See It, Fix It—A Dangerous Reflex That Took My Mother’s Life

A bombshell study in the New England Journal of Medicine (November 21, 2025) should change medical practice overnight. It probably won’t. I know because I’ve seen this movie before—and in my family, it ended with my mother’s death after coronary artery bypass surgery she never needed. Once again, researchers are warning that fixing a scary-looking blockage on a scan doesn’t always prevent catastrophe. This time the procedure is endarterectomy on the carotid arteries. And once again, doctors who’ve been doing these procedures for decades may struggle to let go of habits that feel lifesaving, even when the data say otherwise. The “see it, fix it” surgical solution doesn’t always work.

What Happened to Helen Graedon?

My 92-year old mother was talked into getting a coronary artery bypass procedure (CABG) on December 13, 1996. The cardiologist said that four of her heart arteries were surprisingly “clean.” But one had a partial blockage. The heart surgeon convinced her that performing coronary bypass surgery would make her feel better.

In truth, though, her symptoms were probably due to an inappropriate beta blocker heart drug. But the doctor was convincing because he showed her the blockage on an angiogram. I firmly believe that no cardiologist would perform such a CABG procedure today because better data suggest such interventions are not helpful for a person like my mother.

She was, by the way, sharp as a tack. She quizzed the surgeons during the procedure and found them lacking in their knowledge of the playwright Voltaire. You can read my mother’s story and the problems with routine stents or bypass surgery for stable heart disease at this link.

What Does “See It, Fix It” Mean?

Most people might assume that the “see it, fix it” phrase makes sense. If you discover that something is broken, why not fix it?

The problem with that approach in medicine assumes that observing that something is not quite “normal” means that it is broken. That is not necessarily correct. More to the point, just because something is not perfect does not mean it needs to be “fixed.” Before you fix something, you better be sure that the “fix” will be helpful and does not cause unnecessary expense or undue harm.

Cardiologists and the “Oculostenotic Reflex”

During the 1980s and 1990s, CABG (coronary artery bypass grafting) became extremely popular. Hundreds of thousands of such procedures were performed. Many were justified because the blockage was extremely extensive. But many others may have been unnecessary.

Cardiologists began embracing balloon angioplasty plus bare metal stenting in the late 1980s and early 1990s. The problem was that the body often reacted to the metal mesh scaffolding that held the artery open. Tissue overgrowth narrowed the opening in the artery and often led to what doctors called “restenosis” (re-narrowing of the artery).

To prevent restenosis, doctors started using drug-eluting stents (DES). The stents were coated with immune-suppressing drugs. Hundreds of thousands of such procedures have been performed annually for many years. Again, many of these procedures were not justified by solid scientific research.

Why so many inappropriate operations, like the one performed on my mom? It was because of the “oculostenotic reflex.” We first heard this term used during our interview with one of the country’s leading cardiologists on The People’s Pharmacy radio show. He went on to become Commissioner of the Food and Drug Administration.

The phrase is actually an insider’s joke meaning that if cardiologists see stenosis (narrowing of a coronary artery) on a scan, they reflexly want to fix it.

Our term for this process: See It, Fix It:

A commentary in JAMA Internal Medicine (Oct. 2014) was titled:

“Fighting the ‘Oculostenotic Reflex'”

The authors state:

“In recent years, there has been intense focus in the scientific community and media on the potential overuse of percutaneous coronary interventions (PCI) in patients with stable angina. Although PCI has proven to be effective in decreasing mortality rates among patients with acute myocardial infarction [heart attack], it has not been shown to prevent cardiovascular events for patients with stable angina…About 30% of PCIs performed in the United States each year are to treat patients with stable angina.”

OK, that is quite technical. What it means in normal English is that if someone has modest narrowing of a coronary artery and experiences “stable angina” they do not necessarily need balloon angioplasty and a stent. Just because they experience some chest tightness or even pain when exercising or under emotional stress, it should not automatically lead to surgery.

The COURAGE Trial: ‘See it, Fix It’ Did NOT Prolong Life!

The study that confounded many cardiologists was published in the New England Journal of Medicine (April 12, 2007). The investigators randomly assigned 2,287 heart patients with coronary artery disease to receive drug therapy and lifestyle management or that same “optimal medical therapy” plus angioplasty and stent placement. These patients were followed from 2.5 to 7 years (median was 4.6 years).

