Places to Find My Work
Hi everyone, As you can see, I have not kept active on this blog. But I am active writing in other places. You can find my latest on my Substack. It’s called Stop and Think. I got that name from my granddaughter who came home and said her computer teacher told them to stop and think before hitting a key. Grin.
I also host the This Week in Cardiology podcast (#TWICPodcast). I review the top studies in cardiology each week.
And of course I still love my work with TheHeart.org | Medscape Cardiology. My column is called Musings from Mandrola
Another place to find my work is a new venture called Sensible Medici...
Source: Dr John M - July 25, 2022 Category: Cardiology Authors: Dr John Source Type: blogs
The Case Against Watchman
Many readers have asked me to update my feelings about Watchman and other percutaneous appendage closure procedures. The short answer is that I remain unconvinced that this is a beneficial procedure. New data has been sparse and unconvincing.
I’ve recently started a newsletter on Substack. It’s called Stop and Think. In the latest post, I have included a Watchman lecture I gave at the Heart Rhythm Society meeting in Boston.I hope you subscribe to the newsletter. It’s about science and medicine. Here is the link for the Case Against Watchman
JMM
Related posts:
Still Negative on Watchman
Say No ...
Source: Dr John M - August 18, 2021 Category: Cardiology Authors: Dr John Source Type: blogs
Shining Bright Spot of 2020 — The RECOVERY Trial
Take a look at this article in The Times. It tells the story of Oxford professors named Martin Landray and Peter Horby.
When they saw the pandemic unfolding in China and Lombardy, their first thought was to design a proper clinical trial to determine what works for COVID19.
Normally, it takes a year or more to design a medical trial, but they got it done in weeks. This process is super important. You have to write a design first and decide what you will measure. Here is the protocol.There were two keys to success: one was that the trial had to be simple and the other was that it needed buy-in from hospitals and doc...
Source: Dr John M - January 1, 2021 Category: Cardiology Authors: Dr John Source Type: blogs
No, Young Adults Should Not Live in Fear from Coronavirus
What follows is an OpEd that I co-authored with Andrew Foy, MD, from Penn State University. Andrew is an academic cardiologist who studies the quality of scientific evidence.
Two outlets have declined to publish our piece. This is not surprising given that we critique a research letter written by prominent academic leaders. As you read our take, please keep in mind that we oppose only the ideas expressed in the interpretation of data.
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The Journal of the American Medical Association recently published a research letter that reported an excess of nearly 12,000 deaths among younger adults th...
Source: Dr John M - December 29, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Follow-up on my Eight COVID Assertions
Yesterday’s post generated some good comments.
Two emergency medicine specialists felt that I was both wrong and insulting in saying that hospitals were not overwhelmed.
As a doc in NYC, I would suggest that your assertion 3 was indeed quite wrong and will be wrong in many more places before we are done— Josh Socolow (@Docjoshsoc) December 13, 2020
Jfc you weren't in Connecticut in April, and you aren't here now.We weren't (and aren't) fatally overwhelmed because of massive & costly efforts by our system. Anything less would have been catastrophic.Your blithe dismissal is kind ...
Source: Dr John M - December 13, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
What I Got Wrong (and Right) about COVID19
In May, I wrote a column about COVID19 that got some attention.
My reason for writing was the change in messaging about the strategy of flatten-the-curve. We were first told to flatten-the-curve to prevent overwhelming hospitals. But then the thinking changed to flatten-the-curve to save lives.
I made eight assertions about COVID19. Let’s see how I did.
Assertion 1: The virus will not be contained. Verdict: Correct.
You might argue that New Zealand and Australia contained the virus, but I would counter that these are not fair comparisons to the US, Canada, and the EU.
Assertion 2: Tests...
Source: Dr John M - December 12, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
New column and podcast up:
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 EXCE...
Source: Dr John M - October 3, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Lecture on Scientific Bias in Cardiology
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...
Source: Dr John M - September 29, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Doctoring and Activism
I got myself into a bit of tussle on Twitter today.
In a provocative piece on the newsletter Persuasion, Dr. Sally Satel argued for caution in the matter of doctors becoming political activists.
