JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 65, NO. 16, 2015

ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 0735-1097/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jacc.2015.03.041

LEADERSHIP PAGE

A Challenge Let Us Strive to Be #2 Kim Allan Williams, SR, MD, FACC, ACC President

T

he influenza pandemic of 1918 was the one

it—many of whom were in makeshift emergency

and only time in the last century that cardio-

hospitals because of a shortage of hospital beds.

vascular disease was not the leading cause of

Since then, the United States and the rest of the

mortality in the United States. Although no one

world have clearly come a long way with treating and

knows exactly how many people died from influenza

preventing influenza, thanks to vaccine research and

during that year, the total number of global deaths is

development and large-scale public education cam-

estimated to be at least 20 million. Of this number,

paigns that were able to spread quickly in later years

roughly 675,000 were Americans (1).

due to wider use and production of radios and tele-

According to the U.S. Department of Health and

vision. Today, the Centers for Disease Control and

Human Services, the influenza pandemic occurred in

Prevention can get information into the hands of the

3 waves, with the first occurring in the spring and

public even more quickly (in a matter of minutes,

summer of that year as World War I came to an end

if not seconds) with the widespread use of mobile

and soldiers started returning home from Europe. The

devices and social media.

second wave occurred with an outbreak of severe

Of course, this also means that cardiovascular dis-

influenza in the fall of 1918, and the final wave

ease has held steady as the leading cause of death in

occurred in the spring of 1919 (1).

the United States and around the world in all of the

What made the pandemic so different from other

years after the influenza pandemic. Although we have

outbreaks is that mortality was not limited to just the

made significant gains over the last 6 decades in

young and elderly. Healthy men and women between

reducing cardiovascular mortality and preventing

the ages of 20 and 40 years also succumbed. Perhaps

and treating the disease, we have not been successful

this was because it was a period at the end of war

in taking it down a notch. I think it is time to finally

during which limited food supplies had led to nutri-

cede this position. The goal of becoming #2 is well

tion deficiencies and suppression of immune sys-

within our grasp—more so than ever before. However,

tems. Another theory is that the immune system was

if we are serious about doing it, we have to work

part of the problem, with the virus creating an in-

together and build public trust in our efforts to be

flammatory cascade that overwhelmed the host.

successful.

Men traveling home from Europe brought the

A paper published this past October in the

illness back to their families. The influenza virus also

New England Journal of Medicine examined the

spread quickly at a time when many communities

declining standing of U.S. physician leaders in

were facing shortages in trained medical personnel

the public eye since the 1960s. In 1966, 75% of

due to the war. The Public Health Service had fewer

Americans surveyed had great confidence in physi-

than 700 officers at the time and was unable to keep

cians, but by 2012 only 34% shared this outlook (2).

up with the number of requests for nurses and doc-

This lack of trust places the United States well behind

tors. Those medical personnel that were sent to pro-

other developed countries like Turkey, France,

vide aid often became ill themselves or arrived at

Finland, Britain, the Netherlands, Denmark, and

their destination unprepared to provide meaningful

Switzerland, where >75% of adults agree that doctors

assistance to the large number of people that needed

could be trusted (2). The authors, who are affiliated with the Harvard School of Public Health and the Harvard University Program in Health Policy, suggest

From the American College of Cardiology, Washington, DC.

that this lack of trust may diminish the influence of

Williams, Sr.

JACC VOL. 65, NO. 16, 2015 APRIL 28, 2015:1700–1

Leadership Page

physicians in decision-making around the next stages

new digital technologies to reduce disparities in care

of health system reform.

and provide easy access to clinician and patient tools

The American College of Cardiology (ACC) is

and resources previously accessible by only a few.

committed to working with its members to improve

The list goes on. We need to do a better job touting

public trust, whether it is showing that we can and will

these successes.

hold each other accountable for providing appro-

We also need to tout what it means to be a fellow or

priate, evidence-based care; involving our patients in

associate of the American College of Cardiology

their care decisions so that they best understand the

(FACC or AACC)—to our patients, our lawmakers, and

best course of treatment and why; or using data from

others in our community. We are best positioned to

registries like those in the National Cardiovascular

show by our actions and our words that these 4 letters

Data Registry (NCDR) to improve patient outcomes

demonstrate a commitment to providing the best

and close gaps in care. We must own our actions—both

possible care to patients—and we should be trusted

good and bad—and be visible to the public and our

because of them.

patients in positive ways that affect their lives.

Finally, and most importantly, ACC members must

The Harvard study showed that poor people in the

take advantage of being part of the College. ACC

United States have a substantially lower level of trust

members are the College and are at the core of its

in the entire health care system. Adults from families

mission. The College does not exist for its own sake.

earning