causes, 87
United Nations program, 286
Yale-New Haven Hospital research, 1, 40–41
Alzheimer’s disease, 62, 98–99, 272, 284–85
American Heart Association, 28–29 America’s Pharmaceutical Companies, 96–97
angina, 65, 132, 244, 245–46, 258
angiography
of the author: attempt to see Dr. Beck, 71; by Dr. Cabin, 3, 6, 80, 83
definition, 1
historical background, 93, 230
angioplasty
definition, 1–2
percent of patients who need second, 43
percent of unnecessary, 37
research by Helfant, 263
risks and benefits, 43–44
stent: failures, 99, 132; impact of this development, 15, 43, 95; probability of needing second, 44
antibiotics
effects on mortality rates, 109–10
historical background, 94, 109, 270–71
pathogen resistance to, 26, 102, 255, 288
production by microorganisms, 270
treatment for bypass patients, 259
antibodies, 255
antidepressant medications, 43, 97, 154
antipsychotic medications, 105, 150, 268
antiretrovirals, 40–41, 255, 282–83
aorta, 36, 70, 245
arm pain, 5
Armstrong, Moe, 17
arterial plaque. See plaque
aspirin, 70, 252, 259
Atelenol, 70
Atherosclerosis
early research, 92–93
genetic aspects, 114
infectious disease linked with, 259, 260
as an inflammatory process, 255–60, 272
limitations of medical knowledge, 16, 43, 249, 252, 260
limited role of risk factors, 30, 256
back pain
author’s symptoms prior to surgery, 59, 60, 64, 65, 69, 245
placebo effect with, 154
Barker, David, 30
Barnard, Christiaan, 281
baseball, 11, 13, 190–91, 235–36
basketball, 13–14, 17, 80, 120
Baycol, 133
Bay State Hospital (Springfield, Mass.), 8
beating-heart surgery, 33
Beck, Dr., 70, 71
beta-blockers, 69, 70
Bible, 116–17, 212
Big Man (Neugeboren), 77, 213–14
Black Panthers, 189–90, 192
blood clots, 29, 43, 70, 94, 258, See also plaque
blood platelets, 70
blood pressure
levels of the author prior to surgery, 5, 56, 69
rise due to medical exam, 251
as risk factor, 5, 24, 249, 251
blood vessels
collateral, 6, 130, 131
reaction to chronic high blood pressure, 251
body. See also mind-body connection
ability to heal itself, 34, 161, 264
feelings of dissociation, 121, 123
temperature during surgery, 4, 279, 280
brain
damage. See neurological conditions
effects of aging, 222
endorphins released by, 155
inability to heal itself, 87, 162, 216–17
wonders of the, 15
breast cancer, 28
breathing difficulty
with angina, 246
of the author: prior to surgery, 49, 51, 52, 55–57; two years after surgery, 122–23
with viral heart disease, 248
breath strength test, 56
Bronx State Hospital (Bronx, N.Y.), 19–20
Brooklyn Dodgers, 11, 13, 190–91, 235–36
Brumlik, Dr. Joseph V., 242–43
bypass. See coronary bypass
Cabin, Dr. Henry
angiogram by, 3, 6, 80, 83
background, 3, 22
initial visit with, 1–6, 8–9
postsurgery checkups with, 22, 127, 130
views: on being “cured,” 233; on postsurgery Norvasc, 123
calcium channel blockers, 123, 263
cancer. See also Hodgkin’s disease
breast, 28
cervical, 32
chemotherapy and life expectancy, 99, 112
future scenario for treatment, 116
genetic aspects, 117
Li-Fraumeni cancer syndrome, 274
mortality rates, 91, 111–13
MRI for diagnosis, 231
P53 system and the aging process, 272–75
prostate, 33, 300
radiation therapy, 77
risk factors, 111, 113, 116, 117
screening and prevention activities, 112, 113, 116, 117
trends in types, 112
cardiac auscultation, 35–36
cardiac care unit, 14, 43, 94, 243
cardiac electrophysiology, 263
cardiac resuscitation, 27, 38
cardiology
historical background, 92–93
limitations of medical knowledge. See medical knowledge: limitations in
multidisciplinary nature of, 277
nuclear, 33, 263
quality of care. See managed care; physicians: relationship with the patient
cardiomyopathy, 70, 82
cardioversion, 38
caregiving
by the author, 5, 13, 58
author’s anxiety about, 42, 58, 65
for chronic conditions, 1990 data, 172
