When doctors can't get a grip on a particular disease, they begin experimenting with ever fiercer treatments on the assumption that the more powerful the weaponry, the greater the likelihood of vanquishing the enemy.
That's certainly the case with heart attacks, still the number one killer of the West. Anyone who has suffered a heart attack, particularly in places like America, has his choice of the most up to date medical nuclear warfare.
Nevertheless, this is a perfect example that, in medicine, might usually doesn't equal right. The latest evidence, where more than a quarter of a million elderly patients in North America were compared, clearly demonstrates that angioplasty and bypass surgery make absolutely no difference in terms of survival.
The study compared the US's use of cardiac procedures with those of Canada. Although America had 11 times the rate of angioplasty and 10 times the rate of bypass surgery than Canada, all this aggressive treatment made absolutely no difference. After a year, .survival rates were virtually identical between the two countries (New Eng J Med, 1997; 336: 1500-5).
We also know from other research that the effects of angioplasty are always shortlived, and that more than one in 20 heart patients given bypass surgery go on to suffer a stroke (New England J Med, 1996; 335: 1857-63).
Still other evidence, also in this issue, shows that the accepted cardiac protective efforts of the moment, such as lowering cholesterol, actually increase the risk of death from stroke.
Many in medicine use what can only be described as an arithmetic sleight of hand to justify the use of many drugs, particularly the "statin" cholesterol lowering drugs. Although pravastatin has been shown to reduce the number of heart attacks, overall, this doesn't translate into any significant number of lives being saved.
The most infuriating aspect of all this nuclear overkill is that solid evidence shows that nothing is as useful in treating heart patients as a simple change in lifestyle. The Mediterranean heart trial comparing patients following a Mediterranean diet, to those on the usual low cholesterol "heart" diet, proved that heart attacks and deaths were decreased by 70 per cent among the group given the Mediterranean diet (Am J Clinical Nutrition, 1995; 61: (6 Suppl): 1360S-1367S). This is more than twice as good as the best that cholesterol lowering drugs can do.
There is also the the work of doctors like Dean Ornish of San Francisco, who continues to demonstrate, through the use of CAT scans, that patients following lifestyle changes of regular exercise, relaxation and a vegetarian diet, actually reverse atherosclerosis over five years (JAMA, 1995: 274: 894-901).
Unlike cancer, heart disease appears to be an enemy that is can be easily vanquished, not by submitting to high tech medical wizardry, but by simply becoming sensible and connected in our lives.
Incidentally, allow me the indulgence of showing off our new daughter Anya, whom we recently (legally) adopted in Russia. She is exceptionally beautiful, placid and relentlessly cheerful, despite a tough start in life, which renews our faith in the irrepressibility of the human spirit.
Although I'm still editing the newsletter, I will be in the office far less for a few months. Please continue to send me information for the newsletter and request urgent medical information. If you have less pressing business requiring a personal answer from me, I'd be grateful if you could wait to write to me in the autumn.