Index

access to health care, 41, 175, 282, 28587

adult-onset diabetes. See diabetes: type 2

aging

attempts to avoid, 98, 99

drug company marketing and, 9698, 99

effects of the immune system, 27172

effects on the brain, 222

nature of the knowledge acquired with, 2034

the p53 system and, 27275

research on cellular processes, 90, 27576

AIDS (acquired immune deficiency syndrome)

political aspects, 195, 282

in South Africa, 28283, 285

transmission, 41, 46, See also HIV: transmission

treatment: antiretrovirals, 4041, 255, 28283; context of a cure, 17374; impact of new, 4041, 43; importance of adherence to the regimen, 18081; low-tech aspects, 166; myths, 282; role of trust, 153, 180; of symptoms vs.

causes, 87

United Nations program, 286

Yale-New Haven Hospital research, 1, 4041

Alzheimer’s disease, 62, 9899, 272, 28485

American Heart Association, 28–29 America’s Pharmaceutical Companies, 9697

angina, 65, 132, 244, 24546, 258

angiography

of the author: attempt to see Dr. Beck, 71; by Dr. Cabin, 3, 6, 80, 83

definition, 1

historical background, 93, 230

angioplasty

definition, 12

percent of patients who need second, 43

percent of unnecessary, 37

research by Helfant, 263

risks and benefits, 4344

stent: failures, 99, 132; impact of this development, 15, 43, 95; probability of needing second, 44

antibiotics

effects on mortality rates, 10910

historical background, 94, 109, 27071

pathogen resistance to, 26, 102, 255, 288

production by microorganisms, 270

treatment for bypass patients, 259

antibodies, 255

antidepressant medications, 43, 97, 154

antipsychotic medications, 105, 150, 268

antiretrovirals, 4041, 255, 28283

aorta, 36, 70, 245

arm pain, 5

Armstrong, Moe, 17

arterial plaque. See plaque

aspirin, 70, 252, 259

Atelenol, 70

Atherosclerosis

early research, 9293

genetic aspects, 114

infectious disease linked with, 259, 260

as an inflammatory process, 25560, 272

limitations of medical knowledge, 16, 43, 249, 252, 260

limited role of risk factors, 30, 256

back pain

author’s symptoms prior to surgery, 59, 60, 64, 65, 69, 245

placebo effect with, 154

Barker, David, 30

Barnard, Christiaan, 281

baseball, 11, 13, 19091, 23536

basketball, 1314, 17, 80, 120

Baycol, 133

Bay State Hospital (Springfield, Mass.), 8

beating-heart surgery, 33

Beck, Dr., 70, 71

beta-blockers, 69, 70

Bible, 11617, 212

Big Man (Neugeboren), 77, 21314

Black Panthers, 18990, 192

blood clots, 29, 43, 70, 94, 258, See also plaque

blood platelets, 70

blood pressure

levels of the author prior to surgery, 5, 56, 69

rise due to medical exam, 251

as risk factor, 5, 24, 249, 251

blood vessels

collateral, 6, 130, 131

reaction to chronic high blood pressure, 251

body. See also mind-body connection

ability to heal itself, 34, 161, 264

feelings of dissociation, 121, 123

temperature during surgery, 4, 279, 280

brain

damage. See neurological conditions

effects of aging, 222

endorphins released by, 155

inability to heal itself, 87, 162, 21617

wonders of the, 15

breast cancer, 28

breathing difficulty

with angina, 246

of the author: prior to surgery, 49, 51, 52, 5557; two years after surgery, 12223

