I had the great fortune and pleasure of studying under the late Kanu Chatterjee during my cardiology fellowship at the University of California San Francisco.
In the early 1970’s, Dr. Chatterjee was among the first to understand the benefits of “afterload reduction” for the treatment of congestive heart failure:
Prior to that time, giving medications that could lower the blood pressure was often seen as heretical. In fact, during the 1950’s and 1960’s, the treatment of heart failure sometimes consisted in applying measures to raise the blood pressure and increase the work of the heart.
The concept of afterload reduction introduced by Dr. Chatterjee and his colleagues was revolutionary. With such a treatment, mortality rates in heart failure were improved for the first time.
Next, Dr. Chatterjee understood early on that inotropic therapy, which stimulates the pumping action of the heart, at best provides only a short-term benefit. In the long term, it increases the risk of killing the patient:
Parenteral sympathomimetic agents, usually dobutamine, and phosphodiesterase inhibitors, usually milrinone, are used for the management of exacerbations of chronic systolic heart failure. Although hemodynamics, and occasionally clinical status, improve, such therapy is associated with increased mortality and can potentially hasten a patient’s demise.
Afterload reduction and avoidance of cardiac overstimulation are now the mainstay of therapy for congestive heart failure.
In contrast, one arm of the current paradigm for the treatment of economic failure is to implement large government spending programs that must be financed by tax increases (actual or inflationary). These programs and taxes increase afterload on the private sector of the economy.
Another arm of standard economic treatment is to apply massive doses of monetary stimulus to improve short term spending and investment. But the patient is still teetering on the brink, and threatens to collapse at any moment.
Isn’t it time to model the treatment for economic failure on the pattern found to be beneficial for for heart failure? Dr. Chatterjee would have made a great Chairman of the Federal Reserve.
May his soul rest in peace.
Michel Accad is a cardiologist based in San Francisco.