Bernard Lown: mensagem

Greetings to ProCOR! 15th anniversary

A message to the ProCor network

ProCor is this month celebrating a 15th anniversary. In this time there have been tremendous changes in the global landscape of cardiovascular prevention...

Bernard Lown, MD

ProCor Founder. Research Pioneer. Nobel Laureate.

Learn more >

The Lown CV Research Foundation

At the same date May 17, 2012 we will celebrate the AMICOR 15th anniversary!

Louise Lown Heart Hero Award

Louise Lown Heart Hero Award


The Louise Lown Heart Hero Award is given annually to celebrate and recognize innovative, preventive approaches to promoting cardiovascular health in developing countries and other low-resource settings.

The annual award amount is US$2000.

Dr. Bernard Lown, Nobel Peace Prize recipient, inventor of the defibrillator, and founder of ProCor created the award in 2007 to honor his wife's lifelong commitment to the rights and wellbeing of others through her work as a social worker, activist, and writer.

Who can apply, criteria, and timeline Application

Global Health Caucus Panel Briefing on "Chronic Disease in Emerging Countries"

[procor] US Congressional Global Health Caucus Panel Briefing on "Chronic Disease in Emerging Countries"

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ProCor	Tue, Aug 11, 2009 at 6:18 PM
Reply-To: Global Dialogue To: Global Dialogue
On behalf of ProCor, I visited Washington DC on July 13, 2009 to participate in a legislative briefing for the US Congressional Global Health Caucus. The briefing convened representatives from the Senate and House of Representatives dozens of NGOs, key US government offices, corporations, and international organizations like the World Bank and WHO. The purpose of the briefing was to increase awareness of chronic diseases in low- and middle-income countries. The panel of experts included: - Dr. Rachel Nugent, Deputy Director for Global Health, Center for Global Development - Dr. Gerard Anderson, Professor of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University - Dr. K.S. Reddy, President, Public Health Foundation of Indian - Dr. Thomas Gaziano, Assistant Professor, Harvard Medical School. Sir George Alleyne, Chancellor of the University of the West Indies, was the distinguished and eloquent moderator of the discussion. In opening the briefing, he noted that "Nowhere in the Millennium Development Goals are noncommunicable diseases mentioned. This is not 'my' disease or 'your' disease. It has been neglected and we must pay attention to it." Thank you to Trevor Gunn, Director of International Relations, Medtronic and Adjunct Professor, School of Foreign Service, Georgetown University, who organized the briefing, for providing the following summary of the discussion. Catherine Coleman, Editor in Chief, ProCor Summary of key points: - Chronic and non-communicable diseases are a worldwide problem, impacting men, women and children of varying ages, races, and income categories. - Many myths surround chronic and non-communicable diseases, from the nature of the disease to the characteristics of people who develop symptoms. In most cases, successful, cost-effective interventions have been identified and tested. A lack of political will and funding are preventing the execution of these programs. - There is some overlap in the treatment and prevention of communicable and non-communicable disease. Treating both is important--one should not come at the cost of the other. Building health systems could directly combat the "double burden of disease" imposed by overlaying non-communicable disease burden on an already severe infectious disease burden. Programs or public health goals, previously only measured by communicable disease variables (as HIV/AIDS, TB, and malaria) should expand the range of measurements to include non-communicable diseases. - To raise awareness and direct funding toward intervention, the issues of non-communicable and chronic diseases need to be framed in a manner that is accessible to the general public and to governments. A new Millennium Development Goal for NCDs is not necessary. We can simply add "and other diseases" to existing, disease-restrictive (HIV/AIDS, etc.) MDGs related to child and maternal health. -US involvement, starting with public recognition of the need for addressing non-communicable and chronic disease from the Centers for Disease Control and Prevention, the National Institutes of Health, or the US State Department will have a significant impact on donor willingness to participate in efforts to reduce these diseases. - In addition to health consequences, chronic and non-communicable disease have a significant impact on the productivity and earning potential of individuals and consequently on a country's GDP. - Medical device, diagnostic, and pharmaceutical companies can contribute by further advancing lower-cost and easier-use equipment and medications. Moderator Closing Remarks Sir George Alleyne, MD (Director Emeritus, PAHO/WHO): - Non-communicable and chronic disease is not just a problem in the US but is a rapidly growing global problem. - Non-communicable disease has a significant impact on the economic 'bottom line' at both a macro and micro level, impacting the earning capacity of countries and individuals. - Aid organizations and governments have identified the interventions needed to prevent disease and reduce their impacts. But they need to be implemented. - The United States should take initiative and demonstrate leadership in bringing the issue of chronic and non-communicable disease to the forefront. No- or low-cost ways such as speaking at the UN General Assembly will carry tremendous impact. For more information, contact: Trevor Gunn, Director, International Relations Medtronic (Washington, DC) Telephone: +1 202 442 3655 or email: Trevor.Gunn@medtronic.com & Adjunct Professor, School of Foreign Service, Georgetown University/ GunnT@georgetown.edu We welcome your comments. Catherine Coleman Editor in Chief. ProCor

