I am a retired family practice physician. I practiced for 42 years before retiring in 2021 when I refused to take the Covid vaccine. I had never heard of this modality prior to the first article and now this one. Like so many other unorthodoxies in medicine, EECP was never mentioned let alone discussed as a viable alternative to invasive procedures. The idea of collateral circulation in the heart was well established as I can hear my mentors telling me that heart attacks in younger patients were often fatal because they had not had enough time to develop collateral circulation whereas older patients did develop the collateral circulation. The idea that a modality of low morbidity and low cost could actually enhance the formation of collateral circulation was never mentioned let alone discussed in detail. The Covid era opened my eyes to many truths that were buried by the medical hierarchy and the pharmaceutical giants simply because they were an existential threat to their bottom line. This is yet another black mark on medical education that refuses to discuss alternative models of care not because they aren't worthy of discussion but because they do not fit the model of pills and expensive procedures. The "first do no harm" motto that was drummed into our heads seems like just a relic of the past that gets passed down to medical students who take it seriously (I know that I did) but is ignored by powers to be. Sad for doctors who put their faith and trust in the institutions that are supposed to guide us to safer, and better treatments and even more sad for the patients who are deprived of these modalities. This has been quite an educational experience for me as I read through the many articles on substack, and scratch my head and just wonder how many more patients could have been helped if I had known about these alternative modalities. I will just have to keep wondering.
Don't "keep wondering" Joe. Please un-retire. Think about joining a naturopathic group practice or even a tele-medicine practice.
Your recent medical knowledge and the fact that (in my opinion) you seem to be the type of physician who would elect to "do no harm" would now serve your fellow man so very well, in these times, either in your own community or online.
The A.M.A and its evil twin Big Harma are just two of hundreds of subsiidiaries of its death cult parent company which gets easier to confirm every day. Every department and sub department of every genre that employs people regulated in some fashion by the U.S government is antithetical to a healthy human existence bar none. It is an inversion of life and of course all by design with built in road blocks which eats up. time , money and sanity of anyone trying to navigate around it. The latest and perhaps clearest example of what we are up against is playing out in the Middle East where again , the logical way out was rejected as in the past when the U.S would not take YES for an answer. Thanks again to Unbecoming!
Something not mentioned in this article, and what Dr. Cowan, among others, has talked about, is that the heart is not a pump. Thinking that it can pump blood from your chest, down to your feet through those tiny capillaries, then back to your heart is wrong. The blood vessels move the blood through the circulatory system, which is probably why EECP works, by stimulating the growth of new vessels to bypass ones that are blocked. A friend just died from failed bypass surgery. Never made it home.
I first read Tom Cowan's book, 'Human Heart, Cosmic Heart' over 10 years ago because when I heard him first say that, I could not fathom what he was talking about! Academic indoctrination!
I’m happy to learn of this. I am not in need personally, but have family that could benefit. I always love learning about non invasive options. Thank you.
This comment goes to another cardiac treatment recently featured on this stack, strophanthus.
My brother has had atrial fibrillation of increasing severity for fifteen years. Taking beta blockers the entire time in spite of never noticing they had an effect. One week on strophanthus he thought he could detect an improvement. Two weeks and he is notably improved. Five and six strong regular beats separated by a few seconds of the former fibrillation and the regular beats repeat. Formerly even a single clear beat was unusual.
And he just feels better. He is ghosting his cardiologist.
I read about this probably 7 or 8 years ago and would of loved to have tried it but couldn’t find it available locally. I even contacted a company sales person. The purchase cost was too much for me and the closest practice he found that he had supplied was no longer open.
Thanks for writing this excellent piece! I so appreciate you for raising awareness of—and educating us about—EECP.
I have looked into EECP here in the USA. Not surprisingly, Medicare (for those 65 and older) won’t cover it for the purpose of prevention, even if the person has extensive coronary calcium. You’d first have to go through the misery of conventional treatments and have them fail. The closest location to me that offers EECP is about a three-hour drive one way. The only way I could do that would be to rent a place to live in for seven weeks. A cost of $6K per person plus living expenses would be challenging but doable. My husband would also want to utilize EECP, but our priority right now is addressing his lung cancer.
