What Is A Cardiologist?

The skeptical cardiologist recently received a cease and desist letter from a lawyer representing Dr. Steven Gundry who felt I was defaming the goop doctor and supplement peddler by saying he was not a cardiologist.

The lawyer’s letter reminded me that many patients do not understand exactly what a cardiologist is and mistake us for cardiothoracic surgeons.

Here’s how the American College of Cardiology defines a cardiologist:

A cardiologist is a doctor with special training and skill in finding, treating and preventing diseases of the heart and blood vessels.

And here is part of my response to the lawyer which further clarifies the differences:

I understand your confusion with respect to the terminology of cardiologist versus cardiac or cardiothoracic surgeon. A surprising number of patients and readers think that I as a cardiologist perform “heart surgery.” Of course, actual surgery on the heart requiring “cracking open the chest” (which is what most laypeople consider “open heart surgery”) is always done by a cardiac surgeon not a cardiologist.

Like all other board-certified cardiologists I have gone through accredited training programs in internal medicine followed by a formal cardiology training program. There is no evidence that Dr. Gundry has done this.

Cardiologists, being extremely bright, entrepreneurial  and energetic, have expanded the toolkit they have for diagnosing and treating heart disease without having to engage in surgery. Thus,
cardiologists can insert  stents to open blocked coronary arteries, implant pacemakers and even replace valves all by accessing the cardiovascular system via its arteries and veins.

We don’t call this surgery because we aren’t surgeons and didn’t go through surgical training. We call these procedures. These are invasive procedures, to be fair, as we have invaded the vasculature and the interior of the heart and from these arterial and venous incursions complications may ensue.

A typical invasive procedure that cardiologists do looks like this:

This is a cardiologist  gaining access to the arterial system by inserting a catheter into the radial artery.

 

 

A typical open heart surgery performed by a cardiothoracic surgeon requires large incisions with direct visualization of the heart and looks like this:

 

 

 

 

 

Cardiologists And Cardiac Surgeons Undergo Totally Different Training

I began my response to Gundry’s lawyer by indicating my surprise that the lawyer felt Gundry was a cardiologist:

This comes as quite a surprise to me as my detailed research into Dr. Gundry’s background, training and credentials revealed absolutely no evidence that he is or ever was a cardiologist as we in the medical community define cardiologist. In fact, as you can see in his listing on CTSnet (which is a network of cardiothoracic surgeons) his post medical school training consisted of the following

University of Michigan Hospitals Surgery Internship (1977-78)
National Institutes of Health, Clinical Associate in Cardiac Surgery (1978-80)
University of Michigan Hospitals Surgery Residency (1980-83)
University of Michigan Hospitals Cardiothoracic Surgery Residency (1983-85)

He is trained as a cardiothoracic surgeon. Cardiothoracic surgeons go through surgical training programs which are completely different from the medical training programs that cardiologists like myself go through.

My description of him in this regards reads as follows:

“He is also widely described as a cardiologist but he is not, He is (or was) a cardiac surgeon (like, strangely enough, the celebrity prince of quackery, Dr. Oz)”

As you can see, my statement is perfectly accurate.

As far as him being a being elected a “Fellow of the American College of Cardiology” I can find no documentation of this and he is not currently listed as a member of the American College of Cardiology. But even if he was this does not make him a cardiologist because many cardiothoracic surgeons are members of the ACC.

Might I suggest you ask Dr. Gundry if he thinks he is a cardiologist. I’m pretty sure he would answer no.

What Is A Quack?

The lawyer then went on to accuse me of suggesting that Gundry is a quack because:

A “quack” is defined in common parlance as a lay person pretending to be a licensed physician. In other words, a fake doctor. The term “quack” connotes dishonesty, deception, fraudulent behavior, etc. Dr. Gundry has been a licensed physician and surgeon since at least 1989 (see Exhibit B attached), performed thousands of heart surgeries, and developed patented, life- saving medical technology. Your statements are not only factually incorrect, but are also irresponsible and intentionally misleading, resulting in harm to Dr. Gundry’s reputation and income.

