Califf: US at ‘moment of reckoning’ for heart disease, public health
Click Here to Manage Email Alerts
CHICAGO — The U.S. is at a “moment of reckoning” in terms of heart disease and other public health issues, and disastrous consequences will ensue if improvements are not made, the FDA commissioner said.
“As American heart people, we’ve got a moment of reckoning right now,” Robert Califf, MD, MACC, commissioner of the FDA, said during a presentation at the American Heart Association Scientific Sessions. “We need to do something more than we’re currently doing, and something different, because what we are doing now has stalled and is not working the way it should.”
Source: Adobe Stock
Califf, who is a cardiologist, said the U.S. is the leading innovator in biomedical science and technology, but that has not led to improved health for most Americans on an individual or population level.
“We are failing in the implementation phase in the U.S.,” he said. “Cardiovascular disease is at the tip of the spear.”
He said the U.S. spends more on health care but has lower life expectancy than most developed nations, noting the gap in life expectancy between the U.S. and peer countries has existed since at least 2010, but got worse in 2020, the first year of the COVID-19 pandemic. He noted that the latest life expectancy data show that China has passed the U.S. in terms of average life expectancy.
Poor rural counties have the lowest life expectancy in the U.S., he said, noting the mortality rate has been higher in rural counties than in urban counties since the 1990s, and the gap has been growing wider.
“If you had told me in 1984 that urban people would be exercising more than rural people, I would have said you were out of your mind,” Califf said.
The life expectancy problem is driven by conditions “that we pretty much know what to do with — obesity, diabetes, blood pressure and cigarette smoking,” Califf said. “Yet we are spending so much of our money and energy on things that have marginal return, and we are not focusing on these things that make such a big difference.”
He said: “We are largely not motivated to do something about the common chronic disease problem, but it is going to be overwhelming if we don’t do something. If you take the current risk factor profile of our teenagers, we are headed for big trouble 20 to 30 years from now if we don’t do something different.”
The medical community needs to reinvigorate its evidence generation system around what is known to work, including information about social determinants of health, Califf said, noting that “we should not just focus on things that are high technology and bring the most revenue into American hospitals.”
The challenge is particularly difficult because of the ease of which misinformation spreads over social media, Califf said.
“I believe each of us should, when we get up every morning, put some time into combating this enormous problem that we didn’t used to have called misinformation,” he said. “I’ve been going around saying that misinformation is the leading cause of death right now in the U.S. There is no way to prove that, but I really do believe that it is. It’s not just naive misinformation. There actually are bad actors who are purposefully trying to influence the everyday person to have them do things [that] are negative for their health. We actually did have snake oil salesmen back in the good old days ... but they had no way to reach billions of people. But now, a single snake oil salesman can reach billions of people instantaneously over the internet. I don’t know of anyone who has a plan to deal with this successfully. It’s an urgent matter that we all need to deal with.”
Collapse
Califf R. Opening Session: Moving Science into Public Health: Lessons Learned. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).
Click Here to Manage Email Alerts