Lown Cardiovascular Research Foundation's quarterly newsletter featuring Dr. Bilchik's article on family health history, update on the drug Prilosec, The Lost Art of Healing book translation, training future medical students, global heart health, and heart health community education.
At the Lown Center, we pay careful attention to each patient’s family history in a way that incorporates the complex interaction between environmental, behavioral, and genetic factors. Our approach is in direct contrast to what today is called “personalized medicine,” which is a form of genetic profiling that lumps people together based on inherited risk factors that may have significant prognostic bearing but may actually depersonalize care. “Personal medicine” as practiced at the Lown Center, on the other hand, builds a relationship of trust and openness between physician and patient. It requires time, careful and unhurried listening, and searching out the uniqueness of each patient in order to understand him or her as a unique and complex person. Understanding family history can be a powerful tool for both physician and patient. It provides information and insight that is critical to identifying and preventing heart disease. When addressed proactively, a patient’s family history can become one of the best motivators in promoting healthy behaviors. Conversely, lack of family history is equally important, and should be sensitively considered in order to provide the best care possible for our patients. All in the family: Matters of the heart Brian Bilchik, MD Lown Forum 2010 NUMBER 2 THE LOWN CARDIOVASCULAR RESEARCH FOUNDATION INSIDE 6 Patient guide to family and heart health 8 ProCor at World Congress of Cardiology 9 Training healthcare’s future leaders 10 Family histories 12 Contributing to the community’s health FAMILY ALBUM Four generations of Lown Center patients: One family’s history “We visit the Lown Center in packs,” joked Tony Jarvis, Jr. during a recent visit with his mother, Carol. Tony Jr., as the Lown staff refer to him, is part of the 3rd generation of a family whose history with the Lown Center began over 40 years ago when Carol’s mother was a patient of Dr. Bernard Lown early in his cardiology career. Genetic susceptibility. Support. Learned lifestyle. Happiness. Shared environment. Stress. When it comes to heart health, family matters. Families of all kinds and sizes have been part of the Lown Cardiovascular Center for generations. We care for brothers and sisters, husbands and wives, parents and children, grandparents and grandchildren. Our patients demonstrate the enormous variety of ways in which family sometimes influences cardiovascular risk factors as well as the ways families can promote heart health. A patient’s family history reflects his or her genetic susceptibility to a range of cardiovascular conditions such as premature coronary artery disease and stroke. On top of that, families share environments, eating patterns, and frequently adopt similar behaviors. People can react to their family histories in many ways. Some become crippled by anxiety, convinced that the heart attack that killed a parent will strike them at the same age. Or they may feel falsely reassured by the fact that grandmother lived to be 100 although she smoked like a chimney. Others respond with denial: Dad was diabetic because he was overweight, but I work out. Carol and Tony Jarvis, Sr. (front seat) with children Marcia, Barbara, Nancy, and Tony Jarvis, Jr. Four generations of Jarvises have been Lown Center patients. continued on page 10 2 President’s message 3 Lown Center updates Question from a patient 4 A new renaissance in medicine 5 NewsBeat continued on page 6
Transcript
At the Lown Center, we pay careful attention to each
patient’s family history in a way that incorporates the
complex interaction between environmental, behavioral,
and genetic factors. Our approach is in direct contrast to
what today is called “personalized medicine,” which is a
form of genetic profiling that lumps people together
based on inherited risk factors that may have significant
prognostic bearing but may actually depersonalize care.
“Personal medicine” as practiced at the Lown Center, on
the other hand, builds a relationship of trust and
openness between physician and patient. It requires time,
careful and unhurried listening, and searching out the
uniqueness of each patient in order to understand him or
her as a unique and complex person.
Understanding family history can be a powerful tool for
both physician and patient. It provides information and
insight that is critical to identifying and preventing heart
disease. When addressed proactively, a patient’s family
history can become one of the best motivators in
promoting healthy behaviors. Conversely, lack of family
history is equally important, and should be sensitively
considered in order to provide the best care possible for
our patients.
All in the family: Matters of the heartBrian Bilchik, MD
Lown Forum 2 0 1 0 NUMBER 2TH
E
LOWN CARDIOVASCULAR RESEARCH FOUNDATION
IN
SI
DE 6 Patient guide to family and heart health
8 ProCor at World Congress of Cardiology
9 Training healthcare’s future leaders
10 Family histories
12 Contributing to the community’s health
FAMILY ALBUM
Four generations of Lown Centerpatients: One family’s history“We visit the Lown Center in packs,” joked Tony Jarvis, Jr.
during a recent visit with his mother, Carol. Tony Jr., as the
Lown staff refer to him, is part of the 3rd generation of a
family whose history with the Lown Center began over 40
years ago when Carol’s mother was a patient of Dr.
Bernard Lown early in his cardiology career.
Genetic susceptibility. Support.Learned lifestyle. Happiness. Sharedenvironment. Stress. When it comesto heart health, family matters.
Families of all kinds and sizes have been part of the Lown
Cardiovascular Center for generations. We care for
brothers and sisters, husbands and wives, parents and
children, grandparents and grandchildren. Our patients
demonstrate the enormous variety of ways in which
family sometimes influences cardiovascular risk factors as
well as the ways families can promote heart health.
A patient’s family history reflects his or her genetic
susceptibility to a range of cardiovascular conditions such
as premature coronary artery disease and stroke. On top
of that, families share environments, eating patterns, and
frequently adopt similar behaviors.
People can react to their family histories in many ways.
Some become crippled by anxiety, convinced that the
heart attack that killed a parent will strike them at the
same age. Or they may feel falsely reassured by the fact
that grandmother lived to be 100 although she smoked
like a chimney. Others respond with denial: Dad was
diabetic because he was overweight, but I work out.
