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Cardiologist P. Albert Chan shares critical insights into the importance of preventive care and a holistic approach to longevity and happiness. Drawing on decades of experience across continents, he discusses the prevention and management of the “five devils” of modern medicine—heart disease, stroke, cancer, diabetes, and dementia. Learn practical, evidence-based strategies for promoting a long, healthy, and fulfilling life through diet, exercise, and simple lifestyle adjustments.
P. Albert Chan is a cardiologist.
He discusses the KevinMD article, “How to beat the 5 devils of modern medicine and live a longer, happier life.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Albert Chan. He’s a cardiologist. Today’s KevinMD article is “How to Beat the Five Devils of Modern Medicine and Live a Longer, Happier Life.” Albert, welcome to the show.
Albert Chan: Thank you for inviting me.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Albert Chan: OK. I was born in Hong Kong and came to this country when I was 20 years old. I went to college and then NYU Medical School. After that, I was trained as a cardiologist and started practicing in New York, in New York State.
I lived through what we call the “good old days” many years ago. Then, after a while, with all the HMOs and everything kicking in, I was pretty fed up. So I decided to exile myself to Asia. I closed my practice, sold it, and moved myself and the practice to Singapore. I practiced there for about 15 years.
Kevin Pho: All right. You wrote this KevinMD article, “How to Beat the Five Devils of Modern Medicine and Live a Longer, Happier Life,” and I think that’s certainly informed by your experiences both in America and Singapore. Tell me what you’ve learned. Tell me about this article for those who didn’t get a chance to read it.
Albert Chan: OK. I moved back to the U.S. about 10 years ago and tried to practice cardiology—what we call preventive cardiology. Again, I encountered a lot of problems. The major problem I found was that we, as doctors, are trained to treat diseases, but we are not trained to prevent diseases. That is the major problem.
After 35 years of practicing medicine, I decided to write a book to push for what I call PPPM—primordial, proactive, preventive medicine—to prevent the five devils, which are heart disease, stroke, cancer, dementia, and metabolic disease. Metabolic disease includes obesity, prediabetes, and diabetes. My book is about how to prevent these and, if you already have them, how to reverse them.
Kevin Pho: Having practiced in both Singapore and the United States, did you feel that practicing in Singapore was more focused on prevention?
Albert Chan: Yes. One of the major differences between the health care system in Singapore and America is that 90 percent of the doctors in Singapore are primary care physicians. The focus is on family medicine or internal medicine, so only about 10 percent are specialists.
In the U.S., it’s the other way around—most of us are specialists. We’re trained to treat disease, but the burden of preventing disease usually falls on family medicine doctors and the insurance system. In the U.S., primary care occupies a very small percentage of the doctors practicing medicine.
Kevin Pho: Speaking from the perspective of a cardiologist, what do you feel physicians in America are lacking? What should they be focusing on more when it comes to prevention?
Albert Chan: It’s not just the doctors—it’s the health care system itself. For me, as a preventive cardiologist, most of the patients I see already have heart disease when they come to see me. This is because of the gatekeeper system.
If someone wants to talk about prevention for any major disease, they have to go to their family doctor, the gatekeeper, first. Only when the gatekeeper finds they have a heart problem are they referred to us. This is the problem—I cannot practice preventive cardiology because they don’t come to see me before they develop the disease. That’s the major issue.
Kevin Pho: If these patients came to see you earlier on, and you, as a cardiologist, were able to practice prevention, what would you do?
Albert Chan: There’s a famous cardiologist, Dr. Valentin Fuster, who is the head of the Mount Sinai Cardiology Department. He conducted a major study performing autopsies on children and teenagers who died in car accidents. From that study, they discovered that the development of heart disease—specifically atherosclerosis, the blockage of arteries—starts as young as 10 years old.
The main issue is bad cholesterol, or LDL. But beyond that, it’s the cumulative LDL level. It’s not just how high it is but how long it has been high. That’s how heart problems develop. So, to prevent cardiovascular disease, you need to start prevention at 10 or 15 years old—not wait until they’re 40 or 50 and have their first heart attack or symptoms. That’s the major problem.
Kevin Pho: If you saw these people early on, say at 15 years old, what are some things they could do to prevent any progression of atherosclerosis?
Albert Chan: In my book, I outline 13 basic steps you have to take. For example, knowing your cholesterol level. One major misconception is that if people have a “normal” LDL cholesterol level, they think they’re immune to heart disease. But the problem is that a “normal” level doesn’t mean it’s a healthy level—it depends on your risk.
