How to treat Wang Dongyue's theory of vascular stent?

I don't know who intercepted this video of Wang Dongyue's "scholar" speech and put it in a circle of friends. It seems that quite a few people began to forward it, and later my father handed it to me, but I don't want to fully accept the concept of "scholar" in Wang Dongyue. I insist that this video is just a "popular science", which is a little resonance caused by people's doubts about the medical status quo.

No matter what kind of person "scholar" is, no matter what others say about his philosophical views, I just want to briefly analyze what this video in my circle of friends says. In order to save everyone time watching the video and facilitate the analysis of the video content, I spent half an hour listening to all the contents of this five-minute video sentence by sentence and coding it on the computer:

Moreover, small hospitals don't go, and they all crowd into big hospitals to seek as powerful medical intervention as possible. But everyone should know that medical intervention is very dangerous. Please remember that the modern medical system is a commercial system. The medical system is a commercial system. You can't blame it. You are also a member of the business system. Everything has to make money. How can you ask hospitals and doctors not to make money? Let them all starve to death? But the business system will deviate from its goal. So when you go to the hospital after a serious illness and the information is asymmetric, you may suffer some serious injuries that you don't realize. Let me give you an example: there is a method for treating coronary heart disease, which is called cardiac stent surgery. It is coronary artery stenosis-the so-called coronary artery is the blood vessel that nourishes the heart-coronary artery stenosis, and you have a slight heart discomfort, so you went to the hospital. When you go to the hospital, the doctor will give you an angiogram-coronary angiography, so that you can see for yourself. You are lying in bed with the screen in front of you. Tell you what: You see, your blood vessels have narrowed by 75%. As soon as I heard it, 75% were blocked. Then he said stent, you can't even get out of bed, so he started to plug you with stents. The more you plug, the better. Because a bracket costs two or three hundred, selling it to you is two or three thousand. You should know that all of us have gradually hardened our blood vessels since we were four years old. By the time you are 50 or 60 years old, there is no one without sclerosis and no one without local stenosis. The intima of the blood vessel is very smooth. As we all know, blood is liquid, but it may become solid at any time. For example, if you are injured, blood will solidify in this place, changing from liquid to solid, blocking blood flow and preventing blood loss. Why? Because there is a set of coagulation mechanism in blood, which is divided into twelve steps and positive feedback circulation, the liquid blood quickly becomes a solid blood clot. This change is required, that is, the smoothness of the blood vessel wall is destroyed, such as injury, and the blood immediately collides with this place, so the platelet-releasing factor and the blood twelve-ring factor act layer by layer to coagulate the blood immediately, so the smoothness of the blood vessel wall is very important. Once the smoothness of the blood vessel wall itself is destroyed, the blood will coagulate immediately. Please think about your next bracket, foreign body. No matter how smooth it is artificially made, it is impossible to be as smooth as vascular endothelium. Moreover, it is a foreign body, and the immune system will reject it, so it will cause great danger. So once the stent is removed, in general, about 15% people will have rejection, which will lead to the complete rejection of this blood vessel. Even if you are not in this 10% to 15% population, taking drugs and anticoagulants for life means that the coagulation process is disturbed. You must take this medicine for life, otherwise it is dangerous. You know, you have had arteriosclerosis since you were four years old. The ancients finished at the age of 39, so they couldn't feel this thing. Today, you work so hard that no one can escape. Because it is a long natural aging process, the blood vessels are narrowed by 75%, most people have no symptoms and feelings, and the downstream organs and muscles will not be ischemic and hypoxic. It will progress to 80%, 85% and 90%, and you will begin to have symptoms gradually; It will take about twenty, thirty or even thirty years to get there. And you don't understand this, 75% he has scared you, and then the brackets are put in. You could have put this bracket for 20 years. You gave it to the hospital 20 years in advance, so please keep it for yourself. Therefore, it is a very important concept to see a doctor, treat a serious illness, treat conservatively as much as possible, and be alert to medical intervention as much as possible. It is easy to see that the central point of the whole video, as marked in two bold sentences, can be summarized as follows: If you are seriously ill, you should take conservative treatment, otherwise you may suffer some serious injuries that you are not aware of. Then, the "scholar" took "heart stent surgery" as an example to demonstrate. The overall logic is: because the medical system belongs to the commercial system, the goal of hospitals and doctors is not only to save lives, but also to make money. Therefore, in the face of serious diseases, we should try our best to give up medical intervention and medical intervention and adopt conservative treatment.

