My Heroes at Harvard

Harvard is not perfect, but it is the oldest university in the country. It was founded in 1636— almost 150 years before the Declaration of Independence was written. Harvard is in Boston, and it played a significant role in the American Revolution, acting as a hub for revolutionary thought and action. Many of its students, alumni, and faculty were active in the cause, and the university itself was used for meetings and planning. It was an important part of the founding of the United States. Many would argue that it is the most prestigious university in the country. Only 6% of applicants to Harvard undergraduate education are accepted.

Now Harvard is under attack by our government because of its diversity, equity, and inclusion programs as part of a broader culture war. There are also claims of a hostile environment for Jewish students. Harvard is one of the most sought after universities in the country. Being admitted there is a huge advantage for a young person. Jews make up 2% of our population and they are 20% of the student body at Harvard. It is hard to argue you are being discriminated against when your admission rate is ten times your representation in the population.

Federal grants have been withdrawn from Harvard along with its tax-exempt status. It will not longer be allowed to educate foreign students. It has been singled out because of its extraordinary history and reputation. But even if Harvard caved and totally eliminated DEI, that does not end affirmative action at Harvard. These are draconian measures that will damage ongoing research and harm the university.

Affirmative action has existed at Harvard for over 100 years. “Donor-related applicants to Harvard were nearly seven times more likely to be accepted than were other admission seekers. Similarly, students whose parents and family members were alumni of the institution were nearly six times more likely to be admitted.” Nearly 100 years ago, intent upon maintaining the white Christian character of the student body, Harvard instituted legacy admissions providing admission preference to children of white Christian men to limit admission of Jewish applicants. When DEI is gone, all that is left is “who is your daddy?” The affirmative action that is left gives you an advantage if your father a graduate and if he has enough money make a big donation and then pay your tuition. ($60,000 a year!)

Those are points I wanted to make first because I want you to know, I don’t have rose-colored glasses on. I know nothing is perfect. I know Harvard is not perfect, but it is a national treasure especially in the field of medicine. Two of my heroes are Harvard faculty members. Dr. Peter Libby is a giant in the field of cardiovascular medicine, and he changed my professional life forever. Dr. Libby is a cardiologist on the Harvard faculty who is one of the leading authorities in the field of atherosclerotic vascular disease.

My internal medicine career was shaped by Harrison’s Principles of Internal Medicine. Dr. Libby wrote the chapter in the book on atherosclerotic vascular disease which has been a huge focus in my work. An article that he wrote in 1995 Molecular Bases of the Acute Coronary Syndromes in the American Heart Association Journal Circulation had even more influence on me. This landmark article changed, or should have changed cardiology practice forever. It changed me forever. Up until that time, we thought that opening heart arteries with stents and bypasses prevented heart attacks and sudden death. It made perfect sense, but Dr. Libby said flatly that opening arteries relieves symptoms, but it does not prevent heart attack or sudden death.

“The above discussion has summarized elements of a new understanding of the pathophysiology (causes) of the acute coronary syndromes (heart attack) based on episodes of plaque disruption (acute blood clot) rather than gradual progression to complete occlusion of fixed coronary stenoses (blockages). As noted above, bypass surgery or transluminal angioplasty (stents) provide rational and often effective therapies for these fixed, high-grade stenoses (blockages). However, these treatments do not address the nonstenotic but vulnerable plaque. It is of interest in this regard that despite the well-accepted benefit of coronary bypass surgery on anginal symptoms, this treatment aimed at severe stenoses (blockages) does not prevent myocardial infarction (heart attack). To reduce the risk of acute myocardial infarction, one must stabilize lesions to prevent their disruption, particularly the less stenotic plaques.” In other words, opening arteries does not protect you while best practice medical treatment to stabilize soft, inflamed cholesterol deposits so that they don’t rupture and cause a clot does prevent heart attack. That one paragraph set me on this journey to help others understand the power of the best practice treatment of artery disease.

A few years later, I attended a meeting about high blood pressure in Manhattan. When I reviewed the agenda, I saw that Dr. Libby would give a talk. I had to attend. After he finished speaking, in the question-and-answer period, I asked Dr. Libby if his statement that bypass surgery does not prevent heart attacks was still valid. He became very animated, and he left the 200 clinicians in the room with no doubt that he meant what he said.

I have since learned that Dr. Bernard Lown on the Harvard Faculty had used best practice medical treatment for heart artery disease long before 1995. Let’s let Dr. Lown tell his story:

“I was persuaded that investigating this problem would be difficult once patients were hospitalized. As a result I founded the Lown Clinic. Almost immediately we launched a study. We intended to randomize post angiography patients to either revascularization or medical therapy. The study aborted before it began. After patients were informed by interventionists and house staff of their coronary anatomy, coached in the lurid prose then and now in use, every patient opted for coronary artery bypass grafting (CABG).

Coronary angiography was a funnel for interventions. Its purpose was largely to guide the operator to the narrowed vessel. To diminish coronary procedures required bypassing coronary angiography. We decided to study patients with multivessel disease over a long time frame without resort to angiography. (heart cath)

During the ensuing 35 years we published four studies in high profile medical journals involving about one thousand patients. Outcome data were remarkably consistent. Cardiac events were extraordinarily low, about 1.0 percent annual mortality rates. Our referral for revascularization increased from 1.1 percent annually during the CABG era to around 5 percent during the stenting era. Since a majority were second opinion patients, nearly all would have been revascularized.

Let me repeat. Over any five-year period we referred less than 30 percent of patients with multivessel coronary disease for revascularization.” That means that 70% of patients who had a stent recommended did not need it.

Dr. Lown explains why he did this work. “From my earliest days in medicine I have struggled against the prevailing model of healthcare. My opposition in part was provoked by the growing prevalence of overtreatment.” Dr. Libby and Dr. Lown are my heroes. Those brilliant men did not go along to get along. They worked out what works most effectively to treat heart artery disease and they have stood by their convictions in the age of money medicine. They took a position that makes people healthier for less money. Harvard and men like these are a national treasure. There is always room for improvement, but they should not be casualties in some political culture war.