The world renowned cardiologist and UCLA professor talks about his new text, The Heart Healers.
Author/Cardiologist Dr. James S. Forrester
Tavis: Dr. James S. Forrester is a pioneer in cardiovascular medicine. The former Chief of Cardiology at Cedars-Sinai and current Professor of Medicine at UCLA has written a new text about the revolutionary discoveries and heroes of his field.
It’s called “The Heart Healers: The Misfits, Mavericks and Rebels Who Created the Greatest Medical Breakthroughs of Our Lives”. Dr. Forrester, first of all, thank you for your work all these years. An honor to have you on this program.
Dr. James S. Forrester: Well, thank you for having me.
Tavis: I want to start at the beginning, at least the beginning of your career. You had a patient named Willie and it really was Willie who convinced you that cardiology was where you wanted to be. Tell me about Willie and what happened.
Forrester: Well, he was a 39-year-old man who I had seen as an outpatient, then he came in as an inpatient with chest pain. His name was Willie and I was in Philadelphia, so I called him Willie the Phillie [laugh].
Willie the Phillie on about his third hospital day developed recurrent chest pain and got worse and worse and I called for the resident as a trainee. He didn’t arrive and I essentially stood there and watched Willie pass away because I had no treatment.
At that time when I was going into medicine, we had no treatment for any form of heart disease. No cardiac surgery, no devices, very few drugs, so it turned out that that was an impetus to me to say we’ve got to do better than that. And what has happened is from that point, we are now at a point where heart disease will no longer be our number one killer in the next five years or so.
Tavis: My godmother, who’s 85 years of age, was at Cedars just two weeks ago. So for the last few weeks, she’d been in the hospital and I’m her guardian trying to take care of her. She’s 85, as I mentioned.
And we finally got her well enough to leave Cedars and, at the moment that we were sitting in her room waiting for the attendant to bring the wheelchair to get her out of the hospital, the man in the room next to her who I’d seen every day for weeks going to visit her, literally passed. I’m standing in the doorway looking at him. His family comes running down the hallway, the machine is starting to, you know, make the sound.
I actually for the first time ever looked at what someone in the room next to her–I just stood there and watched him die. I thought in that moment a number of things. First of all, I told my godmother how blessed she was that this guy just transitioned and you actually get a chance to go home and to live a little bit longer. So I was just grateful that she had survived her stay at Cedars, number one.
But what hit me in that moment, though, was how–I don’t want to use the wrong word here, but how does one get accustomed to particularly working with heart patients knowing that some of the people you work with are just not going to make it no matter what the advances? How do you ever get used to seeing people like Willie die in front of you?
Forrester: Well, of course, you never do. But the big thing, Tavis, is that the tremendous advances we’ve made have made it so that so many people who were going to die don’t die now. When I went into cardiology, the mortality from heart attack was 30% in the hospital. Now it’s 5%. So I think you take great joy in moving the field forward and accept that, of course, mortality is going to be with all of us. But, yeah, it’s painful to lose a patient. No doubt about it.
Tavis: Speaking of advances, I saw this–show this little–you brought a couple of things with you. I was fascinated by the size of this thing and what it–you’ll explain what it is.
Forrester: Yeah. This is an aortic valve that the surgeon puts into the heart to replace a diseased one.
Tavis: So small, yeah.
Forrester: Yes. Well, there are different sizes. And the question which hopefully we’ll talk about it is how can I get that valve in without opening the chest like a steamer trunk? And the answer is, what you do is you crimp it over a balloon so it’s just the size of the balloon, then you pass it up around and you position it just right. That’s it. You go home two days later.
Tavis: Technology is amazing, isn’t it?
Forrester: It’s astonishing, yeah.
Tavis: Which is what this book is really about, “The Heart Healers: The Misfits, Mavericks and Rebels Who Created the Greatest Medical Breakthrough of Our Lives”. What is it that we ought to know, you want us to know, about these misfits, mavericks and rebels who brought this technology to us?
Forrester: Well, let me tell you the beginning of heart surgery because it’s fascinating. It started in a World War II battlefield where a young, fiery redheaded surgeon with a temper to match confronted a soldier with shrapnel sticking out of his heart. And he knew that the leading surgeons of that time said that a man who tries to repair a heart injury deserves the condemnation of his colleagues. That was the thought of the time.
But he decided to go ahead anyway and he put a clamp on that shrapnel and yanked it out and got hit with a torrent of blood and the chest cavity filling with blood. He stuck his finger in that hole and began to suture all around it and slowly the bleeding stopped. When he finished, he discovered he’d sutured his glove to the heart [laugh], so he had to cut it off–not his finger, the glove.
Although I trained with him years later and a number of us said–because he was an intimidating man–he could have just as easily cut off his finger and left it there [laugh]. But in any case, that was the beginning of cardiac surgery. He did it 16 times more in other soldiers and proved that it was possible to operate on the heart. So it was a fascinating beginning.