The scholar used the words "as far as possible", "as far as possible" and "possible" in the key sentences to express his views very cautiously and skillfully, which made people feel that what he said was very reasonable.

Text: I checked the information and made the following discussion.

1. Seventy-five percent of coronary artery stenosis and arteriosclerosis:

HowNet Encyclopedia explains coronary artery stenosis like this:

The picture is from China HowNet Encyclopedia Coronary Angiography and Clinic. What is the value of 75%?

According to the current international standards, the degree of coronary artery stenosis determines whether patients receive interventional therapy. If the CAG (coronary angiography) stenosis degree is 40%-70% or 50%-70%, it belongs to borderline coronary artery disease, then 75% of coronary artery stenosis already belongs to coronary artery disease. Coronary angiography will inevitably underestimate the degree of stenosis of the lesion.

The degree of lumen stenosis can be expressed in four grades: grade ⅰ: lumen stenosis below 25%; Grade ⅱ: lumen stenosis 26 ~ 50%; Grade ⅲ: lumen stenosis 51~ 75%; Grade ⅳ: lumen stenosis above 75%.

The picture comes from the analysis of related influencing factors of coronary borderline disease. The picture is from China HowNet Encyclopedia, Coronary Angiography and Clinic. In the clinician's handbook:

It can be seen that paroxysmal chest pain or chest discomfort can be diagnosed as angina pectoris after 75% coronary artery stenosis is examined.

Well, in the face of such coronary artery disease, this "scholar" said this:

Vascular stenosis is 75%, most people have no symptoms and feelings, and there will be no ischemia and hypoxia in downstream organs and muscles. It will progress to 80%, 85% and 90%, and you will begin to have symptoms gradually; It will take about twenty, thirty or even thirty years to get there. Coronary atherosclerosis leads to coronary artery stenosis, which in turn leads to myocardial problems and then develops into coronary heart disease. Coronary heart disease is divided into chronic myocardial ischemia syndrome and acute coronary syndrome. The "scholar" didn't say what kind of person was in the case.

So I continued to look at the subordinate classification of two cases in the Guide to Rational Drug Use for Coronary Heart Disease (Second Edition) (the explanation of evidence-based medicine composed by the Expert Committee of Rational Drug Use of the National Health and Family Planning Commission and the Chinese Pharmacists Association on 20 13- 18), and finally determined the general principles of the revised guide and the core questions to be answered in the new guide after three joint meetings):

Chronic myocardial ischemia syndrome is divided into three representative diseases, and acute coronary syndrome is divided into three representative diseases. Well, it seems that what the "scholar" said seems to be the recessive coronary heart disease classified by chronic myocardial ischemia syndrome in the Guide to Rational Drug Use for Coronary Heart Disease (2nd Edition).

Then look at what the clinician's handbook says:

Well, what if it is really a hidden heart disease? Preventive and therapeutic measures are outlined in the clinician's handbook:

Occult coronary heart disease is usually asymptomatic, but it is easy to quickly transform into other types of coronary heart disease or myocardial infarction or sudden death, requiring drug treatment or interventional therapy. The specific treatment plan always depends on the actual situation. It is definitely not a disease that can drag on for 20 or 30 years, and gradually show symptoms when it is narrow and successful.

The Scholar also said:

You know, you have had arteriosclerosis since you were four years old. The ancients finished at the age of 39, so they couldn't feel this thing. Today, you work so hard that no one can escape. Because it is a long natural aging process, blood vessels are narrowed by 75%, and most people have no symptoms and feelings ... "Angiosclerosis begins at the age of four." I don't know where this "four-year-old" comes from, but it ages with age-degenerative diseases do exist:

For atherosclerosis and atherosclerosis, some people say this:

With the increase of age, arteriosclerosis is a normal aging phenomenon. If there are no symptoms, we don't need treatment. However, the aging phenomenon is "everyone can't escape", and getting sick (coronary heart disease) because of this aging phenomenon is not "everyone can't escape". The Scholars quietly established an equation in ambiguity: aging phenomenon = disease, which is obviously not true. Your living habits will also affect the speed of aging. If you keep good living habits, you won't have any symptoms even if you age slowly. If the vascular stenosis reaches 75% and you feel unwell and need to go to the hospital, then it is not called "asymptomatic" and needs treatment.

