I’m glad you joined us because we have Ton Dobbe and Dr. Warrick Bishop here. Ton is the Chief Inspiration Officer at Value Inspiration. Dr. Warrick Bishop is a cardiologist, international bestselling author and keynote speaker. It’s going to be a fascinating show.
Listen to the podcast here
Standing Out In A Crowded Marketplace with Ton Dobbe
I am here with Ton Dobbe who is the Chief Inspiration Officer at Value Inspiration. He helps business software CEOs reimagine what can be to deliver a remarkable impact. It’s nice to have you here, Ton.
Thank you for having me on your podcast. I’m looking forward to this.
I’ve been looking forward to this. I got to be on your show and that was fun. Now, you get to be under the spotlight a little bit, which will make it interesting to get a different perspective. On your show, we talked a lot about curiosity and some of the stuff I’m working on. I want to talk about some of the stuff you deal with because you deal specifically in the software industry. You help CEOs who struggle to stand out in their category. What got you into that? Can you give me a little background?
I’ve been in the business software industry for many years. I’ve always been in product marketing and product management space. At my previous company, I ran the global product marketing portfolio of products. I ended up one year as a TV evangelist and that’s also inspired me when I started my own company to say, “This is about value inspiration, which is what my steel is, what I feel passionate about. If I’m the owner, I could call myself a CEO but this is all about inspiration and inspiring other people to do something different to stand out in the market.” The logical connection to my name would be, “I’m the Chief Inspiration Officer.” That’s how the title came out. The reason why I started this business is when I left the company I used to work for, one of the things I saw in the marketplace, and that’s not unique to business software companies, it’s very universal, is that a lot of organizations have a real big problem to stand out in a crowded marketplace. There are all kinds of negatives to get.
It stops them from creating momentum. It sometimes creates products. I’m sure you’ve heard people talk about the best-kept secrets. What is the fun or the benefit of the best-kept secret if no one knows about it? A lot of companies struggle with this and it creates a lot of negative spin around it. They don’t get invited to the party to be part of a sales process. When they are in, they hardly make it to the shortlist. If they’re in the shortlist, they are starting to compete on price with others that are also doing something similar and also don’t stand out. The only thing the customer can say, “Who’s the cheapest?” That then leads to profit issues to revenue issues. What I’ve always been doing is I want to I want to help software companies to get out of their struggle and help them to stand out and to be remarkable. That’s how it started.
You do a lot of remarkable things and that’s how I was introduced to you. Dr. Cindy Gordon had introduced us. We talked about a lot of things on your show, but I loved a couple of words because you wrote about a couple of things on your site that are some of the stuff I research. I’m into researching perception and different things. You put two words about you that’s your added value and you put perceptive and energy. Perception is such a huge issue for me of what I’m researching. I want to get your perspective because you’re a world traveler guy. You’re in Spain. Where are you from originally?
I’m Dutch. I lived my whole life in the Netherlands until the point where I got international. I was more outside of the Netherlands than inside. In the Netherlands, it rains a lot. We were driving at some point from the west to the east of the Netherlands, two-hour drive or something like that. We had all the seasons you could possibly imagine in one drive and we said, “Why don’t we live in Spain? Why don’t we live in a place where it’s warm?” That’s how it came about there. This is a fantastic place to live. It has great weather and has great airports because everybody wants to go here. From here, I can literally go anywhere directly at least in Europe.
In Europe, everything’s smaller. I’m used to the United States where everything’s in the United States. There, you’re in different countries every two minutes almost. I’ve been to all the areas that you mentioned and they’re beautiful and I could see why you’d want to live there. What I’m interested in is your global perspective because you have all this value you’re adding to these CEOs. I meet a lot of students, leaders and people who want to stand out, but a lot of them need a better understanding of what their perception is, how they’re perceived and how they perceive others. You say you have the rare ability to see what others cannot and that’s perception. How do you develop that? How much of a problem is it if you don’t have that? What do you think holds people back from having that?