Louise Lown Heart Hero Award

From: Ramos, Juan   ProCOR

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The 30 April 2009 deadline for the Louise Lown Heart Hero Award is fast
approaching! Community-based initiatives from around the world that promote
heart health are encouraged to apply for the US$2000 award.

Information about the award including who can apply, criteria, and the
application are provided below. The information is also available in Word and
PDF at www.procor.org or by emailing Juan Ramos, ProCor program coordinator, at
jramos3@partners.org.

The award is administered by ProCor (www.procor.org), a US-based communication
network that uses email and the web to support knowledge sharing of
cardiovascular health among a global community working in clinical, community,
research, and policy settings.

Past recipients of the award include the Rheumatic Heart Disease Prevention
Program in Tonga (2008), which screens primary school children for rheumatic
heart disease and provides early, effective treatment; and the Heart and Stroke
Foundation South Africa Children's Programme (2007), which teaches heart healthy
practices, such as growing vegetables for their daily meals, to over a million
children in rural and urban impoverished settings throughout South Africa.

Dr. Bernard Lown, Nobel Peace Prize recipient, inventor of the defibrillator,
and founder of ProCor, created the award in 2007 to honor his wife's lifelong
commitment to the rights and wellbeing of others through her work as a social
worker, activist, and writer.

Who can apply
Applications are encouraged from community-based programs (non-profit,
governmental, or private sector) that have successfully worked to promote heart
health in developing countries or other low-resource settings (i.e.,
disadvantaged communities in developed countries) through innovative, preventive
approaches. The Heart Hero Award is not a grant. Applicants should focus on
their past accomplishments that deserve recognition, rather than future
initiatives that need funding. Programs that are accepted for consideration but
that do not receive the award will gain increased visibility through ProCor
among a diverse global community committed to sharing knowledge in order to
prevent cardiovascular disease.

Examples of eligible initiatives include community programs promoting physical
activity, nutrition, or tobacco control; population-based interventions reducing
diabetes, hypertension, and obesity; patient-focused clinical programs
increasing access to screening, identification, and control of risk factors;
advocacy and policy activities; and resource development and dissemination.

Award criteria
Applicants should focus on one specific initiative rather than an organization's
entire scope of work. The initiative must:
- Build awareness or support action that promotes heart health.
- Be community-based and innovatively respond to local health needs.
- Demonstrate success.
- Be cost-effective and potentially sustainable.
- Have the potential to be adapted or replicated in other settings.
- Have been in operation for a minimum of one year.

Application process and timeline
- Applications are accepted year-round.
- Deadline for the 2009 award is 30 April 2009.
- Applications are reviewed on a continuous basis by an award committee.
- Applicants are notified whether their program has been accepted for
consideration.
- Information about programs that are selected for award consideration may be
published in ProCor's email news and discussion forum and website
(www.procor.org).
- Funds are provided directly to the organization or individual with primary
responsibility for the initiative.

