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 […]

Health Care Health Care Reform Reflection

We get what we tolerate…

Richard Fries, a cycling-safety advocate in Boston, uses the phrase we get what we tolerate to describe the dire situation of drivers killing cyclists and pedestrians. Many humans die from these collisions because we tolerate it. An inattentive driver kills a person on a bike; then nothing changes. The phrase applies well to other dubious […]

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 […]

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 […]

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 […]

Health Care Health Care Reform

Fight On Healthcare Reform Misses Core Problems

Politicians and policy makers are fighting over new health reform proposals. This debate misses the core problems in US healthcare. Look at this graph from the Our World In Data website: It shows that Americans pay too much for lousy health outcomes. Fixing the problem on that graph should be the focus of reform. I […]

AF ablation Atrial fibrillation Doctoring General Medicine Health Care

Should AF ablation require approval from a heart team?

A patient presents with atrial fibrillation (AF) and a rapid rate. He doesn’t know he is in AF; all he knows is that he is short of breath and weak. The doctors do the normal stuff. He is treated with drugs to slow the rate and undergoes cardioversion. During the hospital stay, he receives a […]

AF ablation Atrial fibrillation Doctoring General Cardiology Health Care Knowledge

Is AF ablation a big placebo?

Turkish authors boldly raised this question in a recent editorial. They likened AF ablation to renal denervation, a procedure in which RF ablation in the kidneys was felt to reduce BP. Many studies showed kidney ablation markedly lowered BP. Then a trial was done with a sham control (people got part of the procedure but […]

AF ablation Atrial fibrillation Doctoring Health Care Health Care Reform Healthy Living


…the quality of having experience, knowledge, and good judgment. I read today a collection of words that exude wisdom. I share it with you because the purpose of this blog is to do create value through education. Peggy Girshman was an award-winning health journalist. When ill with a life-limiting illness, she wrote her own eulogy. […]