The dispute rages: Are drugs or surgery more effective?
The operating room in Milwaukee’s Mount Sinai Medical Center is crowded with a 10-member surgical team. Over the loudspeaker Strauss is playing. Chief surgeon Dudley Johnson likes the classics, and while the rest of the team would prefer something a little more hip, Johnson will make it up to them later by springing for pizza.
At the moment Johnson, 48, is involved in a heart bypass operation that may last nine hours, talking softly except for an occasional loud “God damn it” when he thinks a colleague’s sutures are not properly placed. He stands, one bootied foot atop the other, methodically cutting and stitching. The surgeon admits that he got an A in seventh-grade sewing class and that his mother taught him to crochet.
Johnson’s calm belies the fierce controversy that has erupted over heart bypass surgery. Simply stated, the bypass is a way of circumventing clogged portions of coronary arteries using veins lifted from the patient’s legs. With blood flowing freely through the arteries again, the danger of heart attack lessens, and the stabbing pain of angina pectoris is eased if not eliminated. The arterial clogging is caused by cholesterol deposits.
Some 80,000 Americans spent more than $1 billion last year for bypass operations. Johnson and his partner did about 800 at an average cost of $15,000. Despite its widespread use, however, the bypass is not universally accepted. A Veterans Administration study published last year concluded that in most cases there was little difference in survival rates of bypass patients and those treated only with pain-relieving drugs. “We have yet to demonstrate that life can be prolonged by this type of surgery,” says Dr. Henry D. McIntosh of Lakeland, Fla., onetime chief of cardiology at Duke and Baylor medical schools. As a result of the controversy, an estimated 10 percent fewer bypass operations now are being performed. (The most famous recent patient was comedian Jackie Gleason, who had the surgery in Chicago early this month.)
Johnson is among a wide range of doctors who question the validity of the VA study. Others include famed Houston transplant surgeon Denton Cooley and Dr. René Favaloro, who established the bypass procedures in 1967. “When we operate on patients with good hearts,” Johnson claims, “we get a 98 percent five-year survival rate.” That is “enormously better,” he says, than anyone has achieved with non-surgical treatment. Johnson believes that cardiologists oppose the bypass primarily because of the prospect of poor or mediocre surgery.
Dr. W. Gerald Austen, president of the American Heart Association, says, “Coronary bypass surgery works beautifully. It takes away symptoms, lets a person go back to work and gets him off the dole.” A recent National Institutes of Health report suggests that patients whose operations are successful can expect the bypass to work for at least 4.5 years, although other arteries may cause problems.
Johnson’s contribution to the art has been the multiple bypass, during which he grafts as many as eight veins. He makes clear, however, that his patients can help themselves most by “staying off fatty food and not smoking.” (He confesses to be 10 pounds overweight himself, at 165. He stands 5’9″.)
Born in Madison, where his father taught engineering at the University of Wisconsin, Johnson studied medicine at Illinois. “I disliked surgeons and their pompous attitudes,” he recalls. But after a U.S. Public Health Service stint in Ohio, he moved to Milwaukee and went into practice with Dr. Derward Lepley Jr. Johnson began studying bypass techniques and teamed with Lepley in a 1968 heart transplant on Mrs. Betty Anick—who lived almost nine years, longer than any other transplant patient.
He now lectures frequently on multiple grafts in such far-flung places as West Germany, Hawaii and India. This summer he is preparing to marry Sharon Clark, 30, a nurse who once worked for him. Johnson has three children by his first wife, who lives in California with their two daughters. Son Steve, 17, shares a 23-acre farm outside Milwaukee with his father.
Like so many surgeons, Johnson is a compulsive worker—in and out of the OR. “I am going to my place up north near Marion next week,” he reports happily, “and plant 2,000 pine and spruce trees.” Fiancée Sharon examines the long scratches Johnson has from tree-planting binges in the past. “He’s not a bit careful with his hands,” she says.