Many readers have contacted me to ask whether my negative viewson left atrial appendage occlusion with Watchman have changed since 2017. The short answer is no. My views are even more negative today. In 2016, I published an editorial on theHeart.org | Medscape Cardiology arguing that this procedure should stop. One of the rebuttals was that… Continue reading Still Negative on Watchman
Joan has left an excellent comment on my recent 2019 AF ablation update. She brings up many important issues. Letâ€™s dissect it. Q: Joan asks if it is common to see patients who think they are cured after AF ablation but are still in AF?Â A: The scenario I described in my previous post is… Continue reading AF, Ablation, Stents and Five Nuances
Most years I write an update on any big developments in AF ablation. This year’s version will be a short one. I have little new to report. But it’s worth reviewing some basic issues. We still do not know the cause of atrial fibrillation (AF). That makes it hard to fix with ablation. Knowledge Deficits:… Continue reading AF Ablation Update 2019
This post introduces my latest column over at Medscape. I hope you go read the full piece.Â Medical overuse bothers me. Consuming medical care that does not improve outcomes makes you poorer, and puts you at risk for being harmed. I think a lot about why Americans consume more healthcare than our peers in other… Continue reading Missing an Obvious Cause of Medical Overuse
Apple products are cool. I love them. But (even) Apple will struggle delivering health. Making healthy people healthier is fraught with problems. At the core of this issue are the many snags of screening people for disease. Here are 600 words I wrote for Medium:Â Iâ€™m a Heart Doctor. Hereâ€™s Why Iâ€™m Wary of the New… Continue reading Thoughts on the Apple Watch
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban). My views on this matter have changed. But first, I want to… Continue reading How dangerous are NSAIDs in patients with AF?
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?
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… Continue reading Forgotten Concepts in Medical Practice
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
Hi all. TheHeart.org | Medscape Cardiology published my picks for the top stories of 2017. Here is the link:Â 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
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,… Continue reading Not Challenging Science is Anti-Science