Transcript: Heart of the Matter | Jul 26, 2019

Nam sits in the studio. She's in her early forties, with shoulder length curly brown hair. She's wearing glasses and a black blazer over a pink blouse.

A caption on screen reads "Getting to the heart of the matter. Nam Kiwanuka, @namshine, @theagenda."

Nam says HEART DISEASE KILLS FAR MORE
PEOPLE EVERY YEAR THAN CANCER.
THAT'S A FACT
THAT MAY SURPRISE YOU.
IF IT DOES, IT'S PROBABLY THANKS
TO THE MANY SUCCESSES
THAT SCIENCE AND THE MEDICAL
PROFESSION HAVE ACCOMPLISHED
THAT'S MADE IT LESS SCARY
THAN IT ONCE WAS.
HAIDER WARRAICH
IS A CARDIOLOGIST
AT DUKE UNIVERSITY
MEDICAL CENTER
IN DURHAM, NORTH CAROLINA.
HIS NEW BOOK,
STATE OF THE HEART:
EXPLORING THE HISTORY, SCIENCE
AND FUTURE OF CARDIAC DISEASE,
TAKES IN THE SWEEP
OF THAT PROGRESS.

Haider is in his forties, clean-shaven, with short, receding black hair. He's wearing glasses, a gray suit, pale pink shirt, and black floral print tie.
A picture of his book appears briefly on screen. The cover is half white and half beige, with a drawing of a heart that is half hyper realistic and red, and half drawn in pencil in vintage style.

Nam continues IT'S VERY NICE TO MEET YOU
TO TALK ABOUT THIS.

Haider says THANK YOU SO MUCH.

Nam says UM, I WAS REALLY
SURPRISED TO LEARN
THAT HEART DISEASE HAS BEEN
STUDIED SINCE ANCIENT TIMES.
WHY DID YOU WANT TO EXPLORE
THAT HISTORY IN THE BOOK?

The caption changes to "Haider Warraich. Author, 'State of the heart.'"
Then, it changes again to "The cardiac landscape."

Haider says WELL, I THINK THAT, YOU KNOW,
PART OF IT IS BECAUSE
I THINK
UNLESS WE LOOK AT HISTORY
AND LOOK AT IT
IN A CRITICAL WAY,
THEN HOW WE WILL LEARN ABOUT,
YOU KNOW,
WHAT ARE THE THINGS
THAT WE CAN DO BETTER
MOVING FORWARD?
AND CERTAINLY, THE HEART
HAS BEEN SUCH AN INTEGRAL...
PART OF OUR LIVES, REALLY
FROM THE FIRST FEW DESCRIPTIONS
OF NOT JUST HEALTH
BUT OF HUMAN LIFE,
THAT I FELT THAT THERE'S
A LOT MORE THAN WE CAN LEARN,
ESPECIALLY AS WE TRY AND AVOID
SOME OF THE MISSTEPS
WE'VE MADE IN THE PAST.

Nam says ONE THING I REALLY LIKED ABOUT
THE BOOK IS THAT YOU MAKE
EASY TO UNDERSTAND A VERY
DIFFICULT TOPIC, WAS THAT
ONE OF YOUR INTENTIONS IN
WRITING THIS BOOK?

Haider says I MEAN CERTAINLY I THINK THAT
WHEN I WROTE THE BOOK
I REALLY WANTED PEOPLE TO GO ON
A JOURNEY, THAT THEY CAN BE
IMMERSED IN.
AND IF I MAKE IT TOO HARD OR
TECHNICAL THEN I'LL LOSE PEOPLE
ALONG THE WAY, SO I WANTED TO
WRITE SOMETHING THAT PEOPLE
CAN REALLY, REALLY GET INVOLVED
IN.
AND NOT JUST THINK ABOUT THE
HEART BUT REALLY THINK ABOUT
WHAT THIS MEANS ABOUT WHAT IT
MEANS TO BE A HUMAN BEING.

Nam says AND ALSO TO KNOW THEIR BODY A
BIT BETTER, MAYBE.
EARLY ON IN
STATE OF THE HEART,
YOU WRITE...

A quote appears on screen, under the title "A modern malady?" The quote reads "Even as we have made tremendous progress in helping people live through heart attacks, there is still so much we don't know about what causes heart attacks and what is the best way to treat them. Many think of heart attacks as being a modern disease, a consequence of the ills of our sedentary, overconsumptive lifestyles, yet that couldn't be further from the truth."
Quoted from Haider Warraich, "State of the heart." 2019.

Nam says SO, WHEN I READ THAT,
I HEAR THAT YOU'RE SAYING
THAT A LACK OF EXERCISE
OR MAYBE EATING
THAT EXTRA PASTRY
DOESN'T CONTRIBUTE
TO HEART DISEASE.
IS THAT
WHAT YOU'RE SAYING?

