The Medicine Man

GUEST: Isadore Rosenfeld, M.D.
VTR: 01/22/2004

I’m Richard Heffner, your host on The Open Mind. And my guest today, New York City internist and cardiologist Dr. Isadore Rosenfeld has for many years now been a most effective spokesperson for an essentially commonsense approach to medical information for the general public. Even in the midst of modern medicine’s extraordinary technological advances.

His new Rodale Trade paperback, “Breakthrough Health, 2004 Edition” is but the latest of my guest’s many best selling books on medical matters that, along with his popular magazine articles and broadcast appearances reach millions of Americans.

Indeed, in my own recently published “Conversational History of Modern America” I point out not only how wisely Dr. Rosenfeld has offered advice, comfort and clarification on the medical issues that cloud our lives, and commented as well on their broader social implications. I also indicate how amazingly many of his medical opinions on The Open Mind, nearly a quarter century ago ring true today.

Which, of course, leads me to ask my guest whether there is a particular vision of medicine’s future that he has now, one that I can hold him to at this table in another couple of decades. How about it? Picture of medicine in the future?

ROSENFELD: I think that technology will continue to proceed at a tremendous pace. And we’re looking at two main areas for the future. One is stem cells and the other is gene therapy. Both of which, I think, will change the face of medicine, longevity, certain diseases will be eradicated, others will be better controlled. My main concern is not technological advance, but availability of medical care …

HEFFNER: What do you mean?

ROSENFELD: … of Americans. I mean that right now there are more than 43 millions who have no access to a doctor, other than in an Emergency Room where they should bring their own beds because they are going to be staying there for a long time; for hours and hours. No, I think that our most pressing need now is to formulate a health policy that makes all these advances available to the sick.

HEFFNER: Do you see that as one in which the nation itself, the government would be the final payor?

ROSENFELD: My own personal preference is a universal health care system. Not Medicare, or Medicaid everybody to get the same medical care that they need. I, I have the same qualms about government delivering such care. But I prefer it to, to profit motivated delivery systems. I think the most inept civil servant is better than somebody … than the most efficient person who is driven by profits. So my feeling, I hope that I live to see the day when we have a universal health care system run efficiently by the government and made available to everybody who needs it.

HEFFNER: What about the examples that we have of such systems in other countries?

ROSENFELD: You know, other countries are not a model for this country. We are unique. We are the richest nation and the most powerful nation in the world. And we do many things. I mean the President talked about going to Mars and the billions of dollars setting up a station on the Moon. All of these things are wonderful, but in my view, it’s a matter of priorities. You do what you can with the resources that you have, and it’s a matter of allotting the resources to what you consider to be most important. In my view, not only as a physician, but as a father, a grandfather, a husband, a neighbor, a friend, the greatest priority is the health of our people. And I don’t think there’s any point in comparing with Canada or Sweden or any other countries that all have medical care systems that make care available to everybody. I think with American expertise and resources and dedication we can have an efficient medical care system.

Take Medicare for example. We all complain about Medicare, it’s running out of money and so on. But if you know anybody over the age of 65 who’s on Medicare and most of us are, it’s a very efficient system. It’s not perfect, but it’s very efficient. People over 65 with limited resources can find a doctor, can get treated and now with, hopefully, with the introduction of help to pay for drugs, I mean I think it’s a satisfactory system. Nothing is perfect, but it’s satisfactory.

HEFFNER: All right. I understand your point of view about the 40 plus million Americans who are not covered. But assume that the best thing that you hope for and the best thing I hope for, comes to pass. Tell us about medicine in the future.

ROSENFELD: Well, I already alluded to stem cell therapy. That’s on the immediate horizon. We are already taking stem cells … let me tell you what stem cells are … they’re very primitive cells. We all have them in our own bodies and they’re also available in embryos. I don’t want get into a political …

HEFFNER: Available

ROSENFELD: I don’t want to get into the political aspect of it; I think that ultimately, whether there’s another Administration or whether this Administration bows to scientific pressure, I think that ultimately that we will have access to embryonic tissue. They have it in England and all over the … the rest of the world.

But even forgetting about that, our own body’s have primitive cells that are available to us in our bone marrow, for example. Now the thing about these primitive cells is they’re very, very early, they’ve just been formed … the bone marrow forms them every 90 days and then they mature to become red blood cells. But if you take out such a primitive cell before it has decided to become a red blood cell, and you take it and put it into a heart, it becomes a heart cell, or it becomes a vascular cell that can make arteries to go in the heart.

