Tough Sell: WCC 2012 Course Coaxes Trainees Toward Preventive Cardiology

Shelley Wood

April 18, 2012

April 18, 2012 (Dubai, United Arab Emirates) — It's a tricky question: how to convince young doctors to get involved in CVD prevention, when other areas of cardiology are so alluring--and more lucrative? That conundrum was, in part, the impetus for a three-part preventive-cardiology session aimed at students and cardiology trainees that opened the World Congress of Cardiology (WCC) 2012.

It's a tough sell in a part of the world where salaries and cost of living are high, prestige and reputation are paramount, and other specialties pay better. The UAE has one of the highest per-capita incomes in the world, according to 2011 figures from the International Monetary Fund, with doctors earning some of the highest salaries; there is no income taxation in the UAE.

Prevention does not in the mind of the public carry the charisma of invasive cardiologists or cardiac surgery.

"Prevention does not in the mind of the public carry the charisma of invasive cardiologists or cardiac surgery," Dr JM Muscat-Baron (Department of Health and Medical Sciences, Dubai) acknowledged to his young audience at the start of the first session. "[But] you are the future and the catalysts for change; you are the teachers of tomorrow."

Dr Nooshin Mohd Bazargani

This is the first time the WCC has included a preventive-cardiology session specifically aimed at general medical students and cardiology trainees, one of the WCC 2012 program committee members, Dr Nooshin Mohd Bazargani (Dubai Hospital), told heartwire . Preventive cardiology, she pointed out, is not actually taught in many medical schools in the Middle East, despite the burgeoning need.

Almost one in four deaths in the UAE is from cardiovascular disease, she notes, and almost one-third of the population has hypertension. According to WHO statistics, almost 40% of women and 25% of men in the Emirates are obese, and upward of one-fifth of the population has diabetes; indeed, Middle Eastern countries make up six of the 10 countries with the highest diabetes prevalence in the world.

"We believe that it is our young trainees who need to be taught how to practice preventive cardiology," Bazargani said. "Unfortunately, preventive cardiology is not well known in our region, and we believe that the only way we can reduce the burden of CVD is through preventing it."

Creating Superior Doctors

Among the speakers in today's course were some household names in international cardiology, including Dr Ralph Sacco (University of Miami, FL), Dr Nathan Wong (University of California, Irvine), Dr David Wood (Imperial College School of Medicine, London, UK), and Dr Sidney Smith (University of North Carolina, Chapel Hill), the current president of the World Heart Federation. To inspire the audience, Smith closed his talk with a quote from a 2600 BC Chinese medicine text that read: "Superior doctors prevent the disease, mediocre doctors treat the disease before it is evident, and inferior doctors treat the full-blown disease."

"My hope," he said, "is that in the relatively short future we will begin to implement [strategies for better preventing CV disease]."

Wood, likewise, quipped that he hoped the morning's session would convince young doctors "to go into preventive medicine rather than palliative care."

People are fascinated by big hospitals, big cath labs, big procedures, and it's easy to be lost in that glorious area of medicine.

For the first trainee-focused course of the day, the room was less than half-full--with women filling at least three-quarters of those seats (although in fairness, 8 am is an early start in a city known to stay up late and sleep later). Students who spoke with heartwire said they found the talks--spanning global trends in heart disease, stroke, smoking cessation, and dyslipidemia--"interesting" if somewhat heavy on stats, rather than hands-on practical information.

But students persuaded to focus on CV prevention may need to get used to intangibilities, Bazargani observed. "It takes at least 10 years before you can see what you have done! That’s why it so difficult to convince people to become preventive cardiologists and also to convince the government and policy makers that this is important."

Some Successes, Many Hurdles

Bazargani points to some recent accomplishments that the UAE can be proud of, not the least of which was winning the bid to host WCC 2012, something many hope will raise the profile of heart-disease risk factors and prevention in this part of the world. Currently, tobacco products in all forms are sold very cheaply in the UAE, with no standardized warnings on the packaging. Starting in August 2012, taxes on tobacco products are increasing 200%, and all packages will be required to have a warning, including graphics, covering at least 50% of any packaging.

"Our next concentration will be salt," she told heartwire . Currently 32% of the population has hypertension, and "a major source is bread, which we all eat every day." She and others are working with policy makers on plans to gradually reduce sodium content in foodstuffs, including bread, over the next few years.

But there are other hurdles that won't be so easily overcome in this part of the world, where most fresh water comes from desalination plants, and green spaces are artificially constructed and costly to maintain. Dubai is a city of drivers, rather than walkers, and shopping opportunities outstrip gyms and public sporting facilities. Even the climate, which rarely dips below 20ºC (68ºF) and soars between 30ºC and 40ºC (86ºF–104ºF) five months of the year, is a disincentive for movement.

Bazargani, however, discounts climate as a barrier. "If people want to exercise, they find a place to exercise," she insisted. "A gym, a pool, the sea."

Mindset and Money

Dr Nathan Wong [Source: University of California, Irvine]

Wong, one of the chairs for the Dubai course, told heartwire he was "amazed" by the turnout, adding that 175 students/trainees had registered. "In the Middle East . . . prevention of cardiovascular disease has been a rather low priority. However, with the substantial recent increases in obesity, metabolic syndrome, and diabetes, the cardiology community in the Middle East is realizing that they cannot ignore prevention. . . . We do know that certainly many of the cardiologists in the Middle East do interventional cardiology; however, a number of them also have a long interest in preventive cardiology, and we are seeing an emergence of combined preventive and interventional cardiologists, which is typically not seen in, for example, the US."

Dr Alawi Alsheikh-Ali

Also speaking with heartwire , Dr Alawi Alsheikh-Ali (Sheikh Khalifa Medical City, Dubai) was less confident that prevention efforts were catching on among heart specialists, pointing out that like most places in the world, when cardiologists have a procedure-based specialty, "you are more attractive to hospitals and you bill more: that incentive is here also."

Alsheikh-Ali thinks that ultimately, it is not the young cardiology trainees who will have an impact on CVD or even the medical students who end up working as generalists, but more frontline healthcare workers with less specialized training who end up screening students in school or adults applying for health insurance. "When was the last time a 20-year-old or a 30-year-old saw a cardiologist?" he points out.

To that, Bazargani counters that if they are more aware of the need for prevention, physicians and cardiologists can play a more active role in urging government and policy makers to help make the community a "better environment to live healthily."

And a first step, she argues, is piquing an interest. "Cardiology is a very rich branch of medicine--we are very blessed because every day there are new developments and achievements in cardiology. So people are fascinated by big hospitals, big cath labs, big procedures, and it's easy to be lost in that glorious area of medicine," she laments. "But preventive medicine is different: you don't see any effects of your work."