No, Young Adults Should Not Live in Fear from Coronavirus
What follows is an OpEd that I co-authored with Andrew Foy, MD, from Penn State University. Andrew is an academic cardiologist who studies the quality of scientific evidence. Two outlets have declined to publish our piece. This is not surprising given that we critique a research letter written by prominent academic leaders. As you read our take, please keep in mind that we oppose only the ideas expressed in the interpretation of data. *** The Journal of the American Medical Association recently published a research letter that reported an excess of nearly 12,000 deaths among younger adults th...
Source: Dr John M - December 29, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Follow-up on my Eight COVID Assertions
Yesterday’s post generated some good comments. Two emergency medicine specialists felt that I was both wrong and insulting in saying that hospitals were not overwhelmed. As a doc in NYC, I would suggest that your assertion 3 was indeed quite wrong and will be wrong in many more places before we are done— Josh Socolow (@Docjoshsoc) December 13, 2020 Jfc you weren't in Connecticut in April, and you aren't here now.We weren't (and aren't) fatally overwhelmed because of massive & costly efforts by our system. Anything less would have been catastrophic.Your blithe dismissal is kind ...
Source: Dr John M - December 13, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

What I Got Wrong (and Right) about COVID19
In May, I wrote a column about COVID19 that got some attention. My reason for writing was the change in messaging about the strategy of flatten-the-curve. We were first told to flatten-the-curve to prevent overwhelming hospitals. But then the thinking changed to flatten-the-curve to save lives.  I made eight assertions about COVID19. Let’s see how I did.  Assertion 1: The virus will not be contained. Verdict: Correct. You might argue that New Zealand and Australia contained the virus, but I would counter that these are not fair comparisons to the US, Canada, and the EU.  Assertion 2: T...
Source: Dr John M - December 12, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

New column and podcast up:
Last week, I wrote a column on one of the most controversial clinical trials in cardiology. The EXCEL trial pitted stents vs bypass surgery for people who have left main coronary artery disease. The trial has been beset with controversy. The three areas of debate surround the definition of MI (or heart attack), the increased risk of death in the stent arm, and selective publishing of data. Here is the column: Latest EXCEL MI Analysis Settles Nothing; Flaws Remain You should study this one because it hints at how precarious medical evidence can be. On the This Week in Cardiology podcast, I discuss EXCE...
Source: Dr John M - October 3, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Lecture on Scientific Bias in Cardiology
Last month I gave a lecture in Brazil (via my house in Kentucky) on scientific bias in cardiology. It’s about 20 minutes. Dr Bob Kaplan from Stanford also spoke on issues relating to how FDA approves drugs–a timely topic. Many of you know that I espouse a medically conservative approach to medical practice. My lecture explains some of the reasons I take that approach. I try to make the case for a humble approach to medical evidence and what doctors can do. We have a 30 minute discussion after the lecture. That was fun. The intro and moderator is my friend and colleague Dr Luis Correia, who is...
Source: Dr John M - September 29, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Doctoring and Activism
I got myself into a bit of tussle on Twitter today. In a provocative piece on the newsletter Persuasion, Dr. Sally Satel argued for caution in the matter of doctors becoming political activists. I retweeted it below: Doctors excel at treating people with disease. That is our calling. Political activism is fine, but it ought be done only as private citizens. I agree with Dr. Satel> https://t.co/xGS2P9a8lq(Kudos to @Yascha_Mounk for starting Persuasion) pic.twitter.com/aW83MvwJnz— John Mandrola, MD (@drjohnm) August 23, 2020 Most of the replies express extreme disagreement. One question stood out as...
Source: Dr John M - August 22, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Deeper Worries in America
I worry about the coronavirus. It’s already killed more than 100,000 Americans. The recent protests have created a nerve-wracking public-health situation for the next weeks. I really worry about racism. Not only racism in police systems but more systemic racism in our culture. My friend Dr. Andrew Foy sent me this slide and post showing the large disparity in black and hispanic representation in medical education. There can be no rest so long as a man like Dr. Otis Brawley, a distinguished professor of medicine, “can get thrown to the ground, handcuffed and questioned at gunpoint for looking ...
Source: Dr John M - June 6, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Stopping COVID19 in Nursing Homes is No Easy Task
My city, Louisville KY, recently had a spike in COVID19 infections. It came from a handful of nursing homes. That nursing home and long-term care facilities account for large percentages of COVID19 cases has been well documented. In some cities, the majority of cases come from these facilities. These facts have sprouted platitudes about “protecting our elderly.” What makes this a platitude is that it belies the challenges faced by nursing facilities. Two recent papers shed light on these challenges. First is an article by Chris Pope in the City Journal. Second is an academic-like defense of Stoc...
Source: Dr John M - May 26, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

