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Cardiologists Challenged

The opening scientific session at the annual American College of Cardiology meeting kicked off with a glitzy video montage that would have made Hollywood proud. I half expected to see a reminder to visit the concession stand crawl across the big screens. But just as the hype was beginning to overwhelm, Dr. James Orbinski rose to deliver the most scorching presidential lecture in memory.

Image courtesy TheSilentPhotographer at en.wikipedia (CC)

The internationally acclaimed physician and humanitarian challenged the audience to get involved in global heath and to tackle issues that most people write off as hopeless causes. He pointed out that the $13,000 price of antiretroviral drugs to combat AIDS was once a virtual death sentence for all but the wealthy.

With vocal outrage from humanitarian groups including Dignitas International, which he cofounded with James Fraser, however, the price tag has dropped to just $64 per year for generic therapies, and somehow, Big Pharma did not collapse, as was prophesied, he said.

Dr. Orbinski didn’t shy away from politics, which at most medical meetings is politely veiled in talk of pending legislation.

As Chief of Mission to Rwanda with Médecins Sans Frontières during the genocide, he recalled a young girl brought to his care who avoided being hacked to death as her mother had been by hiding in a latrine. He scolded France for supplying arms to the Habyarimana regime, and the global compliancy exhibited by countries including the United States despite overwhelming evidence of genocide.

Dr. Orbinski, who collected the Nobel Prize on behalf of MSF for its work in Rwanda, spoke of the need for ongoing research of neglected tropical illnesses and the growing threat that West Nile virus and Dengue fever pose to even the most well-heeled Americans. He spoke about climate change and the political unrest caused by hunger, now experienced by one in seven persons across the globe.

He reminded us that 43 years ago today when Dr. Martin Luther King Jr. was assassinated in Memphis, no one would have dreamed that it was possible for a black man to become president of the United States.

The lecture was nothing like I’ve ever heard before.

Dr. Ralph Brindis

When he finished, the packed ballroom was silent and still. Many rose to give Dr. Orbinski a standing ovation, but some did not. So when outgoing ACC president Dr. Ralph Brindis rose to speak, there was something of a sense of relief in the air. It was short lived.

Dr. Brindis cited the recent ICD-registry study by Dr. Sana Al-Khatib and colleagues that found that 22.5% of 111,707 patients received nonevidence based ICD implantations for the primary indication of sudden cardiac death between January 2006 and June 2009.

Dr. Brindis said he has been disappointed in physician participation with the National Cardiovascular Data Registry, despite its ability to provide greater understanding of physician practice as well as local and national trends in socioeconomic disparity.

“The NCDR data are your clinical data,” said the mild-mannered Dr. Brindis, while pointing his finger squarely at the audience. “You are responsible for the accuracy of the information, and you should strive to take advantage of these reports to discover opportunities to improve the care of your patients.”

This reporter tips her hat to the ACC for selecting New Orleans for its annual meeting and for being bold enough to challenge its members. Thinking outside the box beats Hollywood any day.

—Patrice Wendling from New Orleans

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