Book Review

Saving the Heart: The battle to conquer coronary disease

N Engl J Med 2000; 342:746March 9, 2000

Article

Saving the Heart: The battle to conquer coronary disease
By Stephen Kliadman. 288 pp., illustrated. New York, Oxford University Press, 2000. $25. ISBN: 0-19-511279-2

This is an American book for American readers, written mainly for physicians and associated professionals, but also for interested lay readers. The author, Stephen Kliadman, is a journalist with a remarkable knowledge of medicine — in particular, cardiology — and the American health system. The book is written in a dynamic journalistic style, easy to read and informative. Enlightening case presentations are entertaining. The book eloquently recounts the history of coronary artery disease in 14 chapters, from the historical beginning (i.e., the description of angina pectoris by William Heberden).

Well-edited chapters deal with anatomy, diagnostic tools, treatment (e.g., drugs, bypass surgery, angioplasty, and stenting), angioscopy, intravascular ultrasonography, magnetic resonance ultrasonography, and future directions. Appendix A describes strategies for designing and conducting clinical trials. Appendix B, entitled “What Patients Need to Know,” contains useful, basic information for patients with coronary disease. True highlights are the vital biographies of the pioneers in the field, which are based on detailed personal interviews with contemporary cardiologists and cardiac surgeons.

Kliadman provides the reader with authentic information that cannot be found anywhere else. He informs the reader superbly about medical heroes such as Nobel prize winner Werner Forssmann, Mason Sones, René Favaloro (known for his contribution to the development of coronary bypass surgery), John Kirklin, Andreas Grüntzig (known for perfecting techniques of angioplasty), Valentin Fuster, and many others. Previously unknown facts about the development of coronary arteriography, stenting, and minimally invasive bypass surgery are reported.

The structure of the book, however, is not strictly chronologic or scientific. A historical time line and a list of the names of the pioneers in cardiology would have been helpful, and the text should have been supported by more figures, tables, and illustrations. The unconventional reference list gives more information than usual. There are only small mistakes: Willem Einthoven was not a physician, but a physiologist; Kreuznach (where Forssman practiced) is not in the Black Forest; and Dresden (Grüntzig's birthplace) was destroyed by Allied bombs in February 1945 not 1944. Kliadman's view of what it takes to be a heart surgeon will probably not be shared by everybody.

Kliadman is critical about money as a motivator in medicine. In particular, he addresses the overuse of techniques such as balloon angioplasty and the contribution of such overuse to the ever-rising cost of health care in the United States. The attempt to pressure patients to participate in clinical trials for obvious financial reasons is discussed frankly. Kliadman suggests banning cardiologists from holding any financial interest in any device used in their practice. The last sentence of the book should be kept in mind: “We must find a way to transform medicine from the industry it has become into a caring profession again!”

I highly recommend this book to physicians, patients, politicians, and health care authorities.

Berndt Lüderitz, M.D.
University of Bonn, D-53105 Bonn, Germany