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Kartik Thoughts

Two’s …. … the Universe

In the Beginning, there was Balance and there was Nothing.

Zero.

There was no up or down. No truth or untruth. No sin or good deed. No joy or sorrow. No beauty or ugliness. No day or night. No black or white. No God or Devil.

From the singular Nothing came Two. A Positive and a Negative. Balance continued as Nothing gave rise to Something. As each dyad multiplied to bring forth Existence, Balance continued, as it does to this day. As these positives and negatives intermingled, like a fractal pattern, the universe grew and formed. As they clashed, came forth light, forces of electromagnetism, of gravity, of strong and weak forces, space and mass. As the great expansion began, the dimension of time came into being as well.

This Universe is at heart a Zero. Nothing. It really both exists, and yet, doesn’t exist. For each positive out there, a corresponding confounding canceling negative ensures the zero sum.

Not just in physics, but in life.

For each good and benevolent act, a malevolent evil springs forth. For each act of charity, an act of meanness. For each give, a take. Because that is where Balance is. And Balance is the underlying principle that underlies this Non-existent – Existence.

If all acts are evil and good, why act? If it is all a Zero-Sum, why bother?

Because Purpose forced the creation of this Existence. To force the creation of the primordial Dyad from Nothing. Purpose expands the universe, all the while adhering to Balance.

Each individual out there has Purpose. Following that Purpose is nature. Lion eating seemingly innocent Deer eating seemingly innocent Grass seemingly eating Soil enriched by Lion (in life and death). Following your Purpose, whether benevolent or malevolent, is Nature.

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Kartik Thoughts

How “Science” is killing innovation

As a frontline healthcare worker and proud COVE trial participant, I was unblinded today. To my relief, I was both declared immunized and not a hypochondriac (as some “kind” friends had wondered – helpfully adding that I might have gotten the placebo). It felt like a tremendous weight was off my shoulders, in this dark, heavy time of death and disease. As I gave thanks to the trialists, the NIAID, the companies that made the vaccine and the Federal Operation Warpspeed that made this medical miracle my wonderful reality, I began the search for where the vaccine came from.

The story reveals a cautionary tale as to how we nearly did not get these amazingly effective tools. As with all things, the reality is that scientific discovery is predicated on funding. Owing to the prestige (and supposed independence/flexibility) of it, most scientists prefer to stay in academic environs. Funding comes for a variety of peer-reviewed sources, University endowments, national and international societies, and, most significantly the NIH (and some other agencies) a.k.a Big Science. Although notionally impartial and encouraging of innovation, the experience and story of Katalin Kariko (and God know how many others) tells differently.

A rash of stories in the media highlight how an immigrant, previously academic scientist, who was the focal point of the discovery that made this vaccine possible, was rejected time and again by Big Science in her pursuit of this exact discovery. As a nearly former scientist, this tale is one that I have seen time and again. Big Science is predicated on who you know, and how your work conforms to dogma of “established” science. People that are “unknown” or have novel (heretic) ideas are seldom tolerated and never funded. It is both a wonder, and a blessing, that Dr. Kariko managed to carry her work to fruition despite this consistently adverse environment.

Time and again, mediocre science, bereft of novelty, harvests rich rewards from Big Science, whereas true innovation is felt to be “too risky” to support. This runs contrary to the spirit of scientific inquiry. Institutionalized religion draws power from dogma and hierarchy, and Big Science is no different. Any challenge to either is met with being ignored, excommunicated, exiled and (if possible) death. In other words, Big Science is the new Inquisition. Cloaked in the respectability of academic titles and degrees, these are the same dogmatic and mediocre thinkers who are in science for the prestige and not the passion of discovery, to whom novelty and breaking the mold are anathema, and woe betide any who speak to challenge them.

As someone currently carrying funding from Big Science, is this ingratitude? Bitterness, at the small share of my spoils? Jealousy at those who are better endowed than I?

Maybe.

Is it all this bad? Is there no good in the system?

Or maybe, I’m just an honest taxpayer with a unique view of how billions of tax dollars of an unwitting public are divided up by Big Science acolytes.

