John Mandrola, MD
@drjohnm
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Heart rhythm doc, writer for @Medscape , host of This Week in Cardiology podcast, cyclist, #MedicalConservative . The more you see, the harder medicine gets
Louisville, KY
Joined May 2010
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Pinned Tweet
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.
Thanks to the
@amjmed
for publishing this.
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To everyone on Twitter -- stop saying myocarditis is mild
From...
...someone who deals w the (sometimes late) complications of inflammation-induced scar in the heart
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Before I ReTweeted the former dean of Harvard medical school, I read every sentence of this paper.
It is persuasive.
Silence of the medical profession regarding the coercion of young people to take a potentially net harmful medical intervention is shocking
Wow. New paper makes strong case that COVID booster mandates in young adults (as in many US universities), caused net harm, and must be judged unethical. This should not have happened, and we should insist on accountability.
@KevinBardosh
@TracyBethHoeg
@VPrasadMDMPH
👇
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As a cardiologist, I liken calling myocarditis 'mild' to the saying about 'minor' surgery.
Minor surgery is surgery on someone else.
Mild myocarditis only occurs in other folks' kids.
I love the COVID vaccine for at-risk adults, but for kids, we need more caution.
To put this into perspective, if we vaccinate 1 million 12-17 year olds, we could see 30-40 MILD cases of myocarditis. In this same 1 million, through vaccination we AVOID: 8,000 cases of COVID-19, 200 hospitalizations, 50 ICU stays & 1 death. The benefits far outweigh the risks.
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I used to think Medicine could be separated from politics.
Gosh. That was super dumb.
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The more that people ride bikes, the more hip fractures and cranial bleeds we will see.
The pandemic is essentially done.
Human life has to be more than avoiding one pathogen.
With respect...sir, please, stop.
The more people who gather indoors, the greater chance that someone could spread Covid and that someone else, perhaps with an underlying condition they're not aware of, could be infected and get seriously ill.
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I seem to remember a time when the observations of doctors seeing patients in the hospital were widely accepted
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Private message from a
#COVID19
hot spot. To mainstream media,
@nytimes
@WSJ
@washingtonpost
@propublica
@charlesornstein
This is a huge problem. Healthcare workers need PPE. Note .. many docs not allowed to speak candidly. Hence the private message.
@califf001
@EricTopol
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Direct Messages like this feel like a tailwind on the bike. Cc
@VPrasadMDMPH
@sdbaral
#MedicalConservative
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Can We Discuss Flatten-the-Curve in COVID19? My Eight Assertions
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My Facebook feed is different from my Twitter feed. I rarely mix the two.
Today is different. Here is what I said to my friends on FB:
#aha19
#MedicalConservative
#RCT
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My friends
COVID or not. You must resist.
1+3 is not 13.
School is important.
Rational thinking must remain.
End/
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The fastest way to lose trust (in the clinic) is to be overly certain in the face of obvious uncertainty then double down and appeal to authority in the face of reasonable questions
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It boggles my mind that seemingly smart people in the CDC think two-year-olds should (or could) wear masks.
Nonsense like that shreds public trust. Why can’t they understand that?
@sdbaral
@JenniferSey
@badtakesbad
@DrKristenW
@TracyBethHoeg
@MonicaGandhi9
Unfortunately the CDC's guidance is clear that 2 year olds and up must wear a mask.
Apart from heartbreaking stories like this, toddlers still learning to talk also have to wear masks all day in childcare, etc.
I hope this is on the
@CDCDirector
's list of things to revisit.
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The problem w mandating masks on toddlers is not so much the harm to toddlers, who, I suspect, are resilient, it's the utter shredding of trust in public health.
People are like: if you truly believe masks in daycare do anything, how am I supposed to believe anything you say?
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Two things about basic medical practice; Interns learn these in their first month:
1) Never do a test if it won’t change what you do post test.
2) Always tailor therapies based on harms/benefits of an individual
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What this shows, with stunning clarity, is the massive divide b/w
#COVIDTwitter
and regular folk
Huge swaths of people have long ago made their decision on risk tolerance.
To me, it seems bold, but is this not the “public” part of public health?
#vaccineswork
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"Percent of fully vaccinated people who were hospitalized?”
0.0008%
What has happened to risk tolerance and numerical literacy in our country?
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If you want the public to trust science, stop citing BS studies. And oppose the Twitter policy of removing Tweets you don’t agree with.
I’m not sure why smart people can’t see that science’s trust problem is hubris. Be honest w people about uncertainty.
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Thread: To me, the most stunning report from
#ESCCongress
thus far: RATE-AF trial
Older pts w/ permanent AF + shortness of breath. (there are lots of these pts).
Rate control is crucial
In 2020, most receive beta-blockers.
