Medical ethics | Dr.S.Venkatesan MD

Archive for the ‘Medical ethics’ Category

Management of ACS : The eleven new commandments

Posted in acute coroanry syndrome, acute coronary syndrome, Medcal research, Medical education, Medical ethics, Primary -PCI, Primary PCI, Thrombolysis, tagged acc aha esc scai criteria, captim trial, cardiology, danam 2, defining success in pci, drsvenkatesan, ethics in medicine, golden hour, medical ethics, nejm, nstemi, pharmaco Invasive strategy, prague 2, pre hospital lysis, ptca, stemi, stream trial, successful primary PCI, symptom to balloon vs symptom to needle time, symptom to door vs door to needle time, time windows in STEMI on June 8, 2025|

How can we use AI as a tool of knowledge distillation ?

Here is a deep discussion with Grok 3, on the merits, limitations & validity of DANAMI 2 and PRAGUE 2 , the two old studies on pPCI. Curiously , we don’t have any other studies to quote. As on 2025 , superiority of pPCI hangs precariously on these two decade old studies, which has some serious omissions in the primary end point and its Interpretation. To get into the facts , please go through the following link.

https://grok.com/Is primary PCI really superior to lysis in a global perspective /

It is a long chat, I am sure most of you can’t spare your vital time. But, the truth comes out only at the fag end of the conversation.

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Lancet : A 200 year old Idea and a process towards righteousness

Posted in Medical ethics, Uncategorized, tagged lancet, lancet 200nyears, medical education, medical ethics, principles ofpractice of medicine on January 4, 2024|

It was 1823, a genesis of a new thought process in medical publication began. The man who started it all, Dr.Thomas Wakley the founder of the most famous medical journal (Ref 1)

One of his peers described him what sort of an Image he had. “Thomas Wakley the editor as we find him—a courageous challenger of the medical establishment who was usually right and whose language, however tasteless it might seem today, was well suited to the rough and tumble of the time in which he wrote and spoke”

Lancet celebrates 200 year anniversary

On this 200th anniversary Lancet , looks back ,introspects and redefine the agenda of medical profession. We need more and more people like Wakley in the current era.

The Lancet editorial team has come out with two clips one podcast and other a brief video for a total of 28 minutes . If you have enough patience to hear to this , you are probably in the right direction to understand what exactly is the purpose being a Doctor.

After going through the history of medicine through the lens of Lancet, and understanding its original motto, one thing is very clear. Science and research are vital for progression medical science . But, the least important enemy to handle for a healthy planet and mankind is not diseases and afflictions as such, but the unkind behaviour of biased power centres, skewed knowledge, and unhealthy & unequal practices of health care invention and delivery.

Final message

Doctors are primarily healers, all right; more importantly, they are guardians of goodness and justice in healthcare. For this, we need to “Wakleyse the medical education“, meaning, keep a watch always on the true aim and action of medical establishment under which you work . I know, this post might sound pessimistic for many of you, … but that’s where optimistic goals are hidden deep .

Reference

Thomas Wakley (1795–1862): a biographical sketch

sharp2012 Download

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A potential new face of “Ethical dysfunction” is waiting to unfold !

Posted in bio ethics, Medical education, Medical ethics, medical satistics, tagged best medical quotes, bmj, dr venkatesan sangareddi, first do no harm primum nocere, hippocrates, Hippocratic oath, inappropriate medcial care, jamanetwrok, lancet, madras medical college, medcial ethics, medical science future, nejm, nobel prize in medicine, over treatment, principles of practice of medicine, william osler on September 8, 2023|

Postamble

This quote is being sent for the annual meet of “Right care movement” I know ,this can sound outrageous, permissble limits of abuse ? Up to 2% or 5% ? Let it be anything . Meanwhile try to enlighten yourself , the key differences between misuse & abuse.

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When”Cath lab viability” competes with myocardial viablity … Just carry on !

Posted in bio ethics, cardiology wisdom, cardiology-ethics, Cardiology-Statistics, cath lab tips and tricks, Medical education, Medical ethics, medical quotes, medical satistics, Two line sermons in cardiology, wisdom in cardiology, tagged cath lab viablity vs myocardial viablity, myocardial viablity before pci ptca, myocardial viablity study on June 8, 2023| Leave a Comment »

Pure science

Whenever possible ,before doing a coronary revascularisation procedure , check twice the segments you try to perfuse is really short of blood supply and truly needs the procedure. Don’t ever waste your resources and try to blood-feed the dead myocardium. It’ can never be awakened !

Pragmatic science

I was conversing with my colleague recently , who has grown into suave , Interventional cardiologist with a huge academic & societal repute .He owns a personal cathlab and planning to get one more.

I learnt a non-academic reality lesson from him .

myocardail viablity viability study pci ptca cath lab ethics

When planning myocardial revasascularisation, apart from myocardial viablity status, there is one more viability issue which is done in the account books of finance mangers across big hospitals. Its Cath lab viablity. Trust me, he used exactly the same word ! He went on to explain in detail , how, every day there must be a minimum number of procedures to keep the machine alive. Which is under the eagle eyes of the guys who funded the state of the art lab !

“So, what do you say,I asked him ?”