with viral heart disease, 248

breath strength test, 56

Bronx State Hospital (Bronx, N.Y.), 1920

Brooklyn Dodgers, 11, 13, 19091, 23536

Brumlik, Dr. Joseph V., 24243

bypass. See coronary bypass

Cabin, Dr. Henry

angiogram by, 3, 6, 80, 83

background, 3, 22

initial visit with, 16, 89

postsurgery checkups with, 22, 127, 130

views: on being “cured,” 233; on postsurgery Norvasc, 123

calcium channel blockers, 123, 263

cancer. See also Hodgkin’s disease

breast, 28

cervical, 32

chemotherapy and life expectancy, 99, 112

future scenario for treatment, 116

genetic aspects, 117

Li-Fraumeni cancer syndrome, 274

limitations in medical knowledge, 91

mortality rates, 91, 11113

MRI for diagnosis, 231

P53 system and the aging process, 27275

prostate, 33, 300

radiation therapy, 77

risk factors, 111, 113, 116, 117

screening and prevention activities, 112, 113, 116, 117

trends in types, 112

cardiac auscultation, 3536

cardiac care unit, 14, 43, 94, 243

cardiac electrophysiology, 263

cardiac resuscitation, 27, 38

cardiology

historical background, 9293

limitations of medical knowledge. See medical knowledge: limitations in

multidisciplinary nature of, 277

nuclear, 33, 263

quality of care. See managed care; physicians: relationship with the patient

cardiomyopathy, 70, 82

cardioversion, 38

caregiving

by the author, 5, 13, 58

author’s anxiety about, 42, 58, 65

for chronic conditions, 1990 data, 172

Care of the Psyche (Jackson), 15859

CAT scan, 95, 118, 133, 222, 23031

Centers for Disease Control and Prevention, 46

cervical cancer, 32

Charyn, Jerry, 80

chest pain or discomfort

author’s symptoms prior to surgery, 50, 51, 52, 55, 59, 64

heart attack with lack of, 28

stopping movement until it recedes, 65

as symptom of heart disease, 5, 246

childhood diseases, 8694, 10910, See also specific diseases

Chlamydia pneumoniae, 259, 260

chlorpromazine, 268, 269

cholera, 102

cholesterol. See also cholesterol-lowering medications

author’s blood level: after surgery, 134; prior to surgery, 5, 59, 69

heart disease with normal levels, 29, 259

LDL and HDL, 29, 132

risk of death with low, 30

cholesterol-lowering medications, 29, 3132, 99, 133, 260, 26263

cholestyramine, 262

Christopher Reeve Paralysis Foundation, 269

Chronic Care in America: A 21st Century Challenge (Robert Wood Johnson Foundation), 17172

cigarette smoking. See smoking

clinical science

limitations in, 33, 17576

rise in the influence of, 16869

clozapine, 150

cognitive losses, risk with coronary bypass, 9, 44

colchicine, 140, 141, 143

collateral blood vessels, 6, 130, 131

Columbine High School, 234

The Coming Plague (Garrett), 255

communication in relationships, men vs. women, 125

compassion, 20, 212, 26566

computed tomography. See CAT scan; CT screen

conflicts of interest, 37, 26162, 290

Cooley Dickinson Hospital (Northampton, Mass.), 68

coronary bypass

of the author: diagnosis, 4; exercise in the hospital after, 14; “last words” before, 13; procedure, 13, 8385, 179; scars in penis due to catheterization, 140; symptoms prior to, 5, 8, 47, 4962; timeframe of surgery, 13; use of his own arteries, 84, 123

beating-heart, 33

cost of surgery, 43

definition, 4

effects of cholesterol-lowering medications, 29

mental decline from, 44

no cure for, 21, 22

number of patients annually, 118

number performed annually, 5

percent of patients who need second, 43

risks and benefits, 9, 4344

unnecessary overuse of, 37

use of heart-lung machine, 4, 13, 27780

coronary disease. See heart disease

cortisone, 268

C-reactive protein, 25859

CT screen, 132, 133

cultural aspects of

disease transmission, vs. biology of organism, 18384, 194

of infant mortality, 18182

influence on values, 45, 237

not showing fear, 48

of poverty, 18485

cystic fibrosis, 250

cytomegalovirus, 260

Dalai Lama, 263

Darwinian medicine, 25257, 259, 271, 272

The Deadly Truth: A History of Disease in America (Grob), 86

death. See also life expectancy

author imagining his, 78

coming to terms with, 73

end-of-life care, 163, 289

medical data. See mortality preparations for, 8283

as a series of preventable diseases, 98

defibrillator, 38, 95, 243, 290

Demetri, Mrs., 89

depression

clinical judgment in diagnosis, 204

following a heart attack, 154

of Friedland’s father, 196

impact of new treatments, 43

placebo effect with, 154

postsurgical, 48

rank in global burden of disease, 204

DeWood, Marcus, 9293

diabetes

coexistence with heart disease, 28

complications, 107

incidence rate, 107

inflammation and, 272

preventive measures, 1067

risk factors, 1067, 249

type 2, 1067, 249

diagnosis

as an art: importance of listening. See listening to the patient; role of instinct, 101, 105, 247; role of judgment. See physicians: judgment skills; role of technology, 32, 34, 43, 95, 147, 233; uncertainty and probability, 292, 296

of the author: Dr. Flynn’s analysis of the echocardiogram, 70; Dr. Flynn’s analysis of the EKG, 6970; Helfant’s analysis of the echocardiogram, 82; for Hodgkin’s disease in college, 76; “missed,” 8, 24, 28, 31, 47, 74; possible viral infection, 8, 70, 71, 247; reaction to, 34

