David K. Cundiff, MD

Is anticoagulation bleeding risk worse in the real world?

June 6, 2026Jun 6, 2026

For decades, the medical community has accepted a foundational principle of cardiovascular care: patients with non-valvular atrial fibrillation (AFib) require aggressive, lifelong stroke prophylaxis. When a patient also presents with stable coronary artery disease (CAD), standard practice has historically gone a step further, layering an antiplatelet such as aspirin on top of an oral anticoagulant such as warfarin or a modern direct oral anticoagulant (DOAC). To frontline hospitalists and patients, …

Heparin for acute coronary syndrome: a closer look

June 2, 2026Jun 2, 2026

Last week, KevinMD published my blog titled "The anticoagulant standard of care nobody tested." This week I'll continue with a discussion of patients who may have been harmed by anticoagulants. In 2001, two co-authors and I initiated a systematic review…

Last week, KevinMD published my blog titled “The anticoagulant standard of care nobody tested.” This week I’ll continue with a discussion of patients who may have been harmed by anticoagulants.

In 2001, two co-authors and I initiated a systematic review of “Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism.” The Cochrane Database of Systematic Reviews delayed publishing it until 2006. Because of the delays, Medscape General …

The anticoagulant standard of care nobody tested

May 30, 2026May 30, 2026

In 1997, the LA Times published my article titled "Good Medicine, Fewer Hospital Beds." Writing as an attending internist at a large public teaching hospital, I criticized a decision to spend $900 million on a massive 600-bed replacement facility. My…

In 1997, the LA Times published my article titled “Good Medicine, Fewer Hospital Beds.” Writing as an attending internist at a large public teaching hospital, I criticized a decision to spend $900 million on a massive 600-bed replacement facility. My experience affirmed what federal, state, and county analysts already knew: Resources were poured disproportionately into expensive acute inpatient specialty services, leaving primary care and out-of-hospital services for millions of …

Ecovillages and organic agriculture: a scenario for global climate restoration

January 10, 2026Jan 10, 2026

Eight years ago, motivated by concern for my six grandchildren and future generations, I began a systematic study of climate change through the assessment reports of the Intergovernmental Panel on Climate Change (IPCC). That work led me to focus on a central omission in mainstream climate modeling: The failure to model global conversion to exclusively organic agriculture.

In 2024, the preprint journal SSRN published my scenario to reduce net projected greenhouse …

Accountable care cooperatives: a 2026 vision for U.S. health care

January 7, 2026Jan 7, 2026

As of January 1, 2026, the American health care system is in crisis. People can no longer afford their health insurance premiums or even to afford to pay for any health insurance. Recently, a 62-year-old self-employed friend of mine saw his premiums increased tenfold in a single cycle. I am lucky that I am over 65 and have Medicare insurance as well as a pension from my employment. Millions of …

Conditions and diseases

Are mild hypertension guidelines driven by pharma ties?

January 5, 2026Jan 5, 2026

In the early 2000s, I included "drugs for mild hypertension" in my book, Money-Driven Medicine: Tests and Treatments That Don't Work. By 2007, I proposed a Cochrane systematic review of randomized controlled trials (RCTs) to settle the debate. Cochrane is…

In the early 2000s, I included “drugs for mild hypertension” in my book, Money-Driven Medicine: Tests and Treatments That Don’t Work. By 2007, I proposed a Cochrane systematic review of randomized controlled trials (RCTs) to settle the debate. Cochrane is widely considered the “gold standard” of evidence-based medicine; its reviews can shift global clinical practice and multibillion-dollar drug markets.

In 2012, Cochrane published the systematic review of Pharmacotherapy for …

Conditions and diseases

Methodological errors in Cochrane reviews of anticoagulation therapy

January 4, 2026Jan 4, 2026

My previous KevinMD article discussed a Cochrane Collaboration review that was completed in 2002 but was not published until 2006. This review examined three randomized controlled trials (RCTs) comparing anticoagulants with placebos or anti-inflammatory drugs for venous thromboembolism (VTE). Along…

Along with my two co-authors, I found that across these three trials, anticoagulant-treated patients had six deaths out of 66 patients, compared to only one death out of 60 in the placebo …

The anticoagulant evidence controversy: a whistleblower’s perspective

December 29, 2025Dec 29, 2025

My partner broke her femur in a Zumba class just before Christmas 2025 and had successful surgery. Following successful surgery, physicians prescribed Lovenox (an anticoagulant) and Plavix (an antiplatelet drug), the standard regimen for preventing or treating venous thromboembolism (VTE). However, the intervention proved very risky: She lost three pints of blood into her leg and required a two-pint blood transfusion, direct complications of the Lovenox and Plavix.

Physicians adopted anticoagulants …

Accountable care cooperatives: a community-owned health care fix

December 13, 2025Dec 13, 2025

After the longest government shutdown in U.S. history (one triggered by battles over health care funding) the core issue remains unresolved. Neither political party has produced a durable solution. The Centers for Medicare and Medicaid Services (CMS) projects U.S. health care spending will reach nearly $9 trillion by 2035, consuming 20 percent to 22 percent of GDP. The Congressional Budget Office projects that without significant changes in policy, …

Conditions and diseases

A call to retract the JNC-8 hypertension guidelines

January 4, 2014Jan 4, 20145

JAMA published the long-awaited Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-8 (JNC-8) guidelines December 18, 2013. They recommended blood pressure lowering drug treatment for patients 60 years old and over with systolic blood pressure…

JAMA published the long-awaited Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-8 (JNC-8) guidelines December 18, 2013. They recommended blood pressure lowering drug treatment for patients 60 years old and over with systolic blood pressure (SBP) 150 or higher or diastolic blood pressure (DBP) 90 mm Hg or higher. For patients under 60 years old, they recommended medications for DBP 90 mm Hg or …

Physician voices

Cut hospitalizations to reduce hospital related medical errors

May 25, 2011May 25, 2011

To address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative. Secretary Sebelius referred to a…

Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused by human errors (i.e., preventable), occur about 10 times …

How ACOs creatively destroy fee for service medicine

May 13, 2011May 13, 201138

The U.S. Department of Health and Human Services (HHS) advocates the "creative destruction" of the traditional system of U.S. physicians practicing solo or in small groups operating as small businesses. Republicans and Democrats approve of ACOs in concept. The Affordable…

The U.S. Department of Health and Human Services (HHS) advocates the “creative destruction” of the traditional system of U.S. physicians practicing solo or in small groups operating as small businesses.

Republicans and Democrats approve of ACOs in concept. The Affordable Care Act of 2010 calls for shifting from fragmented care …

Physician voices

The story behind a whistleblower doctor license reinstatement hearing