Imagine if there was an emerging epidemic of slow cyclists. It wasnâ€™t always like this. Despite their lack of feather-light bikes, carbon-soled shoes, wind-cheating lycra, people used to go really fast on their bikes.
Are you still imagining?
Imagine if people spent more money on â€œthingsâ€ that might make them faster: they buy better equipment, monitor their meager outputs, and report them to a
provider coach. They even have strategy sessions online with teams of their peers and coach.
But yet they pedal fewer watts.
The problem, of course, is that going faster on the bike comes from making the personal commitment to ride. Your bike doesnâ€™t ride itself; your watt meter doesnâ€™t generate watts; and your coach canâ€™t pedal for you.
Herein lies my problem with our governmentâ€™s new initiative to reduce the expanding burden of heart disease.
The Million Hearts Initiative is the catchy name given to the program aimed at preventing a million heart attacks and strokes over the next five years. The leaders of the CDC and CMS, Dr Frieden and Dr Berwick introduce the highly progressive program in this grandiose essay in the NEJM.
Now to be fair, before launching into a pessimistic and endothelial-unfriendly rant, let me lay out the positives. (Always look for the positive firstâ€”thatâ€™s heart-healthy.)
- The goals of the program are spot-on. Of course we need to address the onslaught of heart disease. No one can argue that the burden is expandingâ€”both in human costs, as well as in dollars.
- To increase public awareness of heart disease is a beneficial side-effect. Though many argue thereâ€™s enough public information available for anyone to know whatâ€™s healthy and whatâ€™s not, I say keep the information flowing.
- Promoting â€œCommunity-basedâ€ prevention strategies sounds encouraging. Does this mean more bike lanes, walk paths and more accessible health facilities? Government support of human-powered transportation would surely make cyclists feel less unwell on April 15th.
- And I was delighted that Mrs Obamaâ€™s quest to fight childhood obesity, the â€œLetâ€™s Moveâ€ campaign, got an early mention.
Thatâ€™s the good stuff. Good intentions, good goals, and exercising kids. Beautiful.
Now for the glaring problems. It’s the idea that someone else is in charge of our health. Let me go over a few of their lofty principles:
Their first principle is to focus. But they do not mean focus on taking care of oneself; rather they mean doctors should focus on reporting better data to Medicare. Translation: we should get better at filling out forms. Cycling simile: Recording data alone, does not make you fast.
Secondly, they recommend â€œprovidersâ€ (Gosh I hate that word) use computers to make people healthier. Yeah, right. That will work. Listen to their words: (they are not bloggers)
HIT (Health Information Technology) enables providers and facilities to improve cardiovascular care and target intervention to patients in need of intensified care through registries and EHR functions used at the point of care.
Yep, these guys keep it simple. Cycling simile: Buying complicated training software doesnâ€™t make you faster.
Thirdly, they recommend clinical innovation. What they are getting at here is the notion that team-based care, which they call, the patient-centered medical home, holds promise in getting more to take their aspirin, blood pressure and cholesterol medicines and to stop smoking. Maybe they are right, but there is no data that I know of to suggest that medical teams function more effectively than individuals. Cycling simile: your bike team doesnâ€™t pedal your bike for you.
Finally, the idea that government will regulate, mandate, and control our salt and trans-fat intake bothers me. Should government–or doctors–be our mothers? Is it really governmentâ€™s role to make our Chinese take-out less salty, or our French Fries less toxic? Who is forcing us to eat that high-fat, high salt, highly processed pizza? What’s more, who is forcing us to eat the entire pizza?
Not once in the Millions Heart essay is the word â€œexerciseâ€ used. In the many hundreds of very large words, only â€œphysical activityâ€ gets a couple token mentions. Want to engineer something? Engineer a culture that holds exercise as the wonder pill. Start in the schools–by making gym class a daily affair. Change the upcoming generation. Get people thinking this: for preventing heart disease, a lifetime of regular (non-excessive) exercise tramples pills.
Never once is the notion that preventing heart disease stems from individuals making good (and simple) decisions. Things like not munching potato chips all night in front of the TV, or that one would have to run for thirty minutes to burn off that double mocha latte. Tell people the truth; it’s not mean.
The essence of the Million Hearts campaign espouses that government, doctors and computers hold the answer to better heart health.
Do they really think this?
P.S. For another, slightly less progressive take on the Million Hearts campaign, I would recommend this post by my EP colleague, Dr Wes Fisher.