The Wellness Cardiologist
Dr. Frank Yanowitz tells the following story to his fourth-year medical students.
It was graduation day at Harvard Medical School, and the top student, Michael, was walking along the Charles River with his favorite professor. Suddenly, a drowning man crying for help came floating down the river. Michael jumped into the water, pulled the man above water after he had gone under for the third time, dragged him, unconscious, to the shore, and applied closed-chest cardiac massage and mouth-to-mouth resuscitation—until finally the victim regained consciousness. Michael was elated to have had this opportunity to shine in the eyes of his teacher, and his professor congratulated him on a job well done as the ambulance arrived to take away the victim.
Wet and exhausted, Michael continued walking with his teacher until a second victim crying for help came floating down the river. Again, Michael jumped in to the rescue and brought the victim back to consciousness on the shore. Incredibly, this happened again and again until, when the seventh victim came floating down the river, an exasperated Michael turned to his professor and said: "I know I'm a doctor dedicated to helping people, but I just can't keep this up anymore!"
"Then," replied his professor, "why don't you run ahead upstream and stop whoever is pushing these unfortunate people off the bridge?"
Cardiologist Frank Yanowitz is the medical director and cofounder of The Intermountain Health & Fitness Institute at LDS hospital, a high-technology medical center in Salt Lake City, Utah.
The Fitness Institute is run by some of the best physicians and therapists in the country, but they rarely see a patient with a disease. Instead, the Fitness Institute focuses on the prevention of disease among very healthy individuals—keeping wellness-oriented people from becoming customers of the sickness industry. Dr. Yanowitz's personal intrapreneurial story and that of the Fitness Institute provide a glimpse into the future of medical wellness.
Frank Yanowitz was born in 1939 in Malone, New York, a small town at the northern tip of New York State near Montreal. In public high school he developed a love of music and studied classical piano and trumpet. In college at Cornell, he bounced between various engineering disciplines, and became interested in medicine when he took a course in physiological psychology and comparative neurology.
In 1971 he entered the U.S. Air Force School of Aerospace Medicine in San Antonio, Texas, where he had his first encounter with wellness.
Unlike the patients of most cardiologists, the patients Yanowitz got to see in San Antonio were extremely well. As jet pilots, they were some of the healthiest and most fit individuals in the nation. They were required to see Yanowitz on a regular basis just to maintain their flying qualifications, and they were required to report even the slightest abnormality in their physical condition.
Moreover, Yanowitz was given virtually an unlimited budget to investigate the pilots' condition and to work with them to maintain their flying fitness. This gave him a unique preview of the a priori effects of diet and exercise on health.
"It was there," he reflects today, "that I began to see the very earliest stages of heart disease—long before I would normally encounter these patients in a typical hospital setting." This experience taught him a lot about the connection between diet, exercise, and disease.
After serving in the Air Force, Yanowitz accepted a position as a cardiologist at LDS Hospital in Salt Lake City and as an instructor at the University of Utah School of Medicine. The first thing he noticed when he came to Utah was the need for a specialized cardiac rehabilitation program to work with patients following heart surgery, but there was little support back then for such a program. The prevailing view was that a patient who had had heart surgery was "fixed" and that you shouldn't waste time and money on someone who was already fixed. Undeterred, Yanowitz and a physical therapist named Marlin Shields started a cardiac rehabilitation program, but they got very few patients. Although they received tremendous gratitude from the few patients they had, who were happy to be regaining their health and learning how to diet and exercise, "We got very few referrals from the medical community, who felt no need to send patients after they had been 'fixed.'"
In the late 1970s, Yanowitz began working with three colleagues: a student working on his PhD dissertation in exercise physiology (Ted Adams), an orthopedic surgeon (Tom Rosenberg), and physical therapist Marlin Shields. The four of them formed the Fitness Institute in 1980 to focus on prevention and wellness, screening individuals at high risk for heart disease, cardiac rehabilitation, and sports medicine. But by the end of its first year, the Fitness Institute was almost entirely focused on prevention and wellness.
When they first opened, the expected referrals from other physicians never occurred, and their business lost money for its first 10 years. This forced them to learn how to market directly to their customers, and today they put fitness tips on the radio and meet directly with major employers and executives in the area.
I first became aware of their work when I was a 47-year-old patient completing my annual physical. After telling me I was in perfect health, my internist (Dr. Mary Parsons) asked me if there was anything I wished I could change about my body. Completely in jest, I said, "Sure, when I bike up to Jupiter Peak [10,300 vertical feet] I collapse on the dirt, as I have trouble breathing after riding for 10 miles uphill!" Dr. Parsons then referred me to the Fitness Institute for a VO2 Max test before recommending that I begin a strenuous bike training program. A VO2 Max calculates the maximum amount of oxygen that can be removed from circulating blood and used by working tissues during a specified period.
When I arrived at the Fitness Institute I thought I was walking into a very modern, high-technology fitness club—until I looked closer and saw that each of the machines for working out had a dizzying array of meters and probes attached to them.
As Dr. Yanowitz explained to me, "People don't come here to work out but to be evaluated." The institute offers a complete line of internal medical care, but it does not manage any chronic problems, catering mostly to a market for periodic checkups and to people dissatisfied with their HMOs or primary care physicians. Here's what a typical six-hour first visit to the Fitness Institute (which costs about $1,500) includes:
An analysis of all body systems, including cancer screening
Blood and urine tests to assess your risk for heart disease, diabetes, infection, and anemia
A maximal treadmill stress test by a cardiologist to screen for heart disease and to assess your fitness level
Written evaluations to assess medical history, personal stress factors, and nutritional adequacy
Hydrostatic (underwater) weighing to determine your percent of body fat and ideal body weight (based on BMI)
Pulmonary function tests to screen for obstructive lung disease
Orthopedic evaluation by a physical therapist to assess your strength, flexibility, and risk for orthopedic problems
One-on-one wellness counseling to review results and recommend necessary changes in diet, exercise, and stress management
Screening test for colon and breast (women only) cancer
A take-home copy of Maintaining the Miracle: An Owner's Manual for the Human Body, a comprehensive personal wellness encyclopedia published by the Fitness Institute
Not surprisingly, Frank Yanowitz has had his own wellness transformation. In 1978, at age 37, while teaching some high school students how to use a sphygmomanometer, one of the students took his blood pressure, whereupon Yanowitz was shocked to see an unexpectedly high reading. He had the student repeat the test again and again, in front of the entire class, to confirm the results. That night he realized the irony of his developing an interest in wellness when he himself was overweight, sedentary, out of shape, and now had dangerously high blood pressure. He began a regular program of watching his diet, taking medication to lower his blood pressure, and exercise. Within a year he was running 40 to 50 miles a week and doing 10K and half marathons.
Today, at age 67, although never athletic as a child or in college, Frank Yanowitz has completed four marathons, runs 10 to 15 miles each week, mountain-bikes, roadbikes, hikes, skis, and snowshoes.
His curriculum vitae includes 80 publications and 18 major research projects. He has written a full-length book titled Coronary Heart Disease Prevention. He was the first chairperson of the Utah Governor's Council on Physical Fitness. He has personally affected the lives of tens of thousands of patients. But Yanowitz lights up the most when he talks about the groups of medical students assigned for one-month tours of duty at the Fitness Institute—the cardiologists of tomorrow—who will hopefully go forth from his tutelage dedicated to preventing heart disease rather than just treating its symptoms.