Like many good acts of religious orders, there is tremendous good that is done by Big Science. However, over time, our rate of discovery is slowing. As we grow more content and established, our output has increased but the effects of this increased output have not.

As a publicly funded enterprise, Big Science has to be accountable to the people that pay for this. By chanting scientific hymns beyond the understanding of a lay-person and a few light-shows in test tubes, a dazzled public stands by while Big Science divides the spoils. As a scientist with a commitment to study, science and discovery and not, a blind loyalty to the Big Science establishment, and as a responsible citizen I need to speak up.

As of today, over 300,000 people are dead from this virus. That this vaccine may save untold more and was almost a non-entity is a painful reminder of how essential is our need for major reform. If you can, share this widely, talk about it, send it to the media, the Congress, the Senate and your leaders. Tell them that Big Science may not be the panacea they think it is. We need to salute heroes like Dr. Kariko. And we need to be able to use our tax dollars to support the untold others that Big Science rejects in their unholy desire to enforce conformity and dogma.

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Cars

Rattle and hum!

U

should drive a 60’s race-car

2

Wasting a rare 60 degree cloudless December day in St. Louis certainly rises to the level of a misdemeanor. To do so, as a Backdraft owner, is pure felony. Anticipation fills my heart as I wash away the clouds of weekly drudgery and commuting. The approach of noon and the assurance of knowing that all my neighbours are out in their yard, power-tools ablaze, fills me with the courage to awaken the stuporous elapid in her heated pen.

Despite a slight struggle with “winter”-gas (a pox on the house of the inventor of this bane), she thunders into life, with throbbing anger as her electric choke settles her carb in. Many people, myself included, think that “sports-cars” with their special exhausts sound loud. I am pleased to report that there is simply NO point of reference when it comes to the sound of a fully roused 427 ci classic race engine. It is not just loud, but also rich and deep. It permeates the environ, filling the listener with warmth of a bath in warm chocolate sauce on a frozen morning. The sound equivalent of a Chocolate Fudge Sundae. On a Saturday.

Like all good things, driving a Cobra replica, is filled with an elaborate ceremony. 4-point seatbelts. A tiny metal key. Turning the battery contact. And then, the starter button. Followed by the eruption of sounds and smells that embellish the whole experience. Being older and weaker, the wimp in me opted for the power steering and the modern T5 gearbox. While this takes something away from the rawness of the original, it does make backing out of a curved driveway a lot easier.

Starting cold, the car seems a little lumpy at low speeds. Even the initial takeoff on the ramp to the expressway seems to betray greater deliberation. Overall, when fully warmed up the ideal cruise is at around 2200 rpm, when the engine feels most relaxed. 1900 rpm seems to be the harmonic frequency of the engine and results in a fair amount of vibration, particularly in top-gear. For most driving in urban areas, 4th gear is a comfortable top. Going to 5th at below 65 mph is clearly uncomfortable, both for car and driver. Interestingly, the space between 2200 and 3100 rpm is the sweet spot for a drive. Above 3000 rpm the engine gets a bit shouty, but heading towards higher rpm results in a more coherent sound as she seems to settle into her preferred race-car state.

Heading out on a country road, this car is in its element. Sharing Ken Miles’ intials (but alas, none of his skill), I pilot this brooding serpent through a beautifully surfaced and banked country road as the fallow winter landscapes flash by. Yes, the race suspension from a 2010’s BMW M3 is firm but surprisingly unpunishing. For a change, I care little for the racket I make as there is no-one around save the hibernating wildlife.

Heading back to the expressway, the car does not skip a beat in switching back to highway cruiser. Sailing with silent (relatively) menace, every Mustang, Corvette and muscle car d’jour slows to match in awe of her beauty and character. A bevy of waves, “thumbs up”, and honks accompany her as she imperiously strides on her homeward trek.

And what of the driver?

Unlike Bond’s martini, stirred AND shaken.

And who needs a dessert, a drink or a drug, when the high that ensues from driving this is so magical that the whole point of each week is looking forward to this weekend dalliance.

