Joining The ISCVP (International Society for Cardiovascular Disease Prevention)
Recently I gave a presentation about metabolic syndrome emphasizing my successful last twenty-year approach and at the end of the lecture I divulged that I did not heavily rely upon therapeutic lifestyle changes. I came under severe rebuke by one attendee despite the fact in my lifetime I had obtained a medical degree, accumulated more than 45 years of medical practice, quadruple board certification especially in Cardiovascular Disease and Clinical Lipidology, the latter in which I recently became a grandfathered diplomate, one of the only 200-250 in the country, I proceeded to cite a more recent New England Journal of Medicine article, the LOOK AHEAD trial, discussed by Jay Cohn MD at a recent ISCVP sponsored course in Sarasota. But that was to no avail. Old untrue concepts die hard and can persist for centuries.
However, confusing as it is, even at this course there were some speakers still espousing the benefit of TLC with regard to event reduction and longevity. I personally detect in my life time the ceding of treatment standards away from physicians to other financially controlling groups and probably computers in the future.
For the last 20 years I have not pushed therapeutic lifestyle changes upon my patients as I did in the first 27 years. This was simply because, whatever the reason, it did not work. I noticed years ago that the vast majority of patients had difficulty adhering to any diet regimen outside of their race, ethnic or religious background and forget about any substantial sustained weight loss. My previous instructions about TLC learned from my early medical training caused me to lose more patients then I ever helped. Patients did not return either because they were disappointed with their results from my instructions that they could not personally attain or sustain. Secondly they could not face the disappointment in themselves or envisioned in me during their office visit. Thirdly they may have felt I did not know what I was talking about. As time progressed the latter became the truth but I was smart enough to stop TLC emphasis 20 years ago.
This group in the International Society for Cardiovascular disease prevention is the first time I have heard any individual from any medical society move toward the conclusions I drew 20 years ago and consequently because of his more realistic approach, I enrolled as a member.
When I finished my training we had little to offer the public e.g. the care rendered to Dwight Eisenhower for recurrent myocardial infarctions and frequent flyer status to the hospital for his cholesterol problem. Although today we have the statins and other anti-cholesterol medications as well as other enormously expensive medicines approaching the market, we still have had a steady unabated stream to the hospital for interventional or bypass procedures.