But BB can cause dyspnea.
What about dig?
Gulp! 1/
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Well, well…
Another report of mRNA vaccine-induced Myocarditis in young males.
Incidence low, but more than expected.
Are we sure we should be mandating
#COVID19
vaccines in younger age groups?
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For those not familiar w medical jargon, torsades-de-pointes is French for polymorphic ventricular tachycardia. Translation: the main “side effect” of hydroxychloroquine/azithromycin is sudden cardiac DEATH. Which is exactly why Fauci says we need proper trials.
#COVID
Long time since I’ve seen torsades-de-pointe!Careful out there! Please educate your cummunity on the the use of
#Hydroxycloroquine
#COVID
—19!
@drjohnm
@EJSMD
@PrashSanders
@MihailChelu
@NazemAkoum
@andreanatalemd
@aalahmadmd
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Med journal sent me a new editorial:
Reducing the Risks of Nuclear War —The Role of the Health Professional
👆I struggle w this. To me, healthcare people would do well to focus on treating the ill. Journals might focus more on better adjudication of science
Am I wrong?
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This may be one of the most important pieces of content
@medscape
has ever published. What if we are doing it wrong in the treatment of
#COVID19
? What if
@cameronks
is correct?
Thread
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Here is baby John, our newest grandchild. I just told him the p value was 0.06
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I am pro-vaccine. I encourage my adult pts to take it.
But the lack of stratification by age and gender, which obviously hides the vax-myocarditis signal, tempts one to be cynical about science adjutication.
While mRNA vax are amazing this study has fooled many.
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Imagine a society that was accustomed to science being presented in apolitical neutral ways.
Imagine a society taught to embrace the uncertainty of science—as the NORM
In this world, there would be no need to fear nor censor anecdotes—from either a disease or its treatment
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Science changes way too fast for social media companies to judge.
Banning/removing scientific takes is a TERRIBLE idea.
Just awful.
@mikejohansenmd
@VPrasadMDMPH
@DiseaseEcology
@aetiology
@BillHanage
@MartyMakary
@WSJ
@ChristosArgyrop
Facebook’s truth reviewers would have banned me in March 2020 for claiming we should be wearing masks
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Sometimes I do Twitter like I did criteriums: I get excited and make mistakes.
Here were two big ones. I regret them but want to own them.
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Mind-boggling COVID insanity
"All but 8 were vaccinated, and the vast majority are asymptomatic. A small number have minor, cold- and flu-like symptoms, and none have been hospitalized.."
Why are we testing healthy kids?
#DELTA
is literally everywhere!
#WeHaveToLiveWithIt
Duke implements an OUTDOOR mask mandate after students test positive with at most mild cold like symptoms
What is the goal? And
Why recommend something that doesn't work for any goal?
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News organizations like
@propublica
will be crucial in sorting out the lessons from the
#COVID19
crisis. This report on CDC emails tells a shocking story.
Caroline Chen is smashing it.
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Good morning friends.
A reminder that our most amazing therapies in modern Medicine, for instance, insulin, antibiotics, pacemakers, can sometimes cause harm.
That a therapy has an adverse effect does not diminish its value.
Adverse effects are normal.
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PSA for COVID19 Rx
Don’t use flawed observational data to start giving potent anticoagulation to sick pts with COVID19. Even if it is published in a big journal
Read Immortal Time Bias.
Here is a COVID pt treated with “preventive AC”
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I lost the stent debate tonite. I showed evidence. The neg RCTs: Courage, Rita-2 Bari2D, Orbita etc. It didn’t matter. My opponent told scary stories, and then he showed a prox LAD lesion. All the audience wanted the stent. Facts don’t persuade.
@ProfDFrancis
@ScottAdamsSays
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This beautiful note is on a nurse-manager’s door on one of our wards.
#truth
cc
@AllenFrancesMD
@PlenarySessShow
@AndrewFoy82
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Please don’t tell me social media has not upended
#MedEd
. Twitter, YouTube, Podcasts transformed early
#COVID19
care—for the better. Superb, important, piece on stopping the harmful early intubation practice. By
@strauss_matt
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Due to research I’m part of, I know this is true👇🏻
Why haven’t we published it? We’ve been trying!!!
Stay tuned.
Also… you can be pro-vaccine (I am) and totally open about the different harm/benefit vax tradeoffs for young people. Thx WG.
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Here is something that all medical peeps on Twitter ought to easily agree on>
No government funded medical research should be behind a paywall.
The results should not be the property of a for-profit journal, they are the property of humanity.
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Way to gain followers during the pandemic: bash the US. Promote fear. Consider every
#COVID19
case as a stab in the heart. Be certain.
