 The history of medicine bounds with false dogmas that were simply assumed, and later, sometimes much too long later, overcome. Like the Women's Health Initiative study, the show that giving women premarin hormone replacement therapy increased the risk of the number one killer of women heart disease, as well as breast cancer risk to boot. Millions of women stopped taking it, and the breast cancer rates came down. Another such reversal of established medical practice is angioplasty and stents for stable coronary artery disease, for which billions are spent on procedures shown unequivocally to offer no benefits. So why are cardiologists still doing them? Researchers did some focus groups and concluded that although cardiologists may believe that they're benefiting their patients, this belief appears to be based on emotional and psychological factors, rather than on evidence. The sense of irrationality surrounding this practice is so strong that the phenomenon has been coined the oculostenotic reflex, like you see are narrowing, and they stent it like they can't even help it. Since the procedure carries some risk, including death, there's an argument that stents should only be used for people who are actively having heart attacks in an emergency or unstable situation. Thankfully, there are now published appropriate use criteria in place to help guide cardiologists, and the good news is that now 82% of stents are reported to be performed in these emergency or unstable situations, so we can disregard that study that showed there's no benefit in stable patients, since now it's almost always done, just in unstable patients like it should be, or at least it's almost always reported that way. There are two ways that physicians could comply with the rules. One is to do fewer unnecessary procedures, which is the whole point, but hey, where's the money in that? The other way to comply is to make unnecessary procedures seem necessary. Wait, are they implying that a doctor would try to game the system by telling a patient that they had much more serious unstable disease than they actually had, so they could carry out the procedure anyway? This is referred to up-coding. Another word for it would be fraud. Researchers found that some of that decline in inappropriate use may indeed be doctors falsely and intentionally misclassifying patients with stable angina as unstable angina, because as soon as those appropriate use criteria went into effect, all of a sudden, there was suspiciously a 4 to 10-fold increase in the rates of stents for acute coronary syndromes like heart attacks. In New York, the proportion of stents labeled as acute, but performed as outpatient procedures increased 14-fold. There's no biologically plausible reason why that would happen, so they were unnecessary procedures, unnecessary cost, and unnecessary patient harm. Harm not only from the risk of getting an unnecessary stent, but also by lying to the patient by exaggerating how bad their heart disease is. At best, this practice damages the credibility of the profession, violates patient autonomy, and puts the patient at risk for complications, and at worse, may cross the threshold into criminal activity. What's the solution? There could be like an independent review panel to protect patients, or we could simply remove the financial incentive to perform more procedures. How many other established standards of medical care are wrong? Who knows? Bloodletting with standard of care for thousands of years. Rigorous questioning of long-established practices is difficult. I mean, there are thousands of clinical trials, but most deal with trivialities or efforts to buttress the sales of specific products. Given this conundrum, it's possible that some entire medical subspecialties are based on little evidence. Ironically, in the case of heart stents, in the landmark courage trial that showed stents were useless for extending life, what did seem to determine longevity was how many risk factors they were able to control. Those that nailed all six by lowering their blood pressure, cholesterol, weight smoking, and improving their diets in activity had five times the survival over the subsequent 14 years than those who didn't. I mean, should we be surprised that angioplasty and stents failed to improve prognosis? I mean, after all, it does nothing to modify the underlying disease process itself. In other words, it doesn't treat the cause. Even if stents helped with symptoms beyond the placebo effect, it would still just be treating the symptoms and not the disease. And so no wonder the disease continues to progress until the patient is disabled and to death. Thus, Dr. Asselstyn wrote, the leading killer of men and women in Western civilization is being left untreated. What is instead being practiced is palliative cardiology, non-treatment of heart disease leading to disease extension and frequently and eventually fatal outcome. Deaths by the plane load every week, just regarded as unfortunate rather than a national preventable tragedy. It's just no one ignoring this dairy, oil, and animal product-based illness. We are wedded to provide futile attempts at temporary symptomatic relief rather than the cure. Thankfully, we are on the cusp of a seismic revolution in health, not another pill, a procedure or operation, but instead treating the underlying cause of heart disease with whole food, plant-based nutrition. Perhaps the mightiest tool medicine has ever had in its toolbox. To get there, we need to fight a key nutrition deficiency in education. 90% of cardiologists, 90% reported receiving no or minimal nutrition education during their cardiology training, leaving fewer than 1 in 10 confident in their nutrition knowledge. So maybe it's a good thing that most spend three minutes or less discussing nutrition with their patients, only one in five themselves, even eight five servings of fruits and veggies a day. Thankfully, this life-saving information is slowly but surely getting out there. Medical education is focused on being the ambulance at the bottom of the cliff rather than a fence at the top. Money talks, very little money promoting eating broccoli and going for a walk. I was so eager to see the citation they used for that and was so honored.