Science: A Playground for the Perpetual Child

Yesterday I read a hardcore Genetics textbook. As I thumbed the pages, simultaneously struggling to appreciate the concepts behind the words and reveling in the wonder of our being, I was struck by the fact that I love to learn. Both friends and self would have flagellated me had I stated that fact (or even felt it) as a young man or child.  Studying and learning were fancies of the nerds. Now I reflect on childhood, mine as well as that of our children. I recall mostly the experiences of our three infants and toddlers. They perpetually tested their environment. The distance of a jump, height of a tree climb, method of a toss, or speed of a swing: Everything was under scrutiny because everything was to be improved. They’d try different methods to accomplish their latest feat and after failure upon failure they’d find a way to succeed. Sometimes they’d later revise their techniques, using the wisdom of age and experience as their guide. In essence they were continuously studying and experimenting on themselves and their environs. They not only loved to study; they lived to study.

Today I find myself in a similar place. No longer able to accomplish past physical achievements, I am relegated to handsprings of the mind. I think and learn voraciously. What I learn, I teach. Though I miss the physical challenges and conquests of youth, this phase of life has plenty to offer. Often I communicate with similarly minded colleagues to discuss the latest and greatest ideas and discoveries. What fascinates us most though, and lures us in more than anything else, is our perpetual amazement by the bottomless well of knowledge from which we draw. It is not intimidating; it is invigorating. Our understanding takes us back in time, to the adventures of childhood. Science is an endless quest for very old children; a fearsome ride one never wants to leave. The adage, “the more you know, the more you realize how much you don’t know” is not only true, it’s tantalizing. It embodies the glory that keeps us steadfast in the game while we are fortunate enough to remain above ground.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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The 2015 Dietary Guidelines: Defining a Healthful Diet

The 2015 Dietary Guidelines have been released, and some supposedly significant changes, advised. Cholesterol intake is no longer limited. Saturated fat is to represent < 10% of daily caloric intake. Sustainability considerations are now to be considered. Simple sugars are anathema and caffeine is okay. Vegetables and fruits remain highly emphasized. Has much changed? Not really. Most of us in Cardiology and Lipidology dropped the cholesterol ban a decade ago. We typically emphasize fresh fruits and vegetables, low fat meat that is organic and devoid of antibiotics, and a limitation of simple sugar. Most of us don’t consider sustainability issues when advising our individual patients. Many of us believe that world issues – including economics – should stay out of the exam room and remain in the courtroom. (I am a member of that camp). But what is the layperson to do with these Guidelines? Does he or she have to make dramatic changes in his or her diet? The answer of course depends upon the individual patient’s status. Is weight loss necessary; does the patient have cardiovascular disease or very high LDL cholesterol, for instance? Let’s first look at the history of man, briefly examine the state of dietary literature, and then make some generalizations.

Anthropology unequivocally demonstrates that human beings are omnivores. In fact, all of our primate relatives also rely upon meat in the wild. They even need it in captivity. When the Washington DC Zoo attempted to breed the Amazon Golden Marmoset monkey, they failed miserably. It was not until meat was added to their diet that the monkeys begin to thrive and reproduce. Since the beginning of our tour on earth we have also eaten meat. In fact, for the first 4 million years of our existence, meat was our main source of nourishment. About 10,000 years ago we introduced farming and animal husbandry. Most farming was done to feed our animals as they represented our most desirable food source. Recently we have fallen prey to our own impact on nourishment – we have started processing, and ruining, our food. Sugar has been added; nutrients have been stripped from grains; grains are squeezed (instead of eaten whole) to produce oils; and animals have been raised in pens, limiting their ability to develop lean muscle mass, and also often requiring the introduction of antibiotics. We have created a food supply that is most likely killing us.

