Angioplasty and heart bypass surgery are giants among medical procedures in America. They are performed more than a million times each year and together drive a $100-billion industry. But an article in the recent issue of Harvard Magazine explores a frightening truth: There’s no evidence that they improve life expectancy by even a single day.
Journalist Alice Park looks at a new book by Harvard professor David Jones called, “Broken Hearts: The Tangled History of Cardiac Care.” Jones explains that bypass surgery developed in the late-1960s and angioplasty started to become popular a decade after that. Doctors latched onto these procedures because they made intuitive sense: If a heart valve is clogged, detour around it (bypass surgery); or better yet, use a stent to reopen it (angioplasty).
Both procedures were in widespread use before there had been any clinical trials assessing their effectiveness. And when that data started to come in, it suggested the procedures were not actually helping most people live longer. “Angioplasty can save the lives of heart-attack patients,” Jones says in the article. “But for patients with stable coronary disease, who comprise a large share of angioplasty patients? It has not been shown to extend life expectancy by a day, let alone 10 years.”
How is it that two of the highest-profile surgeries in medicine might not be doing much if any good for most patients who receive them? The article highlights a couple of reasons.
First, “one of the little dirty secrets of cardiac care” is that until the 1970s, “heart experts could not agree on what was causing heart attacks.” Today, cardiologists believe that “invisible lesions” in the heart vessels—not major artery blockages—are primarily responsible for causing heart attacks. So, in a sense, bypass and angioplasty were grandfathered in as treatments from an era when we didn’t really understand why heart attacks happen.
Second, the popularity of bypass surgery and angioplasty reflects a larger cultural issue with medicine: We overtest and overtreat. Doctors and patients tend to think, “Well, if this procedure could help, let’s do it.” But every surgery comes with risks, of infection, and, in the specific case of bypass surgery, of long-term neurological complications. “It’s important not to do everything that could be done,” Jones told Park.
The mixed blessing of bypass surgery and angioplasty is fascinating as a lesson in the history of medicine. The story of the two procedures also draws out a very practical problem: Some treatments will save your life; others are not worth the risks or the side effects; and for an individual trying to manage his own medical care, it’s virtually impossible to tell the difference between the two.
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Leon Neyfakh is the staff writer for Ideas. Amanda Katz is the deputy Ideas editor. Stephen Heuser is the Ideas editor.
Guest blogger Simon Waxman is Managing Editor of Boston Review and has written for WBUR, Alternet, McSweeney's, Jacobin, and others.
Guest blogger Elizabeth Manus is a writer living in New York City. She has been a book review editor at the Boston Phoenix, and a columnist for The New York Observer and Metro.
Guest blogger Sarah Laskow is a freelance writer and editor in New York City. She edits Smithsonian's SmartNews blog and has contributed to Salon, Good, The American Prospect, Bloomberg News, and other publications.
Guest blogger Joshua Glenn is a Boston-based writer, publisher, and freelance semiotician. He was the original Brainiac blogger, and is currently editor of the blog HiLobrow, publisher of a series of Radium Age science fiction novels, and co-author/co-editor of several books, including the story collection "Significant Objects" and the kids' field guide to life "Unbored."
Guest blogger Ruth Graham is a freelance journalist in New Hampshire, and a frequent Ideas contributor. She is a former features editor for the New York Sun, and has written for publications including Slate and the Wall Street Journal.
Joshua Rothman is a graduate student and Teaching Fellow in the Harvard English department, and an Instructor in Public Policy at the Harvard Kennedy School of Government. He teaches novels and political writing.