For more information
Contact Juan Ramos, ProCor Program Coordinator.
Email: jramos3@partners.org
Telephone: 1 617 732 1318 ext. 3319

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Application

The following required information may be submitted via fax, postal mail, email
attachment, or in the text of a plain text email. Abstracts will not be
considered.
- Program title
- Program location (e.g., country, state/province/region, city/town/village)
- Contact person
- Organization
- Mailing address
- Telephone
- Fax
- Email
- Website

Please describe the initiative in approximately 500-1000 words. Applications
exceeding the word count requirement will be returned for revision or rejected.
The following must be included:
- Program purpose
- Program history
- Local needs that are addressed
- Local partners, resources, sources of support
- Strategies or activities that build awareness of cardiovascular disease and/or
support action to promote heart health
- Evidence of success and accomplishments (e.g., statistical data, anecdotal
stories, etc.)

References
Please provide contact information for three (3) people we can contact to learn
more about your program.

Please read and sign the following
- The information submitted in this application for the Louise Lown Heart Hero
Award is accurate to the best of my knowledge.
- If this application is accepted for award consideration, I understand that the
references provided above may be contacted for more information.
- The information submitted may be published in ProCor's electronic mailing list
and website (www.procor.org), and/or in materials produced by the Lown
Cardiovascular Research Foundation, and may be edited prior to publication. I
understand that the purpose of sharing this information is to promote
cardiovascular health.
- I waive and release all claims for any compensation for such use of this
information, or for damages, and I hold the Lown Cardiovascular Research
Foundation and its funders harmless against any and all claims for damages
rising out of the use of this information.

Signature: __________________________           Date: _________

Send the information requested to Juan Ramos, ProCor Program
Coordinator.
Email: jramos3@partners.org
Fax: 1 617 277 0347
Mail:   Louise Lown Heart Hero Award
Lown Cardiovascular Research Foundation
21 Longwood Avenue
Brookline MA 02446 USA

Women’s Heart Health

Learn more about Women’s Heart Health on ProCor's website. You can filter what you find by country or region. Visit: www.procor.org/issues/issues_list.htm?attrib_id 152.
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"Health is linked to status in society. It benefits from equality and suffers from discrimination. For women, the rapid rise in noncommunicable diseases not only affects their health directly, it can also severely impact on their assumed gender role as unpaid carers of the sick." (1)

Nearly everywhere in the world, women live longer than men. But a longer life is not necessarily a healthier life. A woman's health is affected by her role in her society, the culture in which she lives, unique female biological characteristics, the choices she makes, and an array of socio-economic factors. In turn, women's health has an enormous effect on the health of those around them. Women give birth to and nurture the next generation. They procure and cook food for their families, friends, and communities. In some cultures, girls begin caring for other family members at a very young age. As women grow older, they often find themselves taking care of their own children, their children's children, their older parents, their in-laws, and their male partners--who often are less healthy. Focused on taking care of others, women may necessarily neglect taking care of themselves physically or financially. Poverty disproportionately affects women's lives and their health, according to WHO, which estimates that 70% of the 1.2 billion people living in poverty are female. Twice as many women as men are illiterate.

Heart disease and stroke are already the leading causes in women in developed countries and will be the leading causes of death in women in poor countries by 2020. CVD currently causes about one-third of women's deaths globally, with a majority of these deaths occurring in low- and middle-income countries. Unfortunately, the enormous global toll of cardiovascular disease among women, is not generally recognized. Heart disease and stroke are responsible for twice as many deaths as all cancers combined, but many women are more aware and more fearful of cancer than CVD.

The need for increased awareness, education, and action is clear, not only to promote women's health and well-being, but for the health and well-being of our communities and countries.

A comprehensive overview of determinants and challenges relevant to women's heart health, and an outline of opportunities and recommendations on which we can act, are presented in "Women and the Rapid Rise of Noncommunicable Diseases." Published by the World Health Organization in 2002, its contents are illuminating, useful, and highly relevant. Thank you to Derek Yach, one of the report's authors, for bringing it to our attention as we highlight women's heart health issues in anticipation of International Women's Day on Sunday, 8 March 2009. The report should be included, as a valuable reminder and a useful, usable resource, in everyone's library of CVD literature, and can be downloaded at no cost at: (PDF 111 KB) http://whqlibdoc.who.int/hq/2002/WHO_NMH_02.01.pdf.