In response to our understanding of the role cholesterol plays in heart disease – and it does play a significant one – we have introduced guidelines to try to reduce cholesterol. Saturated fat eaten to excess does raise LDL (not a good thing), but cholesterol consumption has little impact on our LDL levels. Therefore the current Guidelines did what was appropriate and removed restrictions on cholesterol consumption while maintaining limitations on saturated fat. They also appropriately implore us to eschew sugar. No one will argue against the latter recommendation (except perhaps the sugar industry). But are there studies to support such advice? Unfortunately, beyond PrediMed (which demonstrated the cardiovascular advantage of a Mediterranean diet) no high level studies have been performed. Many observational studies exist, but doing a solid dietary trial is actually immensely difficult. Thus we are left to rely upon our understanding of basic science, animal experiments, pathophysiology, and anthropology. The conclusion for most of us I believe follows Aristotle’s ancient tenet of moderation. We should consume natural foods whenever possible, avoid processed foods, eat copious quantities of vegetables, consume ample fruit, and don’t worry so much about consuming lean meat, fatty fish, and some chicken as well. We should do this in the context of seeing our physicians, discussing our own personal issues, and modifying our diets to adjust to individual needs when indicated. Eating has become a complex endeavor, yet it ought to be much more straightforward. What we need though is access to the aforementioned natural food, the type of food that has been unscathed by human hands. And therein, unfortunately, lies the rub.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Doctors as a Commodity: the Ruin of Modern Medicine?

Did you ever wonder why doctors are reimbursed on the same fee schedule regardless of their experience, qualifications, knowledge, expertise, or interpersonal skills? Why is it that lawyers, teachers, businesspeople, military personnel, hospital administrators, and virtually every other person in our nation is reimbursed for his or her services on the basis of qualifications and experience, yet physicians – arguably the most highly trained group of the lot – are not? Examine this hypothetical (yet common) scenario. Joe Thomson graduates at the bottom of his medical school class and then completes training in a sub-par general surgery residency. His parents, though not highly educated, are very wealthy – they earned their fortune flipping houses in the early 2000’s. Because of an unforeseen turn of events, they were forced to sell their house-flipping empire just before the market crashed. Fortune indeed smiled upon them. Not having benefited from higher education, they had always had high aspirations for their only son. And so when Dr. Joe was at long last a licensed general surgeon, his parents wanted him to practice in the finest locale. They rented a beautiful Brownstone in Manhattan just across from the most highly regarded general surgeon in the city. And, they employed their marketing skills to spread the word about their up and coming son. Shortly after opening his practice he was called to the Emergency Room to care for a patient who required an extraordinarily complex surgery. This particular surgery is long, intricate, and carries a very high complication rate. Given the mandatory call system in his hospital, it was however the young surgeon’s turn to be “up at bat.” The accomplished surgeon across the street had already done well over 100 of these surgeries while our young doctor had yet to perform a single one on his own. (He had assisted in 3 during his five-year residency).

There are two issues to consider here. First, indisputably the unwitting patient would be better served with the far more experienced surgeon.

Second, both surgeons – one with no experience while the other a veritable expert – will be reimbursed exactly the same for this very difficult operation. You see, the doctors are a commodity – pork bellies, concrete, orange juice etc. Their skills are ostensibly indistinguishable and therefore interchangeable. Now imagine you’re the patient. Which doctor would you choose? If given the opportunity (which you don’t have under current insurance restrictions) would you pay more for one over the other? I know whom I’d choose, even if I had to take out a loan, skip vacations, work extra hours and the like. Here’s an added irony. The experienced doctor is on faculty at a medical school. His hard-earned skills are so great that a competing private hospital purchases his practice (and him), thereby increasing his income three fold. In sum, in order to make more money he left his position at the academic institution where he had used his superior skills to train young doctors. Within two years he becomes so highly respected at the new hospital that he’s advanced further, to the position of hospital CEO. Now he truly earns a hefty income. But, he no longer practices medicine. To “get ahead” monetarily, he had to leave the pool of expert practicing clinicians whose sole purpose is to help patients. To earn more money, our great surgeon had to stop doing surgery. He had to become an administrator.

I know it is considered indecorous for doctors to be concerned about money, but when our incomes fall while expenses rise; when we find it difficult to put our children through college or save enough money for retirement; when we cannot foresee how we will ever repay our college and medical school loans; when we lose our voice in how we are compensated; we have no choice but to become “normal” people and consider our incomes and how to best maintain and even grow them. In truth there is nothing inherently wrong with physicians’ focusing some attention on how much money they earn. In the past though doctors earned enough so as to not care about reimbursement. Their financial contentment yielded great dividends; they devoted all their free time to bettering themselves as physicians. They devoured journals and took medical courses; attended meetings and discussed interesting cases with their colleagues. Though some physicians still practice in this vein, many do not. Instead, most doctors today read Medical Economics and The Wall Street Journal, watch financial news on television, read books about alternate methods to make money, and carefully plan their premature exit strategies from the practice of medicine. The state of Medicine today is nothing short of depressing.