Haider says WELL, WHAT I'M SAYING IS
I THINK THAT
BOTH OF THOSE THINGS REALLY DO
CAUSE HEART DISEASE,
BUT IN SOME CASES.
I THINK INCREASINGLY,
WHAT I'VE SEEN
AND WHAT I THINK OTHERS
HAVE NOTED AS WELL
IS THAT PEOPLE...
WHEN SOMEONE GETS HEART DISEASE,
IT'S ALMOST LIKE IT IS
THEIR FAULT.
THAT,
"OH, YOU WEREN'T CAREFUL ENOUGH.
YOU DIDN'T EAT RIGHT
OR YOU DIDN'T EXERCISE."
BUT THAT'S JUST PART OF
THE STORY.
I THINK
WHAT WE ALSO NEED TO LOOK AT
IS THAT A LOT OF PEOPLE GET
HEART DISEASE, YOU KNOW,
REALLY OUT OF THE BLUE,
JUST BECAUSE OF, YOU KNOW,
BAD GENETICS OR REALLY, THE SORT
OF SOCIETAL STRUCTURES
THAT ENABLE SUCH POOR
LIFESTYLE CHOICES
TO OCCUR IN THE FIRST PLACE.
YOU KNOW,
WHEN WE LOOK AT SOMEONE...
WHEN WE LOOK AT PEOPLE
AND THEY'RE HAVING
A LOT OF SORT OF...
THEY'RE MAKING A LOT OF
BAD DIETARY CHOICES,
WE NEED TO LOOK AT
WHAT ARE WE DOING IN SOCIETY
AND WHAT ARE WE DOING
IN OUR HEALTH SYSTEM
THAT ARE ALLOWING FOR THAT
TO HAPPEN.
AND THE REASON THAT'S
REALLY IMPORTANT IS BECAUSE
I THINK THAT
IF PEOPLE DON'T HAVE...
IF PEOPLE BELIEVE THAT HEART
DISEASE IS SOMEONE'S FAULT,
THEY'RE NEVER GOING TO REACT
TO IT IN THE SAME WAY.
IF YOU THINK ABOUT
WHAT HAPPENS
WHEN SOMEONE GETS DIAGNOSED
WITH CANCER, FOR EXAMPLE...

Nam says PEOPLE RALLY BEHIND THEM.

Haider says IT'S...
IF I GO TO A PATIENT'S ROOM
AND THEY'VE JUST BEEN DIAGNOSED
WITH CANCER,
IT'S USUALLY FULL OF PEOPLE,
IT'S USUALLY FULL OF CARDS,
FULL OF FLOWERS,
FULL OF HOPE, FULL OF STRENGTH.
AND THERE'S A...
SOCIETY, FAMILY, REALLY RALLIES
AROUND PEOPLE IN A WAY
THAT THEY DON'T DO
FOR HEART DISEASE,
AND THAT'S ONE OF
THE REASONS WHY
I WANTED TO WRITE THE BOOK:
TO CHANGE THOSE NARRATIVES.

Nam says OVER THE COURSE
OF THE BOOK, YOU WRITE THAT
THE NUMBER OF PEOPLE DYING
FROM HEART DISEASE
IS INCREASING,
BUT THAT ALSO,
ADVANCEMENTS
IN THE TREATMENT
OF HEART DISEASE
ARE LEADING TO
FEWER DEATHS.
SO, HOW CAN IT BOTH OF
THOSE THINGS?

The caption changes to "Haider Warraich, @haiderwarraich."

Haider says WELL, FIRST OF ALL, THE NUMBER
OF PEOPLE WHO REACH OLDER AGES
HAS INCREASED.
AND SO, AS THE NUMBER OF PEOPLE
WHO ARE, YOU KNOW,
LIVING TO THEIR 70S AND 80S
IS INCREASING,
THAT PREVAL...
THAT ALSO MEANS THAT
THE NUMBER OF PEOPLE
WHO ARE AT RISK
FOR HEART DISEASE
HAS ALSO INCREASED.
THE OTHER THING
THAT WE HAVE SEEN IS THAT ALSO
THE TYPES OF HEART DISEASE
THAT WE ARE SEEING IS CHANGING.
SO, IN THE 1960S,
OR REALLY, SORT OF MOST OF
THE 20TH CENTURY,
THE MAJOR CAUSE OF DEATH WAS
PEOPLE DYING OF HEART ATTACKS.
AND OVER THE LAST
50 YEARS,
WE'VE SEEN TREMENDOUS PROGRESS
IN THAT SPACE.
BUT NOW, WHAT WE'RE ALSO SEEING
IS THAT PEOPLE ARE LIVING
THROUGH THOSE HEART ATTACKS,
BUT ARE DEVELOPING
OTHER CONDITIONS
SUCH AS HEART FAILURE,
WHICH IS REALLY
A MORE CHRONIC CONDITION.
SO, EVEN THOUGH
THE NUMBER OF PEOPLE
WHO ARE DYING OF HEART DISEASE,
THE RATE IS REDUCING,
BUT THE NUMBER OF PEOPLE
WHO LIVE LONG ENOUGH
TO HAVE A HEART ATTACK
IS INCREASING.
THE OTHER THING
THAT WE ARE SEEING IS THAT
HEART DISEASE
USED TO BE THOUGHT OF
AS A DISEASE
OF AFFLUENT COUNTRIES.
WE USED TO THINK THAT,
WELL, IF YOU'RE IN
A PLACE LIKE INDIA, PAKISTAN,
CHINA, BRAZIL,
YOU'RE MORE LIKELY TO HAVE
AN INFECTIOUS DISEASE,
ET CETERA.
BUT THAT HAS REALLY CHANGED,
BECAUSE OF, AGAIN,
PROGRESS IN OTHER DISEASES,
BUT ALSO PEOPLE LIVING LONG
ENOUGH TO HAVE HEART DISEASE.
SO NOW, HEART DISEASE,
HEART ATTACKS
AND SORT OF
THE WHOLE SORT OF MILIEU,
IS RESPONSIBLE...
IS THE REASON FOR
THE MAJORITY OF DEATHS.
NOT ONLY IN COUNTRIES SUCH AS
THE UNITED STATES OR CANADA,
BUT ALSO IN COUNTRIES SUCH AS
INDIA, CHINA, BRAZIL,
PAKISTAN, ET CETERA.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Nam says SO, IT'S A GROWING PHENOMENON
AROUND THE WORLD?

Haider says IT IS,
AND IT'S CHANGING HOW I THINK
WE NEED TO REALLY SORT OF
FRAME THINGS
AS FAR AS, YOU KNOW,
WHAT CAN WE DO TO HELP
THE REST OF THE WORLD.
A LOT OF TIMES WE FOCUS ON
JUST INFECTIOUS DISEASES,
BUT WE REALLY NEED TO
START THINKING MORE ABOUT
THESE NON-COMMUNICABLE DISEASES
LIKE HEART DISEASE.