It’s part of my nervous system. I didn’t even realize it until I did a test from Sally Hogshead. That’s where it came out and I was like, “That is completely true.” I did other tests as well. In a professional outset, for example, working with my clients on our new value propositions or product strategies I happen to ask the right questions. At some point, see the red line. Maybe it’s because I’m an outsider, but I start to see things popping up that people that are working for the same company that I provide the value for don’t see themselves because they’re maybe too close. It’s paying attention. It’s a lot of listening. It’s putting things down and then suddenly you start to see patterns. I’m into technology. My podcast, for example, is all about the fantastic things we can do with AI. Their particular pros around talking about for me are the least tech technology savvy there is because I work a lot with Post-it notes. My whole basket is filled with Post-it notes. I start shuffling things around and then suddenly it’s there.
It’s all colored Post-it notes. What do the different colors mean? Is that to keep you organized?
No. I use colors for example for the goals the company have and for a division that they express. I use the colors to highlight what are the external trends that the company is facing. I’m using another color, for example, for the internal roadblocks that they’re facing and for the risk of doing nothing. With all of those ingredients, then suddenly something starts to reveal. First of all, what is the most valuable thing to focus on? What is the most urgent thing to focus on within those valuable things? To watch the customers that I have, it’s about how you do then transform yourself or do things differently with your messaging. If your products say in order to address those things in a way that makes you stand out. You don’t have to stand out hours at every single level as long as you have two or three that are valuable to the customer. The urge is enough for them to say, “This is important,” and then the magic happens. That’s what I’m doing on a day-to-day basis.
A lot of people need to learn some of the things that you have you say come naturally. I believe a lot of people could develop some of these traits that you have, especially in the global setting where we were impacted by different cultures. Our perception’s two ways. How people perceive us and how we perceive them. How do we teach people to improve what they’re able to see? That’s what I’d like to do, to help people connect those dots that you’re able to connect. I’m curious how you think that ties into innovation. If you’re able to see what others cannot and you’re able to help these CEOs and other people be more successful. What do you do to help them see what they can’t see to get them more innovative?What is the fun or the benefit of a best-kept secret if no one knows about it? Click To Tweet
It always starts with the value foundation. It’s typically addressing or highlighting what is the big idea. You might be surprised that a lot of companies don’t know what their idea is. They’re in a market and they sell a particular product and they already start to excuse him saying, “We’re doing a lot like what everybody else is doing in this space.” To go back a number of steps and say, “What is the big problem we are addressing that if we solve it creates a lot of value to our customers.” That’s one thing. It’s also making choices about who do you make it for. A lot of organizations make the mistake that they say, “It’s solution XYZ. For example, we need something fascinating in procurement and it’s for everybody.” Yes and no. It’s addressing what type of organizations. If you look at it beyond the demographics of a particular industry or particular size, what are their mindsets? What do these organizations want to achieve?
Every organization in those areas had a different ballgame. Maybe you know the technology adoption curve by Geoffrey Moore, who’s talking about mindset like, “These are innovators. These are early adopters. These are the early majority.” Even organizations that are in each of those markets, they’re happy there. Some of them want to be an innovator and they are happy to make more risks, but they’re looking for something that stands out for what they want to achieve. For business, it’s important to address that. Are you addressing them or are you addressing the ones that are coming to market what everybody has already moved a few years ago? If you’re clear about that and it doesn’t matter who you’re focusing on, then you can start to articulate, “If I provide that market with that mindset and products, what do they find important? In what way can I then make myself stand out from the pack in a different way?” That’s where it starts.
Opening your eyes about what is your ideal customer? What is that mindset? From there, what is important and valuable to them? I’m in the technology space. A lot of technology that’s coming out to the market, if you looked at press releases, you look at the website, it’s all shiny. In many cases, it’s more an interesting thing than a valuable thing to bring to market because they want to be part of the hype like, “We have fantastic AI products.” Good for you, but what does it do? What problem does it solve?
I had somebody on my show and we were talking about all the jobs that will be replaced because we won’t need these employees anymore to do these things. He said, “They’ll create products that people don’t need but they think they want and that’ll be the new product.” That’s an interesting way of looking at it because we do have a lot of things that we have that maybe aren’t so valuable but we add a perception of value to it.
That’s the perception again. Sometimes that’s the simplest status.
It is the mindset. It’s all that you’re talking about where people are thinking about what they want, what they don’t want. In software, it’s a time when you can almost tell people what they want because there are many options. Do we have stuff that we don’t need but we think we want it?
As long as someone comes along that stands out in your eyes, he or she could sell you something that you might not need but you want. That’s fascinating about people. Sometimes it’s tangible, “I want this because it brings me more revenue. It brings me more profits.” Sometimes it gives me the competitive advantage. It goes from hard facts to soft things. Sometimes it’s status.