categories, changes over time, 92

danger of dependence on technology. See technology: vs. listening to the patient

heart disease

cardiac care unit, 14, 43, 94, 243

difficulties and limitations, 16, 2829, 30-31: test results, 3234, 248; evaluation of heart sounds, 3536; “missed,” 29, 32, 24849

percent of information in patient history, 38

physician conflicts of interest, 37, 261, 290

diet

of the author, 134

as risk factor for cancer, 116

as risk factor for heart disease, 24, 106, 26063

as risk factor for type 2 diabetes, 107

digestive system, 91, 109, 156, See also peptic ulcer

digoxin, 86

diphtheria, 90, 109, 110, 271

direct-to-consumer marketing of drugs, 26, 9697, 260, 26162, 290

disease. See also infectious disease

after reproductive age, and natural selection, 254

chronic: increase in the U.S., 17173, 272, 289; salaries for health-care workers, 290

“conquest” of, 26, 9091, 9698, 26869

germ theory, 26, 249

global, ethics and policy, 28688

Koch’s postulates on, 24950

preventable, mortality rates, 286

prevention: effects of activities for, 112, 113, 116, 117, 119; need for medical school training, 163, 173

as punishment from God, 11617

reemergence of, 26, 90, 102, 255

symptoms vs. causes, 87

use of technology prior to true understanding of, 4445

vs. illness, 156

dizziness, 5

DNA. See genetic aspects

doctor-patient relationship. See physicians: relationship with the patient

drug industry

economic aspects of research, 28687

marketing: the concept of choice, 287, 290; at conventions, 37; direct-to-consumer, 26, 9697, 260, 26162, 290; life extension claims, 9698, 99

physician conflict of interest, 37, 261, 290

drug-resistant pathogens, 26, 102, 255, 288

drugs. See medications

Dupuytren’s contracture, 137

ebola, 255

echocardiogram

of Aaron Neugeboren, 36

of the author, 5, 8, 31, 6869, 70, 82, 131, 24748

false positives, 33

economic aspects

average health care spending annually, 286

care for chronic conditions, 172, 225, 289

cost of coronary bypass, 43

fee-for-service, 293

HIV/AIDS treatment and research, 282, 291

low- vs. high-technology treatment, 16566

managed care, 29293

market values and choice, 287, 290

medical industry and physician conflict of interest, 37, 261, 290

medical school, 166

neonatal intensive care, 295

psychotherapy, 208

ejection fraction, 3, 70, 82, 130, 131

electrocardiogram

author’s, 8, 31, 59, 6668, 6970, 81, 24748

false positives, 33

procedure, 6667

Ellen, 50, 52, 53, 58, 74, 80

endocarditis, 36

end-of-life care, 163, 289

endorphins, 155

Erasmus High School (Brokklyn, N.Y.), 11, 12, 72, 185, 229, 238, 300

ethical issues

access to AIDS treatment, 41, 282, 286

physician conflicts of interest, 37, 26162, 290

treatment of global disease, 28688

evolutionary medicine, 25257, 259, 271, 272

Ewald, Paul W., 25257, 259

exercise

by the author: first few weeks after surgery, 17, 18, 121, 122; in the hospital after surgery, 14; prior to surgery, 5, 6, 24, 47, 49, 53, 69; two years after surgery, 12223

importance of, 6, 131

as risk factor for heart disease, 24, 106

as risk factor for type 2 diabetes, 106, 107

exercise capacity test. See stress test

faintness, 5

faith, 157, 204

Fallot’s tetralogy, 280

false negatives, 133

false positives, 3233, 133

family

history, of the author, 5, 9, 24, 45, 241

as predictor of recovery, 40, 41

as a support system, 42

family medical history. See patient medical history

Farber, Dr. Sidney, 76

fatalism, 25

father, author’s

background, 62

closeness to, after death, 6163, 14445

health conditions, 5, 57, 61, 247

as a parent, 62

recipe for longevity, 75

visit to, 136

fatigue, unusual, 5, 121

fear

of AIDS, 187

author’s, 48, 50, 53, 63, 66, 144

marketing based on, 9698, 133-34. See also cholesterol-lowering medications

role in illness, 265

fetal environment, 30

fitness, evolutionary, 25354

Fleming, Alexander, 270, 271

Flexner Report, 168, 169

Flynn, Dr.

diagnosis, 70

echocardiogram by, 5, 8, 6869

letter to Dr. Katz, 69

stress test appointment, 56, 6668

Friedland, Gail, 6, 127, 190, 282, 299

Friedland, Jerry

AIDS research and care: commitment to patients, 46, 18889; future international work, 296; in Nigeria, 17984; patients’ trust in, 151, 153; research on adherence to medications, 41; research on HIV transmission, 18687; in South Africa, 16667, 19192, 28184; at Yale-New Haven Hospital, 1, 41

