The Coronary Artery Entrapment

The Coronary Artery Entrapment

Bernard Lown, MD


Essay 31

What propelled the transformation of medicine from a humanitarian profession to a costly technocracy? It has seemingly happened in a single lifetime, and I witnessed much of it. Let me relate what transpired. Be forewarned, however: history is more accurately perceived as a Rashomon experience than garnered from near-deathbed confessionals.

In the metamorphosis to medical modernity cardiologists led the charge. The focus of their concern was the epidemic prevalence of coronary artery disease (CAD). For the past fifty or more years CAD has been the leading cause of death. It kills and disables people during the most productive period of their lives. Women lag about ten years behind, with CAD manifesting usually after the menopause. By age 70 about a fifth of Americans of both sexes are afflicted with some form of heart disease.

The overwhelming power — nay, seductive charm or even stranglehold — of technology in medicine was manifested first in relation to CAD. The Faustian bargain was as insidious as it was all-consuming. The devil’s emissary promised wealth, scientific pretensions of unimpeachable verisimilitude, leadership in the cutting edge of medical innovation, and most irresistibly, the transformation of work into child’s play, with novel, unimaginably versatile toys. In return the doctor promised adherence to the demands of workplace industrialization, thereby augmenting both efficiency and profitability. While the cardiologists were triumphant, something vital was leached from doctoring. It meant spending less time with patients and abandoning the ancient skills of listening as well as the consummate art of the physical examination. Some doctors felt an ache like the passing of a dear friend. Most, though, never experienced even a quiver of loss. These humanitarian skills, not being taught in medical schools or mentored in hospitals, were never acquired, thus never lost.
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Doctor as scientist, healer, magician, business entrepreneur, small shopkeeper, or assembly line worker — which is it?

Bernard Lown, MD
June 26, 2012

In the tumultuous debate about health care convulsing public discourse, the focus is on escalating costs and possible economic remedies. But the innards of the ailing system have not been adequately exposed to searching analysis.

Health care systems are stressed by a burgeoning global population, multiplying in my lifetime 3.5 fold, to seven billion. They are distorted by the increasing dominance of market forces, focused primarily on profitability rather than patients’ well-being. They are mal-aligned by growing inequities in wealth between developed and developing countries, and by the decimation of the middle classes in industrialized countries. They are challenged by adverse ecological transformations that afflict us with puzzling new diseases as well as with drug-resistant microbes and viruses. Life on earth is undermined by the chemicalization of ecosystems, the pollution of air and water, and climate change threatening the planet as a comfortable habitat for human civilization. This veritable witches’ brew has other malign elements, most noteworthy the commoditization of everything within market reach, including art, education, and religion — ensnaring the most intimate of human interactions as well as our inner selves. The result is the alienation of people from their communities, families, friends, and ultimately themselves.

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