‘Struck Down by the Gods: Causes and Prevention of Stroke’

Author Peter Gates challenges conventional wisdom regarding stroke risk and prevention.

By Prof. Tissa Wijeratne

Tissa Wijeratne

Readers of World Neurology may remember “Cure for Neurophobia,”¹ a game-changing book that helped many clinicians rethink how we teach and learn neurology. The same author, Peter Gates, has now delivered another gem. This time, the focus is stroke prevention.

Stroke remains one of the leading causes of death and disability worldwide. We have long known that up to 90% of strokes are preventable, at least in theory. Yet prevention continues to fail at scale. This book asks a confronting question: Is there something fundamental we have been missing?

This is an engaging and challenging book. It explains the different types of stroke in clear language. It also describes medical conditions that are often mistaken for stroke. The book is written for nonmedical readers, but it has strong value for health professionals at all stages.

A central theme is atherosclerosis. This process causes most heart attacks and many strokes. Gates challenges the idea that smoking, obesity, high cholesterol, diabetes, and high blood pressure are the direct causes. He explains that while these factors increase risk, they do not fully explain why atherosclerosis begins. Strong autopsy evidence shows the process can start decades earlier, sometimes even before birth.

The book offers rich historical insight. It traces how ideas about vascular disease have evolved over centuries. Concepts such as absolute and relative risk are explained simply and clearly. This helps readers better interpret medical research and public health claims.

Importantly, the author does not minimize risk factors. Smoking and obesity are highlighted as powerful markers of risk, especially in today’s obesogenic environment. Practical advice is provided on what individuals can do to reduce their risk of stroke and heart attack.

A particularly strong feature of the book is its call for greater transparency in medical research. Gates argues for independent data monitoring, clear disclosure of industry funding, and honest reporting of benefit and harm. He encourages reporting absolute risk, numbers needed to treat, and cost–benefit analyses. His argument that new treatments should be compared with existing effective therapies, rather than placebo, is provocative and carefully reasoned.

This book informs, challenges, and empowers.

It is recommended for lay readers, medical students, early career clinicians, and experienced neurologists alike. It is an enjoyable read, but more importantly, it encourages clearer thinking about stroke, prevention, and evidence in medicine. I read this book from cover to cover. It is an easy and engaging read. It has earned a permanent place on my bookshelf, along with “Cure for Neurophobia.” That is a strong recommendation.

Prof. Tissa Wijeratne, OAM, MD, PhD, is an elected trustee of the World Federation of Neurology.