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Kartik Thoughts

Thoughts on a Sunday…

It is 6AM on a relatively bright and crisp Thanksgiving weekend. Alpana checks her patient list as she heads to work to see a host of patients, some with COVID19 and others with the usual ailments that fill our plates at work. We talk about how the pandemic has affected us and its impact on society in general. The CNN headline on Japanese suicide rates, the resignation of a local health official over threats to her family and the increase in local spread among the community feature, as we look to the winter ahead with trepidation.

A bright spot in our thoughts, is the possibility that a vaccine might be a savior. But will it be too little, too late? Only time will tell. As more of our colleagues test positive, we look to our own safety. As more and more public officials, on both sides of the political spectrum, show support for preventative and safety measures, we look at the increasing fatigue that we (as much as everyone else) are experiencing in this new reality.

But wait, masks, distancing, washing hands? Restrictions? What restrictions?

As a proceduralist, these aren’t restrictions, these are my every day activities. As they would be for welders, mechanics, sanitation workers, doctors, nurses, respiratory therapists… you name it. And every occupation has its own.

When do these rules of behaviors become a restrictive burden?

I think the answer is in us.

They are “restrictive” as much as we want them to be.

We are “restricted” to breathe air, want for food, desire shelter and companionship.

We are “restricted” to need to care for family and friends.

We are “restricted” to the boundaries of our locale, city, state, country, planet, solar system and galaxy.

Most of all, we are “restricted” to the confines of this body, the most precious gift endowed us by our Creator.

In the face of these restrictions, what of the mere mask, the “6-foot rule” and the hand-washing? When seen from this overarchingly “restricted” life, these seem like just a fraction. But are they “just an increment” or “the last straw”?

Again, the answer lies in us. Despite the profusion of death and disease all around, many, including friends and family, move to the latter. Their attitude, one of defiance in the face of logic, as they abandon all pretense. Social media, the bane and savior of our isolated world, relays videos and pictures of indoor get-togethers, as families and friends gather in close embrace, singing and sharing.

How will this end?

Who knows?

Maybe the naysayers are right. Maybe this is all fake. Or #fake. Maybe this is just physicians trying to whip up panic to demonstrate their power.

Smart people discuss the ethics of caring for individuals that don’t isolate or take precautions. They even suggest that only “good” people deserve to be treated.

My take on this is as follows:

I am a physician who provides a service to those who need it. No part of this involves my judging their behavior or character. What’s more meaningful is that I am PAID to deliver said service. Just like, smoking, sloth, gluttony and pollution that keep our clinics humming, the pandemic is just another, newer, source of activity.

I plan to keep doing what I do for each patient.

Be the best physician I can be.

Dispense the right advice – for THEM to make the best decision.

Do what I can to help them, and let them do what they wish to do. The day that I am paid to police their activity and make their decisions for them, that is the day I leave medicine.

That said, as an individual I can judge and decide who I want to be friends with. That includes family members that I want to relate to and those that I don’t. Like any individual, I retain the freedom to be as arbitrary as I please in doing so.

So.

If you don’t want to wash hands, if you want to make a point of posting pictures and videos of indoor maskless groups, holding hands and in close proximity and if you think you are “tired” of this pandemic and all the “restrictions”, I am happy to be your physician, just not your friend.

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Serpentine adventures…

Hello, again. Our Cobra adventure is now three days in. After the torrid rainstorm, that was the St. Louis Diwali, a bright, crisp and windy Sunday meant 2 drives with the Blue Snake.

After waiting till the sun was truly in the clear (and neighbours likely awake from their slumber), it was two pumps on the gas pedal and a push on the starter pedal to awake the beast. From the usual explosion of noise, her engine settles into a Brrump-Brrump-Brrump rhythm. Strapped in my four point harness, like a biplane pilot, I gingerly engage reverse as I crawl out onto my driveway. Pedestrians enjoying the morning walk regard me with disdain as I try to enter the roadway.

