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The Beta Blocker and Clonidine Protocol

Lesson 6
ACC & AHA Guidelines

9. Risk Reduction Thought Experiments

So what do I suggest? Let me do a thought experiment. I am going to give each of you a choice.

bullet Choice number 1: I am going to give you $10,000 (thought experiment dollars only). You are going to go to a casino of your choice. You will be allowed to do any test you would like on all the slot machines in the casino. You can CT the machine, stress test it, echo, whatever test you want. Then you have to pick the one machine that is going to pay off and bet on it.

Choice number 2: You can have the take from every machine on the floor for one hour.

Now remember, the risk of losing on a slot machine is 3-5% depending on the casino. So the risk is very much like the risk of cardiac morbidity. If you try to find the machine that is going to have an event and then bet on it, you are always going to lose. If you just assume that there is set event rate, and then reduce the set event rate by 50-90% in every patient, you reduce mortality at very low cost.

Do like the casinos do. Bet on everyone. Reduce every patient's risk by 50-90% with BBAC for $1 (oral beta blockers) to $7 (clonidine patch) a patient. See, even the cost of the bet is similar to the one-armed bandits!

How to beat the odds

How does the casino win?
How does the state benefit from the lottery?
Win a little on every bet. Reduce everyone's risk.

Win a little on every bet. Don't try to be clever. Reduce everyone's risk.

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Content by Art Wallace MD PhD
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