Author Archive: Glenn Reynolds

FINALLY:

HAPPY 25TH ANNIVERSARY TO INSTAPUNDIT! This blog started on August 8, 2001. I can’t promise I’ll still be blogging in 25 years — but I can’t promise that I won’t, either.

HENRY VIII SEIZED THE MONASTERIES, SO THERE’S PRECEDENT FOR WHAT I’M ABOUT TO SUGGEST . . .

WELL, YOU GOTTA GET THE GUAC:

THIS IS LITERALLY THE MOST EDUCATIONAL THING THAT HAS HAPPENED AT CORNELL IN YEARS AND THEY KILLED IT:

THAT WAS THEN, THIS IS NOW:

The truth changes when the needs of the party change, comrade.

HE’LL BE HAPPY THERE. IT’S BETTER FOR EVERYBODY, REALLY.

THE REAL AFFORDABILITY CRISIS ISN’T ABOUT BURRITOS:

ASKED AND ANSWERED: What has cardiology gotten spectacularly right, and spectacularly wrong, over the past 30 years?

The treatment of acute coronary syndrome and MI. Young clinicians may not be able to remember how MI care was transformed with emergency PCI and stents but it is amazing. People with MIs often leave the hospital the next day with only a band-aid on their wrist. The heart and person saved.

This has led to fewer cases of heart failure and arrhythmia. I live in a city of million people and rarely do primary prevention defibrillators for ischemic-related cardiomyopathy—because of all these fixes.

The corollary to acute care has also been disease-modifying therapy for CAD. When I started my career, an MI was often followed by another and another. Now, with optimal medical therapy, recurrent events are much lower. Patients with MI usually live long enough to die of something else.

Heart failure care has also been transformed with the four classes of HF medicines. What was once a miserable death sentence has been transformed into a livable chronic condition. Of course, the challenge in HF care is using it wisely, because most cases of HF are not in ambulatory males with solid blood pressure, but in older patients with many co-morbidities.

Catheter ablation technology has been a spectacular success for every arrhythmia except AF. Ablation renders patients with arrhythmias from focal areas like surgical patients: cured. We still have a huge knowledge deficit in AF pathophysiology. More on that below.

In structural interventions, TAVI is nothing short of spectacular. We can extend the quality and quantity of life for many older adults who faced certain death from aortic stenosis—without open heart surgery.

Much more at the link.

OPEN THREAD: Ring in the weekend.

THE REAL FIRST RESPONDERS ARE THE PEOPLE WHO ARE ALREADY THERE WHEN IT HAPPENS: Before the Police Get There: Armed People Save Lives More and More Often. “Everything takes time. Depending on the location and the number of civilians there, a killer can shoot about 15 people if we wait for the police to arrive and stop an attack. We’ve seen that data play out over the last decade. We have hundreds of examples. That’s the ugly calculus of time.”

When seconds count, the police are only minutes away.

DAVID STROM: I Hope This Is My Last Post on Jason Arday, but It Needs Saying. “But there is a lot to unpack here, and little of it has to do with the man himself. For Cambridge University and for academia as a whole, he was an empty vessel into whom they poured their ideology, self-delusion, pride, and sense of moral superiority.”