Care of the Psyche (Jackson), 158–59
CAT scan, 95, 118, 133, 222, 230–31
Centers for Disease Control and Prevention, 46
cervical cancer, 32
Charyn, Jerry, 80
chest pain or discomfort
author’s symptoms prior to surgery, 50, 51, 52, 55, 59, 64
heart attack with lack of, 28
stopping movement until it recedes, 65
as symptom of heart disease, 5, 246
childhood diseases, 86–94, 109–10, See also specific diseases
Chlamydia pneumoniae, 259, 260
chlorpromazine, 268, 269
cholera, 102
cholesterol. See also cholesterol-lowering medications
author’s blood level: after surgery, 134; prior to surgery, 5, 59, 69
heart disease with normal levels, 29, 259
LDL and HDL, 29, 132
risk of death with low, 30
cholesterol-lowering medications, 29, 31–32, 99, 133, 260, 262–63
cholestyramine, 262
Christopher Reeve Paralysis Foundation, 269
Chronic Care in America: A 21st Century Challenge (Robert Wood Johnson Foundation), 171–72
cigarette smoking. See smoking
clinical science
limitations in, 33, 175–76
rise in the influence of, 168–69
clozapine, 150
cognitive losses, risk with coronary bypass, 9, 44
colchicine, 140, 141, 143
collateral blood vessels, 6, 130, 131
Columbine High School, 234
The Coming Plague (Garrett), 255
communication in relationships, men vs. women, 125
compassion, 20, 212, 265–66
computed tomography. See CAT scan; CT screen
conflicts of interest, 37, 261–62, 290
Cooley Dickinson Hospital (Northampton, Mass.), 68
coronary bypass
of the author: diagnosis, 4; exercise in the hospital after, 14; “last words” before, 13; procedure, 13, 83–85, 179; scars in penis due to catheterization, 140; symptoms prior to, 5, 8, 47, 49–62; timeframe of surgery, 13; use of his own arteries, 84, 123
beating-heart, 33
cost of surgery, 43
definition, 4
effects of cholesterol-lowering medications, 29
mental decline from, 44
no cure for, 21, 22
number of patients annually, 118
number performed annually, 5
percent of patients who need second, 43
risks and benefits, 9, 43–44
unnecessary overuse of, 37
use of heart-lung machine, 4, 13, 277–80
coronary disease. See heart disease
cortisone, 268
C-reactive protein, 258–59
CT screen, 132, 133
cultural aspects of
disease transmission, vs. biology of organism, 183–84, 194
of infant mortality, 181–82
influence on values, 45, 237
not showing fear, 48
of poverty, 184–85
cystic fibrosis, 250
cytomegalovirus, 260
Dalai Lama, 263
Darwinian medicine, 252–57, 259, 271, 272
The Deadly Truth: A History of Disease in America (Grob), 86
death. See also life expectancy
author imagining his, 78
coming to terms with, 73
end-of-life care, 163, 289
medical data. See mortality preparations for, 82–83
as a series of preventable diseases, 98
defibrillator, 38, 95, 243, 290
Demetri, Mrs., 89
depression
clinical judgment in diagnosis, 204
following a heart attack, 154
of Friedland’s father, 196
impact of new treatments, 43
placebo effect with, 154
postsurgical, 48
rank in global burden of disease, 204
DeWood, Marcus, 92–93
diabetes
coexistence with heart disease, 28
complications, 107
incidence rate, 107
inflammation and, 272
preventive measures, 106–7
risk factors, 106–7, 249
type 2, 106–7, 249
diagnosis
as an art: importance of listening. See listening to the patient; role of instinct, 101, 105, 247; role of judgment. See physicians: judgment skills; role of technology, 32, 34, 43, 95, 147, 233; uncertainty and probability, 292, 296
of the author: Dr. Flynn’s analysis of the echocardiogram, 70; Dr. Flynn’s analysis of the EKG, 69–70; Helfant’s analysis of the echocardiogram, 82; for Hodgkin’s disease in college, 76; “missed,” 8, 24, 28, 31, 47, 74; possible viral infection, 8, 70, 71, 247; reaction to, 3–4
categories, changes over time, 92
danger of dependence on technology. See technology: vs. listening to the patient