One last thing. (This is actually my 3rd comment; I’m not sure it’ll show up after my 2nd comment.) I asked Grok: “What percentage of people die from a heart attack as a first “symptom” of heart disease? I don’t want to be one of those people.”
Here is Grok’s response:
Roughly 50% of deaths from coronary heart disease occur as the first (and only) symptom—meaning the person had no prior diagnosis, chest pain, shortness of breath, or other warning signs.
This figure comes from long-standing data by the American Heart Association and other major sources:
• Sudden cardiac death (SCD)—often triggered by a fatal heart attack or arrhythmia from undiagnosed coronary artery disease—accounts for approximately 50% of all cardiovascular mortality in the U.S. and other developed countries.  
• In the majority of these SCD cases, victims had no preceding symptoms and were not previously identified as high-risk. 
• A 2008 analysis from the Society of Nuclear Medicine similarly concluded that as many as 50% of cardiac deaths due to coronary vessel disease happen in people with no prior history or symptoms. 
More recent studies (e.g., a large Danish nationwide analysis) put the share of sudden cardiac deaths with no previous cardiovascular disease diagnosis at about 44–45%, while an Oregon study showed that “SCD as first manifestation” continues to drive a substantial portion of cases, especially in women. 
In short, your fear is grounded in real statistics: for nearly half of people who ultimately die from heart disease, the fatal event is the first symptom.
I had a chat with the Grok AI about eligibility for insurance coverage for EECP in the USA. I figured I’d copy that here, as an FYI. Here goes:
Primary Eligibility Criteria (Indications)
EECP is FDA-approved and widely covered (including by Medicare) for patients who meet all of the following key criteria, based on national guidelines and major sources like Cleveland Clinic, CMS (Medicare), and major insurers:
• Disabling chronic stable angina: Typically classified as Canadian Cardiovascular Society (CCS) Class III or IV (or equivalent, such as New York Heart Association Class III/IV angina). This means severe, limiting symptoms (e.g., pain with minimal activity or at rest) that significantly impact daily life.
• Refractory to maximum/optimal medical therapy: Symptoms persist despite the best available medications (e.g., beta-blockers, nitrates, calcium channel blockers, statins, antiplatelet drugs, ranolazine, etc.).
• Not readily amenable to revascularization: In the opinion of a cardiologist or cardiothoracic surgeon, the patient is not a good candidate for procedures like percutaneous coronary intervention (PCI/angioplasty/stenting) or coronary artery bypass grafting (CABG) due to one or more of these reasons:
• The condition is inoperable.
• High risk of operative complications or postoperative failure.
• Coronary anatomy is not suitable for such procedures.
• Renewed symptoms after previous procedures (e.g., post-stent or post-bypass angina).
Some centers may consider it for milder cases (e.g., CCS Class II) or other conditions like certain heart failure patients, but coverage is typically limited to the above for insurance/Medicare reimbursement. EECP is not a first-line treatment—it’s reserved for refractory cases.
I'm wondering if EECP would help an aortic dilatation or aneurism, or stiffness of the left ventricle? My husband has been diagnosed with those conditions.
The substack says: "EECP decreases central aortic stiffness" and "reduces arterial stiffness throughout the body".
"The absence of large, independent trials is not evidence that EECP doesn’t work. It is evidence that the research funding apparatus cannot investigate treatments that threaten its revenue base. The definitive studies were never going to be funded — not because the questions aren’t worth asking, but because the answers might cost the system too much."
Unbekoming has talked a lot about the bad ideas and approaches in medicine which cannot be falsified.
Here we see the problem with lack of "truthification".