The major issue with heart disease is understanding your risk at any age and stage. Then, you need to correct your risk factors, reverse them, or prevent the disease from happening altogether. This includes focusing on diet, exercise, happiness, sleep, and managing inflammation. These are not new concepts, but they are integral to preventive medicine.
Kevin Pho: In our health care system, even as a primary care physician, what about the system prevents us from doing some of the things you’re suggesting?
Albert Chan: One of the major problems is that nobody truly cares about you as a patient. Health insurance companies only care about their bottom line—how much money they can make. Even major hospitals, despite being nonprofit, have to ensure they balance their budgets and make money.
Even the government may not care about your happy longevity as long as you don’t use too much money and seem cool and healthy. So, you need to be proactive. You have to protect your own health and do something as early as possible because, at this stage, unfortunately, doctors aren’t happy, and patients aren’t happy either. That’s why I’m promoting a movement to achieve happy longevity. That should be everyone’s goal.
Kevin Pho: So what are some of the next steps to achieve that? If we were to take small steps toward turning our health system around, what would you advise patients to do? What would you advise doctors like myself to do?
Albert Chan: I promote four steps to achieving happy longevity.
First, as I mentioned earlier, is PPPM—primordial, proactive, preventive medicine. People need to know their risks, which we call risk stratification, at any age. You should know your risks even as young as 20 years old or as old as 90 years old. This means understanding your risks for developing the five devils—heart disease, stroke, cancer, dementia, and metabolic disease—at any stage and taking steps to address them.
Second, I believe everyone should have a concierge doctor to act as their personal trainer for happy longevity. This doctor should know your background, your problems, your family situation, and your financial situation. They can then promote prevention or, if you already have a disease, help you work to reverse it.
The third step is what I call happiness enhancement. Happiness promotes longevity, and longevity without happiness is meaningless. Even if you live to 90 years old, if every day you’re lying in bed staring at the ceiling, that kind of longevity is not worth it. We need to encourage happiness enhancement tailored to each individual. For some people, that might mean solving a problem like constipation. For others, it might mean improving their sex life or getting better sleep. Whatever happiness means to that person, we need to help them achieve it.
The fourth step, which is very important, is preparing for aging at home. Too many people end up in nursing homes or hospitals as they get older, losing not just years of happiness but also potentially years of life. People need to prepare financially and physically to age at home. With advancements in AI and technology, this is now more doable than ever and can even be done at a lower cost. But it requires preparation—buying or building a house that supports aging at home and planning ahead for yourself and your loved ones.
Those are the four steps I promote to help everyone achieve happy longevity.
Kevin Pho: Tell us a story or give us a case study. If you were to build an ideal health system that focuses on prevention proactively, what would that look like to you? Can you give an example of a patient interaction in your ideal system?
Albert Chan: Ideally, and I’m working on this, I envision a clinic or a place where I can practice what I preach. The ideal health system would include several key components.
First, we need to promote PPPM—preventive medicine—so everyone can have a screening to know their risks. This doesn’t have to involve expensive tests. It just means providing people with the tools to understand where they stand at different stages of their lives.
Second, I hope to promote a system of personal physicians. For a small fee—perhaps a couple of hundred dollars extra per year—patients could have a concierge doctor who takes care of them for their entire life. This personal doctor would act as their health trainer and guide, helping them navigate their health journey.
Third, there would be a multi-specialty clinic that can address different aspects of happiness and health. This clinic could include specialists like sleep experts, dietitians, sex therapists, or psychologists. These professionals could work together to solve patients’ problems and promote happiness at the lowest possible cost.
Finally, I want to help people prepare for aging at home. This includes creating systems and spaces that allow people to stay in their homes safely and comfortably as they age.
I’m actively working on setting up a clinic where I can implement these ideas and practice everything I preach.
Kevin Pho: We’re talking to Albert Chan. He’s a cardiologist, and today’s KevinMD article is “How to Beat the Five Devils of Modern Medicine and Live a Longer, Happier Life”.” Albert, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Albert Chan: Sure. There are five take-home messages I’d like to share.
First, in order to have happy longevity, the most important thing is not to die young. It sounds simple, but you have to take steps to prevent early death.
Second, make sure your loved ones don’t die young either. Losing someone you love can take away many years of your happiness.
Third, take action to address your risks. Understand what your risks are and work to minimize them.
Fourth, remember that nobody cares about you as much as you care about yourself. You have to take responsibility for your own health and happiness.
Fifth, read my book! It’s all about achieving happy longevity through evidence-based medicine, combining the best of Eastern and Western approaches. There’s also a website, happylongevityebm.com—”EBM” stands for evidence-based medicine—where you can find all the information you need to start your journey toward happy longevity.
Kevin Pho: Albert, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Albert Chan: Thank you for inviting me.