I like when you were talking about looking at things from an outside point of view too because fresh eyes are critical. There was a part in my book where I talked about the hospital that brought in the racing team to look at how things were done for efficiency. A lot of companies get all held up not only they don’t think outside their cubicle. They don’t think outside their silo. They don’t think outside their company. They don’t think outside their industry. It helps to get an outsider in with fresh eyes. Do you see a light bulb going off in their face when you bring up something that should have been right in front of them that they can’t see?
All the time, sometimes it’s simple. That’s also good because if it’s simple and if it’s something that’s always been there, but you see that becomes a strength. Not only can they talk about it with more passion, but they can also get the failure across in a better way. They can also pick it up with a lot of evidence and that creates trust with buyers. It’s how you translate that into something that you always thought was obvious or there. You didn’t see it as something that stood out to others that you can then start to translate that in a way that it becomes something that’s valuable. People say, “This is interesting. I didn’t realize it,” and you start to change the perception of those organizations.
We’re back to perception because it’s important and we’re back to looking at patterns and things that we can do to remain relevant. Curiosity is the key to staying relevant. What other terms do you come up with when you’re talking to people, in addition to curiosity, perception? I know you talk about energy, perseverance. What are some of the things that you think these CEOs need to work on in terms of developing to be remarkable?
The fact that you wrote your book about The Curiosity Code made me realize how important that particular area is. We haven’t talked about it. I would say it’s a critical asset. It’s a critical trait of a remarkable company that they embrace being curious. To me, that goes into various layers. It’s curious about what is going on in the mind of your ideal customer to create the foundation about what value you deliver. It also then goes into how do you then stay relevant and how can you keep that remarkable edge to your customer or your product strategy so it’s continuously challenging yourself. What is out there? Look around the corner. How is your customer changing? How is the business changing? How is their mindset changing in terms of their beliefs and their wants? Continuously develop solutions for it that hits the right level of urgency, but also are done in a way that you exceed expectations.
When it comes to sales, it’s the same thing again. On the sales side, you have to be curious because there’s no such thing as a similar customer. You always have to get into their shoes, look at the whole thing from their perspective and then translate what you offer in a simple but compelling way so that they can only say yes to you, that it’s irresistible. It’s an important thing to embrace. I work with companies that are startups. I’ve been there for two or three years. Their product is fantastic because they’ve started and it’s all about the latest and greatest, but they don’t have a way to get across how great is the market place. It’s the translation of that value.Look at things from an outside point of view because fresh eyes are critical to innovate. Click To Tweet
What I also see is that there are other companies I work with have been around for 20, 30 years. What you typically see there is a level of what I call complacency. They start to believe their own story about they’re doing great and that’s a dangerous thing to have in a company. You’re talking to your own language. We’re doing great. We’re growing good 5% to 7% a year where possibly they could go 20%. Profit is good. It’s 12% to 15% where it could be 25%. Our customers are happy, but would they buy it again?
What you see is that there’s a vicious cycle that at some point in time they’ve got success. Gardner has said that a trough done at the hype curve with the trough of the solution. You see those with companies. These are chauffeur companies I’m focusing on. It’s definitely universal. You start. You get that momentum. What you brought to the market is wanted. The customers love it. Once you get over that first few years, then it starts to settle down and it becomes less of a thing. In order to stay on that high energy level, you have to stay curious. That’s the magic there. The moment you lose it, it’s gone.
I have a lot of people who contact me because I had Barry Rhein on my show who teaches curiosity in sales. I’ve had people contact me or thinking of creating sales type curiosity assessments and different things like that. A lot of it is you have to show a sense of interest in someone else and to put yourself in their shoes, which is a big part of empathy, which is a big part of emotional intelligence. This all ties into all that. You developed an approach to find a spark that will unlock true potential in people and that grows buyer curiosity. What you do to help them get the buyers more curious? We’re always looking at it from the employee and the leader’s point of view in terms of curiosity, but what about the message that you’re sending out to spark curiosity in people who buy?
