Tuesday 12 May 2015

Taking Tea with Bernie

“I’ll just nip upstairs. There’s something I want to get for you.” And he does.

The 93 year old Dr Bernard Lown nips upstairs and comes back with a signed copy of his memoir, The Lost Art of Healing; and another slim volume Never Whisper in the Presence of Wrong. The latter is a selection from speeches he gave on nuclear war and global survival. Never whisper in the presence of wrong. It resonates. And he lived by it. Still does.

I am at Harvard briefly as a Bernard Lown visiting professor. It will entail another couple of visits to Harvard – no penance. The best part is the privilege of taking tea with Dr Bernard Lown at his home in Chestnut Hill, a leafy suburb of Boston. (I suspect that there is an inverse correlation between age of Harvard medical professors and the distance west of the Longwood Medical Area of Boston that they live. The newer the recruit, the further out they have to live. Harvard professors, high status, no doubt have long life expectancy, keeping the desirable properties occupied. That said, at 93, Dr Lown must be among the more senior. He is relatively close in.)

I know him as the co-founder, with brother cardiologist Evgeni Chazov of the Soviet Union, of International Physicians for the Prevention of Nuclear War (IPPNW) in 1980. They were awarded the Nobel Peace Prize in 1985. Leaning against a wall, I nearly dislodged a photo of Lown meeting with Mikhail Gorbachev in the Kremlin.

Bernard Lown - Image Source Boston Globe 2008


But there’s so much more. All over the world, patients with cardiac arrhythmias can be treated with cardioversion, a DC electrical shock to the heart, timed to miss a vulnerable interval in the cardiac cycle. Lown developed that. Patients with heart attacks used to be confined to absolute bed rest for weeks. Now they are mobilised quickly to prevent venous thromboembolism and pneumonia. Lown and Dr Samuel Levine, his mentor in cardiology at the Peter Bent Brigham Hospital of Harvard, were responsible for that. Patients treated with digitalis and diuretics could develop fatal cardiac complications. Lown showed that low potassium – which could be caused by diuretics – made digitalis potentially toxic. He did as much as anyone to draw attention to the issue of sudden cardiac death.

He was an early and firm believer in the importance of the mind in both the onset and recovery from cardiovascular disease. Had he done nothing else, his reputation would be secure as having made a fundamental and lasting contribution to the management of patients with cardiovascular disease. But he always saw clearly his wider responsibility to society.

Why is a cardiologist based at Harvard School of Public Health? He graduated from Johns Hopkins in 1945. American paranoia about communism, which led to the excesses of McCarthyism, meant that belonging to many student organisations with a social responsibility put you beyond the pale politically. Simply, his political beliefs made him difficult to employ in the fevered atmosphere of the time. Seems bizarre now. A Harvard professor, he has twenty honorary degrees, numerous medals and awards, a Nobel Peace Prize, and all the recognition as a clinician and scientist that one could imagine. Yet his undoubted ability was not enough. When the famous Brigham hospital was closed to him, he looked around Harvard, but the politics seemed to get in the way. Finally, he found Dr Fred Stare, head of Nutrition, at Harvard School of Public Health who offered him a job, and space for a research lab. Lown told Dr Stare that there were some political issues he should know about. Stare’s response: you’re an American; that’s all I need to know.

The frustration was that the two and a half hours I spent with Dr Lown, and his wife since 1946, Louise, meant that we had only just got started. He said he would give me the tour on my next visit.

Much to discuss.

Thursday 7 May 2015

Bringing SDH to Tehran and Iran to SDH


Mostly, I don’t wear hats. But if I am going to, it may as well be more than one; in the case of this meeting in Tehran, three. The short version of the story started in Tunis. Ala Alwan, Regional Director of WHO EMRO Region, wanted to put social determinants of health firmly on the agenda for his region and wanted my help to get the approval of member states at their Regional Committee in Tunis last October. I did and we did. That was the first hat: an academic getting excited, yet again, about the social determinants of health message and possibilities for action.

Now I was hooked in. The next step was a regional consultation and I felt duty bound. Advisors to the Minsters of Health in Iran said that Iran would host it. Second hat: advisor to WHO EMRO on SDH. Senior people from most of the Eastern Mediterranean countries came together to consider next steps on social determinants of health – truly exciting.

The deputy mayor of Tehran put social justice firmly on the agenda. He appeals to the Koran for this argument. I appeal to our sense of what is right. Nine years ago when the CSDH met in Tehran, I said that members of the Commission come from the world’s great religions, and from science, rationality and humanism. But if we can agree on what is the right thing to do to create a more just distribution of health, then we work together in brotherhood.

We talked about having two or three partner countries. Iran would like to be one. Although not too much is happening at the national level on SDH, Tehran is doing interesting things at the city level. They have had several city initiatives for a healthy Tehran, including Urban HEART – health equity analysis and response tool. The WHO Kobe Centre ran the CSDH Urban Settings Knowledge Network. They did a fine job and were so pleased with the activity that they developed this tool to take SDH forward at the Urban level. We visited one “Health House” that was involving community groups in setting agendas to improve their own health and well-being. There are 374 of these health houses – one for each neighbourhood of the city (although the number of neighbourhoods has now come down a fraction). Under Urban HEART, surveys of people in local areas yielded the following top seven priorities:

  • being overweight and obese
  • waste disposal
  • being elderly
  •  tobacco
  • female breadwinners
  • domestic violence
  • unemployment

Much to do on these seven. And there is no question that central action would reinforce the local level.

My third hat was as President-Elect of the World Medical Association. The President and Board of the Iranian Medical Council invited me to a breakfast meeting with them. I told them I was trying to get the doctors involved on SDH. Could I interest them? I also noted that they were not members of the WMA. Perhaps I could interest them in that too? It looks rather positive on both counts.

Alireza Marandi was a member of the CSDH. He is an MP in Iran and President of the Academy of Medical Science. He expressed his willingness. If we think of the Academy as representing academia, and we have the doctors, the city level, and the Ministry of Health, we could be in business. Especially as the Minister assured me that he is setting up a cross-departmental commission on social determinants of health.