A new book by Dr. Michael Ozner takes on the cardiovascular surgery industry head-on. The aptly titled Great American Heart Hoax claims that although insurers pay $60 billion per year invasive cardiovascular surgery, 70%-90% of these procedures are unnecessary. The book has three major themes: What is heart disease? Why is heart surgery a hoax? and What is the solution?
What is heart disease?
The book has a nice summary of some of the risk factors from heart disease as well as the types of cardiovascular surgeries. Dr. Ozner also describes the different the side effects from bypass surgery and pharmaceuticals used to treat atherosclerosis. This portion of the book is educational and clearly explained.
Why is heart surgery a hoax?
Dr. Ozner cites numerous studies demonstrating that bypass surgery does not generally help heart patients. Two studies–the Coronary Artery Surgery Study (CASS) and the European CASS–both found that “a majority of patients who underwent bypass surgery did not live significantly longer or have fewer heart attacks than those who did not undergo surgery.” However, bypass surgery can be beneficial for patients with “critical left main coronary artery disease and a weak heart muscle, and patients with severe disabling chest pain despite maximal medical therapy.” Most patients who undergo bypass surgery, however, do not fall into these groups.
Dr. Ozner also criticizes the use of other surgical procedures. The Atorvastatin Versus Revascularization Treatments (AVERT) Trial found that “the lives of patients treated with angioplasty were not significantly prolonged compared to similar patients who received medical therapy alone, nor did they suffer fewer heart attacks.” Stents were also shown to be problematic in the Occluded Artery Trial.
Even CAT scans are dangerous because they expose patients to excessive radiation. CAT scans can be useful when heart disease symptoms appear, but Dr. Ozner finds that CAT scans are counterproductive for healthy patients. When the doctor conducts a CAT scan, it may substitute for time spend taking the patient’s medical history–which is much more useful.
The problems with these types of surgeries are certainly the heart of the book. Financial incentives, however, continue to give doctors the motivation to continue performing these surgeries. Showing that these high cost surgeries may not be in the patient’s best interest is the most important contribution of the book.
What is the solution?
This portion of the book is fairly disappointing. Dr. Ozner’s solution is to eat healthier and exercise more. This is nothing new. In the “eating healthier” portion, Dr. Ozner pushes the “Mediterranean Diet” he advocated in an earlier book. Getting people to eat healthier and exercise is easier said then done. Deep dish pizza tastes better than broccoli; eating healthier means forgoing some of these tasty treats. Further, some people enjoy exercise while others dread it. Working out 30 minutes per day involves a significant time and energy commitment. Thus, while Dr. Ozner’s solution is sensible, it is not easily implemented.
Overall the book is important in that it clearly explains the dangers of excessive heart surgery. However, the solutions of eating healthy and exercising are already well-known and the Dr. Ozner’s support of the Mediterranean Diet dominates the last half of the book.
- Ozner M (2008) The Great American Heart Hoax, BenBella Books Inc., 224 pages.
- See also the N.Y. Times review.