To the surprise and dismay of many cardiologists, opening clogged coronary arteries with a balloon and propping them open with stents did not prevent fewer heart attacks or strokes and did not prolong life.

Fast Forward to 2025 and the CREST-2 Trial:

Stenosis (narrowing) of an artery can occur in the neck as well as in the heart. Instead of coronary artery disease, this condition is called carotid artery disease. People with clogged carotid arteries in the neck area can develop TIAs (transient ischemic attacks) and/or strokes. Just as cardiac surgeons thought that performing a coronary artery bypass graft operation would prevent heart attacks, many vascular surgeons believe that performing an “endarterectomy” would prevent strokes.

An endarterectomy involves removing the atherosclerotic plaque lining the walls of a carotid artery. It is supposed to improve blood flow and reduce the risks of strokes. The new study was called Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials (CREST-2). It was published in the New England Journal of Medicine (November 21, 2025).

Here is the overview:

Most patients (75 to 80%) with clogged carotid arteries who undergo surgery (endarterectomy) or stenting do not have symptoms. Doctors describe such people as “asymptomatic.” Nevertheless, there is concern that the stenosis in their neck arteries could lead to strokes or death.

The CREST-2 trial involved nearly 2500 patients with “high-grade carotid-artery stenosis” (blockage) without recent symptoms. None had experienced a TIA or stroke.  All patients received “intensive medical management.” In other words, their blood pressure, LDL cholesterol and blood sugar were controlled. They were also offered health coaching to assist them in exercising and managing weight.

There were 1,240 patients in the surgical (endarterectomy) trial. They were randomized to get surgery or medical management.

The researchers reported these disappointing results:

“Carotid endarterectomy plus intensive medical management did not provide a significant benefit as compared with intensive medical management alone.”

An editorial in the New England Journal of Medicine, (November 21, 2025) concluded:

“The management of carotid-artery stenosis that has not caused recent symptoms — asymptomatic carotid stenosis — has been controversial. Clinical trials that began more than 30 years ago showed a small benefit of carotid endarterectomy as compared with medical treatment, but improvements in medical prevention of stroke call into question whether endarterectomy is still beneficial.

“The findings in the CREST-2 endarterectomy trial are in keeping with the results of two other recent, smaller trials that investigated similar questions…We can conclude that there is no longer a role for routine carotid endarterectomy in persons with asymptomatic stenosis.”

In other words, patients with clogged carotid arteries may not benefit from endarterectomy surgery to remove the plaque from their neck arteries.

On the other hand, inserting a stent into the carotid arteries did provide significant benefit. After 4 years, 6% of the patients in the group that received intensive medical management with drugs and lifestyle coaching experienced stroke or death. In the stenting group the incidence of stroke or death was 2.8%. This difference (3.2%) was statistically significant.

The authors add this important point:

“As in previous trials involving patients with carotid-artery disease, all the treatment groups, including the medical-therapy groups, had low rates of disabling stroke.”

Final Words:

We hope that the new findings in the New England Journal of Medicine (Nov. 21, 2025) will have a profound impact on the number of endarterectomies performed in this country. The old idea of “See it, Fix it” with the surgical removal of plaque will likely fade, just as it has with coronary artery bypass graft procedures.

There are always exceptions! A heart attack demands immediate treatment, often with angioplasty and a stent. And a stroke can often be handled in a somewhat similar manner. A surgeon can insert a catheter into an artery, pass it up to the brain where the blockage has occurred and remove the clot. If such a thrombectomy is done promptly, it can often restore brain function without much, if any, residual damage.

I know this was a complex medical topic. If you have read through to this point, thank you. If you are confused by anything in this article, please take a m0ment to put your question in the comment section below. If you have had an endarterectomy, please share your experience as well.

Before agreeing to elective vascular surgery, ask your doctor if there is well-established evidence that the procedure will improve your health outcomes. It can be helpful to request the “absolute risk reduction.” In other words, how many people out of 100 get benefit from the intervention? If you are unsatisfied with the answer, seek a second opinion. My mother never got that chance.