Open Heart (58 page)

judgment skills concerning,
31
,
35
–
36
,
265
–
66

mortality rates,
28
,
91
,
119

progressive,
28

risk factors: of the author,
5
; effects on mortality rates,
106
; exercise test as predictor,
30
; fetal environment and infant weight,
30
; relative to total incidence rate,
30
; statistical aspects,
252

symptoms,
5
,
87

treatment of symptoms vs. causes,
87

heart-lung machine,
4
,
13
,
277
–
80

heart surgery.
See
coronary bypass; heart transplant; open-heart surgery

heart transplant,
95
,
277
,
281

Helfant, Rich

childhood and adolescence,
7
,
12
,
72
,
235
,
237
–
40

as a consultant: after surgery,
123
–
24
,
130
–
31
,
132
,
136
; on diagnosis of viral infection,
28
,
71
,
247
; on the EKG,
81
,
248
; on Peyronie's disease,
136
; prior to surgery,
7
–
8
,
59
,
65
–
66
,
71
–
72
,
79
,
81
,
244
–
49

education,
12
,
72
,
239
,
240
,
241
–
43

family,
72
,
128
,
237
–
38
,
239
,
240
,
241

family history,
241

friendship with the author,
12
,
72
–
73
,
124
–
27
,
201
–
2
,
238
–
39

heart disease research,
8
,
131
,
257
,
258
,
263

interests,
72
–
73
,
263
–
64

motivation to be a cardiologist,
242
,
267

views: on clinical trials,
176
; on determination of “normal” cholesterol levels,
29
; on the human genome project,
114
; on the importance of listening,
93
,
101
,
244
; on Jackie Robinson,
235
–
37
; on Jerry Friedland,
46
; on limitations of medical knowledge,
15
–
17
,
249
,
252
,
260
; on medical community conflicts of interest,
37
,
261
–
62
; on the mind-body connection,
264
–
65
; on the physician-patient relationship,
163
–
64
,
265
–
66

writings by,
16
,
28
,
73
,
296

Helicobacter pylori
,
260
,
268

Herrick, James,
92

highly active antiretroviral treatment (HAART),
40
–
41
,
255
,
282
–
83

Hippocrates,
40
,
159

Hippocratic Rule,
162

historical background

ancient healing practices,
158
–
59

antibiotics,
94
,
109
,
270
–
71

aspirin and blood clotting ability,
70

clinical science,
168
–
69

decrease in infant mortality,
94

germ theory of disease,
26
,
249

heart attack research,
92
–
93

heart-lung machine,
277
–
80

increase in life expectancy,
94
,
107
–
8

Koch's theory of disease,
249
–
50

medicine prior to 1940,
86
–
94
,
109
–
10

neurology,
229
–
30

rise in hospital/laboratory medicine,
167

HIV (human immunodeficiency virus)

antiretroviral treatment,
40
–
41
,
255
,
282
–
83

epidemiology,
193
–
94

infection of medical personnel,
283

number of children infected annually,
41

in South Africa,
282
–
83
,
284
,
285

transmission,
186
–
87
,
191
,
193
,
194
,
283

hives,
156

Hodgkin's disease,
5
,
76
–
77
,
135

hormone replacement therapy,
295

hospitals

differences in quality of care,
10
–
11

infections acquired within,
26
,
255

medical errors which occur in,
11

shift in focus from patient to disease,
167

human genome,
113
–
15
,
212
,
276

Huntington's chorea,
250
,
254
,
297

Huntington's disease,
295

hypertension,
5
,
24
,
249
,
251

illness, vs. disease,
156

Imagining Robert
(Neugeboren),
19
,
72
,
244

immune system

age bias of the,
271
–
72

antibodies,
255

evolutionary context,
253
,
254
,
271

vaccines and the,
156

infant mortality,
94
,
102
–
3
,
108
,
109
,
181
–
82
,
286

infant weight, and risk of heart disease as adult,
30

infection

acquired in the hospital,
26
,
255

from leaking aortic valve,
36

risk with coronary bypass,
9

risk with open-heart surgery,
44

infectious disease

change in treatment with understanding of,
45

drug-resistant,
26
,
102
,
255
,
288

evolutionary context,
254

historical background: germ theory,
26
,
249
; treatment for childhood diseases,
88
–
90
,
109
; treatment prior to 1940,
86
–
94
,
109
–
10