More on COVID19 Testing and How This Virus Makes Us Use Our Noggins
My friend Anish Koka, a cardiologist, wrote a beautiful review of COVID testing over at the HealthCareBlog. The great pandemic is wreaking havoc, we are told, because the nation is not testing enough.  The consensus from a diverse group that includes public health experts, economists, and silicon valley investors is that more testing will allow the country to restart the economy and do it safely.  No, it’s not quite that easy, Anish writes. You will learn a lot from his long column. You might wonder why a COVID post from a cardiologist is worth reading. First, since COVID is novel, there are few t...
Source: Dr John M - May 19, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

COVID19 and Finding Effective Medical Therapies
This post introduces a column I wrote over at TheHeart.org | Medscape Cardiology — The good news is that most people infected with coronavirus don’t need a hospital or doctor. But some do. Some get very ill. The maddening thing is that doctors don’t have an effective treatment for the virus. There are no cures. The Worldmeter today shows nearly 5 million infections and more than 300,000 deaths. And no effective therapy. Excluding a possibly modest effect of Remdesivir, our care is supportive, which is medical jargon for giving simple things like oxygen, acetaminophen, IV fluids and letting ...
Source: Dr John M - May 16, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

The Case for Opening (some) Pools In COVID19 Pandemic
The COVID crisis has decimated water exercise. Can we rethink pool closures? A significant number of my older patients relied on pools for their fitness. During a pandemic, you can stay active or fit only if you have good legs and joints. Walkers, runners, and cyclists have no problem; they play outside in the Spring weather. People with bone/joint problems, fitness swimmers, and young children who normally take swim lessons this time of year are out of luck. Consider the place I swim—the Mary T Meagher Natatorium, named after Mary T, a Louisville native, who won Olympic gold in 1984. The place is an ode to Sp...
Source: Dr John M - May 12, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Will the Uncertainties of COVID Science Resurrect Blogs?
Health news was popular before the pandemic. Now, almost all news is health news. It’s not only a rapt audience contributing to the deluge of COVID19 news. Two other factors: 1) the availability of preprint servers, digital archives where a scientific paper can be published without formal peer-review and 2) the attention economy. Attention is currency. Since the business model of both scientific journals, internet-based medical news sites and mainstream media is attention (citations, views), both groups are eager to publish all that is COVID. The slew of COVID papers are outpacing the normal vetting proce...
Source: Dr John M - May 8, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Like Minds on COVID19
At the nearly the same time I posted yesterday, The Lancet published this editorial from Swedish epidemiologist Prof Johan Giesecke. Some excerpts: It has become clear that a hard lockdown does not protect old and frail people living in care homes—a population the lockdown was designed to protect. Neither does it decrease mortality from COVID-19, which is evident when comparing the UK’s experience with that of other European countries. … Everyone will be exposed to severe acute respiratory syndrome coronavirus, and most people will become infected — There is very little we can do to prevent this sp...
Source: Dr John M - May 5, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Can We Discuss Flatten-the-Curve in COVID19? My Eight Assertions
Conclusion: I did not have a clear answer for my couple. But after thinking and writing about this question it seems that the most reasonable approach in this crisis is transparent information–no matter how stark. And, crucially, we must have space for public debate. I hate this virus. I wish it never came. But we can make it worse by avoiding hard discussions on tradeoffs, the limits of modern medicine and risk. JMM P.S. I am very interested in your rebuttals to any of my assertions but will block vitriol and politicized nonsense. Related posts: The Debacle of Hydroxychloroquine and Azithromycin for ...
Source: Dr John M - May 4, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