The report advocates several specific responses to the challenges we face in addressing women's health issues globally:
- Obtain more and better gender-sensitive information with data collection and analysis that seeks to understand gender differences in morbidity, mortality, and risk.
- Create linkages among existing programs that address infectious disease and maternal and child health with programs preventing chronic disease-for example, by promoting tobacco cessation in TB clinics, or providing nutritional advice to new mothers that can help prevent CVD in adulthood.
- Develop policies that address the determinants of noncommunicable diseases. Global and national interventions that are affordable can effectively reduce risk factors for chronic diseases. Banning tobacco advertising requires political will rather than funding; in countries like Poland, Iran, and Thailand, tobacco taxes generate fiscal resources that are used to support health programming.
- Refocus health systems on chronic disease and primary health care instead of acute disease. Implicit in this is the need to reduce barriers' to women's access to care in terms of cost, convenience, service provider genders, etc.
- Expand partnerships among programs that address the full range of issues affecting women's health, like gender equality and sexual and reproductive rights.

As International Women's Day approaches, let's all take a moment to honor the contributions of women everywhere, as well as to take a look at what more our organizations or projects can do to promote women's health and wellbeing.

Catherine Coleman
Editor in Chief, ProCor

Citation:
1. Yach D, Brands A. Women and the rapid rise of noncommunicable disease. World Health Organization: NMH Reader, Issue 1, January 2002, http://whqlibdoc.who.int/hq/2002/WHO_NMH_02.01.pdf

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To post a new message, send an email to procor@list.procor.org.

Archives of ProCor's Global Dialogue are available at www.procor.org/globaldialogue.

To join the list: send an email to subscribe-procor@list.procor.org or subscribe online atwww.procor.org/joindialogue.

Prof. Bernard Lown Interview

From: Coleman, Catherine

12:14 PM (12 minutes ago)

Twenty-three years ago, on 10 December 1985, ProCor's founder, Dr. Bernard Lown, and Russian cardiologist Dr Evgueni Chazov accepted the Nobel Peace Prize on behalf of International Physicians for the Prevention of Nuclear War (IPPNW), the organization they co-founded.

An interview with Dr. Lown by The World marking this anniversary can be heard online athttp://www.theworld.org/?q=node/23106. In the interview, Dr. Lown talks about his newly published book, Prescription for Survival, which recounts the founding of IPPNW and culminates with the controversial awarding of the Nobel Peace Prize.

The current global health crisis is Dr. Lown's subject in a "web extra" available via the same link (just scroll down on the page); he reflects on the current direction of health care, the role of technology in medicine, and shares his memory of his mother's death and his thoughts on the use of the defibrillator, which he developed.

Catherine Coleman
Editor in Chief, ProCor

The doctor as placebo

"Maria Inês Reinert Azambuja"  to Cardiovascular

Dear Dr. Lown
Very beautiful text, and a necessary reflection at a time when medical doctors seem to be completely taken by the pharmaceutic industry mermaid
song...
Best regards,
Maria Inês Azambuja

The Doctor as Placebo

I am now convinced that the  placebo effect is not limited to drugs or surgical procedures, that it is a far more universal phenomenon. The words of doctors and other health professionals are the most potent placebos of all...

Lown RCTs (Random Clinical Thoughts): The doctor as placebo
Bernard Lown, MD

We are living in a paradoxical age. From medicine we expect miracles; from doctors, brush-offs. Physicians, no longer revered figures, communicate less and less with their patients. History gathering is hurried and frustrating, and even these precious minutes are misspent. Instead of focusing on the patient, the doctor peruses electronic records. Frequently, he or she does so facing a computer screen instead of the patient. The scene recalls a robotic transaction. Eyes do not bind, voices do not connect, communication is at cross-purposes. After a brief séance, patients are sent for a panoply of tests, imaging procedures, and visits to indifferent specialists.

The present disjuncture in medicine results from a market-driven health care system wherein doctors sell services to optimize their bottom line. They envision themselves not as healers but as medical technologists qua scientists. Thereby they have put themselves at odds with professional doctoring.

