Taking Healthcare by Storm: Industry Insights with Jack Clifford

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Jack Clifford, a retired U.S. Coast Guard Master Chief Petty Officer (E-9) with 21 years of service and founder of eecplocator.com, Atlantic EECP, and the EECP Retreat at Waking Dreams Wellness in Asheville, NC. His book, EECP: The Most Underutilized Therapy in Medicine, is a comprehensive guide for patients, caregivers, and physicians.

Jack recounts being diagnosed at 47 with a 100% blocked LAD “widow maker” and severe multi-vessel disease, then pausing to question immediate bypass surgery and choosing noninvasive enhanced external counterpulsation (EECP) to improve circulation. He explains why EECP is still underused despite FDA approval and research, and describes building eecplocator.com to expand access, educate patients and clinicians, and push for reimbursement tied to endothelial dysfunction.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-061926-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hi, everyone. Welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality Insights. And today, we're gonna be exploring the intersection of patient advocacy, innovation, and the power of questioning the expected path in healthcare. Something I am deeply interested in, and I, think many of you out there will find this interesting as well. My guest is Jack Clifford So he's faced with a life-threatening diagnosis, a hundred percent blocked LAD artery, which it's left anterior descending artery, and this is often referred to as the widow maker, as when this artery becomes blocked and you have a heart attack as a result, you often, don't survive, or it's, pretty catastrophic. So he was advised to undergo immediate bypass surgery, which is often advised as a treatment. But instead, he made a decision that many of-- will find difficult. He's paused, which is, I think, oftentimes the best approach. He asked questions, and he ultimately pursued a non-invasive therapy called EECP, and we're gonna be talking about that today. What followed is not just a story of survival, but one of resilience, curiosity, and a commitment in helping other patients navigate complex health decisions. Jack is now the founder of eecplocator.com, a resource designed to connect patients with EECP providers across North America. So we're gonna be talking about courage, the patient experience, and what happens when individuals take an active role in their care, which patients always should be. Jack, thank you so very much for joining us today. Yeah. My pleasure, Jean. Super excited to be here. Yeah. I would love to start with your journey and I know we're gonna be talking about what happened to you and what led you to this passion with EECP, but I wanna start with your journey. How did your military service shape who you are today, and how did that ultimately lead you to the work you're doing now in patient advocacy and cardiovascular health? That's, That's interesting. Yeah. So I joined the military when I was seventeen, so in many ways I was raised up in the military 'cause I didn't retire until I was thirty-nine. And just in order to be successful in the military, even though it might seem a little counterintuitive, you have to learn how to, Investigate problems at a really deep level and sometimes just not take no for an answer, even though there's a right and a wrong way to do that, just I suppose like there is in healthcare where you can be persistent and challenge the system and do it in a way that does not necessarily alienate yourself to everyone at the same time. And so I think in order to be successful in the military, which I certainly was I made it to E9 in just seventeen years, which is pretty unique. You have to be willing to give a lot of, pushback to various things, but again, do it in the right way, which again, I think translates to that world of challenging healthcare to really get the best outcome for yourself or whoever you're advocating for. Yeah, I love that. Stand up for yourself, which, yeah, sometimes I think you know, in healthcare that's a very challenging thing, most definitely. I described in the introduction that you were diagnosed with 100% blocked left anterior descending or LAD artery, and you were told you need to have bypass surgery, which is pretty serious. They open up your chest and try to do a bypass with another... with a vein around that blocked area. So can you walk us through that moment that you... when you were diagnosed, and what was going through your mind when you were given that recommendation? Yeah. It was, It was really over a series of you know, about a day and a half, I suppose. but... And it wasn't just, I mean, yeah, the LAD was 100% blocked, but I was 95 on the left, and I was 80 on the right and I was... My stress, my nuclear stress test was one of the worst they'd ever seen. The doc who gave it, I later found out he personally said it was the worst he's ever seen, and he was a pretty old doc that had been doing that a long time. But anyhow and that was, you know, at 47, a pretty young age. And so yeah, I got to the hospital. It was the day after