Non-physicians probably won’t want to hear what I’m saying. They might quip that doctors should be above money or that doctors make more than “enough” as it is. Be that as it may, the reality is that as a consequence of changes in medical economics as well as an explosion in the bureaucracy involved in private practice, many of the up and coming “best and brightest” are flocking to finance and business, and away from medicine. And that will leave us all at a distinct disadvantage when we seek and require top quality doctors down the road. Like it or not if we hope to bring back the doctors of yesteryear, we must face facts and acknowledge why so many doctors today are unhappy. We must identify what it will take to rejuvenate the medical field, and make it once again an enticing and challenging goal to which our young will aspire.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Doctor’s Prescriptions for Their Patients: Old Frustrations Persist

In a perfect world with boundless resources, patients would always have access to every doctor’s prescription. But our world is not perfect and our nation is in deep debt. Consequently every day doctors across the country receive denials for medications and procedures that we have prescribed. We know our patients need these medical interventions yet our hard earned positions as practicing physicians (requiring decades of study) are no match for the far less qualified employees of insurance companies. Oftentimes our prescriptions are lifesaving. Yet we are told patients can’t have what we’ve ordered. What we have ordered is simply “too costly”. We are forced to choose something else, even if it is an inferior approach and leaves our patients – those people we have all sworn oaths to protect – relatively unprotected. So, with resources limited to such a degree that we have lost access to solutions we know to be beneficial, what are doctors and patients to do? Let’s look at a disorder deserving great attention and intervention; yet oftentimes remaining hidden in the shadows. The disease is called FH (Familial Hypercholesterolemia) and it occurs in about 1 out of every 200 people.

One of the disorder’s characteristics that makes it difficult to diagnose is the wide variation in how it manifests; some people have LDL cholesterol levels well over 200 (I’ve seen levels over 500) while others are not so badly impacted. Some patients have heart attacks in their teens while others never experience such premature disease. One of modern day medicine’s most well established “facts” is that the lower a person’s LDL, the less likely he or she is to have a heart attack or stroke. Now consider those individuals with FH in whom we simply cannot, no matter how hard we try, adequately reduce their LDL utilizing insurance approved modalities such as statins and dietary modifications. Such people may have already suffered heart attacks at very young ages. They are at extraordinary risk for a future heart attack or stroke. Yet, their insurance carriers still often create impenetrable barriers for access to additional medications as well as LDL apheresis, a method that was FDA approved in the 1990s, and lowers LDL by a whopping 70%. Carriers bemoan the costs of the medications or procedure and cite a lack of adequate “outcome data” as their reason for denial. Though doctors explain that it is now accepted as doctrine by lipid experts across the globe that lowering LDL by any means provides dramatic CVD risk reduction, they remain intransigent. We share our knowledge of Mendelian Randomization studies, which have proved beyond a shadow of a doubt (in the framework of present-day science) that lowering these patients’ LDL levels will vastly decrease their chance of suffering repeated heart attacks, strokes, stents, and bypasses. Still their ears and minds are shut. We, the doctors, are powerless. And our patients suffer the consequences. And, compounding the problem, there is currently active consideration among insurers to make it even more difficult for patients to receive LDL apheresis.

The New Year has just begun and my colleagues and I have already received a plethora of complaints from patients bemoaning the fact that their insurance carriers have increased their medication costs to such a degree that for many they can no longer afford to take them. What will happen to these patients? Will they develop unnecessary heart attacks or strokes? Will they need unwanted and otherwise preventable procedures like bypass surgery and stents? I do worry they will fare less well than had they been permitted to follow the care so cautiously outlined by their treating physicians. And medical evidence does support my concern. I believe an outcry from patients is needed. Doctors will continue to make our case, but until the voices of worried patients achieve adequate volume, I fear the status quo will reign.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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The National Lipid Association – A Glimmer of Hope

The field of Medicine is undeniably in turmoil. Patients are unhappy with long wait times in doctors offices coupled with ever shortening visits with their physicians. Doctors are dismayed by their unprecedented spike in “busy work,” instigated predominantly by insurance companies and governmental mandates. The fallout from more time spent on paperwork is of course less time spent with patients. There are after all only 24 hours in a day.  So it is eminently fair to say that neither doctors nor patients find themselves happy with the current course Medicine is following. Oftentimes outlooks are so bad that many of us in the field feel there is no hope. In essence we believe the battle has been lost; there is no chance of recovery.

