy is 50 mg/dL and LDL-C 45 mg/dL. THANK YOU REPATHA @nationallipid @society_eas @ASPCardio
