universal, 175, 289
in the U.S. See drug industry; managed care; medical industry
health-care workers, 166, 290
heart
beats per minute after surgery, 127
ejection fraction, 3, 70, 82, 130, 131
pounding, prior to surgery, 60
slowing down for self-protection, 82, 246
sound of common abnormalities, 35–36
heart attack
asymptomatic (silent), 25, 28–29
author’s possible, 67, 68, 70
depression following, 154
early research, 92–93
indication on an electrocardiogram, 67
with normal cholesterol levels, 29
risk with open-heart surgery, 44
role of arterial plaque and inflammation, 29, 105, 255–60
heart disease
asymptomatic, 24–25, 28–29
coexistence with diabetes, 28
difficulty in diagnosis, 16, 28
effects of prevention activities, 119
genetic aspects, 24, 114, 250, 251, 265
judgment skills concerning, 31, 35–36, 265–66
mortality rates, 28, 91, 119
progressive, 28
risk factors: of the author, 5; effects on mortality rates, 106; exercise test as predictor, 30; fetal environment and infant weight, 30; relative to total incidence rate, 30; statistical aspects, 252
symptoms, 5, 87
treatment of symptoms vs. causes, 87
heart-lung machine, 4, 13, 277–80
heart surgery. See coronary bypass; heart transplant; open-heart surgery
heart transplant, 95, 277, 281
Helfant, Rich
childhood and adolescence, 7, 12, 72, 235, 237–40
as a consultant: after surgery, 123–24, 130–31, 132, 136; on diagnosis of viral infection, 28, 71, 247; on the EKG, 81, 248; on Peyronie’s disease, 136; prior to surgery, 7–8, 59, 65–66, 71–72, 79, 81, 244–49
education, 12, 72, 239, 240, 241–43
family, 72, 128, 237–38, 239, 240, 241
family history, 241
friendship with the author, 12, 72–73, 124–27, 201–2, 238–39
heart disease research, 8, 131, 257, 258, 263
interests, 72–73, 263–64
motivation to be a cardiologist, 242, 267
views: on clinical trials, 176; on determination of “normal” cholesterol levels, 29; on the human genome project, 114; on the importance of listening, 93, 101, 244; on Jackie Robinson, 235–37; on Jerry Friedland, 46; on limitations of medical knowledge, 15–17, 249, 252, 260; on medical community conflicts of interest, 37, 261–62; on the mind-body connection, 264–65; on the physician-patient relationship, 163–64, 265–66
writings by, 16, 28, 73, 296
Helicobacter pylori, 260, 268
Herrick, James, 92
highly active antiretroviral treatment (HAART), 40–41, 255, 282–83
Hippocrates, 40, 159
Hippocratic Rule, 162
historical background
ancient healing practices, 158–59
antibiotics, 94, 109, 270–71
aspirin and blood clotting ability, 70
clinical science, 168–69
decrease in infant mortality, 94
germ theory of disease, 26, 249
heart attack research, 92–93
heart-lung machine, 277–80
increase in life expectancy, 94, 107–8
Koch’s theory of disease, 249–50
medicine prior to 1940, 86–94, 109–10
neurology, 229–30
rise in hospital/laboratory medicine, 167
HIV (human immunodeficiency virus)
antiretroviral treatment, 40–41, 255, 282–83
epidemiology, 193–94
infection of medical personnel, 283
number of children infected annually, 41
in South Africa, 282–83, 284, 285
transmission, 186–87, 191, 193, 194, 283
hives, 156
Hodgkin’s disease, 5, 76–77, 135
hormone replacement therapy, 295
hospitals
differences in quality of care, 10–11
infections acquired within, 26, 255
medical errors which occur in, 11
shift in focus from patient to disease, 167
human genome, 113–15, 212, 276
Huntington’s chorea, 250, 254, 297
Huntington’s disease, 295
hypertension, 5, 24, 249, 251
illness, vs. disease, 156
Imagining Robert (Neugeboren), 19, 72, 244
immune system
age bias of the, 271–72
antibodies, 255
evolutionary context, 253, 254, 271
vaccines and the, 156
infant mortality, 94, 102–3, 108, 109, 181–82, 286
infant weight, and risk of heart disease as adult, 30
infection
acquired in the hospital, 26, 255
from leaking aortic valve, 36
risk with coronary bypass, 9
risk with open-heart surgery, 44
infectious disease
change in treatment with understanding of, 45
evolutionary context, 254
historical background: germ theory, 26, 249; treatment for childhood diseases, 88–90, 109; treatment prior to 1940, 86–94, 109–10
impact of new treatments, 42, 109
link with coronary artery disease, 259, 260
reemergence, 26, 90, 102, 255
viral. See viral infection
inflammatory process
in atherosclerosis, 255–60, 272
role in the immune system, 271–72
influenza, 91, 109, 110
insulin, 86
“insult accumulation,” 92
insurance companies
approved physicians, 39
frustration with, 39, 100, 160, 233
malpractice lawsuits, 289
valuing technology over time, 88, 169–70, 175
isolation, 82, 148, 150, 297