Enter the National Lipid Association (NLA). Currently boasting over 3,000 active members, the NLA is a group of diverse doctors, nurses, dietitians, scientists, and exercise physiologists whose governing goal in participating in the organization is to improve healthcare. I just returned from the 2014 Annual NLA meetings in Orlando Florida and was once again struck by the authenticity of this sentiment. Meetings began as early as 6 AM and extended well into the evening hours. And the seats were not bare. They were filled by groups of highly focused and engaged individuals. Ranging from Cholesterol Guideline discussions, to basic science talks on drugs’ mechanisms of action, to lectures reinforcing the need to amplify our efforts to identify and treat patients with the not so rare but highly lethal disorder Familial Hypercholesterolemia, the topics were fascinating and irrefutably pragmatic. The attendees were riveted. Side conversations were plentiful, including promises of new clinical trials and better ways to help our patients. The pace was quick and the excitement, palpable. All this at a medical meeting!

Although uniformly doctors are troubled by Medicine’s fall from grace, rays of hope were clearly visible at the NLA meeting. Beneath our acrimony doctors, nurses, and others in medicine still have at their core the desire to help. We genuinely want to be the ones who people look to during their oftentimes-darkest moments. We also most definitively strive to keep people from experiencing such grim periods. The best way to achieve these goals is to continuously learn. Curiosity, inquiry, dialogue, knowledge, and caring are the cornerstones of the practice of Medicine. And these are the elements that beat at the heart of the National Lipid Association.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Is Marcus Welby, MD Resuscitatable?

Over the last decade or so doctors have felt their stature steadily slip away. Their significance has of course remained; without doctors healthcare would come to a screeching halt. Newly named “physician extenders” cannot do what most physicians can. They are simply not trained for the task. As important and passionate as they are in healthcare delivery, physician assistants and nurse practitioners possess just a small portion of the training required to become practicing MDs. Doctors often spend more than a decade after college training to a level required to deliver the most sophisticated and complex care. Many laypeople seem oblivious to this fact; some likely have intentionally blinded themselves to it. Physicians are “where the buck stops”. We are the CEOs of our practices, the generals if you will. Yet, the insidious degradation of doctors has led to a variety of deleterious and likely unintended forms of fallout. Most obvious is our title. Once called nothing but “doctor”, we are now dubbed, “health care practitioners”, “health care providers”, and most recently, “EP”s or eligible professionals. This fact may seem trivial, but its reverberations run deep. We have been equated to all others who treat patients – nurses, advanced nurse practitioners, physician assistants, medical assistants, and physical therapists…  Our distinction as leaders in patient care is being eroded. Imagine if the same were true in the military – no more generals, colonels, sergeants or the like. Just “military personnel.” Or, what if we applied the same rule to government – no more senators, congressmen, mayors, governors, or even presidents. Simply “public servants.” There is no doubt such an arrangement would be justifiably unacceptable to those involved. These two systems, like the medical system, would crumble absent titular distinctions. But the damage to medicine dives far deeper than this.

We have just witnessed the release of Medicare payment information for each doctor in the US. Soon the “Sunshine Act” will also become a reality. The amount of money paid to highly specialized doctors to deliver educational talks will become fodder for the public to muse. The lunches, coffee, or even requested medical articles brought to offices by pharmaceutical representatives will soon be open for public scrutiny. Total transparency is a beautiful concept for an ideal world. In such a world everyone would love and respect each other; no one would compete with another; and all would be subject to the same laws and regulations. Such is not the case of course. Do you know what your attorney earned last year, or how much money your grocery store pays for its eggs?  Of course not! We live in a land that purportedly permits freedom to compete. Competition requires a high degree of privacy. Our country was in fact built upon such a premise. How can one dermatologist fairly compete with another if confidential internal financial records become open access? There are far too many financial ramifications to explore in this short blog, but the adverse fallout from such transparency will be pervasive. And it will most certainly include a drastic decline in the education of practicing doctors. That of course will translate into deteriorating quality of care.

The most consequential outcome of medicine’s recent evolution will undoubtedly be decay in heath care delivery. Marcus Welby, MD was an excellent television show because it depicted a dedicated, diligent, assiduous, committed physician. Dr. Welby captured the hearts of viewers because he loved his patients and they loved him. He was honored, respected, appreciated, and yes, even well compensated. The reality, for better or for worse, is that doctors are human beings. They crave recognition and appreciation for their sacrifices. Absent such recognition, and assuming a continued decline in reimbursement as well as the massive increase in federal regulations, the Marcus Welby, MDs of this nation will become extinct. At times this augury feels inevitable. At other times there is hope. Unfortunately however, until the general population recognizes the physician resource it is rapidly losing, I believe the more pessimistic outlook will prevail. Marcus Welby, MD may truly be unresuscitatable.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Caution: When choosing your health insurance remember to look to the future!

