For three decades Nortin Hadler, a professor of medicine at the University of North Carolina at Chapel Hill, has been rigorously examining statistics generated by his medical colleagues’ practices and arriving at startling conclusions about their effectiveness. To take just one example, Hadler is credited with leading a complete rethinking about the treatment of back pain, which he finds excessive. He wrote the editorial accompanying a landmark study in The Journal of the American Medical Association two years ago suggesting that the benefits of surgery for back pain are overrated. He has also taken on heart treatment, testifying before Congress and the Social Security Advisory Board and publishing papers arguing that very little data back up the value of modern treatments like bypass surgery and angioplasty. He took his case about cardiac care and other health issues to the public in The Last Well Person: How to Stay Well Despite the Health-Care System (McGill-Queen’s University Press, 2004).
Your book makes the case that too many people are having bypass surgery without much advantage. Under what circumstances do you think bypass surgery is appropriate?
H: None. I think bypass surgery belongs in the medical archives. There are only two reasons you’d ever want to do it: one, to save lives, the other to improve symptoms. But there’s only one subset of the population that’s been proved to derive a meaningful benefit from the surgery, and that’s people with a critical defect of the left main coronary artery who also have angina. If you take 100 60-year-old men with angina, only 3 of them will have that defect, and there’s no way to know without a coronary arteriogram. So you give that test to 100 people to find 3 solid candidates—but that procedure is not without complications. Chances are you’re going to do harm to at least one in that sample of 100. So you have to say, “I’m going to do this procedure with a 1 percent risk of catastrophe to find the 3 percent I know I can help a little.” That’s a very interesting trade-off.
