Finding Truth: How Much Do We Need Experts?

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… Continue reading Finding Truth: How Much Do We Need Experts?

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… Continue reading How Hubris Impairs the Care of the Elderly

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… Continue reading Flat-of-the-Curve Cardiology Practices

CASTLE-AF (Ablation) Trial Delivers Benefits — Was I Critical Enough?

Doctors like me have performed AF ablation for more than a decade without knowing whether the major procedure improves outcomes. That sounds crazy but it’s true. Until now, the only evidence we had that doing all these burns or freezes in the heart helped people was that it made people feel better than they did… Continue reading CASTLE-AF (Ablation) Trial Delivers Benefits — Was I Critical Enough?

Recap of 2017 in Cardiology

Hi all. TheHeart.org | Medscape Cardiology published my picks for the top stories of 2017. Here is the link: Mandrola’s Top 10 Cardiology Stories of 2017 I called it the year of the medical reversal. Medical reversals occur when a superior study contradicts current practice. I love medical reversals. First, they make you think about history.… Continue reading Recap of 2017 in Cardiology

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… Continue reading Left Atrial Appendage Closure Does Not Prevent Strokes

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… Continue reading The Nobel in Economics and Medicine?

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… Continue reading Young people, stroke and a hole in the heart (PFO)

Inflammation, Ablation, Fats, LDL, etc .. My review of ESC 2017

The European Cardiology Congress, ESC as it is called, has grown into the largest medical meeting in the world. This year, more than 31,000 attendees from 153 countries came to Barcelona. I was busy. Here is an update of the big stories: Inflammation:  Experts agree that inflammation associates with heart disease. One of the keys… Continue reading Inflammation, Ablation, Fats, LDL, etc .. My review of ESC 2017

New Data Increase Caution on Left Atrial Appendage Occlusion

I remain concerned about the irrational exuberance among some of my colleagues toward left atrial appendage occlusion devices for the prevention of stroke in patients with atrial fibrillation. In short, these devices are plugs that doctors place into the left atrial appendage. The idea is to stop clots from forming or escaping from the left… Continue reading New Data Increase Caution on Left Atrial Appendage Occlusion

The Future of Predicting Heart Disease May Be In Your Genes

Three cases first: A young woman I met recently (outside the hospital) told me her Dad died suddenly a couple of years ago. He was fine, then he was stone cold dead. The wife went outside for a minute and came back to find her husband dead in the chair. There were no warnings. No… Continue reading The Future of Predicting Heart Disease May Be In Your Genes