CARDIOLOGIST DR. BERNARD LOWN had trouble sleeping. It was the early 1970s, and he and colleagues were trying to prove an idea that had guided their practice: Blockages in the arteries to the heart often were not the ticking bombs people perceived them to be. They could be treated effectively with medications, a healthy diet, and exercise. Yet even when given this more conservative option, patients who had seen the blockages on an imaging test often chose the bypass surgery urged on them by many doctors, with its higher cost and risk of complications. The image of a clogged pipe was a powerful one.
In a move that Dr. Vikas Saini, co-director of the Lown Cardiovascular Center in Brookline, calls “very Lownian,” the practice stopped referring certain patients — those with significant but stable heart disease — for the imaging test. Lown began waking in the middle of the night. He worried about a patient dropping dead. “The family brings a lawsuit,” he recalls thinking. “Now there’s 145 patients who we haven’t referred. We have a class-action suit, millions of dollars. It’s over — my practice, my group, my privileges at the Brigham.”