Carol and Tony
Jarvis, Sr. (front
seat) with children
Marcia, Barbara,
Nancy, and Tony
Jarvis, Jr. Four
generations of
Jarvises have been
Lown Center
patients.
continued on page 10
2 President’s message
3 Lown Center updates
Question from a patient
4 A new renaissance in medicine
5 N e w s B e a t
continued on page 6
PRESIDENT’S MESSAGE
The Affordable Care ActVikas Saini, MD, President
After saturation coverage in the media last
year, the Obama health care reform has
passed. The major thrust of the legislation is to expand
coverage and end the burden of an uninsured population.
Now 45 million uninsured in the US will have access to
insurance, but affordability remains a big unknown.
A mandate to purchase insurance raises a host of issues.
Key to affordable pricing will be the ability to control
medical inflation, but there is much dispute about whether
any of the measures in the bill will actually save money.
Early discussion by the administration of cost-containment
faded quickly, in part because of the ruckus over
“rationing” and “death-panels.” This occurred despite
wide acknowledgement that there is much overuse,
overtreatment, and waste in the health care system, as the
Lown Group has emphasized over many decades.
What aspects of the bill might be of interest to the Lown
community? Some economic elements are worth noting.
In 2010, small businesses get tax credits to offset health
insurance premium costs for employees and participants
in the Medicare Part D “donut hole” in prescription
coverage get a $250 rebate; in 2011 they receive a 50%
discount on brand named drugs.
Prevention is apparently acceptable to both sides of the
aisle: the bill takes small but significant steps in the right
direction. Medicare co-pays for annual wellness visits are
eliminated. Co-pays and deductibles for preventive
services such as screening for cholesterol, diabetes, high
blood pressure and depression are also eliminated in 2011.
Buried in the details are items of potentially greater
significance. Medicare beneficiaries will gain access to a
comprehensive health risk assessment and creation of a
personalized prevention plan and will have financial
incentives to change behavior. The government will
provide grants to small employers that establish wellness
programs and all employers will be able to offer rewards of
up to 30%-50% of the cost of participating in such programs.
Many details remain to be worked out. Increases in
coverage will undoubtedly create crises of access and
budgets as Massachusetts has discovered. What seems
clear is that passage of the legislation marks the
beginning of a long process of change. As the
contradictions are sorted out, we believe that our way of
practicing medicine will be seen as a valuable and
necessary part of the solution we need.
2 L O W N F O R U M
Dear Readers: Please tell us what you think!To make the Lown Forum—the newsletter you hold in
your hand—as interesting and useful as possible, we
are seeking feedback and ideas from you, its readers.
We have embarked on a survey of what you think and
what you would like to see in future issues.
Our brief questionnaire should only take 5-10 minutes
Email appointment reminders The Lown Center continues to collect and update patient
email addresses in anticipation of installing an email alert
system to remind patients of upcoming appointments.
These emails will be sent a week before the
appointment. Please update your demographics during
your next visit, or call the office at 617-732-1318 x3315.
New government regulation Do not be surprised if you are asked to provide your
driver’s license or social security card when checking in
at your next appointment. Federal legislation aimed at
protecting medical information and records from
fraudulent use requires health care providers to confirm
patient identity. We are striving to copy a government-
issued ID of all patients seen at the Lown Center. Your
cooperation is appreciated.
The Lown Foundation
welcomed three interns
during the summer of
2010. They worked on a
number of ProCor-
related projects
including writing and
posting prevention
updates and other daily
content, creating and evaluating a survey of the ProCor
community, investigating the effectiveness of social
media in developing countries, and producing a global
CVD fact sheet. Meet the interns!
Fiat�Vongpunsawad,�MPH, is a 2010 graduate of Boston
University School of Public Health. He received his Bachelor
of Science degree from Brigham Young University. His
focus of study includes epidemiological surveys, oral public
health, and Southeast-Asian orphanage health policy.
Zoe�Blatt is a junior at Union College in Schenectady, NY.
In addition to pursuing a Bachelor of Science degree in
Environmental Sciences with a minor in Sociology, she is
on the Pre-Med track. She spent part of her summer in
Alaska examining the interface between science and
society’s role in mitigating hazards.
Romey�Sklar is a long-time Brookline resident and a
senior at Brookline high school. He is interested in
pursuing an education and career in foreign relations and
global communications in college. His other interests and
skills include website and graphic design.
L O W N F O R U M 3
Does Prilosec, which I take for
heartburn, increase my risk of a heart
attack? I read that it diminishes the
effects of Plavix, which I take in order
to prevent blood clots in my stent.
Drug-eluting medicated stents (DES) are frequently used
to open blocked heart arteries. However, the medicine in
the stent, which helps to prevent tissue growth and
future blockages might interfere with prevention of blood
clot formations and result in stent occlusion (thrombosis).
To minimize the risk of DES thrombosis, patients are
treated with long-term Plavix (clopidogrel) and aspirin to
“thin” their blood. The downside of this intensive
treatment with two “blood thinners” is a higher risk of
bleeding, in particular gastrointestinal (GI) bleeding.
Proton pump inhibitors (PPIs) such as Prilosec, Protonix,
and Nexium are frequently prescribed to patients with
DES to address their higher risk for GI bleeding. However,
because they compete for the same metabolic pathway,
PPIs may inhibit Plavix transformation to a more potent
form resulting in a potential decrease of active Plavix
availability by almost 50%.
Although this interaction is of concern and theoretically
might increase the risk of stent thrombosis and
subsequent incidence of heart attacks, so far there are no
credible high-quality clinical studies that confirm worse
outcomes in DES patients using PPIs.