impact of new treatments,
42
,
109

link with coronary artery disease,
259
,
260

reemergence,
26
,
90
,
102
,
255

viral.
See
viral infection

inflammatory process

in atherosclerosis,
255
–
60
,
272

role in the immune system,
271
–
72

influenza,
91
,
109
,
110

insulin,
86

“insult accumulation,”
92

insurance companies

approved physicians,
39

frustration with,
39
,
100
,
160
,
233

malpractice lawsuits,
289

valuing technology over time,
88
,
169
–
70
,
175

isolation,
82
,
148
,
150
,
297

Judaism

cultural values,
45
,
227

on miracles,
85

Yom Kippur,
219
,
283

Kanof, Dr. Abram,
240
–
41

Katz, Dr. David

author's call to office prior to surgery,
49

diagnosis of Aaron Neugeboren,
36

EKG by,
59

letter from Dr. Cabin to,
130

letter from Dr. Flynn to,
69

physical exam by,
55
–
56

Kotker, Norman,
51

laboratory tests

danger of too much dependence on.
See
technology: vs. listening to the patient

duplicated, variation in results,
31

false positives,
32
–
33

historical background,
167

interpretation of results,
31
,
32
,
34
,
248

percent of total information needed for diagnosis,
38

replacement of stethoscope techniques,
35
–
36

language, challenges for medical care,
39

lawsuits,
289

legionnaires' disease,
255

Lescol,
29

life

as a gift,
22
–
23
,
24
,
83
,
120
–
21
,
129
,
178
–
79

quality of,
133

life expectancy

drug company marketing for increased,
96
–
98
,
99

increase in the 1900s,
94
,
107
–
9

research,
275
–
76

vs. lifespan,
275

Life Without Disease: The Pursuit of Medical Utopia
(Schwartz),
90
–
91

Li-Fraumeni cancer syndrome,
274

Lipitor,
29
,
99
,
114
,
132
,
134
–
35
,
260

listening to the patient,
27

actively,
21
,
88
,
93

with compassion,
20
,
212
,
265
–
66

for full medical history,
38
,
202
–
3
,
229
,
243
–
44

keeping an open mind,
16
,
21

and mental illness,
20

vs. the “objectivity” of technology,
101

lithium,
268
,
269

The Lost Art of Healing
(Lown),
38

Lott, Bret,
56

Lown, Bernard,
38

lysozymes,
271

macrophages,
248

Madeleine,
17

magnetic resonance imaging (MRI),
33
,
95
,
231

malaria,
102
,
108
,
253
,
286

malpractice lawsuits,
289

mammograms,
118
,
295

managed care.
See also
drug industry; insurance companies; medical industry

achievements,
292
–
93

approved physicians,
39

damage to patient-physician relationship by,
34
–
35
,
159
–
61
,
232
–
33

dehumanization of physicians,
35
,
87
–
88
,
164
–
65

inadequacy for chronic disease,
171
,
225
,
289

need for training in new technologies,
37
–
38
,
133

no value placed on physician's time,
88
,
169
–
70
,
175

physician's conflicts of interest with,
37
,
261
,
290
,
293

policy overriding physician's judgment,
35
,
160
,
169
,
226
–
27

rise in hospital medicine,
167

role of specialists,
35
,
232
–
33
,
292

Massachusetts General Hospital (Boston, Mass.),
71

matrix metalloproteinases,
248

measles,
94
,
109
,
110
,
286

Medawar, P. W.,
32

media

hype of medical “breakthroughs,”
27
,
38
,
45
,
114
–
15
,
133

questionable reality on medical television show,
27

Medical Committee for Human Rights,
189

medical history.
See
patient medical history

medical industry,
37
,
261
,
290
,
See also
drug industry; managed care

medical knowledge.
See also
technology of the aging process,
90

art and science of.
See under
diagnosis: as an art

of atherosclerosis,
16
,
43
,
249
,
252
,
260

“conquest” of disease,
22
,
25
–
26
,
90
–
91
,
96
–
98
,
268
–
69