Well, thank you so much for coming, and it's my pleasure to be here to speak to you all there in Mount Sinai and the critical care department.

I'm going to talk a little bit about when medicine comes with an expiration date.

And by way of background, I'm a professor here at the University of California, San Francisco.

I'm a practicing he monk doc.

You'll find me there every week in clinic at the San Francisco General Hospital, our county hospital, and I attend on service there a few months a year. I'm also primarily

a faculty in the Department of Epidemiology, where I teach a number of courses like on publishing

and presenting research and designing clinical trials, and I do a lot of research in epidemiology

methods and health policy.

All right, let's get started.

So, you know, we've been interested in this topic for quite some time.

This was a paper we wrote a few years ago called,

should evidence come with an expiration date?

And this was a paper I wrote with Palmer Green and Adam Sefu,

who's my longtime collaborator.

And basically the theme of this paper was that there are many medical practices that appear to be beneficial,

but only in the context of the surrounding medical care of the time.

The example we used, of course, was a daily aspirin, which seemed to work very well in a population that was enriched with smokers that had a lot of hypertension

that was untreated. But then the same preventive aspirin, primary prevention aspirin studies,

when done again in the modern age in a population that was more obese, that had less smoking,

that had more statin use, those studies were negative. And so our question was, should medicine

and medical evidence that guides our

practice come with an expiration date? I think that's particularly relevant for critical care

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