Rewards, risks, and responsibilities of globalization for the cardiothoracic surgeon

The 2005/2006 Council of the AATS.

The author (left) and Gerard Martin, MD, co-directors of the Children’s’ National Heart Institute, Washington, DC.

Adelaide, capital of the Australian state of South Australia. Adelaide First Light, Kenneth Jack, 1977.

H. D’Arcy Sutherland, a pioneer of heart surgery in Australia and past president of the Australian College of Surgeons.

The author (right) with Dr D’Arcy Sutherland in Adelaide, South Australia, 2004.

Melbourne is the capital of the Australian state of Victoria.

Brian Buxton, MD (left), director of cardiothoracic surgery at the Austin Hospital, Melbourne, and James Tatoulis, MD (right), director of cardiothoracic surgery at the Royal Melbourne Hospital, Melbourne, Victoria, with whom the author trained at the Royal Melbourne Hospital.

Roger Mee, MD, at left, past director of the Royal Children’s Hospital, Melbourne, Australia, with Fabio Sallum, MD, Milton Meier, MD, both of Brazil, and the author.

Staff and trainees of the Green Lane Hospital Open Heart Surgery Unit, Auckland, New Zealand. Alan Kerr, MD, is third from left.

Sir Brian Barratt-Boyes. Used with permission from Dr Randolph Chitwood.

Harvard-based cardiothoracic surgeons honor Denton Cooley. Dr Dwight Harken, pioneer of cardiac surgery at Brigham & Women’s Hospital, is on Dr Cooley’s right. Dr Jack Collins is at far right, and Dr Larry Cohn is back row, fourth from left.

Dr Aldo Castaneda (left) and Dr William Norwood (right), Children’s Hospital Boston.

The author operating at Xin Hua Hospital, Shanghai, China, with Dr Ding Wen Xiang and Dr Su Zhao Kang.

Classification of attendees at a recent AATS meeting broken down by subspecialty.

Attendees at the AATS meeting, United States versus non–United States, 1997 to 2005.

Manuscripts submitted to the Journal of Thoracic and Cardiovascular Surgery by region of origin, 2000 versus 2005.

The Mt Washington Hotel in the White Mountains of central New Hampshire was the birthplace of the World Bank, the International Monetary Fund, and the World Trade Organization in July 1944. Courtesy of The Mount Washington Resort at Bretton Woods.

The Global Burden of Disease Report from 1996 predicted that by 2020 ischemic heart disease would be the number 1 disease entity, as measured by DALY (disability-adjusted life year). COPD, Chronic obstructive pulmonary disease. Data were obtained from Mathers C, Loncar D. Project of global mortality and burden of disease from 2002 to 2030. PLOS Medicine. 2006;3:2011. Copyright 2006, Public Library of Science.

The increase in life expectancy between 1900 and 2000 for American men and women. Data were obtained from Mathers C, Loncar D. Project of global mortality and burden of disease from 2002 to 2030. PLOS Medicine. 2006;3:2011. Copyright 2006, Public Library of Science.

Total number of smokers is projected to increase by more than 30% globally in the next 20 years. Data were obtained from “Tobacco is impoverishing people and nations, WHO warns” available at http://www.wpro.who.int/NR/rdonlyres/7321AD83-6AB5-4071-B374-535C243684DA/0/TobaccoImpoverishing.pdf

In 2003 there were 20,000 more deaths among women from lung cancer than from breast cancer. Data were obtained from www.who.int/gender/documents/LungCancerlast2.pdf

A worldwide survey on cardiac interventions in 1995 documented that many countries globally were tremendously underserved for cardiac surgery at that time. Source: Cox JL. Presidential address: Changing boundaries. J Thorac Cardiovasc Surg. 2001;122:413-8. Reprinted with permission of The American Association for Thoracic Surgery.

The structural adjustment programs applied by the International Monetary Fund and World Bank from the early 1990s are based on the “Washington consensus.” Data were obtained from “Social development—Debating the Washington consensus” available at (http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALDEVELOPMENT/0,,contentMDK:20116211∼menuPK:199474∼pagePK:64020865∼piPK:149114∼theSitePK:244363,00.html).

Although the most wealthy nations have benefited from tremendous economic expansion between 1970 and 1995, there have been few gains for the middle and bottom two thirds of countries globally. GDP, Gross domestic product. Data were obtained from the World Economic Outlook Database, available at www.imf.org

Benjamin Franklin, quintessential American, one of the authors of the Declaration of Independence, was also a globalist responsible for a number of diplomatic initiatives. Reprinted from earlyamerica.com