The Davis/Walton-Shirley Dilemma - What's the Answer?

WOW! The recent comments elicited by my latest blogs on PCI demonstrate a profound concern and understanding about the dilemma of heart attack prevention versus intervention. It does my heart good (pun intended) to realize there are so many people out there who not only give this issue thought but are willing to share those thoughts. Thanks go out to Dr. Walton-Shirley and Dr. Davis for taking time out of what I am certain are very hectic schedules and the legion of commenters like Bix, wccaguy, warren, and the ever-enigmatic "Anonymous."

This issue has many real life similarities. For example, even though my parents, teachers, insurance agent, and Smoky the Bear all extol the virtues of fire prevention, it is still nice to know the fire department is only a call away to bail you out when you do something stupid (like when I went into my backyard to pitch a few golf balls while waiting for a pan of oil to heat up on my oven top). The same could be said for heart disease prevention except for the fact that, unlike fire prevention, figures of authority preaching prevention are few and far between. It leads the conspiracy theorists among us to wonder if this peculiar situation is a matter of incompetence or perhaps planned obsolescence! Remember, it was not that long ago that Detroit purposely designed cars to need expensive repairs after several years.

So what to do? On the one hand preventionists have a hell of a point, the technology to prevent most heart attacks exists today and is simply not being made available on a widespread basis. On the other hand, we have a large segment of society that either blindly follows outdated health practices or are simply to dumb or lazy to take responsibility for their health. What do we do, let them die? (Darwinists might argue that this is a valid option).

I believe the comments made on this blog point the way. Yes, let's continue to develop fast, cost-effective rescue measures for the unlucky few who infarct despite prevention or those too blind to help themselves. But, at the same time, let's DEMAND that the medical establishment educate and discipline itself to practice modern prevention. Let's have the interventionalists actively put pressure on their own colleagues to balance their practice with prevention and throw out the ones who operate "catheterization factories." There is no room in medicine for putting unethical profit and "God complexes" above lives. Remember, even if there were an interventionalist in every "pot" and a cath lab in every "garage" many people would still die needlessly.

So, there's my compromise. Any takers?


HeartHawk