New post up at Medscape Cardiology: Are novel anticoagulants better than warfarin?
For the prevention of stroke in atrial fibrillation, the novel anticoagulant drugs dabigatran (Pradaxa, Boehringer Ingelheim), rivaroxaban (Xarelto, Bayer Pharma/Janssen Pharmaceuticals), apixaban (Eliquis, Pfizer/Bristol-Myers Squibb), and edoxaban (Lixiana, Daiichi-Sankyo) have been sold as both superior and more convenient than warfarin.
But is this true? More than 60,000 patients have been enrolled in randomized controlled clinical trials. Recently, two meta-analyses (studies that combine trials) have been published. That’s a bunch of data.
I had originally set out to explain how these meta-analyses had once and ...
Source: Dr John M - December 20, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
The best New Year’s resolution video you will ever see…
My messages are simple:
Mastery of the obvious;
Reflective learning;
Balancing optimism with realism;
Plan for health;
and this biggie:
Stack together lots of small changes. Strive for small wins. They add up to big things.
They are all here, plus some science. Dr. Mike Evans is a doctor, professor and creator extraordinaire. This is talent. If you care about learning and health and communication, this 5:47 gem will have you tingling. Enjoy.
JMM
Related posts:
Is there anything we espouse now that will be this silly in 50 years?
Blogging resolution(s) for 2012
Cycling Wednesday: New Year’s resolution (Source: Dr John M)
Source: Dr John M - December 17, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
The biggest mistake is not learning from one…
A friend recently asked me why I am so hard on doctors. “You write a lot of negative stuff about us,” he said.
That worries me. I am not a nihilist. I believe in what we do. I put doctoring decidedly in the noble category, right alongside teachers.
In fact, my attachment to doctoring is the reason I write about it.
Here’s my thinking about confronting negative stuff: One of the major problems with healthcare at this moment is an erosion of trust in doctors. We have a credibility problem.
The information age has changed the landscape of medicine in two major ways: First, access to health information is n...
Source: Dr John M - December 15, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Are doctors being duped through medical education? Could social media help?
I made a discovery this week about the novel anticoagulant medications, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Lixiana). I was looking into the often-asked question of how these new drugs compare to the old standard, warfarin.
The discovery felt like a Eureka moment. I ran it by my stats guy–my son–and a couple of colleagues, and they confirmed, that my discovery was truth. I’m working on a post now that discusses the details of how the medical world has been misled about these drugs. Stay tuned.
Medical Education:
For now, though, this revelation got me thinking abo...
Source: Dr John M - December 14, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
New post up over at The Atlantic — Improving US healthcare by looking at strategies from India
Some things are hard to see until one leaves his or her normal surroundings. For American doctors, especially procedure-based doctors, it’s easy to get used to the wastefulness and largesse of delivering care. Then you travel. You go to another healthcare system and are left to gasp. An AF ablation ‘costs’ 100,000 in the US, while the same procedure in Germany costs 10,000$? It’s cheaper still in India. How could this have happened to us? Can we do better?
My wife says it’s burdensome to be clear seeing about some things. She was talking in the context of seeing the folly of futile care at e...
Source: Dr John M - December 11, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
The Waiting Room — a film that makes you think about healthcare
Last night, Staci and I watched the award-wining documentary, The Waiting Room. Here is an intro from the website:
The Waiting Room is a character-driven documentary film that uses extraordinary access to go behind the doors of an American public hospital struggling to care for a community of largely uninsured patients. The film – using a blend of cinema verité and characters’ voiceover – offers a raw, intimate, and even uplifting look at how patients, staff and caregivers each cope with disease, bureaucracy and hard choices.
The film touched us both. More than once, as we sat together on a couch watching a hi...
Source: Dr John M - December 7, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
With vaccines…Is there no middle ground, no room for questions?
“We should be as demanding of ourselves as we are of those who challenge us.”
Dr. Jerome Groopman, writing in the New Rupublic
Writing about the medical decision-making surrounding vaccines proved to be sketchy. Yesterday’s post brought stinging criticism from both sides of the debate. A pediatrician felt the structure of the post was patronizing. Just an hour later, a skeptic sent me the same message–patronizing. This was educational.
Criticism is taken seriously here, especially when it comes from both sides of an argument. The reflex: Perhaps its useful to write more on the matter? (It’s f...
Source: Dr John M - December 6, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
The vaccine debate — Could compassion and nuance be an antidote?
I’ve been thinking a lot about vaccines. As a learner, an observer of humans and our nature, a worshiper of the scientific method, a doctor, a new grandfather, and a member of society, few debates could be more compelling. The kerfuffle over vaccines has it all. It’s the Lance Armstrong story on steroids. (Grin.)
