Forging new pathways in cardiovascular disease

Hearts too good to die: Remembering how the defibrillator was invented

In the 1950s, cardiac death was the leading cause of fatality in the U.S., claiming 500,000 victims annually. The problem was ignored, largely because it happened outside hospitals and was deemed the result of a massive coronary artery thrombosis incompatible with survival. Our research in dogs led to the development of the first effective direct current (DC) defibrillator. Once a dog’s heart was defibrillated, it recovered and survived despite the blocked coronary artery. The implication was momentous: sudden cardiac death was likely afflicting patients with hearts too good to die.

Lown’s observations about doctor-patient relationships in the 1960s resonate even today.

The growing dominance of market forces was transforming health care. The human dimension of the doctor-patient relationship was rapidly being denatured by overtreatment, endless tests, unwarranted referrals, and polypharmacy. At the epicenter were highly trained specialists dealing with parts of disembodied patients. Emerging was a sickness system centered on a magnificent emporium, the modern hospital. Prevention, the foundation of a sound health system, was scorned in practice as it was honored in preachment.

An early casualty was listening. Since listening to a patient consumed much time and was minimally reimbursed, it became cursory, circumscribed, and frequently bypassed.

When doctors don’t listen, treatment is compelled by the chief complaint, which frequently has little to do with what troubles the patient. This results in a multiplicity of tests and procedures as well as referrals to specialists. Another consequence is polypharmacy, resulting in a profusion of adverse drug reactions that intensify the cycling of patients for tests and referrals. Necessarily this new paradigm undermines patient trust in the medical profession.