Stephen Klaidman’s Saving the Heart is about equal parts history and science journalism. It is readable, contains insightfully presented historical and technical information, includes a few clarifying photographs and illustrations, offers judicious recommendations, and is blessedly clear in describing the treatments for coronary artery disease (CAD), a leading cause of death in the United States. It is also polemical, sometimes misleading, and strangely resentful of the science and medical system it describes. Fans of the history of science, but even more those who suffer from heart disease, should welcome this book, because there is no equivalent up-to-date survey of cardiology and cardiac surgery available. Readers, however, should be aware that the book is more than reportage. Klaidman has an eye for controversy and murky ethics, and he shapes his style accordingly.
That style belongs to modern investigative journalism. It can have a salutary effect on public issues, but it is primarily a persuasive form of rhetoric and often appeals to the reader’s predilections and fears as much as it presents a faithful accounting of the subject. So there is the danger of misapplied emphasis, overselectivity, and coloring of information. In Klaidman’s case, the principal stylistic techniques are anecdotes, capsule biographies, hyperbole, and rhetorical questions. The first two appear more often. In fact, Klaidman relies on dramatic stories of operations and scientific or business innovations to relate the development of cardiac care technology. Brief biographies of the innovators accompany their introduction into the narrative. In both cases this is natural and dramatic, but it all depends upon which details are chosen, and therein lies the danger. Klaidman writes to emphasize conflict, and to do so he sometimes includes biographical details unconnected to the medical subject at hand.
Even without the emotional appeals, it is easy to agree with Klaidman that medicine in the United States suffers from serious problems. He is a senior research fellow at the Kennedy Institute of Ethics of Georgetown University and clearly knows an ethical conflict when he sees one. He sees several: between innovation and established practice; between the need for experimental procedures and patient safety; among the triad of researcher, clinician, and medical entrepreneur; between bureaucratic ethics reviews and the pressure to try out new treatments; and between the financial interest of physicians and optimal care for their patients. Who can be surprised that such conflicts exist? Where there is innovation and competition, there will be uncertainty, and where uncertainty exists there are bound to be ethical concerns. The problem is that Klaidman frequently communicates his own frustration and outrage about such matters to readers, even to the point of name-calling, as when he denounces the use of placebos as a sham and refers to scoffing among conservative doctors without providing much in the way of evidence of the scoffing.
Let the reader be on guard. Given that, trenchant, timely value awaits readers in Saving the Heart. Klaidman provides a reasonable review of ethical issues and beautifully clear set-piece explanations of technical matters, such as the process of atherosclerosis and the techniques of bypass surgery. An appendix tells readers what sorts of questions they should ask their cardiologists and surgeons and the kinds of answers to look for. One chapter offers penetrating, sometimes grimly funny insights into how surgeons view themselves. (For instance, in a list of characteristics surgeons find most necessary, decisiveness and aggressiveness come before manual dexterity and intellect.) Another chapter follows the case of a nearly ideal cardiac patient—well informed, well insured, and patient. In fact, this is a crucial chapter because it involves the responsibilities of patients in their own treatment and recovery. Otherwise, Klaidman spends so much time covering the medical establishment and its supporting research and development industry that the patient’s role looks wholly passive and dependent, which is not the case.
The book also contains a wealth of historical information concerning the rise of modern knowledge about heart disease and its treatments, from the first definition of angina pectoris in 1768 to the development of robot surgery in the late 1990’s. Along the way, readers learn the virtues and drawbacks of angioplasty (use of a balloon on a catheter to clear clogged arteries), bypass surgeries of various kinds, stenting (placing a tiny mesh tube in arteries to keep them open), and drug treatments to dissolve clots or keep them from forming. The drama of the anecdotes and mini-biographies that...
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