Nam says LET'S GO BACK INTO
THE BOOK AGAIN.
AND YOU WRITE
IN
STATE OF THE HEART...

Another quote from the book appears on screen, under the title "Hearts and minds." The quote reads "To win the battle for people's hearts, doctors need to win over their minds."

Nam says HOW MUCH OF A CHALLENGE
IS IT FOR YOU
TO DEAL WITH THE WARNING SIGNS
OF HEART DISEASE
IN A PATIENT WHO SAYS THEY FEEL JUST FINE?

Haider says WELL, I THINK THAT, UM,
FIRST OF ALL,
IF SOMEONE FEELS FINE,
THAT'S GREAT,
AND WE DON'T NEED TO MEDICALIZE
HEALTHY PEOPLE.
BUT AT THE SAME TIME,
WHAT WE ALSO NEED TO DO IS
HAVING PEOPLE THINK ABOUT
THE RISKS OF DISEASE
GOING FORWARD, YOU KNOW?
I THINK ONE OF THE THINGS IS
THAT PEOPLE ARE LIVING
LONGER AND LONGER,
SO WE JUST DON'T...
WE NEED TO HAVE PEOPLE
THINK ABOUT THE LONG GAME.
NOT JUST LIVE...
NOT JUST LOOK AT
THE NEXT FIVE YEARS,
10 YEARS,
BUT REALLY LOOK AT
LIVING A LONG, HEALTHY LIFE.
AND ONE OF THE THINGS
THAT IS IMPORTANT IS THAT
TAKING CARE OF HEART DISEASE NOW
OR THE RISK FACTORS
FOR HEART DISEASE NOW,
SOME OF THE PAYOFFS
WILL NOT HAPPEN
IN THE NEXT FIVE YEARS,
10 YEARS.
IT'LL HAPPEN MUCH LONGER
DOWN THE PATH.
SO, I THINK HAVING PEOPLE
BE MORE ENGAGED
WITH THEMSELVES,
GIVING THEM AGENCY,
TELLING THEM
THAT THEY CAN IN FACT,
IF THEY PUT THEIR HEARTS
AND MINDS TO IT,
THEY CAN IN FACT
CHANGE THEIR OUTCOME
AND THEIR RISK
OF HAVING HEART DISEASE.
I THINK THAT'S REALLY SOMETHING
THAT'S VERY IMPORTANT.
SO, WITHOUT BEING FEAR-MONGERS,
SO TO SPEAK,
I THINK THAT
WHAT WE NEED TO DO IS
CARRY PATIENTS IN THIS JOURNEY.
WALK WITH THEM.
BE IN THEIR SHOES.
AND THEN REALLY HAVE THEM
THINK ABOUT WHAT IT MEANS
TO HAVE A LONG AND HEALTHY LIFE
IN THIS TIME.

Nam says LIKE EMPOWERING THEM?

Haider says MM-HMM.

Nam says YOU HAVE A LOT OF REALLY
INTERESTING STUDIES IN THE BOOK,
AND ONE THAT YOU MENTION WAS
THE RECENT ASSESSMENT
OF 159 MEDICAL STUDENTS.
AND THEY WERE TESTED ON
WHAT YOU SAY ARE
"THE STEPS REQUIRED
FOR ACCURATE
BLOOD PRESSURE MEASUREMENT."
HOW MANY OF THOSE STUDENTS
GOT ALL THE STEPS CORRECT?

Haider says I THINK IT WAS SO LOW THAT I...
I THINK IT WAS ONE.

Nam says IT WAS JUST ONE?

Haider says MM-HMM.

The caption changes to "Testing, testing..."

Haider says AND AGAIN, THAT GOES BACK TO
THINKING ABOUT HEART...
HYPERTENSION USED TO KILL
ONE IN EVERY TWO PEOPLE
IN THE UNITED STATES.

Nam says WHAT IS HYPERTENSION?

Haider says HYPERTENSION
IS HIGH BLOOD PRESSURE,
AND AGAIN, THE DEFINITION
OF THAT HAS CHANGED OVER TIME.
BUT IT IS ONE OF THE BIGGEST
PREVENTABLE CAUSES OF DEATH
IN THE ENTIRE WORLD.
AND YOU'D THINK THAT
THAT WOULD BE SOMETHING
THAT ELICITS MORE ATTENTION:
NOT JUST FROM THE PUBLIC,
BUT REALLY FROM THE PHYSICIANS
WHO ARE TAKING CARE OF IT.
AND YET, AS THIS STUDY SHOWED...
AND IT WAS EYE-OPENING FOR ME...
THAT VERY FEW PEOPLE
EVEN KNOW
HOW TO MEASURE
BLOOD PRESSURE WELL
BECAUSE AGAIN,
IT JUST DOESN'T EVOKE
THE SAME TYPE OF ATTENTION.
BUT THE INTERESTING THING
I WOULD STILL SAY IS THAT
EVEN WHEN
NOT MEASURED ACCURATELY,
IT STILL GIVES US
SO MUCH INFORMATION.

Nam says WELL, HOW MUCH
DO YOU REALLY LEARN
ABOUT A PATIENT'S HEART HEALTH
FROM TAKING
THEIR BLOOD PRESSURE?

The caption changes to "Haider Warraich. Duke University Medical Center."

Haider says I MEAN, HIGH BLOOD PRESSURE
NOT ONLY LEADS TO...
IS ONE OF THE BIGGEST
RISK FACTORS FOR HEART ATTACKS,
BUT IT ALSO IS ONE OF THE...
PROBABLY THE BIGGEST RISK FACTOR
FOR STROKE,
ONE OF THE BIGGEST RISK FACTORS
FOR HEART FAILURE.
SO, JUST THAT SIMPLE STEP
IS ACTUALLY...
REALLY OPENS UP A WINDOW
INTO SOMEONE'S HEALTH
UNLIKE VERY FEW THINGS
THAT WE HAVE IN OUR ARSENAL.

