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M. P. Ravindra Nathan
‘BRIDGING THE GAP BETWEEN SCIENCE AND PRACTICE’
By M. P. Ravindra Nathan, MD, FACC

In spite of the numerous advances in cardiology to date, believe it or not, more people still die of heart disease in United States, ahead of cancer and strokes. Although a lot of research is being conducted, many are not yet translated into bedside therapies. Therefore, “Bridging the Gap between Science and Practice” was the theme of the recently concluded 54th annual Scientific Sessions of American College of Cardiology (ACC) in Orlando.

And indeed this convention, one of the biggest international medical meetings in the world attended by more than 30,000, including cardiologists, internists, nurses, scientists, technologists and industry specialists, was a true showcase of new research, trials and products, all of which promise to make a dent into the ravages of heart diseases. From practicing physicians to high-level researchers, there was something for everyone.

Cholesterol, as usual, received top billing and new lipid-lowering strategies across the risk continuum were discussed by the many experts who noted that an expansive gap exists between published practice guidelines and actual practice in the area of lipid management. One evening, all Indian cardiologists met American Association of Cardiologists of Indian Origin (AACIO) to discuss the burning issue of “Heart Disease among Indians,” in the States. Sandip Mukherjee from Yale presented convincing evidence that Indians need to go one step beyond the standard guidelines recommended by the National Cholesterol Education Program (NCEP).

Evidence-based medicine

During the opening-day plenary session, Michael J. Wolk, president of ACC, stressed the importance of practicing “evidence-based medicine,” a term which you will be hearing more often in future. “Today, with all the marvels of medical science at our finger tips, we are blessed with an arsenal of high-tech weapons and therapeutic agents to combat heart disease. Yet, all this sci-fi ability presents us with the unique challenge and frustration of determining appropriate application and equitable allocation,” he said.

As we begin to understand the basic mechanisms of diseases better and develop newer and more effective treatment protocols, it is important to carefully apply these strategies in a discrete manner using the published evidence as your guideline for choice of therapy. Prescribing paternalistic medicine, simply based on your convictions or past experience, is not acceptable any more; one must rely on proof that such therapies actually work and are indeed helpful in a given patient.

I still remember when I was a young medical student, I used to suffer from recurrent urticarial rashes and got treated with IV Calcium injections. I didn’t particularly like the feeling of the warm flush as the calcium flowed through my system while forced to lie on a cot in a hot, humid room. One day, I asked the elderly professor, “Sir, does this actually work?” Suddenly the façade of collegiality vanished from his face and he gave me a stern look which meant, “Don’t question me, boy, I know what is good for you.” Well, those days are gone, this is the age of consumerism and you have every right to ask questions, especially when it comes to your health.

Overall, this convention was one of the best in my recent memory, although at times it took the ambience of a mela. “The lower the better” was the take-home message, meaning, the lower your bad cholesterol (LDL), the lower the BP, the lower the blood glucose in diabetics and pre-diabetics, and the lower the CRP (a marker for inflammation connected with heart disease), the better you will do in life. As the ACC president Wolk said, “It is critical to move the paradigm from intervention to prevention of heart disease, and to move to the adoption of evidence-based guidelines.”

Cardiologist Dr. M. P. Ravindra Nathan lives in Brooksville.



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