Quasi-News and Commentary

by Wordworks2001

From time to time, I get on my anti-coronary artery bypass kick and stir up a hornets nest of single, double, triple, quadruple and even quintuple recipients of this highly popular form of mutilation for the sake of medicine. There is absolutely no proof that the CABG treats angina. The surgery was never tested in a double blind study before it was approved. And, after the first few seemed to “cure” angina, well, surgeons came out of the woodwork to learn how to do the moneymaking procedure. CABGs haven’t really been around all that long.

  • 1962: Drs. Sones and Shirey, Cleveland Clinic, demonstrate first practical angiography to visualize blockages in coronary arteries. Using the brachial arterial approach under X-ray visualization, they manipulated a catheter into the coronary ostia and injected contrast solution while watching the image intensifier and recording image on movie film.
  • 1968: René G. Favolaro, Cleveland Clinic, achieves restoration of coronary blood flow in 171 patients with saphenous vein grafts bypassing occlusions in several positions, sometimes with multiple grafts in the same patient.
  • 1973: Benetti, Calafiore, Subramian achieve direct anastamoses between left internal mammary artery and left anterior descending artery on beating hearts, operating through 10 cm. incisions between ribs.

But it took 22 years before the huge medical products industry in the USA saw CABGs as a cash cow and decided they wanted part of the action. The cardiac surgery business has been one of greed and lust for power and money ever since.

  • 1995: The medical products industry, with significant venture capital support, launches innovative products to enable coronary revascularization on a beating heart via a median sternotomy without an external perfusion circuit or through intercostal ports while using the perfusion circuit. This stimulated development of techniques and products designed to minimize the risk associated with cardiac surgical procedures.

Dr. Howard Wayne, a cardiologist who was founder and director of the Noninvasive Heart Clinic in San Diego, once told me that 95% of all CABGs were unnecessary. In more than 25 years of practicing cardiology, only a handful of patients he saw required surgery before being tried on a medication regimen first. He prided himself on losing staff privileges at most of the hospitals he was affiliated with for lack of admitting patients.

Many cardiologists try to convince their patients that opening an occluded artery with angioplasty, or bypassing it with coronary artery bypass surgery, will prevent heart attacks or premature death, and that an alternative or alternatives to bypass surgery such as medical treatment with drugs is not an option and will not work. Such decisions against an alternative or alternatives to bypass surgery are usually based solely upon the results of an angiogram that show the presence of coronary artery disease.

Unfortunately, no prior angiogram is usually available to determine whether the patient’s coronary artery disease is new or old. Without a prior angiogram to compare with, it is impossible to determine whether the patient’s coronary artery disease has recently progressed.

In other words, any coronary artery disease found has often existed in unchanged form for years. It is, therefore, coincidental, and there is another reason for the patient’s chest pain. If so, then it is even more likely there is an alternative or alternatives to angioplasty or bypass surgery. This is particularly likely to be true in patients with recent onset of chest pain.

Finally, other doctors are starting to tout medical treatment before surgery for people with CAD. One is Dr. Nortin M. Hadler, is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and attending rheumatologist at the University of North Carolina Hospitals in Chapel Hill, N.C.

In a scathing editorial on ABC News website Health section yesterday, Hadler really beat up on the invasive crowd of cardiologists. He pointed out, “Thanks to the skeptics, thousands of men with heart pain were soon enrolled in trials in the United States and Europe that compared CABG surgery with medical treatment — such as drugs and a doctor’s lifestyle advice. These studies continued for more than a decade, until around 1980. The results weren’t very encouraging for those who believed in heart surgery. With the exception of a small group, the patients who underwent CABG did not live any longer than those treated medically.”

Even worse, a lot of the CABG patients died before they could leave the hospital, about half had a stormy recovery, and nearly that many experienced memory loss that lasted a year after surgery.

Hadler continues in his editorial, “Despite their own failures, cardiologists and cardiac surgeons still… talk about new procedures, new widgets and gizmos but don’t wonder whether they are chasing after the wrong idea… You have two options: Avoid the sting of experimental surgeries, or survive it. I prefer the former. If I have heart pain, I’d want a doctor’s advice and watchful eye, along with aspirin and a few other drugs. No, I’m not willing to go quietly into the great unknown. But I’m at least as likely to do well with some medications as with letting someone do violence to the plaque in my coronary arteries.”

Finally, here is some more news your invasive cardiologists do not want you to know: A Harvard group of cardiologists published two studies in JAMA showing that when patients are sent for bypass surgery or angioplasty, 75-80%% were judged not to require the procedure upon referral for second opinion.

Then, in the journal Circulation, there was no difference in survival between patients randomized to have either bypass surgery or conservative medical treatment.

Even worse, the Lancet showed that when patients were randomized to have either angioplasty or conservative medical treatment, the angioplasty group actually had more heart attacks and deaths (6.3%%) than the medical group (3.3%%).

Therefore, the published data show that these invasive and expensive procedures are 75-80%% unjustified and do not improve survival overall.

Show this post to your friendly neighborhood cardio-thoracic surgeon. No, on second thought, maybe you shouldn’t. You might give him a heart attack.
Wordworks2001 is a retired US Army master sergeant who resides in Indianapolis and works in Nigeria. He blogs at http://wordworks2001.blogspot.com

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