Maybe He Is Right, But Publication of This Article Will Harm Soviet Physicians
“Maybe he is right, but publication of this article will harm Soviet physicians.”
This was the official review that blocked one of my early articles on myocardial infarction in the late 1970s. The reviewer was a leading Soviet cardiologist. The issue was not that the work was obviously wrong, but that accepting it openly would have forced the system to revise a comfortable doctrine.
My article argued that myocardial infarction in living patients is not simply “coronarogenous myocardial necrosis” but a special form of acute aseptic coronary‑induced inflammation. It also suggested that many so‑called “complications” of infarction arise when this naturally organized inflammatory healing process is disturbed.
At that time, this was considered too disruptive to publish. Today, the inflammatory nature of myocardial infarction is far less controversial—but the mechanisms, consequences, and clinical implications are still not widely integrated into everyday thinking. That is why I finally wrote my book The Science of Healing: Optimality and New Understanding of Myocardial Infarction.
What I Am Arguing—In Brief
Without going into technical detail here, the central ideas are simple:
Myocardial infarction behaves as an acute aseptic inflammatory process, with destruction and repair tightly coupled in time.
The outcome—uncomplicated scar formation or dangerous complications—depends on how well this process remains synchronized at local (infarct zone) and systemic (stress and regulation) levels.
Many familiar clinical phenomena around infarction, from leukocyte changes to arrhythmias, can be understood as parts of an evolutionarily shaped healing program, which can be either optimal or disrupted.
This leads to a broader Principle of Disease Optimality: for each illness there is an “optimal” course that uses the least health resources to achieve the best possible recovery; the task of the physician is to help the patient’s disease follow that optimal track.
In other words, infarction is not just something that happens to the heart; it is also the way the organism attempts to rescue the heart under catastrophic conditions.
Why This Matters Beyond Myocardial Infarction
I see myocardial infarction as a particularly clear model of how the body manages acute damage. Once you look at it this way, similar logic applies to:
Infarctions in other organs, including stroke
Many “complications” that turn out to be failures of otherwise optimal repair strategies
The Principle of Disease Optimality invites us to rethink the relationship between health and disease: not as simple opposites, but as two states connected by structured, purposeful processes. It also forces us to ask a difficult question: are all of our standard interventions truly helping these processes, or do some of them interfere with nature’s best available plan?
I do not try to answer all of that here. My aim in this article is only to outline the perspective and explain why it has taken almost half a century for my early work to be recognized.
If You Want the Whole Story
This brief sketch cannot replace detailed explanation, data, and clinical discussion. For those who want to see:
How experimental and clinical observations led to this inflammatory view of infarction
How uncomplicated and complicated healing differ in mechanisms and clinical patterns
How the Principle of Disease Optimality is formulated and applied in practice
I have set all of this out in my book:
The Science of Healing: Optimality and New Understanding of Myocardial Infarction (2024)
In that book, I also describe the scientific and personal path behind these ideas—how they developed under the conditions of Soviet medicine, why they were resisted, and how they connect to a broader philosophy of health and disease.
If this article has raised more questions than it answered, that is intentional. The details—and the arguments—are in the book.
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