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Source: Dr John M
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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
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.
***
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
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
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
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
The Debacle of Hydroxychloroquine and Azithromycin for COVID19
I discussed the use of hydroxychloroquine and azithromycin for patients with COVID19 on my March 27th edition of This Week in Cardiology Podcast.
This is an important topic not only because of the specifics of treating patients but also vital because it shows how easily human beings can be misled.
Here is a an edited transcript of my words:
A conversation I had with my Dad this week made me realize the seriousness of this matter. My Dad is a retired insurance executive with a background in electrical engineering.
He is smart, but I could not convince him that the evidence prompting people to advoc...
Source: Dr John M - April 5, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
2020 Mandrola Update
This study garnered the big stage at the Heart Rhythm Society meeting and its findings were published in two leading cardiac journals–JACC and Heart Rhythm. (We kept the spin to a minimum!) Being part of an RCT was almost as nifty as pacing the his bundle.
That image is intoxicating.
A cool thing about the time we live in is the ability to have mentors all over the world. Here, Dr. Andrew Foy and his team at Penn State University in Hershey PA, deserve mention. Andrew is a true academic; he has helped me understand research methods. We have published many papers together, including my favorite: The Case for B...
Source: Dr John M - January 3, 2020 Category: Cardiology Authors: Dr John Source Type: blogs
Change and the Case for Being a Medical Conservative:
When my favorite podcaster, the economist Tyler Cowan, asked Dr. Ezekiel Emanuel what nonobvious advice he would give to medical students today, the answer surprised me.
The famous bioethicist said:
I do think that this is probably the most exciting time in American medicine in a century, since really about 1910, 1920. And it causes a lot of anxiety for people, so I want to be sympathetic to that….
…We would prefer no change. But I do think, if you can go with the change, this is a super exciting time when lots of things are changing, and you can have a real positive impact in shaping the future, pr...
Source: Dr John M - May 26, 2019 Category: Cardiology Authors: Dr John Source Type: blogs
Still Negative on Watchman
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 it was a blog post, not an academic editorial.
Months later, Andrew Foy, Gerald Naccarelli and I put the same argument into academic-speak and the influential journal Heart Rhythm published it.[1]
I have debated and presented this topic multiple times ...
Source: Dr John M - May 17, 2019 Category: Cardiology Authors: Dr John Source Type: blogs