Based on current evidence, medical associations have
formulated the following recommendations:
1. Following placement of DES, aspirin and Plavix or a
similar drug are recommended for at least one year.
Patients who are at high risk for bleeding or who are
expected to have surgery within a year after stenting
might benefit from a bare-metal—non-medicated stent,
which does not have the long term anti-clotting
properties of a drug-eluting stent, and therefore requires
only short term treatment with Plavix.
2. PPIs may be prescribed quite safely to patients taking
Plavix if they are at very high risk for significant GI
bleeding, or have experienced such bleeding previously.
3. Patients with heartburn or other mild symptoms of acid
reflux should use H-2 blockers such as Zantac (ranitidine)
or Pepcid (famotidine); but not Tagamet (cimetidine)
instead of PPIs in order to minimize a potentially harmful
drug interaction with Plavix.
QUESTION FROM A PATIENTShmuel Ravid, MD
ProCor Interns: Romey, Zoe, and Fiat
Meet ProCor’s summer interns
4 L O W N F O R U M
A new renaissance in medicineBernard Lown, MD
This spring Louise and I visited Rome and Florence. Italy
for us evokes images of expressive people, radiant
sunshine, good wine, delectable food, and above all else,
the Renaissance. This cultural rebirth, begun seven
centuries ago, transformed the way human beings
perceived themselves and the natural world around them.
During the preceding era of medievalism, life was short,
uncertain, and miserable. The dominant worldview was
insular, steeped in superstition, charged with dread and
bigotry. The singular aim of life was to serve an
inscrutable, unpredictable God. Human history had
reached a dead end.
The Renaissance, in the course of two centuries, washed
away much of this medievalism. Launched in Florence, it
swept through Italy and Europe. The new vision was
captured in painting, sculpture, architecture, literature,
and science. Thinking dramatically shifted away from the
centrality of God to the godliness of man.
An invitation from the distinguished Italian cardiologist
Attilio Maseri would have elicited an automatic
acceptance but for the oddity of the stated purpose of
the visit. Apparently I was to have an audience with Pope
Benedict XVI—in the Vatican. An extensive email
exchange over the ensuing months revealed a different
intent.
This mini-drama began when
Leonardo Bolognese, the editor-
in-chief of the Italian Journal of
Cardiology, serialized over four
consecutive months (September-
December 2009) an unabridged
translation of my book, The Lost
Art of Healing. This unprecedented
action evoked a flurry of
approving letters from readers. It
led to the publication of the book
by a Florentine-based medical
foundation, Fondazione per il tuo
Cuore. A first printing of 10,000 copies was distributed
without charge to every Italian cardiologist.
By the time we arrived in Rome, it seemed that the
meeting with Pope Benedict XVI was a formality merely to
bless the Italian edition. The book was to be launched in
Florence. But in Italy few events are enacted without
operatic flair. In St. Peter’s Square, with an assemblage of
more than 10,000 Catholic pilgrims from around the
globe, Dr. Maseri handed the pope the Italian translation,
and I surprised the pontiff by giving him a copy of the
edition published in German, his native language, with a
painting on the cover by Goya, himself as patient being
ministered by his doctor. We shook hands, we were
blessed, and we received rosaries.
The book launch in Florence took place in the Palazzo
Vecchio, the most important civic monument in Florence
and the former home of the Medici family. A symposium
titled “A New Renaissance in the Relationship between
Doctor and Patient” assembled distinguished political,
academic, scientific, and medical leaders. Among the
speakers were the president of Tuscany, the mayor of
Florence, the rector of the university, the dean of the
medical school, the director of the Italian equivalent of
our NIH, and leaders from various medical specialties.
The key issue addressed was the loss of the human
relationship between doctor and patient. Speakers
acknowledged that medicine is
increasingly focused on the diseased
organ rather than the troubled
human being. They also recognized
that many medical decisions are
shaped by economic forces to the
detriment of patients. Time
pressures and ever more
sophisticated technologies are
rapidly industrializing the practice of
medicine. Interesting ideas were
raised on how to integrate scientific
advances without losing sight of the
centrality of the human narrative.
The gauntlet thrown down from a modest
cardiovascular clinic in Brookline some four decades ago
is now being taken up by the world. The Lost Art of
Healing has been published in Brazil, China, Germany,
India, Italy, Japan, Korea, Russia, and Taiwan and is being
translated in other countries. It was appropriate,
though, that Italy reminded us of the urgency of a
second Renaissance, a rebirth of human values in the
doctor-patient relationship. To continue medicine as a
calling, physicians need to reclaim their long hallowed
tradition of healing.
Dr. and Mrs. Lown in
Florence, where the
Italian translation of
The Lost Art of
Healing was launched
in May 2010.
Pope Benedict XVI, Dr. Attilio Maseri, and Dr. Bernard
Lown during the papal blessing of the Italian
translation of The Lost Art of Healing.
L O W N F O R U M 5
The Lost Art of Healing: A tale ofmany translationsThe Lost Art of Healing was first published in 1996. Dr.
Lown had authored several medical texts, but this was his
first book for a non-clinical audience. A summation of
medical experience over four decades, “The Lost Art took
three years and a lifetime to write,” he recalls. “I wrote it
for patients, not for medical professionals. It expresses a
style of clinical care that combines advancing scientific
insights with a core of human values. The way to influence
medicine is to educate patients so they will have a higher
level of expectation.”
Though The Lost Art received positive reviews in the media
and medical literature and remained on the Boston
Globe’s bestseller list for months, “It wasn’t a stunning
success,” he notes. “Unexpectedly, however, it was
translated and published in Japan in two beautiful
volumes.”
