John Mandrola, MD
@drjohnm
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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.
Louisville, KY
Joined May 2010
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. https://t.co/nZXrnvMQqP Thanks to the @amjmed for publishing this.
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Seems like a good night to remind everyone that before 1991, nearly every cardiologist thought it was good to suppress PVCs after MI
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I use ICE. Because I can. Like most US docs. It’s ok. But the nanosecond CMS reimburses ablation as they do in Europe, (bundled),watch for similar studies showing that ICE makes no difference. And ICE use would plummet. Because: #Incentives Travel. Check my work 👆
New Evidence in AF Ablation: ICE Matters! A multicenter study shows that confirming catheter tissue contact with ICE during PFA dramatically improves outcomes. Recurrence: ICE 12.6% vs Fluoro 22.3% Reconnection at redo: ICE: 10.3% vs Fluoro: 59.2% Source: HRJ, 2025 Mohanty et al.
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I agree w JA. That this attempt at persuasion is only available to @NEJM subscribers is akin to a pro-stent lecture at a stent conference. Or, gulp, a pro appendage closure lecture at an appendage closure conference. Persuasion on public health matters should be public. IMO
Should be made open access
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If you thought the status quo was holding, well, you weren’t really reading the room.
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💯
Muting is dignified and generous. The muted assumes he’s cut you to the quick and you have no comeback to his last remark. What better way to elevate the mood and self-confidence of emerging thinkers?
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Rare are editorials this good. The asymmetry of risk is such an important concept. The topic below is lead extraction but @nntaleb notion of fat tails apply to many things in medicine. Beware of absolute risk reduction probabilities. https://t.co/lW3pLBX85W via @rdschaller
heartrhythmopen.com
A fat tailed distribution describes a statistical pattern in which extreme events occur more often than traditional models predict. Rather than clustering comfortably around an average, the distrib...
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Thanks for being my favorite podcaster for 3rd consecutive year @drjohnm !! #SpotifyWrapped. https://t.co/b32W3DHtTA
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Harms vs benefits of the COVID vaccine in young people years ago https://t.co/jYmfU4TxqC via @AndrewFoy82 & @adamcifu & @drjohnm @Vageesh_Jain
sensible-med.com
Harms vs benefits of the COVID vaccine in young people years ago and how to a patient with stable chest pain.
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Need to reiterate a tenet of Medicine: Preventive treatments given to healthy people should always pass the highest evidentiary bar. This is not controversial. It’s EBM 101
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I agree w Alex. A long time ago @ProfDFrancis taught us the limits of NNT in time controlled experiments. NNT is fine for ICU interventions measured in hours or days, it’s far less good for primary prevention trials where Rx effect may care over a decade or more
I agree with the push for better precision medicine. I think such a future will be invaluable. But the way NNT is being used in this post is a gross misrepresentation. NNTs for the top 10 drugs come almost entirely from short trials, usually 2 to 5 years, while people live with
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The Study of the Week on @Sensible__Med covers a substudy of ARTESIA where the authors characterize bleeding in the OAC vs ASA arms There are lessons for the appendage closure proponents. My take
sensible-med.com
The Study of the Week reviews a sub-analysis of the recent ARTESIA trial of apixaban vs aspirin in low-burden AF. The findings relate to left atrial appendage closure
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These news are very sad and align with the preschool-aged child that died in the moderna mRNA COVID-19 KidCOVE trial after receiving a booster shot. These vaccines should never have been given to children, teens and healthy adults, only those at very high risk of severe COVID-19.
The @US_FDA acknowledgement that at least 10 children died from COVID vaccination, must be followed with disclosure to the parents! Far too long regulatory agencies & public media have gaslighted vaccine injured, including the parents who lost their precious child. This is not
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Knowing Vinay I’m quite sure the evidence will be clear. Then. There will be a lot to look back on. A real lot.
To be clear, I believe there should a proper scientific report backing these conclusions related to vax myocarditis I have faith that it will come in due course I don't believe a leaked email starts a clock on how quickly that science must be released or indicates a cover up
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v1.0 no myocarditis from vax (debate is evil!) v2.0 vax myocarditis is always benign (disagreement is murder!!) v3.0 vax myocarditis is less bad than C19 (nuance means death!!!) ... <@VPrasadMDMPH led @US_FDA CBER does a proper study which raises important concerns> <sends
Seems like Vinay Prasad is the FDA person delaying the release of the case files on the alleged patient deaths. Maybe someone will need to subpoena him to disclose. Whatever happened to the FDA’s policy of “radical transparency”?
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So let me get this straight... Internal FDA results leaked before intended for public consumption which are not immediately backed by a full public report is a coverup But... years of echoing biotech/pharma press releases prior to data is "journalism"?
Seems like Vinay Prasad is the FDA person delaying the release of the case files on the alleged patient deaths. Maybe someone will need to subpoena him to disclose. Whatever happened to the FDA’s policy of “radical transparency”?
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Imagine a scenario where all leaders in gov’t had this high level of clarity of thought. It would be like Denmark The ONLY way to restore trust in public health and regulation is this approach The old way shredded trust. If you are a vaccine proponent you should applaud this
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Lot's of folks like @EvidenceOpen -- I decided to ask it about left atrial appendage closure. Grin. It parrots all the talking points of proponents. It took me many queries to get this:
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Vinay should just post his CBER emails to his Substack and send his “team” a link. Gosh. Can his “team” not wait a day before leaking internal emails? I look forward to the details of the investigation—though it’s a bit late.
NEWS: An internal FDA review found at least 10 children died following the COVID vaccine. FDA Chief Medical Officer Vinay Prasad is calling for introspection, humility and reform at FDA in light of the finding. "For the first time, the US FDA will acknowledge that COVID-19
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When I (a non academic) do a peer review, one three letter word comes to mind: WHY?
The sad truth is that very few folks want to do peer reviews. Good reviews are extremely valuable but many are pedestrian. The whole process takes way too long. So glad to be a part of a journal that is fundamentally rethinking this whole process! @NEJM_AI
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