(++) HEALTHIER HEARTS HERE?

The Heart Health Bible: The 5-Step Plan to Prevent and Reverse Heart Disease. By John M. Kennedy, M.D. Da Capo. $15.99.

     Plainspoken and intelligent advice from an expert and experienced cardiologist is somehow coupled with errors, omissions and abysmal writing and/or editing that collectively take a book that ought to be celebrated and turn it into one that can barely be trusted. This is more than a shame: it is a genuine risk to cardiac health.

     It is reasonable to come to The Heart Health Bible with high expectations. John M. Kennedy, M.D., sits on the board of the American Heart Association and is a clinical associate professor of cardiology in California – recognized and respected both for his work in invasive cardiology and for his championing of alternative and complementary medicine. On paper, he is just the sort of person to whom one would wish to turn for information on living a life that is better for your heart – and lowering one’s risk of heart disease, the number one killer and leading cause of disability in the United States. The “5-Step Plan” of his book’s title has, as it turns out, an unfortunate acronym and no really new or different recommendations, but it is clearly presented and does contain ideas that, if followed carefully, will improve many people’s heart health. It is, in fact, the reason that this book gets a (++) rating rather than (+).

     Dr. Kennedy’s plan calls for a well-known approach toward lowering cardiovascular risk: exercise and reduce weight, blood sugar, blood pressure and triglycerides. Those are the five elements – one positive and four negative. But in the search for a catchy acronym, Dr. Kennedy has to torture the elements of the program to make them fit. The acronym, which certainly is catchy, is H-E-A-R-T. But here is what the letters mean: Heal blood pressure; Energize your heart through exercise; Act on fat by losing weight; Reduce blood sugar; and Tackle triglycerides. Sorry, but this does not work at all: a good acronym has to have an immediate, clear, readily understandable relationship to its underlying recommendations, and this one is overly complex and not sufficiently clearly connected to be useful.

     It does, however, contain the germ of a good idea – several good ideas, in fact. And Dr. Kennedy says, correctly, that his program requires basic behavioral changes that can be very difficult for people to make; he even tries to come up with ways to encourage people to make them anyway, and ways to lessen the inherent difficulties.

     All well and good. But scattered throughout the book, again and again and most unfortunately, are so many mistakes and instances of poor writing that it is impossible to take anything Dr. Kennedy says at face value – because there is no way to know whether errors have crept in and, if so, how significant they are.

     For example: “Just a decade ago, before the clinical availability of insulin….”  What? Insulin was first given  by injection in 1922, crystallized in 1926, fully sequenced in 1955, chemically synthesized in 1963, manufactured in significant quantities in 1978 (by Genentech), and made widely available (as Humulin) in the early 1980s. A decade ago?

     Or consider this sentence: “Thus, the comparatively primitive brains of our forbearers [sic] may have developed neural pathways that heightened their desire for high calories [sic] foods.” Does writing like this encourage you to follow the author’s recommendations?

     There are also subtler mistakes, apparently born of Dr. Kennedy’s predisposition to favor lifestyle changes over any other approaches to limit cardiovascular-disease risk. In a quiz about modern portion sizes, for example, he compares today’s portions with those of 20 years ago (an interesting idea) and explains how much exercise would be needed to work off the excess calories of larger portions (also an interesting idea). But he does not play fair. One question says, “A muffin 20 years ago was 1.5 ounces and had 210 calories. How many calories do you think are in a muffin today?” The choices are 320, 400 or 500, and the answer is 500 – for a five-ounce muffin. But wait: that means today’s muffins have fewer calories per ounce than those of 20 years ago (100 today vs. 140 two decades in the past). Isn’t that at least worth mentioning? And in another question, he compares a “box of popcorn” 20 years ago with “today’s tub of popcorn,” never explaining how many ounces either contains and not discussing whether the popcorn, either in the past or today, is air-popped, made with oil, coated with butter or artificial butter flavor, etc. Skewing questions this way in order to skew the answers is not medicine – it is propaganda.

     It has to be said that to the extent that The Heart Health Bible is propagandistic, it is in a good cause: heart disease is a huge problem, and finding ways to cope with it is important. But that does not justify serious lapses of accuracy or deliberate omission of alternative approaches that Dr. Kennedy may use himself but apparently does not like. An example of the latter: his 286-page book devotes a mere two pages to statins, which are among the world’s most-prescribed medicines, are specifically designed to reduce heart-disease risk, and are credited by many cardiologists with having such power to lower cardiovascular events that they believe millions more people should take them, beyond the millions who already do. This is an arguable proposition, but not a casually dismissible one – yet Dr. Kennedy does dismiss it, devoting his two pages not to the medicines’ enormous successes and benefits but to the comparatively rare side effect of cognitive impairment (which, unlike other side effects of statins, some cardiologists deem anecdotal rather than proven). Dr. Kennedy prescribes statins himself – he says so, and even affirms that he “feels so strongly” about them because they work so well in certain patients. That being the case, his brief treatment of the statin option and his emphasis on the negatives of this class of drugs seem disingenuous, or at least uncalled-for.

     Dr. Kennedy has enormous knowledge and experience in cardiovascular disease, and clearly is on a mission to help people reduce their risk of developing it. But The Heart Health Bible, because of its errors and the skewed elements of its presentation, unfortunately undermines that mission more than it advances it.