Former FDA commissioner warns that US healthcare system is falling behind
The United States is entering an unprecedented era of medical innovation. Unless the healthcare system improves its prevention efforts, expands patient access and fights back against misinformation, however, the nation's health outcomes will fail to improve. This was the dire message from former FDA commissioner Robert Califf, MD, MACC, a veteran cardiologist and and instructor at Duke University, who gave the keynote address at SCCT2026, the Society of Cardiovascular Computed Tomography (SCCT) annual meeting.
Califf said the country faces a troubling paradox where revolutionary advances in cardiovascular imaging and artificial intelligence (AI) are occurring at the same time Americans are experiencing poorer health outcomes than other developed nations.
"The U.S., relative to other high-income countries, is not looking too good in terms of longevity or healthy longevity," Califf told Cardiovascular Business after his presentation. "We have a surplus of chronic disease, and cardiovascular disease is still the leading cause of death in the U.S."
Advanced imaging transforming cardiovascular care
Califf highlighted how cardiac imaging has evolved dramatically during his career. As a young cardiologist, he recalled reviewing coronary angiograms on film and relying on rudimentary echocardiography. Today, clinicians can noninvasively evaluate coronary anatomy, quantify plaque burden, assess plaque composition and measure fractional flow flow reserve (FFR) using coronary CT angiography (CCTA).
He also pointed to the growing availability of low-cost coronary artery calcium scoring CT scans, which can often be obtained for less than $100 and provide valuable information about a patient's cardiovascular risk.
The challenge, he said, is ensuring these technologies are used to improve population health rather than benefiting only a small segment of society.
"We need to figure out how to make it accessible to all 360 million people in the U.S., not just the 20% of people that have all the expendable cash," Califf said.
AI should restore the human side of medicine
Rather than replacing physicians, Califf believes AI has the potential to restore one of medicine's most valuable assets: physician time with patients. He argued AI should automate many of the administrative tasks that currently consume clinicians' days, including documentation and billing requirements created by electronic health records.
"Algorithms will do everything that algorithms can do better," he said. "If we handle things correctly, that will give us more time to focus on the human side of medicine and healthcare."
That human interaction remains essential, particularly for helping patients adopt healthier lifestyles.
"It's not as if people who are overweight or have uncontrolled blood pressure don't know they have a problem," Califf explained. "That last mile of how do you motivate people to eat the right food, exercise and control blood pressure and lipids—is going to require human interactions."
Prevention must become the priority in healthcare
Califf said the American healthcare system remains overly focused on treating disease after it develops instead of preventing it. He argued hospitals should increasingly be viewed as places people need only when preventive care has failed.
"The purpose of clinics ought to be to keep people out of the hospital. The best way to do that is to put the technology in the community," he said.
By combining AI with expanded access to preventive imaging and treatment could allow healthcare systems to reach far more patients despite ongoing workforce shortages.
Social media is driving poor health decisions
Califf highlighted the increasing battle clinicians are facing with misinformation that easily circulates on social media and what he described as today's fractured information environment. He said social media has fundamentally changed how Americans receive health information, often exposing them to unproven treatments and commercial interests that compete directly with evidence-based medicine.
Combatting this requires a change in how physicians get their message out, and that required using social media and other platforms that are outside peer review journals and main-stream media. Califf said academic medicine needs a stronger digital presence capable of delivering reliable, science-based information where people now spend their time online.
"We're in a battle over information for what people are going to believe and do," he said. "We're not even on that playing field. We've got to get out there on the playing field if we're going to reverse the trends that are happening in the U.S."
Mixed views on the MAHA movement
Califf also discussed the Trump administration's Make America Healthy Again (MAHA) initiative, saying it deserves credit for drawing attention to the nation's worsening health and redirecting attention on some off the basics.
"I think we need to give MAHA credit for saying we're headed the wrong direction," he said. However, he stressed that any healthcare reforms should remain grounded in scientific evidence.
While supporting greater emphasis on nutrition, exercise, blood pressure control and cholesterol management, Califf questioned other aspects of the MAHA plan
He said said inexpensive preventive measures such as generic medications to treat hypertension and hyperlipidemia, and eventually generic GLP-1 drugs, could have a much greater impact on public health than many expensive new technologies if they become broadly accessible.
Technology alone will not solve America's health challenges
Although the SCCT meeting showcased cutting-edge cardiovascular imaging technologies using AI automated assessments for plaque risk stratification, inflammation imaging and FFR-CT and procedural image guidance, Califf concluded that innovation alone will not improve national health outcomes. Instead, he called for a healthcare system that combines advanced diagnostics, AI-powered efficiency, stronger preventive care and renewed emphasis on patient relationships.
"We've got to advance the technology, get really good at the human aspect of clinical care and make sure we're serving everyone, not just the wealthy," he said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]