Revised Starling’s Principle (RSP): A misnomer as Starling’s law is proved wrong.

Revised Starling’s Principle (RSP): A misnomer as Starling’s law is proved wrong.

  • Dr. Ahmed N. Ghanem Retired Consultant Urologist Surgeon & Independent Investigator
  • Dr. Khaled A. Ghanem Trust Grade F2, Endocrine. Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE.
Keywords: Starling’s Law for the capillary-ISF transfer, Revised Starling’s Principle, Capillary physiology, Hydrodynamics, Shock, Oedema, ARDS


Substantial evidence based on results of new physics experiments and physiological research affirm Starling’s law wrong. Here we demonstrate that the Revised Starling’s Principle (RSP) is also misleading. The article is a futile attempt to revive Starling’s law after it has long been dead and buried. A most recent article seriously criticized RSP. We hope the excuse for the authors is unawareness of new contributions rather than a desperate attempt to defend the indefensible. Nether Starling nor the authors who made the hypothesis a law were aware of the discovery of the precapillary sphincter that demonstrates capillary pressure induce suction not filtration as demonstrated in the G tube, and the wide intercellular slit pores of the capillary wall that allow the passage of plasma proteins, thus nullifying oncotic pressure in vivo. In addition to previously reported 21 reasons affirming Starling’s law is wrong we add two more that concern the main reports that transformed Starling’s hypothesis into a law. Physiologists and physicists are concerned about formulae and calculations while physicians are more concerned about the lives and safety of their patients. Hence physicians understand the importance of discarding Starling’s law; being wrong is responsible for the induction of the new volume kinetic shocks and the causation of the acute respiratory distress syndrome that kills hundreds of thousands of patients every year. Now, there is a replacement for it: The hydrodynamic phenomenon of the porous orifice (G) tube. It is time to say goodbye Starling’s law, hello G tube.


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The Authors. Published by TRIDHA Scholars

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How to Cite
Ghanem AN, Ghanem KA. Revised Starling’s Principle (RSP): A misnomer as Starling’s law is proved wrong.: Revised Starling’s Principle (RSP): A misnomer as Starling’s law is proved wrong. Med. res. chronicles [Internet]. 2020Sep.7 [cited 2020Sep.24];7(4):198-06. Available from:
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