Sudden death and a common antibiotic

The longer I practice medicine, the more nervous I get about medications, especially when patients are already on other drugs for chronic diseases. I much prefer deprescribing. A recent study on the common antibiotic cotrimoxazole, which is a combination of sulfamethoxazole and trimethoprim, and often referred to by its brand name, Bactrim or Septra, lends […]

Public health is on the ballot this Election Day

Credit: High Mark Foundation

The election I am going to watch today is in San Francisco. On the ballot there is Proposition E, an initiative to add a 2-cent tax for every once of sugary beverage. Choose Health SF, a group supporting the tax, estimates it would raise $54 million, which would go towards, get this: “funding active recreation […]

Transforming the human heart with the best medicine

This is a short intro to my latest column over at Trials and Fibrillations on theHeart.org Medscape|Cardiology. —- I am not sure why doctors so often look past the best medicine. It’s right there before our eyes. Yet somehow we get sidetracked by the culture of pills and procedures. Modern-day caregivers fail to master the […]

Let’s stop the unnecessary treatment of heart disease

There are many reasons doctors suffer from burnout and compassion fatigue. One of the least-mentioned of these reasons is that much of what we do is so damn unnecessary. In the US, the land of excess everything, caregivers, especially cardiologists, spend most of our time treating human beings that didn’t need to have disease. Let’s […]

Endurance exercise and the heart — a mention in the New Yorker

Do you exercise a lot? Have you been at it for years? Are you the type that rides around the neighborhood to make a 98-mile ride into a century? Do you get squeamish if you can’t exercise for 24 hours? Are you curious about that beautiful machine in your chest? You know, the rhythmic coordinated […]

Exercise, over-indulgence and atrial fibrillation — seeing the obvious

If you like thinking and writing, few topics are better than the excess exercise and heart disease story. Indeed it is a matter for the curious. Two studies published last week in the British journal Heart addressed the relationship of exercise and heart disease. (See references below.) Although these studies garnered mainstream media attention they […]

New post up on Medscape/Cardiology: Ablation versus medicine as an intitial strategy for treating AF

Earlier this month I promised to put together teaching points from the Rich Peverley story. His was an interesting case of  sudden collapse that likely occurred as a result of atrial fibrillation therapy rather than atrial fibrillation itself. This was my original report: Important lessons from the collapse of NHL player Rich Peverley (BTW: It […]

2013: Year-end summary of top cardiology stories

When the editors of Medscape asked me to write a Top Ten article on the best Cardiology stories in 2013, I jumped at the chance. I spent a lot of time thinking about Cardiology this year. I was invested. Plus, 2013 was a year for pivoting–big time pivoting. What made news in 2013 was not […]

Prolonged exercise leads to heart damage — pro/con debate

Dr. Larry Creswell, of the Athlete’s heart blog, just posted an interesting debate from the Journal of Physiology. The question of whether longterm endurance exercise leads to heart damage is a hotly contested issue in cardiology. For those who are curious about this intriguing topic, his links lead to very readable prose. Larry suggests paying […]

Day 2 ESC — AF ablation and more bike commuting

IMG_3298

Okay, I’m getting the hang of this. The Monday morning and evening commute in Amsterdam is something special. You talk about focus. It requires laser-like focus. You’ve got bikes, narrow lanes, buses, trams, pedestrians and tourists. Still though, traveling 6k by bike took 15 minutes; a cab from the convention center, more than 30. I […]