And there are at least three institutions now treating people who’s heart muscle has been damaged by untreated, long-standing high blood pressure, by multiple heart attacks, by whatever. Or in severe congestive failure. They take these stem cells, they implant them into the heart, and they become heart cells. And in some patients who have received this treatment it’s very early … their, their condition has improved, they’re able to do more, they’re, they’re in less severe failure.

As far as gene therapy is concerned that’s also in the offing. I don’t, I’m not familiar with the … I mean I have a patient who received gene therapy, but I’m not familiar with the … I’m not impressed, so far with the results of gene therapy.

What the gene therapy does is they inject the gene that has the potential to form blood vessels, it’s called angiogenesis … and they put the gene into a weakened heart, or in a heart that has insufficient circulation where the coronary arteries are completely blocked and too small to be fixed, to be ballooned or repaired and these genes form little new blood vessels that supply the heart.

And I think gene therapy will be important, not only for heart, but for really, for every other disease.

HEFFNER: Iz, let me ask you a question that you may find very strange. To what end? To the end that we live forever?

ROSENFELD: No. To the end that we live better. You know I’m a cardiologist. I have many patients who are … who are so constantly short of breath and weak, can’t … the feet are swollen, they can’t get about; their hearts aren’t pumping. Now if you can devise a technique for, for making the quality of their life; these people aren’t ready to die emotionally and mentally. They are physically; they’re physically crippled. If you can develop techniques that can keep them going … I’m not saying to take somebody with a terminal cancer and giving them a gene in the heart. I’m not talking about prolonging suffering. I’m talking about eliminating suffering. And that has nothing to do with, you know, with the question you raise.

For example, people who have had a stroke are … and a portion of their brain has been damaged by a hemorrhage or a clot, and it’s not functioning, they’re paralyzed … they … we are now working on injecting these stem cells into the brain and I told you that these stem cells become whatever … wherever you put them. And it’s an incredible thing. And as a matter of fact, you can inject these stem cells and let them go their own way. And they make a bee-line to the organ in which they’re needed. I mean this is fantastic stuff.

HEFFNER: You know you’re always … you’ve always been the great optimist; the “positivist”. And I went back the other night and looked at a transcript of a program we did a quarter century ago. And I was baiting you in a sense. I think at the time we had just experienced someone who had had the implantation of an artificial heart. And I tried to get you to draw a line someplace that we were not going to have bionic women and bionic men.

ROSENFELD: I remember reading that, yeah.

HEFFNER: And your, your enthusiasm … you said no matter what, they can work, we’re going to do it. You still feel the same way?

ROSENFELD: I absolutely do. As I said the objective is not simply to prolong life; make people live, you know, older. The objective is to make them live better at whatever age. And you can do it.

You know cataract surgery used to be such a horrible thing. I remember my Uncle was in the hospital for a month after cataract surgery. I had a cataract done the other day and I was out in an hour. And reading an hour later. Even in the area of artificial hearts I think there is promise. Somebody has … every organ is working, the brain, everything … the heart’s gone. There are, there are cardiac assist devices that can improve … what’s the alternative? The alternative is to say to a patient, “listen there’s nothing I can do for you. Lay down and die.” I’m not ready to do that.

HEFFNER: The patient obviously isn’t, either.

ROSENFELD: No.

HEFFNER: And you’re not. But now let’s go back to where we began today and that is the matter of people uninsured. And money, the monies involved in establishing a payor of last resort, that is the, the government. How much can a) our Treasury afford and how much b) maybe it should be a) can the natural life span afford. Going to the second question, do you think that there is a natural, built in, genetically determined end of life …

ROSENFELD: Yes, there is.

HEFFNER: … not going to go much further than this.

ROSENFELD: No. Oh, I think it’s around, at the moment …

HEFFNER: Yeah.

ROSENFELD: It’s around 120. But you know, let me tell you something …

HEFFNER: 120?

ROSENFELD: 120 is, I think the genetic limitation at the moment. But, let me tell you something at the beginning of the 19 hundreds, do you know what the average life expectancy in this country was?

HEFFNER: Probably around 40.

ROSENFELD: 47. Now in the last century our … life expectancy is now something like 86 or 87. That’s fantastic. And I as a practicing doctor lived through most of that.

When I started to practice cardiology, I had only at my disposal my five senses, my compassion, an electrocardiograph machine and that’s all. And my stethoscope. I mean look at what has happened. Today we can, we can visual … I’ve had an angioplasty … you know 20 years ago, 25 years ago I would have needed open heart surgery. 35 years ago I would have nothing, I would have become a cardiac cripple.

