The Boston Medical Library presents the 10th J. Worth Estes, MD History of Medicine Lecture. David S. Jones, MD, PhD, A. Bernard Ackerman Professor of the Culture of Medicine, Faculty of Arts and Sciences and the Faculty of Medicine, Harvard University, will present his talk “Broken Hearts: The Tangled History of Cardiac Care” on Wednesday, May 28 from 5:30 PM to 6:30 PM in the Cannon Room/Building C/HMS Quad.
J. Worth Estes was a beloved professor in the Department of Pharmacology at BU.
Every day, all over America, people visit their doctors with chest pain and other symptoms of coronary artery disease. Each year over a million of them choose to undergo bypass surgery or angioplasty. Are these decisions good ones? Even though modern medicine has committed itself to an ideal of evidence-based medicine, with its clinical trials, meta-analyses, and practice guidelines, the answer is not always clear. By looking closely at the history of these procedures, it is possible to understand some of the reasons why this is the case. One problem is that clinical trial data has never monopolized medical decisions. Doctors and patients also pay attention to how treatments work, and if an intervention directly addresses the perceived cause of a disease — as often happens with surgery — then doctors assume that it will work. The challenge here is figuring out whether or not our understanding of the causes of disease is correct. The history of thinking about heart attacks shows how complicated this can be. Another problem is that clinical research generally often under-estimates the risk of medical interventions. It is easier to study the desired outcomes of an intervention than its expected or unexpected complications. As a result, doctors often end up with more thorough knowledge of a procedure’s efficacy than of its risks, an asymmetry that introduces a bias in favor of medical intervention.
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