Broken Hearts: The Tangled History of Cardiac Care

by David S. Jones

Overview

A history illustrating the complexity of medical decision making and risk.

Still the leading cause of death worldwide, heart disease challenges researchers, clinicians, and patients alike. Each day, thousands of patients and their doctors make decisions about coronary angioplasty and bypass surgery. In Broken Hearts David S. Jones sheds light on the nature and quality of those decisions. He describes the debates over what causes heart attacks and the efforts to understand such unforeseen complications of cardiac surgery as depression, mental fog, and stroke.

Why do doctors and patients overestimate the effectiveness and underestimate the dangers of medical interventions, especially when doing so may lead to the overuse of medical therapies? To answer this question, Jones explores the history of cardiology and cardiac surgery in the United States and probes the ambiguities and inconsistencies in medical decision making. Based on extensive reviews of medical literature and archives, this historical perspective on medical decision making and risk highlights personal, professional, and community outcomes.

Product Details

ISBN-13:	9781421408019
Publisher:	Johns Hopkins University Press
Publication date:	03/01/2013
Pages:	336
Product dimensions:	6.00(w) x 9.00(h) x 1.30(d)
Age Range:	18 Years

About the Author

David S. Jones is the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard University.

Table of Contents

List of Figures vii

Preface ix

Acknowledgments xi

Introduction. An Embarrassment of Riches 1

Part I Theory and Therapy

1 The Mysteries of Heart Attacks 27

2 The Case for Plaque Rupture 39

3 The Case against Plaque Rupture 48

4 Learning by Doing 57

5 The Plaque Rupture Consensus 71

6 Rupture Therapeutics 79

7 Therapeutic Ruptures 87

8 Fear and Unpredictability 102

Part II Complications

9 Surgical Ambition and Fear 113

10 Suffering Cerebrums 125

11 Deliriogenic Personalities 141

12 The Case of the Missing Complications 149

13 Selective Inattention 157

14 The Cerebral Complications of Coronary Artery Bypass Surgery 170

15 A Taxonomy of Inattention 180

16 Competition's Complications 189

Conclusion. Puzzles and Prospects 203

Notes 229

Bibliography 257

Index 311

What People are Saying About This

Christopher Lawrence

Very informative and containing important insights, Broken Hearts is thoroughly researched, well written, and the only work of its kind dealing with these treatments of heart disease.

From the Publisher

Very informative and containing important insights, Broken Hearts is thoroughly researched, well written, and the only work of its kind dealing with these treatments of heart disease.
—Christopher Lawrence, University College London

Editorial Reviews

Offers a historical perspective on medical decision making in the case of heart disease.
—The Chronicle Review

For anyone who has had a heart attack or whose family member has had one, this book is definitely worth reading.
—Stephen Goddard, History Wire - Where the Past Comes Alive

Any health collection strong in cardiac care will find this a winning presentation perfect for general health or specialty collections alike.
—Midwest Book Review

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, Scientists' Bookshelf

A surprising and sobering book. David S. Jones combines rigorous research with a clear narrative style to produce a very persuasive historical analysis. I heartily recommend that physicians read Broken Hearts to benefit from a dose of detective work, a dose of insight, and a good dose of humility.
—Jack Coulehan, MD, Pharos

Jones does a very good job of outlining how difficult it is to understand all the workings of the human body, what is involved in medical research, and how that research is applied to human subjects through the lens of one medical specialty.
—Katherine Burger Johnson, Watermark

All in all, Jones presents a different and refreshing take on the challenges before us. He provides more questions than answers, but this is all to the good. Unless we pose the proper questions we cannot ever hope to obtain the right answers.
—Allen B. Weisse, Bulletin of the History of Medicine

Wide-ranging, full of interesting and telling historical details, steadily paced yet thorough in its making sense of complex medicine, Broken Hearts exposes cardiac care as neither mundane nor settled.
—Janet K. Shim, Sociology of Health and Illness

Jones asks us to embrace the complexity of medical decision-making, to recognize medical research gains and gaps, and to acknowledge the social values and priorities that shape our present scenario. Difficult decisions in medicine remain, but perhaps Jones’s book will contribute to more judicious ones.
—Shelley Mckellar, Technology and Culture

For the past half century, patients have been advised to undergo valve replacement, angioplasty, or coronary artery bypass graft procedures to prevent or ameliorate cardiac pathologies. But how good are these procedures? How certain are the surgeons or physicians who recommend them that they will work? How do they know? Giving some answers to these questions and showing how the criteria for making medical decisions change over time are the themes of Broken Hearts.
—Choice

Jones’s larger point is a meditation on how we understand and misunderstand medical knowledge.
—Sarah Dine, Health Affairs

This book will appeal to a wide audience interested in the history of coronary artery disease, its treatment options, and medical decision-making. For those wanting more, there is an extensive bibliography. In closing, Jones asks us to embrace the complexity of medical decision-making, to recognize medical research gains and gaps, and to acknowledge the social values and priorities that shape our present scenario. Difficult decisions in medicine remain, but perhaps Jones's book will contribute to more judicious ones.
—Shelley McKellar, Technology and Culture