The country is in the midst of a monumental healthcare debate. Physicians like me treat individual patients, not populations. Thus this note of caution is meant for you, the individual who now must determine what health insurance plan best suits you and your loved ones. This blog in no way addresses the merits or lack thereof of the Affordable Care Act (ACA). I have been a practicing Cardiologist for over twenty years. During that time, my practice has run the gamut from intervention to prevention. Although it would be hyperbole to say “I have seen it all”, my varied experience has afforded me the opportunity to participate in the most intimate and meaningful aspects of a great many patients’ lives during so many different types of medical trouble. I have also myself unfortunately been a patient with life-threatening ailments on more than one occasion. To say I am an expert in the medical arena is therefore not hyperbole.

Now that many Americans must examine their health insurance with a new perspective I want to raise a single note of caution: When choosing your plan, always look to the future. It is one thing to keep your current doctor; that is indisputably important. Possibly even more consequential though is the fact that many of us ultimately develop complex, serious, and even rare medical disorders. We do this “in the future”, and to make matters worse, we never know when the axe will fall. Sadly but irrefutably we are all vulnerable to this fate. When this occurs, patients invariably and appropriately want to “see the best”. To do so often requires long trips to a variety of places in America (as an aside, it is ALWAYS in America where you will find “the best”). I have patients and loved ones who have traveled to Nebraska and Texas for the treatment of Lymphoma; Sloan Kettering for Neuroblastoma and other cancers; the Brigham and Women’s, Massachusetts General Hospital, Columbia Presbyterian, the Mayo Clinic and Cleveland Clinic for Cardiovascular issues; and many other centers of excellence for a host of other ailments as well. Every time patients travel afar to see the experts they do coordinated research with their physicians in order to identify the doctor and institution best suited to manage a particular condition. This is always a difficult and emotionally challenging task. Now consider this. The majority of plans under the ACA do not have contracts with most of the aforementioned hospitals. In fact, it is my understanding that perhaps the finest cancer center in America is not on ANY of the ACA plans. So, when choosing your health insurance, please focus on what you don’t know. Give the future as much attention as the present. Being unable to see a true expert to treat the disease you have not yet developed (but sadly will most likely afflict you or your loved ones at some point in your life) would be a catastrophic event. Buy your plan with your eyes wide open. Know what you’re getting for now, as well as for the days that lie ahead.

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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“Find a Doctor You Trust And Trust Him”

woman runner stretching
A patient recently shared advice given him by his close friend (who also happens to be a physician). When my patient questioned his friend about the best way to make medical decisions in the context of today’s information-overload (which can be not only misleading but downright wrong and dangerous) he counseled him to “Find a doctor you trust and trust him.”

This philosophy may appear simplistic, superficial, or even tautological. It is not. Actually, it is brilliant in its simplicity. After all, how is anyone, doctor or layperson, to understand everything about medicine? Advances and discoveries abound. I’ve said this before – but it is certainly worth repeating, – every day hundreds if not thousands of articles are published in the medical space. It is impossible for even the most studious physician to appropriately assimilate such exhaustive data. A judicious doctor will however rigorously read the most pertinent trials and merge them into his well-established and highly-refined approach to health and illness. This approach is founded upon oftentimes decades of combined arduous education as well as invaluable clinical experience. Recognizing everything that goes into a fine physician’s decision-making process how is it remotely possible for even the most voracious reader of internet tomes to come close to the well-considered recommendations of such doctors? It is just not possible. This realty does not imply that patients shouldn’t educate themselves to become their own best advocates. They should; and in fact they must. Knowing more will help patients find those doctors they trust. But at that point patients ought to let their guard down just enough to accept the well-considered advice of their trusted physician. Without doing so, patients leave themselves wide open for not just doubt and concomitant angst, but inferior care as well.