Christmas, which was a Friday. This was five years ago. And ended up getting admitted had the weekend to think about it, which was really fortunate because they weren't gonna do the heart cath until Monday. But the outcome was fairly, fairly certain, so it did end up being... I got the measurements, just to be clear, at a different hospital about two weeks later. had, I had a heart cath, but I did it at a hospital that didn't do bypass surgery, so that wasn't a risk. And I was really facing that risk, like the consent forms they wanted me to sign and everything and my conversations with the doc were really like, "Yeah, we're gonna go do a heart cath." But you know, in my mind I'm like, "Well, based on everything that we're seeing and the little bit I know and some questions I asked a few folks, like I'm gonna wake up having had my chest cracked open." And for me that was it's not a small thing for anybody, but I saw my mom go through it five years before that, and then I saw her cognition just start to decline steadily until today she's in in a memory care unit. For anybody that doesn't know, that just means she's in a a nursing home, but in a the part where everybody's brain is gone. Bypass surgery to me just felt like an unacceptable risk until I had tried everything else because I felt okay. You know, I wasn't in crisis. They acted like I was in crisis. I had a nitro patch on, which I didn't need, like a big glob of it on my chest. I had all these machines beeping a- around me, hooked up to different things all week long, but I felt fine. I knew those machines were not doing anything for me. I didn't need the nitro big patch on my chest. I'm sitting there like I had just been in a car crash or something. I was okay, there was no immediate crisis. So that was what was going on through my mind was I wanted to try everything else before I subjected myself to something that I personally felt like had a level of risk that wasn't really being explained to me by anyone else. That's amazing that you had that pause to do that because it's scary, right? When there's- Yes ... all that stuff going on. Absolutely. Yeah. Yeah, and, many people would just blindly follow that recommendation to undergo bypass surgery, not question it, and say, "This is, this is what I gotta do." Yeah. So how did, how did you find the courage to step back and do your own research? And then ultimately pursue a completely different- Yeah ... path with- Yeah ... EECP. And I'm gonna ask- I'm gonna ask you to explain EECP. Sure. Yeah. But let's... I really-- I'm very, you know, as a clinician and as someone that, that teaches other providers, I'm always interested in that m- moment when you have- Yeah the courage. Yeah. So I'm curious about that. Yeah. I appreciate you asking that specifically. So I like to call myself a master level biohacker, and I-- it's not like there's a biohacker school. But my wife who's a nurse with her doctorate in nursing and you know, a pretty seasoned healthcare person herself, but she's faced a series of medical issues that physicians, doctors didn't have answers for. And so that's, that, that dates back to 2008. so, with each thing that she ended up having In each instance, there was three specific things that were all three of them were catastrophic. Doctors had no answers, and we had to sort of biohack our way out of it, for lack of a better word. Maybe biohacking isn't the best word for it, but we had to find the answers, and we did in all three cases. And so, harking back to five years ago when it's my turn to have a health issue and, I'm kind of like, "Well, geez, like there was all these other situations where there were other answers than the one being presented, which sounded terrible. So perhaps with cardiac issues, there's other answers. I hadn't looked into it to the level that I knew about some of these other things, but I just knew that there, there often are other answers, and I didn't know why we didn't... hadn't... weren't presented with the other answers for my wife. But I just... that's why in my head we gotta try everything else 'cause perhaps there is something else out there. And of course there was, but I... at that time, I did not I wasn't certain. Yeah, I mean, that, that's really scary. And so e- for listeners who might not be familiar, can you explain what EECP is and what it stands for, how it works, and- Absolutely What is it like from a patient perspective? Yeah. Yeah, that's really, really amazing. It stands for enhanced external counter pulsation, and if you look into it, you may also just hear it called external counter pulsation. The enhanced is just a trademark term from one of the manufacturers that kind of just stuck, for lack of a better word. So they call it EECP, external counter pulsation. It is... functionally, it's a bed you lie in, and it has compressors, and you are hooked up to a three-lead EKG, so three leads on your chest and into your shoulders. And then you have cuffs that wrap around your calves, your thighs, and your hips. And then the machine detects your heartbeat, and in between your heartbeats, those cuffs inflate with air. And when you're lying