Black Panthers and, 18990, 192

childhood and adolescence, 11, 12, 185, 19697

as consultant, 42, 79, 80, 84, 136

education, 188, 189, 19496

family, 188, 19293, 19697, 282

friendship with the author: after author’s surgery, 202, 281, 298301; during childhood and adolescence, 12; like family, 124, 126; prior to author’s surgery, 2, 10, 12

in Israel, 192

motivation to be an infectious disease physician, 46, 17985, 191, 196, 267

personality, 46, 18788

teaching positions, 192, 19798

views: on AIDS research, 28283; on health care policy, 289; on the human genome project, 11415; on importance of trust, 151, 153; on insurance companies, 88; on medical school, 16465, 17071

work hours, 2

Friedreich’s ataxia, 234, 297

friends. See also Friedland, Jerry; Helfant, Rich; Rudy, Arthur; Yarnell, Phil

effects of author’s experience on, 25

importance of, 12, 14, 21, 40, 82, 12427, 14953, 2012, 301

Gage, Phineas P., 218

gastrointestinal disease, 91, 109, 156

“gatekeeping,” 35, 292

genetic aspects

of aging, 98, 117

alleles and genetic variability, 276

of cancer, 117

diseases with single causative abnormality, 250

ethical issues with testing positive, 295

of heart disease, 24, 114, 250, 251, 265

human genome, 11315, 212, 276

of Huntington’s disease, 295

of natural selection, 254

of neurological conditions, 234

paragenetics, 26465

P53 system, 27275

germ theory, 26, 249

Gibbon, John, 27780

Gilda’s Club, 29798

gingivitis, 259, 260

Granberg, Ronald, 89

Granger, Beth, 22325

HAART (highly active antiretroviral treatment), 4041, 255, 28283

Haight, Dr. Malcolm, 13738, 140, 143, 14547, 148

Hashim, Dr. Sabet

background, 9

postsurgery checkups with, 123, 127

quintuple bypass surgery by, 13, 8385

trust in, 4, 6, 8, 13, 15

visit prior to surgery, 910

healing

body’s ability to heal itself, 34, 161, 264

faith, 157

as a natural process, 149

placebo effect, 15357, 161, 264

health care

access to, 41, 282, 28587

policy-making, 28791

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, 3536

heart attack

asymptomatic (silent), 25, 2829

author’s possible, 67, 68, 70

depression following, 154

early research, 9293

indication on an electrocardiogram, 67

with normal cholesterol levels, 29

risk with open-heart surgery, 44

role of arterial plaque and inflammation, 29, 105, 25560

heart disease

asymptomatic, 2425, 2829

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, 3536, 26566

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, 27780

heart surgery. See coronary bypass; heart transplant; open-heart surgery

heart transplant, 95, 277, 281

Helfant, Rich

childhood and adolescence, 7, 12, 72, 235, 23740

as a consultant: after surgery, 12324, 13031, 132, 136; on diagnosis of viral infection, 28, 71, 247; on the EKG, 81, 248; on Peyronie’s disease, 136; prior to surgery, 78, 59, 6566, 7172, 79, 81, 24449

education, 12, 72, 239, 240, 24143

family, 72, 128, 23738, 239, 240, 241

family history, 241

friendship with the author, 12, 7273, 12427, 2012, 23839

heart disease research, 8, 131, 257, 258, 263

interests, 7273, 26364

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, 23537; on Jerry Friedland, 46; on limitations of medical knowledge, 1517, 249, 252, 260; on medical community conflicts of interest, 37, 26162; on the mind-body connection, 26465; on the physician-patient relationship, 16364, 26566

writings by, 16, 28, 73, 296

Helicobacter pylori, 260, 268

Herrick, James, 92

highly active antiretroviral treatment (HAART), 4041, 255, 28283

Hippocrates, 40, 159

Hippocratic Rule, 162

historical background

ancient healing practices, 15859

antibiotics, 94, 109, 27071

aspirin and blood clotting ability, 70

clinical science, 16869

decrease in infant mortality, 94

germ theory of disease, 26, 249

heart attack research, 9293

heart-lung machine, 27780

increase in life expectancy, 94, 1078

Koch’s theory of disease, 24950

medicine prior to 1940, 8694, 10910

neurology, 22930

rise in hospital/laboratory medicine, 167

HIV (human immunodeficiency virus)

