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 spread: a l...
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 future, pr...
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 know a lot of peo...
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 should definitely not assume a tr...
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 was the...
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-watchs-heart-tracking-fe...
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