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Jay N. Cohn, MD: From a focus on end-stage disease to prevention
Jay N. Cohn, MD, said the focus of his medical career shifted drastically over the years, from end-stage HF to the prevention of CVD.
Cohn’s biography is lengthy, as he has made numerous contributions to the field of cardiology. He was among the first to encourage bedside hemodynamic monitoring in acutely ill patients, which led to the development of ICUs. He was among the first to document the value of vasodilator drugs for improving left ventricular function, which led to the development of medications that remain the current standard of care. He was among the first to identify neurohormonal activation in vasoconstriction as a key contributor to HF progression, among other notable accomplishments.
Cohn graduated from Cornell University Medical School in 1956 and completed his internship and residency at Beth Israel Hospital in Boston. His career then led him to Washington, D.C., where he was a CV research fellow and clinical investigator at Georgetown University and the Veterans Affairs Medical Center, and later named professor of medicine at Georgetown and chief of hypertension and clinical hemodynamics at the VA Medical Center. Cohn moved west in the 1970s, where he served as chair of the CV division at University of Minnesota through 1996. Today, he is professor of medicine and director of the Rasmussen Center for Cardiovascular Disease Prevention at the University of Minnesota.
Much of his career has been concentrated on the management and treatment of HF. Cohn organized and chaired the Veterans Affairs Cooperative Study Program on Vasodilator Therapy of Heart Failure (V-HeFT), the first long-term clinical trials of HF. He was the founder and first president of the Heart Failure Society of America and founder and first editor of the Journal of Cardiac Failure, both of which are well respected in the cardiology community today. More recently, Cohn has shifted his attention to screening asymptomatic individuals for CVD and to demonstrating the importance of slowing the progression of disease.
What do you enjoy doing when you’re not practicing medicine?
I regularly play tennis, mostly singles and, sometimes, doubles. I enjoy playing golf in the wintertime while we are snowbirds in Florida. My wife, Syma, to whom I’ve been married for 62 years, and I have a rather active cultural life, with music, art and theater a focus of our energies and support.
If you hadn’t gone into cardiology or medicine, what would you have done?
Much of my career is heavily dedicated to writing, so I may have been a writer. I was initially interested in writing fiction, but am now focused on nonfiction, narrative and opinion writing. I have published a number of essays. I also have a book, Saving Sam: Drugs, Race and Discovering the Secrets of Heart Disease, that will be published soon. The book is a scientific memoir about my involvement in the development of BiDil and new therapeutic approaches that have led to a revision of medical thinking in the past 50 years. BiDil is aimed at the treatment of HF in black patients. When approved by the FDA, it created a remarkable stir in the medical community because of the drug’s emphasis on a single racial group. The history, scientific process, controversy, as well as what this development meant for the future of cardiology, are covered in this book.
Cohn and his wife Syma on a recent cruise on the Rhine River.
Photo courtesy of: Jay N. Cohn, MD
What would you consider one of your biggest successes in your specialty?
Application of the concept that understanding the mechanisms of disease is a prerequisite to developing rational therapy. That approach began with our insight into the use of vasodilator drugs to treat HF, a strategy which has become the primary mode of therapy in recent years. We are now dedicated to understanding the mechanisms of progression of CVD so we can intervene in asymptomatic patients to delay morbidity. If we start early enough, I am confident that symptomatic CVD can be essentially eliminated before the age of 100 years.
What is the last art show you attended? What did you think of it?
My wife and I recently attended a show of works by Edward Hopper (an American painter and printmaker). It gives great insight into the process of creation. Hopper was an artist dedicated to precision in showing images in a way that elicited his desired response from the viewer. He placed great emphasis on developing these images in multiple sketches displayed in this show. His devotion to image development is similar, in my view, to the effort of the writer to find the right arrangement of words to convey the desired response from the reader.
What is the best advice you’ve ever received?
I may or may not have received this advice at one time, but I often give it: Never accept a job bigger than you are. People often fail to recognize when they accept positions that the position may come to define them so that they will be diminished when they leave. Two, the only thing worse than being a leader is not being a leader. Many people shun leadership; others seek leadership. We need leaders, but their goal should not be self-aggrandizement.
What do you think will have the biggest influence on cardiology in the next 10 years?
The future is in prevention. We now know enough about CVD that we should no longer be treating end-stage disease. We are pouring all of our money into new and better therapies for patients with advanced disease, when in fact with effective insight and growingly effective preventive therapies we should be able to prevent illness in those with early disease. Unfortunately, that is not the agenda of the health care system. We must revise our focus and recognize that health care should aim at preventing disease, not treating end-stage disease.
What is your favorite travel destination?
Syma and I spend the winter months in Longboat Key, a town in Sarasota County, Fla. We have also done a lot of traveling over the years. France and Italy, particularly Tuscany, probably stand out as the countries we most enjoyed visiting.
What is your favorite restaurant?
In the past, a great meal required travel to France or other food meccas to eat at Michelin-starred restaurants with outstanding chefs. The world has changed. You no longer have to travel the world to eat well. Today, great cuisine is available in almost every community in this country. We can go in our own neighborhood in Minneapolis to eat delicious and creative food. In Florida, one of our favorites is Maison Blanche, a French restaurant run by a French chef that is a half-mile from our condominium on Longboat Key and perhaps as good as any restaurant in the world. – by Katie Kalvaitis