Halfway through Dr Sandeep Jauhar’s Heart: A History is a little anecdote about John Heysham Gibbon Jr, who was instrumental in the invention of the heart-lung machine. Gibbon considered quitting medicine to become a writer, but was advised by his father to finish his medical degree, as he would not “write worse for having it”.
And here we have Dr Jauhar who manages to straddle both fields as a practising cardiologist (he is the director of the Heart Failure Program at Long Island Jewish Medical Center) and best-selling author (he is a contributing opinion writer for The New York Times and has two books to his credit). Excerpts from a telephonic interview.
What led you to write Heart: A History ?
I wrote it for three reasons. First, my family has a history of heart disease. My father’s father died suddenly of a cardiac arrest when my dad wasn’t even 14. He never quite got over it and I grew up with a certain amount of grief at home that was replayed from time to time. This led me to fear the heart as an executioner of men in their prime.
Second, the heart itself is a fascinating object. It’s probably the most amazing machine that Nature has devised. A typical human heart can empty a swimming pool in a week. It works harder than any other organ in the body.
Last, the history of heart science is as fascinating as the organ itself. The heart was never operated on till the late 19th century. I didn’t really appreciate the fact that the heart presents unique challenges to medicine and the obstacles that had to be overcome to learn the techniques that we take for granted today. The book is in part about the incredible feats of scientific discovery. Also, the heart has a huge grasp on cultural imagination; it is possibly the most metaphorised object in human life. I wanted to write as much about the metaphorical aspects of the heart as I did the medical.
You talk about the need to recognise psycho-social and emotional factors that affect the heart. How do you think that shift will be achieved?
It requires a shift in consciousness from the people in medicine. As doctors, we focus on the heart as a bio-mechanical pump. When I was in training, we talked about fluid-filled chambers with a certain capacitance, coronary arteries as tubes, clinical trials... never about emotion. In fact, the American Heart Association still does not list emotional factors or stress as key risk factors for heart disease. One of my hopes is that reading this book will lead people to appreciate that the emotional heart is real and it does affect the biological heart.
What more do you see in the future understanding of heart health and medicine?
There will definitely be more scientific and technological breakthroughs. We would be limiting ourselves if we think we have reached the end. In the last half century or so, the advances have been incredible... coronary angiography, angioplasty, bypass surgery, valve replacement, defibrillators, transplants... We will continue to make progress. On the scientific front, I still hold hope for stem-cell therapy to treat heart disease and more non-invasive ways of fixing the heart.
In many cases, the earlier advances that you mention often meant a great risk for the patients but, today, there is more informed consent.
One thing we tend to overlook is that, in medicine, there is always going to be a learning curve when it comes to new technology. Someone has to go first. In the 1950s, it was small children. The parents decided it was worth the risk because these children would have succumbed to their disease before adulthood. And the consent that these parents gave is very different from the informed consent today.
The process is now longer. Will that slow down progress? That’s an open question. Protections are necessary because medicine is littered with examples when the patient’s rights were trampled upon. So we need to have informed consent. But I do wonder if the process can be streamlined.
When it comes to eating heart-healthy, we hear something new every other day. How much can we rely on this?
My advice would be to ignore most of it. (laughs) There is so much bad information out there. And people ask me this all the time. We have data supporting a Mediterranean diet: lots of fruits and vegetables, olive oil, moderate amount of alcohol. One thing we tend to see is that a high-carbohydrate diet is the least healthy. And the Indian diet is carbohydrate-heavy.
I am an advocate of the Michael Pollan way. His prescription is very simple: Eat food, by which he means what your grandmother would recognise as food and not too much. I would suggest: Eat whole foods. Mostly plants. Don’t eat too much. Try to avoid meat to a certain degree.