I retweeted it below:
Doctors excel at treating people with disease. That is our calling. Political activism is fine, but it ought be done only as private citizens. I agree with Dr. Satel > https://t.co/xGS2P9a8lq(Kudos to @Yascha_Mounk for starting Persuasion) pic.twitter.com/aW83MvwJnz— John Mandrola, MD (@drjohnm) August 23, 2020
Most of the replies express extreme disagreement. One question stood out a...
Source: Dr John M - August 22, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Deeper Worries in America
I worry about the coronavirus. It’s already killed more than 100,000 Americans. The recent protests have created a nerve-wracking public-health situation for the next weeks.
I really worry about racism. Not only racism in police systems but more systemic racism in our culture.
My friend Dr. Andrew Foy sent me this slide and post showing the large disparity in black and hispanic representation in medical education.
There can be no rest so long as a man like Dr. Otis Brawley, a distinguished professor of medicine,
“can get thrown to the ground, handcuffed and questioned at gunpoint for looking ...
Source: Dr John M - June 6, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Stopping COVID19 in Nursing Homes is No Easy Task
My city, Louisville KY, recently had a spike in COVID19 infections. It came from a handful of nursing homes.
That nursing home and long-term care facilities account for large percentages of COVID19 cases has been well documented. In some cities, the majority of cases come from these facilities.
These facts have sprouted platitudes about “protecting our elderly.” What makes this a platitude is that it belies the challenges faced by nursing facilities.
Two recent papers shed light on these challenges.
First is an article by Chris Pope in the City Journal. Second is an academic-like defense of Stoc...
Source: Dr John M - May 26, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
More on COVID19 Testing and How This Virus Makes Us Use Our Noggins
My friend Anish Koka, a cardiologist, wrote a beautiful review of COVID testing over at the HealthCareBlog.
The great pandemic is wreaking havoc, we are told, because the nation is not testing enough. The consensus from a diverse group that includes public health experts, economists, and silicon valley investors is that more testing will allow the country to restart the economy and do it safely.
No, it’s not quite that easy, Anish writes. You will learn a lot from his long column.
You might wonder why a COVID post from a cardiologist is worth reading. First, since COVID is novel, there are few t...
Source: Dr John M - May 19, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
COVID19 and Finding Effective Medical Therapies
This post introduces a column I wrote over at TheHeart.org | Medscape Cardiology
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The good news is that most people infected with coronavirus don’t need a hospital or doctor. But some do. Some get very ill.
The maddening thing is that doctors don’t have an effective treatment for the virus. There are no cures. The Worldmeter today shows nearly 5 million infections and more than 300,000 deaths. And no effective therapy.
Excluding a possibly modest effect of Remdesivir, our care is supportive, which is medical jargon for giving simple things like oxygen, acetaminophen, IV fluids and letting ...
Source: Dr John M - May 16, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
The Case for Opening (some) Pools In COVID19 Pandemic
The COVID crisis has decimated water exercise. Can we rethink pool closures?
A significant number of my older patients relied on pools for their fitness. During a pandemic, you can stay active or fit only if you have good legs and joints. Walkers, runners, and cyclists have no problem; they play outside in the Spring weather. People with bone/joint problems, fitness swimmers, and young children who normally take swim lessons this time of year are out of luck.
Consider the place I swim—the Mary T Meagher Natatorium, named after Mary T, a Louisville native, who won Olympic gold in 1984. The place is an ode to Sparta...
Source: Dr John M - May 12, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Will the Uncertainties of COVID Science Resurrect Blogs?
Health news was popular before the pandemic. Now, almost all news is health news.
It’s not only a rapt audience contributing to the deluge of COVID19 news. Two other factors: 1) the availability of preprint servers, digital archives where a scientific paper can be published without formal peer-review and 2) the attention economy.
Attention is currency. Since the business model of both scientific journals, internet-based medical news sites and mainstream media is attention (citations, views), both groups are eager to publish all that is COVID.
The slew of COVID papers are outpacing the normal vetting process. ...
Source: Dr John M - May 8, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