We should not be led to the idea that "we will get old sooner or later, and we will get sick anyway". Seventy-five percent stenosis is nothing, and there is no difference between cure and cure. As long as there is nothing serious, we can postpone it. "

2. Anticoagulants and stents:

(1) What is coagulation? The "scholar" said this in the video:

The intima of the blood vessel is very smooth. As we all know, blood is liquid, but it may become solid at any time. For example, if you are injured, blood will solidify in this place, changing from liquid to solid, blocking blood flow and preventing blood loss. Why? Because there is a set of coagulation mechanism in blood, which is divided into twelve steps and positive feedback circulation, the liquid blood quickly becomes a solid blood clot. This change is required, that is, the smoothness of the blood vessel wall is destroyed, such as injury, and the blood immediately collides with this place, so the platelet-releasing factor and the blood twelve-ring factor act layer by layer, and the blood immediately coagulates ... To sum up, it is: "Because the smoothness of the blood vessel wall is destroyed, the blood coagulates."

China HowNet Encyclopedia explains this:

Well, it's the rupture of the blood vessel wall that causes blood coagulation. But it seems that it can be understood that "scholar" only expressed the concept of "vascular wall rupture" in a popular way of "vascular wall is not smooth", so he went on to check the information:

(2) Does coronary heart disease need "anticoagulant"? The clinical situation is more complicated, so let's make do with the statement in the Guide to Rational Drug Use for Coronary Heart Disease:

Drugs for treating coronary heart disease can be divided into three categories: drugs for improving ischemic symptoms, drugs for preventing myocardial infarction and improving prognosis, and related Chinese patent medicines for treating coronary heart disease. Antiplatelet drugs and anticoagulant drugs are divided into drugs to prevent myocardial infarction and improve prognosis.

(3) Then why take "anticoagulant"?

The video says this:

The intima of the blood vessel is very smooth. As we all know, blood is liquid, but it may become solid at any time. For example, if you are injured, blood will solidify in this place, changing from liquid to solid, blocking blood flow and preventing blood loss. Why? Because there is a set of coagulation mechanism in blood, which is divided into twelve steps and positive feedback circulation, the liquid blood quickly becomes a solid blood clot. This change is required, that is, the smoothness of the blood vessel wall is destroyed, such as injury, and the blood immediately collides with this place, so the platelet-releasing factor and the blood twelve-ring factor act layer by layer to coagulate the blood immediately, so the smoothness of the blood vessel wall is very important. Once the smoothness of the blood vessel wall itself is destroyed, the blood will coagulate immediately. Please think about your next bracket, foreign body. No matter how smooth it is artificially made, it is impossible to be as smooth as vascular endothelium. Moreover, it is a foreign body, and the immune system will reject it, so it will cause great danger. So once the stent is removed, in general, about 15% people will have rejection, which will lead to the complete rejection of this blood vessel. Even if you are not in this 10% to 15% population, taking drugs and anticoagulants for life means that the coagulation process is disturbed. To sum up, it is: "Because the stent is not smooth enough, the blood will coagulate and anticoagulant is needed"; But the facts do not seem to support his statement:

First of all, let's understand what thrombosis is:

Thrombosis is caused by blood coagulation in the heart or blood vessels.

Different books have their own explanations about the causes and conditions of thrombosis:

The explanation of thrombosis in the Dictionary of Clinical Drugs is more clear in the Dictionary of New Gerontology:

It can be seen that the formation of thrombus is a dynamic process influenced by many factors, including but not limited to the damage of cardiovascular wall, and the smoothness of vascular wall mentioned by scholars is destroyed. Once the smoothness of vascular wall itself is destroyed, blood will react immediately in coagulation state ... "Can't be equated, but scholars involve anticoagulant drugs."

