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Five lessons from the Niacin failure
This week the New England Journal of Medicine published two studies on the role of niacin in preventing future cardiac events. The short story is that niacin was ineffective and associated with significant harm. A number of excellent summary pieces have been written, and I will reference them at the end.
The purpose of writing my thoughts on this matter is to put these unsurprising results into a larger context of health, and also to consider the changing role of the physician.
Lesson 1: Association does not equal causation
For years, medical experts have observed that patients with high HDL levels (good cholesterol) had ...
Source: Dr John M - July 17, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
We depend on each other…
What is the greatest possible thing that could happen to you today?
Is it winning a million dollars? Seeing your children smile? Going to a job you love? Perhaps it is waking up next to a spouse whom you love and is also your best friend?
These are all winners, for sure.
But what if you actually saved another person’s life? No, not figuratively, but really. Imagine: another person just up and dies in front of you, and you take decisive action to save her. And she lives.
I can testify that truly saving a life is indeed a life-changer. You never forget.
The scenario of out of hospital cardiac arrest is not an uncommon one....
Source: Dr John M - June 13, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The ECG told the whole story, but no one listened: ECG interpretation skills are critical to patient outcomes.
Preface This was sent by a medical student somewhere in the world who will remain anonymous. But it happened at a prestigious cardiac center. Details are scant so that it cannot be recognized.The minute this medical student saw the first ECG, he knew the diagnosis without any further information. Reading ECGs is hard, but can be done with commitment to learning, which comes from an awareness of its importance. My most talented blog readers are paramedics because they have to put themselves on the line every time they activate the cath lab. And they teach me a lot. One of my most talented reade...
Source: Dr. Smith's ECG Blog - March 30, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
New post up on Medscape/Cardiology: Ablation versus medicine as an intitial strategy for treating AF
Earlier this month I promised to put together teaching points from the Rich Peverley story. His was an interesting case of sudden collapse that likely occurred as a result of atrial fibrillation therapy rather than atrial fibrillation itself.
This was my original report: Important lessons from the collapse of NHL player Rich Peverley (BTW: It set a blog record for pageviews on a single day.)
This was the follow-up post in which I discuss the fact that atrial fibrillation featured prominently in the mishap: Atrial fibrillation features prominently in Rich Peverley collapse
Mr Peverley and his doctors announced a great dea...
Source: Dr John M - March 25, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
A follow-up on the LifeVest…and decision quality
One of the most controversial posts I have ever written concerned Zoll corporation’s wearable cardiac defibrillator, which they have smartly branded the LifeVest. Here is the link to the 2013 post:
LifeVest: A Precarious and Unproven Bridge . . . to Somewhere
The less-than-glowing assessment brought me a great deal of criticism, both publicly and privately. I was proud of theHeart.org, which is now Medscape/ Cardiology, for publishing the piece without editing.
I bring this topic up again because of an email I received this week. It came from a patient who had been prescribed a LifeVest. Here is the email, which I po...
Source: Dr John M - March 23, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Eye-Opening Medical Missions in India and China
By Zubair Chao, MD
I had an opportunity to visit India as part of George Washington University’s International Emergency Medicine & Global Public Health Fellowship Program in April 2013. I gave lectures on endocrinology and HEENT as teaching faculty. I had already planned to go to China with my residency program and ultrasound fellowship directors, Drs. Cook and Hunt, respectively, and it was an easy decision for me to combine the trips for a firsthand view of emergency medical services in the world’s two most populated countries.
Emergency medicine is new in India, and it is not widely accepted as a reco...
Source: Going Global - March 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Transcript of podcast interview with Jeff McCormick, candidate for Governor of Massachusetts
This is the transcript of my recent podcast interview with Jeff McCormick, independent candidate for Governor of Massachusetts. Visit the original post to listen to the podcast and read a summary. This is part of a series of interviews with all nine candidates for Governor. The full schedule is available here.
David E. Williams: This is David Williams from the Health Business Blog. I’m speaking today with Jeff McCormick, candidate for Governor. Jeff, thanks for being with me today.
Jeff McCormick: David, thanks so much for having me.
Williams: Jeff, does Chapter 224 represent the right approach to addressing risin...
Source: Health Business Blog - March 4, 2014 Category: Health Managers Authors: David Williams Tags: Podcast Policy and politics election Governor health care health care reform health information technology healthcare Massachusetts Source Type: blogs
Boehringer Kept Pradaxa Analysis From FDA, Records Show
Boehringer Ingelheim GmbH didn’t disclose a data analysis to U.S. regulators that indicated the blood-thinner Pradaxa may have caused more fatal bleeding after it was cleared for sale than the drug did in a study used to win approval, unsealed court filings show.Boehringer gave U.S. regulators one analysis of data gathered after the drug’s October 2010 approval that showed the number of people who died from bleeding was less than expected, according to internal documents made public in lawsuits over the product. The company didn’t share a second analysis showing a higher death rate, the documents show.The F...
