LECTURES

Ottawa Heart Institute Alumni Spring Lecture
April 24, 2007

"Willie Sutton, Louis Pasteur and John Snow:
The Three Stars of Prevention?"
Dr. Andrew Pipe

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The intriguing title of this excellent presentation was: "Willie Sutton, Louis Pasteur and John Snow". Some one hundred participants came to find out how these three individuals link in the mind of our highly knowledgeable and entertaining speaker, Dr. Pipe. Dr. Pipe, who is known to many of us, is the Medical Director, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute as well as Associate Professor at the University of Ottawa.

We noted that the new UOHI pin on one lapel was beautifully counterbalanced on the other lapel with his Order of Canada pin! Congratulations, Dr. Pipe, a well deserved honour.

At the outset, Dr. Pipe put forward the thesis that in order to eradicate major diseases, both socio-economic changes leading to prevention as well as cures are required. The high rate of cardiovascular disease is partially the result of the agricultural and industrial revolutions that provide Western Civilization plenty of food and a more sedentary lifestyle. We now have a large variety of food, many causing build-ups and blockages in coronary arteries leading to strokes and heart attacks. The growing obesity rate in children is alarming. Today's generation is more likely to stay at home to play video games while snacking in contrast to previous generations who played more outdoors, walked and bicycled, and ate less and healthier foods.

So the first line of attack is prevention. As Louis Pasteur said; "Whenever I meditate about a disease, I always think of preventing it, rather than finding a cure".

Dr. John Snow was a British physician who is considered one of the founders of epidemiology for his work identifying the source of a cholera outbreak in Soho in1854. At the time, it was assumed that cholera was airborne. However, Snow argued that in fact germs entered the body through the mouth. After careful investigation, including keeping track of houses where cholera deaths occurred and plotting them on a map, he was able to identify a water pump on Broad Street that leaked sewage and was the source of the disease.

This situation brought into prominence the importance of urban planning, density of dwellings, and living conditions. Urban planning has evolved over the past century from high density crowding that gave rise to slums, overcrowding and pollution leading to infectious diseases to today's sub-urban low density living that results in isolation, alienation and continuing pollution, fostering chronic diseases.

Socio-economic changes are required to address infrastructure needs and make urban design more people and ecology friendly. For example, an individual who spends 2 hours a day commuting will spend the equivalent of eleven 40-hour weeks a year so doing. Clearly we must find a better way. Dr. Pipe drew attention to the fact that change happens when there is a:

• "crisis"
• critical mass of scientific evidence
• shift in social attitudes
• growth of public cynicism
• build-up of political pressures

Finally, we were reminded that Willie Sutton was a notorious bank robber in the 1940s. When asked why he concentrated on robbing banks, he responded simply "I rob banks because that's where the money is!". Today we are looking for the biggest bang for our investments. In avoiding cardiovascular disease, the biggest bang is in smoking cessation. Mortality after an incident can be reduced by as much as 50%. There is a need to continue to educate the public and hospitals must place greater focus on how many of their patients are smoking and help them to stop after they are discharged.

In this regard, the Heart Institute has achieved remarkable success by demonstrating that through its program, the percentage of patients who have continued to stop smoking after a year has risen from 35% to 50%. The program is now being implemented in every regional hospital in the Champlain district. The attendees warmly acknowledged Dr. Pipe and his presentation. Alumni President Dennis Doucette thanked him for providing the members with a most valuable and entertaining presentation and opportunity for discussion.

We look forward to welcoming Dr. Pipe again.

Editor's Note: Dr. Pipe kindly permitted that his presentation be videotaped.

View the video!

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