Surprising revelations from Cardiology leaders…

Six hundred seventy dollars per year is the cost for my membership to the American College of Cardiology. With this comes the bimonthly Journal of the American College of Cardiology (JACC).

This May’s edition of JACC features two incredibly comment-able pieces.

Exhibit A, in the better late than never category, is Dr Anthony DeMaria’s piece on nutrition entitled “Eat food, not very much, mostly plants.”  Dr DeMaria is a famous professor of Medicine, former president of ACC, and current Editor-in-Chief of JACC.  He chastises himself for his former habit of eating low-calorie, low-fat, but highly processed man-made food.  Telling of his transformation, he now espouses the benefits of eating natural foods, like fruits and vegetables–no more foods with wrappers or more than five ingredients.  It seems Dr DeMaria has only recently discovered that eating stuff from the periphery of supermarkets, devoid of packaging and multiple difficult-to-pronounce chemicals is beneficial.

Years ago, I met a number of young professional cyclists, who with only high school degrees knew the benefits of “real food.”  They insisted on shopping at the local organic “natural” supermarket.  Many were vegetarians.  (The power that a professional cyclist can generate, even without ever consuming flesh, is striking.)

America is in the midst of a nutritional quagmire and in May 2010, the editor of JACC has just discovered the benefits of healthy non-processed foods. Maybe cardiologists need a little less information on coronary calcium CT scans, and a little more on lifestyle basics.

Exhibit B in this same journal, is an opinion piece on how cardiologists must be leaders in health-care reform. It emanates from a Dean at UVA, an MPA and the president of the ACC, so undoubtedly it will reflect the “real world.” They even tell us, “we understand the dilemma that we face: provide more appropriate care and make less money.”  

Don’t misunderstand me, I am respectful of the distinguished authors.  Their bios are extremely impressive, much more than that of a lowly blogger private practitioner.  It’s just that residence in Charlottesville, VA and Washington DC may not be representative of the real world.  Like that idyllic enclave in the hills of Virginia, their recommendations to practicing cardiologists are a bit dreamy.

For instance, they suggest that cardiologists should..

• practice more like those in San Francisco, as they seem to provide the least expensive care.
• be nicer; they use the more complicated word, “professionalism.”
• work as salaried doctors, or even worse,
• embrace “bundling payments,” wherein payment for a diagnosis is fixed and all tests and procedures are included.  Use up all your money on that expensive MRI and the rest of the work-up is on the house.  Ouch.
• embrace EMR as if it will be a savior for medical cost containment and quality.  They must be getting this from another address in Washington, DC.
• not recommend expensive treatments which only extend life a few weeks (think ICDs in the infirmed.)  This is a rock solid notion, but the “death as failure” credo is solidly ingrained in cardiologists from the beginning of their training.

Further, they recommend a new branch of the NIH, the “National Institute for Keeping People Healthy.” Really, I think they are serious. Yes, that’s it, a new institute will surely turn around our obesity and sedentary lifestyle epidemic, just like that. I can report to the provost and president, that most cardiologists who see an incessant stream of fatigued, short of breath obese patients are fairly pessimistic that a healthy-living think tank is a viable solution.

Recommending cardiologists be sweeter?  This is like getting bike racers to do tai-chi.  It just so strikes me that leaders of our field preach to us with flowery prose from President Obama’s inaugural address.  Sure, I am for kindness and helping thy neighbor and all, but this Pollyanna-ism is insulting to those of us who toil on the front lines of patient care.

I do not have the answers, but believe strongly that real world doctors’ voices need to be heard alongside preaching from the academic towers.

We can start the debate on solutions to health-care with the idea that re-imbursement for cardiac procedures like catheterization, pacemakers and defibrillators should be equal to root canals.

JMM