antiretroviral treatment, 4041, 255, 28283

epidemiology, 19394

infection of medical personnel, 283

number of children infected annually, 41

in South Africa, 28283, 284, 285

transmission, 18687, 191, 193, 194, 283

hives, 156

Hodgkin’s disease, 5, 7677, 135

hormone replacement therapy, 295

hospitals

differences in quality of care, 1011

infections acquired within, 26, 255

medical errors which occur in, 11

shift in focus from patient to disease, 167

human genome, 11315, 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, 27172

antibodies, 255

evolutionary context, 253, 254, 271

vaccines and the, 156

infant mortality, 94, 1023, 108, 109, 18182, 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

drug-resistant, 26, 102, 255, 288

evolutionary context, 254

historical background: germ theory, 26, 249; treatment for childhood diseases, 8890, 109; treatment prior to 1940, 8694, 10910

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, 25560, 272

role in the immune system, 27172

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, 16970, 175

isolation, 82, 148, 150, 297

Judaism

cultural values, 45, 227

on miracles, 85

Yom Kippur, 219, 283

Kanof, Dr. Abram, 24041

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, 5556

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, 3233

historical background, 167

interpretation of results, 31, 32, 34, 248

percent of total information needed for diagnosis, 38

replacement of stethoscope techniques, 3536

language, challenges for medical care, 39

lawsuits, 289

legionnaires’ disease, 255

Lescol, 29

life

as a gift, 2223, 24, 83, 12021, 129, 17879

quality of, 133

life expectancy

drug company marketing for increased, 9698, 99

increase in the 1900s, 94, 1079

research, 27576

vs. lifespan, 275

Life Without Disease: The Pursuit of Medical Utopia (Schwartz), 9091

Li-Fraumeni cancer syndrome, 274

Lipitor, 29, 99, 114, 132, 13435, 260

listening to the patient, 27

actively, 21, 88, 93

with compassion, 20, 212, 26566

for full medical history, 38, 2023, 229, 24344

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, 29293

approved physicians, 39

damage to patient-physician relationship by, 3435, 15961, 23233

dehumanization of physicians, 35, 8788, 16465

inadequacy for chronic disease, 171, 225, 289

need for training in new technologies, 3738, 133

no value placed on physician’s time, 88, 16970, 175

physician’s conflicts of interest with, 37, 261, 290, 293

policy overriding physician’s judgment, 35, 160, 169, 22627

rise in hospital medicine, 167

role of specialists, 35, 23233, 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, 11415, 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

“conquest” of disease, 22, 2526, 9091, 9698, 26869

limitations in, 1517, 21, 26, 8792, 249, 271

media hype of “breakthroughs,” 27, 38, 45, 11415, 133

of neurology, 87, 216, 26869

paradigm shifts, 92

rise of clinical science, 16869

role of serendipity, 114, 268, 27071

medical school

additional training needs: disease prevention, 163, 173; end-of-life care, 163; evaluation of heart sounds, 3536; history of medicine, 163; new technologies, 3738, 133; public health, 163

courses on the physician-patient relationship, 164

economic aspects, 166, 16970

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, 15354, 18081

antibiotics. See antibiotics

antidepressants, 43, 97, 154

antipsychotics, 105, 150, 268

antiretrovirals, 4041, 255, 28283

aspirin, 70, 252, 259

beta-blockers, 69, 70

calcium channel blockers, 123, 263

cholesterol-lowering, 29, 3132, 99, 133, 260, 26263

clot-busters, 43, 94

colchicine, 140, 141

discovered through serendipity, 114, 268, 27071

“lifestyle,” 97

to minimize possibility of heart attack, 4

“pharmacological forgiveness,” 180

prior to 1940, 8694, 10910

for treatment of mental illness, 1056, 150

vasodilators, 70

Melman, Dr. Arnold, 13942, 143, 145, 14647

men

communication style in relationships, vs. women, 125

mortality rate for heart disease, 2829

prostate cancer, 33, 300

mental decline

Alzheimer’s disease, 62, 9899, 272, 28485

with coronary bypass, 9, 44

mental illness

belief in recovery, 14950

importance of humane treatment, 20, 103, 148, 150

isolation with, 82, 148, 150

leading conditions which cause disability, 2056

learning to live with, 103

need for skill as well as compassion, 20

patient is not the disease, 14748

role of medications, 1056, 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, 26465

placebo effect, 15357, 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, 10910

cancer, 28, 91, 112

changes in major causes of, 8694

coronary bypass, 44

drug-resistant infections, 26, 255

effects of inferior medical care, 3940

heart disease, 91, 119: heart attack, 25, 2829, 154; and weight as an infant, 30

infant, 94, 1023, 108, 109, 18182, 286

open-heart surgery, 44

mother, author’s

Alzheimer’s disease, 62, 9899

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, 25355, 272

nausea, 5

neonatal intensive care, 29495

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, 12021

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, 7980, 81

trip to Israel, 135, 145

trip to London, 52, 5354

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, 7677, 135

initial doctor’s visit, 16, 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, 12021, 130, 300

as a single parent, 7, 12, 4142

trip to Alaska, 178, 179

trip to Israel, 135, 145

trip to London, 52, 5354

trip to Norway, 17779

who will be caregiver for, 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, 5354

