Except the conditions that the trials were done are different than now.

Back in the 80s no one was getting a stent in the first 120 minutes of a heart attack (or the first 90 minutes of reaching a hospital). Now it's considered standard of care. This one change has rocked the world of cardiology and has reduced mortality from heart attack dramatically.

Heart attack trials done before this have to be re-done in a more modern era.

No one has recommended beta blockers as a first line therapy for hypertension for decades.

This article isn't about the treatment of hypertension. This article is about the treatment of the acute phase of myocardial infarction.

Also, blood pressure lowering (regardless of the medication used) absolutely lowers the risks of heart attacks, strokes, and other hypertension-related problems. It's just in the acute phase of a heart attack we have to be more careful of which agent to use and other agents have added benefits over beta blockers.

I'm not much of an economist, but I know that since beta blockers have been generic for decades, there are a lot of players on the market. Profits on generic beta blockers are razor thin. It's not even a blip on the radar in terms of profits for any large pharmaceutical company.

As I said earlier, the price per month is somewhere between $4 and $10. You can't extract more than that in profits in a month. And if you try to extract more profits, the pharmacy will find a cheaper generic pharmaceutical company to supply them.

Compare that to other heart medications and it is a drop in the bucket. Like Jardiance for heart failure. $600 a month.

Yes, it's $10 billion in sales. But not $10 billion in profits. It can't be at $10 per month per patient. If it was, there would be 1 billion Americans on beta blockers. I don't think there are that many Americans out there.

I'm not sure if you are being facetious or not.

There has been discussion in cardiology circles for the past decade that beta blockers likely should play a smaller role in the post-MI (myocardial infarction == heart attack) care.

Beta blockers were initially prescribed post-MI to reduce the amount of arrhythmias post-MI. That being said, with the advent of early revascularization post-MI with patients going to the cath lab earlier rather than later (or never), the paradigm has shifted. The early revascularization is also associated with the preserved EF that is being teased out in this study.

Data science has evolved dramatically in the last couple decades and there are great discussions about these studies as they come out on Twitter, various blogs, and podcasts. Good studies are hard to do, and excellent evaluation of the results of the studies help guide us towards better outcomes. A shout out to the This Week In Cardiology podcast -- https://podcasts.apple.com/us/... -- , which is a great starting point for the discussion of how trials should be interpreted in the real world.

(I am a cardiologist)

This is an interesting thing, and needs to be followed closely.

There are a group of medications that have been made the standard of care for the treatment of a heart attack. These medications were tested in numerous high quality trials (randomized, double blind, placebo-control). But many of the trials are old. They don't take modern practices into account.

The problem with "just repeat the trials" is that trials are both hard and expensive. Expensive to get enough people enrolled in them and followed for a long enough time to get a good outcome. Hard because it's hard to enroll someone who is in the acute phase of a heart attack into a trial. Doubly hard if you are trying to test something that was previously believed to be the standard of care.

Imagine being a patient and being offered "We have this medication that we want to test whether it's going to help you after your heart attack. Would you be willing to be in a trial, where you are not sure if you are going to get the medication or not? If you don't want to be in the trial, you will almost definitely get the medication, because it's considered a lifesaving medication after a heart attack."

These trials are great and I give props to the study authors and their team to tease out this information. It's not practice-changing... yet, but certainly challenges the idea that every patient needs a beta blocker post-myocardial infarction (heart attack).

In reality, we are pushing more ACE-I than beta blockers on the discharge medications, but beta blockers are still on the list of required medications at the time of discharge to meet "quality of care" metrics. Maybe those metrics will get updated to be based on post-MI ejection fraction.

Your tinfoil hat is a little too tight.

I am a cardiologist.

Beta blockers are cheap. We're talking ~5 dollars a month, with several options that are generic in most countries (including the US). This includes carvedilol and metoprolol succinate, the two most commonly prescribed beta blockers after a heart attack in the US and Europe. No drug company is getting rich off of them.

Thunderbolts was okay.

For me, the test will be if I decide to rewatch it in a few months or even a year. Right now... maybe? It was kinda funny and had a few good scenes.

Frankly a lot of stuff Marvel has put out recently is not re-watch worthy for me. That includes most of the MCU TV shows.

I will rewatch Agents of SHIELD and Legion. I will rewatch all the Avengers films and the second and third Thor movies, the Marvels, and (of course) the first three Captain America movies.

I guess when there are a lot of options we tend to get more picky.

Same thing with any other computer.

The Vision Pro shouldn't be marketed as a virtual reality headset. Because that's not what it is.

It should be marketed as an all-in-one computer with a virtual monitor. And as such, it should be updated every 1-2 years with faster hardware and more memory, just like every other desktop and laptop computer.

MI:2 was made for people who thought the original Mission: Impossible movie was too complex, needed a love interest, and needed more action sequences.

That being said, credit where credit is due: The original Mission: Impossible movie stands up really well even now. Complex storytelling with an engaging plot. The flashback where Ethan Hunt is trying to put together what happened while he is being told what happened is a great example of an unreliable narrator. But we need to figure that out. It's not spoon fed to the viewers.

Still my favorite movie in the franchise.

Which presumably mean they also didn't purchase the yearly subscribers from the previous company. I think a judge would be quite critical of a purchase of all customers except the ones that would be a long-term liability.

Parent here, with a son graduating high school. ChatGPT is used by everyone he knows in high school. He used it recently to write an essay for a highschool class. But it's not the essay he handed in. More like it wrote out an outline that he used to get started on his essay. Kinda like a first draft, but more just to give him inspiration for him to get started in writing something in his own voice.

I saw him do it, and told him that it was reasonable so long as he didn't try to submit something that was completely written by AI. He already knew that the AIs are not at all good enough to be trusted for that (yet). But it is a good way to get a start on a paper. Kinda like writing a paper on a topic and reading the Wikipedia page on it first.

AI is a tool. To be used or misused.

Teachers can have kids do short tests in person in class to test knowledge, while using projects that allow AI input to test understanding.

Are republicans actually buying Teslas in significant numbers?

Also, remember that rare earth elements aren't that rare. There actually were mines in the U.S. that mined for them. The U.S. mines closed down because it was cheaper to export the mining to China. We had the benefit of getting cheaper Rare Earth Elements while exporting all the harm of mining them to China.

Now we can mine them in the U.S. if we want to (at a cost significantly higher that getting them from China) and get to make more sick people in the U.S., bolstering the U.S. health care industry. And if the sick miners and their families don't have health insurance, they can just go to the hospitals and get treated for free (*).

(*) Well,l it's not free. They will be charged and just not pay the bill. Then the hospital eats the cost and raises the cost of other things so that it doesn't go bankrupt. It's the American way. :-)

They found a complete, pristine, 35mm film copy that remained intact since the release. Independent of the people that made Project 4k77.

Hope this original film gets transferred to a digital copy and used to improve the quality that the 4k77 people have (which is already quite beautiful, for the most part).

Oops. Totally wrong link. Here it is: https://system76.com/cosmic/?s...