![]() “If more than a half century ago overtreatment was at a trickle pace, it is now at flood tide.” Pacemakers though were small cost items compared to what soon followed. Compared to my colleagues, I was implantin g only about a third as many and inactivating like numbers. “ Recognition that new technologies were driving overtreatment became evident with introduction of implanted pacemakers in the 1960’s. He went on to include a surprising number of popular procedures on his “overtreatment” list of excessive interventions, most notably the pervasive rush to revascularize* (meaning to open up or replace a blocked coronary artery by implanting a coronary stent or by open heart bypass graft surgery): While patients were harmed, doctors profited.” “One should mention, if only as a historical footnote, that there was not a scintilla of evidence supporting prolonged bed rest. “I am not aware of a single cardiovascular measure since then that improved survival of heart patients as much as this common sense change in medical management. In fact, hospital mortality from acute myocardial infarctions (heart attacks) more than halved, depression diminished, pulmonary emboli nearly vanished, hospitalization was markedly shortened, rehabilitation and resumption of work was hastened. This was a massive and controversial change in cardiac care, initially opposed by staff – until they witnessed the changes in their patients. Samuel Levine urged him to let heart patients at the Lown Clinic that he’d founded in 1947 get out of bed and recover in comfortable chairs. Lown explained that in the early 1950s, his teacher and mentor Dr. ![]() In fact, I was told by my CCU staff that as soon as I could demonstrate my ability to walk up and down stairs (and pee – but definitely not at the same time), I might be allowed to go home early!ĭr. I was certainly told to do so while recuperating in the CCU (the intensive care unit for heart patients – coincidentally, just one of many concepts in cardiology invented by Dr. Other physicians were aware of this danger, too, but they also thought they needed to protect heart attack survivors against “cardiac rupture” – considered at that time to be due to physical activity.Ĭurrent evidence-based practice means, of course, getting heart patients up and out of that bed and moving around. Worse, he added, unnecessary bed rest requirements actually made heart patients worse, increasing their risks of deadly heart rhythms and further coronary artery blockages. It promoted depression, bed sores, intractable constipation, phlebitis, lethal pulmonary embolism and much more.” “ It involved keeping patients with acute heart attacks on strict bed rest for 4-6 weeks. Lown’s first observations of cardiac overtreatment – unlike almost all modern examples – were not related to technology at all. Resorting to excessive interventions seemed to be the illegitimate child of technology in the age of market medicine.”īut Dr. “My opposition in part was provoked by the growing prevalence of overtreatment. “ From my earliest days in medicine, I have struggled against the prevailing model of health care. “Ĭonsider this excerpt fr om his important presentation to his colleagues: Lown spoke at the Avoiding Avoidable Care conference, whose lofty annual goal is “the transformation of health care culture from one focused on volume and quantity to one centered on value and quality. Lown was Professor of Cardiology Emeritus at Harvard, but to me he was always the physician I loved to quote here on Heart Sisters – as in my blog post title, “ Why Aren’t More Doctors Like Dr. Bernard Lown summed up his long and impressive career as a rebel.ĭr. “From my earliest days in medicine, I have struggled against the prevailing model of health care” is how the pioneering cardiologist Dr. Bernard Lown, pioneering cardiologist, humanitarian, and founder of the Lown Institute, died on Februat the age of 99, pre-deceased by Louise, his wife of 73 years, survived by three children, five grandchildren and one great-grandchild. By Carolyn Thomas ♥ very sad to say that Dr.
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