heart disease
cardiac care unit, 14, 43, 94, 243
difficulties and limitations, 16, 28–29, 30-31: test results, 32–34, 248; evaluation of heart sounds, 35–36; “missed,” 29, 32, 248–49
percent of information in patient history, 38
physician conflicts of interest, 37, 261, 290
diet
of the author, 134
as risk factor for cancer, 116
as risk factor for heart disease, 24, 106, 260–63
as risk factor for type 2 diabetes, 107
digestive system, 91, 109, 156, See also peptic ulcer
digoxin, 86
diphtheria, 90, 109, 110, 271
direct-to-consumer marketing of drugs, 26, 96–97, 260, 261–62, 290
disease. See also infectious disease
after reproductive age, and natural selection, 254
chronic: increase in the U.S., 171–73, 272, 289; salaries for health-care workers, 290
“conquest” of, 26, 90–91, 96–98, 268–69
germ theory, 26, 249
global, ethics and policy, 286–88
Koch’s postulates on, 249–50
preventable, mortality rates, 286
prevention: effects of activities for, 112, 113, 116, 117, 119; need for medical school training, 163, 173
as punishment from God, 116–17
reemergence of, 26, 90, 102, 255
symptoms vs. causes, 87
use of technology prior to true understanding of, 44–45
vs. illness, 156
dizziness, 5
DNA. See genetic aspects
doctor-patient relationship. See physicians: relationship with the patient
drug industry
economic aspects of research, 286–87
marketing: the concept of choice, 287, 290; at conventions, 37; direct-to-consumer, 26, 96–97, 260, 261–62, 290; life extension claims, 96–98, 99
physician conflict of interest, 37, 261, 290
drug-resistant pathogens, 26, 102, 255, 288
drugs. See medications
Dupuytren’s contracture, 137
ebola, 255
echocardiogram
of Aaron Neugeboren, 36
of the author, 5, 8, 31, 68–69, 70, 82, 131, 247–48
false positives, 33
economic aspects
average health care spending annually, 286
care for chronic conditions, 172, 225, 289
cost of coronary bypass, 43
fee-for-service, 293
HIV/AIDS treatment and research, 282, 291
low- vs. high-technology treatment, 165–66
managed care, 292–93
market values and choice, 287, 290
medical industry and physician conflict of interest, 37, 261, 290
medical school, 166
neonatal intensive care, 295
psychotherapy, 208
ejection fraction, 3, 70, 82, 130, 131
electrocardiogram
author’s, 8, 31, 59, 66–68, 69–70, 81, 247–48
false positives, 33
procedure, 66–67
Ellen, 50, 52, 53, 58, 74, 80
endocarditis, 36
end-of-life care, 163, 289
endorphins, 155
Erasmus High School (Brokklyn, N.Y.), 11, 12, 72, 185, 229, 238, 300
ethical issues
access to AIDS treatment, 41, 282, 286
physician conflicts of interest, 37, 261–62, 290
treatment of global disease, 286–88
evolutionary medicine, 252–57, 259, 271, 272
Ewald, Paul W., 252–57, 259
exercise
by the author: first few weeks after surgery, 17, 18, 121, 122; in the hospital after surgery, 14; prior to surgery, 5, 6, 24, 47, 49, 53, 69; two years after surgery, 122–23
importance of, 6, 131
as risk factor for heart disease, 24, 106
as risk factor for type 2 diabetes, 106, 107
exercise capacity test. See stress test
faintness, 5
faith, 157, 204
Fallot’s tetralogy, 280
false negatives, 133
false positives, 32–33, 133
family
history, of the author, 5, 9, 24, 45, 241
as predictor of recovery, 40, 41
as a support system, 42
family medical history. See patient medical history
Farber, Dr. Sidney, 76
fatalism, 25
father, author’s
background, 62
closeness to, after death, 61–63, 144–45
health conditions, 5, 57, 61, 247
as a parent, 62
recipe for longevity, 75
visit to, 136
fatigue, unusual, 5, 121
fear
of AIDS, 187
author’s, 48, 50, 53, 63, 66, 144
marketing based on, 96–98, 133-34. See also cholesterol-lowering medications
role in illness, 265
fetal environment, 30
fitness, evolutionary, 253–54
Fleming, Alexander, 270, 271
Flexner Report, 168, 169
Flynn, Dr.