We need to prevent thrombosis and vascular embolism, so we use antithrombotic drugs:

These include antiplatelet drugs and anticoagulant drugs:

For antiplatelet drugs, modern medical dictionaries explain it like this:

Several antiplatelet drugs are listed in the portable clinical medication guide. Let's look at their signs:

For anticoagulants, the Cardiology Dictionary explains this:

The use of anticoagulants in anticoagulation therapy is also strict, so it will make people "eat for life" casually:

Anticoagulants mentioned by scholars should actually refer to antithrombotic drugs. Taking these drugs is to reduce the possibility of thrombosis and arterial embolism, and to reduce the probability of myocardial reinfarction and sudden death. Or thrombosis with arteriosclerosis leads to blood coagulation and platelet activation and aggregation, which may form thrombosis. In order to avoid local blood circulation disorder caused by thrombus blocking vascular lumen, drugs need to be taken.

Simply put, these drugs are mainly used to prevent intravascular thrombosis, which is not directly related to whether the stent is unobstructed.

So I guess what "scholars" may want to say when they associate anticoagulants with stents is actually in-stent restenosis (ISR):

The direct damage to the vascular wall after stent implantation will lead to restenosis in the stent, and thrombosis may occur in the stent after stent implantation. In order to prevent restenosis and thrombosis in the stent, anticoagulants and antiplatelet drugs are really needed, but unlike what scholars have said, this has nothing to do with the patency of the stent itself;

Regarding the probability of in-stent restenosis, here I would like to quote the contents of the article "Mechanism Understanding and Prevention of in-stent Restenosis of Coronary Artery" written by Ge Junbo and Yang Wei from the Department of Cardiology of Zhongshan Hospital affiliated to Fudan University and Shanghai Institute of Cardiovascular Diseases in 2006:

In the past 20 years, through the continuous exploration of the vast number of scientific workers, the prevention and treatment of restenosis has achieved one after another. In the early stage of coronary intervention, the incidence of restenosis caused by simple balloon dilatation was 50%, and the application of bare metal stent reduced the restenosis rate by 20% ~ 30%. The application of drug-eluting stent further reduced the restenosis rate to 5% ~ 10%. It is believed that in the near future, the restenosis rate will be further reduced and local thrombosis will occur. So I don't know where the data in the mouth of "scholars" came from.

(4) How long do you need to take "anticoagulant"?

View video content:

Even if you are not in this 10% to 15% population, taking drugs and anticoagulants for life means that the coagulation process is disturbed. You must take this medicine for life, otherwise it is dangerous. Let's go back to the Guide to Rational Drug Use for Coronary Heart Disease.

Remember that coronary heart disease is divided into chronic myocardial ischemia syndrome and acute coronary syndrome? Treatment strategies are given in the Guide to Rational Drug Use for Coronary Heart Disease:

The first is the treatment of st-segment elevation myocardial infarction in acute coronary syndrome:

Treatment of ST-segment elevation myocardial infarction (STEMI) in acute coronary syndrome (in which: PCI (percutaneous coronary intervention) is the general name of a kind of methods used in "coronary intervention").

Among them, antithrombotic treatment schemes are:

So the treatment strategy of unstable angina pectoris and non-ST-segment elevation acute coronary syndrome:

Among them, antithrombotic treatment schemes are:

Zoom in here to see clearly: whether it is PCI (percutaneous coronary intervention), CABG (coronary artery bypass grafting) or simple drug treatment, all patients should take anticoagulant and antithrombotic drugs such as A (aspirin), C (clopidogrel), P (prasugrel) and T (Grelleaud) for at least one month to at least one year.

Finally, the treatment principles of chronic stable angina pectoris:

Among them, antithrombotic treatment schemes are:

Huh? "Aspirin should be taken for life" appeared here, and it also appeared in "Clinical diagnosis and treatment of modern cardiovascular diseases":

Are you familiar with aspirin?

The description of aspirin in commonly used drugs, the description of aspirin in general practitioner's drug manual and the description of aspirin in practical drug manual, but please pay attention to the function of aspirin-inhibiting platelet aggregation. Aspirin is an antiplatelet drug, not an anticoagulant drug, which has nothing to do with "no matter how smooth it is artificially made, it is impossible to have the smoothness of vascular endothelium".

