Caspian Kuma Folmsbee MD

internist - primary care - assistant professor | - (Salary 233k + RVU bonus) - no other COI

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

Living thread of lessons learned after attempting primary care academic medicine since 2013--🧵

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@drbennisahmed The fact that the signal is so consistent makes me nervous given the populations were so separated in time (25 years between DIG and DECISION), rhythm (DIG excluded Afib) and formulation (digoxin vs digitoxin)

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@JAMACardio I think I found a big typo in your digoxin metanaysis. DIG trial only included sinus rhythm patients (was not an exclusion).

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

The fact he took the time to read what I wrote is one of my proudest moments. RIP

[Richard Lehman @RichardLehman1]

This truly nails it. Shared decision making is a mirage without shared understanding and a relational context.
I gave up believing it possible until the arrival of generative AI. The BMJ triadic care Analysis articles explain how it might be achievable. @crblease

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

“Not caring about their health” is such a superficial understanding of how complex we all are, not to mention a system stacked against them.

[Crémieux @cremieuxrecueil]

This is a poignant reminder about patient motivation.

Even *a literal heart attack* is not enough to get most patients to care about their health, and these aren't particularly hard targets to reach!

I bet if this chart added obesity, it would look even worse.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@AnilMakam @PaulSaxMD Fuzzy line between medical advancement vs medical reversal. Warfarin, asa, revasc, bblockers are victims of progress. Other just had expiration dates

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

“The best medicine is the one they will take”—a phrase that runs counter to shared decision making.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

Living thread of lessons learned after attempting primary care academic medicine since 2013--🧵

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

”A jack of all trades is a master of none, but oftentimes better than a master of one."

[Anish Koka, MD @anish_koka]

2018 vs 2026 Lipid guidelines compared.

The visually striking thing is the number of recommendations made in 2026 vs. 2018 : more than 4x as many recommendations, and observational-evidence recommendations replaced RCTs as the foundation.

The COI story is interesting🧵

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

AI is making us worse. Repeated bullet points. CAC point talks about meds? Do we even care what we share anymore?

[Roger Blumenthal @rblument1]

Great summary by ACC/AHA/Multisociety Dyslipidemia/Prevention GL ‘26

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@venkmurthy can't argue with the increased RVUs CAC generated.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

More nuanced and low value. Perfect for AI.

[Chris V MD @ChrisVMDHealth]

I genuinely disagree with this.

More and more nuanced management flow charts mean that we are getting closer and closer to the ideals of precision medicine: matching the right patient to the right treatment.

It means our understanding of disease and risk mitigation is getting more nuanced. (Caveats here about evidence tiers for some recommendations.)

Is it a pain? Sure. But that's the job.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

Publishing Class I recommendations while studies are still incomplete threatens recruitment of those studies and seeds distrust

[Less-Is-More Cardiologist @DavidLBrownMD]

@neeche41 @pash22 @dmljmd @venkmurthy It’s going to be very embarrassing to have to downgrade the recommendations after Corcal and ROBINSCA.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

Why does everyone assume brainstorming with an LLM is helpful? Wouldn’t it just feed you other people’s ideas and limit your own creativity?

[Ash Paul @pash22]

To statin or not to statin
https://t.co/aTHFSqJh24 via @KumaFolmsbee

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

The end caps of my local grocery store. We are cooked.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

How about restricting its use to primary care only…

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@AnilMakam @hswapnil @kidney_boy I'm all for a bigger trial, but I wonder how much the heterogeity of the disease will limit understanding, not to mention the fact that many nephrologists already wouldn't enroll patients. Equipoise feels messy in this space.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

Is #NEPHJC going to cover LIBERATE-D? Or do you think we already know the answer (less is more).

@kidney_boy @hswapnil

https://t.co/4bhDD0ox3I

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@hswapnil @kidney_boy Appreciate you taking the time to read my rant. The authors made a compelling case for superiority. @Proximal_Baxi tells me HD PRN is SoC here in humble Chicago.

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

@kidney_boy @hswapnil Oh shoot, not sure how I missed it. Should have just read yours, its got it all. I love the bottom line point of how will this get translated into the real world

[Caspian Kuma Folmsbee MD @FolmsbeeMD]

Took a deeper dive into LIBERATE-D after listening to your episode. Less practice changing and more guideline nudging?

@adamcifu @drjohnm

https://t.co/4bhDD0nZea