The spark for writing on this matter came from reading a mother’s impassioned call for reason. (Link at the end.) The author is a young lawyer who writes (skillfully) about being married to a young doctor. Her vaccine post went viral, garnering 483 comments—which, for a blogger, is akin to nirvana.
In ...
Source: Dr John M - December 4, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Thinking of Mom
Two years have passed since my mom died on Thanksgiving morning.
The Mandrola children lived a blessed childhood, immersed in love and nurturing. A cocoon of normalcy, if you will. This morning, as I sit at the computer in the predawn stillness, I reread the post I wrote in the days after Mom died. I don’t normally re-post old writings. But I’m thinking of my mom today.
****
Joan Evelyn Mandrola Jan 14 1939 – Nov 24 2011
So Mom…
Your love and devotion to me approached infinity.
As a younger, I longed for nothing.
You loved me—whether I was on a podium or not. This was a mother’s love. Your ...
Source: Dr John M - November 28, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
First ever invited commentary in a medical journal — JAMA-IM
I’m going to be proud for a moment.
Yesterday, the journal JAMA-Internal Medicine published an invited commentary that I co-wrote with Dr. Dan Matlock (@Dan_Matlock) from the University of Colorado. The title of the piece is The Antidote for Unprepared Patients — A Caring Clinician. It’s available for free.
Invited editorials in medical journals are often used to emphasize or clarify impactful scientific articles. The study that Dan and I commented on was a retrospective review of the Features and Outcomes of Patients Who Underwent Cardiac Device Deactivation. (Also available for free.) The Mayo Clin...
Source: Dr John M - November 26, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Recap of 2013 American Heart Association Session
Just a few weeks before the 2013 American Heart Association Sessions, Shelley Wood, the managing news editor of theheart.org emailed to ask if I was up for going to the meeting. With trips to San Francisco, Denver, Athens and Amsterdam already in the books this year, I had counted 2013 as a win. I was ready to ease into Thanksgiving and conclude the bike season with a couple of cold-weather CX races. But when opportunity presents itself, ie,,,when the big strong guy in front of you attacks, it makes sense to follow.
Yes. Yes. I am in. I was excited to see my THO friends again. I was excited to write and learn.
My role at m...
Source: Dr John M - November 24, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
New post up over at TheHeart.org-Medscape Cardiology — Part 2 of Progress in Cardiology
Part one of Progress in Cardiology was a sober look at the current lull in innovation. In part 2, as promised, I tell you what is right and optimistic about my field. There is a lot.
The post touches on the return of the basics. Basics in doctoring and basics in therapeutics are huge new developments in cardiology. Then, I talk about the less is more movement, which thankfully, pervades all aspects of cardiology.
Radial artery catheterization gets a nod, as does caution with combining drug therapy aggressively. Treating to surrogate markers is out. No longer do doctors worship at the altar of cholesterol values, rather, we...
Source: Dr John M - November 15, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Dear America: Embrace the bike culture…It’s heart healthy
I love cycling. Being outdoors, pedaling, feeling the swoosh of the wind, these are all sensations that more people should enjoy. They are sensations of happiness. And oh, does the heart love happiness.
I also love my country. America is an amazing place. If you take a moment to really look past the mundane of everyday life, you see a country that has a lot to offer its human inhabitants. Try this for a day: put yourself in the shoes of a foreigner.
But when Americans fight cycling, I find myself in a quandary. How could a smart, compassionate and successful nation not see the benefits of cycling?
This morning, the WSJ pub...
Source: Dr John M - November 9, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Film recommendation — Amour teaches important lessons about humanity
It goes without saying that having an appreciation for humanity is critical for doctoring.
One of the areas of medicine that is most tragic is how we treat the elderly. If I could change one thing about medical care, I would make the care of the elderly more gentle. Dr Dan Matlock (@Dan_Matlock) is a friend and academic physician interested in improving decision quality. He wrote this in a comment on my recent Medscape/Cardiology post.
Somewhere in the last 100 years, we have replaced humanity with technology. I actually think we have huge gains to make in bringing the humanity back to medicine. A field of medicine wit...
Source: Dr John M - November 3, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
The enormous power of Social Media in health care.
I recently gave a lecture on Social Media to medical student leaders at Indiana University. The experience energized me. It also promoted thought-provoking questions. Let’s consider two of the best questions. This one came by email.
I was wondering if you have any suggestions on how to write a twitter post to direct people to a blog you’ve written without it sounding self-serving. Is it enough to just say something to the extent of “I’ve written something new. Check it out.” Or is it better to give an excerpt or something to that effect? Is it even good form to self-publicize on Twitter.
The f...
Source: Dr John M - November 1, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
