Constantly Re-Working the protocols on the Photon Counting CT scanner People usually think that you put a patient in the scanner and after a few runs the protocols is done and you start working like it's a car. It's not. The work is basically never ending and after many years of working on Photon Counting CT scanners I am still changing and tweaking the machine integrating experience, new applications, and research potential. Having at your disposal hundreds of parameters to modify is a great advantage if you know what you are doing and you how to leverage them. This is part of the constant job of a PCCT super-user.

Questo è un mio nuovo paziente: Steve Kaplan @ROIdude Ci siamo conosciuti online nel mezzo delle mie discussioni su TAC del Cuore e Photon Counting CT. Ha appena finito di scrivere un libro che a breve sarà disponibile online e su Amazon da Ottobre e dove parla anche di me. Ora si può già pre-ordinare l'audio book: amazon.com/dp/B0HHTJLGRJ?lv=…, Naturalmente il libro e l'AudioBook sono in inglese. Il libro parla della sua storia e delle sue coronarie con una immersione in questo mondo da paziente che voleva capire e risolvere un problema importante che hanno moltissimi altri pazienti. E' venuto dalla West Coast degli Stati Uniti a Milano al Centro Diagnostico Italiano per risolvere un quesito importante e difficile sulle sue coronarie per completare il suo percorso e vedere se le sue intuizioni erano corrette. Ovviamente con la tecnologia Photon Counting ❤️. Il Libro si intitola: "The Stents I didn't Get" (Gli stent che non mi sono messo) e già da qui si può intuire in che area si sviluppa la sua storia. In seguito vi racconterò/racconteremo più dettagli. Stay Tuned.