Source: PharmaGossip - February 26, 2014 Category: Pharma Commentators Authors: insider Source Type: blogs
A tribute to a great cardiologist from Grady !
Today , we post cases for coronary angiogram , just like sending clients to breakfast table ! Close your eyes. Think for a moment. It is heartening to know how cardiac catheterization grew from a humble beginning . We know , Forssman , Cournand and Richardson who shared the Nobel price for Inventing cardiac catheterization in 1930s .
Soon after it’s invention it was criticized by most, few ridiculed it outright , few others wondered about it . One man from the iconic Grady memorial hospital , attached to Emory silently adopted this procedure and almost single-handedly did more than 1500 cardiac ...
Source: Dr.S.Venkatesan MD - February 16, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology classics Cardiology-Land mark studies cath lab tips and tricks Great Men in cardiology history of cardiology Land mark articles in cardiology Uncategorized concept of physician assistant dr stead eugene anson father of physici Source Type: blogs
A tribute to a great cardiologist from Grady !
Today , we post cases for coronary angiogram , just like sending clients to breakfast table ! Close your eyes. Think for a moment. It is heartening to know how cardiac catheterization grew from a humble beginning . We know , Forssman , Cournand and Richardson who shared the Nobel price for Inventing cardiac catheterization in 1930s .
Soon after it’s invention it was criticized by most, few ridiculed it outright , few others wondered about it . One man from the iconic Grady memorial hospital , attached to Emory silently adopted this procedure and almost single-handedly did more than 1500 cardiac ...
Source: Dr.S.Venkatesan MD - February 16, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology classics Cardiology-Land mark studies cath lab tips and tricks Great Men in cardiology history of cardiology Land mark articles in cardiology Uncategorized concept of physician assistant dr stead eugene anson father of physici Source Type: blogs
Why 90 % of cardiologists suffer from coronary blindness ?
Note :This is a copy of my earlier blog on coronary micro-circulation published few years ago.Recently this got numerous hits .Hence I have just reposted it with slight modification.
Human coronary circulation stands unique among others as it is a life-sustaining circulation.It is indeed a great medical achievement to visualise the right and left coronary artery system by coronary angiogram. Actually, what we see is only a fraction of the surface area of coronary circulation .The surface area of epicardial coronary arteries constitutes less than 5 % of entire coronary vascular tree .
And . ...
Source: Dr.S.Venkatesan MD - February 12, 2014 Category: Cardiology Authors: dr s venkatesan Tags: cardaic physiology cardiac physiology Cardiology -Coronary collateral circulation Cardiology quotes coronary angiogram coronary blindness coronary micro circulation Source Type: blogs
Who really discovered trisomy 21? (righting an old wrong)
A few days ago a French student in my Useful Genetics Coursera course posted a link to an article in Le Monde (sorry, it's both in French and behind a paywall, but this link might get you a translation). It reported that a Jan. 31 award ceremony for the discovery of the cause of Down syndrome, part of the 7th Human and Medical Genetics Congress in Bordeaux, had been blocked by a Down syndrome support organization (Fondation Jerome-Lejeune). The back story is very depressing, an egregious example of a woman scientist being denied credit for her discovery.Photo source: Le MondeThe woman is Dr. Marthe Gautie...
Source: RRResearch - February 6, 2014 Category: Medical Scientists Authors: Rosie Redfield Source Type: blogs
The CVS tobacco decision is no small thing — Keep the chips and soda please
Yesterday, CVS Caremark announced that its 7600 stores will stop selling tobacco products. Company leadership said that selling tobacco is not consistent with being a health company. This decision, which takes effect in October 2014, will result in 2 billion less revenue.
I am no business person, (though, as an observer of humans, I follow business news), but giving up 2 billion dollars in revenue seems like a bold and courageous move. Forbes journalist Matt Herper explains the business aspects. He teaches us that CVS’ model is changing. Not only are pharmacies like CVS turning into health care delivery portals, with...
Source: Dr John M - February 6, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Physician whose mother had heart surgery reflects on sane EHR use
The following from a physician I know, an ED physician, on the care their mother received at a major academic medical center's teaching hospital using EHR.Emphases mine:Mom just had aortic valve at hospital [name redacted] associated with [redacted] Medical School. EHR used was [major EHR vendor name redacted] but it clearly had been pushed into the background......1) Every ICU patient also had a printed chart in a notebook (paper) medical record book kept at the nursing station. Just like the old days. It was the most commonly used source of info to the residents and staff.2) Not once did I see an EHR physical...
Source: Health Care Renewal - January 24, 2014 Category: Health Medicine and Bioethics Commentators Tags: EHR-associated clerical work healthcare IT risks Source Type: blogs