Surprisingly, the clutch is light, the transmission precise as I gently advance through first, second and third as I trudge down Wydown – just under the limit. Shouting a big “Thank you” to the county of St. Louis for fixing Big Bend, I traverse the segment from Wydown to the 40 without the usual bone-shaking that the ultra-stiff suspension of this replica of a 60s racer has. With the smoothness of a P-51 taking wing in the crisp November air, she delights as I gently advance the gas pedal to match the expressway speed as she settles into her overdrive at a meager 1800 rpm and 60 mph. Occasionally buffeted by the near gale-force winds that remained from the prior night’s storm, she continues unabated, her steering light (and a little numb – thanks to the power assistance) and drawing on easy reserves of power to climb inclines without even the thought of a downshift.

Despite the balmy 50o weather, freezing air rips through the cabin as it creeps through the tiny spaces in the soft top. Notwithstanding my relaxed grip, my fingers are numb on the moto lita at 11 and 2 as we coast to the exit towards the Chesterfield Airport. Returning back to the expressway from the overpass, she eases into roadways speeds with the easy alacrity of an old hand, gently reminding me of how outmatched I am to what she is capable of, yet welcoming me to enjoying her thoroughbred power as she flexed her considerable muscle. Her dimunitive proportions (the same as the Mazda Miata) make her a dream to point and steer as she switches lanes accurately and without complaint.

Thundering back up our driveway, she returns to her abode with a clatter and a clang as I remove the battery-kill tag. I enter to find her angry namesake, looking in askance to being left behind. Apologies delivered, I head to work in my trusty Golf.

Returning from work, I find both ladies ready to embark again. The cobra ready to dance, and Alpana dressed in biking gear. A smile on the latter, broader than the Chesapeake Bay greets me as I start up the 4-wheeled one. Accompanied by the thunder of her exhaust, we go through a gentle drive through the quiet Clayton Sunday, as the smiles continue to grow.

Trundling home, my wife looks at me. Of all the cars I’ve had, this would be the first time, her face was both content, yet excited, as she pronounced that this was her favorite car ever.

Which would make sense.

Of all the cars I’ve owned, this is by far the prettiest, meanest, most characterful car that carries a streak of mischief but remains responsible, gentle and smart. Probably my second best choice in all my life.

BDR#2122

RT4 with an Iconic 427 ci engine. 488 bhp/533 lbft on the dyno. BMW E91 rear independent suspension with coilovers. 4 piston 13 inch brakes in front and single piston in the back. 18 inch 245/40 (front) and 295/40 (rear). Heated seats and interior with cloth soft top.

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Cars

Move over Eagle Speedster, THIS is the prettiest car in the world.

The rarefied club of readers of this blog will recognize my many prior ululations in salute of my erstwhile Carrera 3.2. These astute few may also remember that a few months ago, that car had left our families fold, as we searched anew for a replacement. One, distinct from the stark and dull 80s look to a more chrome laden, but new car. Discerning readers might think that a Porsche reimagined by Singer might meet these criteria, but to an untrained eye (and we have many in our family), they still seem like an acquired taste. As cars go, built with Germanic precision, with crisp handling and accurate dynamics, nothing comes close to a Porsche in maximizing the drivability and performance to price ratio. However, the real price you pay, is the push-me, pull-you bug-eyed appearance. Despite my many efforts to portray it otherwise, the beholder that finds a Porsche pretty is rare.

Which is why, the aesthete of the family and love of my life, never really warmed up to it. Also, growing up in a middle-class household, we could never really think of a “used” car as special. On a jaunt to Fastlane Cars in St. Charles, MO, we came upon a gorgeous Porsche Blue Shelby Cobra Replica made by Backdraft Racing in Boynton Beach FL. Coming on the heels of watching Matt Damon and Christian Bale in Ford vs. Ferrari, she was familiar with the shape but enamored of the brightwork and the colors of this beautiful car.