there you... It feels rather-- You feel kind of trapped 'cause you know, these cuffs are all, cinched up into you, and they gotta be cinched up into your groin area. And, but it's not that big of a deal. You're just lying on a bed comfortably. It's a comfortable bed. You can have a pillow if you want. And it the machine starts to inflate and deflate, and you just lie there. You don't gotta really do anything at all. The starting pressure of the machine is around one point three pounds per square inch, and then It goes all the way up to six pounds per square inch. And one point three doesn't feel like a lot. Six feels like a lot. You kind of graduate into that pressure if you're doing it right. So that can be over a series of sessions or p-possibly just one session. Depends on your bo- how your body reacts to that pressure. But what feels like a lot of pressure at the beginning doesn't once your body gets used to it, and that happens within seconds to minutes, sometimes longer. But anyhow, what it's functionally doing is it's pushing all the blood from your, not all the blood, but a large amount of blood from your lower body into your upper body, and that's forcing that blood through a bunch of small vessels in your vascular system that haven't had that level of blood flow going through them. it produces a phenomenon called shear stress that happens in reaction to that. So you're inducing a lot of shear st-stress throughout your vascular system. But the easiest way to think about EECP is that it just, it simulates cardiovascular exercise while you're lying comfortably in a bed, and I like to say while the machine is pulsing to the beat of your heart 'cause it, it can be very relaxing. And it's almost hypnotic and in some way. Just like exercise, I think everybody is pretty familiar with starting to do something that felt hard physically and then over time you do it more and it gets easier and easier, and then you gotta up the intensity 'cause it's so easy after a certain amount of time. And you know, that's the, the exercise phenomenon. EECP works just like that. doing it at a level I that's s-super physiologic, so it's levels that a human can't perform on their own. It doesn't matter how fit you are, y-you just can't replicate that any other way. And yeah that's, the phenomenon. I can certainly go into a lot of detail about how the body responds to it and what it tends to work for and so on and so forth, but I think it's very interesting, and I think maybe many people appreciated that you said it's actually relaxing. So Yeah. Yes. So you mentioned your wife a little bit, and you've had the experience of caring for your wife, so how did that chapter of your life influence your passion for EECP and ultimately led you to create eecplocator.com? Oh, yeah. Thank you. I saw my wife benefit incredibly from the machine, so there's that. But I've seen lots of people benefit from the machine and, I guess I, I just get an intense amount of satisfaction from seeing people get better. you know, seeing people reach their goals and their dreams, and if I can be some small part of that, that gives me a deep level of satisfaction. So however we get there, we get there. But with EECP it, it has the potential to just profoundly change someone's health status in ways I, I don't... I could go on a diatribe for hours, and I still wouldn't have said enough as far as I'm concerned. But You know, like every time I tell somebody, like they're like, "ECP what?" It doesn't matter if you're a doctor or a patient or whatever, everybody's like, ECP what?" Cardiologists are like, "ECP what?" It's just, the whole thing is crazy as far as I'm concerned. my book really details the why at a kind of a pretty intricate and involved level. So if anybody's interested, that's fine. I'm not trying to sell books. But at the end of the day, like the fact that this thing does all of the amazing things that it does, and then everyone's like, ECP what?" Is just crazy, and we have to get to the other side of that. But there are specific reasons why. There's a lot of institutional reasons why, but there's also just functional logistical reasons why. ECP, a full course of therapy requires thirty-five hours on a machine. Right now we have around hundred and fifty providers in the United States. If you don't live more than... If you live more than thirty minutes away from somewhere, you have to go thirty-five times in a row within a seven-week period, then in reality you're probably not gonna do it. In my case, I drove three hours, stayed in a hotel Monday through Friday over and over again until fortunately I got my own machine, which is a whole other conversation we can have. But the ask of getting somewhere thirty-five times is just a lot over a seven-week period. and so, you know, this amazing therapy is Practically invisible because no one can get somewhere that where the machines are. If you happen to just luck out and live down the street from one, then great but that's pretty unlikely. More than, I think I am estimating well over seventy percent of the folks in the United States live more than thirty minutes away from a, an access point for