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Balloon Angioplasty Is Described as Dangerous, Unproven Medicine

April 05, 1990

Does the media encourage dangerous, unscientific medicine?

Apparently.

On Feb. 22, (the Health & Fitness column) featured a Newport Beach stockbroker who, like millions of others, is battling the effects of sedentary living and rich foods which are known to produce both obesity and premature heart attacks.

He was evaluated at UC Irvine and underwent an exercise stress test that produced some abnormal "squiggles" on the EKG. These changes can indicate poor blood flow through the heart arteries, but the changes were minor, "so slight that the doctor didn't even notice them at first."

Presumably this stockbroker will immediately undergo further testing and possibly a diagnostic heart catheterization to see if there are any cholesterol blockages in his heart arteries. If blockages are found, a new and risky procedure, balloon angioplasty, may be used to open these blockages, thus "preventing" a heart attack.

For years, I have witnessed and criticized the unscientific and seemingly whimsical manner in which the medical profession implements costly and dangerous therapies before there is any proof of long-term benefit. To use the diagnostic heart catheterization and balloon angioplasty in men with no symptoms and only minor exercise-induced EKG changes is an excellent example of the "treat first, ask questions later" attitude of modern medicine.

Not one shred of significant scientific evidence indicates that this approach will do anything but increase the risk of death and injury for this stockbroker.

Unbelievably, the long-term effects of balloon angioplasty in men similar to this stockbroker have not even been studied, much less proven. No one knows if it prevents heart attacks or not. It is medicine by assumption, and just might be medicine at its worst because what is known is that, when that balloon is inflated inside of a heart artery, a lot can go wrong. It could be worse than the disease.

The death rate from this procedure is between 2% and 4% nationwide with wide variation from hospital to hospital. Recent reports indicate that, as its popularity increases, the death rate seems to be rising. In addition, an emergency open heart surgery team must be ready to rescue patients from a variety of non-fatal complications.

If the balloon angioplasty were a new drug, it would never reach the marketplace. It is far too dangerous.

There are roughly 20 million men in situations similar to this stockbroker, and most of them do have some blockages in their heart arteries. If the angioplasty were used on all of them, (the procedure) would be fatal for 400,000 to 800,000 men, a death rate higher than all who currently succumb to fatal heart attacks.

As for patients with abnormal stress tests and blocked arteries, the overwhelming majority don't need anything but a good diet and appropriate medications.

There are numerous studies showing that patients with known blockages in their arteries do surprisingly well without surgery of any kind. In one study, 156 men recommended to undergo immediate bypass surgery, "just said no." They all had significant blockages and most had significant heart pain, but the annual death rate of the whole group was less than 1% per year.

In addition, the medical literature overflows with articles voicing concern over the inappropriate use of invasive therapies on heart patients and the obvious conflicts of interest that attend them. These procedures gross billions of dollars annually for the medical industry, a cost that is hundreds of times higher than safer, conservative approaches. This begs the obvious question--who truly benefits from these procedures?

Julian M. Whitaker MD

Newport Beach

Editor's note: The Newport Beach stockbroker, Kae Ewing, did not undergo any further procedures. He was prescribed diet and exercise.

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