After several years, a German
translation was published and was
immensely popular, appearing in four
hardcover editions and in paperback.
Translations followed in Taiwan,
South Korea, China, and Brazil. In
2009, the book was picked up by a
publisher in India, where it was
heralded by the popular press.
“Then I received a call from a professor of English I had
met in Moscow, who asked me if she could translate it
into Russian,” Dr. Lown recalls. “She said, ‘I got such joy
out of it, I want it to exist in the Russian language.’ She
took her translation from publisher to publisher, and it
appeared in Russia in May 2010 under the title Children of
Hippocrates of the 21st Century.”
Though each of the translated versions
was a surprise to Dr. Lown, he was most
astonished by the recent translation of
The Lost Art into Italian where it was
serialized in a leading cardiovascular
journal, then published in hardcover and
distributed at no cost to 10,000 Italian
cardiologists.
“I have not had a role in any of the books that have come
out in other countries,” he observes. “I think it reflects a
humanitarian crisis that afflicts medicine because the
profession is losing its human touch.”
Order The Lost Art of Healing and other books authored by Dr.Bernard Lown at www.bernardlown.org.
LOWN CARDIOVASCULAR CENTER
N e w s B e a tDr.�Fred�Mamuyawas the keynote speaker
at the Healthy Living Expo on May 4, 2010 in
Hyannis, MA. The topic of his presentation
was “Your heart, your health.”
Dr.�Charles�Blatt addressed the NewBridge
on the Charles community on May 19, 2010 in Dedham,
MA. The topic of his presentation was "Bypassing the
bypass: The overuse of coronary bypass surgery in
America."
Dr.�Tom�Graboys and his wife Vicki
discussed his memoir, Life in the
Balance, at the Ogden Surgical-
Medical Society’s 65th Annual
Medical Conference in May in
Ogden, Utah. Dr. Graboys and his
daughter, Dr. Sarah Graboys Valeo
were guest speakers on June 24,
2010 at Chestnut Park’s Summer Author Series in
Brighton, MA, where he discussed his book and his
experience as a patient.
Dr.�Brian�Bilchik, ProCor director, and Benn�Grover,
ProCor editor, attended the 8th Annual National Forum
for Heart Disease and Stroke Prevention in April 2010. The
two-day conference, “Creating the Will for A Heart
Healthy and Stroke Free Society” took place in
Washington, DC. Dr. Bilchik facilitated the session,
“Organizing Global Initiatives to Improve Education and
Training in CVD Prevention.”
The�Bernard�Lown�Award�for
Excellence�in�Teaching�at
Brigham�and�Women’s�Hospital
was awarded to Dr.�Tracey
Milligan at the Harvard Medical
School Teaching Awards
Celebration on May 10, 2010.
Since joining the neurology
faculty at BWH, Dr. Milligan has
taken on diverse teaching and leadership roles in
education. Dr. Milligan is a well known and highly
regarded teacher and lecturer, which nominees attributed
to both her brilliance and her interactive, approachable
style.
Dr.�Vikas�Saini has given a series of talks over the last
three months in several local communities, including
Acton, Milton, and Belmont. See page 12 for a related
story.
Dr. Tracey Milligan and
Dr. Bernard Lown
6 L O W N F O R U M
Genetics: Legacy of risk, knowledgeRecently, a man who accompanied his wife to her
appointment at the Lown Center stopped in my doorway
and said: “My mother just had a heart attack and bypass
surgery. I wonder if I should get myself checked out?”
Inherited risk factors for heart disease come in two forms.
Some, like cardiomyopathy (thickened or weakened heart
muscle), valve problems, or aortic aneurysms, are “silent”
until an acute problem manifests. Or someone may be
having symptoms of an underlying condition and not
realize it.
People who have experienced the sudden, early death of
a close relative—particularly a parent or sibling—should
be proactive in being screened. A thorough family history
coupled with a careful clinical
examination and noninvasive
tests like EKGs or
echocardiograms can help
identify abnormalities and set
people on the path to avoiding
future problems.
For example, sons of mothers with coronary artery
disease tend to develop heart problems ten years earlier
than daughters. If a condition is identified early on, we can
determine whether it is benign—it poses no risk —or how
we can reduce risk. For many people, quitting smoking,
reducing salt intake, regular physical activity, or losing
weight can be enormously helpful in protecting their
health despite the presence of such conditions.
Hypertension and high cholesterol can also be inherited. A
nonsmoker with a healthy diet and active lifestyle may
unknowingly develop high cholesterol or high blood
pressure at an early age. With early detection and
appropriate management, problems later in life can be
averted.
An older patient of mine who is diabetic and has coronary
artery disease recently learned that two of her three
grandchildren have type 2 diabetes. She wept as she told
me how guilty she feels for passing this on. I made it clear
to her that science has advanced remarkably, and that her
grandchildren were identified at an early age. I reassured
her that by being positive and supportive she can
encourage them to adopt the behaviors that will protect
them as they grow older.
If risk factors, premature heart disease, or sudden death
are part of your family history, it’s never too early to check
out your cardiovascular health—whether you make an
appointment at the Lown Center or elsewhere.
Addressing modifiable risk factors at an early age is
imperative. We can’t exchange our genetic inheritance,
but we can change our lifestyle and environment.
Behavior and environmentHeart disease, diabetes, hypertension, and obesity are
affecting more people at earlier ages—a result of tobacco
use, unhealthy foods, and sedentary lifestyles. Younger
people, especially teens and young adults, comprise an
increasing segment of Lown Center patients. Concerned
parents who have learned the importance of healthy
behaviors often bring their children who are overweight
or who smoke. Others, grappling with their own heart
disease, want their children not only to be screened but
also to understand the importance of early intervention.