Judaism
cultural values, 45, 227
on miracles, 85
Yom Kippur, 219, 283
Kanof, Dr. Abram, 240–41
Katz, Dr. David
author’s call to office prior to surgery, 49
diagnosis of Aaron Neugeboren, 36
EKG by, 59
letter from Dr. Cabin to, 130
letter from Dr. Flynn to, 69
physical exam by, 55–56
Kotker, Norman, 51
laboratory tests
danger of too much dependence on. See technology: vs. listening to the patient
duplicated, variation in results, 31
false positives, 32–33
historical background, 167
interpretation of results, 31, 32, 34, 248
percent of total information needed for diagnosis, 38
replacement of stethoscope techniques, 35–36
language, challenges for medical care, 39
lawsuits, 289
legionnaires’ disease, 255
Lescol, 29
life
as a gift, 22–23, 24, 83, 120–21, 129, 178–79
quality of, 133
life expectancy
drug company marketing for increased, 96–98, 99
increase in the 1900s, 94, 107–9
research, 275–76
vs. lifespan, 275
Life Without Disease: The Pursuit of Medical Utopia (Schwartz), 90–91
Li-Fraumeni cancer syndrome, 274
Lipitor, 29, 99, 114, 132, 134–35, 260
listening to the patient, 27
actively, 21, 88, 93
with compassion, 20, 212, 265–66
for full medical history, 38, 202–3, 229, 243–44
keeping an open mind, 16,
21
and mental illness, 20
vs. the “objectivity” of technology, 101
lithium, 268, 269
The Lost Art of Healing (Lown), 38
Lott, Bret, 56
Lown, Bernard, 38
lysozymes, 271
macrophages, 248
Madeleine, 17
magnetic resonance imaging (MRI), 33, 95, 231
malaria, 102, 108, 253, 286
malpractice lawsuits, 289
mammograms, 118, 295
managed care. See also drug industry; insurance companies; medical industry
achievements, 292–93
approved physicians, 39
damage to patient-physician relationship by, 34–35, 159–61, 232–33
dehumanization of physicians, 35, 87–88, 164–65
inadequacy for chronic disease, 171, 225, 289
need for training in new technologies, 37–38, 133
no value placed on physician’s time, 88, 169–70, 175
physician’s conflicts of interest with, 37, 261, 290, 293
policy overriding physician’s judgment, 35, 160, 169, 226–27
rise in hospital medicine, 167
role of specialists, 35, 232–33, 292
Massachusetts General Hospital (Boston, Mass.), 71
matrix metalloproteinases, 248
measles, 94, 109, 110, 286
Medawar, P. W., 32
media
hype of medical “breakthroughs,” 27, 38, 45, 114–15, 133
questionable reality on medical television show, 27
Medical Committee for Human Rights, 189
medical history. See patient medical history
medical industry, 37, 261, 290, See also drug industry; managed care
medical knowledge. See also technology of the aging process, 90
art and science of. See under diagnosis: as an art
of atherosclerosis, 16, 43, 249, 252, 260
limitations in, 15–17, 21, 26, 87–92, 249, 271
media hype of “breakthroughs,” 27, 38, 45, 114–15, 133
of neurology, 87, 216, 268–69
paradigm shifts, 92
rise of clinical science, 168–69
role of serendipity, 114, 268, 270–71
medical school
additional training needs: disease prevention, 163, 173; end-of-life care, 163; evaluation of heart sounds, 35–36; history of medicine, 163; new technologies, 37–38, 133; public health, 163
courses on the physician-patient relationship, 164
economic aspects, 166, 169–70
efficacy, 170
mentoring, 170
overview of coursework, 170
percent of physicians who would repeat, 226
Medicare, 163
medications. See also drug industry; specific brand names
adherence to the regimen, 41, 153–54, 180–81
antibiotics. See antibiotics
antidepressants, 43, 97, 154
antipsychotics, 105, 150, 268
antiretrovirals, 40–41, 255, 282–83
aspirin, 70, 252, 259
beta-blockers, 69, 70
calcium channel blockers, 123, 263
cholesterol-lowering, 29, 31–32, 99, 133, 260, 262–63
clot-busters, 43, 94
colchicine, 140, 141
discovered through serendipity, 114, 268, 270–71
“lifestyle,” 97
to minimize possibility of heart attack, 4
“pharmacological forgiveness,” 180
prior to 1940, 86–94, 109–10
for treatment of mental illness, 105–6, 150
vasodilators, 70
Melman, Dr. Arnold, 139–42, 143, 145, 146–47
men
communication style in relationships, vs. women, 125
mortality rate for heart disease, 28–29
prostate cancer, 33, 300
mental decline
Alzheimer’s disease, 62, 98–99, 272, 284–85
with coronary bypass, 9, 44
mental illness
belief in recovery, 149–50
importance of humane treatment, 20, 103, 148, 150
isolation with, 82, 148, 150
leading conditions which cause disability, 205–6
learning to live with, 103
need for skill as well as compassion, 20
patient is not the disease, 147–48
role of medications, 105–6, 268, 269
symptoms vs. causes of, 87, 269
mentoring, 170
Mevacor, 29
