Bypass Surgery

Flashback Friday: Told You Need Bypass Surgery? Get a Second Opinion

One of the best things about the natural therapies I’ve been prescribing patients for more than 35 years is that they are safe, effective—and enduring. They worked three decades ago, they work today, and they will continue to work five, 10, even 100 years from now.

In this special Flashback Friday blog post, I’m going to share an article I published in Health & Healing back in January 1992. It’s all about the importance of getting a second opinion if you are recommended to have bypass surgery. The information in this article is every bit as true today as it was more than 20 years ago. I hope you enjoy this still-relevant walk down memory lane.

Second Opinions for Bypass Surgery

Health & Healing, January 1992, Vol. 2 No. 1

“You are a walking time bomb. Unless you have immediate bypass surgery, you are going to die.”

The chances are pretty good that you or someone close to you will hear that proclamation. What do you do? Get a second opinion! I am going to show you how to do that—but first, some background information.

In 1977, the results of the Veterans Administration’s Cooperative Study, a scientifically controlled trial testing the power of bypass surgery to save lives, were published. Result: Surgery was no better than conventional medications  at preventing heart attacks or saving lives.

Five hundred and ninety six patients, all with the same degree of blocked arteries, were randomly assigned to receive either bypass surgery or medical therapy. At the end of 36 months, the death rate in both groups was exactly the same, no difference at all.

At that time, I thought that bypass surgery would be abandoned, and we docs would get on to using approaches that actually worked. I had just spent six months working with Nathan Pritikin at the Longevity Institute, and had seen hundreds of heart patients get well on a low-fat diet alone.

Boy, Was I Wrong!

I did not believe that the profession would promote bypass surgery, even though it did make a lot of money, after it had been so soundly defeated in a fair trial.

I was wrong. In 1977, about 77,000 bypass procedures were done. Growth accelerated.

In addition, the surgeons demanded another study, so the government coughed up another hundred million to repeat the study, this time called the “Coronary Artery Surgical Study” (CASS).

Seven hundred and eighty patients, all with severely blocked arteries, were again equally divided into two groups; one received surgery, the other conventional medical therapy. The results were published in 1983, and-as far as surgery was concerned-the results were even worse. Not only was there no difference at all in death rate between those who had the bypass and those treated conservatively; but after five years, the nonsurgical group had an annualized death rate of only 1.6% per year. That, folks, is a yearly survival rate of 98.4%!

The researchers concluded, “Patients similar to those enrolled in this trial can safely defer surgery until symptoms worsen to the point that surgical palliation is required.” That means it is safe not to have surgery and that if surgery is needed, it should be used for pain relief only, not for preventing fatal heart attacks.

Surgery Increases Your Risk

The CASS study revealed another alarming fact.  For the average patient undergoing bypass surgery, the risk of dying from the surgery is about three to five times greater than the risk of dying from the disease. Risk of fatal heart attack for the average bypass candidate is between 0.5% and 2.5% per year (1.6% in the study). Risk of death from surgery: According to the California Office of Statewide Health Planning, in 1987 there were 30,040 bypass operations in the state. The average in-hospital death rate from the procedure was 5.73%—one out of 17 patients.

In an editorial that accompanied the CASS study, Eugene Braunwald, MD, chief of cardiology at Harvard Medical School, predicted that use of bypass surgery would decrease. “Will the frequency of the procedure continue to increase? Probably not. I believe that a combination of several factors will arrest its further growth and may actually lead to a decline in its frequency.” He thought that improved medical therapy and a “lack of statistical evidence in CASS that surgery improves survival in any patient other than those with disease of the left main artery” (about 4% to 7% of those receiving bypass surgery) would halt growth.

He was wrong. The number of procedures performed that year was about 189,000. Growth only accelerated. The estimated number of bypass surgery procedures for 1991 is over 400,000.

When the CASS study was published, I began to wonder how heart surgeons and aggressive cardiologists stayed out of jail! They wouldn’t, if society interacted with the medical profession in a semi-rational manner. However, historically and even in today’s enlightened society, we simply believe anything doctors say. We are too frightened to do anything else. We would follow docs into hell if they told us it was “necessary to save our lives.”

Why the Heart Surgery Industry Still Flourishes

If the profession followed the recommendations of its own scientific studies, the heart surgery industry would collapse overnight. In order for that industry to survive, and certainly to flourish, it must perform large numbers of totally unnecessary procedures. And since that industry churns out about 1,000 newly minted heart surgeons each year, all eager to ply their craft “helping folks” with this terrible disease, the heart patient with just a little heart disease swims with sharks in a feeding frenzy.

Folks, this is not a scientific debate among hard-working, concerned physicians doing their best to help their patients.

This is fraud on a monstrous scale.

What You Need to Know Before You Get a Second Opinion

However, you need to know how to get a second opinion when either bypass surgery or angioplasty (the balloon technique for opening up blocked arteries) is recommended. For over 15 years, writing a second opinion for patients told that they needed heart surgery has been a major part of my medical practice. If you are going to seek a second opinion, you need to have some control of the situation, and in order for you to do that, you need some knowledge.

The most important medical article published on second opinions for bypass surgery was written by Thomas Graboys, MD, a teaching cardiologist at Harvard Medical School (“Results of a Second-Opinion Program for Coronary Artery Bypass Graft Surgery,” Journal of the American Medical Association, 1987; 258:1611-1616).

In this article, Dr. Graboys and others outline a noninvasive protocol to assess such things as the degree of pain, performance on a treadmill, health and function of the patient’s heart, and the patient’s willingness to intensify a medical regimen in lieu of surgery. Graboys demonstrated how the patient’s risk of having a heart attack could be determined by noninvasive methods, and how that risk could then be compared to the risks of surgery.

Graboys and his colleagues reported the results of 88 patients told to have surgery. Even though all of the patients had significant blockages in their heart arteries, it was determined that 74 of the 88 (84%) did not need surgery at that time. After two years, there were no deaths in these patients even though 60 of the 74 did not have the surgery.

In the same issue of the journal, Henry McIntosh, MD, past president of the American College of Cardiology, wrote an editorial supporting this systematic approach to giving second opinions when bypass surgery is recommended (“Second Opinions by Aortocoronary Bypass Grafting are Beneficial,” Journal of the American Medical Association, 1987; 258:1644-45).

Avoid the Cardiology Club Rubber Stamp

This is the protocol that must be used to avoid the cardiology club rubber stamp: “Oh yeah, you need surgery tomorrow—just look at those blockages!”

When discussing your case with the physician evaluating you, politely request reprints of scientific studies from the doctor that are the basis for his decision, one way or the other. I routinely give my patients copies of numerous scientific articles.

When doctors make proclamations and pull out a bunch of unsubstantiated statistics and opinions from who knows where, they are not doctors, they are soothsayers.

I steer most people away from heart surgery, not because I am against surgery, but because the nonsurgical approach is usually the safest and most effective course to take. (Patients who are true candidates for bypass surgery are those who have a severe blockage in the left main artery—very rare, severe incapacitating chest pain not controllable by medicines, or three vessels blocked and evidence of a damaged heart.)

I then encourage the patient to return to the original physician and discuss the second opinion and the scientific studies that support it. Then consider the options again. A decision to have surgery should be made by a well-informed patient, not someone terrified beyond all reason.

I also start each patient on an “aggressive conservative approach,” consisting of a healthy diet, an exercise program, large doses of vitamins and minerals, and sometimes EDTA chelation therapy. This will help even if the patient decides to undergo surgery.

As the police sergeant in Hill Street Blues says to end the morning briefing, “OK, folks, that does it, and remember, let’s be careful out there!”

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