That's crazy. Yes. Yeah. So it's FDA approved. Yes. It's been around for a long time. More than thirty years. Yet many clinicians, yeah, many clinicians, including me, are, and patients, are unfamiliar with it. Yeah. So why do you think EECP remains underutilized in the United States? Okay, so institutionally, the first reason is because it grew up in the cardiac space, and so cardiologists they got excited about it. There was upwards of two thousand centers at one point. I don't know the exact number on that. I can't find it but in the early two thousands everybody was getting excited about this therapy, at least in the cardiology space. And Medicare approved it for treating angina that was in the class three, four range. So when you're really having trouble even like around your house and whatnot. But I think there was a lot of hope that it would get approved for, even less strenuous indications in the cardiac space. And cardiologists were buying machines and people were using them, and people were excited, and there was increasingly more studies in the US and then, uh, Medicare kind of deflated that boom when there was a study for heart failure. And it was of like, you know, it was a decent study. The results were still positive. It wasn't a super well-designed study, but for whatever reason, Medicare was like, "No." A really good read is to go to the comments section of that decision on CMS, the Center for Medicaid Services website, because there's like several hundred EECP providers who comment and are like, "You're not gonna cover this? Here's my experience treating patients." And it's just, it's a crazy read. And that's from two thousand and six. So around that same time, drug-eluting stents became like- way better than the previous version of stents had a lot of complications. So stenting became a better process on the patients, and more and more cath labs started popping up out of the middle of nowhere, and more hospitals started creating heart centers, and it's a giant revenue source. And EECP is like a thirty-five-hour protocol might, might cost you five thousand dollars, probably somewhere between three and seven. But you know, a physician can make ten grand on a stent in two hours. They're gonna tie up a patient room thirty-five times for an hour and make what they can make in two hours? There's no real incentive and there's never gonna be. Like, it's just the nature of things. But it doesn't change the realities. And here's the funny thing, like EECP is-- could, it could possibly be, and I can't say for sure it is, but if it ain't, it's in the ballpark of things, the most well-researched medical device on the planet. So th- this is not for a lack of data saying validating the kind of things that I'm saying are true. They're true. I-- that's not rude, some of it's debatable. Some of the things I think about EECP are debatable. Mo- a lot of them are not. How it works on angina and heart failure, that's not debatable at all. Y-you-- that's just you can't debate that. The research has already put that to bed. So it's an awareness issue and an access issue Yeah, and that can be fixed, right? Yes. I mean It should be fixed. And here's a, here's a little tidbit I'd love your audience to know. If you read the FDA indication that approved EECP machines in twenty fifteen and forward, and I think there's been about six approvals since then, it says approved for use in angina and heart failure and I think acute cardiac shock or something, so all these cardiac indications. And then it says, "Approved for general circulation use," and at least in one indica- instance it says, "in VO two max increase in healthy patients." And so, like, where I'm going with that is, yeah, it's medical, but it can kind of move from the, the medical to the wellness space if you think about it from a, "Hey, I'm just trying to improve my circulation generally" perspective. And that lowers the bar for people to, to offer this to folks, right? And I'm not trying to take things away from doctors. I think they can and they should, and they can bill insurance for it and make a decent money that way too and help their patients. But what I care about is access points. I want people to be able to get this therapy into their lives. I want other people in my life that I can relate to that have had my similar experience. Yeah. People that just... Not necessarily that they need to not get bypass surgery, but just have an option, right? Yes. just think about it. I mean, Do bypass if you want to. This works great with everything. Yeah. It just... There's really nothing that I can think of that wouldn't be, wouldn't work better if we threw EECP into the mix. That's perfect 'cause I wanna explore that. It's... 