Nam says SO, THE DOCTOR...
THE STUDENTS LEARNING
TO BE DOCTORS
HAVE TO KNOW
ALL THE STEPS CORRECTLY?

Haider says ABSOLUTELY.

Nam says IN THE BOOK,
YOU SHARE THAT
YOUR FATHER EXPERIENCED
A HEART ATTACK.
WHAT HAPPENED AFTER
HE HAD THE HEART ATTACK?

The caption changes to "In stents we trust."

Haider says WELL, I, UM...
(CLEARING THROAT)
I WAS ASLEEP, AND MY FATHER...
I WORK IN THE UNITED STATES.
MY FATHER IS BACK HOME
IN PAKISTAN.

Nam says IN PAKISTAN?

Haider says AND MY, UH...
THIS HAPPENED IN THE MORNING,
HIS TIME.
HE HAD NEVER HAD
ANY TYPE OF HEART ISSUES,
AND HE STARTED FEELING SWEATY.
AND HE DIDN'T FEEL RIGHT,
AND MY MOTHER, WHO'S A DENTIST,
IMMEDIATELY KNEW
SOMETHING WAS WRONG.
AND INSTEAD OF CALLING
THE AMBULANCE,
SHE PUT HIM IN THE BACK OF HER...
THE CAR,
AND JUST DROVE HIM TO
THE NEAREST HEART HOSPITAL
SHE COULD GO TO.
AND WHEN HE GOT THERE,
THEY DID AN EKG,
AN ELECTROCARDIOGRAM,
THAT YOU HAVE DISPLAYED NICELY
IN THE BACK.

A wide-shot of the studio shows a wall screen behind Haider and Nam, displaying an image of an electrocardiogram.

Haider continues THEY FOUND OUT
THAT HE WAS HAVING
A HEART ATTACK.
AND THEN, BY THE TIME...
WITHIN ABOUT 30 OR 35 MINUTES,
THEY HAD ALREADY DONE
THIS PROCEDURE
IN WHICH THEY HAD OPENED UP
THE BLOOD VESSEL
THAT WAS BLOCKED AND
THAT WAS OBSTRUCTING BLOOD FLOW
IN HIS HEART.
SO, WHEN HE CALLED ME,
EVERYTHING WAS TAKEN CARE OF.
AND TO ME, THAT WAS SUCH A...
I FELT BOTH HELPLESS,
THAT I AM NOT THERE WITH HIM,
BUT AT THE SAME TIME,
I WAS SO THANKFUL
THAT WE HAD MADE
THAT TYPE OF PROGRESS:
THAT THE TYPE OF CARE
THAT HE WOULD HAVE RECEIVED
IF HE WERE IN TORONTO, IF
HE WERE IN BOSTON OR NEW YORK,
HE GOT THE SAME TREATMENT,
THE SAME CARE IN PAKISTAN.
AND THAT IS
SUCH A GREAT, UM...
AND EVERYONE WHO'S INVOLVED
WITH THAT JOURNEY,
ALL THE PEOPLE WHO HAVE HELPED
DEVELOP THESE THERAPIES,
THAT HAVE THEN HELPED PATIENTS
GET THEM,
THEY SHOULD BE PROUD OF THAT.
THAT YOU CAN BE, REALLY,
IN MOST PARTS OF THE WORLD,
YOU'LL BE ABLE TO GET
SUCH GREAT THERAPIES
FOR HEART ATTACKS.
AND THAT IS SOMETHING
THAT I THINK
NOT A LOT OF PEOPLE REALIZE
IS ONE OF
THE GREATEST ACHIEVEMENTS
OF OUR SPECIES, ALMOST.
AND SO, TO ME
IT WAS HUMBLING,
AND THANKFULLY,
HE HAS DONE GREAT SINCE THEN.

Nam says I WAS JUST ABOUT
TO ASK YOU.

Haider says YEAH. HE'S DONE GREAT.
HE TAKES HIS MEDICATIONS.
HE'S NEVER HAD
ANY OTHER SYMPTOMS SINCE THEN.
BUT I THINK THAT
WHEN I LOOK AT THAT,
I THINK THAT'S A STORY
THAT MOST PEOPLE DON'T REALIZE
THE IMPACT OF THAT.
FOR NOT JUST PEOPLE HERE
IN COUNTRIES LIKE CANADA
AND THE UNITED STATES,
BUT REALLY, ALL OVER THE WORLD.

Nam says AND WE HAVE LONGER TIME
WITH OUR LOVED ONES.

Haider says OF COURSE.

Nam says AS PART OF YOUR DAD'S
CARDIAC TREATMENT,
HE RECEIVED A STENT?

Haider says MM-HMM.

Nam says WHAT EXACTLY IS THAT,
AND HOW DID THEY COME
TO BE USED?

Haider says SO, HOW HEART ATTACKS HAPPEN
IS THAT...
SO, YOUR HEART IS SURROUNDED
BY BLOOD VESSELS
CALLED THE CORONARY ARTERIES.
AND SO, EVEN THOUGH
THE HEART IS FULL OF BLOOD,
IT STILL NEEDS
BLOOD SUPPLY
TO KEEP DOING
WHAT IT'S DOING,
AND THOSE COME FROM
THESE BLOOD VESSELS
THAT WRAP AROUND
THE HEART.
ONE OF THESE BLOOD VESSELS
IS CALLED THE LAD,
ALSO REFERRED TO AS
THE WIDOW-MAKER.
AND IN HEART...

Nam says BECAUSE BEFORE,
IT WAS...
SOMEONE WOULD LOSE THEIR SPOUSE,
USUALLY MEN?