I am a retired family practice physician. I practiced for 42 years before retiring in 2021 when I refused to take the Covid vaccine. I had never heard of this modality prior to the first article and now this one. Like so many other unorthodoxies in medicine, EECP was never mentioned let alone discussed as a viable alternative to invasive procedures. The idea of collateral circulation in the heart was well established as I can hear my mentors telling me that heart attacks in younger patients were often fatal because they had not had enough time to develop collateral circulation whereas older patients did develop the collateral circulation. The idea that a modality of low morbidity and low cost could actually enhance the formation of collateral circulation was never mentioned let alone discussed in detail. The Covid era opened my eyes to many truths that were buried by the medical hierarchy and the pharmaceutical giants simply because they were an existential threat to their bottom line. This is yet another black mark on medical education that refuses to discuss alternative models of care not because they aren't worthy of discussion but because they do not fit the model of pills and expensive procedures. The "first do no harm" motto that was drummed into our heads seems like just a relic of the past that gets passed down to medical students who take it seriously (I know that I did) but is ignored by powers to be. Sad for doctors who put their faith and trust in the institutions that are supposed to guide us to safer, and better treatments and even more sad for the patients who are deprived of these modalities. This has been quite an educational experience for me as I read through the many articles on substack, and scratch my head and just wonder how many more patients could have been helped if I had known about these alternative modalities. I will just have to keep wondering.
Don't "keep wondering" Joe. Please un-retire. Think about joining a naturopathic group practice or even a tele-medicine practice.
Your recent medical knowledge and the fact that (in my opinion) you seem to be the type of physician who would elect to "do no harm" would now serve your fellow man so very well, in these times, either in your own community or online.
The A.M.A and its evil twin Big Harma are just two of hundreds of subsiidiaries of its death cult parent company which gets easier to confirm every day. Every department and sub department of every genre that employs people regulated in some fashion by the U.S government is antithetical to a healthy human existence bar none. It is an inversion of life and of course all by design with built in road blocks which eats up. time , money and sanity of anyone trying to navigate around it. The latest and perhaps clearest example of what we are up against is playing out in the Middle East where again , the logical way out was rejected as in the past when the U.S would not take YES for an answer. Thanks again to Unbecoming!
Something not mentioned in this article, and what Dr. Cowan, among others, has talked about, is that the heart is not a pump. Thinking that it can pump blood from your chest, down to your feet through those tiny capillaries, then back to your heart is wrong. The blood vessels move the blood through the circulatory system, which is probably why EECP works, by stimulating the growth of new vessels to bypass ones that are blocked. A friend just died from failed bypass surgery. Never made it home.
So sorry for losing your friend.
I first read Tom Cowan's book, 'Human Heart, Cosmic Heart' over 10 years ago because when I heard him first say that, I could not fathom what he was talking about! Academic indoctrination!
I’m happy to learn of this. I am not in need personally, but have family that could benefit. I always love learning about non invasive options. Thank you.
As I commented on your recent article that first mentioned EECP, I had excellent results from it. Here is a Substack I wrote about it.
https://corrin.substack.com/p/75-is-the-new-60?r=ze2j1&utm_medium=ios
This comment goes to another cardiac treatment recently featured on this stack, strophanthus.
My brother has had atrial fibrillation of increasing severity for fifteen years. Taking beta blockers the entire time in spite of never noticing they had an effect. One week on strophanthus he thought he could detect an improvement. Two weeks and he is notably improved. Five and six strong regular beats separated by a few seconds of the former fibrillation and the regular beats repeat. Formerly even a single clear beat was unusual.
And he just feels better. He is ghosting his cardiologist.
I read about this probably 7 or 8 years ago and would of loved to have tried it but couldn’t find it available locally. I even contacted a company sales person. The purchase cost was too much for me and the closest practice he found that he had supplied was no longer open.
Stunning article.
Thanks for writing this excellent piece! I so appreciate you for raising awareness of—and educating us about—EECP.
I have looked into EECP here in the USA. Not surprisingly, Medicare (for those 65 and older) won’t cover it for the purpose of prevention, even if the person has extensive coronary calcium. You’d first have to go through the misery of conventional treatments and have them fail. The closest location to me that offers EECP is about a three-hour drive one way. The only way I could do that would be to rent a place to live in for seven weeks. A cost of $6K per person plus living expenses would be challenging but doable. My husband would also want to utilize EECP, but our priority right now is addressing his lung cancer.
