51成人动漫

Last week I was invited by the Heart Failure Association (HFA) of the European Society of Cardiology to debate Nassir Marrouche (an electrophysiologist) on the utility of catheter ablation for the treatment of atrial fibrillation in patients with heart failure. The HFA is the primary meeting of heart failure specialists in the world.

Cardiology subspecialists are very communal. Electrophysiologists and heart failure specialists live in distinct worlds, with different customs and beliefs. I sensed my debate opponent felt like a stranger in a strange land. So I tried as hard as I could to make him feel at home.

During the debate, we disagreed on nearly everything. But throughout, we agreed on the most important thing: respect and honor for differences in our views.

I admired Marrouche's passion and told him so. Afterwards, he sent me a follow-up email:

"Was great to finally meet you! You are actually nicer than I thought! :-) A real gentleman! Learned so much and thanks for the great debates! You are a master in science!"

I responded to Marouche with a similar sentiment:

"It was truly an honor, and we had a wonderful time. This time, I had the home-field advantage. Next time I will not be so lucky. :-) "

This interchange is the essence of honest scientific communication. As a result, our views converged a bit, but equally importantly, we understood our differences much better. The progress was important. To top it off, we both published a well-received - in Circulation last week.

But some electrophysiologists are not so open-minded.

At the HFA, a friend told me that I was lighting up Twitter. Readers of this blog know my views about that platform: it provides a soapbox for rash, ill-conceived expression. (Witness the absurd, often-retracted tweets of public figures.)

My friend showed me a few tweets about me. Many were delightful. People appreciated my points of evidence as well as my sarcasm. And amazingly, no one rebutted my scientific arguments.

But there was also real darkness.

Those who objected to -- but could not rebut -- my scientific arguments resorted to anecdote and animosity. They tweeted sentiments they would never have had the courage to express to me directly. That, I expected.

But there was something darker. Many tweeters were placing their beliefs above the facts. Or worse, they were distorting evidence to conform to their beliefs. Their devotion was obvious, and their fervor was religious.

They seemed to be preaching the gospel according to Saint Ablation.

Are ablationists religious purists? Many seem to worship at the altar of regular sinus rhythm. Heretics are to be burned at the stake. Actually, they are prepared to burn any tissue that stands in their way.

They are not pleased to have their dogma questioned. To many, those who insist on proper analyses are considered nonbelievers. Anyone with opposing views is to be undermined and discredited.

Am I exaggerating?

Two weeks ago, The New York Times published an . Written by , a cardiology fellow at Duke, it summarized our current state of uncertainty about the efficacy of cardiac devices and procedures.

Immediately, Dr. Warraich was condemned by many electrophysiologists on Twitter. The attacks on him did not question his evidence. Instead, they questioned his credentials. How could person still in training know the truth? Some proposed a campaign to post negative comments about him on The New York Times website. Here is one tweet from @TrueEP ():

" ... we need your voice on the comments section. There must be some subtle put down included in it. We must shut this down."

Wow! This is extraordinary. An electrophysiologist was making a direct appeal to his followers to smear a colleague because he had told the truth.

What would happen if they could physically capture the poor fellow? Would they put him on trial? Would they demand a public retraction on the pain of excommunication? Would the Inquisition make its appearance again?

I do not think that the trial would go well for him. The outcome would be predetermined. Would he be forced to confess to symptoms he did not have? At the end, he would be strapped to the cath table, and catheters would be passed into his atria. His cardiac tissue would be burned at the stake.

Following the imposition of sinus rhythm, the fellow would be released, and his rhythm (and views) would now be forced to be concordant with everyone else's.

Predictably, some electrophysiologists on Twitter did not appreciate my efforts to mix truth and humor. They claimed incorrectly that my embrace of the principles of proper clinical trial analysis represented an attack on the discipline. Apparently, some had little interest in respecting the data (or perhaps themselves).

One electrophysiologist () mistakenly proposed that I hated the entire subspecialty. But his Twitter profile indicated that he had previously been a car mechanic. The connection with electrophysiology made perfect sense.

Some have implied that the electrophysiology community might be motivated by money. But now I know better. Financial motives undoubtedly apply to some, but for many, this isn't really about remuneration. It is really about religion. At least one electrophysiologist () agreed.

Ablation can relieve disabling symptoms in certain patients. But it is not the elixir of life. Those who claim that the procedure saves lives, prevents strokes or treats heart failure are doing a disservice to themselves and their patients.

Will this post evoke a negative response from the electrophysiology community? Certainly, the backbiting will resurge. Some will probably make an appeal that all my papers should be boycotted. (What a relief!)

This is what zealots do. They did it to Dr. Warraich. If you perceive that your religion is threatened, you attack, distort or misinterpret science.

This characterization does not apply to most electrophysiologists. But honest electrophysiologists should be condemning inappropriate behavior when they see it amongst their followers. That would make an important statement. ( is an exemplar of thoughtful reasoning.)

The heart failure community created a high standard of evidence interpretation many years ago. The electrophysiology community needs to do that now.

My favorite tweet was . She wrote to one electrophysiologist:

"You are a fascinating doctor. On twitter all day and all night frequently arguing against colleagues. As a pt, my bottom line is to trust none of you, close my eyes, and hope for the best."

As far as I could tell, her post received no comments, no retweets, and no likes.

I was not surprised.

Comment