diagnosis, 70
echocardiogram by, 5, 8, 68–69
letter to Dr. Katz, 69
str
ess test appointment, 56, 66–68
Friedland, Gail, 6, 127, 190, 282, 299
Friedland, Jerry
AIDS research and care: commitment to patients, 46, 188–89; future international work, 296; in Nigeria, 179–84; patients’ trust in, 151, 153; research on adherence to medications, 41; research on HIV transmission, 186–87; in South Africa, 166–67, 191–92, 281–84; at Yale-New Haven Hospital, 1, 41
Black Panthers and, 189–90, 192
childhood and adolescence, 11, 12, 185, 196–97
as consultant, 42, 79, 80, 84, 136
education, 188, 189, 194–96
family, 188, 192–93, 196–97, 282
friendship with the author: after author’s surgery, 202, 281, 298–301; during childhood and adolescence, 12; like family, 124, 126; prior to author’s surgery, 2, 10, 12
in Israel, 192
motivation to be an infectious disease physician, 46, 179–85, 191, 196, 267
personality, 46, 187–88
teaching positions, 192, 197–98
views: on AIDS research, 282–83; on health care policy, 289; on the human genome project, 114–15; on importance of trust, 151, 153; on insurance companies, 88; on medical school, 164–65, 170–71
work hours, 2
Friedreich’s ataxia, 234, 297
friends. See also Friedland, Jerry; Helfant, Rich; Rudy, Arthur; Yarnell, Phil
effects of author’s experience on, 25
importance of, 12, 14, 21, 40, 82, 124–27, 149–53, 201–2, 301
Gage, Phineas P., 218
gastrointestinal disease, 91, 109, 156
“gatekeeping,” 35, 292
genetic aspects
of aging, 98, 117
alleles and genetic variability, 276
of cancer, 117
diseases with single causative abnormality, 250
ethical issues with testing positive, 295
of heart disease, 24, 114, 250, 251, 265
human genome, 113–15, 212, 276
of Huntington’s disease, 295
of natural selection, 254
of neurological conditions, 234
paragenetics, 264–65
P53 system, 272–75
germ theory, 26, 249
Gibbon, John, 277–80
Gilda’s Club, 297–98
gingivitis, 259, 260
Granberg, Ronald, 89
Granger, Beth, 223–25
HAART (highly active antiretroviral treatment), 40–41, 255, 282–83
Haight, Dr. Malcolm, 137–38, 140, 143, 145–47, 148
Hashim, Dr. Sabet
background, 9
postsurgery checkups with, 123, 127
quintuple bypass surgery by, 13, 83–85
trust in, 4, 6, 8, 13, 15
visit prior to surgery, 9–10
healing
body’s ability to heal itself, 34, 161, 264
faith, 157
as a natural process, 149
placebo effect, 153–57, 161, 264
health care
access to, 41, 282, 285–87
policy-making, 287–91