It’s addressing either an ambition they have and get the message across in a way that they can say that it hits the right nerve. It’s something that you’re sending a message out that they can go two ways, which is more about sending a fear like, “I don’t want this to happen. I’m fearful it will happen, as a consequence, I want to know more.” What are the things that I do? For example, I sometimes train salespeople on how to deliver a remarkable pitch. I’ve learned a great deal or I’m using a great deal the concept of the book, Made To Stick, from the brothers, Dan, and Chip Heath. They use a concept of the word SUCCESS. If you look at a pitch, if you look at your marketing message with those six characters like the S for is it surprising? Is it unusual? There’s a C for is it concrete? Is it credible? The E is for emotion and the S is for story. The moment you use those ingredients, most people use or can create something that’s simple, that is concrete because I talk about something that you can see in front of you. They can create credibility because of their skills.
Frankly, they’re using a customer example. They can also blend in a story, maybe a customer anecdote. With those four characteristics, your score is six or seven or a B. It’s not bad. It’s not good, but you won’t get far with it especially when your competition is doing better. The moment you start to add that the U for unusual or E for emotion, these things start to become easily an A and that’s where things started to resonate. They start to click with people. They start to create curiosity with them. We see many things coming our way every day and messages that don’t resonate. People set out things where you say, “I’ve heard it 1,000 times now. What’s different?” It’s all about creating differentiation and helping to get a differentiation across in a way that it stands out. That’s a good formula to apply. I would recommend everybody to read a book not only for the book itself but to use it in day-to-day life.
You brought up a couple of things that are helpful in the sales arena because I’ve spent decades in sales. A lot of it is we’re hearing more emotions involved than we ever did and more listening involved. That’s why introverts are talked about in sales, which they never work in the past. Susan Cain’s book, Quiet, made a big impact. People looking at the value of what introverts can add in all areas. With sales, it’s particularly interesting that everything has teams a lot more now than they were in the past. Before they gave you a phone book, they gave you zip code and said, “Have a good time.” You’ve got this person calling this person, following up this person. You’ve got a whole different setting. You can have an introvert do certain parts, an extrovert does certain parts and it’s such a different process. I love the aspects of different personality traits tying in to bring together a more complete puzzle and a more complete relationship with the buyer.
What you’re doing is helpful. It’s funny that you’re in the software industry because that was one of the first jobs I had. It was selling computer software in the ‘80s with IBM and that group. Some of the same issues are still there that we saw then. It’s interesting to see the changes and how everybody’s adapting, but a lot of people could use help from somebody like you who has these perceptive energy issues that you are able to help them with, that you can have so great with that. You have a way of having fresh eyes and helping them see things from a unique perspective. If somebody is reading this and you don’t just work in Spain, I want to make sure people know that.
My world is global. I just live here.
I wanted to make sure everybody was aware of how they could find you. How they could work with you, website information and all that. Would you mind sharing that with everybody?
One thing to do is to go to my website, ValueInspiration.com. You can find everything that I’ve been talking about. There is my blog. There is my podcast and my three-step approach to become a remarkable software company. Another thing to do is to go to LinkedIn and find me with my name, Ton Dobbe, and connect me there.Curiosity is the key to staying relevant. Click To Tweet
This has been fun to talk to you. I hope people check out your podcast because I was on one of those episodes too. He gets some interesting people he talks to on that and he’s got a lot of great information on his site. Thank you, Ton. I appreciated having you on the show.
It was a pleasure on my side.
Imaging Scans For Heart Disease with Dr. Warrick Bishop
I am here with Dr. Warrick Bishop who is a practicing cardiologist, number one international bestselling author and keynote speaker who has a passion to help prevent heart disease on a global scale. He is the author of Have You Planned Your Heart Attack. I am anxious to talk to you about this. Welcome, Dr. Bishop.
Thank you for having me, Diane. Thanks for taking the time to allow me to join you from the other side of the world.
You have quite an impressive background. I was looking at all your memberships and certifications and boards you’re on and different things that you do. I could see why you would be an expert in all the issues that you write about. I have a family that’s got a terrible history of the hypercholesterolemia and whatever else that you probably wrote about in your book. I’m interested in heart disease. My husband and I ran for the Stroke Association to raise money and different things. You’ve been recognized by the medical school of the University of Tasmania with academic status. You’ve got quite a background in the cardiac realm. This is going to be interesting to me since I sold cardiac meds. You’re talking about a lot of things that my husband and I talk about in terms of misinformation. Even by doctors don’t have a good idea of what’s good and what’s not good for the heart and they’re going off the old information. Let’s start with your background. Tell me a little bit about you, where you’re from and how you got to be this cardiologist that’s specialized.
