Internal Mammary Artery Ligation — the Angina Cure Fake Surgery Matched in 1959

In 1957 surgeon J. Roderick Kitchell and colleagues at Presbyterian Hospital in Philadelphia, following an Italian lead, began tying off the internal mammary arteries in the chests of angina patients and reporting that roughly two-thirds felt better — and the gap between that reported relief and the operation’s actual physiological effect is the entire case, because the operation did almost nothing the body could measure. The procedure was supposed to relieve the crushing chest pain of coronary disease by occluding the internal mammary arteries so that blood would be diverted into the heart muscle. It was simple, it was fast, it was performed under local anaesthetic, and within two or three years it had been carried out on thousands of patients across Italy and the United States on the strength of uncontrolled before-and-after testimonials.

The reported numbers looked persuasive: in the largest case series, on the order of two-thirds to three-quarters of patients said their angina improved, many dramatically, with effects holding up over months and years of follow-up. What no one had done was ask whether the cut, rather than the ligature, was doing the work. Angina is a subjective, fluctuating symptom, and the act of being operated on by a confident surgeon is among the most powerful placebos in medicine.

The reckoning was unusually clean and unusually fast. Between 1959 and 1960 two small randomized trials — Leonard A. Cobb’s group at the University of Washington and E. Grey Dimond’s at the University of Kansas — did something no surgical evaluation had done before: they randomized angina patients to either the real ligation or a sham operation, an identical skin incision in which the arteries were exposed but left intact, with neither the patient nor the assessing physician knowing which had been done. The sham patients improved exactly as much as the ligated ones. The exercise electrocardiograms were unchanged by either operation. The benefit was real to the patients and entirely placebo in origin.

The operation was abandoned almost immediately — not banned by any agency, not litigated, but disproven and quietly dropped. Its lasting legacy is the opposite of its intended one: internal mammary artery ligation is now the founding textbook example of why surgery, like a drug, must be tested against a placebo, and of how a self-limiting subjective symptom plus an enthusiastic operator can manufacture thousands of “cures” out of nothing but expectation and a scar.