I would like to help restore the former health professionalism of physicians. Such a reinvention requires that doctors resume their role as placeboist. Some will recoil. Aren't placebos a "pious fraud," as Thomas Jefferson suggested nearly two centuries ago? For many the word evokes an image of fake treatments, of charlatans dispensing snake oil. This has been my opinion as well. I believed that the handing out of inert sugar pills to the worried-well ran against the grain of scientific medicine. Fifty years of medical practice has altered my views.

Clinical Experience
My rethinking of this issue began with an anecdote I heard many years ago about Mark Twain. One sweltering summer night he was in a cheap hotel in Mississippi. Soaked in sweat from the oppressive heat, he tossed and turned in the stagnant, stale air. Though dead tired he could not sleep. Growing desperate, he hurled a shoe against the closed window. As the glass shattered, he felt a cool breeze wafting off the Mississippi River. Sound sleep was immediate. The next morning he found the shattered glass of a mirror adjoining the still-closed window. The listener of this tale usually nods knowingly, ascribing the imagined breeze to the power of the mind. Indeed we are not disembodied from our executive brains.

What mainly made me gain respect for the placebo was clinical experience. The more extensive my experience, the more evident was the power of the placebo effect.

When in fellowship training with that masterful clinician Dr. Samuel A. Levine, I was frequently provoked by his cavalier response to patients with intractable symptoms. He would fish in a pocket and hand out a pill that was either a bromide, a barbiturate, or a vitamin. By contrast, before prescribing any medication, I would scrupulously comb the scientific literature for the latest evidence-based remedies. The difference in outcome between Levine's patients and mine was stark. His improved promptly; mine did not fare as well. In later years, I came to suspect that the explanation lay in the placebo effect.

The more patients I saw, the more frequently I encountered the magical placebo. I recall a middle-aged man, Mr. B., with angina pectoris. This was before introduction of a host of effective anti-anginal drugs, coronary bypass surgery, angioplasty, or coronary artery stenting. Nitroglycerin was then the sole remedy. Anginal attacks totally immobilized him, as the slightest exertion intensified the pain. Mercifully, a nitro pill under the tongue consistently and promptly resolved the discomfort. One day while walking on a beach in bathing trunks, Mr. B. experienced angina. Unable to find the pillbox, which he'd left in a pants pocket, he panicked. Mounting anxiety intensified the pain, and he was unable to move. Mr. B. asked a passerby to fetch the pills, pointing to his trousers under a beach umbrella twenty yards away. The man readily found the pillbox, and as he waved it in the air, Mr. B.'s pain abated as though the nitro had already dissolved under his tongue. He later related that on many occasions, the angina disappeared when he took out the pillbox. Many other patients have noted that merely handling the small nitroglycerine bottle assuaged their discomfort. The container acted as a placebo.

Historical Record
The placebo has a long history. Indeed, it was supreme during several millennia of medical treatment. Already in Roman times, the famous Galen Pharmacopeia contained 820 placebo remedies. Galen insightfully observed, "He cures most successfully in whom the people have the most confidence." The pioneer placebo researcher, Arthur Shapiro, maintains that nearly all of the 16,842 ancient remedies, with but few exceptions, were placebos. (1)

The modern mind is unable to comprehend the extent of public gullibility. Over many centuries people succumbed to bizarre, unpalatable, sickening, and sometimes lethal pharmaceutical concoctions. The chemist-pharmacist of old would grind dust from precious stones together with a maddening hodgepodge consisting of scorpions, worms, or wood lice, the entrails of animals, and perhaps a bit of human placenta, admixed with saliva, the sexual organs of executed convicts, and all sorts of excreta. These remedies, deemed panaceas, were indiscriminately prescribed for a wide spectrum of maladies.

Even more remarkable was that patients submitted to bleeding, sweating, purging, puking, leeching, poisoning, cutting, cupping, blistering, freezing, burning, shocking, and a host of other bodily harms. While rehydration and the preservation of blood volume are now a focus of therapy, the very opposite was practiced before the advent of the scientific age. George Washington did not die from a tonsillar abscess, as is commonly believed, but to the leaching out of more than 2.5 quarts of blood within 12 hours. A similar fate of phlebotomy until death befell Giuseppe Mazzini, the founder of the modern Italian republic. One wonders why people accepted noxious methods. One also wonders why physicians were honored though their practice was often irrational and at times fatal.

