<International Circulation>: Do you ever stop and think that you are doing things very differently from twenty or thirty years ago?
　　Dr Smith:  Someone did ask me if I ever thought I would be doing so much international networking such as meeting two US Presidents in the Oval Office and certainly when I started medical school， that was not the plan. It has been interesting I assure you. Overall I really think this Congress has been quite good. The thing that is unique about this though is that it is the biggest cardiac meeting ever in this part of the world and the faculty roll here is amazing. There is dialogue going on here between those who would not normally have a chance to do so in a serious manner. I don’t think we have had this broad exposure previously where， for instance， multiple groups from the Middle East can talk about where medicine is headed here and what the issues are.
　　<International Circulation>: Obviously you are not a cynic， but does it upset you to see developing countries repeating or copying the mistakes of the developed world?
　　Dr Smith:  Yes it concerns me and I have said it previously. You start out with a system where things happen to people (they have heart attacks or break hips and so on) and they go into hospitals rather than homes and they need to be treated by doctors. The whole healthcare system in the United States is built around medical schools that are aligned with hospitals and I went into medicine because I wanted to help people get better. But where we are headed now is that there is a huge need to prevent illness and to promote health. We have a healthcare system in the United States with huge resources going into healthcare but very little going into promoting health. When I look at the developing countries it is like a branch in the road where they are at a point where they can say we have x amounts of dollars to invest and we are not going to put a huge chunk into treatment and a small amount into prevention like has been done in the US， but we will put at least an equivalent amount into prevention. Maybe we won’t get involved in artificial hearts because how many heart attacks could you prevent with the right therapy for the cost of putting in an artificial heart? It can be a hard choice to make because resources are limited but it does bother me to see that countries with developing economies copying the hospital-focused model without thinking about how a lot of this could be offset with an investment in prevention.