To which I responded:

There seems to be an attempt here to suggest that by saying he is not a cardiologist I am calling him a quack. But as my previous information should have convinced you he is not a cardiologist but a cardiothoracic surgeon. He has done very good work as a cardiothoracic surgeon and I am happy to attest to that. I will be happy to add that information to his description in my up and coming posts on him.

At no point do I call him a quack in my posts. Clearly if I’m calling him a cardiothoracic surgeon I am acknowledging that he is a licensed physician and not, clearly, a fake doctor.

I have to admit my definition of quack has not been the common dictionary definition of “fake medical doctor.”  I have always considered those who engage in quackery to be quacks.

Quackery is defined at Quackwatch (the definitive website on the topic) as the promotion of unsubstantiated methods that lack a scientifically plausible rationale. 

And one can have a perfectly legitimate training as a medical doctor and engage in what most would consider quackery.

Even board-certified cardiologists like myself can engage in quackery.

Clearly there is a disconnect between the common definition of quack and that of quackery and in a  subsequent post I will delve further into the miasma of quackery, quacks and quacking,

Anatinely Yours,

-ACP

N.B. While researching this post I came across a fantastic article on Gwyneth Paltrow’s goop Doctors from David Gorski at Science-Based medicine. I highly recommend reading the entire piece (gwyneth-paltrow-and-goop-another-triumph-of-celebrity-pseudoscience-and-quackery) for your edification and pleasure.

Gorski’s paragraph on Gundry begins

  • Dr. Steven Gundry, a cardiothoracic surgeon very much like Dr. Mehmet Oz who, as he took incredible pains to lecture Dr. Gunter in his section of Goop’s hit piece on her, who once was a very respectable academic surgeon and, even better than Dr. Oz, served as Chairman of Cardiothoracic Surgery at Loma Linda University for a number of years, before leaving academia to undertake his private practice. (No wonder he and Dr. Oz seem to have an affinity for each other!) These days, he devotes his time to his practice, writing books, giving talks, and selling expensive supplements like Vital Reds (a bargain at $69.95 for per jar, discounted to $377.73 if you buy six jars) and Lectin Shield (a slightly more expensive bargain at $79.95 a jar, $419.70 for six), while bragging (as he did in his response to Dr. Gunter) about how so very, very hard he works and even—gasp!—accepts Medicare and Medicaid patients. His most recent book is The Plant Paradox: The Hidden Dangers in “Healthy Foods” That Cause Disease and Weight Gain. (Spoiler: That “hidden danger” is lectins.)

 

Featured image Photo by Ravi Singh on Unsplash

18 thoughts on “What Is A Cardiologist?”

  1. And right you are. There are many many “quack” doctors out there who actually have a valid license however, absolutely do not have their patient’s best interests at “heart” (No pun intended. Their interests lie in lining their pockets with “green stitches”. It extends beyond the specialty of cardiology). There is a most serious and important distinction to be made between a cardiologist, an interventional cardiologist and electrophysiologist etc.

  2. It took me a minute to connect the anatine dots — clever!

    A Cease and Desist letter is practically as good as trending, indicating that you have sufficient credibility to be considered a threat. Congratulations.

    People who promote products, procedures, and positions that lack supportive evidence do not get to hide (duck?) behind their credentials.

    That is a dangerous practice for at least two reasons. First, when we rely on things that are NOT evidence-based, we are likely not utilizing those things that are.

    Second, when so-called experts convince others to do something based on opinion, people are being taught to toss critical thinking aside and engage in the Logical Fallacy of Appeal to Authority.

    This is unfortunate. We should be teaching people to think critically, ask for evidence, and question authority — not follow a siren song dressed up as credibility.

