I used to think that companies like Apple, Amazon, Google and Facebook were the masterminds of marketing, but an article in the May 31st  New York Times has changed my opinion. In “For some, exercise may increase heart risk” science writer Gina Kolata asks whether exercise could actually be bad for some people. She reports on data from six retrospective exercise studies involving over 1600 people showing that, for those who exercise regularly, about 10% become worse on measures related to heart disease—blood pressure, insulin resistance, and levels of HDL cholesterol and triglycerides. About 7% grow worse on two or more of these measures. What a, um, stroke of good fortune for cardiologists and what a fabulous marketing strategy for the field.

Most people who exercise a lot are young adults who usually don’t frequent a doctor’s office very much, and do not spend a lot of time and money being evaluated by cardiovascular and endocrinology specialists. Now, in this brave new world where exercise can be dangerous, unless you are properly evaluated, you won’t know which group you belong to—the fortunate 90% that will benefit from exercise, or the luckless 10% who would be harmed by it, or could be harmed by it over the, um, long run. So the active, healthy cardiologist avoiders will now be loping to the cardiologists as fast as their Nikes will carry them.

The folks who hate exercise will now use the report to stay away from activity or exercise even less, not knowing which group they belong to. But for anybody who wants to be sure, the only option is more visits to the cardiologist and more extensive checkups than the 3.7-5.0 minutes usually allowed for an office visit. Sorry, couch potatoes, you don’t get a free ride on this one.

With a stroke of a pen, the relative value units[1] of millions of people will dramatically increase. Can you imagine how General Motors would respond if it found a marketing strategy that could increase its sales by millions of customers just by issuing a report? I should’ve listened to my parents when they pleaded with me to become a “heart doctor."

With all the pressure to reduce health-care costs, the issues of maintaining physician income and increasing clinical revenue streams to safeguard the status quo are growing in urgency, so this report could not have appeared at a better time.

I now stand in awe of cardiology. With this marketing report they have struck the mother lode. Even if the studies prove to be flawed or downright wrong, their new revenue streams could be fantastic before any corrective actions can be taken.   

So congratulations, cardiologists--you are the new masters of the universe. At least until the new studies come along showing that sleeping and or sex shortens our lifespan.

[1] A relative value unit is an AMA copyrighted formula for figuring out what fees physicians can charge Medicare or other patients for their services. The more "resources" the doctors use (tests, time spent in the office with the patient, etc.), the higher the relative value of that unit. Old folks are typically worth far more in RVUs than a young and healthy patient. Today, most physician incomes are based on RVUs. The more RVUs he or she produces, the higher the salary.    

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