I appreciate the introduction. Truth be told, you’ve described me as someone far smarter than the person sitting here talking to you at the moment. The reality is that I was a fairly average and mediocre general cardiologist. In fact, I had something happen a couple of years ago which changed my direction. That change in direction falls to a whole heap of changes, a whole heap of focus and drove me to join the boards, do more in the research space, to be engaged in preventative issues. My background is I grew up here in Tasmania, which is the island south of Australia. I did a lot of my training here in Australia and around Australia and focused on adult medicine, which was clinic-based. I did blood pressure and chest pains and funny heartbeats and looked after heart attacks and all the standard stuff.
Angina is chest pain from ischemia, lack of oxygen to the heart. I have a certification training. That’s a couple of years of graduate level as a certified medical rep when I was a pharmaceutical rep. I had to take a lot of anatomy and physiology and we studied a lot of this stuff. The heart was my main focus since I sold Tenormin and Zestril and a lot of those medications, lisinopril, and atenolol now that they’re generic. What I found when I was a pharmaceutical rep was it was scary to see behind the curtain of what doctors knew and didn’t know. You could get a little bit worried about this because they can’t know everything. They’re smart. They got into what they’re doing but there are many medications, there are many different ways of looking at the research. One day it’s good to eat carbs and still be the best thing and the next thing it’s the worst thing. Where do you stand on carbs now? Is it the inflammation that’s going to give us heart disease or is it okay to eat carbs?
I’m going to respond and then sidestep. This is my own experience. We have to be aware and cognizant of the limitations of our knowledge and how complex individuals and their biological systems are. We know so much in medicine, but we run into problems when we start to believe we know it all. There’s no doubt in my mind that knowledge is incredibly important and we always have to be open to what more we can learn. I’d love to indulge you with a story that set me on a different path and it’s probably ended up with me speaking with you now.
In May of 2005, I was driving to work. I had patients to see. At the same time, there was a fun run in progress. In Australia, we do things called fun runs where people all get together and run five or ten kilometers. This was for the city to casino fun run. As it happened, the course was right past or close to where my hospital was. As I went to work, I was running past the field of runners. I noticed there was a commotion in the crowd. There was an ambulance, there were people standing around. I literally thought, “I’m a doctor. I don’t know if I can help, but I’ll stop and see if I can offer some support.” It turned out a man while in this fun run had literally dropped dead from a heart attack and was being resuscitated by the roadside. He’d had a heart attack and a cardiac arrest.
I was involved in that resuscitation with a couple of other bystanders and the paramedics from the ambulance. That man survived. He did so well that we got him to a local hospital, the nearest hospital. He got stents put in and because he did so well, he ended up on the front page of the paper a day or two later. I don’t want to sound too self-indulgent, but that was a pretty good story and it was a pretty good thing to be involved with. I’ve got a copy of the paper, perhaps a little bit proud. I wandered into my office and showed my staff and said, “I was there.” At which stage, one of my staff who recognized the name of the patients said, “Warrick, you saw him about eighteen months ago. He’s one of yours.”
I can’t tell you how I began to feel when I realized that a man I’d seen only eighteen months earlier had dropped dead during a running race. I went back and looked at his notes. I’d seen him in 2003. He’d come with some nonspecific chest pain. I’d done a treadmill test, which at the time was exactly what we should do. He performed well on that because he’d been keeping himself fit. He had a little bit of blood pressure. We adjusted his medication a little bit and I suggested he take a little bit of aspirin and that was it. That was the list that was appropriate at the time. I didn’t do anything wrong, but I realized it wasn’t right.
The upshot of that was I became aware of any technology that may allow us to be far more precise in assessing risks. I’d done the treadmill test on this guy and I could tell him he was fit. I could tell him he could exercise for nine-and-a-half or ten minutes, but I couldn’t tell him the health of his arteries. That’s what put him down. That’s what allowed him to have a heart attack in the middle of this fun run. It turned out that literally around that time, more and more technology and more and more information was coming out around imaging the heart. The way to take pictures of the beating heart inside someone’s chest to literally get pictures of the arteries and see what the health of those arteries looks like. Knowing that some people can look fit and well on the outside that can still have a heart attack.
