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This chapter examines how women who are in support groups after myocardial heart infarction are silenced by approaches to treatment that are derived solely from men's experiences with heart disease. It presents evidence of how treatment can address self-silencing in order to facilitate women's positive coping to help them return to health. It discusses the relevance of silencing the self theory in conceptualizing women's experience of cardiovascular disease, particularly in light of the lack of attention given to women's—as opposed to men's—experience of heart disease. Using illustrative case examples, the chapter demonstrates the contradictions between women's needs to focus on their own recovery and to simultaneously meet the needs of those around them. The chapter also describes possible psychosocial approaches for recovery and rehabilitation for women with cardiovascular disease.

This chapter discusses the importance of conscious thought in making important decisions in relation to the death of the relative, describing the case of 28-year Michael, who suddenly died of a heart attack and whose mother was hospitalized just hours after his death. The chapter explains that following trauma it is frequently necessary for the traumatized individual to make a clear decision to live, and suggests that when the traumatized person's eyes travel, do not speak; but when the eyes return, wait for four to five seconds before speaking.

This chapter focuses on the later life and career of Dorothy Fields. Dorothy's last three musicals were separated by long intermissions. There were seven years between Redhead and Sweet Charity and another seven years between Sweet Charity and Seesaw, her final musical, written in collaboration with Cy Coleman. Dorothy died unexpectedly on March 28, 1974. The New York Times listed heart attack as the cause of death.

This chapter examines price indexes for medical care, focusing on heart attacks (acute myocardial infarction). It first describes several conceptual issues related to medical care price indexes and considers some basic descriptive information on changes in the treatment of heart attacks over time. It then treats formally two types of medical care price indexes, a service price index and a cost-of-living index. A key practical problem in estimating both types of indexes is measurement: list prices (“charges”) and harder-to-measure transaction prices have diverged increasingly, the development of new or modified medical treatments complicates the comparison of “like” goods over time, and determining the effects of medical treatment on important health outcomes is confounded by many intervening factors. The chapter summarizes the results for heart attack price indexes and extends them to include quality of life and more recent time periods. It also discusses inflation rates and benefit payments.

This chapter discusses the result of a detailed review of the literature on how technological change has actually occurred for one important component of treatment of cardiovascular disease: the care of heart attacks. The findings indicate that formal applied research studies alone cannot explain much of the observed changes in practice that accounted for declining heart attack mortality, and that clinical practices generally “lead” the results of the trials, sometimes by many years, and also “lag” behind the results of the trials, often responding only slowly to new formal research findings. The chapter highlights the importance of an understudied source of new biomedical knowledge and thus of technological change in health care.

Japanese medical malpractice law governs an industry that in many ways differs—radically—from the American health care industry. Before turning to that malpractice law in Chapter 5, consider the industry itself. It is an industry covered by a national health insurance. To extend that coverage, the government provides a subsidy that raises the demand for medical services. In the face of the increased demand, it then suppresses costs by suppressing prices. 4 illustrates two effects of this national insurance. First, the most talented doctors disproportionately shift into “superfluous” sectors not covered by the national insurance, and there invest heavily in their expertise. Second, both physicians and hospitals lack substantial experience in the complex procedures that lie at the heart of modern medicine. The result is a substantial increase in mortality from strokes and heart attacks.

Age-adjusted mortality rates for ischemic heart disease have fallen for the last thirty years. The reasons for the decline — which include primary prevention of coronary events, secondary prevention, improved outcomes of the events themselves, and changes in event severity — have been the subject of considerable debate. Much of the debate centers on the relative importance of medical technology versus lifestyle changes or other sources of reductions in risk factors. The debate has important implications for priorities in health care research and policymaking: if medical interventions have been relatively unimportant, then the direction of more resources to research and education on preventive care may be worthwhile. Using evidence from the clinical literature and a range of empirical databases, this chapter looks at the impact of particular changes in medical treatment in acute myocardial infarction (AMI) or heart attacks over the last two decades. It first discusses trends in disease incidence, medical treatments, and thirty-day mortality before estimating the overall cost-effectiveness of all AMI treatments combined.

This book starts with the story of Susan Halvorsen and her husband Jim Gjebic, who died of a heart attack at the age of thirty-four. Like thousands of heart disease victims and their spouses throughout the country, Halvorsen sought legal counsel in the hope of receiving compensation for her loss and some degree of retribution from the large multinational corporation that, she was convinced, had caused Jim's untimely death. Upon contacting a Michigan lawyer, however, Susan learned to her great dismay that her lawsuit was a nonstarter, not because of something she or Jim had done but because of a law that the Michigan legislature had enacted in 1995 as part of a “tort reform” package aimed at protecting a large Detroit drug company from alleged “lawsuit abuse.” .

This chapter examines the effects of new pharmaceutical introductions on a direct measure of health: life years saved. It reviews some of the previous evidence on the impact of drugs on life expectancy, including anecdotal evidence, a case study of a specific disease (heart attacks), and data from a few clinical studies of specific drugs. The analysis reveals that the typical new drug approved in the period 1970–91 saves over 11,000 life-years annually. The chapter concludes that the estimated benefits of new drugs have vastly outweighed their costs of development.

This chapter focuses on Enver Hoxha’s more than four decades of dictatorship in Albania. Hoxha lived a complex life. He was a cultured man who studied in France, wore dapper suits, knew history, and enjoyed literature. On the other hand, he was a paranoid and brutal dictator with a ravenous appetite for power who eliminated opponents real and perceived. He created enemies, distrusted friends, and ruled Albania with a mix of cruelty and charm. This chapter chronicles Hoxha’s rise to power in 1944 and examines his repressive measures as leader of Albania, along with his foreign policy and his attempt to eliminate his successor, Prime Minister Mehmet Shehu. Hoxha died in April 1985 after suffering a second heart attack, marking the end of his oppressive regime.

