Michael Ostacher, MD, MPH
@RecoveryDoctor
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Professor of Psychiatry & Beh Sciences @StanfordMed decreasing stigma/increasing evidence/improving care. Food tweets. Digital Ed @BMJMentalHealth Opinions mine
Stanford, CA
Joined January 2013
Just had a patient tell me today that my prescribing acamprosate saved his life. Hasn't drank since. "I just don't think about it anymore." Never had someone taking gabapentin tell me that, so just a reminder to all of you out there to follow the data and to watch your biases.😀
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An attempt at Czech food for a dinner with friends. They use a lot of caraway and marjoram. Who knew? #twittersupperclub
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Concierge Medicine Signals the Failure to Invest in Primary Care in USA https://t.co/uywydTT9to via @adamcifu . Are we headed this way in @NHSEngland Steve @DrSteveTaylor ?
sensible-med.com
At this point in my career, I know what I do well and what I do less well.
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Liraglutide separates from control on about day 2 with most of the effect before 30 days for stroke outcomes? Nah. It is not credible that this is actually the case in this open-label study, and performance bias dooms it. Retract it. @adamcifu
@drjohnm
jamanetwork.com
This randomized clinical trial examines the safety and efficacy of liraglutide in patients with type 2 diabetes and minor acute ischemic stroke or high-risk transient ischemic attack.
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Don’t prescribe olanzapine and don’t argue with me
🚨 LANDMARK STUDY ALERT The largest, multicenter, assessor-blinded, RCT of antipsychotic efficacy was just published this week. 7 arms. 7 antipsychotics. 3000 patients. » All antipsychotics ↓ symptoms by 50% in 6 weeks » Olanzapine, risperidone > the rest
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To add worry: plenty of crummy RCTs make clinical practice recommendations too.
Observational studies often make clinical practice recommendations: an empirical evaluation of authors' attitudes https://t.co/ycIrS08Vxs via @adamcifu et al
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They actually found the opposite, endorsing sertraline as a treatment for depression: “In conclusion, we show that sertraline has direct effects on individual anxiety and depression symptoms, as early as ~2 weeks into treatment”
BMJ report on re-analysis of PANDA trial (sertraline vs placebo) questions the relevance of the small effects on some selected symptoms and highlights how the main outcome was negative
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I appreciated just about everything in this measured piece on the need for scientific investigation of the possible benefits of psychedelic compounds in psychiatry — except for their certainty that benefits would actually be proven to be found. I’ll wait.
jamanetwork.com
This Viewpoint addresses the dual domains of psychedelic experience—neurobiological changes and subjective experience—and argues for rigorous investigation of both domains.
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🚨 Holy. Mushrooms. The entire field of psychedelic neuroimaging may have just gotten everything wrong. Psilocybin decouples neurovascular response from neuronal activity. That means fMRI studies on hallucinogens could be picking up vessel, rather than neuronal effects.
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Foot longs courtesy of my buddy, Lee, at the game. No, there’s no Jersey Mike’s close by and these hit the spot. #twittersupperclub
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Maple lime glazed scallops and Brussels sprouts with bacon, Eric Kim’s recipe. How about bacon fat, olive oil, and butter in one dish? Came out good. #twittersupperclub
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@TheBorisLab People expecting ketamine are bound to be disappointed. Well, until the novelty is worn off.
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The authors modestly state: "Unlike some prior ketamine research that relied on self-selected volunteers, the present trial enrolled consecutive inpatient admissions at an academic center, potentially reducing selection bias and moderating expectancy effects." @TheBorisLab
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In case you wondered about ascertainment bias, "Most patients and raters accurately guessed treatment allocation." Loss of novelty might be the most parsimonious explanation.
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Why am I not surprised that ketamine doesn’t actually work for depression (at least in this small study)? It may well be because the novelty has worn off. Next: compare zuranolone for postpartum depression to a benzodiazepine, too.
Serial intravenous ketamine infusions were not superior to midazolam in reducing depressive symptoms among inpatients with moderate to severe depression, with no significant differences in efficacy, cognitive, economic, or quality-of-life outcomes. https://t.co/OMV8TZ4urE
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CA’s new Prop 36 (“treatment-mandated felony”) just hit 6 months: 🧾 8,895 cases filed 💊 1,290 chose treatment ⚖️ 771 ordered in ✅ 25 completed ❌ 163 sentenced It’s a new experiment between diversion & incarceration. #Prop36 #AddictionPolicy
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