May 12th, 2011 by John Mandrola, M.D. in Health Policy, Opinion
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Largesse: (Form thefreedictionary.com):
1. a. Liberality in bestowing gifts, especially in a lofty or condescending manner.
b. Money or gifts bestowed.
2. Generosity of spirit or attitude.
Two days into last week’s Heart Rhythm Society meeting, Propublica, an independent online investigative journalism-in-the-public-interest endeavor published a series of high profile articles as part of their Dollars for Docs series. Their marquee piece, published prominently in the USA Today, chronicled the strong financial ties (the ‘largesse’) that bind medical societies to industry. Reporters Charlie Ornstein and Tracy Weber highlighted the meeting’s ‘mansion’-sized exhibits, intense advertising, and the fact that most of the opinion leaders, officers of medical societies and guideline writers, the experts, have financial ties with medical device companies. More than half of HRS’ revenues came from industry.
Well.
I’ll offer four simple thoughts about all this conflict:
1. Nothing about industry influence at medical meetings is new news. I have been attending medical meetings for nearly twenty years, and industry has always been there. And here’s something you don’t read much about: it was far worse then. That’s all I will say about that. I won’t tell you how cool it was seeing the Charlie Daniels Band play at a medical meeting for free.
You can quibble with the extent of these current-day “cozy” relationships, or the glitz of exhibits at our gatherings, but you should also know that there is progress. The show is now out in the open. There is infinitely more disclosure. Smart people are now watching, tweeting, and reporting. Any doctor who’s been around more than a few years will agree that things have grown increasing more transparent. Which I believe is an improvement. Read more »
*This blog post was originally published at Dr John M*
May 6th, 2011 by John Mandrola, M.D. in Health Tips
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The number of emails that come from fellow cyclists (and endurance athletes) with heart rhythm issues amazes me. I am more convinced than ever that our “hobby” predisposes us to electrical issues like atrial fibrillation (AF)—that the science is right.
Obviously, my pedaling “habit” creates an exposure bias. I hear from many of you because we cyclists understand each other. Like you, I consider not competing a lousy treatment option.
As a bike racer, I know things: that prancing on an elliptical trainer at a health club doesn’t cut it, and, that spin classes may look hard, but do not come close to simulating real competition. I know the extent of the inflammation required to close that gap, to avoid getting dropped when one of the local Cancellara-types have you in the gutter in a cross-wind, or the worst one of all, to turn yourself inside out to stay with a group of climbers over the crest of a seemingly endless hill—”ten more pedal strokes and I’m out”…Then ten turns to 20, then 40, and maybe you hang, and maybe not. The common denominator of all this: suffering.
It’s little wonder that we get AF.
With that as a backdrop, my goal for this post is to provide a modest amount of insight to the most common question asked by athletes with AF.
“Should I have an ablation, or not.”
Though my two episodes of heart chaos amount to only a mild case of AF, I think it’s fair to say that personal experience with a problem helps a doctor better understand your choice. I’ve thought to myself, on more than one occasion, what would I do if the watt-sucking irregularity persisted? Would I have an ablation; would I live with it; would I stop drinking so much coffee? Read more »
*This blog post was originally published at Dr John M*
May 2nd, 2011 by John Mandrola, M.D. in Research
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Wait…
Before reading any further, I would like to issue a warning. If your ideas about healthcare delivery are of an older ilk; if you cling white-knuckled to past dogma, please stop reading now. What follows may cause your atria to fibrillate.
Last month I wrote that the best tool for treating atrial fibrillation (AF) was to give patients information—to teach them about their AF, its complications, role of lifestyle factors and the many treatment options. I didn’t say this was easy. In fact, thoroughly explaining AF takes nearly the same time it takes me to isolate the pulmonary veins–a lot longer than the 10 minutes allotted for a typical office visit. (Remember: of a 30 minute office visit, I have to review your chart, listen attentively to your story, examine you, and complete the e-record. That doesn’t leave much time for teaching.)
I was serious about the role of education in AF therapy, but I didn’t have any hard data to support such a bold claim. All I could offer was 15 years of experience on the front lines of treating AF—cardiology’s most expensive and prevalent disease.
But now I have found some real-world data to support the thesis that good teaching translates to better AF outcomes. Read more »
*This blog post was originally published at Dr John M*
April 23rd, 2011 by John Mandrola, M.D. in Opinion
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After spending an entire vacation reading stories, I would like to start tonight’s post with a tiny dose of fantasy. Can we try using a daydream to learn something about the challenge of making good nutrition choices?
The fantasy goes something like this…
You have just been sentenced to eternal life on a far-away sun-drenched island. This island has mountains, paved roads, wide bike lanes, and mountain bike trails. You get to take two bikes, a couple riding buddies and your family—if they’ll go. You also get to take one Apple product.
Sounds good so far.
The kicker is that you only get four food choices—and liquids count.
You are a cyclist, so after coffee and beer there are only two food choices remaining. Obviously, you will need a protein source. Smart choices here would include nuts, mercury-free fish or organically-fed animals. The protein isn’t the point, let’s keep moving.
Now we are down to the carbohydrate source.
Choose one of the following:
A.) Arugula
B.) Quinoa
C.) Cranberries
D.) Fruit Loops
Herein lies the primary hurdle that smart-nutrition advocates face: unhealthy simple sugars taste really good. Read more »
*This blog post was originally published at Dr John M*
April 7th, 2011 by John Mandrola, M.D. in Research
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For competitive cyclists, Sunday morning usually signifies a time for combining spirituality with calorie-burning. Whether we are immersed in the total focus of a hotly-contested bike race or meditating our way through a seemingly endless training ride, it’s a given that most cyclists use Sundays to churn out the kilo-joules.
This kind of Sunday-behavior differs significantly from many regular (normal) people, who like to sleep late, get up slowly, dress themselves nicely and amble off to church. It goes without saying that this kind of spiritual exercise doesn’t burn many calories. And it is also well known that worship and consuming high-calorie comfort food frequently go hand in hand.
In the hard-to-believe-that-people-study-this kind-of-thing category, comes a report that frequent churchgoing in young adulthood increases the risk of obesity in middle age. Really, I am not making this up. The story was reported prominently here, on the theHeart.org. Read more »
*This blog post was originally published at Dr John M*