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, 15051

humane care at Bronx State, 1920

life in New York City, 285

move to New York City, 58, 12829

notification about the surgery, 13

neurological conditions

from coronary bypass, 44

impact of new treatments, 43

importance of family, 41

swelling, 22223

traumatic injury, 105, 22023, 26869

neurology, 216, 218, 22930

Nigeria, 17984

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), 11516

open-heart surgery. See also coronary bypass

general procedure, 4

historical background, 27780

risks and benefits, 4344

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, 3637

osteoporosis, 272

outcome studies, 33

oxygen

decreased body temperature and, 4, 246

supply to the heart, 24546, 25758

PABA (potassium para-aminobenzoate), 138, 140, 143, 145

pacemakers, 94

palpitations, 5

Pam, Dr. Alvin, 1920

paradigm shifts, 92

paragenetics, 26465

patient medical history of the author, 5, 57, 59, 60, 80, 247

correct diagnosis from the, 38, 2023, 229, 24344

as risk factor for cancer, 17

taking time to get, 38, 16970, 175

patients

with disease that is a unique entity, 33

experience of illness vs. disease, 156

ignored by physician, 68, 13839, 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, 9596, 14748, 167

relationship with the physician. See physicians, relationship with the patient

as unique individuals, 21, 88, 149, 176, 229

Paxil, 97

Peace Corps, 180, 182

peak flow meter, 56

Penicillium notatum, 27071

penile induration. See Peyronie’s disease

peptic ulcer, 260, 268

periodontal disease, 260

persistence, 39, 45

PET-scans, 231

Peyronie’s disease of the author, 13542, 143

spontaneous remission, 146

variation in recommended treatments, 143

P53 system, 27275

pharmaceuticals. See drug industry; medications

physical examination

of the author, prior to surgery, 5556

percentage of total information needed for diagnosis, 38

physicians

dehumanization of, 35, 8788, 16465

economic conflicts of interest, 37, 26162, 290

important qualities: active listening, 21, 88, 93; compassion, 20, 212, 26566; saying “I don’t know,” 16, 244; sympathy, 212; training in new technologies, 3738, 133

judgment skills, 88. See also listening to the patient; content and context for, 26566; for diagnosis of depression, 204; as a gift, 34; impact of technology on, 3536, 13334; impaired by managed care, 3435, 15961, 23233; importance in choice of treatment, 31, 34; role of instinct in diagnosis, 101, 105, 247

recent graduates, gaps in training, 3536, 3738, 163, 173

relationship with the patient, 17, 26: and clinical science, 16869, 17576; cultural aspects, 45; importance of, 38, 15859, 265; lack in managed care system, 3435, 15961, 163, 175, 23233, 293; lack of time, 88, 16970, 175; listening. See listening to the patient; the power of authority, 124, 13435, 14546, 164; restoration, 294; as the “science” in medicine, 32; trust, 41, 146, 15154, 175, 18081, 2023, 265