Aspirin is described in "Common Drugs for Secondary Prevention of Coronary Heart Disease" under "Summary of Common Drugs for Coronary Heart Disease" in the Guide to Rational Drug Use for Coronary Heart Disease:

In the medical rehabilitation guide, the contribution of aspirin to the treatment of cardiovascular diseases is written as follows:

The treatment of coronary heart disease should be long-term, and taking medicine is for antithrombosis, not because of stent implantation. Even if no stent is implanted, you need to take medicine for a long time and insist on cultivating good living habits to treat coronary heart disease.

However, it is undeniable that patients need to take anticoagulant drugs for an additional period of time during the perioperative period after interventional therapy:

(5) Under what specific circumstances should the scaffold be erected?

Let's first recall what a doctor in the mouth of a "scholar" does:

When you go to the hospital, the doctor will give you an angiogram-coronary angiography, so that you can see for yourself. You are lying in bed with the screen in front of you. Tell you what: You see, your blood vessels have narrowed by 75%. As soon as I heard it, 75% were blocked. Then he said stent, you can't even get out of bed, so he started to plug you with stents. The more you plug, the better. According to the "coronary heart disease" provided by China HowNet, there is a clear discussion:

The doctor in the "scholar" example did not make any mistakes in the first angiography, and did find the problem of coronary artery stenosis in the patient; Then the question of whether to build scaffolding can only be left to everyone to judge for themselves:

If talking about toxicity without dosage is hooliganism, then talking about treatment without personal details can be said to be streaking.

(6) Will scaffolding cause rejection?

Look at what this "scholar" said:

Once the stent is removed, in general, about 15% people will have rejection, which will lead to the complete rejection of this blood vessel. Rejection is a concept in organ transplantation ... meow? Meow? Meow? If the gallows are organs, I can't help it.

But ... it's too hard to suddenly scrap a blood vessel. That scholar is a werewolf.

(7) What are the complications of stent implantation?

Since it is a "rectification", there must be risks. Discuss some complications of PCI in minimally invasive hypertension surgery, among which stent thrombosis is related to video content:

(8) Which is better, stent implantation or drug therapy?

This problem is also mentioned in Rehabilitation Therapy of Coronary Heart Disease with Integrated Traditional Chinese and Western Medicine:

Everyone's situation is different. According to different situations, stent implantation and drug treatment have their own advantages and disadvantages. Everyone also has the right to choose what kind of treatment to receive.

"Scholar" is really eloquent. First, the cause of blood coagulation is changed to the concept of "smooth blood vessel wall", and then the "not smooth enough" hat is buckled on the head of the stent, so that the stent carries the pot of "taking anticoagulant for life". The "scholar" chose the restenosis point in the stent to enlarge from the consequences of stent implantation, saying that interventional therapy for occult heart disease with 75% coronary artery stenosis was nothing to find, and finally pointed the finger at those hospitals and doctors, thus completing an example demonstration.

Of course, I'm not a clinical student. I can only find these theoretical materials to distinguish right from wrong for everyone. The clinical situation is so complicated that doctors can't treat people just by reading manuals and guides. The question of "whether to intervene in treatment" is implemented in different situations for everyone, and people are different and cannot be generalized.

3. Hospitals and doctors: The descriptions of hospitals and doctors in the video are as follows:

The modern medical system, please remember, is a commercial system, but its target information will be biased and asymmetric. You had a slight heart discomfort, so you went to the hospital. He said that if you can't even get out of bed, he will start inserting stents for you, and there are many. It costs 200,000 to 300,000 to plug as many stents as possible. If you don't understand this, his 75% has scared you. Then you put the stent in and give it to the hospital 20 years in advance, which saves you your own trouble. After taking these short sentences out of the video, you can obviously feel some feelings of "hating doctors" or "suspecting doctors": from the hospital's point of view, because the modern medical system is a commercial system, it wants to make money, for example, it will blackmail you to make money with "information asymmetry"; From the patient's point of view, it is the patient who is scared by only 75% because of "information asymmetry" and then gives the money to the hospital.

This reminds me of how Grindelwald incited others to become his followers.