Tavis: Is it primarily the advances that we have made that are allowing persons with heart disease to live longer or are there changes in our behavior that we are or should be engaging in that would help aid and abet that as well?
Forrester: Terrific question because it’s actually both. But here’s the thing that we’ve learned, Tavis, that is so fascinating. Coronary artery disease, our number one killer, is actually a preventable disease, actually preventable with the things that you would be most interested in, I suppose, which is diet, exercise, and also drugs when necessary.
Here’s the thing with diet. It’s really pretty simple. There are good things to eat and bad things to eat. And the good things are fish, fruits, nuts, tea. They all have antioxidants in them. Leafy vegetables are good because they increase the intestinal transport and decrease absorption of bad compounds. Bad things are trans fats which are fats that are solid at room temperature, simple sugars. They increase fat in the blood and also in the body.
Now you say, well, how do I translate that? A fascinating thing that was just recently published is a 20-year follow-up of men, 45,000 of them, and looking at one source of potential risk and that was drinking soda. People who drank more than one soda pop a day had a 20% higher risk of having coronary disease than those who did not. Amazing.
Tavis: That’s a high percentage.
Forrester: Yeah. And half the people in the U.S. drink a soda pop a day.
Tavis: One can a day, yeah.
Forrester: Yeah, yeah. So if you wanted a diet, the Mediterranean Diet is probably the best for heart disease. It has fish and all the other things I mentioned, plus olive oil and red wine very frequently in moderation. Compared to a low-fat diet, it has about a 30% less rate of developing heart disease.
Tavis: Are these discoveries, these heart healers that you talk about in the text, are these primarily Americans or are these discoveries from persons around the globe?
Forrester: They are from persons around the globe. I’ll tell you one person from around the globe was a young man in Zurich who got the idea that he could open obstructed coronary arteries with a balloon, and he worked–his bosses said that’s impossible.
He worked for five years in a Zurich kitchen, in his own kitchen, finally perfected the balloon and, when he did, it was astonishing. He opened up coronary arteries. He came to the United States. It’s actually the story of Icarus, the Greek god who flew too close to the sun.
He became wealthy. He divorced his wife, found a beautiful medical student that he married, bought a very expensive car and a mansion and became a pilot and, early in his 40s, crashed his own plane flying back in a Georgia field when he tried to do instrument flying during Hurricane Juan. So he was a consummate risk-taker, made a great contribution, and we lost him so young.
Tavis: And those balloons, those things are pretty routine now.
Forrester: Yes, they are. They completely passed bypass surgery as one of the mechanisms of treating angina that is the chest pain brought on by exertion.
Tavis: What most excites you about the future of these discoveries?
Forrester: I think that the most exciting thing is we are going to conquer this disease and it’s going to happen all in my lifetime.
Tavis: That means one of two things. It will happen really fast or you’re going to live a long time [laugh]. Which one is true?
Forrester: I think I got five years left, Tavis [laugh].
Tavis: I hope you do, and you’re in great shape. You’re in great shape, but I’m sure you have more than five years. But all joking aside, that’s a serious question because if it’s going to happen that quickly, that’s pretty revolutionary.
Forrester: Yeah. Well, the reason is basically we now understand about diet and exercise and we’re getting people to do it. And in addition, we have statin drugs and finally we have a new drug on the horizon that is an additive to statin so that we can get everybody down to a normal level of cholesterol, if we choose to do so.
Tavis: You know what scares me? I’m almost out of time, but what scares me is that, for all the advances that we have made that you’ve described for us tonight, it is this childhood obesity.
Forrester: That’s right.
Tavis: So this heart disease now is not even just in people my age or your age, but these kids are developing heart problems at such a young age because of the obesity issue.
Forrester: That’s right.
Tavis: So you’re making advances on the one end, but you’re losing ground on the other end.
Forrester: If my prediction is wrong, the reason will be obesity and the reason will be essentially the diet of our young kids who are eating the wrong things and drinking pop. And another fascinating recent observation is, if you watch three hours of television a day, kind of makes you a couch potato definitionally, you have a 20% risk of having heart disease compared to the person who doesn’t, probably because you’re both inactive and because you have a poor diet.
Tavis: I guess the moral to this conversation, the moral of the story, is don’t drink soda every day and don’t watch TV more than three hours.
Forrester: Yeah, but do tune into Tavis [laugh].
Tavis: I was about to say that. My man [laugh]. I was about to say that. Can I get 30 minutes at least? If you’re going to do three hours, give me 30 minutes of it. The name of the book is “The Heart Healers: The Misfits, Mavericks and Rebels Who Created the Greatest Medical Breakthrough of Our Lives” written by the eminent M.D., James S. Forrester. Doc, thank you for coming on.
Forrester: Indeed. Thanks for having me.
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