Last April, Muller brought some of the leading cardiovascular epidemiologists in the world to Lexington, Ky., to begin the search for clues. But the environment one finds oneself in dictates the choices people make. By any measure, residents of Eastern Kentucky have very limited choices. Poverty and chronic disease among the former miners and their families are the legacy left by Big Coal, now that the mountains' wealth is gone. Many communities lack doctors or any medical providers, and health education is virtually nonexistent.
Tobacco is pervasive.
When I got here, I couldn't believe the number of people I treated who had already had one heart attack and still smoked. Not surprisingly, Kentucky also ranks No. 1 in lung-cancer deaths. Nearly 45 percent of adults admit they have a sedentary lifestyle and engage in no leisure-time physical activity, second only to adults in Georgia. Kentucky is also among the top states where adults say they are overweight, as are adults in most of the coronary-valley states. Spady is an anomaly among physicians.