I don't know what the cost of a stent is, but does the stent implantation cost include the hospital fixed equipment such as blood pressure monitoring, ECG monitoring and X-ray fluoroscopy, the operation expenses of doctors in various departments, the stent and its auxiliary materials (guide catheter, guide wire and balloon) for establishing the delivery track, and the expenses of anticoagulants and anesthetics? Does the sentence "scaffolding costs two or three hundred dollars and I will sell it to you for two or three thousand dollars" ignore the value created by other people and things? Is it irresponsible speech deliberately concealed to achieve the purpose of speaking?

4. Finally,

The "scholar" in this video is really a smart card. He skillfully expressed the central idea as "conservative treatment of serious illness" Here, serious illness is understood as a life-threatening disease, and conservative treatment is understood as a low-risk and stable treatment. At first glance, there is nothing wrong with it. After all, this is his personal unique view on medical treatment. The phenomenon of "random stent" may have occurred or appeared, but when he described this example of "heart stent", he still left many loopholes. It is not difficult to see that he deliberately ignored or covered up some facts in order to better demonstrate. Carefully scrutinizing his logic that "because the medical system belongs to the commercial system, the goal of hospitals and doctors is not only to heal the wounded and rescue the dying, but also to make money, so in the face of serious illness, we should try our best to give up medical intervention and medical intervention and adopt conservative treatment", so the hospital can't let him make money from me, which can arouse high resonance. Such a statement is easy to convince people who have never known it.

The most difficult thing to distinguish is the intertwined language of truth and falsehood, and the most difficult thing to refute is the statement that it is not absolute, not completely positive or negative.

Listen to the video as a whole and see the article as a whole. It can't be said that his central point seems reasonable. So all his statements and all the argumentation processes are correct, right?

If someone writes an article, there is a paragraph praising the quality of Guan Yu in the Romance of the Three Kingdoms, so he writes: "Guan Yu is loyal and loyal. For example, in order to avenge his green brother Jia Baoyu, he took his golden cudgel and fought Ximen Qing for 300 rounds, killing all the adulterers and prostitutes. " How do you comment on this passage? Some people only read the first sentence, which makes sense, and they can also learn from this passage that Guan Yu has the quality of "righteousness", which is not wrong; But let me talk about my feelings: Guan Yu is loyal to loyalty and attaches importance to friendship. This is true, but the examples cited are too wrong. First of all, we should deduct points from this example. Joking is not nonsense, and adaptation is not random. Secondly, we find that the author has studied four classic novels before, but he can still write such examples. It can be seen that he didn't do enough homework before writing an article, and he didn't appear to be responsible for what he wrote, which reduced his impression of the author. (3) Finally, think about why the author wrote this way. If he doesn't know that this example is wrong, he just wants to explain the quality of Guan Yu. What does he want if he knows that this example is wrong?

The video of "Scholar" is to confuse right and wrong or is incomplete, so I won't say that what he said is totally unreasonable. But if we want to talk about the problems of the medical system, wouldn't it be good to discuss them with those who are in or can influence the medical system? As it happens, the audience of the "Scholar" video is ordinary people, so I want to ask, isn't it common for doctors to think twice before choosing surgery? Why do "scholars" emphasize this issue in different ways? Repeating the connection between "business" and "medical care" in everyone's ears like this will not only provoke the relationship between doctors and patients, but also benefit the society. Are fewer people cheated by doctors? Or can we rebuild the "ideal" medical system by overthrowing the hospital system together? No, he is a philosopher. Of course he won't think so simple.

Answer the question: What do you think of Wang Dongyue's theory of vascular stent?

I dare not judge the correctness of the "vascular stent theory". I don't know what to say in the whole lecture, so it's not easy to comment; However, the "vascular stent case" in the video has obvious loopholes. I can only hope that people who have watched the video will use Wang Dongyue's "stent case" less to illustrate the commercial purpose of the medical system.

From the perspective of "scholar", he is not a bodhisattva who helps the world. He gave such a lecture for a purpose. In his words, he is also a member of the business system. Since it is a commercial system, his goal will be biased. What he said makes people feel reasonable and resonates, so he can gain fans. Then what "commercial" action he will have next is unknown.

From the audience's point of view, it is most important to gain something from the lecture. What I can learn from this video varies from person to person. Anyway, after watching the video, I feel that I have nothing but "be careful when choosing surgery in the face of serious illness". I regret it even more after I accidentally coded these words. This video is not worth it.