'Cause EECP is being used for other conditions. So what are those conditions? And then why do you think this therapy- does have potential across multiple- Mm-hmm ... clinical areas? Oh my goodness. Okay. Yes. So, Let's start with dementia. Dementia was studied in twenty twenty-three by uh, first author Dr. Moriarty wonderful man. Had a really great conversation with him, and he's out of Kansas University Medical Center. it was like a hundred mm, patients in the pro- in the, in the treatment arm and like, 100 in the sham roughly. and, you know, in a demented patient a year is a lot of time for progression of disease. You should definitely see a, a serious progression in a year in a dementia patient's life and yet... And these were mi- mild cognitive impairment, I should be clear not, full dementia. But anyhow They all got better. The diabetics got way better. And that says to me like, hey if you continued with the therapy, maybe your brain would come completely back. Who knows? But at least you weren't getting worse. So that says we can stop the progression. Now that's dementia. And long COVID been really well studied for long COVID, like 80% success rate over a couple of different studies recently. And I'm only citing US studies. Let's talk about China. This therapy has been in China for a long time. Well, before it's been in the US, it was jointly developed between the US and Chinese scientists in the US and then Chinese scientists took it back to China and innovated on it. The US kind of did a little bit and stopped. And so, there's like 5,000 access points in China. They use it for all kinds of things. It's part of the standard of care for any kind of cardiac treatment in like their normal conventional dogma. so long COVID, erectile dysfunction, honestly any pelvic anything. Like it works amazing in the pelvis because when the blood gets pushed by the machine up to your upper body that blood has to return to your lower body, but it gets trapped by that second subsequent wave right in your pelvis. And so the blood flow increased to your heart maybe is like 120%, your brain might be in that same neighborhood. Uh, it's like 200, 250 to the pelvis. It's like crazy. Anyhow kidney disease. Like I swear that I believe that if you were heading towards having to be on dialysis, that EECP could stop you from ever having to go on dialysis. That's my firm conviction. I'd love to see someone study that, but wouldn't you rather deal with an EECP machine that you could have in your house and use, keep your kidneys working as, as well as they can, start to improve them some instead of slipping down that slope of dialysis? Oh, absolutely. Absolutely. Wow. But the re- the reasons are, it's well documented to release a significant increase in hematopoietic stem cells. It's well documented to increase vascular endothelial growth factor. It's well documented to increase nitric oxide in the endothelium inner lining of the blood vessels. It's well documented to reduce inflammation systemically. I could go on and on. Stroke recovery is another area stroke prevention of course, but stroke recovery. it works because a lot of aging is about reduced blood flow. I'm sure you know this as a doctor like, we age these young people running around with all these stem cells going through their body and everything repairing really quickly it's about how it gets there in many ways. And once you have reduced blood flow, things just can't get to where they need to be. Yeah. Yeah. Yeah. So yeah. Blood flow is the key, right? If we don't have blood flow, we don't have... We're not living. So- Yes ... important. the last question, and I love this question I ask almost every guest. If you were in charge of healthcare in the United States- What is the first change that you would make to improve care and access to treatments like EECP? It's a change. I'm trying to think of whether systemic or something I can just wave a wand. But I would really focus on getting the cost of EECP down and encourage reimbursement. Like we're working right now to try and... We're actually really petitioning the government through our Congress people and, also some health insurers and some, some other areas where we think we might have a, willing ear to get an indication for endothelial dysfunction. If we had a, if we had a diagnosis code of endothelial dysfunction, there's already an ICD code for billing on EECP we could get insurance to pay for like preventative care related to all of these things that we label as heart disease, stroke, diabetes, whatever, that have a giant blood flow component to them. And if we could treat endothelial dysfunction, which EECP clearly treats, that's not really debatable from the scientific literature, then I think we could change the disease status of this entire country like massively and quickly, like this one little change. Because if insurance would pick up the tab, they would save so much money so quickly on, prevention. But I think that's where it is. Let's get a, let's get a, diagnosis of endothelial dysfunction that we can apply a billing code of an e-- one hour of EECP against it and let people get reimbursed for this. 