Modern Clinical Experience
Back in the early 1950s, I came across a case report that left a lasting impression. A pregnant woman suffering from severe and intractable nausea had a balloon inflated in her stomach to record the gastric contractions that provoked the nausea. The vigorous contractions were observed to coincide with her complaint. She was given ipecac-a drug that causes vomiting-and assured that it would bring relief. Within minutes after the ipecac, the intense stomach contractions ceased and with it the nausea. (2)

Investigations by Dr. Henry Beecher, the distinguished Massachusetts General Hospital anesthesiologist, removed placebos from the realm of humbug. As a surgeon in World War II, he observed that the pain experienced by severely wounded soldiers was relieved by small doses of opiates. This contrasted with his civilian experience. At times even massive doses of narcotics failed to ease the pain of young victims injured in car accidents. Beecher concluded that analgesia involved more than the pharmacological action of drugs. The wounded soldier was a hero who no longer had to face the frightening ordeal of battle and the possibility of being killed. The victim of a car crash foresaw no such redemption. He was more likely to face parental censure and perhaps punishment for wrecking the family car.

These observations intrigued Beecher and led him to an extensive exploration of the role of the placebo. (3) He studied 1082 patients with pain from diverse causes. Placebos afforded satisfactory relief in 35% of the cases, (4) a result that has since been consistently confirmed. Beecher was persuaded that placebos activate physiological and biochemical mediators that alter brain function and affect perception of noxious stimuli. He suggested that some of the benefits of surgery are due to placebo mechanisms. Beecher concluded that all drugs exert dual effects, one related to intrinsic pharmacological properties and the other inseparable from placebo action.

Just like drugs, placebo pills exert stronger effects when prescribed in larger doses. The effect is more marked when the capsules are bigger. Relief is greater when the dose is doubled and is more marked when the placebo is injected than when taken orally.(5) Pills colored red, yellow, or orange are likely to stimulate; while blue or green tend to tranquilize.(6,7)

Knowing of the reputed benefit of a remedy is itself likely to increase the efficacy of a placebo. A doctor's affirmation of the value of a prescribed measure will promote a positive placebo effect, especially if the clinician is highly reputed and conveys the aura of long experience and authority.

Patient confidence in the placebo treatment enhances its curative effect. It has long been known that patients who rigorously comply with instructions for taking a drug fare better than those who do not. And those who have faith in a treatment are more likely to comply. What is astonishing, though, is that patients who comply with a placebo regimen also do better than those who haphazardly take the pills. In a large randomized placebo-controlled trial of cholesterol-lowering drugs among coronary heart disease patients, those who took the placebo pills consistently had a lower mortality than those who did not. (8) Even more striking is that the imagined effects of a substance can sometimes directly countermand its actual pharmacology. For example, if a stimulant is given but the patient is informed that it is a sedative, the response will be relaxation and sleep rather than agitation and wakefulness.

Notwithstanding the indubitable power as well as potential benefits of placebos, many physicians harbor a distrust of placebos and contempt for patients who are "fooled" by them, as though responding to an imaginary medication stems from a character defect. A prevailing impression is that the poorly educated, the less intelligent, and the submissive are placebo prone. Psychological studies provide no support for these assumptions. Response to a placebo appears to be far more related to immediate situational and interpersonal factors such as the quality of the doctor-patient relationship, the gravity and type of illness, the severity of symptoms, and a host of others. (9)

Words and doctors as placebos
I am now convinced that the placebo effect is not limited to drugs or surgical procedures, that it is a far more universal phenomenon. The words of doctors and other health professionals are the most potent placebos of all. The capacity of a doctor's word, either to heal or to maim, is determined by the physician's demeanor, the certainty with which information is communicated, the level of empathy displayed, and above all a readiness to listen.

