The Right and Wrong Way to Think About Heart Attacks: From Marin's Narrative Crawl

This is a response to the article The Right and Wrong Way to Think About Heart Attacks.

This article is misguided and an excellent example of why people do not understand health care as a whole. It implies that there is no medical reason to insert these medicine coated stents in individuals who are not suffering acute coronary episodes, it implies that thrombolytics are ineffective in treating acute coronary episodes, and it also implies that these stents do more harm than good.

It provides support for none of the above. One article in the New England Journal of Medicine does not a medical truth make. Also, the statement that "angioplasty needs to be used more" in the emergent setting fails to take into account the *plethora* of factors that are involved in undertaking such a procedure. This is why we have doctors who have gone to school for 14 million years; to evaluate the risks of procedures, determine which will work better for their patient, and act accordingly. It's remarkably easy to be a Monday morning quarterback when it comes to emergent care; every medic I've ever met, including myself, has found things they'd like to redo or do differently with every patient they've ever had. And that is not overstatement. So why should I believe a journalist who has no (to my knowledge) medical background, and can't even explain the physiology without using the metaphor he started out by despising?

Thrombolytic treatment is highly effective and safe when used in the correct patients and done correctly. It is used to treat occlusive strokes, as well as myocardial infarction (MI). This particular piece seems to overlook that, and doesn't supply the multiple studies that have proven the efficacy of this treatment and the benefits of its continued use.

I also do not like the overemphasis of one cardiologist's statement regarding the "adrenaline rush" that comes from treating a patient. That demeans the medical profession and every individual who works in it. I am certain there was much more to that cardiologist's statement, if he is indeed a professional and comports himself as such. There are many motivations for becoming a cardiologist. I'm sure adrenaline and the ability to think quickly under physiological and psychological stress is certainly a draw, but an affinity for providing good medical care and an intense intrigue with the human body are also necessary portions. I'd like to see a quote that more accurately represents my profession, and am not happy with this journalist for yet again going for the "blood guts and glory" quip.


The crux of the problem I have with this article, however, is that the author failed to take into consideration the fact that there *is* a good reason to place stents in the population that is not suffering from an acute cardiac event. Stents are placed in these individuals not to prevent acute MI's. That is not the intention with this therapy. What this author fails to present is the fact that these stents are placed to diagnose and treat lesions that lead to other conditions, which include CHF (congestive heart failure) and angina, which is pain that occurs when the oxygen supply to the heart is inadequate. Both of these lead to cardiac damage and further health compromise. If this author had fully researched the topic, instead of assuming that these procedures were being done unnecessarily by focusing only on their emergency use and assuming that that was the only mode in which it is used, then he would have been able to present a balanced story.

Also, comparing lipitor to increased estrogen use is just simply comparing apples and oranges. One was a hormone used because short term observations indicated positive results. One is a cholesterol lowering agent. Two different drugs with different pharmacological actions. Not to say that the pharmaceutical companies don't under test drugs. Just saying that this is a poor analogy to use. A general statement or examples of a few drug types that have been recalled or utilized in different modes would have been much better.

The only redeeming facet of the article is the advocacy for moderated lifestyle, with better diet, exercise and cessation of smoking. That's scientific fact and something that people should be much more aware of.

I would like to see articles that are explained using plain English, that cover simple physiology (really, it's not that difficult... if I can explain it to a 13 year old boy scout, then authors with much better capacities than I can explain it to the general public...) and the different factors that go into health care, including pathologies and treatments. These articles should be referenced to multiple studies from multiple well-regarded scientific sources, for those of us who read such things so that we can further our education and better care for our patients. But that's a perfect world scenario.

In short, don't believe everything you read that says "explanation of heart disease" or any other condition, and make sure you check your facts with your doctor before you choose treatments. Also, should you find yourself confronted with medical decisions, ask your doctor for references and material to read so that you can be well informed. Trust, but verify. Ask if you don't understand.

If any of this language is too technical for anyone, let me know and I'll clarify it for you. I can and will translate out of "docspeak," it is just simpler for me to write it initially this way.