He was frank enough to admit, he felt always happy when he is able to convert angiograms into angioplasties.He went on to add , the Ideal CAG-PCI conversion ration should be atleast 3:1 or more.

“Whenver I hear such genuine statments from real world people , it pains, as it tends to confirm my assumptions ”

Final message

I am wondering with all my lost wisdom. Why should any cardiologist after 30 years of training, fight for cath lab viablity , and get into a conflict with the very organ they are supposed to care and protect.

When did we become so Inferior beings & fight for the survival of these life less machines ?

Meanwhile, major text books , has un-intentionally facilitated this academic deciet .They have largely taken away the sting out of the snake . Myocardial viablity , hibernating, stunned myocardium , are rarely given importance nowadays and made it appear taboo concepts,in cardiology academia.

Postamble.

Will be extremely happy if what is portrayed in this post is not really true.

Reference

Nandan S. Anavekar, Panithaya Chareonthaitawee, Jagat Narula, Bernard J. Gersh, Revascularization in Patients With Severe Left Ventricular Dysfunction: Is the Assessment of Viability Still Viable?,
Journal of the American College of Cardiology, Volume 67, Issue 24, 2016,Pages 2874-2887,

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Who is guiding the guidelines?

Posted in bio ethics, Cardiology quotes, Centre for cardiology unlearninng, Medcal research, Medical education, Medical ethics, medical quotes, Quotes, Science and Religion, Uncategorized, wisdom in cardiology, tagged best quote on medical education, cardiology quotes, dr venkatesan cardiologist, guidelines protocols recommendation acc aha esc scai, medical ethics, venkat quotes on July 14, 2022|

Who is the guiding the guidelines, which have become omnipresent & omnipotent ?

I don’t know really. Some good people I guess. But, the doubt creeps in when they try to coerce it on us.

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What is the true success for a scientist ?

Posted in bio ethics, Histroy of medicine, Medcal research, Medical education, Medical ethics, medical quotes, tagged ethics in medical research, ethics in medicine, greatest award in medicine, medical quote, nobel prize in medicine, publish or perish, what is success in scientific world on November 26, 2021|

What is the true success in a scientific career?

It is not the number of publications in journals or getting those big awards or memberships in prestigious scientific societies. True success is “something else,” says the Nobel Medical Laureate Dr Willam Kaelin

Great thoughts. Just wondering, what are those elements beyond our controls he was alluding to?

Video courtesy and thanks : http://www.nobel.org

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Let us Ignore this smart study on statins…one more time !

Posted in Diabetes and Heart, lipids lipid metabolism, Medical ethics, Uncategorized, tagged diabetes and statins, JUPITER study, risk of diabetes with statins, statin induced diabetes new onset and progression, statin side effects on October 5, 2021|

This is not a breaking news story. It’s the same old secret that was exposed in JUPITER trial with Rosuvostatin 14 years ago. Yes, I am talking about the relationship between the usage of statin and the occurrence of diabetes. Now, we have this huge study on possible diabetes progression with statins. It’s not from a small journal to ignore.

83 thousand patients data, the world’s largest series on link between statin therapy and diabetes.

This study has this to conclude

Diabetogenic statins

Something* happens as the statins antagonize the HMG COA enzyme that resides within the delicate membranes of the endoplasmic reticulum inside the most specialized cells in our human body, called hepatocytes.

*What is that something?

Image source Umme Aiman et al Journal of Pharmacology and Pharmacotherapeutics 5(3):181-5DOI: 10.4103/0976-500X.136097

How to go about this issue?

With-holding statin in as many as possible is the best thing for such diabetic (non-diabetic?) patients. But, the more pragmatic option is to ignore these negative studies, and instead intensify diabetes management if it worsens. After all, we can’t afford to lose the prodigious evidence-based cardio-vascular protective effects of statins and earn the wrath of our patients and peers you know!

Further Interest

1.Mansi IA, Chansard M, Lingvay I, Zhang S, Halm EA, Alvarez CA. Association of Statin Therapy Initiation With Diabetes Progression: A Retrospective Matched-Cohort Study. JAMA Intern Med. Published online October 04, 2021. doi:10.1001/jamainternmed.2021.5714

2.Aiman U, Najmi A, Khan RA. Statin induced diabetes and its clinical implications. J Pharmacol Pharmacother. 2014 Jul;5(3):181-5. doi: 10.4103/0976-500X.136097. PMID: 25210397; PMCID: PMC4156828.

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“Unconquered” enemy of scientific research in medicine

Posted in bio ethics, Ethics in Medicine, evidence based cardiology, Medcal research, Medical education, Medical ethics, medical quotes, medical satistics, Two line sermons in cardiology, tagged evidence based falsehoods, evidence based lies, evidence based medicine, evidence based nonsense, experience based truths, principles of medicine on October 3, 2021|

Is there a solution?

As I understand, we don’t have any. Maybe, we can try this. No way, I can prevent it from appearing ridiculous for the mainstream scientists.

Truths often lie silently buried deep (many times intentionally). They definitely deserve an intellectual resuscitation beyond the dirty world of data and evidence. Further, why should experience be considered as enemy of evidence ?

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