Broken Hearts: The Tangled History of Cardiac Care 1st Edition

I learned a great deal about our evolving understanding of heart attacks from this book. It is well written and well documented. The vested interests in cardiology and industry are explained very well. This book gives a very different explanation of heart attacks than the compelling documentary The Widowmaker, which is narrated by Gillian Anderson, which swayed me mightily. Broken Hearts definitely changed my opinion.

I purchased this book when I heard that my dad was going to have angioplasty and then he wound up having bypass. I found the history of the procedures very interesting, and I thought the book had some good critiques of the culture surrounding the procedures, both on the medical side and on the patient side. But ultimately the book trails off on social science tangents and vague assertions of discrimination and whatnot that were far afield from assessing whether angioplasty and bypass are a bright idea for anyone. Also, I was disappointed that there wasn't more discussion of the changes in conventional wisdom about why people have heart disease. In particular, some discussion of how America went overboard on low-fat diets and narrow fixation on LDL cholesterol. Given the discussion of statins in the book, I thought there might be a critical appraisal of those issues, but there was not.

Could have been an awesome book on an important topic. It isn't. It is a good book on the history of angioplasty and bypass that will help some folks think critically about the procedures.

WHAT IS MY CONNECTION TO THIS BOOK -- "BROKEN HEARTS: The Tangled History of Cardiac Care" by David S. Jones, MD, PhD, the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard Medical School? Especially given the title I have selected for this review, I should make clear that I have not been asked by anyone to write this review. Neither have I communicated with anyone about it, nor do I know the author or anyone who knows him. I write this review solely because I hope to persuade as many people as possible to read this exceptionally well researched, beautifully written, and ever so timely and important book.

And so that you might have some perspective regarding my own professional background to enable you to evaluate better my remarks herein, my own personal perspective is as follows. I am not a medical doctor. My professional career has been in finance on Wall Street, which I left after 30 years to establish my own financial organization in Russia. Throughout my life I have had a keen interest in medicine in general and in medical history in particular. Truth be known, although Wall Street was a great ride, I probably would have even more enjoyed becoming a physician or surgeon. Nevertheless, I have for many years been involved in different ways in national medical policy issues, and I have served for long periods on the clinical trial review boards of four of the largest and best academic medical centers in the country, during which years I developed personal relationships with some of the best medical scientists in the world. I hope you will therefore conclude that my remarks are independent and objective, and hopefully that they come from a background that provides me with a wee bit of familiarity about the subject of this book.

AN APT COMPARISON: A little over two years ago I wrote an Amazon review of Siddhartha Mukherjee's THE EMPEROR OF ALL MALADIES: A BIOGRAPHY OF CANCER which did in fact go on to win the Pulitzer Prize in Nonfiction in 2011. At the time when I wrote that review I thought "Emperor" was the best book of its kind that I had ever read and that I would never see another similar book of the same caliber. I was wrong because I believe BROKEN HEARTS is such a book. These two books are bookends on the top shelf of medical histories and popular yet serious medical stories, encompassing all the rest. EMPEROR is somewhat deeper in the historical aspect, necessarily so, but not by much. BROKEN HEARTS is heavier on the decisional aspects, necessarily so, and from a public policy and personal decision making standpoint it is a bit more immediately useful, but not by much,. The research underpinning each is bed rock solid. And they are both exceptionally well organized and splendidly written. (Where do these physicians get off anyway, writing THAT well?) Overall, on a one to ten scale, they are both elevens.

SO WHY READ IT? Beyond its general excellence, why should you be interested in this general topic and this book? Because, statistically speaking, you the reader of this review will be fortunate if heart disease does not someday involve you or your immediate family because heart disease remains the leading cause of death worldwide. Hopefully heart disease will never be a part of your life. But if it is, I promise you that you will be grateful you read this book as you and your family and your physician develop a master plan regarding your treatment and survival strategy. And I personally say that as one who has heart disease, and who has had a heart attack, and who has read this book. My regret is that Dr. Jones did not write this book years ago. It would have helped me tremendously at the time and it again may still, depending upon what fate holds in store for me.

