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The Cardiology Industry

Aloyzio Achutti

Saving the Heart: The Battle to Conquer Coronary Disease. Stephen Klaidman. xvi + 272 pp. Oxford University Press, 2000. $27.50.

Stephen Klaidman's characterization of the struggle to conquer coronary disease as a battle is apt: In a war we need extraordinary strengths and new strategies—and a great deal of money—to conquer difficult positions; we have heroes, many unknown soldiers and a population needing to be saved; we have the wounded and the dead; we have excuses for decisions that may be precipitous or unethical. Conflicts are widespread, and some combatants exhibit extraordinary creativity.

Klaidman explains the development of arteriosclerosis, its complications and the technologies used to control it, going into sufficient detail to give the reader an appreciation of the difficulties and lack of certainty that persist in this field despite great achievements. In addition, he discusses the extent to which financial enterprise and the entrepreneurs behind some of those achievements have shaped developments in cardiology, and he points out the conflict between profit maximization and patient needs, laying down this challenge: "We must find a way to transform medicine from the industry it has become into a caring profession again."

Although Klaidman is writing primarily for a lay audience, particularly patients, his comprehensive approach and the human drama of the actual cases he describes make this a book also of interest to healthcare professionals, including cardiologists. Since heart disease is such an important cause of death and morbidity worldwide, the book should attract many readers.

Initially, Klaidman describes arteriosclerosis mechanistically as a disease of clogged tubes and describes the tactics and devices invented to unstop the bloodstream. Not until the last chapters does he explain the biochemical and metabolic features of heart disease. Unfortunately, readers who do not reach the end of the book may be left with misconceptions, as are many physicians who have not kept up with developments that have increased our understanding of the causes of heart disease.

The role of prevention in the war on heart disease is covered only superficially, despite its potential for saving lives. Conflicts over prevention are so internecine, though, that perhaps he was wise not to delve into this too deeply; this is a struggle probably best left to another book.—Aloyzio C. Achutti, Academy of Medicine, Rio Grande do Sul, Brazil

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