Good health does not require an Apple Watch
Social media is awash in news about digital health.
I am a skeptic. Health is much simpler. I like this rendering from a kindergarten class.
"Kindergarten teacher asked class to create rules for living healthy. Here's what they came up with" via @rickplus3 pic.twitter.com/cRmHfcfjrf
— Brad Stulberg (@BStulberg) May 9, 2015
When I was a trainee in electrophysiology, I spent oodles of time learning the underpinnings of the heart and its rhythm. I studied molecules, then cells, and then the physics (vectors) of how it all worked together. Catheter ablation of focal circuits or implantation of pacemakers f...
Source: Dr John M - May 10, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Update: Baltimore, Safety in AF ablation, Podcasts, and some personal notes
On Baltimore:
Human beings rioting in the streets of an American city forced cancellation of an important cardiology meeting. This is a vivid example that doctors do not practice in a vacuum. We are connected to this world. Here in Louisville, just a few miles north, an HIV crisis runs amok because of IV drug use. Despair. Inequality. These are no small things. What bothers me most about our healthcare system is the waste. We burn money. If we stopped doing that, we would have more to do for the less fortunate. I make a call out to every day physicians to stop burning money. Medicine Can’t Ignore Baltimore and Fergus...
Source: Dr John M - May 4, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Why don’t people ask their doctors more questions?
I do not get it. Day in and day out, I ask patients why they take a medicine. Many do not know. “My doctor put me on it,” goes the common response.
Take statin drugs, for example. I often ask a person why they are taking the drug? With rare exception, the person says it is to lower cholesterol.
That’s not the right answer–and herein lies much of the problem with preventative medicine. A statin drug does indeed lower cholesterol but its main purpose is to reduce the risk of heart attack, stroke or death in the future. Cholesterol is just a number. It’s a surrogate that we can measure but itR...
Source: Dr John M - April 22, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Update: Social justice of AF care, NOAC monitoring, population health and two new podcasts
Hi All,
Here is a short update of the past week.
The first thing to say is the Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down post has gotten a lot of attention. It stayed on the most popular list all week. It has over a 130 comments, and I have received many emails on it. It is a big moment in AF care.
I would also point you to an interview I did with Dr. Prash Sanders from Adelaide. Prash is the senior researcher on the LEGACY trial. His team’s work has been most responsible for the change in thinking of AF care. The title of the post: LEGACY PI Throws Down the Gauntlet to US Physicians
Is AF care fai...
Source: Dr John M - April 20, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
An update on cycling and writing and video (gulp)
Hi all,
Things have changed for me. I have taken on a larger role at theheart.org | Medscape Cardiology. This means I have less time for original posts here.
I write and read a lot more, though. Almost every day. Writing has morphed into what cycling was: a source of contentment. It used to be that if I had a good workout, I felt good during that day. Now I get those same sensations from writing.
I still exercise but its place in my self-esteem bucket is smaller. Except last Tuesday night during the local “ride,” I was dropped out of a break because of an asthma attack. That sucked. But I redeemed myself last n...
Source: Dr John M - April 8, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The trick of hope — and the medical decision
Last night, during the intro show for the PBS documentary, Cancer: The Emperor of All Maladies, a Ken Burns film based on the book by Siddhartha Mukherjee, Katie Couric interviews both Ken Burns and Dr. Mukherjee.
The moment occurred about 10 minutes into the video.
There is a poignant scene in which two young parents struggle with the decision to enroll Olivia, their 17-month-old baby who has leukemia, into a randomized clinical trial to test one treatment over another. When the doctor tells the parents a computer randomization will determine Olivia’s treatment, you see anguish in their faces. They don’t want ...
Source: Dr John M - March 31, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Writing update: Lown Institute Conference and ACC2015
Hi all,
I have been busy in the last few weeks. Here is an update of my happenings and posts.
From March 8-11, I attended and presented at the third annual Lown Institute Conference in San Diego. I have never felt more at home in a conference than I did at the Lown conference. Take a look at the About Us page of the Lown Institute and you will see why.
Lown Institute Core Values
No matter how things turn out for me in Medicine–today or tomorrow–I am happy and proud to be on the same side as Dr. Bernard Lown and his Institute. The motto of the conference was RightCare. That is perfect. Here is a link to a front ...
Source: Dr John M - March 23, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The right care for patients with atrial fibrillation
I am in San Diego to participate in the Lown Institute Road to Right Care: Engage, Organize, Transform conference. It is an honor to be included in a conference that has “right care” in its title.