Sometimes children who bring their parents to
appointments recognize that they might have a problem
too.
Inherited risk for cardiovascular disease and lifestyle
behaviors coexist in a complex relationship within the
context of people’s lives. Environmental factors such as
work, stress, and air pollution play a significant role in
contributing to cardiovascular disease. It is important for
physicians and patients to understand and respond to
environmental factors, and control them to the extent
that it is possible.
Education and empowermentPeople generally won’t implement change unless they
understand why it’s important. This requires individualized
education and support from someone who is trusted and
respected.
If a person has a family history of coronary artery disease,
I strive to empower them by giving them information they
can understand and use about the potential
consequences of their choices. I may explain, “Tobacco
Patient guide to the role of family in heart healthBrian Bilchik, MD
Addressing modifiable risk factors at an early age isimperative. We can’t exchange our genetic inheritance,but we can change our lifestyle and environment.
A family history how-to
At the Lown Cardiovascular Center, home to generations
of patients and a committed core of physicians, medical
histories are maintained and transmitted. New patients
who come to the Lown Cardiovascular Center complete
a detailed family history questionnaire which is reviewed
in advance of the first appointment, when patient and
cardiologist thoroughly discuss all relevant information.
We encourage patients to bring a family member or
close friend to their appointments. Their support,
perspective, and integration into future planning are of
enormous benefit to both patient and physician.
For new and established patients alike, it’s important to
keep your history up-to-date. Let us know if and when
close relatives experience significant health issues. Talk
to your physician about any new stresses or events in
your life. At the Lown Center, we all firmly believe in the
importance of taking time to talk, and we are committed
to working in partnership with you to achieve optimal
health outcomes.
How to provide a good historyBe open and accurate: Sometimes people are hesitant
to report their family history, and may hide their own
symptoms or behavior out of concern about its effect on
insurance premiums, or because they do not want to be
judged. Or they may unconsciously deny the significance
of family medical history due to fear of what it might
mean for them. Remember that your family history is not
your fate—it’s a valuable tool that can help you protect
your health and avert trouble before it finds you.
Provide a context: Determining the circumstances
around a close relative’s death are important. Was it
anticipated? Did it happen during a time of stress, or
were there other contributing circumstances?
Be a detective: If a parent or other close relative died
prematurely, obtain the autopsy report if one exists.
Though it may be painful, or you might not want to
know why mom or dad died, this information will help us
determine the best approach to managing your health.
When there is little or no family historyFor people who lack information about the health of
their relatives or who are adopted, information about
the environment in which grew up and background on
behaviors are still important. Working with your
physician, you can be attentive and proactive in
protecting and managing your health. You may not have
a choice in your genetic inheritance, but you can control
how you approach your own health.
will increase your risk of heart disease five-fold.
Modifying what you eat and your level of activity can
double your protective factors, but you can’t do one
without the other. If you smoke, you negate all the other
beneficial things you might be doing.”
I never use scare tactics. When people understand how
their bodies work, they are more likely to make informed
decisions and healthier choices. We achieve this by not
talking down to people, but by taking the time to help
them understand the biology and letting them know
we’re interested in their well-being. Individualized
messages are much more effective than one-size-fits-all.
If there’s an inherited disorder, knowledge is powerful.
Education about heart health, especially for young
people, needs to be sustaining and consistent; it requires
reminders and feedback, empowerment and motivation.
The most important asset we all share is a desire to live
longer and healthier. Family history can be a powerful
motivator in choosing a heart healthy lifestyle.
Modeling healthy behaviors: Eat healthyand stay active!Modeling healthy behaviors for children is key to helping
them grow up healthy. Unhealthy behaviors and
addictions to tobacco, salt, or sugar and even “screen
addiction” are often learned within families and passed
on from generation to generation — if you spend your
time in front of the television or computer, your child will
most likely do the same.
Fortunately, healthy behaviors can be modeled and
subsequently adopted by those around us. Many people
find it easier to change their own behaviors when they
realize that it will benefit their children, and spouses are
often willing to change the habits of a lifetime when they
realize it will enhance the life of the person they love.
An obese patient of mine was finally able to address her
own health issues when she recognized that her nine-
year-old daughter was also significantly overweight. She
changed the way her family ate, and they bought a dog
so they could walk together every day. Her strong
motivation improved not only her own health, but that of
her whole family.
Modeling healthy behaviors benefits us all: it increases
our chance of seeing future generations grow up, it
increases the likelihood that they will grow up healthy,
and it helps families and extended families to enjoy each
other more and longer.
L O W N F O R U M 7
8 L O W N F O R U M
Heart health on a global stageBenn Grover, Editor, ProCor
I recently had the opportunity to attend the World Heart
Federation’s World Congress of Cardiology (WCC) in
Beijing, China. The WCC is the world’s largest cardiology
conference, with over 500 presenters and 10,000
attendees. The three-day affair provided the opportunity
for ProCor to learn about the most recent cardiovascular
research, participate in global discussions on
cardiovascular health advocacy, and meet several of
ProCor’s members.
Because ProCor targets cardiovascular health workers in
developing countries, a majority of our audience is unable
to attend conferences like the WCC. By attending the
WCC, one of our goals was to provide daily updates on
research presentations and discussions that are relevant
to the ProCor community. Perhaps the biggest research
news to come from the WCC was the results from the
INTERSTROKE study. The three-year study involving 22
countries found that ten risk factors are responsible for
90% of all strokes. Five of those ten (high blood pressure,
smoking, abdominal obesity, poor diet, and lack of
physical activity) are responsible for 80% of all strokes.
