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 […]
Forgotten Concepts in Medical Practice
A reader asked an excellent question on my last post. Roy wondered if further research in elderly patients would identify a subset of patients that would benefit more from anti-coagulation. My answer is… not likely. The reasons involve three oft-forgotten concepts. See below. To Roy, I say it is unlikely that further research will address […]
How Hubris Impairs the Care of the Elderly
An elderly man with atrial fibrillation (AF) asks whether to continue taking a clot-blocking drug to prevent stroke. This is the gist of a case my colleague Dr Anish Koka recently posted on Twitter. It’s a great thread. Click here to get to the discussion. The first question Anish raised was whether you would keep […]
Flat-of-the-Curve Cardiology Practices
If you think about it, you can’t get much done. So you don’t think about it. You just shake your head and keep tapping on the computer; the next patient awaits. To avoid moral distress, to remain employed as a doctor, you don’t think about the high cost and waste of cardiac care. Dr. Andrew […]
The Truth on Cancer Screening
This week is Cancer Screen Week. It’s a one-sided campaign sponsored by industry and the American Cancer Society that urges people to get screened. The truth is that the scientific evidence for cancer screening is not convincing. What’s more, screening comes with potential harms. I know; it’s counter-intuitive, but it’s what the evidence says. Benjamin […]
Not Challenging Science is Anti-Science
Freedom of speech is in the news. Intolerance of ideas isn’t just affecting our colleges and universities. I think illiberalism has spread to health and medicine. For many reasons, scientists and clinicians alike have grown weary of debate. This is bad. The philosopher Karl Popper said science advances through falsification. Without the challenge of ideas, […]
On a quest to understand medical evidence …
One of the biggest challenges in medicine and science is understanding correlation and causation. Medicine has become increasingly evidence-based. But what does the evidence really say? Is a study signal or noise? Does enough correlation mean causation (e.g. smoking causes cancer)? How much hope can we put on big data? In the last few years, […]
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 […]
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 […]
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 […]
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 […]
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