I’ve had many people I know who have had different things. They go in and they go, “Did you see your head ST-segment depression at your area?” They have no idea that there’s even something wrong with them. Sometimes they don’t even have heart pains. I have had a guy was my physical therapist. He dropped dead at 35 after being in all these marathons and stuff. He happened to do it at work where they saved him. This is many years later, he’s got in his heart a pacemaker. There are many people that we need to do better imaging to find out what’s wrong. Can you pick up things like arrhythmias? What can you see with the imaging now?Read a book not only for the book itself but to use it in day-to-day life. Click To Tweet
This imaging is predominantly and was specifically about coronary artery disease and that’s okay because coronary artery disease separates to arrhythmias and cardiac failure. Coronary artery disease is still the single largest killer in our community and far greater numbers for both men and women. Most importantly, we can do something about it before a problem occurs. We can modify risk and we can alter someone’s outcome. It’s an incredibly valuable piece of information. My journey was about learning more about this imaging and I was the first cardiologist in the area that I work in to do a lot of training in that space.
Honestly, the more I use this, the more I scan people’s hearts, the more I realize that I couldn’t tell what was going on with someone by looking at them from the outside. Checking their cholesterol or blood pressure or how fit they were or what’s their age or what their family history was. I have for example, two sisters from the same family both with high cholesterol, one had terrible arteries and the other had nothing in their arteries. I realized that the complexity of the process of coronary artery disease is something we haven’t got our heads around. We understand lots about it but we don’t understand exactly what’s driving the process. It seems different in different people. If you don’t know, it seems like a good way to find out is to have a look and then go from there.
I worked for AstraZeneca for many years, several of them in pharmaceuticals. When we talked about a lot of this stuff, they were about to sell a lipid-lowering drug at the time when I left. I know that drug companies want to solve all the problems with medications and people want to be able to eat whatever they want. They take these medications and say, “Now, I can eat this double-decker, some greasy, whatever it is I want to eat.” We don’t know what we can eat and then they talk about, “This is cholesterol. First, eggs are bad then they’re good. There’s good cholesterol. There’s bad cholesterol. If you have a good HDL ratio, you’re good. They keep changing it that next time it’s going to be something different. It’s hard as an individual to know what we can do. A lot of people in our audience won’t be doctors. They are going to be people who want to know, “Who do I listen to? Do I ask for this scan? What should I be eating?”
When it comes to the scan, I was energized and focused and I felt like I had a secret that I needed to share with my colleagues and local family doctors here. As I spoke with my colleagues, I realized that change is a difficult thing and they were pretty comfortable doing what they’d been doing for years. It’s what I’d done for the fun runner, which is put people on a treadmill test and reassure them. I got frustrated with that. In fact, I felt like a pioneer getting arrows and criticism. You justify this better than you are and so forth. I got despondent that I couldn’t push this technology locally.
When I spoke with the family doctors, I realized there was a fairly complicated discussion that required more than a quick visit and a couple of main pointers. I ended up in a situation where I wanted to get a thorough explanation and message out. That’s why I wrote the book and I called the book, Have You Planned Your Heart Attack. It sounds a bit tongue-in-cheek. I want people to plan not to have a heart attack, but that’s I wrote the book. In fact, from writing the book it’s sent me on the journey where I’m fortunate enough to have the opportunity to speak with podcasts or radio hosts the other side of the world. I’m still in the process of trying to raise awareness and give people good information.
What does the scan consist of when you go in to look for this? Is this something that they’re going to inject you with any iodine or dye? Is it more like an MRI that they do? Is it a CT scan? What exactly would people go through to make sure that you could see what they need to see?
The scan that we use for the heart is the CT scanner. We’ve been able to do that in the last decade or so because the technology has improved and because the technology has improved, we can now take pictures of the moving heart. The heart beats 60 or 70 times a minute, we needed the technology to be able to freeze the heart while we were imaging it so that we could get reproducible and reliable images. That’s happening. The role of this technology is in trying to inform the best management strategies for individuals. A good way to think of it is if I took an average 50-year-old male who went to his local doctor and said, “What’s my risk of a heart attack?” The doctor might take his cholesterol which could be average, his blood pressure which could be average. He’s a nonsmoker and a non-diabetic.