The placeboic power of words was brought home to me by a critically ill patient. (10) Two weeks after a heart attack, he was still in a coronary intensive care unit. He had experienced nearly every complication in the book. The problem was easy to define: More than half of his myocardium was infarcted. He was in florid congestive heart failure. Severe hypotension reflected a markedly reduced ventricular ejection fraction. He could not sit up due to dizziness and near syncope. Breathless and weak, he had no energy to eat; he also lacked appetite, as the smell of food provoked nausea. Sleep was restless and disrupted. He was cyanotic and periodically gasped for air as though drowning.

Each morning, medical rounds were like visitations from a morose bunch of undertakers. We had exhausted all the encouraging platitudes. In any case, I believed that any reassurance would have insulted the patient's intelligence and further undermined his trust. We sped up the morning visits to avoid his scared, questioning stare. Every day the situation deteriorated. His family agreed to a DNR status.

One morning he looked better, he claimed to feel better, and indeed his vital signs were improved. I could not account for the change. The prognosis was nonetheless grim, whatever the temporary improvement. Believing that a change to a less turbulent environment than the CCU would be less stressful and would afford him a night's sleep, I had him transferred to a step-down care unit. I lost track of the patient when he was discharged a week later.

After about six months he showed up in my office. Free of lung congestion and largely asymptomatic, he looked remarkably fit. I was astonished and puzzled. "A miracle, a miracle!" I exclaimed. "Hell no, this was no miracle," he responded. I was taken aback by his certainty that divine intervention had played no role in the miraculous recovery. "What happened?" I asked.

He stated emphatically that he knew exactly when the so-called miracle happened. He was aware that we were at our wits' end, blundering and confused, and did not seem to know how to help him. We had convinced him that we had given up hope and that "his goose was cooked."

He continued, "One Thursday morning, April 25th, you come in with your gang, surround the bed, and look as though I was already in a casket. You put your stethoscope on my chest and urge everyone to listen to the 'wholesome gallop.' I figured that if my heart was still capable of a healthy gallop, I couldn't be dying, and so I got well. So you see doc, it was no miracle. It was mind over matter." The patient was of course unaware that a gallop was a bad sign. A wholesome gallop is an oxymoron.

Words are the most powerful resource a doctor possesses. Patients crave caring, which is dispensed largely with words. Talk can be therapeutic. It is one of the most underrated tools in the physician's armamentarium. Medical experience provides constant reminders of the healing power of words. I know of few remedies more effective than a carefully chosen word. (10)

But the doctor's possibility of acting as a placebo is not limited to words. Minimizing the waiting time begins the process. Greeting a patient with a warm handshake followed by an unhurried, uninterrupted visit further enhances the placebo effect. A careful history, taken without interrupting the patient, fosters trust. An affirmative demeanor, a ready smile, a positive word, speech that is direct rather than equivocating, helps a doctor connect with another human being and form an enduring relationship.

In the most cloudy situation, one can discover a silver lining. This has little to do with truth or falsehood. It flows from the deepest intent of doctoring, to help a patient cope with a condition. Even when a cure is impossible, that does not mean healing is impossible. The very sick are not taken in by phony optimism, but they are eager for a warm touch and the caress of human concern. While medical science has limits, hope does not. I believe the maxim proposed by the physician Edward Trudeau about a century ago: "To cure sometimes, to relieve often, to comfort always." Miracles reside in the capacity for comforting and healing. Doctors can reclaim medical professionalism by resuming the role of a "placeboist."

Citations:
1. Shapiro AK, Shapiro E. The placebo: Is it much ado about nothing? In The Placebo Effect, edited by Anne Harrington. Cambridge, Mass.: Harvard University Press, 1997:12.
2. Wolf S. Effects of suggestions and conditioning on the action of chemical agents in human subjects: the pharmacology of placebos. J Clin Inv1950; 29: 100-109.
3. Beecher HK. The powerful placebo. JAMA. 1955;159:1602.
4. Beecher HK. Surgery as placebo. JAMA 1961;176:1102.
5. Blackwell B, et al. Demonstration to medical students of placebo responses and non-drug factors. Lancet 1972; I; 12:79-82.
6. Buckalew LW, et al. An investigation of drug expectancy as a function of capsule color, size and preparation form. J Clin Psychopharmacol 1982; 2: 245-48.
7. de Craen AJM, et al. Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness. BMJ 1996; 313: 1624.
8. Coronary drug project research group. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. NEJM 1980; 303: 1038-41.
9. Frank J and Frank JB. Persuasion and Healing. 3rd ed.. Baltimore, Md.: Johns Hopkins University Press; 1991.
10. Lown B. The Lost Art of Healing. New York: Random House; 1999.

