We all need to understand that as a physician our first priority is to do no harm. It is acceptable to offer treatments without randomized trials when empirical evidence suggests patients benefit. When empirical evidence however suggests harm we should not offer that treatment until good science has determined if it helps or harms. My motivation to caution all CCSVI'ers about jugular stents has been called into question. I have dedicated my career to you all. It is unfortunate that personal shots are taken in public but such is life in this realm. I will not be deterred. My goal is not to knock other physicians. At no point did I say anything about a physician who puts them in. In fact I admit I have! My goal is to spare as many people as possible from HARM. If what I am about to say hurts your feelings, I am sorry but DO NOT HAVE A JUGULAR STENT!