August 12, 2009

Voice of Permanente pioneer Martin Reisman, MD

When I learned that the Centers for Disease Control (CDC) presented Kaiser Permanente with its Pioneering Innovation Award in late July for leadership in combating obesity with its associated rising rates of Type 2 diabetes and cardiovascular disease — news of the award brought to mind a voice from forty-five years ago.

First the award. Dr. William Dietz, the Director of CDC’s Division of Nutrition, Physical Activity and Obesity cited Kaiser Permanente’s comprehensive assault on the health risks associated with the obesity epidemic. Dietz praised Kaiser Permanente’s evidence based clinical programs, its interventions and grassroots coalitions to improve food and physical activity environments, and its advocacy for public policies that promote healthy eating and active living. Now let's take note of an early pioneer in this effort.

In January 1965, Dr. Martin Reisman, a pediatric cardiologist at the Kaiser Foundation Hospital, Los Angeles and a professor in the Department of Pediatrics at the UCLA School of Medicine published an article “Atherosclerosis and Pediatrics” in The Journal of Pediatrics. This was the first article in the pediatric literature to suggest that atherosclerosis was a “pediatric disease” with onset within the first two decades, and that pediatricians should begin to participate in appropriate research and possible clinical primary interventions.

The current relevant literature and research were reviewed by Dr. Reisman with special emphasis on the pathologic studies from the Korean War casualties. A significant degree of coronary arteriosclerosis and narrowing of the coronary lumen were noted in the young American casualties in their early twenties. In contrast Chinese and Korean war dead showed virtually no evidence of this early onset of heart disease.

Dr. Reisman noted, “As a pediatric cardiologist, I find myself uncomfortable at the thought that standard pediatric practice might be contributing to the development of acquired heart disease. These considerations have prompted many observers to believe that the present standard American diet is a major contributing factor in the etiology of atherosclerosis. The larger part of the incubation period of this disease may very well be the first two decades of life, and a modest change initiated early and sustained through life might be clinically significant.” He went on to say:  “It is time for us to join intellectually with colleagues in adult medicine and concern ourselves with a disease that is probably a mutual responsibility.”

Dr. Reisman, during his career as a pediatric cardiologist worked to encourage screening for hyperlipidemia and intervening when appropriate with dietary / life style changes and use of lipid lowering medications. This effort has been continued and expanded by colleagues who followed him.