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.
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
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!