Haider says IT WAS THOUGHT AT THAT TIME
THAT HEART DISEASE
IS PURELY A PHENOMENON
THAT AFFECTS MEN,
AND WE CAN TALK ABOUT THAT
AS WELL.
BUT HAVING AN...
WHAT WOULD HAPPEN...
WHAT HAPPENS IN HEART ATTACKS
IS THAT YOU GET BLOCKAGES
IN THESE BLOOD VESSELS.
SO, THE HEART ITSELF
DOESN'T GET BLOOD
AND HEART TISSUE
STARTS TO DIE OFF.
AND NOW, WE HAVE A LOT
OF THERAPIES
THAT CAN HELP IN THE LONG TERM.
BUT IF YOU HAVE
AN ACUTE OBSTRUCTION
OF BLOOD FLOW
IN ONE OF THE ARTERIES,
THAT CAN RESULT IN
A HEART ATTACK
CALLED A MYOCARDIAL INFARCTION.
AND SO, THAT'S WHAT HE HAD.
AND STARTING IN THE 1970S,
SCIENTISTS
AND CLINICAL RESEARCHERS
REALLY STARTED TO THINK ABOUT,
WELL, HOW CAN WE HELP PATIENTS
IN THIS HOUR OF NEED.
AND ONE OF
THE THERAPIES
THAT WAS DEVELOPED
WAS THE STENT,
WHICH IS REALLY
A SMALL SORT OF METAL WIRE FRAME
THAT CAN BE DEPLOYED USING
MINIMALLY INVASIVE TECHNIQUES
THROUGH
JUST A SMALL INCISION:
SOMEONE'S LEG
OR IN SOMEONE'S WRIST,
ALL THE WAY TO THE HEART.
AND THAT CAN BE USED
TO OPEN UP
THESE OBSTRUCTIONS.

Nam says SCIENCE IS AMAZING.
(LAUGHING)

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Haider says IT'S AMAZING, AND IT'S REALLY,
REALLY WONDERFUL.
AND THE DATA
IN ACUTE HEART ATTACKS
IS REALLY SO COMPELLING,
AND THE STORY OF HOW
THESE THERAPIES WERE DEVELOPED
AND THE PEOPLE WHO DEVELOPED IT
WAS JUST SUCH A
FASCINATING JOURNEY FOR ME.
UH, AND REALLY READING ABOUT,
YOU KNOW,
THESE TRAILBLAZERS WHO...
ONE OF THE KEY PEOPLE
THAT I TALKED ABOUT
WAS ANDREAS GRUENTZIG.
HE WAS A GERMAN-BORN
CLINICAL RESEARCHER,
AND HE DEVELOPED THESE...
THE TECHNOLOGY THAT NOW HELPS US
DELIVER STENTS
ON HIS TABLE,
ON HIS DINNER TABLE
AND IN THE KITCHEN SINK.
AND IS NOW...
HE UNFORTUNATELY TRAGICALLY DIED
IN A PLANE CRASH
WHEN HE WAS STILL A YOUNG MAN,
AND I WISH HE WERE HERE
TO SEE THE THINGS
THAT HE SET INTO MOTION
HAVE SAVED SO MANY PEOPLE'S
LIVES, INCLUDING MY DAD'S.

Nam says HIS LEGACY
LIVES ON.

Haider says MM-HMM.

Nam says YOU POINT OUT THAT
THE MEDICAL DEVICE INDUSTRY
IN THE STATES IS VALUED AT
140 BILLION dollars.
THAT IS A STAGGERING
AMOUNT OF MONEY.
HOW HAS THAT INDUSTRY INFLUENCED
THE USE OF THINGS
SUCH AS STENTS
AND NEW FORMS
OF CARDIAC IMAGING?

Haider says SO, YOU KNOW, I THINK TALKING
ABOUT ANDREAS GRUENTZIG,
BEFORE THERE WAS REALLY
AN INDUSTRY,
MEDICAL DEVICES AND TECHNOLOGY
WAS BEING DEVELOPED
BY SCIENTISTS AND RESEARCHERS,
YOU KNOW,
IN THEIR KITCHEN SINK,
BASICALLY.
BUT AS TECHNOLOGIES DEVELOPED
AND MATURED,
AND THEY CONSOLIDATED
INTO WHAT COULD BE CALLED
THE MEDICAL DRUG AND DEVICE
INDUSTRY...
AND I THINK STENTS
ARE A GREAT EXAMPLE
OF WHAT THE IMPACT
OF THIS INDUSTRY HAS BEEN
IN HELPING PATIENTS.
BUT AT THE SAME TIME,
WE HAVE TO REALIZE THAT
THESE ARE ALL BUSINESSES
AND THEY'RE RUN LIKE
ANY OTHER BUSINESS WOULD.
AND IN THE END,
EVEN THOUGH THEY DO ACHIEVE
GREAT OUTCOMES
FOR A LOT OF PATIENTS,
IN THE END WHAT IS
VERY IMPORTANT TO THEM
AND THEIR SOLVENCY IS, UM,
REALLY IS MONEY.
AND THIS IS ALL...
AND WHAT
THEIR SHAREHOLDERS' INTERESTS
WILL TRUMP ANY OTHERS'.
SO, I THINK THAT WE NEED TO BE
ENCOURAGING OF INNOVATION
IN MEDICAL DEVICES, BECAUSE AS...
YOU KNOW, I THINK THE
STENT STORY IS A GREAT EXAMPLE
OF HOW THEY CAN IN FACT
SAVE LIVES.
BUT AT THE SAME TIME,
WE ALSO NEED TO PUSH BACK
WHEN SKEPTICISM IS NECESSARY
ABOUT THESE DEVICES,
BECAUSE IN THE END, THEY ARE
GOING INTO OTHER HUMAN BEINGS.
AND WE NEED TO HOLD THEM TO
A LEVEL OF EVIDENCE
THAT WE WOULD
FOR DRUG COMPANIES.
SO, ONE OF THE INTERESTING
THINGS THAT HAS EVOLVED IS THAT
THE LEVEL OF EVIDENCE REQUIRED
FOR A DEVICE TO GET APPROVED
IS MUCH LOWER THAN
THAT FOR A MEDICATION.
AND I THINK
THAT'S ONE STANDARD
THAT DEFINITELY NEEDS TO BE
LOOKED AT VERY STRINGENTLY.
AGAIN, THIS IS NOT TO SAY THAT
WE NEED TO SLOW DOWN INNOVATION
OR THAT, YOU KNOW,
THEY'RE ALL BAD GUYS.
IN FACT, YOU KNOW,
THE BENEFITS OF THE INDUSTRY
ARE FOR EVERYONE TO SEE.
BUT AT THE SAME TIME,
I DO THINK THAT WE CAN HOLD THEM
TO A HIGHER STANDARD OF SAFETY.