One last thing. (This is actually my 3rd comment; I’m not sure it’ll show up after my 2nd comment.) I asked Grok: “What percentage of people die from a heart attack as a first “symptom” of heart disease? I don’t want to be one of those people.”
Here is Grok’s response:
Roughly 50% of deaths from coronary heart disease occur as the first (and only) symptom—meaning the person had no prior diagnosis, chest pain, shortness of breath, or other warning signs.
This figure comes from long-standing data by the American Heart Association and other major sources:
• Sudden cardiac death (SCD)—often triggered by a fatal heart attack or arrhythmia from undiagnosed coronary artery disease—accounts for approximately 50% of all cardiovascular mortality in the U.S. and other developed countries.  
• In the majority of these SCD cases, victims had no preceding symptoms and were not previously identified as high-risk. 
• A 2008 analysis from the Society of Nuclear Medicine similarly concluded that as many as 50% of cardiac deaths due to coronary vessel disease happen in people with no prior history or symptoms. 
More recent studies (e.g., a large Danish nationwide analysis) put the share of sudden cardiac deaths with no previous cardiovascular disease diagnosis at about 44–45%, while an Oregon study showed that “SCD as first manifestation” continues to drive a substantial portion of cases, especially in women. 
In short, your fear is grounded in real statistics: for nearly half of people who ultimately die from heart disease, the fatal event is the first symptom.
I had a chat with the Grok AI about eligibility for insurance coverage for EECP in the USA. I figured I’d copy that here, as an FYI. Here goes:
Primary Eligibility Criteria (Indications)
EECP is FDA-approved and widely covered (including by Medicare) for patients who meet all of the following key criteria, based on national guidelines and major sources like Cleveland Clinic, CMS (Medicare), and major insurers:
• Disabling chronic stable angina: Typically classified as Canadian Cardiovascular Society (CCS) Class III or IV (or equivalent, such as New York Heart Association Class III/IV angina). This means severe, limiting symptoms (e.g., pain with minimal activity or at rest) that significantly impact daily life.
• Refractory to maximum/optimal medical therapy: Symptoms persist despite the best available medications (e.g., beta-blockers, nitrates, calcium channel blockers, statins, antiplatelet drugs, ranolazine, etc.).
• Not readily amenable to revascularization: In the opinion of a cardiologist or cardiothoracic surgeon, the patient is not a good candidate for procedures like percutaneous coronary intervention (PCI/angioplasty/stenting) or coronary artery bypass grafting (CABG) due to one or more of these reasons:
• The condition is inoperable.
• High risk of operative complications or postoperative failure.
• Coronary anatomy is not suitable for such procedures.
• Co-morbid conditions create excessive surgical risk.
Additional supporting factors often include:
• Documented coronary artery disease (e.g., >70% stenosis on angiography, prior heart attack, positive stress test, or nuclear imaging showing ischemia).
• Renewed symptoms after previous procedures (e.g., post-stent or post-bypass angina).
Some centers may consider it for milder cases (e.g., CCS Class II) or other conditions like certain heart failure patients, but coverage is typically limited to the above for insurance/Medicare reimbursement. EECP is not a first-line treatment—it’s reserved for refractory cases.
I'm wondering if EECP would help an aortic dilatation or aneurism, or stiffness of the left ventricle? My husband has been diagnosed with those conditions.
The substack says: "EECP decreases central aortic stiffness" and "reduces arterial stiffness throughout the body".
Thanks, Unbekoming! Good material.
Sayer Ji also wrote a great article about this last year: https://greenmedinfo.com/content/second-heart-you-never-knew-you-had.
"The absence of large, independent trials is not evidence that EECP doesn’t work. It is evidence that the research funding apparatus cannot investigate treatments that threaten its revenue base. The definitive studies were never going to be funded — not because the questions aren’t worth asking, but because the answers might cost the system too much."
Unbekoming has talked a lot about the bad ideas and approaches in medicine which cannot be falsified.
Here we see the problem with lack of "truthification".