placebo effect, 15357, 264

plaque

in the author’s arteries, 4

components, 29

limitations on knowledge about, 255

role in a heart attack, 29, 105, 25758

Pneumocystis carinii pneumonia (PCP), 193

pneumoencephalography, 230

pneumonia, 91, 109, 110, 193, 271

policy-making, 28791

poliomyelitis, 8889, 109, 110

political aspects of AIDS treatment and research, 282

Porphyromonas gingivalis, 259, 260

positron emission tomography (PET), 231

post-traumatic stress disorder, 211, 219, 298

potassium para-aminobenzoate (PABA), 138, 140, 143, 145

poverty

access to AIDS treatment, 41, 282, 286

access to vaccinations, 28586

in American culture, 18485

childhood mortality from preventable diseases, 286

Pravachol, 29, 96, 260

prostate cancer, 33, 300

prostate-specific antigen test (PSA), 118, 138, 145

Prozac, 97, 99, 154

psychological aspects

appreciation of life. See life: as a gift

compassion, 20, 212, 26566

concept of choice, 28788, 290

distancing from reality, 68

effects of author’s experience on friends, 25

effects of positive attitude, 40, 47, 83, 131

empathy, 42

fatalism, 25

fear. See fear

feeling of no use, 297

importance of friends. See friends persistence, 39, 45

safety as an illusion, 210

self-revelation and self-reflection, 202

shock and denial, 34, 47

sympathy, 212

unreliability of memory, 50, 61, 69

of writing, 1819

psychotherapist, of the author, 51, 6364

public health

historical background, 91, 111

importance of clean water, 1023, 108

medical school curriculum, 164, 165

in policy-making, 289

pulse, 5, 127

“pump-time,” 13

racial aspects

baseball, 236, 237

discrimination, 23637, 281

quality of medical care and mortality statistics, 3940

radiation therapy for Hodgkin’s disease, 76

recovery

of the author: after two years, 12223; first few hours after surgery, 299300; first few weeks, 17, 18, 12021

effects of a caring relationship, 14950

effects of positive attitude, 40, 131

family support as predictor for, 41

Reeve, Christopher, 26869

retinal damage, 9

rheumatic fever, 111

rheumatic valve disease, 249

rheumatoid arthritis, 268, 272

The Rise and Fall of Modern Medicine (LeFanu), 262

risk factors

cancer, 111, 113, 116, 117

heart disease, 5, 30, 106, 252

type 2 diabetes, 1067, 249

Robinson, Jackie, 23537

Rofman, Sam and Elaine, 80

Rogaine, 97

Rudy, Arthur

background, 11, 12

education, 200, 201, 206, 209

friendship with the author, 1112, 122, 12428, 152, 199, 207

motivation to be a psychologist, 200, 2058, 21112, 267

personality, 199

responsibilities as a psychologist, 11, 200, 29798

support for the author prior to surgery, 79, 81

in Vietnam, 20911, 21314, 219

views: on his future, 298; on the role of psychotherapy, 1035

Rudy, Marcia, 213, 219

Rudy, Paulette, 200, 219, 297

Sachs, Fred, 300

Saving the Heart: The Battle to Conquer Coronary Disease (Klaidman), 3334

scarlet fever, 94, 109

scars, 123, 14041

Schaufenster schauen strategy, 65, 66

schistosomiasis, 18284

self-revelation and self-reflection, 202

September 11 attacks, 151, 152, 285, 298

serendipity, role in medical discovery, 114, 268, 27071

Seth

at the hospital during author’s surgery, 12, 14, 84

trip to London, 52, 5354

visit with author after surgery, 17

wedding, to Miriam Neugeboren, 12, 57, 130

Sharon, 7374, 7576, 7879

sickle cell anemia, 250, 253

Siegel, Asher, 192

smallpox, 90, 109, 110, 111

smoking

as risk factor for cancer, 111, 113, 116, 117

as risk factor for heart disease, 5, 24, 106

tobacco marketing, 291

social aspects

effects of a caring relationship on recovery, 14951

importance of family and friends.