  3. Quackery:
    Beginning prescribing the following preventive measure for the more mature among us who, granted, generally accumulate more elaborate “risk factors” (You know how accurate and dependable THOSE are!).
    …statins.

    Where do you stand?

  4. If you watch and listen carefully to Dr. Oz, you will know that he is a snake oil salesman. The products and gimmicks he peddles never mention RCT’s, FDA approval, or ongoing research studies. This is why I personally use Medscape for the medical information I need. Recently, Medscape published an article on prescription Omega-3’s for CAD. Note, that research clearly indicates non-prescription Omega-3’s show no evidence of being effective. Now, how many well-designed research studies show that statins clearly reduce CVD events? Including studies done in the US, Europe, and China, there are hundreds of well-designed studies. I speak of well-designed rather than designed by the Oz method.

    1. Erin,
      Agree totally.
      Oz like Gundry trained in highly respectable and competitive programs from medical school through cardiothoracic residency, had significant research and clinical contributions in their respective areas and held prestigious academic positions. What factors caused them to veer off the science-based path and veer so heavily into pseudoscience? One can only speculate but money and fame are powerful forces.

  5. Dr. Pearson:
    Well done. You may have waited your whole life for the opportunity to sign off “Anatinely Yours,” and the moment finally arrived. Perfect!

      1. About omega 3’s: we must NOT prejudge what has not actually been tested. The recommended dose of omega 3’s (should be distilled/just the liquid; an honorable name is Carlson’s–I have no relationship wi them) by some is 1 tsp (5,000 mg = usually 5 gel caps & who needs whatever the gel caps are made of) up to 1 tbsp = 15,000 mg a day. Until these doses are used in studies, no comparison can actually be made or be stated. BTW: fish oil is highly unsaturated and such oils have been linked to an increased risk of cancer. Best to get the TG down by diet.exercise, weight loss naturally except in RARE cases.

    1. Yes, atorvastatin is quite effective, but the dose must be adequate, or give with other cholesterol-reducing meds, to achieve a nonHDL cholesterol level of 90 or less, where, for all practical purposes, atherosclerosis ceases to progress and can even begin to regress. HRS, MD, FACC

  6. Janine expresa perfectamente lo que siento cuando leo tu blog por lo que con su permiso hago mías sus palabras “Me encanta tu minuciosidad (y lo apasionado que eres). Es por eso que sigo tu blog. Siempre educativo (y entretenido)”.

    Soy Médico de Urgencias en el Hospital Universitario de Burgos España. ( La medicina de urgencias no está reconocida desgraciadamente cómo especialidad médica en España, de momento ). Disfruto leyéndolo y al tiempo mejoro mis conocimientos de Cardiologia clínica .

    Mi apoyo a su “cruzada” contra los seudocientificos . Reciba un fuerte abrazo desde Burgos, España.

    Disculpenme Usted y todos sus lectores en inglés que haya usado mi lengua nativa para escribir mi comentario. Me pareció más espontáneo (además las traducciones de Google Translator son inmejorables.)

    1. Where says “Yo también más espontáneo” I wont to write ” Me pareció más espontaneo”. Sorry. -;)

    2. Javier,
      Thanks for the kind words from Spain!
      You are correct. Google translate did a fine job on your words.
      Janine expresses perfectly what I feel when I read your blog so with her permission I make her words mine “I love your thoroughness (and how passionate you are). That’s why I follow your blog. Always educational (and entertaining). ”

      I am an Emergency Doctor at the University Hospital of Burgos Spain. (Emergency medicine is unfortunately not recognized as a medical specialty in Spain, at the moment). I enjoy reading it and at the same time I improve my knowledge of Clinical Cardiology.

      My support for your “crusade” against pseudoscientists. Receive a big hug from Burgos, Spain.

      Excuse me You and all your readers in English who used my native language to write my comment. I found it more spontaneous (besides the translations of Google Translator are unbeatable.)

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