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Broken Hearts

, 336 pages

25 b&w illus.

December 2012



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Broken Hearts

The Tangled History of Cardiac Care

Still the leading cause of death worldwide, heart disease challenges researchers, clinicians, and patients alike. Each day, thousands of patients and their doctors make decisions about coronary angioplasty and bypass surgery. In Broken Hearts David S. Jones sheds light on the nature and quality of those decisions. He describes the debates over what causes heart attacks and the efforts to understand such unforeseen complications of cardiac surgery as depression, mental fog, and stroke.

Why do doctors and patients overestimate the effectiveness and underestimate the dangers of medical interventions, especially when doing so may lead to the overuse of medical therapies? To answer this question, Jones explores the history of cardiology and cardiac surgery in the United States and probes the ambiguities and inconsistencies in medical decision making. Based on extensive reviews of medical literature and archives, this historical perspective on medical decision making and risk highlights personal, professional, and community outcomes.

David S. Jones is the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard University.

"Offers a historical perspective on medical decision making in the case of heart disease."

"For anyone who has had a heart attack or whose family member has had one, this book is definitely worth reading."

"Any health collection strong in cardiac care will find this a winning presentation perfect for general health or specialty collections alike."

"The light Jones shines on the interventional cardiovascular enterprise illuminates numerous, sometimes fatal and always costly flaws that every patient and society at large ignores at great peril."

"A surprising and sobering book. David S. Jones combines rigorous research with a clear narrative style to produce a very persuasive historical analysis. I heartily recommend that physicians read Broken Hearts to benefit from a dose of detective work, a dose of insight, and a good dose of humility."

"Jones does a very good job of outlining how difficult it is to understand all the workings of the human body, what is involved in medical research, and how that research is applied to human subjects through the lens of one medical specialty."

"All in all, Jones presents a different and refreshing take on the challenges before us. He provides more questions than answers, but this is all to the good. Unless we pose the proper questions we cannot ever hope to obtain the right answers."

"Wide-ranging, full of interesting and telling historical details, steadily paced yet thorough in its making sense of complex medicine, Broken Hearts exposes cardiac care as neither mundane nor settled."

"Jones asks us to embrace the complexity of medical decision-making, to recognize medical research gains and gaps, and to acknowledge the social values and priorities that shape our present scenario. Difficult decisions in medicine remain, but perhaps Jones’s book will contribute to more judicious ones."

"For the past half century, patients have been advised to undergo valve replacement, angioplasty, or coronary artery bypass graft procedures to prevent or ameliorate cardiac pathologies. But how good are these procedures? How certain are the surgeons or physicians who recommend them that they will work? How do they know? Giving some answers to these questions and showing how the criteria for making medical decisions change over time are the themes of Broken Hearts."

"Jones’s larger point is a meditation on how we understand and misunderstand medical knowledge."

"Very informative and containing important insights, Broken Hearts is thoroughly researched, well written, and the only work of its kind dealing with these treatments of heart disease."

"This book will appeal to a wide audience interested in the history of coronary artery disease, its treatment options, and medical decision-making. For those wanting more, there is an extensive bibliography. In closing, Jones asks us to embrace the complexity of medical decision-making, to recognize medical research gains and gaps, and to acknowledge the social values and priorities that shape our present scenario. Difficult decisions in medicine remain, but perhaps Jones's book will contribute to more judicious ones."

"A fascinating and insightful history of the interplay between research on the causes of coronary artery disease and the development and assessment of therapeutic—especially surgical—approaches to cardiac care... There is much to recommend in Broken Hearts. It is accessible, it will appeal to a wide range of readers, and it offers a useful overview of the complex issues surrounding cardiac care at a time with health-care policy, both in the United States and globally, is fiercely debated and rapidly changing."

"An excellent resource... The information gleaned from the book will aid the patient in understanding his or her disease and will assist one in decision-making."

"Jones's book is a sophisticated history of heart attacks and some of the most spectacular medical interventions of the twentieth century. It is meticulously researched and thoughtful, and Jones pays equal attention to technical details, social contexts and economic implications. The book will be of interest to anyone interested in the uncertainties of modern medicine: uncertainties associated with understanding the cause of illness and, perhaps more importantly, the success of treatment."

"Broken Hearts is a captivating study of the history of cardiology. By moving away from the long-standing tendency to frame the history of cardiology as a progress-narrative, this book makes a great addition to the emerging body of literature that adopts a critical stance towards cardiac care..."

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