These findings are particularly important to ProCor
because, for the first time, the burden of stroke is heavier
on developing countries than developed countries, and
the majority of strokes can be prevented by lifestyle
modifications like exercising and healthy eating.
Although I spent a tremendous amount of time running to
different presentations, I also had the opportunity to
meet with several ProCor colleagues from across the
globe. Dr. Collins Kokuro, Assistant Director of the
Ashanti-ProCor Project to Increase CVD Knowledge and
Practice Among Health Workers, several ProCor members,
and I discussed the future of cardiovascular health
education in Ghana and what strategies we could employ
to meet the informational needs of cardiovascular health
workers in rural areas. Ideas for meeting those needs
ranged from creating low-literate health education
pamphlets to developing a massive mobile phone text-
message network to provide cardiovascular health
updates. Once we finish with the Ashanti-ProCor project,
we will look at these options in greater detail as we
determine what action steps we can take to increase their
knowledge of cardiovascular health.
Dr. Toakase Fakakovikaetau, the director of the rheumatic
heart disease (RHD) prevention program in Tonga and our
2008 Louise Lown Heart Hero Award winner, discussed
with me the progress made on eradicating RHD in Tonga.
Unlike most heart diseases, RHD is caused by an infection,
and 95% of cases occur in developing countries. It also
happens to be one of the easiest heart diseases to
prevent—thanks to penicillin. It only costs around US$46
to prevent one case of RHD and it is very successful (60
children need to be treated before one case of RHD is
prevented; whereas for hypertension, 800 cases need to
be treated before one case is prevented). Dr. Toa’s
program is making tremendous strides in catching RHD in
children before it’s too late, however RHD remains a
neglected disease relegated to developing countries. The
World Heart Federation has recognized the need for more
advocacy and has made eradicating the disease one of its
six main goals for the years to come.
The UN has recognized the burden of non-communicable
diseases (NCDs) on the developing world, and will convene
a general summit in 2011 to discuss the issue. The goals of
the summit are recommended and determined by the
member states, and organizations such as the World Heart
Federation and Australia’s Heart Foundation work to
inform member states what those goals should be. Several
brainstorming sessions to determine this unified, global
strategy for advocacy were held during the WCC. By
participating in these ground-level discussions, ProCor is
working to ensure the needs of cardiovascular health
workers in developing countries will be at the forefront of
the UN’s agenda. The last UN general summit on a health
topic (infectious diseases) resulted in the Global Fund to
fight HIV/AIDS, Tuberculosis, and Malaria as well as
mandated disease reporting from member states. The
greatest advocacy goals going into the new summit are to
raise NCDs to a similar level of global awareness and to
push for similar funding and reporting requirements for
NCDs.
A tremendous amount of the information presented is availableon the ProCor website. To read about the presentations at theWCC or learn more about the global impact of CVD, please visitwww.procor.org.
Rajesh Vedanthan, MD MPH, Mount Sanai Medical Center; Benn
Ghana and Assistant Director, Ashanti-ProCor Project.
Marc Walker is one of a small but growing
number of medical students simultaneously working
toward a Master of Business Administration (MBA)
degree. In the past decade, the number of US medical
schools offering MBAs doubled from 33 to 65, and a
recent survey showed that the vast majority of MD-MBA
graduates remain involved with patient care, take on a
leadership role in their first jobs, and rate making a
difference in medicine as a high priority.
“My experience at the Lown Center offered a dimension
of comprehensive care that I would never have seen in an
inpatient service, where you have specialists and
technology at your fingertips. I wanted to see patients
more than once and take care of them over a longer
period of time. And though I assumed that patients in a
community practice like the Lown Center don’t present
with acute issues, in fact they do and I was able to see
how they are treated in an outpatient setting, which is
where most medicine takes place.”
During his Lown Center training, Marc reports that he
learned more than clinical skills and cardiovascular
expertise. “Dr. Saini taught me to take the time to listen
and build a comprehensive picture of the patient, and
then use that for diagnosis and management rather than
just jumping to radiology or invasive procedures. Issues in
the patient’s life may be contributing to their health
problems. For example, chest pain can be associated with
stress or an unhealthy diet. Taking the time to listen to
people’s personal struggles, then counseling them on
exercise and good nutrition, makes it easier for patients
to comprehend and comply.”
Surveying health care systems from a business
perspective, Marc feels that the Lown Center is at the
forefront of the new wave of medical practice. “If you
compared outcomes at acute care facilities with those at
outpatient centers that focus on listening and
comprehensive care, I think you’d find that the time
invested on the front end by the physicians at the Lown
Center will more than pay off in the long run. This model
L O W N F O R U M 9
will probably be much more successful at treating the
patient, managing cost, and producing an acceptable level
of reimbursement given the care that is being provided.”
Training the next generation: A Lown Center traditionThirteen Harvard Medical School students trained at the
Lown Center during the 2009-2010 academic year.
Also completing their year-long Primary Care Clerkship at
the Lown Center were Walter Lin, who trained with Dr.
Fred Mamuya, and Ibrahim Khansa, who worked with Dr.
Brian Bilchik.
The Lown Center also provides intensive training to one
HMS student each month through its Clinical Cardiology in
the Outpatient Setting course, which has been directed
for more than a decade by Dr. Charles Blatt. In addition to
spending each day seeing patients with Lown physicians,
these students attend weekly Lown Center clinical
conferences; develop and present a seminar; and
accompany Lown Center
physicians to Grand
Rounds and medical
conferences at Brigham
and Women's Hospital.
Russell Goodman
worked alongside Dr.
