Intended for healthcare professionals

Feature Christmas 2014: Going to Extremes

Against the odds in Las Vegas

BMJ 2014; 349 doi: (Published 17 December 2014) Cite this as: BMJ 2014;349:g7669
  1. Krishna Chinthapalli, associate editor, The BMJ
  1. kchinthapalli{at}

“Sin City” ranks poorly on health and has a doctor deficit. Krishna Chinthapalli investigates the reasons

A Las Vegas casino can get the pulse racing, if only until it stops. Low ceilings, a maze of walkways, and the lack of clocks or windows keep customers inside. Flashing lights, jackpot sirens, reddish hues, ashtrays for cigarettes, and waitresses for alcohol all keep customers excited.1 It is not surprising then that the rate of cardiac arrests at a casino is quadruple that in hotels.2

There are other places to die in Las Vegas, even excluding the plotlines of its television show Crime Scene Investigation. In February 2013 John Alleman had a heart attack in front of his favourite restaurant, the Heart Attack Grill. The owner is controversial Jon “Dr Jon” Basso, who later displayed Alleman’s ashes in his restaurant. Customers there are made to wear patient gowns and give their orders to waitresses who dress as nurses and write down orders on “prescription” pads. His “quadruple bypass burger” has a Guinness world record for the most calorific burger, at 9982 kilocalories (41.7 MJ), and he has a weighing scale to offer free burgers to customers weighing over 350 pounds (160 kg) each. Basso is unrepentant and says that his restaurant publicises the issue of obesity and calories. “It helps more people than it hurts,” he says. “Sure, we do caloric harm to that very small percentage of society that comes in, yet that momentary caloric harm is nothing compared with the long term memory when they walk away from us.”

Two months before Alleman’s death, across the city in the MGM Grand Hotel, Manny Pacquiao lunged towards the bloodied face of Juan Manuel Marquez. It was the last second in the sixth round of their boxing match. Marquez ducked …

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