How Therapeutic Practice Develops Over Time

Case studies of coronary bypass surgery and angioplasty for treating chronic angina

    • March 19, 2014

Dates of Project: June 2008 to July 2013

Harvard historian of medicine David S. Jones, MD, PhD, used his RWJF Investigators Award in Health Policy Research to study the evolution of coronary artery bypass surgery and coronary angioplasty to demonstrate how medical practice can deviate from medical evidence.

Key Findings

  • Research in medicine today is far more focused on finding evidence of the potential efficacy of a given treatment than on its potential side effects. Studies therefore tend to exaggerate benefits while underestimating the risks, an imbalance that encourages physicians to recommend a procedure.

  • Physicians often follow different models that explain the pathophysiology of disease. The popularity of a given model can influence their choices of treatment, even when clinical trials have shown those treatments may be less effective than many physicians believe.

“Patients considering a medical procedure often ask their physicians, ‘Is there any chance this procedure will help?’ Since there is almost always a chance that it will help, patients then decide to have the procedure done. Patients instead should ask, “Is it likely that expected benefits will outweigh the expected risks?” That’s a much more difficult, but much more relevant, question—David S. Jones, MD, PhD