Doctoring General Medicine Health Care Knowledge

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, […]

Doctoring General Medicine Health Care Knowledge

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, […]

Doctoring General Ablation General Medicine Health Care Health Care Reform Knowledge

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 […]

Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Doctoring General Cardiology General Medicine Knowledge

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 | Medscape Cardiology column. Watchman and other similar devices are plugs that occlude the left atrial […]

AF ablation Doctoring General Cardiology ICD/Pacemaker Knowledge

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 […]

Doctoring Health Care Health Care Reform Knowledge

Big lessons from my error

I was furiously tapping on the computer when he asked: “Doc, what happens if I don’t have the procedure you are recommending?” Glee spread through my body. I grinned and nearly jumped up from the stool to hug him. I enthusiastically answered. Few patients ask this vital question. I tweeted about the encounter: An older […]

Atrial fibrillation Doctoring General Medicine Knowledge

Beta-blockers, Statins, AF, and the Nocebo Effect

Our brains can easily fool us. No experienced doctor would deny the power of the placebo effect. Today I want to discuss the nocebo effect, which occurs when negative expectations of something causes it to have a more negative effect than it otherwise would. Drugs can exert a strong nocebo effect. If your brain thinks […]

Athletic heart Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Doctoring General Cardiology General Medicine Health Care Healthy Living Knowledge Nutrition

Statins, Like All Medicines, Are Neither Good Nor Bad

We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers […]

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On the intolerance of ideas, and liberty …

I like thinking and learning. Birthdays surely make one slower on the bike, but birthdays, it seems, do not have the same drag on the brain. For me, birthdays have increased my appreciation of liberty. In the Constitution of Liberty, Hayek defines it as the absence of coercion. Such is a beautiful definition. Don’t coerce […]

Doctoring General Medicine Health Care Health Care Reform Knowledge

Trust and Medical Science

Concerned citizens will march this weekend to defend science. Standing up for science is a worthy cause. Look at what medical science has accomplished in recent times: serious diseases, HIV, heart attack, many forms of cancer, have been tamed by the advance of science. We need more not less science. It’s nuts to cut funding […]

AF ablation Atrial fibrillation Doctoring General Medicine Healthy Living Knowledge

Four Crucial Questions To Ask Your Doctor

I am seeing an increasing number of patients who did not know they had a choice about taking a medicine or having a procedure. Why did you have that heart cath? A: My doctor said I should. Why are you on that medicine? A: My doctor prescribed it. It’s time we re-review the basic four […]