mind-body connection, 114, See also family; friends; social aspects
conditions that reflect, 156
paragenetics, 264–65
placebo effect, 153–57, 264
reaction to physician’s presence, 161
miracles, 85
mitral regurgitation, 70
Montaigne, Michel de, 151, 152
mortality. See also death; life expectancy
AIDS, 41, 43
associated with control of infectious disease, 109–10
cancer, 28, 91, 112
changes in major causes of, 86–94
coronary bypass, 44
drug-resistant infections, 26, 255
effects of inferior medical care, 39–40
heart disease, 91, 119: heart attack, 25, 28–29, 154; and weight as an infant, 30
infant, 94, 102–3, 108, 109, 181–82, 286
open-heart surgery, 44
mother, author’s
Alzheimer’s disease, 62, 98–99
caretaking of, 42
childhood memories, 52, 76, 77, 197
long life of, 5
MRI (magnetic resonance imaging), 33, 95, 231
Muhlestein, Dr. Joseph B., 256
multiple sclerosis, 234, 268, 297
muscular dystrophy, 250, 268
myocardial infarction. See heart attack
National Academy of Sciences, 11
National Health Service Corps, 166
natural selection, 253–55, 272
nausea, 5
neonatal intensive care, 294–95
Neugeboren, Aaron (son)
heart condition, 36, 68
at the hospital after author’s surgery, 299
at the hospital during author’s surgery, il, 14, 84
move to author’s home after surgery, 17, 120–21
in Northampton, 7
reaction to author’s diagnosis, 79
Neugeboren, Eli (son)
in Brooklyn, 7
childhood, 120
at the hospital during author’s surgery, 11, 14, 84
reaction to author’s diagnosis, 79–80, 81
trip to Israel, 135, 145
trip to London, 52, 53–54
visit with author after surgery, 17
visit with Friedland, 281, 282, 284
Neugeboren, Jay
as caregiver, 5, 13, 58
childhood and adolescence, 11, 12, 45, 72, 185
family history, 5, 9, 24, 45, 241
family medical history, 5, 57, 59, 60, 80
friends. See Friedland, Jerry; Helfant, Rich; Rudy, Arthur; Yarnell, Phil
Hodgkin’s disease, 5, 76–77, 135
initial doctor’s visit, 1–6, See also diagnosis: of the author
medical history of good health, 5, 52
move to New York City, 22, 121, 122, 298
nickname, 6
nodules on penis. See Peyronie’s disease
open-heart surgery. See coronary bypass: of the author
relationship with children, 9, 14, 120–21, 130, 300
as a single parent, 7, 12, 41–42
trip to Alaska, 178, 179
trip to Israel, 135, 145
trip to London, 52, 53–54
trip to Norway, 177–79
who will be caregiver f
or, 42, 58, 65
writings by. See writing career
Neugeboren, Miriam (daughter)
at the hospital during author’s surgery, 13, 14, 84
reaction to author’s diagnosis, 79, 81
trip to London, 52, 53–54
visit with author after surgery, 17
in Washington, D.C., 7
wedding, 12, 57, 130
Neugeboren, Robert (brother)
author as caretaker for, 13, 42
conversation during author’s recovery, 19
effects of caring relationships on, 150
effects of medications, 150–51
humane care at Bronx State, 19–20
life in New York City, 285
move to New York City, 58, 128–29
notification about the surgery, 13
neurological conditions
from coronary bypass, 44
impact of new treatments, 43
importance of family, 41
swelling, 222–23
traumatic injury, 105, 220–23, 268–69
neurology, 216, 218, 229–30
Nigeria, 179–84
Nightline interview, 17, 51
nitroglycerine, 64, 65, 70
Northampton, move from, 22, 121, 122, 128
Norvasc, 123
nosocomial infection, 26, 255
nuclear cardiology, 33, 263
O’Brien, Dr., 68
One Renegade Cell: How Cancer Begins (Weinberg), 115–16
open-heart surgery. See also coronary bypass
general procedure, 4
historical background, 277–80
risks and benefits, 43–44
organ transplantation, 95
and antibiotic-resistant bacteria, 288
economic aspects, 290
first heart transplant, 281
immune response, 149
importance of heart-lung machine, 277
obsolescence with cure for atherosclerosis, 44
Osler, William, 36–37
osteoporosis, 272
outcome studies, 33
oxygen
decreased body temperature and, 4, 246
supply to the heart, 245–46, 257–58
PABA (potassium para-aminobenzoate), 138, 140, 143, 145
pacemakers, 94
palpitations, 5
Pam, Dr. Alvin, 19–20
paradigm shifts, 92
paragenetics, 264–65
patient medical history of the author, 5, 57, 59, 60, 80, 247
correct diagnosis from the, 38, 202–3, 229, 243–44
as risk factor for cancer, 17
taking time to get, 38, 169–70, 175
patients
with disease that is a unique entity, 33
experience of illness vs. disease, 156
ignored by physician, 68, 138–39, 147
importance of listening to. See listening to the patient
listening to their own body, 61
need for persistence, 39, 45
not a set of symptoms or disease, 20, 95–96, 147–48, 167
relationship with the physician. See physicians, relationship with the patient