By AMERICAN HEART ASSOCIATION NEWS
A century ago, a groundbreaking cardiologist was recommending changes to people’s lifestyle habits that today we often take for granted.
Exercise more. Eat healthy. Learn your family’s medical history.
They were the tenets Paul Dudley White brought with him when he started the first-of-its-kind cardiology unit at Massachusetts General Hospital in 1916. Eight years later, he helped establish the American Heart Association.
“One of the things that Dr. White taught all of us was the importance of risk factors — cholesterol, blood pressure, sedentary lifestyle, diabetes, smoking and family history. Those factors remain striking predictors of heart disease,” said Randy Zusman, M.D., director of the hypertension division of the cardiology unit at Massachusetts General.
“Then, on the flip side, he taught us that lifestyle modification, along with, if needed, drug therapy, is the key to prevention and better health. That has been a principal the American Heart Association has promoted ever since it’s founding.”
Massachusetts General recently marked the centennial of its cardiac unit with a reception and scientific symposium. Zusman, who serves as secretary of the facility’s Paul Dudley White Society, which helped organize the celebration, said many of White’s concepts originally generated controversy and argument in the medical community.
When White was appointed as Dwight D. Eisenhower’s physician following the president’s 1955 heart attack, the doctor’s rehabilitation strategy raised eyebrows, Zusman said.
“There were those who wanted the president to sit quietly in his chair and do nothing. And then there was Dr. White, who wanted the president to get up and be physically active and continue to lead a vibrant life,” he said.
“Dr. White had this clearly revolutionary, for his time, approach to patients and patient lifestyle. That patient-centered focus, along with preventative care, were principals he advocated for the American Heart Association that remain in place today.”
During his tenure as chief of Massachusetts General’s cardiac unit, White published more than 400 papers that covered the entire range of cardiology. He also served as executive director of the National Advisory Heart Council, helped oversee the creation of the National Institutes of Health, and was a major impetus behind the first Framingham Heart Study, ongoing research that has advanced the understanding of cardiovascular disease.
Despite all of his activities, White didn’t care much for politics, said his friend and colleague, Roman DeSanctis, M.D., clinical cardiology director emeritus at Massachusetts General.
“He didn’t like getting involved in bureaucratic type of stuff. He was much more of a visionary, a person who set directions and goals,” DeSanctis said. “He didn’t like the nuts and bolts of politics – medical politics, organizational politics. He sort of shied away from them, but he was always very effective when placed in those roles.”
DeSanctis said White was already well known before he worked as the White House doctor, but became a “rock star” once he took care of Eisenhower.
“He became very famous, but he never used his fame for personal gain. It was always as a platform upon which he could advocate for particular treatment and prevention of heart disease. It was so very important to him,” he said.
White also had a common touch that allowed him to relate to his patients regardless of status, race or income level, DeSanctis said.
It helped that White practiced what he preached – he was known as an avid walker and bicycle rider. A bike path that runs along the Charles River in Boston is now named after White.
“He just advocated for good things in life, particularly how to stay healthy,” DeSanctis said.
Anthony Rosenzweig, M.D., chief of Massachusetts General’s cardiology division, noted that when White first espoused prevention medicine, there wasn’t a lot of hard science to back him up.
“It is remarkable how prescient he was at a time when there wasn’t the data to support him,” he said, noting that statistics eventually followed, in part because of White’s work and because of organizations that grew out of his efforts, including the American Heart Association and the National Heart, Lung and Blood Institute, as well as the Framingham Heart Study.
“Think back to when he was advising people to eat a sensible diet and particularly to exercise. In some sense, he must have intuited this,” he said. “One of his teachings was to listen to your patients and I think somehow, he was able to infer what has taken us many years to really build up the data base to support with rigorous research.”
Today, preventive care plays as large of a role as diagnosis and treatment in the cardiology.
“When he started it 100 years ago, this was the first cardiac unit in the country, and there were no sections within cardiology. But almost each one of these interests of his has grown into a robust field in of itself,” Rosenzweig said.
Preventive cardiology has become a major concentration for Massachusetts General, as well as other top hospitals, and so has research into genetic indicators that can help identify risks for cardiovascular events. The hospital also has multiple areas that concentrate on exercise, and the connection between athletes and heart disease.
“This is the modern embodiment of the common sense and clinical wisdom of Paul Dudley White in terms of practical steps to prevention,” Rosenzweig said.
“Paul Dudley White was way ahead of his time. He set the tone and it took most of the rest of everyone to catch up.”