See family; friends

isolation, 82, 148, 150, 297

loneliness, 50, 55, 56, 58, 64, 129

societal aspects

access to health care, 41, 175, 282, 28587

discrimination, 23637, 281

medical training and service, 166

responsibility to other human beings, 166, 28788

responsibility to provide doctors and universal health care, 166, 175, 289

Some Choice (Annas), 28788

South Africa, 28182, 284, 285

specialists

financial incentives, 295

“gatekeeping” in managed care, 35, 292

missed diagnosis from, 23233

neonatal, 294, 295

vs. general practitioners, 246

spiritual aspects, balance with modern medicine, 184

staphylococcus, 26, 27071

statins, 259. See also Baycol; Lescol; Lipitor; Mevacor; Pravachol; Zocor

stent. See angioplasty, stent

steroids, 268

stethoscope, use in heart disease diagnosis, 3536

streptococcus, 249, 255

streptomycin, 268, 270

stress

of the author prior to surgery, 47, 5052, 61

as risk factor, 24

stress test

of the author, 56, 64, 6668

as predictor for heart disease, 30

procedure, 68

stroke

with coronary bypass, 9

MRI for diagnosis, 231

with open-heart surgery, 44

with type 2 diabetes, 107

surgery. See coronary bypass; heart transplant; open-heart surgery

survival, 12627

symptoms

asymptomatic heart attack, 25, 2829

of the author prior to surgery, 5, 8, 47, 4962

of heart disease, 5, 16

vs. causes of disease, 87

teaching positions, of the author, 13, 57, 82

technology

economic and policy issues, 290

“halfway technologies,” 4445, 87

impact on neurology, 23031

limitations, 21, 101, 133, 244

limited impact on mortality rate, 109, 11112, 119, 294

media hype, 27, 38, 45, 11415, 133

as a modern miracle, 85, 88

need for proper training, 3738, 133

needless and costly overuse, 37, 101, 146, 16263, 294

short timeframe for obsolescence, 3738

trends in, 2526, 9495

vs. listening to the patient, 38, 16768, 2023, 24344, 248, 291

vs. “science,” 85, 88, 95

Thomas, Lewis, 256

Thorsen, Dr. Gerd-Ragna Bloch, 177, 178

Thursday Night Cardiac Clinic, 243

thyroid scan, 77

thyroxine, 86

Time Special Issue: The Frontiers of Medicine, 27

Time to Heal (Ludmerer), 16869

tobacco. See smoking

Transforming Madness (Neugeboren), 53, 66, 82, 300

trauma, 153. See also post-traumatic stress disorder

traumatic injury to the brain, 105, 22023

trust

adherence to medications and, 41, 15354, 180

lack of continuity and time to develop. See managed care

mind-body relationship and, 154, 265

qualities that engender, 14647, 153. See also listening to the patient

role in psychotherapy, 202

role in recovery, 15354

tuberculosis

economic aspects of vaccinations, 28586

integration with HIV prevention and treatment, 283

as major cause of death, 1800s-early 1900s, 91

mortality rate decline, late 1900s, 109

reemergence, 102

streptomycin treatment, 268, 270

treatment curriculum developed by Friedland, 192

United Nations program, 286

typhoid, 109

United Nations, 286

United States

average health spending annually, 286

dismal response to international epidemics, 286

health-care system. See managed care

Medicare, 163

mortality rates. See mortality

universal health care, 166, 175, 289

University of Massachusetts

basketball games, 1314, 17, 80, 120

teaching position (as professor and writer in residence), 13, 57, 82

vaccinations

economic aspects, 28586

effects on mortality rate, 10910

immune system and, 256

for polio, 8889

vasodilators, 70

Vasotec, 70

ventricular assist devices, 9495

Viagra, 97, 99, 137, 150

viral infection. See also HIV

antiretroviral treatment, 4041, 255, 28283

diagnosis of possible, 8, 70, 71, 247

ebola, 255

heart disease symptoms, 248

natural selection and, 255

vitamin E, 138, 140, 143, 145

Waksman, Selman, 270

weight

as risk factor for cancer, 117

as risk factor for heart disease, 30, 249

as risk factor for type 2 diabetes, 106

white blood cells, 248

whooping cough, 94, 10910

Whynott, Doug and Kathy, 66, 81

Why We Get Sick: The New Science of Darwinian Medicine (Nesse and Williams), 271

Wise, Dr. Carl, 77

women

communication style in relationships, vs. men, 125

hormone replacement therapy, 295

mammograms, 118, 295

menopause and heart disease, 12930

mortality rate for breast cancer, 28

mortality rate for heart disease, 2829

World Health Organization (WHO), 286

World Trade Center, 151, 152, 285, 298

writing career of the author

Big Man, 77, 21314

book on Moe Armstrong, 17

book tour, 124

daily routines, 18, 22

first weeks after surgery, 17, 121

Imagining Robert, 19, 72, 244

inspiration for this book, 1819

Nightline interview, 17, 51

prior to surgery, 47

psychological aspects, 1819

Transforming Madness, 53, 66, 82, 300

visualization of, 12

x-rays, 230

Yale-New Haven Hospital (New Haven, Conn.)

AIDS research, 1, 41

author’s decision to go to, 73, 79

trust in, 1011, 42, 80

Yarnell, Barbara, 217

Yarnell, Phil

on Arthur Rudy, 21920

author going on rounds with, 2, 21516, 22021

childhood and adolescence, 10, 1213, 22829

as a consultant, 10, 13637, 245

education, 12, 215, 22728

family, 227, 228, 234

friendship with the author: during adolescence, 1213; after author’s surgery, 128, 202; importance of, 2, 13, 4647, 12427, 220; prior to author’s surgery, 1, 10, 12, 47, 79, 81

marriages, 214, 220

medical responsibilities, 2, 10, 16162, 21516, 22526, 297

motivation to be a neurologist, 99100, 226, 232, 23334, 267

nickname, 227

office decor, 21718, 223, 296

personality, 46, 215

ranch in Kiowa, Colorado, 10

sculptures by, 218

views: on Arthur Rudy, 21920; on death of a young woman, 22125; on drug/technology marketing, 97, 133; on history of neurology, 22931; on Jerry Friedland, 46, 281; on managed health care, 23233

Zocor, 29, 96, 260