Way to lose followers: accept that this is a dastardly difficult pathogen, consider it as just another disease, be uncertain, ask questions
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Perhaps a controversial opinion —
Dear colleagues in cardiology:
Your pictures celebrating first implants of “procedure X” along w shiny-happy industry peeps are unbecoming
A) It’s borderline re -HIPAA
B) You’re being used as advert
C) It’s tacky
#EPeeps
#CardioTwitter
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The more I look under the hood of medical science, the more convinced I become that it is incompatible with profit motive and politics.
It's sad. I wish I didn't feel this way.
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Just want say — cardiology is on the brink of a MAJOR development
Stay tuned. Column coming.
To make it even sweeter: cardiac pacing, yes, bland old pacers, not fancy ablation, or stents, or valves, are a central theme
And … sit down.
Also key: basic physiology!
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Grandson # 4.
Baby Georgie
I just told him there was this pricy cardiac drug that looked GREAT in a subgroup but the primary endpoint was nonsignificant. 👇🏻👇🏻
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What do people think happens in a room of toddlers during nap time and lunch when they are breathing on each other. Does aerosolized SARSCOV2 stop circulating at lunch and nap?
Trust is easy to lose.
Thanks
@bergerbell
-
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My sister is a principal at a big (public) high school adjacent to a big American city.
How’s virtual school going?
-> 42% of the entire school has F’s.
Teachers—- be like nurses, respir techs, docs, bus drivers, grocery workers— go back to teaching.
You are essential
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IMHO: The masses of medical people on Twitter speculating about the president’s condition with no reliable information is ...kinda sad.
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“He was ultimately diagnosed with SVT”—> a benign non-life-threatening condition.
Shameful marketing/reporting
H/t
@cardiobrief
Another life was saved by an
#AppleWatch
, this time a teen athlete in Oklahoma was alerted to an unusually high heart rate while in class.
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Really enjoyed this balanced piece from
@VPrasadMDMPH
on the folly of masking young children.
Thx for being a tireless voice of reason
(Thought you would have mentioned the study showing SARSCoV2 stops circulating during naps and lunch break)
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I study medical evidence. And the
#COVID19
vaccine data is stunningly strong.
Bayes Factor (PFE) ≈ 30 zeros
So I concur w
@VPrasadMDMPH
and
@NateSilver538
Post-vaccine, let people be normal.
Messaging has to be about more than virus avoidance.
Think
#tradeoffs
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Agree…clear signal of a rare but serious complication in an age group who has little to fear from SARSCOV2
My gosh … if this were not so polarized it would be a classic case for shared decision making.
That this vaccine could be *mandated* by schools (now) boggles my mind.
ACIP's slides on mRNA vaccines and myocarditis are now available
Hard to argue this isn't causal
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One of the concepts I try to keep in mind while thinking publicly, and speaking with patients, is that you have to be able to hold opposing viewpoints in your brain and still function
A brief thread
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#Exercise
is the most underused intervention in all of Medicine
I’m no expert, but I would have thought the best way to improve exercise tolerance in heart failure, is to increase tolerance of exercise? Rather than a pill....
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The biggest gain from Paxlovid, IMO, ought to be to teach the public the all-important concept of external validity of trials
So often, trials are held up as gold standards but don't necessarily apply to our particular patient
1/n
When you give Paxlovid to someone who's had three or four shots, you have no randomized data to hang your hat on
Then you get rebound. And you have no idea whether to restart, give a longer course, or if it didn't help at all.
Evidence-based medicine failure.
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Study of the year?
Here… 29 teams of scientists analyzed the SAME dataset asking the SAME research question and came to widely disparate statistical results. Wow. > from
@BrianNosek
et al
#EyesOpen
#BigData
#FOAMed
#EmbraceUncertainty
.
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This week, our hospital (medium sized city in Middle America) has had the lowest numbers of COVID since the pandemic. Period.
Our neighboring hospital system (slightly bigger) had ZERO intubated COVID patients.
I think this is (partly) why 👇
U.S. nursing homes, where penetration with Covid vaccines has been very high, continue to show sharp declines in new cases and bad outcomes.
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I’ve been thinking and reading a lot about the 1- vs 2- shot vaccine debate. I see and understand both arguments.
Truth: I really don’t know.
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If I had only 1 EP pro-tip for hospital docs >>
In patients w co-morbid conditions,
#AFib
is often a bystander, not the main problem. AF demands an explanation— and fixing that problem is often the key to making the patient well
#MEDED
#cardiotwitter
cc
@medicalaxioms
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“Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients. And...
We found greater contamination on the outer rather than inner mask surfaces. “
Well. This complicates things.