The Debacle of Hydroxychloroquine and Azithromycin for COVID19
I discussed the use of hydroxychloroquine and azithromycin for patients with COVID19 on my March 27th edition of This Week in Cardiology Podcast. This is an important topic not only because of the specifics of treating patients but also vital because it shows how easily human beings can be misled. Here is a an edited transcript of my words: A conversation I had with my Dad this week made me realize the seriousness of this matter. My Dad is a retired insurance executive with a background in electrical engineering.  He is smart, but I could not convince him that the evidence prompting people to advoc...
Source: Dr John M - April 5, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

2020 Mandrola Update
This study garnered the big stage at the Heart Rhythm Society meeting and its findings were published in two leading cardiac journals–JACC and Heart Rhythm. (We kept the spin to a minimum!) Being part of an RCT was almost as nifty as pacing the his bundle. That image is intoxicating. A cool thing about the time we live in is the ability to have mentors all over the world. Here, Dr. Andrew Foy and his team at Penn State University in Hershey PA, deserve mention. Andrew is a true academic; he has helped me understand research methods. We have published many papers together, including my favorite: The Case for B...
Source: Dr John M - January 3, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Change and the Case for Being a Medical Conservative:
When my favorite podcaster, the economist Tyler Cowan, asked Dr. Ezekiel Emanuel what nonobvious advice he would give to medical students today, the answer surprised me. The famous bioethicist said:  I do think that this is probably the most exciting time in American medicine in a century, since really about 1910, 1920. And it causes a lot of anxiety for people, so I want to be sympathetic to that…. …We would prefer no change. But I do think, if you can go with the change, this is a super exciting time when lots of things are changing, and you can have a real positive impact in shaping the ...
Source: Dr John M - May 26, 2019 Category: Cardiology Authors: Dr John Source Type: blogs

Survey for Athletes with AF
Hey Athletes: My colleague, Professor Rachel Lampert, from Yale, along with the StopAF.org patient group, seek to learn more about how atrial fibrillation (AF) and its treatments affect athletic people. If you are an athlete or if you regularly exercise vigorously, please give the Yale researchers a few moments of your time. Here is the link to the survey. Since I had AF in the past, I filled it out. It takes only a few minutes. Prof. Lampert’s research into this area is important because AF affects people in vastly different ways. It’s weird; while most AF stems from advanced age or lifestyle...
Source: Dr John M - May 23, 2019 Category: Cardiology Authors: Dr John Source Type: blogs

Still Negative on Watchman
Many readers have contacted me to ask whether my negative viewson left atrial appendage occlusion with Watchman have changed since 2017.   The short answer is no. My views are even more negative today.  In 2016, I published an editorial on theHeart.org | Medscape Cardiology arguing that this procedure should stop. One of the rebuttals was that it was a blog post, not an academic editorial. Months later, Andrew Foy, Gerald Naccarelli and I put the same argument into academic-speak and the influential journal Heart Rhythm published it.[1] I have debated and presented this topic multiple times ...
Source: Dr John M - May 17, 2019 Category: Cardiology Authors: Dr John Source Type: blogs

AF, Ablation, Stents and Five Nuances
Joan has left an excellent comment on my recent 2019 AF ablation update. She brings up many important issues. Let’s dissect it. Q: Joan asks if it is common to see patients who think they are cured after AF ablation but are still in AF?  A: The scenario I described in my previous post is not common, but it is not rare. Since AF ablation entails much instrumentation and many burns, it can affect how the heart feels things. The heart has its own nervous system; yes, the heart feels. Also, the bigger the procedure, the bigger the placebo effect.  Q: If ablation doesn’t work, then I sure k...
Source: Dr John M - February 9, 2019 Category: Cardiology Authors: Dr John Source Type: blogs

AF Ablation Update 2019
Most years I write an update on any big developments in AF ablation. This year’s version will be a short one. I have little new to report. But it’s worth reviewing some basic issues. We still do not know the cause of atrial fibrillation (AF). That makes it hard to fix with ablation. Knowledge Deficits: To explain why not knowing the cause of AF impairs our ability to ablate it, it’s useful to compare AF ablation to WPW ablation. Wolfe-Parkinson-White or WPW syndrome causes rapid heart rates because of an extra pathway from the top to the bottom (atria and ventricle) of the heart. You can cure WPW by ablat...
Source: Dr John M - February 8, 2019 Category: Cardiology Authors: Dr John Source Type: blogs