Looking more into BDR, I found that like a modern-day iteration of Carroll Shelby, this was a company with a strong racing heritage, who were not trying to replicate a Cobra, but build a beautiful modern classic racecar inspired by both the spirit as well as the shape of the Classic Cobra. While Shelby American continues to sell “authorized” continuation copies (both in aluminum and fiberglass), there are several manufacturers that build “replica” cars. I would like to briefly review my thoughts on them from my research on the internet and why one could choose to buy on of them and how it influenced my decision to go with a Backdraft.

  1. Shelby American: These are continuation cars with both aluminum and fiberglass bodies sold as rollers (i.e. rolling chassis with everything minus the engine and transmission). Shelby does make a variety of Ford derived engines that fit these. They do have independent front and rear supsensions with updates to make them more modern, but the original top-loader four and the 427FE engine (while classic – tend to be a bit of a 60s handful). These are also at a significant premium with a take-home cost of $150k (fiberglass) and $250K (aluminum) with a typical engine set up. Cost aside, these do represent a good value when it comes to resale.
  2. Superformance. Licensed by Carrol Shelby (after a lawsuit), these are honest copies of the Shelby with a variety of modern accoutrements to make the Serpent less of a threat. No, you don’t get ABS or traction control, but still. With jewel like precision and superb fit and finish, they seem to have become the industry standard. From the 289 “slab side”, the 289 FIA, the 427 roadster and the 427 s/c, they make Cobras in all flavors and shapes. While respected both as a car as well as with resale, I was some what put off by the unashamed similarities to the original and did not want to come of as a poser. Plus, the original Hi-Tech company and Superformance were originally a collision company restoring old damaged cars, not really a Carroll Shelby esque racing heritage. FWIW, all the cars used in Ford v. Ferrari were SPF replicas.
  3. ERA. With Everrett Morrison, probably one of the oldest acts, these are well respected replicas sold as owner assembled kits. I lack the sophistication to assemble one, nor the confidence to drive something I put together in the garage, a car with an enormous engine trying every second to swallow me whole. That said, a well put together ERA is a beautiful sight, but the key is finding one that is well put together. Also, the whole point was to move away from a used car.
  4. Everret Morrison. Also good cars but IMHO in the second or third rung.
  5. Factory Five Racing. Initially building these cars by putting a fiberglass body on an old Mustang ‘donor’, these have moved to modern chassis with wonderful attributes. The fact that several builders will deliver a turnkey product, does not change the fact that something in their appearance or prior stigma – does not really look right to me.

Backdraft Racing is a South Africa based company with strong racing roots. As winners of Daytona in 1984, Reg Dodd and Tony Martin, imbue these cars with the raw spirit and character of the original car that inspired these. With a subtly different shape, these pay an homage to the artistry of the AC Ace body (originally circa 1953) modified by Carroll Shelby in 1965 with flared front and rear fenders, a giant maw and huge side-pipe exhausts. And yet, looking at the car, it does not look like someone cloning a car but creating a different inspired original. Unlike many of the replicas above, these were built to race first, drive or show last. With a typical ladder suspension bonded to a beautifully painted fiberglass shell, these cars represent the best ideals of the performance of the original Cobra without the weakness of the aluminum body. Fiberglass, the shell used in Carroll Shelby’s first choice, the Corvette.

And what is it like?

Glorious. Simply glorious.

As I gingerly, sat down and was briefed by Dan Hillebrandt, the sales manager at FastLane Cars, the horror stories of crazy cobras and drivers out of their depth, filled my mind. Turning the key and pressing the starter button seemed to unleash Surtur as the entire world began to shake and tremble. Passers-by took a step back. Abashed by the drama, I bid farewell to my guide, engaging first and letting out the clutch as the newest member of our household rolled forwards towards the exit of the lot. It is at this point that I realized that the drivers and passenger side, RayDot mirrors were a wonderful cosmetic addition, with no purpose. The only thing scarier than driving a 2400lb pound car with 7.0L V8 engine with 488 bhp and 533 lb ft of torque, is doing so without knowing who else might be on the road.

