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)? Â How much hope can we put on big data? In the last few years, […]
Category: General Medicine
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 […]
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 […]
(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)Â *** 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 […]
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:Â Experts agree that inflammation associates with heart disease. One of the keys […]
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 […]
I attended the European Heart Rhythm Association meeting last week in Vienna. Here is an update on the stories I found most interesting–the ones I wrote about on the heart.org | Medscape Cardiology. Brain Lesions after AF ablation:Â Electrophysiologists do not talk much about the small brain lesions that appear after procedures in the left […]
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 […]
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 […]
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 […]
Yesterday I posted the four most important questions to ask your doctor. Let’s apply those questions to a typical scenario: Whether or not to take an anticoagulant drug for prevention of stroke in the presence of AF. We need a typical patient. For this example we will pick a typical CHADS-VASC 2 patient. 65 year-old […]