Questioning Your Doctor is Ok
I received a good question(s) from a reader: In your “Changing the culture” posting there is the comment: “Patients seeking medical treatment should not assume a prescribed therapy is beneficial just because a doctor says it is.”… How then does a patient evaluate a proposed treatment in a way that they aren’t thwarting a doctor from performing what may be a needed course of treatment? … Other writing I’ve seen describes doctors being too accommodative to patients reluctance at a treatment. A bad feedback loop if there was one. Patients sho...
Source: Dr John M - November 5, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Grander Lessons from a Failure of Robotic Surgery
This week on my podcast, I deviated briefly from cardiology to discuss a shocking and sad study highlighting the vital nature of doing randomized controlled trials in the practice of medicine. The reason I mentioned a trial comparing 2 types of hysterectomy (removal of the uterus) in women with early stage cervical cancer was not to opine on matters of cancer, but because the tragic story shows the harm doctors can do if we incorporate therapies without proper testing. The New England Journal of Medicine published a trial in which women with early cervical cancer were randomized to two types of hysterectomy: One...
Source: Dr John M - November 4, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Thoughts on the Apple Watch
Apple products are cool. I love them. But (even) Apple will struggle delivering health. Making healthy people healthier is fraught with problems. At the core of this issue are the many snags of screening people for disease. Here are 600 words I wrote for Medium: I’m a Heart Doctor. Here’s Why I’m Wary of the New Apple Watch Here are my thoughts in the Wall Street Journal:  https://www.wsj.com/articles/apple-adds-heart-monitoring-fall-detection-features-to-its-watch-1536792518 And the Washington Post:  https://www.washingtonpost.com/technology/2018/09/14/what-cardiologists-think-about-apple-...
Source: Dr John M - September 18, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

On Our Words
During a recent office visit an older women recited to me what I had said to her over a decade ago on the day she came to the hospital. The detail of her memory gave me pause. I could not remember the scenario but she said that my words had become part of her family’s stories. That is a big deal. And I hear this often. Illness induces a heightened sense of being. The ill and their families remember a lot about their caregivers, especially our words. Think about your own encounters when you have been ill enough to be in a hospital. I surely remember the interactions–both the good and the not-so-good. The dauntin...
Source: Dr John M - August 12, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

How dangerous are NSAIDs in patients with AF?
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban). My views on this matter have changed. But first, I want to mention a study published in JACC that addressed the issue of NSAID use in pts with AF who take an anticoagulant. This was a sub-analysis of the RELY trial, which pitted dabigatran vs warfarin. Remember, in the original RELY trial, the 150mg dose of dabigatran did better than warfarin at...
Source: Dr John M - July 13, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Cardiology Podcast Every Friday
My editors at Medscape warned me years ago that many people, especially younger ones, read a lot less. This saddened me because I’ve spent a great deal of time learning to write. One of America’s most accomplished writers, Malcolm Gladwell, began his podcast because he worried about not reaching younger people. Each week, I spend a great deal of time putting together thoughts on the top 4-5 cardiology stories of the week. Most of the ‘stories’ are studies, but not always. I have been doing this podcast for a couple of years now, but haven’t promoted it because I was not sure it would...
Source: Dr John M - June 25, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Finding Truth: How Much Do We Need Experts?
I am planning a column on the role of experts in translating medical evidence. Evidence is important because it’s how doctors know they are helping not harming people. It’s hardly news that the new (digital) democracy of information has changed the rules of influence in Medicine. In the days of old, academic doctors generated, analyzed and translated evidence. We called these people key opinion leaders (KOLs). To become a KOL, you stayed in academics, published lots of studies, and crucially, you were not too critical of prevailing views. If you did that, you could get invited to speak at meetings, write editor...
Source: Dr John M - June 10, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

A Corrosive Force in Medical Care
It comes in a large white envelope each month. It’s marked confidential. When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away. It’s my monthly productivity report. Most employed doctors get these graphs. These “dashboards” of value include your own productivity as well as many graphs on how you stack up with other doctors across the country. It shows your employer if you are a hard worker. The measure of productivity we use is called the relative value unit or RVU. Doing an ablation, cath, stent or valve replacement earns ...
Source: Dr John M - October 17, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Left Atrial Appendage Closure Does Not Prevent Strokes
Our cautionary left atrial appendage occlusion (Watchman) editorial is now published in a prominent medical journal, called Heart Rhythm. My co-authors are Drs. Andrew Foy and Gerald Naccarelli from Penn State. It was a peer-reviewed version of my previous theheart.org | Medscape Cardiology column. Watchman and other similar devices are plugs that occlude the left atrial appendage in an attempt to reduce the odds of stroke in patients with atrial fibrillation. It was a nice idea but it did NOT work. The link is here> Percutaneous Left Atrial Appendage Closure is Not Ready for Routine Clinical Use In the allott...
Source: Dr John M - October 12, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

