The basis for medical treatment of heart disease is the belief that interventions like coronary angioplasty and bypass surgery are effective, and that their benefits outweigh the risks. Does this conviction stem from a solid scientific foundation, or might it be an illusion? Is it conceivable that both physicians and patients are overestimating the advantages and underestimating the dangers? If trust in such procedures is indeed misplaced, what peril does it pose to the health of society?
All of these provocative questions are addressed head-on in Broken Hearts: The Tangled History of Cardiac Care by David S. Jones, MD, PhD, a physician and professor of the culture of medicine in the Department of Global Health and Social Medicine, Harvard Medical School. Dr. Jones explores the history of cardiology and cardiac surgery in America and examines the inconsistencies of medical decisions. His in-depth analysis emphasizes two troubling problems inherent in modern methods for treating heart disease:
- The medical profession is confused about the fundamental cause of heart attacks, a factor that has led to misdirected treatments.
- Doctors have a myopic focus on the benefits of a treatment, which eclipses their perspective of the risks and skews their decision making.
Dr. Jones’ research explores the history of decision making in cardiac therapeutics, attempting to understand how cardiologists and cardiac surgeons implement new technologies, notably cardiac revascularization. His research is supported by funding from The Robert Wood Johnson Foundation, the Foundation for Informed Medical Decision Making, and the National Science Foundation.
The Mistaken Cause Attributed to Heart Disease
A principle of the medical industry is that an incorrect diagnosis will not lead to an appropriate clinical intervention. Affecting the best outcome of treatment is dependent on finding the root cause of a disorder. Dr. Jones contends that cardiologists erroneously attributed plaque accumulation as the culprit behind heart attacks, rather than plaque rupture. He concludes that since no treatments were available for plaque rupture, doctors cherry-picked the theory of plaque accumulation because it supported the use of bypass surgery and angioplasty – the only interventions that were available for a number of years.
The Skewed Decision Making of the Medical Community
Dr. Jones relates that doctors enthusiastically embraced coronary artery bypass surgery and angioplasty when they debuted on the medical stage, as these costly interventions often resulted in a rapid and dramatic reduction in heart pain. Their early hopes were dashed when long-term research did not show that the procedures increased survival rates for anyone other than the sickest patients, a group that comprised only a small percentage of those who underwent the procedure. Dr. Jones notes, “Some patients believed angioplasty would extend their life expectancy by 10 years!” He adds that, for those with stable coronary disease, “it has not been shown to extend life expectancy by a day.”
The overzealous pursuit of treatment efficacy has made doctors inattentive to side effects and potential risks, Dr. Jones explains. After bypass surgery had been is use for some time, research began to amass evidence that the procedure increases the likelihood of stroke, cognitive impairment, delirium, and personality changes. Despite these findings, coronary bypass remains one of the most frequently performed surgeries today. Dr. Jones dubs the failure of doctors to weigh risks adequately “selective inattention.”
‘Broken Hearts’ is a Compelling Revelation
Dr. Jones’ outstanding book combines rigorous research and astute detective work to show the difficulties physicians have in evaluating the safety and efficacy of their treatment choices. Its exposé of the sobering reality of fallacies in this critical, high-cost area of medical care make it a recommended read for physicians, policymakers, health journalists, health services researchers, and medical directors in health plans, health systems, and accountable care organizations.
“The light Jones shines on the interventional cardiovascular enterprise illuminates numerous, sometimes fatal and always costly flaws that every patient and society at large ignores at great peril.”
Nortin M. Hadler, MD, MACP, MACR, FACOEM, Professor of Medicine, University of North Carolina at Chapel Hill
While it may be unpleasant to become aware of shortcomings in the practice of cardiology, knowledge is always empowering. The first step in improvement is to reveal and define the problem, a pursuit in which Dr. Jones has admirably succeeded.
Dr. Jones is now working on two follow up books. On the Origins of Therapies will trace the evolution of coronary artery bypass surgery. The third book examines the history of heart disease and cardiac therapeutics in India. His first book, Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600, provides fascinating insights on epidemics among American Indians.