Jon the Doc.

Veteran, SMU. GP, EM & HEMS doc. Skydive and Lift weights. Once a prize fighter: Queensbury (amateur) Muay Thai (pro). Frequent coffee drinker.

[a16z crypto @a16zcrypto]

Our Head of Security, Carl, shares practical lessons that can help keep you — crypto founders, operators, and investors — safe in an increasingly dangerous world.

⤵️

[Jon the Doc. @JonCM13]

@Mlbirch11 @DrNadolsky Haha! Yes - well spotted!

[Jon the Doc. @JonCM13]

https://t.co/0HhW2O6sns

@empiremagazine @totalfilm

[John Warren @JohnWar99128716]

Olly Rix would make a great James Bond.

[Michael Albert, MD @MichaelAlbertMD]

🚨 KETO-CTA: A Teachable Moment in Scientific Transparency
- - -
What happens when a highly publicized study FAILS to report its primary outcome?

The KETO-CTA study, designed to evaluate the impact of diet-induced hypercholesterolemia on coronary plaque progression, has sparked interest—and concern. Despite preregistering % change in non-calcified plaque volume (ΔNCPV) as the primary endpoint (see image below), the investigators did not report this outcome directly in the manuscript. Instead, results appeared later...in a social media meme.

🔍 Why it matters:
Non-calcified plaque progression is not a trivial metric—it’s the most relevant measure of early atherosclerotic risk. In KETO-CTA, ΔNCPV was +18.8 mm³ in one year (according to the lead investigator--see below), a rate typically associated with much higher-risk cohorts (e.g., familial hypercholesterolemia or diabetes). This was a study of supposedly "low-risk" individuals.

📉 Additional limitations include:
🔹 Short follow-up (1 year): Too brief to reliably detect meaningful progression in low-risk populations. Most longitudinal plaque imaging studies span 3–6 years.
🔹 Lack of control group: No comparator arm to contextualize imaging findings or isolate effects of diet-induced hypercholesterolemia.
🔹 Historical controls misapplied: Cross-study comparisons without accounting for differences in baseline risk, imaging protocols, or statistical methods.

🧠 This isn’t just about one study.
When primary outcomes vanish from manuscripts, it erodes trust. When clinical implications are downplayed, we risk misleading patients. The duty to report results transparently isn't optional—it’s foundational to scientific integrity.

Let’s be clear: ketogenic diets may offer benefits in select cases. But studies evaluating their cardiometabolic effects must be held to the same rigorous standards applied to all clinical research. In this case, the investigators appear to have fallen short—and possibly engaged in selective or misleading reporting to obscure unfavorable outcomes.

📣 We need better, not louder. We need data, not dodges. Most importantly, we need to treat scientific integrity as non-negotiable.
STUDY: https://t.co/0LFBSJYkxD #EvidenceBasedMedicine #KetoCTA #Cardiology #ResearchEthics #ScientificIntegrity #PreventiveCardiology

[Jon the Doc. @JonCM13]

@Chopperchap @DrJN_SportsMed Absolutely! This is the frustrating part about these image-based discussions. OA is a - mostly - clinical diagnosis. Within reason, who cares about the xray when ruling in.

[Jon the Doc. @JonCM13]

@finnskel @Mr_Andrew_Fox I’m sorry you never got to meet your real dad.

[Jon the Doc. @JonCM13]

@ThatBasedDude @Mr_Andrew_Fox Oh poppet…are you angry because they wouldn’t let you serve with us, or because you you weren’t brave enough to volunteer?

It’s ok. You’re safe.

[Jon the Doc. @JonCM13]

@ThatBasedDude @Mr_Andrew_Fox I’m a Christian. This wasn’t at all offensive to me. Maybe because I try to emulate our lord and saviour who suffered indescribable pain for all mankind. Rather than bleat aboue a picture, like a little bitch.

[Jon the Doc. @JonCM13]

@GregLehman @NickIlic_Physio @mikereinold That’s one of those great “oh…yeah, wait a minute” comments!! I hadn’t thought of that.

[Brian Roemmele @BrianRoemmele]

Right at this moment life is moving at us so fast.

Forces form to keep us in perpetual outrage and on edge.

Take a moment and imagine this is you in the chair.

We now live in a world where this is possible.

This and 1 million other things should lift you to optimism.

[Jon the Doc. @JonCM13]

https://t.co/TTTCzsH51J

[Jon the Doc. @JonCM13]

@ATRightMovies Wasn’t she in Star Trek or something?

[Jon the Doc. @JonCM13]

@KenDBerryMD @Drlipid @ErinMichos As a cognitive heuristic, people who use ‘probably’ at the start of a statement of belief should probably be taken more seriously than those who state “always/never/definitelu/absolutely/only”.

[Mark Frost @mfrost11]

You’re cosplaying your fave Peaks character for Halloween. Who is it? (Pictures will be required if I do a contest)

[Chris Beardsley @SandCResearch]

Reductions in muscle glycogen contribute to fatigue but NOT because of reduced ATP. This study shows that the fatigue mechanism involved reduced calcium ion release from the sarcoplasmic reticulum.

[Scotty Kirkpatrick M.D. @drscottyk]

Coronary artery calcium scan is inferior to both carotid and Ilio-femoral (and also aortic) ultrasound for identification of subclinical atherosclerosis in asymptomatic adults aged 40-54.

Maybe we should use ultrasound more than CAC?!

https://t.co/E4Zi3593L8.

[Jon the Doc. @JonCM13]

@JarretWithOneT @Manderville_RD

[Michael Albert, MD @MichaelAlbertMD]

Why are doctors always late?
Why are they always tired?
Why must they see >20 patients daily to keep the lights on?

It’s important to empathize with each other. Thanks for this powerful analogy, @jjfitzgeraldMD.