Gingerly, easing myself on to the highway, I was immediately pleased to see that the more “novice” T5 gearbox, allowed me to shift quickly through the gears to settle into a legal cruise, while traffic seemed to zip around me. Still, noone seemed to come as close as they are wont (in my other vehicles). I would like to believe that the fearsome thunder emanating from this Reptile had something to do with it. The price of all that thunder? Refueling halfway from home. With an uneventful ride back home, this Indigo Blue RT4 with it’s white racing stripes, noisily slipped up our driveway and joined our family, welcomed by her new namesake, her dog and the two kids as they posed for pics.

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A magical day at Fastlane Classic Cars!

A few blogposts ago, I alluded to Fastlane Classic Cars. It is a cool place to visit and is staffed by car enthusiasts who are driven by the spirit of the car, more than fastidious adherence to purity of lineage. Dan, the general manager, was kind enough to allow me to take some pictures. These were done with my trusty old Leica SL with a 80-200 F4 ROM. All the pictures were taken at wide-open aperture and handheld. It may have been easier to take these with a wider lens, but the importance of maintaining the proportions of these beautiful cars was more imperative than just capturing the whole car.

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Science is under threat…

As readers of this blog might surmise, I am an avid believer in science and keeping an open mind. Dogma is the antithesis to scientific method. The ability to accept that known science may be wrong, is the underpinning of modern scientific method. The advent of COVID19 has changed everything. The nearly 1 million deaths worldwide are a tragedy, but the impact of COVID19 may have much more far-reaching consequences. Imagine if the events of the 1918 pandemic or the Black Plague had resulted in halting of the quantum mechanics and the industrial revolution respectively. The ability of modern medicine to save lives would have been stunted, resulting in billions of deaths. A sort of “butterfly effect”.

Science is under threat today.

Evangelical and religious people are not that threat. It is possible to both be a believer and to have faith and yet, accept science. Science is under threat from within. The core of our community has significant rot, where dogma and petty cronyism as well as politics have reared their ugly head.

Let me give you an example. As the proud few, that make up the readership of this blog, will recall, I signed up to receive the Moderna vaccine against COVID 19. I did it because I went through the due diligence to assure myself that the trialists and the technology proposed made sense. I did so, not as an expert in vaccine design, but as someone that believes that there have to be scientific underpinnings to any approach. Satisfied with the propriety of methodology, I have since received both the primary and booster doses.

The greatest pushback that I have experienced about doing so, has not been from rural farmers or evangelical priests or even some of my mask-refusing compatriots, it has been from so-called people of science: doctors, nurses and self-professed scientists.

This is indeed a surprise.

When I signed up for this, I thought there would be a crush of those who believed in science, lining for this. In fact, my experience is to the otherwise. I do not know of any of my colleagues – in medicine or science – who have agreed to receive the trial vaccine. When asked why, the replies are variants of a single theme:

“I don’t know if it is safe and I’m not willing to take a chance.”

Really?

If people of science do not sign up to these studies, then why should your patients or the public, believe in your scientific edicts. A randomized quadruple blinded research Phase III trial is as scientific and safeguarded as it gets.

Can bad effects occur?

Absolutely.

But I would rather these occurred in a scientific study and not during a wider release of the vaccine.

Many of my colleagues are so-called clinical researchers. This involved convincing patients to try “experimental” treatments. This adds to their scientific glory and promotion prospects. Yet, none of them, are willing to consider this a scientific endeavor that is necessary to change the world.

COVID19 has changed everything. As we wait for the second surge, the IHME modeling suggests mortality this fall, that will make heart disease sink to a second place. We need ALL the tools we can get to deal with this. the first step is accepting and enjoining scientific method as the single most effective tool against this.

I am a scientist and a devout believer. I respect the faith of those who believe in the almighty’s deliverance. I believe that science is a gift to Humankind from the Divine. While the role for faith is something I cannot explain or understand, as a physician, I have seen miracles abound. It does not dim my devotion to science.

The threat to science is not from maskless Evangelicals. It is not from creationists. It is not from the rural farmer who worries about how he/she will make payroll in these times. It is from pseudo-scientists out there, who would be happy for patients to enroll in their well-paying pharma-company sponsored trial, but lack the moral turpitude to stand up for a vaccine to the greatest threat to humanity in modern times.