Nam says TO USE THEM
WHEN THEY'RE NEEDED.

Haider says ABSOLUTELY.

Nam says YOU ALSO WRITE...
WHICH I FOUND
REALLY SURPRISING...
THAT UNTIL
JUST A FEW DECADES AGO,
WOMEN WERE BARELY
THE FOCUS OF RESEARCH
WHEN WE TALK ABOUT
HEART DISEASE.
WHY WAS THAT?

The caption changes to "Gender differences."

Haider says WELL, SOME OF IT...
SO, YOU KNOW,
I THINK JUST FOR EVERYONE,
HEART DISEASE KILLS
AS MANY WOMEN AS IT DOES MEN.
THIS IS SOMETHING
THAT WE RECOGNIZE NOW,
BUT STILL, A LOT OF PEOPLE
DON'T REALIZE THAT.
A LOT OF PEOPLE STILL THINK OF
HEART DISEASE
AS A DISEASE OF MEN.
AND CERTAINLY,
WHEN WE STARTED TO THINK ABOUT...
WHEN HEART DISEASE
FIRST BECAME PROMINENT,
AND THIS WAS REALLY AROUND
THE TIME OF
THE 1940S AND '50S,
IT WAS AFFECTING
A LOT OF YOUNG MEN.
AND SO,
THE IDEA BECAME THAT...
AND YET, THE WOMEN
WHO WERE BEING AFFECTED
WERE EITHER NOT BEING DIAGNOSED
OR THEY WERE BEING...
OR THEY WERE HAVING
HEART DISEASE AT OLDER AGES.
SO, THEY JUST DIDN'T REALLY FIT
THE STEREOTYPE
OF SOMEONE
WHO HAD HEART DISEASE.
THAT'S SOMETHING
THAT'S THANKFULLY CHANGED NOW.
WE ARE STARTING TO REALIZE
THAT WOMEN ALSO HAVE
A VERY HIGH RISK
FOR HEART DISEASE,
ESPECIALLY IF THEY HAVE
RISK FACTORS.
THEY DO HAVE HEART DISEASE
SLIGHTLY AFTER MEN DO.
SO, AMONGST...
YOUNGER WOMEN DON'T HAVE
AS MUCH HEART DISEASE AS MEN DO,
BUT WHEN THEY DO, THEY ACTUALLY
MAY HAVE WORSE OUTCOMES,
BECAUSE THEY MAY NOT
THEMSELVES REALIZE
THAT THEY HAVE
A RISK OF HEART DISEASE.

Nam says BECAUSE YOU WRITE THAT
THE SIGNS, THE SYMPTOMS,
PRESENT THEMSELVES DIFFERENTLY
IN WOMEN THAN THEY DO IN MEN.
HOW DOES IT...
WHAT ARE THE DIFFERENCES?

Haider says SO, THIS IS AN AREA
THAT I WOULD SAY THAT
I THINK MOST PEOPLE THINK THAT
THE NUMBER OF PATIENTS
WITH HEART DISEASE
OR HEART ATTACKS
WHO HAVE ATYPICAL SYMPTOMS
OTHER THAN CHEST PAIN
OR CHEST PRESSURE
OR DIFFICULT BREATHING
IS MORE COMMON AMONGST WOMEN
THAN MEN.
THERE ARE SOME STUDIES
THAT DON'T SHOW THAT.
BUT I THINK IT IS FAIR TO SAY
THAT, UH, MORE STUDIES...
MORE WOMEN ARE LIKELY TO HAVE
ATYPICAL SYMPTOMS
SUCH AS SOMETHING AS SIMPLE AS,
YOU KNOW, NAUSEA OR VOMITING,
OR A FEELING OF
A SENSE OF DOOM
OR BREATHING ISSUES,
AS OPPOSED TO
THE CLASSIC CHEST PAIN
THAT MEN HAVE.
UH, THAT MOST MEN HAVE.
SO, THERE ARE CERTAIN
DIFFERENCES IN SYMPTOMS,
BUT THERE IS ALSO
AN AWARENESS ISSUE,
THAT A LOT OF WOMEN
JUST DON'T THINK THAT
THEY'RE AT RISK
FOR HEART DISEASE.
AND THAT'S A FAILURE ON OUR PART
AS A MEDICAL COMMUNITY,
THAT WE HAVE NOT
SENSITIZED WOMEN ENOUGH
OF THE RISKS OF HEART DISEASE
IN WOMEN AS WE HAVE MEN.
IF YOU THINK ABOUT A DISEASE
LIKE BREAST CANCER, FOR EXAMPLE,
IF YOU LOOK AT THE COVERAGE
THAT BREAST CANCER RECEIVES,
IF YOU LOOK AT THE...
IT IS MUCH... IT IS SEEN...
IT EVOKES A VERY DIFFERENT SET
OF EMOTIONS
THAN HEART DISEASE IN WOMEN.
WHAT WE'VE ALSO REALIZED
OVER TIME IS THAT
THE TYPE OF HEART DISEASE
WOMEN HAVE
IS DIFFERENT FROM THAT IN MEN.
AND ONE OF THE STORIES I SHARED
WAS THAT
OF A WOMAN WHO HAD
WHAT'S CALLED
A SPONTANEOUS CORONARY ARTERY
DISSECTION.
NOW, IN NORMAL HEART ATTACKS,
THERE'S A BLOCKAGE
IN THE HEART VESSEL.
BUT IN THIS CONDITION
CALLED SCAD,
THE BLOCKAGE IS ACTUALLY
BECAUSE OF A TEAR THAT HAPPENS
IN ONE OF THESE CRITICAL
CORONARY ARTERIES.
AND FOR A LONG TIME, WE JUST
DIDN'T EVEN RECOGNIZE IT,
BUT NOW, IT IS BECAUSE OF
WOMEN SUCH AS HER
AND OTHERS
THAT WE ARE STARTING TO REALIZE
THAT NOT ONLY DO WOMEN HAVE
AS MUCH HEART DISEASE AS MEN,
BUT THAT TYPE OF DISEASE
THAT THEY HAVE IS DIFFERENT.
AND WE JUST CAN'T HELP THEM
AS WELL AS WE DO NOW
BECAUSE WE JUST STILL HAVEN'T
STUDIED IT WELL ENOUGH.

