Wednesday, June 25, 2008

"The Russert Effect" in Cardiology?

I have no real good reason for not posting recently, but we'll just say it was my summer break...

Sadly, during that time, the moderator of 'Meet The Press' Tim Russert passed away. He was a relatively unique celebrity, even among the news media types. My connection to him was that he was one of the two speakers at my college graduation, speaking at Class Day. He has been widely eulogized, but for my own little part, I always admired his passion for his profession.

As people absorbed the news and began to reflect on it, many were struck by the suddenness of it all. I imagine it sparked debates in my households, much as it did at my house. My dad strenously argued that Russert was grossly out of shape, and thus, this shouldn't be much of a surprise. While I agree he was overweight, it was still shocking to me to see someone who wasn't truly morbidly obese, still "young" relatively, and leading an active life with no known CAD symptoms to die like that.

The discussion prompted me to do some reading. While I had heard this before, the event really drove home the point that cardiology is still far from truly understanding how plaques rupture and how to predict this:
Clearly, there was sorrow for Mr. Russert’s passing, but also nervous indignation. Many people are in the same boat he was in, struggling with weight, blood pressure and other risk factors — 16 million Americans have coronary artery disease — and his death threatened the collective sense of well-being. People are not supposed to die this way anymore, especially not smart, well-educated professionals under the care of doctors.
Mr. Russert’s fate underlines some painful truths. A doctor’s care is not a protective bubble, and cardiology is not the exact science that many people wish it to be. A person’s risk of a heart attack can only be estimated, and although drugs, diet and exercise may lower that risk, they cannot eliminate it entirely. True, the death rate from heart disease has declined, but it is still the leading cause of death in the United States, killing 650,000 people a year. About 300,000 die suddenly, and about half, like Mr. Russert, have no symptoms.
Cardiologists say that although they can identify people who have heart disease or risk factors for it, they are not so good at figuring out which are in real danger of having an attack soon, say in the next year or so. If those patients could be pinpointed, doctors say, they would feel justified in treating them aggressively with drugs and, possibly, surgery.
Having worked with a cardiologist as a preceptor the past few months, I myself kind of felt that a coronary angiogram may have caught this, but angiograms have their own risk and Russert seemed to be truly asymptomatic, if not clearly healthier than he was a year ago. Given this outcome, I wonder whether this will motivate more people to get a check up, or whether people will view this as a failure of medicine and be more averse to wasting their time / money on something which they believe has little predictive value.
A few years ago, Katie Couric lost her husband to colon cancer. She famously went on air to do a live colonoscopy for the Today Show in an effort to increase awareness of colon cancer screening. Researchers studying trends later on noted a significant change in people's behavior, which they dubbed the "Couric Effect" for gastroenterology. Only time will tell what the "Russert Effect" will be on cardiology.

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