(By Rabbi Yair Hoffman for the Five Towns Jewish Times)

Dr. Edward Horwitz is a leading cardiologist/ lipidologist in Israel. He was trained at the Cleveland Clinic and is one of the only lipidologists practicing in Israel. The Five Towns Jewish Times spoke to him about differences between American medicine and Israeli medicine as it pertains to his field.

It is hoped that this article will help save lives.

RYH: Dr. Horwitz, generally speaking, in the field of cardiology – how does Israel compare to the United States?

DH: For preventative cardiology, they are both poor. Care for diabetics in Israel, however, is particularly dismal. There needs to be drastic change.

RYH: What about dieticians for both diabetic and cardiology patients? How are they doing?

DH: They are both beating around the bush. They focus on the quality of food but for both of these patients it is not quality – it is quantity. Diabetics and cardiology patients have to drastically reduce their caloric intake. That’s the main thing that matters.

RYH: What about the differences in medicines? Are Ace inhibitors and statins the same in Israel as in America?

DH: For the most part we have the same medicines in both America and Israel, but there are some very serious problems in Israel because of the socialized medicine here. For example, the ACE inhibitor called “lisinopril” was removed from the market because of socialism. It is the second most effective ACE inhibitor in existence and it is very, very inexpensive. Ramipril the best one is available and the government subsidizes it. The negative effect is that instead of having two very good ones, we have only one. The makers of the drugs that are not subsidized just cannot compete.

RYH: But if Israel has a good drug, why do they need more?

DH: More options are always better for a number of reasons. Some people do not do respond well with one and not the other. Also, some people need angio-tensin retention blockers (ARBs) – because they cannot take ace inhibitors.

RYH: What are the best ARBs?

DH: The best ARB is Mycardis. In Israel, we have to make do with the second best – Adapro.

RYH: Are you saying that Mycardis is not available in Israel because the competition is subsidized?

DH: Yes, that is exactly what I am saying. The Misrad HaBriut chooses to subsidize certain medicines. The result is that the competing companies don’t even put their medicines on the market. It also reduces the benefits of fair competition in the reduction of prices.

RYH: What other differences in terms of medicine are there?

DH: In the United States, doctors use 6 cholesterol lowering medicines. In Israel – we only have 5. We are missing Pitavastatin – a Japanese drug that has the fewest side effects – it is just not available in Israel because the way the system works here.

RYH: Is there an organization in Israel that tries stopping the subsidization of pharmaceutical drugs?

DH: As far as I know, there is no one who is fighting against socialized medicine. Even Likud does not fight it.

RYH: But can’t the patients pay for these medicines themselves? Or can’t the Kupat Cholims pay for it anywat?

DH: They won’t do that if the competitive drug is cheaper.

RYH: What about high blood pressure?

DH: Hypertension is undertreated in both countries. We had known about the correlation between high blood pressure and heart attacks way back in 1956. They were known as the MRFIT trials. Ancel keys had a registry that showed that blood pressures above 120 over 80 showed increase heart disease and certainly if above 150 its much worse.
Cardiac events decreased if blood pressure is under 120 over 80. Recently it was found to have a 25 percent. They changed the old guidelines which were to treat it only if it was 140 over 90. It is almost criminal that both countries are doing so little in treating hypertension.

RYH: Moving on to another subject. Who exercises more? Israelis or Americans?

DH: Neither one does. Let me make a slight correction. In Israel, younger people do exercise more because of the army. They are in better shape. But when the Israelis get middle aged and older – they stop exercising and let themselves go.

RYH: Are you of the opinion that everyone over a certain age should be on statins?

DH: No, I am not. This is wrong.

RYH: Who then should be on statins?

DH: All diabetics should be on it. Everyone with arteoshlerosis hardening of the arteries anywhere on the body. Anyone with LDL cholesterols above 190 or a non HDL of more than 220. Or anyone who fits the risk calculator.

RYH: Are Jews different than, say, the gentile population in the United States vis a vis lipids?

DH: That is an excellent question. There is a major gene defect that causes heart attacks. This defect is found in 1 in 500 people around the world population. In Israel, this defect is found in 1 in 150 people.

RYH: Is it true that bananas are bad for diabetics because of the potassium in it and that has a bad effect on the kidneys?

DH: All fruits are bad for diabetics. I tell them that they should not have a fruit unless they walked an hour that day.

RYH: Are there any other differences between America and Israel in terms of medicine that you see here?

DH: Yes. Quackery Medicine. There is way too much quack medicine here – much more than in the United States. They believe in alternative medicine much more here than anywhere else and as a result they stop taking their much needed medications. They then have heart attacks and wonder why. No one should ever ever Alternative medicine is pervasive in this country. I have seen many people die from this.

RYH: Are there any other differences?

DH: Yes, in smoking. Israelis smoke at a far greater rate than Americans. There is an erroneous and pervasive belief that one or two cigarettes are fine to have – as long as one is not having a pack a day. This is completely untrue. One or two cigarettes a day can raise your risk of heart attack by fifty percent. The only populations I have seen with higher smoking rates than Israelis are the French and the Germans.

RYH: Which lipidologists in America do you recommend?

DH: Dan Rader at University of Pennsylvania is the best in the world. He developed the Rader method of measuring HDL. Low HDL is a good predictor of heart disease.
I also like Henry Ginsberg at Colombia Presbyterian. A third I like Christie Valentine at Baylor University in Houston and Michale Davidson at University of Chicago. Also, Elliot Brinton in Salt Lake City. There are a lot of other ones but these are the ones that I know personally.

RYH: If lipidology is so crucial – why is there no mandatory Continual Medical Education (CME) in lipidology for both types of cardiologists (plumbers and electricians) and General Practitioners? There is no such requirement either in the United States or in Israel. Why is that?

DH: The truth is that I do not know. It is a no-brainer. Perhaps it is because lipidology loses money – the patients stay well. Doctors don’t make money from it. The only ones that benefit from it are HMOs. Or maybe it is because everyone thinks that they’re an expert in cholesterol but they are not.

RYH: Do the fish pills increase the low HDL numbers which are associated with heart attacks?

DH: There is no proven study that these pills affect the incidence of heart attacks. Exercise is the only proven treatment. But the question remains, Is it due to the HDL increase that heart attacks are reduced or is it due to the exercise?

RYH: Thank you so much for this fascinating interview!

Dr. Horwitz is a lipidologists who works with Leumit Medical Services in the Yehudah and Shomron region.

The author can be reached [email protected]