The Nobel in Economics and Medicine?
Once again, the Nobel prize for economics–not science and medicine–has immense influence on the practice of medicine. Every day, in fact. This year, Richard Thaler, a behavioral economist at the University of Chicago, won for his work on human biases and temptations. The famous writer Michael Lewis (Moneyball) has a nice essay on Thaler’s work here. Along with Kahneman and Tvresky, the work of behavioral psychologists and economists directly relates to clinical medicine because it describes human decision making. Thaler made lists of irrational decisions. For example, we often make choices that don’...
Source: Dr John M - October 11, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

We get what we tolerate…
Richard Fries, a cycling-safety advocate in Boston, uses the phrase we get what we tolerate to describe the dire situation of drivers killing cyclists and pedestrians. Many humans die from these collisions because we tolerate it. An inattentive driver kills a person on a bike; then nothing changes. The phrase applies well to other dubious policies in the US. Before a gunman slaughtered 60 innocent people with a machine gun in Las Vegas Sunday night, I had planned to use the we get what we tolerate phrase in health care policy. I was going to argue that US citizens pay too much for medication, navigate a morass of bureaucra...
Source: Dr John M - October 3, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Medicare for All?
Maybe it’s sampling error, but I am seeing an increasing number of people who are being financially crushed by the US healthcare system. One recent patient had a real rhythm problem, one that could or should be fixed with a procedure. But he could not afford it. He had insurance but could not afford to pay his allotted portion. I felt helpless–because although I could agree to do it for free, the hospital charges would be over $100,000. Another patient suffers from stress-induced arrhythmia because her brother–whom she is close to– is hospitalized and she can’t be with him at the bedside. Why?...
Source: Dr John M - October 2, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Young people, stroke and a hole in the heart (PFO)
(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)  *** We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may be the worst outcome in all of medicine. That’s because stroke can permanently remove basic functions of being human, things such as speech, thought, personality, movement, swallowing, and many others. Stroke is not supposed to happen in young people. But sometimes it does. And in some ...
Source: Dr John M - September 28, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Inflammation, Ablation, Fats, LDL, etc .. My review of ESC 2017
The European Cardiology Congress, ESC as it is called, has grown into the largest medical meeting in the world. This year, about 38,000 attendees came to Barcelona. I was busy. Here is an update of the big stories: Inflammation:  Experts agree that inflammation associates with heart disease. One of the keys to showing inflammation causes heart disease would be to show a reduction of cardiac events with a drug that blocks inflammation. The CANTOS trial tested the ability of a drug called canukinumab, which is already approved for rare causes of inflammatory diseases, to reduce cardiac events. Canukinumab exerts its ant...
Source: Dr John M - September 6, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Big lessons from my error
I was furiously tapping on the computer when he asked: “Doc, what happens if I don’t have the procedure you are recommending?” Glee spread through my body. I grinned and nearly jumped up from the stool to hug him. I enthusiastically answered. Few patients ask this vital question. I tweeted about the encounter: An older pt asked me: "what happens if I don't have this procedure" / I nearly jumped up to hug him!
Source: Dr John M - July 9, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

New Data Increase Caution on Left Atrial Appendage Occlusion
This study took data from more than 61 centers across the world. The details of the studies are included in my column: Real-World Data on Left Atrial Appendage Closure Does Not Reassure The gist of these studies was that clots on the device are not rare; potent clot-protecting drugs are likely required to prevent clots (at least for a period of weeks-months); the presence of clots increase the risk of stroke, and finally, major procedural complications are in the range of 4%. These findings bolster my already cautions approach to this procedure. Remember, left atrial appendage closure is a preventive procedure. Its be...
Source: Dr John M - June 27, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