I mean we have transformed human life and quality of life, not only in terms of its extension, but, but quality and able to do things. You know ten or 15 years ago there were, I think, 6,000 or 8,000 people who were centenarians. We have something like 70,000. I had one come in my office the other day, wanted me to introduce him to a girl, he had … [laughter] … he was 101. God bless him.

HEFFNER: Did you?

ROSENFELD: Absolutely. She was 103.

HEFFNER: [Laughter]

ROSENFELD: Now it’s far … but you know the other aspect that I’m not able to address because I’m not an economist and I’m not a politician is, is the financing of it. But if we can do what we’re doing now with a trillions of dollar deficit. We can certainly provide health care, necessary health care for the, for everybody. And that should be an objective. Your objective. My objective. And the objective of every voter in this country.

HEFFNER: Except as, be fair in terms of the arguments that my friend Dan Callahan puts forth …the money that goes into the 100 and 101 and 102 year old patients does not go into schools, does not go into the well being of young people. Now how do you deal with that?

ROSENFELD: Well, you have to … I, I don’t know how to deal with that. I’m not …

HEFFNER: But you’re a voter, not just a doctor.

ROSENFELD: I think we have to establish priorities. We have to determine … the American people will have to determine what their priorities are. I believe that there … we have the resources to educate our children, to house our people and to keep them healthy. I think those are the three main things in life. I mean what else, what else is important?

HEFFNER: All right. And in the meantime, the answer to my question about a natural life span you said, and I was aware of that, you said it twice “at the moment.” Now what do you mean by that when you think that perhaps 120 is a natural limit. How can you add, “at the moment” … are you going to change nature?

ROSENFELD: You know … a patient comes to a doctor, the objective of the visit is not for the doctor to say, “now listen, I plan for you to reach 117 years of age.” You treat people and you treat their diseases and you treat their problems, their health problems the best way you can. Many of them will respond and continue to lead normal lives. However long those lives are destined to be. I can’t say, “hey, listen, we have a limit and what’s the point of you living to 100?”. I mean I, I … the age doesn’t enter into it; just as the money doesn’t enter into it when you’re dealing with older people because you’re on Medicare.

HEFFNER: Yeah, but you …

ROSENFELD: I don’t understand you … the thrust of your question.

HEFFNER: Well, you use the word “destiny”. And that’s what I’m asking about. Let’s say the patient goes to your office and you handled the diabetes and you handle the heart problems; and you handle …

ROSENFELD: And there’s Viagra, too. Don’t forget Viagra.

HEFFNER: Right. I hope, I hope. I liked what you wrote about “breakthrough health”. Iz, you handle all these things … is the 120 figure that at the end of this, the body just wasn’t destined to go on longer than that?

ROSENFELD: The body was destined, that’s my point. Genetically, the body was destined. How long people live is not for me to determine, it’s for me to facilitate.

HEFFNER: Well, when Lew Thomas sat at this table, a quarter century ago …and I put the question to him …

ROSENFELD: Great man.

HEFFNER: Great man. He saw a very, very shorter natural destiny. Now you, you’re leaving room for it to be worked up further and further.

ROSENFELD: I’m leaving room for us to benefit from whatever science develops … for us. Now I’m not saying that that should be forced and I’m not saying that, you know, when the time comes, the time comes. But until the time comes and I can’t determine when … how long you’re going to live. All I can do is treat your illness and make you enjoy life as long as you can.

HEFFNER: You, you’re not willing to say …

ROSENFELD: What numbers … how, how it ends up on the calendar I don’t know, and I don’t care. I don’t treat a calendar, I treat a human being.

HEFFNER: You’re a good man. You’re a good man. I’m very serious … which brings me to the question, you know, I … I’ve been in California a great deal …

ROSENFELD: I know.

HEFFNER: … and I find that medicine there, in a funny way, is practiced a little bit differently here. Because here I hear you and your optimism and I know what I will hear from you because I know there is such a positive approach that you take. In California I hear that again … “we don’t treat the calendar.” I hear that over and over again.

ROSENFELD: Right.

HEFFNER: I don’t find that to be so true of medicine in the East. Is there a natural geographic division in terms, perhaps of the way medical schools teach …

ROSENFELD: No, I don’t think so.

HEFFNER: … East and West?

ROSENFELD: … no, I don’t think so. I think it’s a very individual thing. I don’t think it goes by regions. There are certain things that go by region. There are certain operations like hysterectomies which are done more often in one part of the country than another.

HEFFNER: Why?

ROSENFELD: I think it’s largely economics and I think it’s, it’s ignorance. It’s ignorance on the part of patients … you know one of the reasons I wrote this book, and incidentally I ought to tell you that it’s a trade paperback because I have decided, along with my publisher, to do one of these books every year. This one appeared in January of this year. And I will have one next January 2005 with all the updates that have happened in that interval.