Blatt every day during
the month of June. “I’ve
never before had the
opportunity to work
alongside someone all
day, every day—and to
receive so much one-on-
one teaching,” he said.
“The Lown Center’s
outpatient setting gave
me the opportunity to see the strength of the
relationships people have formed with Dr. Blatt,
sometimes over decades, and observe how he interacts
with them.”
“One of the biggest lessons I learned is that often the
best medicine is gentle and conservative, that you can be
a great physician by watching the patient closely and
making small, gradual changes. At other facilities, patients
often receive interventional procedures that are
unwarranted. The Lown Center taught me that you don’t
always need to send the patient to the operating room.”
Training future leaders, influencing the future of health care
“Dr. Saini
taught me to
listen,” said
HMS student
Marc Walker
who trained
with Dr. Vikas
Saini at the
Lown Center.
Dr. Charles Blatt and Russell Goodman,
one of ten HMS students who completed
Dr. Blatt’s “Clinical Cardiology in the
Outpatient Setting” course in the past year.
Four generations, one family’s historycontinued from page 1
him healthy for ten years. A lot of other doctors, they just
tell you that you need bypass.”
In 1982, after Tony Sr.’s bypass surgery became necessary,
“We ‘fired’ him,” Tony Jr. reports. “We said, ‘We’ve got
the business under control—go spend your time with
Mom and enjoy life.’ It was hard for him but easy for us.
He’d still pop in at the store, passing out his Jarvis
Appliance grippers and selling stuff.”
Because both Carol and Tony Sr. had angina, they decided
their children’s heart health should be checked. Tony Jr.,
came to the Lown Center for a simple checkup in 2006. “I
felt fine,” he says. “But all hell broke loose on the
treadmill. Dr. Bilchik showed
me the multiple blockages
they found and went over
the report with me. He
recommended that I have
bypass, and I did.”
“Afterwards, I lost a lot of
weight because of Dr.
Bilchik. Before, I was
enjoying life, having fun,
and I didn’t know how bad I
was inside until he told us. I
started walking, eating
healthy, and taking
medication. I take the stairs
instead of the elevator.
When I golf, I park my cart
far from the hole and walk or jog to it. He’s brainwashed
me into doing the right thing,” he jokes.
After her early years with Dr. Lown, Carol saw Dr. Graboys
and now Dr. Bilchik as her cardiologist. If her own
cardiologist is not available, she sees any of the other
Lown doctors. “Dr. Lown instilled his principles in all of
them,” she notes. “They’re all really caring, they really
listen to you, they know what’s important for you.”
“My husband and I passed along heart disease to our
children, they all have some issue. Now they are being
taken care of, and my grandchildren are coming in for
EKGs and stress tests too—they’re in their twenties,
they’re healthy, they’re doing all the right preventive
things.”
“It’s like a big family here at the Lown Center,” Tony Jr.
concludes. “Everyone works together. It’s a lot like our
business. Customers are our family.”
Based on her mother’s confidence in the young Dr. Lown,
Carol convinced her husband, Tony Sr., to seek Dr. Lown’s
advice. When Carol herself developed heart disease, she
became a patient of Dr. Graboys. Concerned about their
family history, so eventually did their five children,
including Tony Jr., and their children’s children, who are in
their twenties and healthy.
“Many years ago my mother had a serious cardiac issue
and they called in Dr. Lown,” Carol recalls. “A little later
my husband began having angina pains. His doctor told
him, ‘Put a flask in your back pocket.’ When my mother
heard that she said, ‘Look, you try to make an
appointment with Dr. Lown because you need care and
he’ll give you the right care.’
We’ve been with the Lown
Center ever since.”
Carol and Tony Jarvis, Sr.
met when he was a service
person for Sears and she
worked in the office. They
got married 3 months later
and were married for 57
years until Tony passed
away in 2009, one week
before his 88th birthday.
Shortly after their marriage,
Tony opened his own
business, operating out of a
1957 black-and-white
Plymouth station wagon with
a “Jarvis Inc.” sign in the window. In 1966 he bought a
store in Wellesley that previously housed a boat business.
“For two years he sold appliances and boats,” Carol
recalls.
Tony Jr. and siblings grew up at the store. “I remember
going there as a little kid. Mom did the bookkeeping and
answered the phones, so she brought us babies in and
put us in playpens by her desk. When we kids all got
married, our spouses started working there too. My sister
Nancy and my wife brought our kids in as infants; we
turned Dad’s old office into a daycare.”
Tony Sr.’s angina was managed by Dr. Graboys with
medication and lifestyle for more than 10 years. “At the
Lown Center, they are not invasive as far as surgery goes;
they try to ward it off,” notes Tony Jr. “My father knew
he’d need surgery sooner or later, but Dr. Graboys kept
Tony Jarvis, Jr. and Carol Jarvis, both patients of Dr. Brian Bilchik,
represent two of the four generations of Jarvises who have been part
of the Lown Center community over several decades.
1 0 L O W N F O R U M
“When you come across a group ofindividuals who care about you as aperson you are blessed…Ourexperiences at the Lown CardiovascularCenter have been top notch. When wecame to the Lown Center, weexperienced the kind of care that trulymakes a difference. Receiving patient-centered care is simply wonderful. Eachtime we contact the office, we aretreated with respect and provided thesupport needed from simple refills ofmedication to questions about changesin my condition.”
Patient letter, January 2010
The Lown Cardiovascular Research
Foundation promotes cardiac care that
advocates prevention over costly,
invasive treatments and restores the
relationship between doctor and
patient.
For more than 5 years, Alicia accompanied her mother,
JeanAnn, to appointments at the Lown Cardiovascular
Center. Alicia, a mother of four
young children, felt and looked
healthy.
