Dr. Michael Farkouh returns home to Sudbury to speak on latest advances in treating cardiovascular disease

BY NORM TOLLINSKY
Date Published | April 20, 2007

North America is facing an epidemic of diabetes because of our sedentary lifestyle, warns Dr. Michael Farkouh, a cardiologist who specializes in the effects of diabetes on the cardiovascular system.

Born in Elliot Lake and raised in Sudbury, Farkouh, 43, teaches at the Mt. Sinai School of Medicine in New York City and works on the FREEDOM trial, a $25-million study to determine the best way to manage and treat patients with diabetes and multi-vessel coronary disease.

According to Farkouh, 10 per cent of the population has diabetes. In 30 years from now, it could be 20 to 25 per cent of the population.

“There’s more obesity than there was 20 years ago,” he observed. “It’s the effect of our lifestyle, stress, lack of exercise and diet. They’ve looked at schools and traced it to pop machines. Kids are playing video games now instead of going out to the playground.
“When we were kids, we’d spend 10 hours at the playground on a Saturday. When I grew up in Sudbury, we had one television channel; we didn’t have cable.”

Diabetes damages blood vessels, making it easier for plaque to form in the arteries, choking off blood supply and driving up blood pressure. Eighty per cent of diabetics die from cardiovascular disease.

The five-year FREEDOM trial, funded by the National Heart, Lung and Blood Institute, will recruit 2,400 patients to determine whether balloon angioplasty using drug-eluting stents is more or less effective than coronary artery bypass graft surgery.

One of the challenges for family physicians is recognizing that diabetes is present, said Farkouh.

Undiagnosed
“About one-third of diabetics are undiagnosed because type 2 diabetes presents in a very insidious way. They could actually have it and not really know, so the most important thing is to screen for it. That’s one tip that the patient has diabetes. It’s also important to listen to the patient’s symptoms because they may have a blurring of their vision, excessive fatigue, they may be passing a lot of urine or experience excessive thirst. These are all signs that people have diabetes.”

Farkouh also recommends that patients with diabetes be treated maximally with medications.

“If someone is being treated for high blood pressure, they should be treated aggressively.” The idea that someone is borderline and may not have to be treated aggressively is misguided, he said. “Either you have it or you don’t, and if you have it, treat it.”

A guest speaker at the MEDnorth Conference in Sudbury, April 20th, Farkouh graduated from Nickel District Secondary School in 1982, studied medicine at the University of Western Ontario and did his residency training at the Mayo Clinic.

He returns to Northern Ontario at least once a year to visit family. His parents and a sister live in Sudbury and his uncle, George, served as mayor of Elliot Lake from 1988 to 2003.

Farkouh has followed the development of the Northern Ontario School of Medicine with keen interest. Growing up in Sudbury, he would never have imagined that there would be a medical school in the city one day. “It would have been a dream,” he said. “I don’t think at the time we would ever have believed it. It’s a great development for the North.”
He has visited the school, given talks and is exploring ways to work together.

“Some of the work we do in New York could be carried out in Northern Ontario,” he said. “There’s a lot of good science going on there and it’s going to grow.”

The school will also be instrumental in alleviating the shortage of physicians in the North, he said.

NOSM
“The Northern Ontario School of Medicine is going to facilitate the delivery of care to a lot of people who otherwise wouldn’t have a primary care physician.”

Farkouh says he often thinks about returning to Canada and believes in the country’s universal health-care system.

“I think we need to preserve it. It’s part of the stability of our society and I believe it’s one of the distinguishing features between Americans and Canadians. Having lived in the U.S. for 20 years, I really appreciate it.”

The Canadian system does have its drawbacks, he said. One of them is the lack of access to high-quality health care for the highest risk patients.

“If you have a rare malignancy in the United States, you’d be treated the next day. In Canada, the likelihood is that you’re going to have some wait time.

“The second thing that concerns me about Canada - and I see this a lot because I take care of a lot of Canadians – is the lack of continuity of care, because most of the care is focused on the hospital and the emergency room and not enough in the outpatient practice.

“In New York, we’re much more focused on outpatient management and keeping (patients) out of hospital. Many patients in Canada only get to see a specialist when they show up in an emergency room.”

There are more cardiologists in New York City than there are in all of Canada, he said. “In New York, you can get any procedure you want the next day.”

“People pay exorbitant amounts of money to get surgery done in a timely fashion because they want to get their hip replaced and get on with life, but if society is going to pay for it, I don’t think there are many more systems better than the Canadian system, where people can have access to quality care regardless of their ability to pay. This is what we need to preserve.”

www.mssm.edu/cvi