Nam says AND MORE TIME
NEEDS TO BE...
TO FIND A BETTER SOLUTION.

Haider says ABSOLUTELY.

Nam says SOMETHING ELSE THAT YOU WRITE
ABOUT IS YOU USE THIS TERM
CALLED
"DIAGNOSTIC CREEP."
WHAT DOES THAT MEAN?

The caption changes to "Redefining heart attacks."

Haider says SO, DIAGNOSTIC CREEP
BASICALLY MEANS
THAT INCREASINGLY, WE ARE, UH...
THAT, YOU KNOW, DIAGNOSES
THAT WERE FIRST MADE
IN VERY, VERY SICK PATIENTS
ARE NOW BEING MADE
IN INCREASINGLY HEALTHIER...
OR SORT OF PATIENTS
AT LOWER RISK.
LET ME GIVE YOU AN EXAMPLE.
UM, ONE OF THE WAYS THAT WE...
SO, WHEN WE FIRST STARTED
DIAGNOSING HEART ATTACKS,
THE ONLY TOOL THAT WE HAD
WAS SOMETHING CALLED THE EKG,
WHICH IS RIGHT HERE IN THE BACK.
THEN...
BUT WE WERE MISSING PATIENTS
WHO WERE HAVING HEART ATTACKS
WHO DID NOT HAVE ABNORMALITIES
ON THE EKG.
AND THEN WE DEVELOPED
THESE LAB TESTS, BLOOD TESTS,
CALLED TROPONINS,
THAT COULD DETECT HEART DAMAGE
IN THE ABSENCE OF ANY CHANGES
ON THE HEART... ON THE EKG.
UH, BUT NOW,
WE ARE MOVING INTO
A TIME WHEN WE HAVE
NEW LAB BLOOD TESTS
CALLED HIGH-SENSITIVITY
TROPONINS.
THESE BLOOD TESTS
ARE SO SENSITIVE
THAT THEY CAN BE ELEVATED EVEN
IN PERFECTLY NORMAL PEOPLE,
PERFECTLY
HEALTHY PEOPLE.
AND SO, THE RISK OF USING THESE
INAPPROPRIATELY
IS THAT YOU MAY DIAGNOSE A LOT
MORE PATIENTS WITH HEART ATTACKS
WHEN THEY
JUST AREN'T HAVING THEM,
AND WHEN WE DON'T KNOW
IF THE THERAPIES
THAT WE ARE GIVING THEM
ARE GOING TO BE AS USEFUL
IN THEM AS IN THOSE PATIENTS
WHO WOULD HAVE
HEART ATTACKS DIAGNOSED BASED
ON PREVIOUS TYPES OF BLOOD TESTS
OR ON THE EKG.

Nam says YOU DISCUSS IN THE BOOK
THE DIFFERENCES BETWEEN
A MEDICAL TRIAL
AND AN OBSERVATIONAL STUDY.
HOW ARE THEY DIFFERENT?

The caption changes to "Understanding quality."

Haider says SO, I THINK THIS IS
ONE OF THE KEY THINGS
THAT I WISH TO DO IN THE BOOK.
A LOT OF TIMES, WHEN PEOPLE...
WHEN THE PUBLIC IS EXPOSED
TO RESEARCH,
THEY'RE DONE SO
IN A VERY FLAWED WAY.
I THINK THAT WHAT WE NEED TO DO
IS REALLY START EDUCATING
THE PUBLIC AT LARGE
ABOUT MEDICAL RESEARCH
SO THAT THEY CAN BE
MORE INFORMED
ABOUT THE INFORMATION
THAT THEY'RE GETTING.
SO, THINK ABOUT THIS.
WHEN I WAS GROWING UP,
I USED TO LOVE READING
READER'S DIGEST.
AND ONE DAY, YOU'D READ THAT
COFFEE IS GOOD,
AND THE OTHER WEEK,
YOU'D READ THAT IT IS POISON.

Nam says IT'S BAD FOR YOU.

