43 Comments

Sub study of REVIVED in Circ last week, looking for differences in all cause death and “aborted SCD” (resuscitated cardiac arrest or appropriate device discharge) also found no benefit with PCI (HR 1.03) Vs OMT. Not sure what could’ve been made of a subgroup of an overall negative trial to begin with. But the effect is impressively null...all day long.

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And yet this important piece of evidence did not change the recommendations for revascularisation in the latest ACC/AHA guidelines for CCS...

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My best friend’s husband just had this done a month ago! New onset CHF. No blockages.

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Would love to hear your analysis of the SELECT trial with Wegovy

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I imagine nobody can answer this question. I took so much junk believing the doctors had an idea of what they were doing, and then the pandemic arrived and it got clear they do not. "Stay Home"..."Do nothing untill you get so bad you need a ventilator" seemed no sensical, independent of having any kind of scientific training. Common sense is a lost currency

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Please DO speculate as to why!

WE do have evidence however that CABG in these cases is better dont we?

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What about the fact that the body is capable of forming collaterals that bypass blocked arteries? You want to help heart patients keep their arteries open? Try high potency cayenne tincture (180K heat units). I know it's against the standard cardiac religion, but for $15 a bottle that lasts 3-6 months, it's well worth experimenting with. It does not hurt anything. Cayenne is a miracle herb. Statins and stents are not.

Once again, the REVIVED-BCIS trial will be ignored. It cuts too deep into the operate-at-all-costs-for-profit model that pervades most of "modern" medicine. Doctors are far too arrogant to ever change. That is why I try everything I can to doctor myself. It is amazing what you can find doing a little research that goes back to the olden days...3-6 decades ago.

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it is so hard to question side effects....I was talking to my doctor the other day and I dispaired. He is so worried to do the best for me that he doesnt question anything, and refuses to argue...I think he believes he needs to show h is sure of himself

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It’s so hard to believe that “fixing blockages” often has no benefit. Damn hard. People are gonna go nuts over this one. Bring popcorn.

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This is a perfect example of the way our medical system ignores powerful evidence to protect highly profitable procedures that don't work. It is all about the money. Congestive heart failure rates are increasing in this country because of our aging population and increases in obesity and diabetes. A Milliman paper says that congestive heart failure generates a third of Medicare spending and is the leading cause of readmissions. Best practice medical treatment for type 2 diabetes lowers hospitalizations for heart failure by 70% over 21 years, yet everyone gets a damn stent and almost no one gets best practice treatment for diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061176/

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What relevance could there be to quality-of-life complaint differentials among the <35% EF cohort?

Given likely comorbidity among a patient cohort weighted toward such vulnerability, how does the flipping of results at the decade-survival point affect the results?

The study results suggest that dual anti-platelet therapy and lipid control seem to become a form of palliative care, given the daily reality of life at an EF of 35%. Perhaps that's the point.

I'll read the study again.

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I have enjoyed this series tremendously. My dad had open heart for a blockage at 42. He is now 76. He has had stents over the years. I sometimes worry if they just stent him...because they do...and it does make me concerned that he may go for a follow up...and be told have a stent...because that's what they do

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Aug 7, 2023·edited Aug 8, 2023

and of course they argue that your Dad would have been dead decades ago if they hadn't done the surgery and stents. Your Dad is proof to them that what they are doing is effective.

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Kind of like claiming almost supernatural powers for vaccines. Oh all these years you've been free of fill-in-the-blank because of the vaccines you took. Yet it's bad manners to suggest all these years you've had a chronic autoimmune problem because of the vaccines you took. Things always seem to cut in favor of interventions, meds or procedures.

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Thank you for this series. It's been fascinating.

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Brilliant job John! I have written about the lack of efficacy of anti-depressants and how that research will not change prescribing patterns. Sad.

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question: Large RCT's are the "gold standard" for approval of new drugs and new "vaccines", right? But are large RCT's required for the latest hack job dreamed up by surgeons? Were RCT's required for open heart surgery that began decades ago? Were they required for other surgical procedures like stents? If not, why not? Why do surgeons get a pass on this?

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I’m glad you tackled this. This has been known for at least 10 years. The idea of treating the heart as plumbing is insane. And insanely profitable.

Yet it is done by the hundreds of thousands or millions. “Good thing we got this in time. That one vessel was 99% plugged up,” the patient hears. Every time.

And this trial is not the only one that has found stents to be pretty much worthless. Here is another from 2007

In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.

https://www.nejm.org/doi/full/10.1056/NEJMoa070829

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I gotta laugh at the 90-99% plugged idea. These arteries may be jammed up to that extent and I wonder why the patient can still be alive. I seriously doubt that in most cases heart attacks are caused by blocked arteries. There is something else at play but to discover the truth might mean the medical people take an income hit.

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