“I’m 38 years old—it never once
crossed my mind that at my age
I might need a cardiologist. But
because of my family history,
coupled with some minor symptoms I was experiencing,
my mother kept urging me to make an appointment for
myself. As the mother of four children all under the age of
11, I knew it was important for me to take care of myself,
so I finally did,” Alicia recalls.
“Seeing Dr. Bilchik gives me peace of mind,” Alicia
explains. “Each visit is very thorough; he always manages
to put my fears to rest. I asked him early on if he sees a lot
of people my age, and he reassured me that he does. In
fact, he prefers to see people when they’re young, before
they have a problem.”
“A lot of people hear ‘cardiologist’ and assume they are
doctors for the elderly. But that’s not true. Seeing Dr.
Bilchik has been a really positive thing in my life. I’m being
proactive and taking care of myself.”
Sisters: Elizabeth and HelenAt age 90, Elizabeth still works part-time at the company
where she has worked for 62 years. Her relationship with
the Lown Center began more
than 25 years ago, when a co-
worker suggested she see Dr.
Tom Graboys.
Soon after her visit, she
recommended Dr. Graboys to
her sister, Helen. The sisters
have been coming to the Lown Center ever since and now
both see Dr. Bilchik. “Our father had heart trouble and
passed away in his 50’s as a result,” Elizabeth recalls. “My
sister and I each first came to the Lown Center because of
different heart trouble.”
They attribute their longevity to “a small glass of
pomegranate juice every day.” Hard work has kept their
minds active, but they always made time to relax. “People
don’t rest enough today,” Elizabeth observes. “It’s
important to slow down.”
Alicia, Jean Ann, and sister
Jennifer
Sisters: Helen and Elizabeth
L O W N F O R U M 1 1
FAMILY PORTRAITS
Mom knows best: JeanAnn and Alicia
Board�of�Directors
Nassib ChamounChairman of the Board
Vikas Saini, MDPresident
Bernard Lown, MDChairman Emeritus
Thomas B. Graboys, MDPresident Emeritus
Patricia AslanisCharles M. Blatt, MDJoseph Brain, SDJanet Johnson BullardJ. Breckenridge EagleCarole Anne McLeodC. Bruce MetzlerBarbara H. Roberts, MDRonald ShaichRobert F. Weis
Advisory�BoardMartha CrowninshieldHerbert EngelhardtEdward FinkelsteinWilliam E. FordRenee Gelman, MDGeorge GraboysBarbara GreenbergMilton LownJohn R. MonskyJeffrey I. SussmanDavid L. Weltman
CONTACT�US
Lown�CardiovascularResearch�Foundation21 Longwood AvenueBrookline MA 02446(617) 732-1318info@lownfoundation.orgwww.lownfoundation.orgwww.procor.org
Lown�Cardiovascular�Center
Brian Z. Bilchik, MDCharles M. Blatt, MDWilfred Mamuya, MD, PhDShmuel Ravid, MD, MPHVikas Saini, MD
Lown�Forum
EditorCatherine Coleman
Editorial�supportClaudia KenneyJessica Gottsegen
c2010 Lown FoundationPrinted on recycled paper withsoy-based ink.
Lown Cardiovascular Research Foundation21 Longwood AvenueBrookline, Massachusetts 02446-5239
Nonprofit Org.US Postage
PAIDBoston, MA
Permit No. 53936
In March 2010, the Lown Cardiovascular Center launched a
heart health education campaign within the greater-
Boston community. “For many years, the work of the
Lown Center has been recognized throughout the country
and the world, but little has been done to reach out to our
local community,” says Dr. Vikas Saini, President of the
Lown Cardiovascular Research Foundation. “Big changes
are coming to the health care system, and we expect the
perspective of the Lown Group to be valuable as we
grapple with achieving quality without unnecessary
interventions.”
Through a series of lecture events at malls, assisted living
facilities, and senior centers, the Lown physicians have
been connecting with the local community to provide
education about the importance of heart disease
prevention. A wide range of topics, including nutrition,
exercise, stress reduction, alternatives to surgery, and
second opinions, have been presented.
“The lectures introduce the physicians to the community,
so people can get to know them and have their
questions answered,” says Nancy Stuart, Outreach
Coordinator at the Milton Council on Aging, where a
recent lecture took place.
During the past five months they have given lectures in
People who attend the lectures often comment on the
valuable information presented and the time the
physicians take to listen and answer questions. According
to one audience member, “The information was easy to
understand and the group setting allowed us to share
different perspectives on what was being discussed.”
The Lown Center has taken the campaign a step further
by reaching out to local businesses to establish worksite
wellness events. Connecting with employees provides a
valuable opportunity to educate adults in their 30s, 40s,
and 50s on the prevention of cardiovascular disease.
“Today, the media is saturated with news about medical
developments, making it difficult for individuals to
separate the wheat from the chaff,” says Dr. Saini. “Many
people don’t realize that much of what passes for medical
news is actually sponsored messaging by vested interests.
At our lectures, we offer an alternative and unbiased view
of technology and practices in the health care system. We
see that there is a huge interest in this kind of information
and discussion. Our events give people an opportunity to
ask questions that they don’t often have time to ask their
own doctor during a regular office visit.”
A participant noted, “This was truly an eye-opener for me!
I learned so much in just one hour and I haven’t stopped
sharing what I learned with my family and friends.”
If you are interested in hosting a lecture on heart health at yourworksite or community organization, please contact JessicaGottsegen ([email protected] or 617-732-1318 x3805).
Dr. Vikas Saini presented on the topic of exercise at the Minutes in
Motion event at the Brookline Senior Center in May 2010.
Contributing to health in the heart of the community