SPECIFICALLY HOW DOES THIS BOOK HELP? BROKEN HEARTS provides you with a brilliant history of the practice of cardiology and of cardiac surgery from the beginning until now. Key players in this development are the history of both coronary artery bypass surgery and of angioplasties. Cardiologists and cardiac surgeons warmly welcomed the arrival of each intervention, providing as they usually did powerful relief from the often extreme physical pain and physiological terror of angina. But whether they increased longevity for non-cardiac arrest patients with general heart disease is another story and Dr. Jones picks that apart carefully, piece by piece. Eventually, as he demonstrates, it became more and more clear that the initial hopes of life extension were not materializing, except with the most seriously ill patients. And these invasive procedures had their own risks of significant adverse events when compared with standard and traditional medical treatments combined with lifestyle changes. Yet both procedures grew very rapidly in usage and popularity. Again brilliantly, Dr. Jones unbundles the reasons for their rapid growth and in the process so very much is illuminated about medical decision making along with some of its obvious as well as its not-so-obvious inherent biases.

Dr. Jones then uses all of this as a platform on which to build his broad conclusions regarding the theory and practice of modern medicine in general, how the medical culture operates, how decisions are often made by physicians and surgeons, on what they focus most heavily when making those decisions, where and when such decision making is valid and when it is not, and how sometimes in this overall process cardiologists and cardiac surgeons inadvertently mislead themselves, their patients, and society in general. To be able to see the ambiguities and inherent biases in such medical decision making, and especially regarding some aspects of cardiology and cardiac surgery, Dr. Jones must take us into the roadside weeds. But fear not when I say that, because he leads us through them clearly, thoroughly, easily, and painlessly.

In doing all of this Dr. Jones provides you with an overall strategy for your and your physician's decision making should you or your closest loved ones ever be confronted with heart disease. He also clearly delineates the implications and costs to the medical profession of some of its somewhat biased decision making models. Finally, the implications to the general community and to public health in general, and especially to the public cost of treatment, are examined in the same clear-eyed fashion and in an eminently balanced manner. THAT sounds pretty scholarly and white-paperish and analytical and maybe even boring. But it is NOT. This book is absolutely the antithesis of boring. It is quite possibly a peek into your own future and if that is to be the case it talks to you about how your probable treatment options got to where they are today and how you can yourself manage that information to your own best advantage. And given that Dr. Jones does this in such a balanced manner, we can take for granted that he and BROKEN HEARTS will likely be shot at from ALL public quarters. That, when you think about it, is about the best testimonial this book can get. The honesty and integrity and skill of his analytical scalpel ranges and touches widely and cuts away much that is dysfunctional or misleading in all this. Naturally it will be painful and upsetting to those being so "touched" of course, but the overall body of medical knowledge and understanding benefits greatly -- as will each of us reading this book.

Kenneth E. MacWilliams
Portland, Maine

I frankly don't know how exactly to describe this book, except to say it is a very precise, methodical look at innovation in heart operations, bypass and angioplasty.
This is not an author who gets on his high horse. Rather, he is mystified about how doctors embrace several life-saving operations, or purported life-saving.
When I read it, I felt like I was watching a chess game. After returning it to the library, I find I would like to read it again. I think I will.
This was very absorbing.
Several points from the book:
Drugs took off in conjunction with the germ theory of disease when antibiotics appeared. Thus, medical innovation depends on doctors' having something to do, along with a scientific theory.
The Rand Corporation had a project to establish consensus among cardiologists about when a bypass is needed - the docs only agreed with each other 50% of the time.
Evidence Based Medicine usually focuses on the efficacy of a treatment, not so much on the side effects.

I highly recommend this book for its thoroughness and factual information about what goes on behind the scenes. There are few like it. This is a book about medical innovation in the case of bypass and angioplasty. The discussion of neurological side effects from bypass is an eye opener.

An invaluable contribution to healthcare in American. David Jones shares information that illustrate aggressive cardiology interventions such as angiograms, angioplasties, and coronary by-pass surgery are overdone and frequently harmful. He takes a historical approach in an attempt to understand this ugly chapter in American medicine. His writing is interesting and illuminating, if a bit long winded. In trying to understand why these procedures are practiced in light of evidence to the contrary, he probes the human psyche and presents several insights. His topic is of critical importance but rarely discussed. The juggernaut of the health care industry rolls along, crushing any opposition in its path. Perhaps that is why he is so diplomatic in his treatise. Dr. Nortin Hadler, a brilliant, profound patient centered physician has written about this cardiology debacle for decades, and is not so timid in reprimanding the physician involvement that drives this sad practice. A must read!