If You Give a Cardiologist a Crystal Ball

My daughter and son loved If You Give a Mouse a Cookie, the sweet children’s book that has figured into many a family’s bedtime routine during the last three decades. When I read the book for the first time to my then-toddlers, I nodded in sympathy as, page by page, the darling little mouse went from receiving a cookie to needing a glass of milk, then a napkin, then a straw, … . Eventually he requires a haircut, a broom, a nap, crayons, Scotch tape and so on.  

For this issue, we gave cardiologists a crystal ball, figuratively, of course, and asked them what they saw for their specialty’s future. We listened as the chief medical officers of three stentmakers joined us for a roundtable discussion of the challenges and opportunities ahead in the cardiology device arena and in healthcare in general. Our story about TMVR shows imagers’ sharing how this new frontier might unfold considering the lessons learned by its forbearer, TAVR. Interventionalists, too, gazed into the crystal ball for a glimpse of what their PCI toolbox might look like a decade from now. Our Health IT feature predicts a world where clinicians and patients meet up via screen as, or more, often than in person, and this issue’s Health Economics story examines the potential of performance-based, risk-sharing agreements—in this case between pharma and payers—to make high-cost drugs easier for the healthcare system to swallow.

One theme that carries through it all is that progress is difficult, especially in the early stages, which is where the U.S. is with new payment models, creative partnerships and the transition from a fee-for-service to a value-based healthcare system. As the stentmakers said, it’s difficult, it’s early, it’s fuzzy around the edges, … there’s a lot to learn.

My other take-away is how one thing leads to another. Steps forward with FFR, IVUS and OCT eventually bring FFR-CT and could lead to virtual reality. Overcome the early challenges of TAVR and a decade later perhaps it all will come together for TMVR. Lead the way with remote cardiac monitors and soon patients who are struggling with side effects from a prescribed medication can see their cardiologists, via screen, without trekking 70 miles to the hospital.   

So where is the connection to the kids’ book? If You Give a Mouse a Cookie ends, essentially, back at the beginning, with the mouse craving another cookie. Put aside the merits of giving cookies to mice, and appreciate not the crystal ball but the vision. Cardiologists envisage a better way to care for their patients—be it safer, more durable, less invasive, more cost-effective—and one thing leads to another. Onward, until they find themselves back at the crystal ball, ready to follow a new vision wherever it leads. I appreciate the optimism of the crystal ball (and cookies) and hope you enjoy this issue.