I have followed the work of the clinical investigators at Duke University1 for the last 15 years as they carefully observed and treated patients with atherosclerotic coronary heart disease.
Whereas many experts demand randomized trials to determine the value of a specific form of treatment, our Duke friends have emphasized that observational studies are also useful in arriving at a conclusion regarding the value of a specific type of treatment. Accordingly, they studied and followed up 5809 patients who either had coronary bypass surgery or were treated medically. I, too, believe that excellent observational studies by superb clinical investigators can teach us all a great deal. So, I wish to compliment the large number of investigators who assisted in the study that is reported in this issue of JAMA.1
During the early 1970s, bypass surgery was restricted to patients who were disabled from angina pectoris despite intensive medical