Haider says YEAH.
AND PART OF WHY THAT'S HAPPENED
IS BECAUSE OF
THE EVIDENCE THAT THOSE FINDINGS
ARE BASED ON.
A CLINICAL TRIAL,
ESPECIALLY A RANDOMIZED
CLINICAL TRIAL,
IS SOME OF THE HIGHEST LEVEL
OF EVIDENCE
THAT WE CAN GENERATE.
BUT A LOT OF TIMES, THE STUDIES
THAT YOU READ ABOUT
IN THE LAY PRESS ARE BASED...
ARE FROM OBSERVATIONAL STUDIES
IN WHICH THEY DIDN'T...
IN WHICH PATIENTS
COULD HAVE BEEN DIFFERENT.
IN WHICH
A LOT OF DIFFERENT FACTORS
THAT MAY BE AFFECTING
THOSE FINDINGS
ARE NOT CAPTURED.

Nam says YOU USE A REALLY
GREAT EXAMPLE
IN THE BOOK ABOUT HAVING
A LIGHTER IN YOUR POCKET.
WE JUST HAVE A FEW MORE MINUTES.
CAN YOU EXPLAIN
THAT OBSERVATION?

Haider says RIGHT. SO, I MEAN...
SO, IF YOU WERE TO GO AROUND
AND LOOK AT PATIENTS
WITH A HIGH RISK OF LUNG CANCER,
AND IF YOU JUST STARTED TO SEE
HOW MANY OF THEM
ARE CARRYING LIGHTERS,
YOU WOULD SEE THAT
PATIENTS WHO HAVE LUNG CANCER
HAD HIGH RISK
IF THEY HAVE LIGHTERS
IN THEIR POCKET.
THAT DOES NOT MEAN THAT
THE LIGHTER IS CAUSING CANCER.
IT MEANS THAT PATIENTS
WHO ARE LIKELY TO SMOKE
ARE MORE LIKELY
TO HAVE LIGHTERS.
SO, THIS IS WHAT'S CALLED
A CONFOUNDING,
AND OBSERVATIONAL STUDIES ARE
AT VERY HIGH RISK
FOR CONFOUNDING,
BECAUSE THEY JUST AREN'T
CAPTURING ALL THE INFORMATION
AND BECAUSE THE PATIENTS
THAT THEY'RE LOOKING AT
MIGHT BE DIFFERENT.
RANDOMIZED, CONTROLLED TRIALS
ARE ABLE TO MINIMIZE OR
ELIMINATE CONFOUNDING FACTORS.
AND THEREFORE,
I THINK WHAT WE NEED TO DO
AND WHAT I HOPE TO ACHIEVE
THROUGH THE BOOK
IS NOT JUST TEACH PEOPLE
ABOUT HEART DISEASE
BUT TEACH THEM ABOUT THE SCIENCE
UNDERLYING HEART DISEASE,
SO THAT THEY CAN BE
MORE INFORMED
WHEN THEY READ STUDIES
OR THEY READ RESULTS
IN THE LAY PRESS.

Nam says AND JOURNALISTS
PLAY A ROLE
IN THIS, RIGHT?
BECAUSE YOU SAY
IN THE BOOK THAT
NEWSPAPERS AND WEBSITES
ARE MORE LIKELY TO COVER
THE OBSERVATIONAL
STUDIES.
WHAT CAN BE DONE
TO ADDRESS THIS PROBLEM?

Haider says SO, FIRST OF ALL,
WE NEED TO WORK TOGETHER.
PHYSICIANS AND JOURNALISTS,
RESEARCHERS.
WE NEED TO WORK TOGETHER
SO WE CAN LEARN FROM YOU
BUT ALSO, YOU CAN LEARN FROM US.
AND ONE OF THE KEY THINGS
THAT I THINK WE NEED TO DO IS
REALLY HOLD EVERYONE,
ALL OF US INVOLVED,
TO A HIGHER STANDARD.
AS ACADEMICS, WE CAN...
THERE'S A LOT OF INFORMATION
THAT SHOWS THAT, YOU KNOW,
UNIVERSITY PRESS RELEASES
ARE VERY INACCURATE
ABOUT STUDIES.
THAT THEY WILL RELEASE STUDIES
THAT WILL OVERSTATE THE FINDINGS
OR MINIMIZE LIMITATIONS.
I THINK THE SAME THING
NEEDS TO BE DONE
FOR THE LAY PRESS AS WELL.
I THINK THAT WE NEED TO BE
MORE SKEPTICAL
ABOUT THE NEWS STORIES
WE PUT OUT,
AND ONE OF THE WAYS
THAT WE CAN DO THAT
IS BY ADDRESSING SOME OF
THE LIMITATIONS OF THE RESEARCH.
SO, FOR EXAMPLE, IF A STUDY
HAS BEEN DONE ONLY IN MICE,
WE NEED TO BE UP FRONT
ABOUT THAT,
THAT THESE RESULTS ONLY REFLECT
ANIMAL DATA
AND THAT THEY DON'T NECESSARILY
TRANSLATE INTO HUMANS SO FAR.
SO, I THINK ALL OF US
CAN DO A BETTER JOB:
ACADEMICS, JOURNALISTS
AND CONSUMERS,
IN REALLY LEARNING
AND GETTING UP TO SPEED
ABOUT WHAT MAKES
GOOD SCIENCE,
AND WHAT ARE FINDINGS
THAT WE CAN BE
MUCH MORE SURE ABOUT
THAN OTHERS.

The caption changes to "Producer: Gregg Thurlbeck, @GreggThurlbeck."

Nam says WELL, I WILL SAY
THIS BOOK IS GREAT.
I LEARNED A LOT MORE.
I DON'T HAVE
A BACKGROUND IN SCIENCE,
BUT I FEEL
A LITTLE SMARTER,
MORE KNOWLEDGEABLE AND
MORE EMPOWERED. SO, THANK YOU.

Haider says OH, OF COURSE. THANK YOU SO MUCH
FOR READING THE BOOK
AND FOR HAVING ME.

Nam says IT'S BEEN A PLEASURE
HAVING YOU HERE.

Haider says THANKS.

Watch: Heart of the Matter