Tuesday, February 10, 2009

The ‘Luck’ Factor in Health and Love - NYTimes.com

For the past 10 years I've celebrated Valentine's Day two days early, because it was on Feb. 12, 1999, that my life — and my heart — was given back to me.

Although I had no conventional risk factors or symptoms, it turned out that two of my three major coronary arteries were 100 percent blocked, the third 90 percent. And so it was that three months short of my 61st birthday, I underwent a six-and-a-half-hour quintuple-bypass operation at Yale University Hospital.

I was back at work in a few weeks and have had no heart problems since. Now nearing 71, I swim three-quarters of a mile most days and play singles tennis (and sometimes win) against players decades younger than I am. And a year ago, after 20 years of bachelorhood, much of it as single parent to my three children, I married again.

How, nearly dead a decade ago, did I get so lucky?

In the aftermath of the revelation last year that Merck and Schering-Plough had been sitting on results of a failed clinical trial of a new cholesterol-lowering drug, an editorial in The New York Times noted that the trial's findings "raise doubts about the current belief that cholesterol is the key to cardiovascular health." Based on my experience, I would suggest that these doubts have been with us for a long time.

Newspapers, magazines, television shows, medical journals and — especially — drug company advertisements all reinforce the notion that lowering cholesterol will prevent heart disease and save your life. Friends regularly call to report their latest cholesterol scores, as if they are somehow gaining ground on the Angel of Death.

But cholesterol, as I've learned, is only a small part of the story. If you combine all known risk factors — high cholesterol, high blood pressure, smoking, genetics, obesity, lack of exercise — the combination still accounts for fewer than half the instances of heart disease. Conversely, as in my case, when none of these factors apply, one can still be days or hours away from cardiac death.

In addition, two doctors who examined me, including a cardiologist, saw no urgency in my condition. It remained for a lifelong friend, another cardiologist, to get the diagnosis right, and this by phone from 3,000 miles away.

When I told him I was concerned about occasional shortness of breath while swimming, and about an intermittent burning sensation in my back, he told me to get to a hospital as soon as possible. Why? Because he knew me, because he listened to me carefully and because he could place my new symptoms in the context of my overall story.

And so I went to a hospital where another lifelong friend, a physician at Yale, saw that I received immediate treatment. The fact that I was privileged — not only to have these doctors as friends, but also to have health insurance that allowed me to receive treatment anywhere and by any doctor — is what saved my life.

I had, that is, what many Americans do not have: access to the best and most timely medical care available.

To get diagnoses and treatment plans right, we need doctors who know us over time, and who have the time to know us. For just as every medication reacts differently in every patient, so too does the meaning of every test result vary with every patient. Paradoxically, the better tests are, the more we need the judgment of doctors to sort out the results and to come up with the right treatments.

We now have technologies to treat virtually all cardiovascular problems, and to save lives we were previously helpless to save. But what many of us do not have is access to these technologies and to doctors who know how to use them.

President George W. Bush famously said that all Americans, even the tens of millions without health insurance, can get health care by going to emergency rooms. Perhaps. But clearly the doctors one meets there have neither the time nor the knowledge — of specific illnesses or of individual patients — to provide anything resembling the best care.

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http://www.nytimes.com/2009/02/10/health/views/10case.html?pagewanted=print