A similar finding was made by the US Veterans’ Administration VANQWISH trial, which tracked 920 patients who had suffered an acute heart attack. Around half had a bypass or other surgery while the rest were treated with conservative ‘watchful waiting’. At the time of discharge from hospital, 21 patients who had undergone surgery had died, compared with just six who had been treated conservatively. After 30 months, 80 of the surgery patients had died whereas, in the ‘watchful waiting’ group, there were only 59 deaths (N Engl J Med, 1998; 338: 1785-92).
The self-healing mind
Even more remarkable than the self-healing body is the healing power of the mind, as researchers have discovered, albeit accidentally. They were endeavouring to determine the efficacy of a new heart procedure called ‘direct myocardial revascularisation’ (DMR), which uses a laser to create tiny holes in those portions of the heart that are not getting enough blood. The holes provide an alternative route for the blood to reach the heart.
Early trials had suggested that DMR was effective, and surgical DMR had been approved by the US medicines regulator, the Food and Drug Administration (FDA), and was being practised, with success, by cardiologists in operating theatres.
But DMR was stopped in its tracks by a major trial which found that it was no better than a placebo. The medical establishment overlooked the profound significance of this result. The trial proved that DMR worked - even for those patients who believed they had received DMR.
The DMR-treated patients reported a significant improvement in exercise capacity and angina symptoms six months after surgery - and the placebo group reported the same benefits, even though nothing had been done to them (Proceedings of the Transcatheter Cardiovascular Therapeutics Conference, 2000).
The power of the mind has also been underlined by another trial that discovered that those patients who prayed after bypass surgery recovered more quickly, and were also less likely to suffer from depression and social distress, common symptoms during the recovery period (J Alt Complement Med, 1997; 3: 343-53).
Who’s for a bypass?
The appeal of the coronary bypass is based on research and findings made more than 20 years ago, when many of the reactions were not properly documented, and the appropriate patient was much younger than those today. Nowadays, cardiologists believe it is safe to operate on patients who are over 80.
‘Best-practice’ guidelines suggest that conservative management is the first option (J Myocard Ischemia, 1995; 5: 7-8; Ann Intern Med, 1997; 126: 551-3), but it’s a message that, at best, is being observed by only a few cardiologists.
The popularity of bypasses differs dramatically between countries, and even between states in the US, with apparently no difference to the long-term health of heart patients. One study highlighted the enormous difference between patients with private health insurance in the US compared with similar patients in Canada who had no insurance. Over 10 per cent of the American patients had a bypass compared with just 1 per cent of the Canadians. In fact, over 60 per cent of the American patients received aggressive treatment, such as a bypass, angiography or angioplasty, compared with 9 per cent of the Canadians. Yet, after 30 days, the mortality rate among the Americans was 21.4 per cent vs 22.3 per cent among the Canadians; after one year, the rates were 34.3 and 34.4 per cent, respectively (N Engl J Med, 1997; 336: 1500-5).