 When he was a surgeon at the Cleveland Clinic, Dr. Caldwell Osselstyn published a controversial paper in the American Journal of Cardiology. Heart bypass operations carry significant risks, including the potential to cause further heart damage, stroke, brain dysfunction. Angioplasty isn't much better, also carrying significant mortality and morbidity, and often doesn't work, in terms of decreasing risk of subsequent heart attack or death. So it seems we have an enormous paradox of the disease that is the leading killer of men and women. In Western society, Western civilization largely untreated. The benefits of the invasive procedures are at best temporary, with most patients eventually succumbing to their disease. In cancer, we call that palliative care. Or we just kind of throw up our hands, throw in the towel, and give up actually trying to treat the disease. So why does this juggernaut of invasive procedures persist? Well, one reason is that performing surgical interventions has the potential for enormous financial reward. That's considered one of the barriers to the practice of preventive cardiology, adequate return. Diet and lifestyle interventions loses money for the physician. Although the practice of preventive cardiology is not as lucrative, this article was hoping to nudge cardiologists in that direction by appealing to less tangible benefits. Another barrier is doctors don't think patients want it. Physician surveys show that doctors often don't even bring up diet and lifestyle options, assuming the patients would prefer, for example, to be on cholesterol-lowering drugs every day for the rest of their lives. That may be true for some, but it's up to the patient to decide. According to the official AMA code of medical ethics, physicians are supposed to disclose all relevant medical information to patients. The patient's right to self-decision can be effectively exercised, only if a patient possesses enough information to enable and inform choice. The physician's obligation is to present the medical facts accurately to the patient. For example, before starting someone at moderate risk on a cholesterol-lowering statin drug, a physician might ideally say something like, you should know that for folks in your situation, the number of individuals who must be treated with a statin to prevent one death from cardiovascular events such as a heart attack or stroke is generally between 60 and 100, which means if I treated 60 people in your position, one might benefit and 59 would not. As these numbers show, it's important for you to know that most of the people who take a statin will not benefit from doing so, and moreover, that statins can have side effects, such as muscle pain, liver damage, upset stomach, even people who do not benefit from the medication. I'm giving you this information so you can weigh the risks and benefits of drugs versus diet and then make an informed decision. Get it? I mean, how many physicians have these kinds of frank and open discussions with their patients? Non-disclosure of medical information by doctors, that kind of paternalism, it's supposed to be a thing of the past. Now physicians are supposed to honor informed consent, unless the patient's in a coma or something, or it's an emergency. But too many physicians continue to treat their patients as if they were unconscious. At the end of this long roundtable discussion on angioplasty and stents, the editor-in-chief of the American Journal of Cardiology reminded the participants of an important fact to place it all in context. Atherosclerosis is due to high cholesterol, which is due to poor dietary choices, and so if we all existed on a plant-based diet, we would not have even needed this discussion.