A bolt of excitement ran through the field of cardiology in the early 1980s when anti-arrhythmia drugs burst onto the scene. Researchers knew that heart-attack victims with steady heartbeats had the best odds of survival, so a medication that could tamp down irregularities seemed like a no-brainer. The drugs became the standard of care for heart-attack patients and were soon smoothing out heartbeats in intensive care wards across the United States.
But in the early 1990s, cardiologists realized that the drugs were also doing something else: killing about 56,000 heart-attack patients a year. Yes, hearts were beating more regularly on the drugs than off, but their owners were, on average, one-third as likely to pull through. Cardiologists had been so focused on immediately measurable arrhythmias that they had overlooked the longer-term but far more important variable of death.
The fundamental error here is summed up in an old joke scientists love to tell. Late at night, a police officer finds a drunk man crawling around on his hands and knees under a streetlight. The drunk man tells the officer he’s looking for his wallet. When the officer asks if he’s sure this is where he dropped the wallet, the man replies that he thinks he more likely dropped it across the street. Then why are you looking over here? the befuddled officer asks. Because the light’s better here, explains the drunk man.
