Having Heart and Heart Attacks…

This morning I went outside to walk; 5 untimed miles in Bradley Park (hill course). I had to stretch the piriformis a couple of times. Then leg weights plus yoga on my own; that hit the spot.

I need to be intentional about stretching and back/piriformis PT.

This is a long article from Harvard Magazine which reviews a book on the history of heart treatment:

In his new book, Broken Hearts: The Tangled History of Cardiac Care (Johns Hopkins), David S. Jones ’92, M.D. ’97, Ph.D. ’01, Ackerman professor of the culture of medicine, narrates the history of two of American medicine’s highest-profile treatments for heart disease: coronary artery bypass grafts and angioplasty. Each intervention, promising lifesaving relief, was embraced with enthusiasm by cardiologists and cardiac surgeons—and both techniques often do provide rapid, dramatic reduction of the alarming pain associated with angina. Yet, as Jones painstakingly explains, it took years to show whether the procedures prolonged lives; in both cases, subsequent research deflated those early hopes. The interventions—major procedures, with potentially significant side effects—provided little or no improvement in survival rates over standard medical and lifestyle treatment except in the very sickest patients. From his detailed study, Jones draws broader conclusions about the culture and practice of modern medicine.

“Doctors generate better knowledge of efficacy than of risk, and this skews decisionmaking,” he says. “They design treatments to do something specific, and design studies to see if those treatments achieved those outcomes; and so accumulate lots of data on whether treatments produce the desired effects. Capturing good knowledge of side effects, especially the unanticipated ones that are so common, is both less interesting and more difficult. Whenever doctors have more thorough knowledge of the possible benefits of a treatment than they do of its potential risks, patients and doctors will lean towards intervention.”

So, one lesson is that while the benefits are a bit more straight forward to track…sort of…ill side effects are another story.
Factors that confound measurement include:
1. Technology keeps getting updated, so the procedure you are testing now may well be upgraded by the time you finish your statistical test
2. Longevity takes, well, a long time to measure and side effects sometimes come on after the fact. Combine this with technology that is continuously being updated (e. g. longevity tests being conducted today are, by their nature, testing technology that is at least a decade old.
3. What do the results mean? As pointed out in the article:

The reason, he argues, is the bias toward intervention that accompanies most new medical treatments. Both doctors and patients evaluate such innovations by asking if there is a chance they will help. “The truth is, there is almost always a chance something will help; there are very few treatments in which there is zero chance that it will help,” says Jones. “Is there a chance that mastectomy will decrease a woman’s risk of dying of breast cancer? Sure there is. Should we do a mastectomy on all young women, because there is a chance it will help them avoid breast cancer? Of course not; we have to figure out when it is appropriate.”

4. Overaggressive treatment may induced LONG TERM side effects:

Jones has some personal experience with such life-and-death decisionmaking. Six years ago, at 37, he was diagnosed with a very rare form of stomach cancer and had a tumor surgically removed. “Mine was cancer therapy as it existed in the 1890s: find a tumor, cut it out, and hope for the best,” he writes in the preface to Broken Hearts. Yet his aftercare was fully twenty-first century, involving frequent Positron Emission Tomography (PET) scans to monitor his condition. Jones has remained cancer-free since then and no longer receives PET scans, as his doctor feels they aren’t needed; he told Jones, “If you were 70 years old, we’d do scans every six months, but if we were to start doing that to you now, you’d die of radiation-induced leukemia before you’re 60.”

The cure might kill faster than the disease.

One other thing: sometimes there are more effective responses…which the patient won’t follow:

Epidemiological surveys like the groundbreaking Framingham Heart Study (a lifestyle study of 5,209 middle-aged residents of Framingham, Massachusetts, begun in 1948 to identify the risk factors for heart disease), began to connect factors like a low-fat diet, exercise, and avoiding smoking to a lower risk of heart attack. But physicians knew that such behavioral changes would challenge their patients. They turned away from prevention and toward treatment: if blocked pipes were the problem, then bypassing the blockage would solve it. “Of course,” says Jones, “treatments for heart disease also generate revenue dwarfing that produced by preventive care.”

Go ahead and read this article; there is still much more there. But once again, we find the old “data challenging what we think that we know” or “what we “know”” isn’t confirmed by data.


February 17, 2013 - Posted by | injury, science, walking |

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