A fascinating and insightful history of the interplay between research on the causes of coronary artery disease and the development and assessment of therapeutic—especially surgical—approaches to cardiac care. . . There is much to recommend in Broken Hearts. It is accessible, it will appeal to a wide range of readers, and it offers a useful overview of the complex issues surrounding cardiac care at a time with health-care policy, both in the United States and globally, is fiercely debated and rapidly changing.
—A.R. Ruis, Journal of the History of Medicine and Allied Sciences

An excellent resource. . . The information gleaned from the book will aid the patient in understanding his or her disease and will assist one in decision-making.
—Robin Wulffson, Examiner.com

Jones's book is a sophisticated history of heart attacks and some of the most spectacular medical interventions of the twentieth century. It is meticulously researched and thoughtful, and Jones pays equal attention to technical details, social contexts and economic implications. The book will be of interest to anyone interested in the uncertainties of modern medicine: uncertainties associated with understanding the cause of illness and, perhaps more importantly, the success of treatment.
—Carsten Timmermann, Social History of Medicine

Broken Hearts is a captivating study of the history of cardiology. By moving away from the long-standing tendency to frame the history of cardiology as a progress-narrative, this book makes a great addition to the emerging body of literature that adopts a critical stance towards cardiac care. . .
—Somatosphere

From the Publisher

Jones asks us to embrace the complexity of medical decision-making, to recognize medical research gains and gaps, and to acknowledge the social values and priorities that shape our present scenario. Difficult decisions in medicine remain, but perhaps Jones’s book will contribute to more judicious ones.

Technology and Culture - Shelley Mckellar

This book will appeal to a wide audience interested in the history of coronary artery disease, its treatment options, and medical decision-making. For those wanting more, there is an extensive bibliography. In closing, Jones asks us to embrace the complexity of medical decision-making, to recognize medical research gains and gaps, and to acknowledge the social values and priorities that shape our present scenario. Difficult decisions in medicine remain, but perhaps Jones's book will contribute to more judicious ones.

Technology and Culture - Shelley McKellar

Offers a historical perspective on medical decision making in the case of heart disease.

The Chronicle Review

A fascinating and insightful history of the interplay between research on the causes of coronary artery disease and the development and assessment of therapeutic—especially surgical—approaches to cardiac care. . . There is much to recommend in Broken Hearts. It is accessible, it will appeal to a wide range of readers, and it offers a useful overview of the complex issues surrounding cardiac care at a time with health-care policy, both in the United States and globally, is fiercely debated and rapidly changing.

Journal of the History of Medicine and Allied Sciences - A.R. Ruis

Jones’s larger point is a meditation on how we understand and misunderstand medical knowledge.

Health Affairs - Sarah Dine

A surprising and sobering book. David S. Jones combines rigorous research with a clear narrative style to produce a very persuasive historical analysis. I heartily recommend that physicians read Broken Hearts to benefit from a dose of detective work, a dose of insight, and a good dose of humility.

Pharos - Jack Coulehan

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.

Scientists' Bookshelf - Nortin M. Hadler

All in all, Jones presents a different and refreshing take on the challenges before us. He provides more questions than answers, but this is all to the good. Unless we pose the proper questions we cannot ever hope to obtain the right answers.

Bulletin of the History of Medicine - Allen B. Weisse

Jones does a very good job of outlining how difficult it is to understand all the workings of the human body, what is involved in medical research, and how that research is applied to human subjects through the lens of one medical specialty.

Watermark - Katherine Burger Johnson

An excellent resource. . . The information gleaned from the book will aid the patient in understanding his or her disease and will assist one in decision-making.

Examiner.com - Robin Wulffson

Broken Hearts is a captivating study of the history of cardiology. By moving away from the long-standing tendency to frame the history of cardiology as a progress-narrative, this book makes a great addition to the emerging body of literature that adopts a critical stance towards cardiac care. . .

Somatosphere

Wide-ranging, full of interesting and telling historical details, steadily paced yet thorough in its making sense of complex medicine, Broken Hearts exposes cardiac care as neither mundane nor settled.

Sociology of Health and Illness - Janet K. Shim

Any health collection strong in cardiac care will find this a winning presentation perfect for general health or specialty collections alike.

Midwest Book Review

For anyone who has had a heart attack or whose family member has had one, this book is definitely worth reading.

History Wire - Where the Past Comes Alive - Stephen Goddard

For the past half century, patients have been advised to undergo valve replacement, angioplasty, or coronary artery bypass graft procedures to prevent or ameliorate cardiac pathologies. But how good are these procedures? How certain are the surgeons or physicians who recommend them that they will work? How do they know? Giving some answers to these questions and showing how the criteria for making medical decisions change over time are the themes of Broken Hearts.

Choice

Jones's book is a sophisticated history of heart attacks and some of the most spectacular medical interventions of the twentieth century. It is meticulously researched and thoughtful, and Jones pays equal attention to technical details, social contexts and economic implications. The book will be of interest to anyone interested in the uncertainties of modern medicine: uncertainties associated with understanding the cause of illness and, perhaps more importantly, the success of treatment.

Social History of Medicine - Carsten Timmermann