Drug treatment doesn't seem to provide long term gains. Other studies show between a 3 and 7 per cent short term (30-35 days) post heart attack survival rate with early drug treatment (Lancet, 1994; 343: 311-22; N Eng J Med, 1993; 329: 673-82). While these numbers may provide comfort for the few who survive, the overall question still remains about the real benefit of conventional treatments or the policy of concentrating merely on keeping patients alive, rather than encouraging them to take steps to improve the quality of their lives.

Heart attack, or myocardial infarction ("death" of the heart muscle caused by an inadequate blood supply) is usually caused by obstruction of the coronary artery due to atherosclerosis. The condition may occur suddenly or after a history of angina pectoris (chest pains). Some people have little evidence of blockage, in which case it is assumed that spasm of the coronary artery is responsible. To treat these two possible causes, patients are offered a range of drugs to unclog and/or dilate arteries, to thin the blood or strengthen the force of the heart beat.

Beta blockers which have both an anti arrhythmic and antihypertensive action only reduce the possibility of a further heart attack by a very small margin and have other implications for a person's health. They cause dizziness, impotence, nausea, coldness in the extremities, nightmares and insomnia. In one study atenol doubled the risk of kidney cancer in hypertensive patients (Hypertension, 1996; 28: 321-4). Beta blockers can also produce sudden, irregular heart beats which can cause death. One trial was stopped early because the side effects were so alarming (Lancet, 1996; 348: 7-12) and the editorial which accompanied this research concluded that we must assume that all anti arrhythmic drugs are potentially lethal.

Calcium channel blockers such as verapamil, diltiazem and nifedipine are also used to treat hypertension. But the FDA has now cautioned against using nifedipine since it has been shown to create first a sharp drop, followed five hours later by a sharp rise in blood pressure, thus increasing the risk of heart attack (JAMA, 1996; 275: 423; JAMA, 1996; 275: 515).

Calcium channel blockers can stop blood coagulating, but what is good for the heart is not necessarily good for the stomach. They have been shown to cause severe stomach bleeding in the elderly (Lancet, 1996; 347: 1056). They can also double your risk of getting cancer (Lancet, 1996; 348: 49).

Anti arrhythmics can cause the problem they are trying to treat. In one large trial there were significant deaths in those taking encainide and flecainide. Nearly 6 per cent of patients died from arrhythmias while taking these drugs, as opposed to 2.2 per cent of those who took placebo (N Eng J Med, 1991; 324: 781-88). Equally, nearly 3 per cent died of heart attack compared with 0.7 per cent of the placebo group.

In the three year SOLVD (Studies of Left Ventricular Dysfunction) trial (N Eng J Med, 1992; 327: 685-91) ACE inhibitors the newest class of heart drug prevented three episodes of non fatal heart failure for each 100 patients treated per year. Because of this it has been suggested that patients should be given ACE inhibitors to prevent further episodes (N Eng J Med, 1992; 327: 725-27). But a look at the long term picture is revealing: ACE inhibitors (in this case enalapril) saved only one life for every 300 patients treated.