Mind and Heart
When a new patient visits Dr. Debra Judelson’s office at the Women’s Heart Institute in Beverly Hills, CA, the first thing she faces, besides the wait to get an appointment, is not a stress test, or a cholesterol test, or even an electrocardiogram–although she’ll eventually undergo all three, if she hasn’t already. Instead, it’s an hourlong investigative interview with the doctor, whose self-described “obsessive-compulsive” attention to detail in patient care is one source of her distinction in a field that she helped create: women’s cardiology.
“So tell me about your 87-year-old mother and the onset of her diabetes,” she’ll say to a patient across her wide, journal-strewn desk, with its collection of glass and polished-metal hearts. “Describe that pain more exactly,” she’ll urge another. “Was it pressing? Burning? Tightening? Squeezing?”
“You’ve got to ask people the right questions and be pushy about getting the answers,” says Judelson, who graduated from MIT in 1973 and founded the heart institute in 1996. “It’s the patients who teach you. Listening to them, digesting what they tell you, and keeping track of it will teach you more than any journal or medical meeting.”
As the patients discuss the answers they’ve supplied on the doctor’s six-page questionnaire, they can end up delivering medical histories that span three generations. “Women tend to want to tell you stories about themselves anyway,” Judelson says. “But they don’t always recognize what they’re experiencing as symptoms of heart disease.”
Dead relatives, dietary habits, stress, and sexual practices are all on the table. Judelson believes they must be, because understanding of risk factors and symptoms in women is still evolving. So are the diagnosis and treatment protocols.
“In the 1970s, cardiologists laughed at the suggestion that women got coronary disease at all,” Judelson recalls. Untold numbers of women died undiagnosed and untreated. “Today,” she says, “we know it’s the number one killer of women.” Cardiovascular disease kills more women than it does men–and more than all cancers, AIDS, and violence combined.
The way women are diagnosed and treated has improved substantially since 1980, when Judelson began studying heart disease. That’s due in no small part to the doggedness and leadership of a woman who started her academic career in materials science but proved her mettle in medicine.
“She’s a superb clinical cardiologist who puts extraordinary time and effort into understanding and solving patient problems,” says Harold Karpman, a clinical professor at UCLA Medical School and cofounder of the practice in which Judelson is a senior partner. “She’s involved in [several] clinical research projects at all times, and she has medical students with her constantly. In the field of women and heart disease, she’s godlike.”
In fact, she’s considered one of the most influential cardiologists and medical educators in the country. Judelson has discussed overlooked women’s health issues on Oprah and written books and articles for popular as well as professional audiences. She’s been quoted in major newspapers and has won more than a dozen awards for her work in medicine and public health. As she sees it, her authority derives from her penchant for “drilling down into the data” and “solving problems,” practices familiar to any scientist or engineer. But she coupled her discipline and her talent for clinical research with a broad commitment to education and communication.
Through the American Medical Women’s Association, Judelson created and chaired an education project on coronary heart disease in women that has trained more than 17,000 primary-care physicians. She coauthored the American College of Cardiology guidelines for prevention of cardiovascular disease in women. And through her books, such as The Women’s Complete Wellness Book, she has reached women and health practitioners around the world.
Though passionate about women’s health, Judelson considers herself a somewhat accidental doctor. As a materials science major at MIT, she hadn’t considered medicine until her junior year, when she worked on a project annealing the alloy Vitallium for use in prosthetic devices–for which the American Society of Materials Science Engineering named her the outstanding student nationwide in metallurgy and materials science engineering. As a freshman, however, she had begun supplementing her Course III requirements with pre-med chemistry and biology courses–mainly because her roommates told her their organic-chemistry professor was “cute,” and Nobel laureate Salvador Luria happened to be teaching biology. “Who doesn’t want to take a class with a cute professor or a Nobel Prize winner?” she says.
Having finished nearly all the requirements for her bachelor’s in metallurgy and materials science engineering in just three years, Judelson started medical school her senior year as one of the first students to enroll in the Harvard-MIT joint program in health sciences and technology. She earned her MD from Harvard Medical School in 1976.
“I hated it,” she says of med school. “MIT taught you how to learn and gave you a degree of freedom to pursue inquiries you were passionate about. In medical school, they teach you to memorize a lot of stuff. Some things were fascinating–dissecting a human body, for instance. But not much else.”
In medical school, Judelson was discouraged from going into orthopedics, though she’d planned to apply her materials science background to bone mechanics and prostheses. “They told me I had to be a big, burly guy to be an orthopedist,” she says. So after an internship and residency in internal medicine at Kaiser Foundation Hospital in San Francisco, she convinced her future husband, AJ Willmer ‘75, to move south and accepted a cardiology fellowship at Kaiser in Los Angeles. (The couple met at MIT, and their two daughters would also attend the Institute.)
Thus, Judelson turned to mastering the mechanics of the heart. It was not, in her estimation, a radical departure. “The heart, after all, is a pump that behaves according to biomechanical principles. And of course, you’ve got Ohm’s law at work,” she says, alluding to electrical conduction in heart muscle. “V = IR in the myocardium, too.”
But Judelson brought more than the principles of engineering to her study of heart physiology; she also brought an intellectual rigor and adaptability that had been cultivated in her since her childhood in Patchogue, NY.
“My father loved to quiz us around the dinner table,” recalls Judelson, who was the third of four children. “He’d say to us, ‘Think of a number between 1 and 100 that can be divided by 11 and found in the living room.” She solved that one as a kindergartner. And her talent for solving problems more complex than her father’s piano puzzle would serve her well in clinical practice.
“I would see women coming in having trouble breathing, their heart muscles weakened,” she says, recalling her days as a young doctor at Kaiser in Los Angeles. By combing through charts and pulling obscure papers from medical libraries, she began to decipher patterns suggesting that “these women had had heart attacks they never knew about.”
That hypothesis launched a line of inquiry now in its third decade and a public-health campaign already in its second. Judelson says there’s plenty more to be done in understanding microvascular disease in women, racial and ethnic variance in the incidence and morbidity of heart disease, and the effects of hormones and hormone therapies on women’s hearts.
But she knows her work has made a difference: “I had a patient come in and ask me if I knew that heart disease was the number one cause of death among women. Or that 10 years ago, four out of five Americans didn’t know that.”
Judelson didn’t tell her patient that she’d designed and popularized the survey she was citing. Instead, she said, “Tell me more about that.” And the data gathering continued.
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