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Dear Dr. Grines,

I’d like to publish my response to your kind comments on the prior blog post. As an SCAI member, I value my Society and your response. But I would like to point out my specific concerns and some suggestions. 

As a long time SCAI member, it pains me to say that the current activities of the society do NOT reflect my perception of what a professional society for interventional cardiologists needs to be.  In these difficult times, it is becoming increasingly hard to practice as an interventional cardiologist out in the community. With multipronged rivalry from interventional radiologists, cardiac and vascular surgery as well as their strongly supportive professional organizations, many of us face uphill battles as we deal with credentialing and new procedures as medicine evolves. The need of the hour is an advocate for our cause, not a witness for the prosecution.  

While elite operators (read: high volume, academic – not necessarily high quality) prefer that we refer our cases to them – in their cocooned environs – this comes at a cost.

Firstly, the patients often need to travel long distances, and deal with physicians and hospitals they are unfamiliar with. For instance, an 81-year old rural farmer with no family in the city, this is a major issue. On top of that, many of our patients are country folk for whom these large cities and mega hospitals are a forbidding prospect, even prior to their high-risk procedures surrounded by people they don’t know or can’t relate to.

Secondly, as you are well aware, the complexity of disease, driven by aging, obesity and diabetes has only increased. By reducing volume in the community and promoting the “high quality (i.e. high volume) referral center” model, it also means that operators in the community are less confident at dealing with these patients when they present in an emergency at 2AM on Christmas night, when the “referral center” team, tens or hundreds of miles away, is warmly tucked away.

How, then, does taking away procedures from us, the community cardiologists, help the specialty? How does it help our patients? What are the metrics that decide who gets to do what?

Here are my suggestions:

As a former member of the QI and advocacy committees, as well as working with Dawn on the PAC, I am only too keenly aware of how lacking we are in member engagement. These are the concerns that I have heard from my colleagues and in this missive, hope to transmit these to you.

1. SCAI, possibly partnering with industry, needs to take the lead in training operators in the community to enhance the procedures they perform, as well as, engage them in ensuring they have the resources to do these safely. 

2. SCAI needs to find ways to HELP interventionalists negotiate the credentialing processes in their local areas to ensure that they are able to deliver the appropriate and safe care to the patients – IN THEIR COMMUNITY.

3. Rather than focusing on volume metrics, SCAI should help operators in the community with creating QUALITY metrics to enhance the safety and appropriateness of the procedures, because we can do it BETTER than any other specialty. 

4. Mandate that at least 30% of the SCAI leadership, at any given time, consist of community cardiologists (not just academic “leaders”). This will need recruitment and engagement but it is work that needs to be done for the good of the Society and the specialty. 

I do not want this letter to come across as self-serving. I am secure in where I am and am writing to you, out of a sense of alarm, rather than a desire to look for any academic growth. While I am happy to help in ALL the society’s efforts, I do not want to seem like I am angling for a position in this. My only interest is preventing the decline in our specialty and our Society. I remain committed to the ideals of SCAI with the same enthusiasm as I did in 2006 and hope that we can reclaim this lost ground. 

Best regards,

Kartik Mani FSCAI

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Reply from SCAI.

In the interests of keeping this an open discussion, I am highlighting the reply from the president of SCAI on the blog.

“As President of SCAI, I have made it my mission to represent the membership, not the elitists.
We share your concerns about the “competency” article. Let me assure you that SCAI DID NOT author this article or endorse it. Its publication was a surprise to all of us. The journal CCI publishes many independent articles, as it did in this case.
We are in the process of writing a rebuttal to this article and its harsh recommendations, and to let everyone know that SCAI HAD NOTHING TO DO WITH THIS ARTICLE
SCAI is trying to be inclusive and we’ve created an opportunity to submit cases through SCAI.org, apply for committee membership and is having several webinars where you can give commentary.
Please let me know how we can do a better job.
Cindy Grines”