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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Freedom through the Eyes of a Preventive Cardiologist

As an Interventional Cardiologist turned Preventive Cardiologist I understand all too well how much better it is to prevent a disease before it ever has the opportunity to strike. After all, what would you rather experience – a heart attack, angioplasty, stroke, or bypass surgery – or simply a modification of your lifestyle – eating better, exercising regularly and perhaps taking a medicine or two? Most of us would opt for the latter. I’ve yet to meet anyone who has enjoyed the experience of a major cardiac event, but most everyone likes being lean, fit, and energetic. Recently I was struck by the application of “prevention” to politics.

Americans are in the throes of controversy regarding freedom. Daily I listen to my patients as they express their worries that we might be on the road to socialism. Most people would reject such a notion, saying, “it’s impossible; America will always be the land of the free.” Yet, the patients who fret the most are those who actually lived through times of dramatic social change – Cubans, concentration camp survivors, former Eastern Europeans… These individuals have had the misfortune of going from freedom to “captivity”. And what’s truly most terrifying is the unwavering commonality of their views. They all echo the same sentiment declaring, “This is exactly what it looked like before Castro, or Hitler”, or whomever it was that led the movement that ultimately stole their freedom. By “exactly what this looked like “ these patients tell me they mean gun control, governmental intervention in business, loss of certain freedoms of religious expression and the like. They uniformly speak of the insidious nature of freedom’s ebb. Citizens of their former nations had decried the possibility that terrible social change was in the winds believing such a thing could not possibly occur. Listening to them intently I have concluded that freedom is much easier to lose than it is to gain.

Now I understand the need for us all to listen closely to what is happening in Washington as well as wherever we live. We must critically evaluate what we hear on the news, and steadfastly maintain open and circumspect eyes. Everyone would agree our country is in the midst of dramatic change. The question of course remains as to what direction we will take. As in the case of medical prevention it is time for us all to make perhaps our most important decision. Are we willing to do what it takes to prevent the loss of something our forefathers fought so bravely to attain? Will we sit back lazily and let the chips fall where they may? Or, will we get in the game, keep up with national and international events, maintain open but cautious minds, and speak loudly if we believe our freedom to be in jeopardy?  Remember the example of medicine – no one wants a bypass. The best way to avoid a bypass is to be proactive. The same, I believe holds true for remaining free.

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A Case Study: The Decline of American Medicine

Imagine this. You are a high school student with superb grades and a disciplined nature. You want to help humanity while simultaneously ensure a secure financial future, one in which you will be capable of sending your future children to college and even graduate school. You even plan to retire someday. You love science and technology and you therefore embark upon the most arduous academic road imaginable, a career as a physician. The road ahead will be tough but the rewards will make your journey worthwhile. And so, understanding the competitive barriers of medical school acceptance you attend the best (and most expensive) college possible. You work assiduously and achieve superb grades. You apply to, and are accepted in, Medical School. Again you select the best Medical School that has accepted you. This too is obscenely expensive. But it will be worth it. You struggle through four years of post-college schooling and then decide to embark on a specialized career. Now you have committed to another seven or eight years of training, a period during which your entire non-career life is placed on hold. But it will be worth it. You marry during residency and your wife works hard as your income is very low (in fact your pay is actually below minimum wage) but again you repeat your mantra, “it will be worth it”. Finally in your mid-thirties you begin your professional career. Although your classmates already own homes; enjoy fine vacations; and have settled into their adult lives, you are just embarking upon yours. You have been socially and economically dwarfed by your chosen profession. But it will be OK. And then you begin your practice. You are a junior member of your group and hope to make partnership by the time you’re forty. You save lives and feel satisfied. You are doing god’s work, helping mankind, and beginning to pay back your loans. You are fortunate. Your parents have paid for much of your education so you have only $200,000 to repay, not the close to $400,000 that some of your classmates bear. But it will be worth it. And then the rules change. Reimbursement falls. Your fees are fixed by the government and insurance companies as well. Governmental regulations grow at an alarming, almost viral rate. You are being crushed economically, emotionally, spiritually. The leader and even savior status you thought you’d earned has been stripped from you. You are no longer a physician; you are a “health care provider”. You are the same in the eyes of payers as others with half your skills. You cannot save money for your children’s education. You are drowning in self-pity, sadness, anger, and despair. Finally, your older partners can no longer tolerate the economic and emotional strain and so they sell the practice to your hospital. Now you are an employee. You are not the master of your own destiny. And you never will be. You are not the gladiator you’ve trained to be. You are a slave. You are a ghost of the man you’d envisioned you’d be. How do you feel? How would anyone feel?

Please learn more about preventive cardiology at www.preventivecardiologyinc.com.

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