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 S ..read more

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-i ..read more

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 amon ..read more

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 of i ..read more

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.  Asserti ..read more

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 disc ..read more

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 ..read more

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 ..read more

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 ..read more

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 St ..read more