John Mandrola, MD
@drjohnm
Heart rhythm doc, writer for @Medscape, host of This Week in Cardiology podcast, editor of Sensible Medicine. The more you see, the harder medicine gets.
Twitter thread coming on what @adamcifu @VPrasadMDMPH @AndrewFoy82 and I think is the BEST approach to pt care. This is ... The Case for Being a Medical Conservative. amjmed.com/article/S0002-… Thanks to the @amjmed for publishing this.
Doctors clicking away prepping charts this morning – look up. There's hope . . . ☀️ "Mouse Clicks and Maze Runs: Can We Escape the EHR Mess with a Little Help From AI?" @Sensible__Med sensible-med.com/p/mouse-clicks…
Who, I ask, hasn’t nodded off b/w cases whilst sitting in the sun w an espresso?
In Japan, exhaustion is celebrated. • "Otsukaresama deshita" = "You look tired" (as a compliment) • Falling asleep at work shows dedication • Inemuri (public napping) is honorable When culture honors rest, your nervous system stops fighting fatigue.
This is a great discussion of the BEST trial (beta-blockade in systolic heart failure) - by @AndrewFoy82 Not many know this trial which was negative. Andrew discusses why the results differ from other BB trials New trials’ reviews coming soon w/ @AndrewFoy82 and @drjohnm
Review of the BEST trial open.substack.com/pub/cardiology…
When the ACA was being crafted, the physician community wanted medical malpractice to be addressed. That was their number one priority. It was also the first thing taken off the table as the legislation was crafted. Hospitals, Pharma and the legal community got everything they…
The average US family health insurance premium has increased from $6,000 in 2000 to over $25,000 in 2024. That’s a 297% increase, more than triple overall inflation. The biggest beneficiaries of this massive increase in costs: health insurance companies.
Yes, and thank goodness that @VPrasadMDMPH is at the helm
I just subscribed to @statnews specifically to stay on top of this story. . . And I’m a device doc. Amazing story that has ramifications well beyond drugs for Duchenne.
Truly curious question for my prevention colleagues. How much does ApoB modify 10-year risk calculations? If it isn’t a lot, why do we measure it at all?
Who, I ask, has not ridden into a parked object?
NEW: Bicycle rider collides with a parked police motorcycle in Carlsbad, California. The bike rider was apparently not paying attention when he collided with the police motorcycle which was parked behind a car getting towed. According to local reports, the man suffered…
Important 👇🏻
Just Published: Potential For Substantial Error When Using Administrative Data to Identify Disease Conditions We assessed the relationship between billing codes for hernia and CT scan diagnosis for the same condition. Only about 1/3 of all cases labelled as hernia from billing…
Stop the presses: a study w finerenone WITHOUT a positive result. (Buy a lottery ticket)
In heart failure patients with mildly reduced or preserved ejection fraction, cardiovascular and sudden deaths were higher in those with EF <50%. Finerenone did not significantly reduce cause-specific mortality. ja.ma/4nC6sw2 @mvaduganathan @HFpEF @AdriaanVoors
Freaked out when your BP spikes? Annoyed with calls from patients with one high reading? Here is the piece for you. Turn Down the Pressure sensible-med.com/p/turn-down-th…
At least all that added cost has led to serious improvements in US health outcomes (Grin)
Hard to see much effect of the ACA in this graph . . .@DutchRojas @DrDiGiorgio
Oh the horror 👇🏻
Reimbursement to physicians performing Left Atrial Appendage Closure to be cut by 27% in 2026. What are your thoughts?
Go ahead SG, give your 4 year old a couple Pop Tarts in the afternoon. I dare you.
Incredible, @VPrasadMDMPH and @Sensible__Med have repeatedly argued that public health decisions MUST be backed by rigorous clinical trial data with practical endpoints, and Makary is just going with family narratives.
Realistic, value-based medicine. No obsession with specific tools — but solving problems and truly sharing decisions. Thanks for this article @drjohnm , @adamcifu, @VPrasadMDMPH and @AndrewFoy82 . Sad that we need definitions for a mindset that should be default.
Well done but sobering piece by @EJSMD "Many doctors have bemoaned their loss of professional autonomy. What AI is likely to bring could be far worse for some doctors—extinction." open.substack.com/pub/sensibleme…
One of our best guest posts 👇🏻 It’s scary. You’ve been warned.
Up now on @Sensible__Med – “When AI Listens In” Ambient AI, trust, and where we might be headed – sensible-med.com/p/when-ai-list…
This is the scariest thing i've read in a long time, and hits home what many of us already know to be true... AI will completely disrupt the healthcare delivery model. sensible-med.com/p/when-ai-list… @Sensible__Med @drjohnm @EricTopol @DrJMarine @AnnGageMD
QT x 1000
Perspective on Covid vaccines and myocarditis from @VPrasadMDMPH and @DrMakaryFDA So many people tried to hide this. I and others were attacked and deplatformed for pointing out this issue. jamanetwork.com/journals/jama/…
Based on the lack of clinical evidence, it’s hard to argue w reduced compensation for percutaneous LAAO. The antidote of course would have been for “scientific leaders” to have insisted on proper evidence
Today @cmsgov announced another significant cut for electrophysiologists (as well as our interventional colleagues), this time for left atrial appendage closure. Starting in 2026, reimbursement will be cut by 27%. This just a few years after the draconian cardiac ablation cuts.…
Today @cmsgov announced another significant cut for electrophysiologists (as well as our interventional colleagues), this time for left atrial appendage closure. Starting in 2026, reimbursement will be cut by 27%. This just a few years after the draconian cardiac ablation cuts.…