Dr John M

cardiac electrophysiologist, cyclist, learner

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New column and podcast up:

October 4, 2020 By Dr John

Last week, I wrote a column on one of the most controversial clinical trials in cardiology.

The EXCEL trial pitted stents vs bypass surgery for people who have left main coronary artery disease. The trial has been beset with controversy.

The three areas of debate surround the definition of MI (or heart attack), the increased risk of death in the stent arm, and selective publishing of data.

Here is the column: Latest EXCEL MI Analysis Settles Nothing; Flaws Remain

You should study this one because it hints at how precarious medical evidence can be.


On the This Week in Cardiology podcast, I discuss EXCEL, but also the issue of trust in science.

This includes a few words on the matter of silly studies that still garner media attention. I’ve come to name these studies, howlers.

One of the reasons behind this is the business model of medical publishing. Medical journals, like any media outlet, need attention. Coffee studies bring attention; statistics studies not so much.

The pandemic has brought oodles of silly studies.

A classic example is the broken study on cardiac MRI in recovered COVID patients. This one had to be corrected due to a slew of errors and now shows no concerning signal of cardiac harm from COVID. But it has hundreds of thousands of page views and will surely bump up the impact factor of the journal that published it.

I discussed CMR, COVID and sports participation a few weeks ago.

The problem with howlers is that they hurt public trust in science. One week coffee is good, the next it is not. Don’t wear masks, do wear masks.

I also discuss the Vitamin D and COVID19 issue. Teaser: it’s folly.

Science leaders, I think, ought to be more candid about the limits of science, the uncertainty. Let the public in on the truth.

You know, a Karl Popper-like message.

Finally, there was big news in nutrition science: a group at the UCSF actually did a randomized controlled trial. This is huge because most nutrition science stems from flawed observational studies.

Here is the pod link: https://podcasts.apple.com/us/podcast/this-week-in-cardiology/id991125169

Let me know what you think. Remember, if you like the pod, give it a good rating so others can find it.

JMM

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Filed Under: Doctoring, General Cardiology, Knowledge Tagged With: COVID19, Evidence, Evidence-based medicine

Lecture on Scientific Bias in Cardiology

September 30, 2020 By Dr John

Last month I gave a lecture in Brazil (via my house in Kentucky) on scientific bias in cardiology.

It’s about 20 minutes. Dr Bob Kaplan from Stanford also spoke on issues relating to how FDA approves drugs–a timely topic.

Many of you know that I espouse a medically conservative approach to medical practice.

My lecture explains some of the reasons I take that approach. I try to make the case for a humble approach to medical evidence and what doctors can do.

We have a 30 minute discussion after the lecture. That was fun.

The intro and moderator is my friend and colleague Dr Luis Correia, who is an excellent doctor to follow on Twitter: @LuisCLCorreia

Here is the Youtube link:

JMM

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Filed Under: Doctoring, General Cardiology, General Medicine, Knowledge Tagged With: Evidence, Evidence-based medicine

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

 

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