At the age of 50, a man moves into what we call intermediate risk. Intermediate risk means that there’s a 10% chance of a heart attack in the next ten years. That doesn’t sound like a lot and historically when we’ve run one of these risk calculators on a patient, this arbitrary 50-year-old male. Historically, we turn around and say, “You’re not that bad. You don’t need treatment. We don’t need to put statins in the water, etc. You’ll be fine. We’ll see in a couple of years and see how you’re going.” We need to reframe the way these risk calculators work and then put them in the context of the individual.
When we use these risk calculators, what we’re saying is if we take 100 people with the same characteristics that you’ve got and follow those 100 people for several years, we know ten of them will have an event. That’s a one in ten or 10% chance. We just don’t know which one it is. Who is it going to be? We take the 100 men through a scanner. We find 25% they’ve got lots of stuff in their arteries, we find 25% have nothing in their arteries and we find 50% who are the average 50% group in the middle. Do you think that could be helpful in directing specific management for those individuals? It is.
When you’re talking about giving these CT scans, what radiation is there involved? How often do you give it? Is that a factor to consider or is it worth doing?
I did cover a lot of the hurdles to change in my book specifically because of things like radiation and costs and the research behind it or all. The excuses or all the replies from people who don’t want to adopt the technology. Who wants to continue doing what they’re doing. Technology is a changing field. You only need to pick up your phone to recognize technology’s changing all the time. When it comes to scanning the heart, many years ago when we were early in our stages of developing this technology, the radiation dose was quite high. To be honest, it was probably verging on unacceptable for broad use within the population. The iteration of scanners using clever technology to minimize radiation dose exposure to patients. It’s a little more than a mammogram dose of radiation. We are comfortable with mammography as a screening tool for a condition that doesn’t kill anywhere near as many people as a heart attack. We can scan the heart with the radiation dose, which is about the same as a mammogram, which makes it incredibly safe and within the expectation we had.
There’s no use of MRI or ultrasound because they’re not able to capture the same thing.We know so much in medicine, but we run into problems when we start to believe we know it all. Click To Tweet
Different modalities look at things slightly differently. The coronary arteries move quickly and the differentiation of the tissue is not enough for the ultrasound and too fast for the MRI. CT works well and that radiation dose is pretty small. For a 50-year-old bloke or a 60-year-old woman for argument’s sake, it wouldn’t have a significant impact at all, particularly when we think that the flip side is a coronary artery disease that kills 50% of the population.
That coincidence that I saw that Susan Lucci found out she had heart disease and who’s in better shape than this actress who’s skinny as a rail and eats perfectly and it’s drawing attention. Let’s say somebody like her or you or me or anybody who is out there. Say we take good care of ourselves. We’ve done well. We do this scan and we find out, “I’ve got the widow maker in trouble here.” How does that happen? What’s the next step?
There isn’t a single answer. That’s important to understand. In fact, when I was in Phoenix I was being interviewed by one of the TV hosts and the interviewer said, “Warrick, what’s the single thing that you want to get across to people?” I said, “Honestly if it were a single thing, I would have written a postcard, not a book.” The reality is it’s complicated. We have to recognize that these things are complicated, but the absolute premise of what we should be trying to do is operate from a platform of the best information. If you’ve got stuff in the arteries, if it’s good, bad or something in between that needs to be matched up with who you are. Are you overweight, underweight, cholesterol high, family history bad, whatever that may be? The extent of your holistic assessment needs to be worked through by someone who knows how to deal with this technology or if they don’t know how to deal with this technology. Hopefully, I’ve written a book that someone will access and get an idea of how you bring all of these issues together to answer the question of the best way forward for an individual.
I know doctors have to go to get their CME credits, the Continuing Medical Education credits, like real estate agents and different people get their continuing guidelines or SHRM in different things. Different industries have their credits they have to continually get. Are they talking about this when you go to meetings? Is this something that you’re seeing is being adopted by the medical associations and societies to which you’re a member?
There was a changing of the tide, no question. A decade or so ago, I was receiving arrows from my colleagues. Now, I’m involved with The Heart Foundation here in Australia. We’re looking to write a position policy on imaging the heart. There’s been a tectonic shift in that regard. I’m also involved with the local Society of Cardiovascular Computed Tomography and that’s the organization in America, which is the parent organization. I’m in one of the local chapters here. We’re looking to start to make inroads into approaching the government here in Australia to make this testing more broadly available for providing the best information in trying to understand someone’s risk into the future. Sometimes we see people who look fit and well on the outside. Until you scan the heart, you can’t tell that there’s rust in the pipes that may cause them problems.