Bernard Lown New Book

Message received from:
Coleman, Catherine
Hello friends,One of the first articles about Dr Lown and his new book appeared on Sunday,here is the link.
http://www.boston.com/news/local/articles/2008/07/20/a_prescription_for_good_deeds/?page=full
For info about readings etc visit www.bernardlown.org.
The book is a GREAT read! It's exciting and inspiring and fascinating. Availablefrom Amazon.
Catherine
Catherine Coleman
Editor in Chief ProCOR
Lown Cardiovascular Research Foundation
21 Longwood Avenue, Brookline, MA 02446 USA
www.procor.orgccoleman5@partners.org

Ten Years ProCOR

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org]
Em nome de Bernard Lown, MD
Enviada em: sexta-feira, 27 de julho de 2007 15:53
Para: procor@healthnet.org
Assunto: [ProCOR] Dr. Vikas Saini joins Lown Cardiovascular Research Foundation

Dear ProCor colleagues,
At this important point in ProCor's history--celebrating our tenth anniversary, launching the Ashanti-ProCor project to advance our understanding of how we can meet CVD information needs in Ghana and globally, and preparing to announce the first Louise Lown Heart Hero Award recipient, I am pleased to share with you the exciting and important news that Dr. Vikas Saini has been recruited as President of the Lown Cardiovascular Research Foundation. As President, Dr. Saini will work with ProCOR and the Lown Foundation's other programs and will participate in the Lown Group's cardiovascular practice.
When ProCOR was founded a decade ago, the primary intent was to rouse awareness of the mounting cardiovascular epidemic emerging in developing countries as well as to focus on prevention as the only effective remedy. A promissory note for success was the cresting information revolution worldwide. Another element we hoped would make our approach unique was bringing the Lown model of cardiovascular care to global attention by sharing the decades of experience of the Lown Group. The Lown Group, by individualizing care and placing a premium on listening to the patient, has minimized costly interventions, empowered patients to take control of their own health and encouraged them to more readily adopt healthy lifestyles.
Now the right individual has joined with us to address this challenge. Dr. Saini brings extraordinary credentials to this role. Born in Hoshiarpur, a small town in Punjab, India, Dr. Saini came to the US at the age of four. His educational background includes a scholarship to Upper Canada College, and at the extraordinarily young age of 16 he was accepted to Princeton University. Dr. Saini graduated with honors from medical school at Dalhousie University in Halifax, Nova Scotia, Canada, and completed his medical residency at Baltimore City Hospitals, a program of Johns Hopkins University School of Medicine.
With a strong interest in researching the physiology of mind-body interactions, Dr. Saini expressed the desire to study investigative techniques at our research lab in Boston. I offered him a fellowship at the Lown Laboratory at the Harvard School of Public Health, and he immersed himself in the research and clinical activities of the group. He later went on to co-found Aspect Medical Systems, Inc., where he served as its first Vice President of Research & Development and on its Board of Directors. As a founding partner of The Cardiovascular Specialists in Hyannis, Massachusetts, USA, Dr. Saini's experience includes a clinical cardiology practice specializing in conservative cardiovascular alternatives to invasive management. As Vice President of Primary Care, LLC, the largest network of independent primary care providers in Massachusetts, Dr. Saini worked with health plans to improve health care delivery within the network and to assess and develop the group's incorporation of health information technology.
Dr. Saini's research includes developing a hypothesis that anesthetic depth alters the body's inflammatory tone long term, which is currently being tested in clinical trials. Other research includes a clinical trial looking at post-operative inflammation and a project assessing the potential of certain dietary plant poly-phenols for cardiovascular prevention.
Dr. Saini complements all those who have helped sustain our vision over the years. Joining us is a vote of confidence; an affirmation of the Lown Group's potential.
Bernard Lown, MD
Founder and Chair, ProCor