2017 European Heart Rhythm Meeting Update
I attended the European Heart Rhythm Association meeting last week in Vienna. Here is an update on the stories I found most interesting–the ones I wrote about on the heart.org | Medscape Cardiology. Brain Lesions after AF ablation:  Electrophysiologists do not talk much about the small brain lesions that appear after procedures in the left atrium. MRI brain scans done before and after procedures such as AF ablation reveal the presence of “white sports” in a not insignificant number of patients. These lesions usually do not cause symptoms and mostly resolve over time. The cause of the brain lesions is...
Source: Dr John M - June 24, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Uplifting book — The Rosie Project
Good book alert: This holiday weekend I read The Rosie Project by Graeme Simsion. Simsion sets the story of a nutty genetics professor in Melbourne, Australia. The book is sweet, funny and uplifting. It’s a perfect escape from the mean-spiritedness of today’s news cycle. An Australian electrophysiologist who I had dinner with during the recent HRS meeting recommended the book to me. The sequel is called the Rosie Effect. I’ll read that one next weekend. I hope the Rosie Project gets made into a movie. It’s that good. JMM Related posts: A doctor’s review of The Book Thief… A vacation b...
Source: Dr John M - May 30, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

How important are short AF episodes?
A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes. Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF). SCAF is AF on a monitor that is often not felt by the patient. Doctors are seeing more of this because patients are increasingly being monitored–with pacemakers, ICDs, long-term event recorders and implantable cardiac monitors. These devices can pick up minute-long or hour-long AF episodes. In the past, AF could only be picked up whe...
Source: Dr John M - May 25, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Medicine at its best is a team sport
Patient safety, quality, and value are new buzzwords in healthcare. No doubt, these are all laudable goals. The problem is that true quality care cannot be put on a spreadsheet and publicly reported. It just can’t. Never. Why? My friend Dr. Wes Fisher explains in this beautiful post called “Wingman:” There is talk of quality in health care. There is talk of safety. Millions upon millions of dollars are spent on “quality and safety” in health care each year. After all, without “quality” and “safety,” how can you have “value?” Business people now call quality ...
Source: Dr John M - May 5, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

The Future of Predicting Heart Disease May Be In Your Genes
Three cases first: A young woman I met recently (outside the hospital) told me her Dad died suddenly a couple of years ago. He was fine, then he was stone cold dead. The wife went outside for a minute and came back to find her husband dead in the chair. There were no warnings. No chest pains, no breathing problems, and no real diseases, except well-controlled high blood pressure. A middle-aged man came to see me in the office because his brother died suddenly while jogging. The patient wanted to know his risk of heart disease and what he could do to prevent premature death. Both my patient and his dead brother were in dece...
Source: Dr John M - May 5, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

New Policy on Comments
I am changing my policy on comments. In the past, if you had one approved comment then all of your subsequent comments would post without moderation. I changed that. Now I will moderate all comments. That means there may be a delay. Another change is that I am not going to allow personal medical anecdotes. The reason is that heart rhythm diseases, especially atrial fibrillation, affect people in diverse ways. I counsel patients never to compare their problem with their friends’ problem. Therapy for AF has to be tailored to the individual. What’s right for you could be completely wrong for your buddy. I will als...
Source: Dr John M - May 3, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Beta-blockers, Statins, AF, and the Nocebo Effect
Our brains can easily fool us. No experienced doctor would deny the power of the placebo effect. Today I want to discuss the nocebo effect, which occurs when negative expectations of something causes it to have a more negative effect than it otherwise would. Drugs can exert a strong nocebo effect. If your brain thinks you will have a side effect, you may actually get that effect. Nocebo brain trickery is relevant to statins. That’s why I used this wording in my last post: (Note the italics) The actual frequency of muscle symptoms is hotly debated. Randomized controlled trials (in which patients don’t know wheth...
Source: Dr John M - May 2, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Statins, Like All Medicines, Are Neither Good Nor Bad
We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers of rivaroxaban settle a class action suit, you can bet apixaban (Eliquis) will be next. These ads are a problem because they use fear persuasion (see Scott Adams’ blog), and because they can induce patients to stop taking or not starting a beneficial medicine.  Lots of other medications suf...
Source: Dr John M - April 30, 2017 Category: Cardiology Authors: Dr John Source Type: blogs