Tomorrow, Dr. David Martin (Lahey Clinic) and I will co-present a case-based session on the overuse and misuse of AF ablation. We will talk about the drivers of overuse, including the confusion about the disease AF, the fee-for-service system, our culture of doing, and the if-you-build-it-they-will-come model of hospital growth.
The tide is changing in how doctors think about AF. Mainstream electrophysiology now gets ...
Source: Dr John M - March 9, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Athletes, AF, Anticoagulants, Statins, Peanuts, and Dishwashers
Here is an update on my recent writing.
Athletes and AF:
I was honored to be invited back to the Western AF symposium in Park City, Utah. Last year, I presented on social media. This year, Dr. Nassir Marrouche (University of Utah) asked me to tackle the topic of atrial fibrillation in athletes. This is no small matter.
In the process of putting together the 20-minute talk, I wrote an essay as a guide. In Athletes and AF: Connecting the Lifestyle Dots, I review the evidence, mechanisms, and treatment considerations of the endurance athlete with AF.
My argument in the talk and essay is that AF happens for a reason–eve...
Source: Dr John M - February 28, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Introducing Dr. Staci Mandrola — @DrStaciM
It took me four years to convince my wife, Dr. Staci Mandrola, to join Twitter. Like many (previously) analog docs, Staci was resistant. “I don’t need another distraction,” went one of the arguments.
Yet I knew if she tried Twitter, she would love the medium. If you care about a topic, if you are curious, and if you are comfortable in your own skin, Twitter works. This is why I predict Staci will do well in the digital realm.
The one bad thing about @DrStaciM being online is that one of my secrets is out. All these years, I have had an advantage–sort of like cheating. How does a cardiologist know th...
Source: Dr John M - February 25, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
A new way to think about curing atrial fibrillation
The problem with AF treatment is that we do not (really) understand the underlying causes of the disease.
Why does the heart fibrillate? What gets those pesky premature beats started? Why do intermittent episodes persist? Why does AF come back after shocks or ablation?
AF has been thought of as its own disease. You have high blood pressure and AF, diabetes and AF, depression and AF. And when there are no other obvious diseases, we used to say “lone” AF, which wrongly assumed that AF was its own disease.*
Atrial fibrillation was just another problem on a list of things to address. It was in a silo–cardiac....
Source: Dr John M - February 22, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Good medicine — making it up as we go along
Do you wonder what makes good medicine?
Really good medicine.
The sort of good medicine that will never be evident on a spreadsheet or publicly reported website.
And surely not the ACE-I, statin, beta-blocker, get an echo, nuclear and cath kind of good medicine.
Just read this. (It’s cyclist friendly, too.)
JMM
Related posts:
Exhibit A on how hubris in medicine can be deadly…Let’s take a time out for skepticism
How much Medicine is enough?
Balance in life and medicine is often elusive… (Source: Dr John M)
Source: Dr John M - February 14, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Public trust, the CDC and Tamiflu
Why do doctors lose credibility?
Consider the few public doctors out there with millions of followers. The majority of the stuff they recommend is perfect: eat good food, exercise, be nice. and sleep. Check. No problem. Everyone is good with that until they shatter the sense with nonsense. One miracle cure or stupid supplement or financial conflict ruins everything.
That goes, too, for the Centers for Disease Control (CDC). These guys must have the highest of the moral ground. For if we are to believe them about public health matters, there can be no conflicts of interest. The public good, pure evidence, that is all.
I rec...
Source: Dr John M - February 13, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Trust in science and medical experts
This week is a good time to talk about trust in expert opinion and science.
For the past forty years, nutrition experts in the US have warned us about cholesterol and fat. Eat too much of it and it will block your arteries, was the proclamation. Americans did what the scientists and experts said. They ate low-fat foods. You see how that worked out.
Now, the Dietary Guidelines Advisory Committee will soon tell the American people that they were wrong about saturated fat and cholesterol. Experts, who had based their recommendations on scientific evidence, will reverse course and say…oops. Our bad. The science was not t...
Source: Dr John M - February 12, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
I will host Hospice and Palliative Care Tweet Chat — #HPM
This Wednesday Feb 11th, at 9 PM EST, one day after PBS Frontline features Dr. Atul Gawande and his new book Being Mortal, I will guest host the Hospice and Palliative Care (#HPM) Tweet Chat.
Dr. Christian Sinclair is a physician leader in HPM and a co-editor of Pallimed. He recently commented on my stewardship piece on theHeart.org. Christian then emailed me to ask whether I wold host #HPM chat on Twitter.
I agreed because I know cardiologists could benefit from talking with hospice and palliative care pros.
The good news about medical technology is that people are living longer. That is also the challenge. Cardiolog...
Source: Dr John M - February 10, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
