Happiness, Medicine and The Human Heart in the Age of AI

Interview with Dr. Josep Brugada by Houda Bakkali

Just days before the opening of the Paris Olympic Games, I have the honor of speaking with Dr. Josep Brugada about the impact of new technologies, including artificial intelligence and augmented reality, on sports medicine, particularly in the field of cardiology. In this conversation, we also reflect on the role of art in medicine — the most human of all sciences — and explore the place that happiness occupies in our overall health and wellbeing.

Dr. Josep Brugada is one of the world’s leading figures in cardiology and one of the most respected and admired voices in medical communication. Senior Consultant at Hospital Clínic de Barcelona and Director of the Pediatric Arrhythmia Unit at Hospital Sant Joan de Déu Barcelona, he described in 1992, together with his brothers, the disease responsible for sudden cardiac death that today bears his name: Brugada Syndrome. A pioneer in the application of the most advanced techniques and technologies in the treatment and prevention of cardiac diseases, his educational, scientific, and research work is reflected in more than 500 articles published in the world’s leading international journals in medicine and cardiology. Recognized with prestigious awards worldwide, Dr. Josep Brugada also led the sports cardiology team of FC Barcelona and has been one of the foremost advocates for the implementation of defibrillatorsin public, private, and especially sports spaces.

We are on the eve of the Paris Olympic Games, the world’s most important sporting event. What is the discipline known as sports cardiology, and how does it prepare an athlete’s heart?

We understand sports cardiology as the branch of cardiology that focuses — a priori — on healthy individuals, namely athletes, in order to determine whether their heart is truly prepared to withstand the physical demands represented by sports at different levels, and therefore how it will adapt depending on the type of athlete. What we observe in an athlete who practices sports occasionally and recreationally is not the same as what we observe in someone who engages in continuous endurance sports such as marathons, ultramarathons, etc. What we look for will be different in each case.

What is being evaluated in each case?

In one case, we want to know whether the heart is in an appropriate condition to perform that exercise and whether it will respond well. In the other, we assess the possible consequences for the heart when engaging in intense and continuous sports activity. Therefore, cardiology will focus on different aspects in order to ensure that the individual can practice the sport they wish to pursue in the most appropriate way.

What impact does artificial intelligence have on sports medicine?

Artificial intelligence, without any doubt, is entering every area of healthcare and can be an invaluable aid in areas that require a high level of protocolization. For example, in the analysis of electrocardiograms, it can be a tremendous support because artificial intelligence can observe and analyze all the aspects we have taught it and return that information to us in a synthesized and organized way that allows us to use it effectively.

However, we should not forget that, ultimately, the person who will make the diagnosis and take decisions will always be the physician. In sports cardiology, artificial intelligence can systematize the way we care for a patient. It can identify or remind us of every aspect, some of which may be extremely rare. It can also help professionals with less experience in certain areas by reminding them of all the possibilities and all the key elements necessary to reach the correct diagnosis and management for each patient.

Do you believe artificial intelligence should be feared?

There is no reason to fear artificial intelligence. On the contrary, it will become an extremely important tool, both for sports cardiology and for many other fields.

Which sport for which heart?

An athlete is, by definition, a healthy individual who takes care of themselves, and therefore our role as physicians is to accompany and advise them according to the condition of their heart. The first thing we must do is ensure that their heart is healthy. This is why pre-participation examinations are carried out, in which we evaluate whether that person’s cardiac condition is suitable for sports practice.

But above all, it is essential to monitor that individual once they begin practicing sports. Not every person will adapt equally to continuous, intense endurance sports. In some cases, we know that the heart may adapt poorly to such intense exercise, and this is something we must monitor through regular check-ups in individuals who practice endurance sports, in order to ensure that their heart is tolerating that level of exertion properly. This is where the cardiologist can advise how far that individual can safely go in terms of intensity.

Defibrillators play a major role in sports. To what extent do they save lives?

Defibrillators are, without any doubt, the key element in saving lives. A person who suffers sudden cardiac death due to what we call ventricular fibrillation — the most frequent arrhythmia causing death — has only one possibility of reversing that situation within the minutes following the event: access to an automatic defibrillator.

A defibrillator makes it possible to restore the normal heart rhythm and save that person’s life if it is used within the first 10 to 15 minutes after the arrhythmic event. Therefore, having semi-automatic or automatic defibrillators available in all sports facilities and public spaces in general saves lives. There are many studies around the world demonstrating that the more defibrillators are available, the more lives we will save because we will be able to reach more patients who have suffered unexpected sudden cardiac death.

Just as we see fire extinguishers in practically all public spaces, we should also have a public network of defibrillatorsthat anyone could use in order to save a person’s life.

Is technology the perfect ally of medicine?

Technology helps us enormously. It is allowing us to achieve truly extraordinary things in the treatment of patients with different cardiac diseases. Therefore, we are very fortunate to live in this era, in which this fantastic technological boomallows us to identify and practically cure almost any cardiac pathology.

Augmented reality and virtual reality: how are they impacting cardiology practice?

Augmented reality and virtual reality help us visualize how to perform specific interventions and determine which technological tool is best suited for each disease or disorder in individual patients. Virtual reality allows us to reproduce, in the laboratory and before performing the intervention, a specific pathology and identify exactly what the best treatment would be.

This will increase exponentially in the coming years with artificial intelligence, but also with 3D printing, the reproduction of all information outside the patient’s body, and many other technological developments.

Some time ago, you told me that medicine is the most human of all sciences. In such a technology-driven context, is that still true?

Medicine is the most human of all sciences, and it must continue to be so. The fact that we are immersed in a technological whirlwind of virtual reality and artificial intelligence should not make us lose the fundamental aspect of medicine, which is the human relationship — the relationship between doctor and patient — where, in addition to scientific work, the physician provides human support to help patients understand what is happening to them and trust that medicine and their doctor are there to help them.

Do you believe art helps humanize medicine?

Art has greatly contributed to humanizing medicine. Everything related to the artistic expression of medicine is a way of enhancing that human value, that value that exists beyond science itself, helping us enter more deeply into the realm of human relationships and emotions, which are absolutely fundamental in relationships between people and especially in the relationship between doctor and patient.

To maintain a healthy heart, what should I not deprive myself of?

That is a very good question because, in general, cardiologists are always asked what people should avoid doing, whereas you are asking me what I should not deprive myself of.

I should not deprive myself of trying to be happy, of trying to live a healthy life, of eating properly, of doing a little physical exercise every day, but above all of maintaining good human relationships — a good relationship with my environment, my family, and my friends — and enjoying the small things of everyday life. These are probably the best medicine for our heart.

That includes a good glass of wine with friends, enjoying a good meal — not because of the food itself, but because of the company and the enjoyment of those moments that make us happy in our daily lives.

Is happiness the best medicine?

The best treatment we have for any disease — not only for the heart — is happiness. When someone is happy and at peace with themselves despite having an illness, when they trust that they are being well cared for, when they feel loved by their friends, relatives, and doctors, that positive attitude toward everything surrounding them is what allows us to accept situations in a healthy way and contributes to the proper physical and emotional care of our heart.