Beginning with an account of two trips Frieden and his wife took in the late 1930s and covering the years of World War II and its aftermath, this portion of Frieden’s memoir has something of a stream-of-consciousness feel to it. The space Frieden devotes to World War II itself is surprisingly limited, given the significance of that event for history in general, and for the fate of world Jewry in particular. Frieden does write somewhat more, however, about the situation in Palestine and about the struggle for Israel’s independence as it developed during the forties. He was, after all, still living through the period of that struggle as he worked on completing his memoir, and the creation of the State of Israel was one of his fondest hopes.

Medical writers have gone through a period of soul searching, a reappraisal of our role as journalists and members of the fourth estate. Are we supposed to simply cover the medical news: the new findings, the “breakthroughs” that appear in medical journals? Or are we also supposed to serve as critics of medicine, uncovering corruption and wrongdoing like our colleagues who cover politics, the military, and business? When I started in this business in the early 19805, we medical journalists liked to talk about ourselves as translators. Our job was to sort through the medical journals, decide what was newsworthy, and then put the jargon of science and statistics into language that ordinary readers could understand. In the intervening years we've done a superb job of translating and conveying information. In fact, we might have done the job too well, because in simply reporting each newsworthy finding in the professional journals, the lay press has helped sell medical products and procedures to a public eager for good news about their health. The upshot is that we've inadvertently helped put a high gloss on medicine, rather than actually keeping the enterprise honest. As medicine has become increasingly commercial and political, medical writers have increasingly assumed the role of critic and watchdog. We still have to cover the medical news, but we also have to provide the social, political, and scientific context for each new finding. These days, getting a medical story right requires more than simply understanding molecular biology, or clinical trial design, or how to express relative risk versus absolute risk. Getting it right also means understanding the role that industry plays in driving medical science. It means questioning assumptions about how disease works. Do a Nexis search for the words “C-reactive protein” and “heart disease,” for instance, and you will find dozens of stories that say, in effect, that C-reactive protein (CRP) is the latest and greatest new predictor of heart disease. But what you won't easily find in all that ink are questions about whether CRP is any better than current predictors of heart disease, like serum cholesterol levels or stress tests.

This chapter examines the final years of Thomas Sadler Roberts, who held the post of director of the Minnesota Natural History Museum until his death. At nearly eighty-two, Roberts no longer moved briskly, but the light in his eyes was still keen and reflective. The museum staff were in the thick of things, coping with the move into the new building. However, they had just barely settled into the routine in the new museum in 1940 when war broke out. World War II affected the operations of the museum as staff members were drafted to serve. By 1942, there were only three main staff members left: Roberts, and his longtime associates William Kilgore, and Walter Breckenridge. The chapter concludes by describing the last moments of Roberts. On April 17, Roberts was rushed to the Eitel Hospital after a heart attack. He passed away two days later.

Three types of blood cells exist in the human body: red blood cells, white blood cells, and platelets, in addition to plasma, which takes up 55 percent of the blood’s volume. Red blood cells take up approximately 45 percent of the blood’s volume. They transport oxygen from the lungs to other body parts. White cells defend us against bacterial and viral invasions. Platelets (less than 1 percent of the blood), the third type of blood cells, are sticky little cell fragments that are involved in helping the blood clot, a process known as coagulation. Without platelets (even though they constitute less than 1 percent of blood), our blood would not be able to clot, and we would have uncontrolled bleeding. However, formation of blood clots is a double-edged sword. Clots are beneficial because they heal cuts and wounds; blood clots in the bloodstream are harmful because they block coronary arteries, constrict vital oxygen supplies, and cause heart attacks and strokes, more and more frequent modern maladies as the baby boomers get older. Whenever the body is cut or injured and blood comes into contact with cells outside the bloodstream, a tissue factor on these cells encounters a particular protein within the blood, which triggers the clotting process. In the same vein, a series of other blood factors then come into action and amplify one another to quickly form a jelly-like blood clot. Blood clots form when an enzyme called thrombin marshals fibrin (a blood protein) and platelets (tiny cells that circulate in the blood) to coagulate at the site of an injury. Individuals with no ability to clot have a genetic condition called hemophilia; such people are also known as “bleeders.” Queen Victoria was hemophilic, and she passed on her genes to her many heirs who ruled Europe for over a century. This is why hemophilia is sometimes known as the royal disease. Symptoms of hemophilia manifest only in male offspring. People with hemophilia must periodically administer a clotting factor to their blood to prevent constant bleeding.

Frequent physical effects of cannabis (marijuana) use are tiredness, dizziness, tachycardia, orthostatic hypotension, dry mouth, reduced lacrimation, muscle relaxation, and increased appetite. Regular consumption of cannabis may accelerate the development of cirrhosis in patients with hepatitis C. No acute deaths have been described that could be unequivocally attributed solely to cannabis consumption. Nevertheless, the vascular effects of cannabinoids may increase the risk of myocardial infarction in persons so predisposed, and it is unclear, whether cannabis use might rarely cause stroke or arteritis. Major concerns are associated with the preferred mode of intake of cannabis, that is smoking, and the prohibition of the drug in most countries, which was intended to reduce its adverse effects by reducing its overall use, but according to increasing evidence, may increase overall harm both to the individual users and to societies.