 Put in stark terms, cardiovascular disease claims one American life every 39 seconds. And for most heart attack deaths, you just keel over. Sudden cardiac death is the first manifestation of coronary heart disease for the majority of individuals, particularly among women. So for many of these sudden death victims, their first indication of the presence of heart disease was their demise. They didn't even know they had heart disease. That's why an ounce of prevention is worth way more than a pound of cure because there is no cure for dead. But that's why the prevention of sudden cardiac death remains such a major public health challenge, because most people don't even know they're at risk. But we've known them for over a half century, when we first started autopsy and young servicemen who died in the Korean War that coronary heart disease begins in our youth, even among young children. So business as usual is simply not going to yield the improvements necessary to radically improve the cardiovascular health of the United States. But the good news is a low-risk lifestyle, not smoking, exercising regularly, having a prudent diet, and maintaining a healthy weight, may be able to wipe out the vast majority of risk for sudden cardiac death. So the time is now long overdue to start aggressive, preventive cardiovascular disease programs in our schools, our homes, our worksites. How about starting in our hospitals? A significant percentage of hospital surveys had fast food restaurants inside them with crispy cream topping the list. Brilliant marketing, given that families surveyed in hospitals with McDonald's were twice as likely to think McDonald's was healthy. After all, they let it in a hospital. But what about food served in hospital cafeterias themselves? Are they much better? 384 entrees were analyzed at 14 children's hospitals in California and only 7% could be classified as healthy. And just in case someone accidentally picked the rare healthy option, 81% of eating venues in children's hospitals made sure to have junky impulse buys like ice cream cookies and candy near the checkout register. And 38% had signs that explicitly encouraged unhealthy eating. Why would they do that? If you ask hospital cafeteria managers that exact question why they don't tend to follow nutrition standards, why nutrition is not a top priority, it's the same answer why unhealthy food is sold anywhere else. The pressure to generate profit, increased emphasis being placed on running a hospital food service department as a profit center, a bigger and bigger profit center. It's such a metaphor for our sickness care system in general where healthy treat the cause approaches are eclipsed by the pills and procedures that bring in the most money. Well, what do you expect from the private sector? But public hospitals don't seem much better. A 2019 analysis of veterans hospitals found that all VA hospitals contain vending machines providing a majority of soda, candy, and junk foods that directly conflict with our government's own healthy food choice recommendations such that ironically hospital visits could theoretically promote worse health. This raises the question why any soda or candy machines are available at our VA hospitals. Are we trading the health of our veterans for profits? Maybe it's time to ban junk food on hospital premises. On daily rounds, it's appalling to see patients gorging on potato chips, candy, soda, or the very foods that may have contributed to their admission in the verse play. Obscene to see fast food franchises on site, legitimizing the acceptability and consumption of such foods in the daily diet. The obesity epidemic represents a public health crisis, but it's a public health scandal that by legitimizing junk food, hospitals have themselves become a risk factor for diet-related disease. Maybe it's time to stop selling sickness in the hospital. What message do residents receive when they are fed pizza and soda pop at grand rounds on obesity? We need a healthcare system with more hypocrities and less hypocrisy.