The purpose of this post is to introduce my most recent column over at theHeart.org | Medscape Cardiology in which I address recent concerns about the drug rivaroxaban (Xarelto). — In 2014, Rivaroxaban (Xarelto) was the most prescribed new oral anticoagulant (NOAC). Millions of patients have atrial fibrillation, so it’s fair to call it a […]
I’ve got a good story for you. One that goes back to the early days of this blog, a time when I wrote about cycling. It turns out that the biggest medical news thus far in 2016 has a connection, albeit slight, to the recent doping news out of Belgium. You’ve heard the news from […]
I do AF ablation. But, similar to my 2015 update, I continue to do fewer of these procedures. What is new in 2016 is more confidence that this is the right approach. My technique for ablating AF has not changed. I do pulmonary vein isolation (PVI) with point-to-point RF. Each burn takes 10-30 seconds, and […]
I’ve never been more concerned about the harms of healthcare. Any exposure to the health care system can get you in trouble. It’s especially scary when healthy people enter the system–often in the name of prevention. Remember that the most likely outcome of a medical intervention in a person without complaints is harm. How can […]
The purpose of this post is to introduce my latest column on Medscape, which is linked at the end. You might wonder why an electrophysiologist is interested in cancer screening. I am interested because it may be one of Medicine’s largest reversals. A reversal happens when something (testing or treatment) doctors did, and patients accepted, […]
Three academic physicians, writing in an editorial in the Journal of the American Medical Association, raised serious (but theoretical) concerns about the risk of Alzheimer’s disease and macular degeneration with long-term use of the new heart failure drug, valsartan/sacubitril (Entresto, Novartis). Here is the translation: Sacubitril is a drug that inhibits neprilysin, which is an […]
Here is my most recent column on theHeart.org | Medscape Cardiology: Mandrola’s Top 10 Cardiology Stories 2015 What follows below is a short-writing summary of my ten picks. The hyperlinks go to earlier columns I wrote on the topic. 1. The FDA approved two new (injectable) cholesterol drugs. The problem with the PCSK9-inhibitors: the study […]
The news this morning is sobering. Poor, white, middle-aged American men are dying at increasing rates. The report, published in a prestigious medical journal by a recent Nobel Prize winner, has shocked the public health community. It should shock you. NPR covered the story. So did the NY Times. Twitter is abuzz with the news. […]
A frail elderly women has a leaky heart valve. It caused her legs to swell and increased her work of breathing when she pushed her walker around the house. One doctor wanted to relieve her suffering. She suggested palliative care; she wanted to make her disease less severe but without removing the cause. Other doctors […]
Last night I talked with one of my partners about a few terrible cases of medical harm from unnecessary procedures. He said, “John, people get this stuff done to them because they fear not being healthy. People are scared.” My answer was that people should fear healthcare more than they do disease. That sounds like […]
Seven out of eight patients in his clinic one afternoon had unnecessary care. This from Dr. Atul Gawande, who may be the most respected physician in the world. And he works at Harvard. Overuse wastes resources. Overuse causes harm. Overuse fosters underuse. We must make it visible. The public needs to know. Here you go: […]