The patient-media twelve: The white coats patients quote between visits and why ApoB is bad for their business. I had Grok analyze X and the youtubes and websites of these 12 influencers to learn how they generate revenue, their positions on LDL and apo B and if they even practice medicine. I followed these influencers for years and have either interacted with these "experts" or even had patients consult with them before I learned about their grift. I used to search for physicians online who would tell me I could ignore LDL. I have the physique. I am insulin sensitive. Triglycerides look great. I wanted the fantasy to be true. It was a good hypothesis. It has failed in front of me. Patients now walk in already subscribed. They are quoting a short list of doctors, a Harvard-Oxford YouTube channel, an engineer, and a fasting cardiologist with a million subscribers. Below is that list, what they actually sell, and the step that pays. This is a map of the library. It is not a claim that every person on it says “LDL never causes disease.” Some are more careful than others. Patients do not hear the asterisk. Jack Wolfson @DrJackWolfson— The Paleo Cardiologist, Natural Heart Doctor. Virtual protocols, coaches, supplements, Costa Rica based. Public line: statins fail, LDL is not the enemy. My clinic line is worse: a patient after a stroke told to stop his meds after paying the “natural heart doctor” $7,000. Aseem Malhotra @DrAseemMalhotra— A Statin-Free Life. The book in the waiting room. The message: we over-statin low-risk people. The problem? Cumulative apo B exposure over a lifetime generates the plaque. Most of these influencers ignore this and latch onto things like the PREVENT score that estimates risk in the next 5 years. Leap patients hear: I don’t need the pill. Philip Ovadia @ifixhearts— surgeon plus cash-pay metabolic practice. No clean public sticker. I had a patient who did a consult with him for a “carnivore diet” then offered again $7,000 in coaching. Thousands of dollars to hear eat-for-metabolic-health, then my patient went on for a triple bypass anway.📷 Tro Kalayjian @DoctorTro— Toward Health telemedicine. Real visits, CGM, advanced lipids. He professes “LDL is a lie.” He still sits in the neighborhood patients use as permission to stay diet-first as if avoiding carbs magically protects against heart disease based off small studies and cherry picked LMHR and keto case studies. I’ll grant him that he actually manages patients and carries medical liability for what he does. Unfortunately his rhetoric affects others and patients will believe him thanks to his MD and white coat and suffer the consequences later. But at least he manages some patients. The rest? Not so much. They sell views and supplements and courses and hide behind “not medical advice” disclaimers. The LMHR story Nick Norwitz @nicknorwitz— MD-PhD, 1.3 million on YouTube, paid newsletter. Public LDL 574 on keto. Patients hear phenotype = safety. He often says the long-term risk is unknown. That sentence is not what gets clipped. Dave Feldman @realDaveFeldman— engineer, not a physician. Named lean mass hyper-responder. Crowdfunded scans. Built the idea Norwitz scaled. Paul Saladino @CarnivoreMD— Heart & Soil organ supplements sells millions, Costa Rica house, psychiatry training. The diet is the SKU. “Maybe treat the ApoB” is a refund risk. Doesn’t carry liability and doesn’t manage patients. The ambient feed Ken Berry @KenDBerryMDand Anthony Chaffee @anthony_chaffee— short-form everywhere. Proper Human Diet / Plant-Free MD. Patients binge this between visits. No consult required. @SBakerMD Shawn Baker — Revero platform, carnivore athlete-surgeon brand. Meat-heals. That is a subscription machine, not the $8,000 MRI menu. Sean O’Mara @DrSeanOMara— publishes the luxury tier: $8,000 Alpha Start, $50,000 leadership protocol. If visceral fat falls on MRI, LDL becomes a footnote. Pradip Jamnadas. Orlando interventional cardiologist who still puts stents in. YouTube product is fasting. Patients use the lecture to delay the medicine he would still use in the lab. These twelve make money selling the LDL and apo B don’t matter grift. Conservaties are more at risk for this grift. Scorned during the scamdemic with lockdowns and vaccine mandates, the distrust for authority and pharma is highest among the Right. The diet often works on what they can feel: weight, glucose, triglycerides, reflux, energy. Those improvements are real. The sale is the next sentence: therefore ApoB can wait. Statin fear is pre-loaded. Muscle aches, an uncle who infarcted on Lipitor, a Malhotra clip, institutional distrust. A cardiologist saying “don’t start it” is a relief purchase. Then identity. Leaving the tribe means the physique was not immunity. I know that sentence because I lived it. What is true, and the step that is not Metabolic disease is neglected. Ultra-processed food is a disaster. The keto/carnis have willfully misinterpreted the data and latched onto the 5 year PREVENT score and studies that run 5 years on a drug that lowers lipids showing minimal decrease in mortality. The reality? People aren’t a 5 year study. Apo B exposure is a lifetime of risk. Plaque builds over 50 years. Apo B doesn’t care if I have visible abs (which I do). Lean people on keto really can run LDL into the 300s–500s with high HDL and low triglycerides. Visceral fat is a real risk marker. Fasting can lower insulin.None of that makes ApoB optional. ApoB-containing particles cause atherosclerosis. Familial hypercholesterolemia. Mendelian randomization. Statins, ezetimibe, PCSK9 inhibitors. Same direction every time particle number falls. “LDL only matters if small and dense” is false. “If insulin is low, ApoB cannot deposit” is false. I used to believe the second one. I checked. It did not hold. LMHR is a phenotype, not a shield. “We lack a 30-year carnivore RCT” is true. “Therefore do not treat a causal risk factor” is not how you practice after you have watched plaque declare itself. A calcium score of zero in a 35-year-old is not clearance. Soft plaque exists. Time exposure under the curve of apo B matters. Secondary prevention is not a podcast topic. After a stroke or an infarct, stopping proven therapy is not root-cause courage. It is preventable recurrence. If the product is eat more meat, skip the statin, buy the consult, or subscribe to the letter, treating ApoB makes the product look unnecessary. They are rarely the physician of record when someone gets an MI or CVA. Bios say educational content only. The house is in Costa Rica. The surgery is locums. The complication lands in a shop like mine. What I tell the patient? You can keep the meat. You can keep the fasting window. You can chase visceral fat. You can refuse a statin and use ezetimibe or a PCSK9 if the fear is the drug class. You cannot buy an exemption from particle-years with a white coat on YouTube. I wanted that exemption. I looked for the same twelve. The data in the chair in front of me did not care what I wanted.

New York City's mayor, Zohran Mamdani, wants the city to open its own grocery stores. Mamdani thinks he can run grocery stores better than Kroger. We analyze companies for a living, and grocery is one of the most difficult businesses in the world. Unless it's canned food, your inventory goes bad. These companies run on 2% or 3% margins. The only way the government can run grocery stores better is with huge subsidies. At the end of the day, it's going to cost taxpayers so much more. They should have just sent $100 checks to poor people. A check lets people buy food anywhere, and it doesn't put the store down the street out of business. That would have done so much better, and there would be no competition issues.