I can remember calling in a doctor who was playing tennis, the best shape of all the doctors I call on. He died playing tennis he had apparently the best information. As a doctor, you would think you guys know the most. It’s hard because you think you know what you know at the time and then somebody uncovers something new. We’ve teased a little bit about what we could eat and I know you want to be focused on this test, which we covered and it’s important. Even when we get to the test, we’re going to find good things are there. How bad are carbs for inflammation? Is inflammation the thing that causes all the problems and people don’t realize it? Is this possible?
There’s a lot of noise on social media which can draw conversations in a particular direction. Certainly, my own practice is to suggest to people that they don’t do too much in the way of carbs. I certainly have a group of patients who risk insulin responders to carbohydrate exposure. For that group of people, I suggest that they try and cut their carbohydrates down as much as possible. They’re the people who may have central weight gain, central adiposity, family history of diabetes, elevated triglycerides. That group of people responds well to the reduction of carbohydrate.
One of the things about information is it’s a complex thing to try and measure and it’s been thrown around a lot in social media particularly and there are papers suggesting that it may be important. There was a trial called the CANTOS trial. That trial literally looked at modifying inflammation to try and modify outcome in terms of coronary artery disease. It did show that inflammation was involved. The trouble was it was only a small amount. It was statistically significant, but it wasn’t dramatic. There’s half a chance that carbohydrates, together with the elevation in insulin and some of the other hormones that are associated with raised insulin, may drive inflammatory changes. It’s a complicated area and it’s important to understand that if we do find someone who’s got stuff in their coronary arteries, then what we want to do is address as many of their risks or address as many of the factors we can that we can modify.
Inflammation and diet are important. Exercise is important. Taking your tablets, whether that’s aspirin or a cholesterol-lowering tablet is important. Getting your blood pressure under control is important. From my perspective, I’m always cautious about people suggesting, for example, I’ll drive from Phoenix to LA and I promise I’ll drive safely but I won’t wear a seatbelt or I’ll disconnect the airbag. When it comes to coronary disease, it’s a bit like driving your car. You want everything on your side in your favor. You want to have as many airbags as possible. You want to have your seatbelt on. You want good brakes, good tires. Diet fits in with that, but so does good mental health and so does good physical health and so does a good doctor who’s evaluated your arteries and knows exactly what you’re dealing with into the future. It’s important, but my observation is a lot of people cling onto one aspect. It doesn’t give you the safest journey. You want everything stacked in your favor.
It’s a tough thing when people are addicted to food and the types of foods that they’re used to eating. It’s a hard thing for people to give up their favorite things. Sometimes they go think they’ll take a pill and that’ll solve that, then they can do what they want to do. It’s hard, but until you’ve gone through one of these major cardiac events to know what it could do to you. Sometimes bad things happen to talk people into doing the right thing unfortunately. It’s great that you’re trying to find a solution to a serious problem. A lot of people would like to read your book, Have You Planned Your Heart Attack. How can they get your book? How can they find out more about you?
The easiest way to find out about me is to go to my website, www.DrWarrickBishop.com. If you googled Dr. Warrick Bishop, you’ll find me on my website. I’ve got a free TV show, which I put together as a compliment to the book. My book is available on my website. The books are available through Amazon as well. It’s also available as an audiobook if that was more convenient.
A lot of people need to know more about this and a lot of people who read this are workaholics and maybe need to take better care of themselves. I hope that everybody takes a look at what you’re working on. Thank you for being on the show, Dr. Bishop. It was nice to have you here.Knowledge is incredibly important. We always have to be open to what more we can learn. Click To Tweet
Diane, thank you. It was a pleasure talking with you.
Dr. Warrick Bishop, thank you. Thank you so much to Ton and to Dr. Bishop.
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- Have You Planned Your Heart Attack on audiobook
About Ton Dobbe
Ton Dobbe is the Chief Inspiration Officer at Value Inspiration. He helps business software CEO’s reimagine what can be, to deliver remarkable impact.
About Dr. Warrick Bishop
Doctor Warrick Bishop is a practicing cardiologist, number one international bestselling author, and keynote speaker and who has a passion to help prevent heart disease on a global scale. He is the author of Have You Planned Your Heart Attack?