Heart Deaths, Medical Progress, and No Free Lunch

There is no such thing as a free lunch.

Milton Friedman (1912-2006), Attributed

January 29, 2012 – Lost in health reform debate is the fact that medical advances contribute mightedly to exploding health costs. In the sometimes hysterical debate over health costs, we have been distracted from factoring in costs of remarkable medical advances that have occurred over the last half century. Health inflation has a positive as well as a negative side. Medical progress exacts a heavy price, but in the case of heart disease, it is worth it.

In an article in the January 5 The New England Journal of Medicine, which celebrates the 200th anniversary of The Journal, “A Tale of Coronary Artery Disease and Myocardial Infarction,” Drs. E.G. Nabel and E. Braunwald put health reform and medical advances in perspective.

A figure in that article chronicles the steep decline in deaths per 100,000 population from 1950 to 2010. Death rates have declined is from 440 to 100 deaths per 100,000, a 4.4 fold or 773% decline, from 1950 to 2010.

Although the authors do not say so, this decline comes as the result of medical trials leading to costly medical procedures and treatment . For example,each bypass surgery in the U.S. costs $59,770, 32 million Americans take statins to prevent coronary artery disease, one statin, Lipitor, produced $7 billion in profit for its maker, and total cost of cardiovascular disease, the leading cause of death in America, is $475.3 billion each year.

The events leading to this remarkable decline include.

• 1954 – First open-heart procedure

• 1958 – Coronary arteriography developed

• 1961- Risk factors defined

• 1961 – Coronary care unit developed

• 1962 – First beta-blocker developed

• 1969-First description of CABG (Coronary Artery Bypass Graph)

• 1972 - NHBPEP (National High Blood Pressure Education Project)

• 1976 – First HMG CoA (3-hydroxy-3-methyl-glutaryl-COA) reductase inhibitor described

• 1979 – Coronary angioplasty developed

• 1980- First implantable cardioverter-defibrillator developed

• 1983- CASS(Coronary Artery Surgery Study)

• 1985 – TIMI 1 (Thrombolysis in Myocardial Infarction)

• 1985- NCEP (National Cholesterol Education Program)

• 1986- GISSI (Gruppo Italiano per lo Studio della Strpetochina i hell Ifarcto Myocardio)and ISIS-2 (International Study of Infarct Survival)

• 1992 – SAVE (Survival and Ventricular Trial)

• 1993 – Superiority of Primary PCI (Percutaneous Coronary Artery Intervention) vs. fibrinolysis in acute myocardial model

• 2002- Efficacy of drug-eluting vs. bare-medal stents determined

• 2002 – ALLHAT (Anti-hypertensive and Lipid-Lowering Treatment to Prevent Heart Disease Trial)

• 2007 – Benefit of cardiac resynchronization therapy in heart failure demonstrated

• 2009 – left-ventricular assist device as destination therapy in advancd heart failure shown to be effective

• 2009 – Genomewide association in early –onset myocardial infraction described

• 2009 – Deep gene sequencing for responsiveness to cardiovascular drugs performed

Tweet: Cardiovascular deaths have declined from 440 to 100 since 1950, thanks to medical advances, which carry a heavy price tag.