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Excited to co-author a piece on
#DamarHamlin
cardiac arrest with
@VPrasadMDMPH
on
@TheFP
(Thanks
@EmilyYoffe
@bariweiss
)
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Screening colonoscopy has become a right of passage in middle-age. Billions of $$ are spent. Yet until last night there was no data.
@VPrasadMDMPH
and I explain the stunning NordICC trial results
It's a shocker. ( cc
@EconTalker
@tylercowen
@nntaleb
)
Screening Colonoscopy Misses the Mark in its First Real Test on Sensible Medicine
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Keeping this confidential but here is a note from a ICU colleague. I asked if she agreed with tinkering with standard protocols for
#COVID19
So
@cameronks
frustrations are not unique.
Unlike HCQ; strategies to improve pneumonia management have far greater plausibility.
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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 >
(Kudos to
@Yascha_Mounk
for starting Persuasion)
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@JReinerMD
Our paper is coming. In the meantime, check out the recent CDC report.
10x myocarditis risk after shot 2 in males 12+
Makes it a call for parents. After shared decision-making
Also I would surely do serology first. If + -> hell no.
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I once thought that it was a bad thing to not get into Harvard, MIT or PENN
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Important read from
@VPrasadMDMPH
on the
@TheFP
-- regarding his dis-invitation to speak at
@ACCP
BTW -- I can't say enough for the incredible job the Free Press is doing during these difficult times. Thx
@bariweiss
@NellieBowles
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A full 30 minutes just to submit an academic article.
This is nuts. Why is this normal?
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What scares me most about TPA in stroke is how a harmful, expensive drug became anointed despite dubious evidence. My critical appraisal > < exposes deep flaws in medical science
#FOAMed
#meded
#CardioTwitter
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I work in a hospital every week
Anil is correct. We now have a diff disease: many if not most COVID+ pts we consult on have + test but an adm Dx for something else
The pneumonias of 2020-2021 are thankfully rare
No predictions but this seems a) important and b) good news
I'm working in the hospital this week. So many of my patients incidentally have COVID with no or minimal symptoms
Hospitalizations as a metric was diluted during BA 1 &2
With BA5 it's fairly useless if using claims or EHR data
We need better data not bigger data
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Vinay makes fun — but this is the sort of BS that shreds public trust in
#COVID19
policy.
Glad we are willing to do the important things to stop COVID19 like removing swings from outdoor playgrounds
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Disinviting speakers is antithetical to science. Better would have been to engage w ideas. Think. Argue. Persuade.
@VPrasadMDMPH
is one of the best medical speakers I have seen. What a loss
@ACCP
BTW David’s fair/thorough coverage is why I’m a paid subscriber to Silent Lunch
Accusations of "misinformation" were made–many without evidence–against
@VPrasadMDMPH
as part of a campaign against him speaking at a conference for Clinical Pharmacists (
@ACCP
). It took less than a day for his invitation to be rescinded.
Details here:
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Proud to be part of this work on vaccine-induced myocarditis in young people 👇🏻👇🏻👇🏻
Our group's analysis of pediatric post-vax myocarditis rates stratified by age, sex & dose. An extensive harm-benefit analysis is included w/consideration of presence or absence of comorbidities
Thanks
@drjohnm
@KrugAlli
&
@ifihadastick
for the teamwork
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NEJM: Re SARSCOV2
"protection of prev infection against hospitalization/death caused by reinfection appeared to be robust regardless of variant"
Offit: This is yet another paper that proves that natural infection protects you against severe illness
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It's published! LA Appendage closure is not ready for routine clinical use. In
@hrs_journal
Thx
@AndrewFoy82
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The bad news is that I cracked my old frame. The good news is 👇
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To those who mostly disagreed w me, I say Happy New Year.
To those who mostly agreed w me, I say Happy New Year.
Here’s hoping for a better and more peaceful 2021.
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3 things I learned in my first 12 hrs in Denmark:
1) people mostly agree on the big issues
2) people trust their government
3) 38 degrees and light rain isn’t that bad a weather for a bike ride
1,2 confirmed by multiple sources
3 confirmed by the mass of humanity riding bikes
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An older pt asked me: "what happens if I don't have this procedure" / I nearly jumped up to hug him! <Please, people, ask your doc that
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A thread on my column this week about independent nurse practitioner and physician assistant medical care.
I'm happy that it has 199 comments -- including one calling it garbage--a sure sign of a decent piece.
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Ky has vaccinated about 1 in 3 older people.
CT has done even better.
The vaccine squelches severe cases
Millions have natural immunity.
Young have almost no risk
The pandemic (of bad disease) is nearly over.
And this is a really worthy cause of celebration!!!!!!
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An echo report w an LV EF of 36% is like a study with a p-value of 0.051. ECHO peeps... can we just call it 35%?
#EPeeps
#echofirst
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