'Cause then we know the access points are gonna come up 'cause people have insurance, they're gonna wanna use it for this stuff, and then we'll have an EECP center every thirty minutes across the country, and you watch dementia go away, you watch heart disease significantly reduce, so many less strokes in this country. Yeah. I could go on and on. Nice. So I maybe I lied. L-let's say just last question. What do you hope p-patients and clinicians take away from your story after they heard it today? Oh, yeah. One challenge the system. It's good. Patients, don't be afraid. Providers, welcome, welcome that conversation. my son's about to graduate medical school, and I tell him often, I say In my opinion, the best thing you can say to a patient when they ask a question if you don't know the answer is, 'I don't know.'" second follow-up should be, "I'm gonna try and find out." But don't be afraid to have an open mind. And you know, encourage your patients to force you to grow as a provider, as a clinician, because that's how we all do better. But, um I would love for everybody to have a crystal clear understanding of EECP and the benefits it can provide them, but that might not be realistic. So, If you just keep an open mind. Go to eecplocator.com. It's filled with, uh, educational material under the provider resources and clinical resources sites. I've tried to break it all down for everybody so they can really see how if I say it works for for dementia why? I've got handouts under the what conditions providers are treating for section, which is towards the bottom of that patient resources page. But I've got easy-to-read documents that, that walk people through the why. That's not Jack saying, it's this study saying, and then it's comparing like a normal treatment with what EECP would... is likely to do for you. So I think people can just noodle through all that. But at the end of the day like I think we're agreeing, like it, it is about blood flow. If we optimize blood flow, like so much else just solves itself. Yeah. Agree. I love this conversation, and then if people wanna find out more, I think we mentioned a couple resources already, but let's reiterate them. Where can people go to find out more about you and what you're doing? Sure. Yeah. So eecplocator.com is what I've built to try and solve this access issue. And if nothing else, it's not invisible anymore 'cause you can see the problems. I've got really good maps, really good interfaces, so you can find where your closest provider is. And I'm also grading the providers trying to get traditional cardiologists mostly but any providers that list it as Hey, we should use this after we've given you seventeen stents and five bypasses, and then we got nothing else for you. Then we'll let you use EECP," that is a bogus presentation of this therapy, and I'm tired of it and I'm not willing to stand for it anymore. So I'm grading those providers with a D. If they don't like it, they can change it. They can do something about it or they're gonna keep their D rating on eecplocator.com. I'm not budging on that. and, uh, you know, really trying to push the conversation so that they understand that there's all these other conditions for it and if you are gonna only use it for cardiac, you certainly shouldn't use it last. That doesn't make any sense. And if you at least use it before bypass surgery, you get a C. If you're open to all these off-label conditions, we'll give you an A or a B, depending. But anyway, so you can, you can navigate all that. And I'm hoping, and I am seeing so they... some new pop, new providers popping up on a regular basis. That's really exciting. So if there isn't anybody there Look back, but also I've got this business model I'm putting forward called EECP Pop-Up Clinic. And so that's just go ahead and put your name in. Say, "I'd like you to bring this therapy to me." If you do that, I'm gonna try and figure out how to make that happen. I don't have all of the logistics solved yet, but if we aggregate access demand, I know we can, find providers for it. I'm certain about that, and I will do that legwork if people just come on the site and tell me, "Hey I'm really interested." And then I've got a Travel for Treatment section, which is saying that you can you can go... There's at least one place you can go and just stay there right next to the machine and knock out what would take you seven weeks normally. You can do it in two and a half weeks 'cause you could do two a day, seven days a week. putting new providers whenever I can find them or they present themselves. I, I'm not, I'm leaving no stone unturned. I've called all the Medicaid providers that have billed Medicare ever for EECP, and I'm saying, "Do you still have a machine? Are you still doing this even if you don't have a website? I wanna make sure your patients or potential patients know about you." So it, it is designed to be really comprehensive. Yeah, and then I wrote my book, you know, uh, EECP: The Most Underutilized Therapy in Medicine. You can go to eecpbook.com. I'm gonna release that towards the end of May, so it should be available for everybody by the time this podcast comes out. And again, that's eecpbook.com. Very exciting. I am so glad that there are people like you in the world with this amount of passion for making things better, especially in healthcare. So thank you so much for the conversation. I really enjoyed it. Yeah, thanks for having me, Jean. It's been wonderful.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

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