Now the reason for that is … is that medical care … the best informed patient gets the best medical care. And if you come to a doctor … let’s say a woman comes to a doctor … she’s got fibroids and is bleeding and the tendency is to say, “Well, you’re not going to have any more children, so let’s do a hysterectomy. That’s the easiest, simplest thing.” It’s easiest for the doctor. It’s not easiest for the patient. And there are ways now that I’ve described here, for example, in which the fibroids can be treated, without surgery. Now, if a woman knows that this option exists she can present it to her physician and they can discuss what’s best for her.

HEFFNER: Discuss what’s best.

ROSENFELD: Yes.

HEFFNER: You make the point that there’s so few doctors who have the time or take the time to discuss …

ROSENFELD: Yeah. Well …

HEFFNER: … with their patients.

ROSENFELD: …right. When is the last time you went to a doctor, you know, we have … we know doctors in common. But when is the last time you went to a doctor … well, maybe you did …but when is the last time the average person went into a doctor and the doctor said, “Sit down. I want to talk to you, I want to tell you about what’s available now.” Here doctors don’t have that time …

HEFFNER: Well …

ROSENFELD: And we don’t use that … but … so the next best thing …

HEFFNER: Yeah.

ROSENFELD: Is for a patient to come and say, “Listen, doctor, I read or I know I have such-and-such a condition, please tell me about such-in-such a treatment.” Now every doctor must be in a position to answer that question, if not to discuss it.

HEFFNER: You must be considered a royal pain in the ass … and I’m not supposed to say that …

ROSENFELD: [Laughter]

HEFFNER: … to your physician friends when their patients come in, whip out “Dr. Isadore Rosenfeld’s Breakthrough Health 2004” and then next year 2005 …

ROSENFELD: And hopefully the year after that …

HEFFNER: Undoubtedly. And say, well, “What about this?” Doesn’t that lead to something I would think you wouldn’t be too happy about and that would be the commercialization …
ROSENFELD: No.

HEFFNER: … of pharmaceuticals?

ROSENFELD: No. You know … back in 19 … I don’t know when it was ’82 or ’83, I wrote a book called “Second Opinion”. All my colleagues …

HEFFNER: A best best-seller.

ROSENFELD: Yes. Well, all my colleagues advised me not to write it. They said it would generate animosity among doctors; doctors don’t want patients to come in and then say, “Listen, maybe I should have a second opinion.” And I pointed out in that book that medical care is not a matter of a doctor’s time or ego; medical care is for a sick person. And if you are told you have an illness that requires surgery or that may threaten your life, you are …you should ask for and are entitled to a second opinion. Well since that time, 20 years ago, second opinions have been … are now paid for by insurance companies and doctors have accepted them. And I think the evolution of doctor-patient relationship which, incidentally is now at its low point because of a, a lack of time. I think that will be restored and should be restored. And that it’s critical in the care of the patient …

HEFFNER: Wait a minute … wait a minute, Iz … we have a minute and a half left … what do you mean …

ROSENFELD: I’ll come back next week.

HEFFNER: Wonderful. Wonderful, you know that. You’re always welcome here. What do you mean it’s going change? How does that change?

ROSENFELD: I think … I was on a panel with the Secretary of Health a couple of weeks ago and I said that the key to prevention; the key to medical care is a medical care system that compensates doctors for their time. That views time as the same, with the same priority as an echo machine or an MRI or a CAT scan or an operation. The most important aspect of medical care is the give-and-take between a physician (and a patient) and the importance of the insurance industry and the government in compensating doctors. That’s inevitable to occur. And when that occurs, that doctor-patient relationship will be restored.

HEFFNER: 30 seconds. What do you mean “inevitable?” Where is it written, except in your books.

ROSENFELD: [Laughter] It’s written in the doctors’ need to be compassionate. Doctors … men and women become doctors because as a rule they are compassionate individuals. And they are frustrated now by their inability to develop and maintain a relationship with a patient. A doctor used to be like a member of the family. And I believe that he one day will be again.

HEFFNER: Iz Rosenfeld …Dr. Iz Rosenfeld, thank you so much for joining me.

ROSENFELD: Always a pleasure. Everybody’s got to read “Dr. Isadore Rosenfeld’s Breakthrough Health 2004”. And then as you say [laughter] 2005, etc.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time, and if you would like a transcript of today’s program, please send $4.00 in check or money order to The Open Mind, P. O. Box 7977, FDR Station, New York, New York 10150.

Meanwhile, as an old friend used to say, “Good night and good luck.”

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.

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