Calculus of the cardiologist

2. November 2006 William Davis (1)
I call this the "calculus of the cardiologist":

Heart procedures = big money

More procedures = more big money

You do the math. If you do more procedures, you get more money.
What if your patients don't need more procedures? That's easy. You lower the bar on reasons to do procedures. You scare the pants off people and lead them to think that all heart disease or questions about heart disease are potentially life-threatening. You could even appear to be doing the patient a big favor. "My Lord! This is potentially dangerous. We need to perform a procedure without delay!"

There are incentives beyond direct cash payment. A patient of mine today showed me a memo to employees in his company that showed why certain hospitals are targeted for care. The criteria for choosing centers was based on number of procedures performed. In other words, the more procedures performed at a hospital, the more procedures will be directed there. Of course, this makes sense at some level. More procedures can also mean greater skill.

But have we lost sight of the fact that the mission is not more procedures and more money, but to get rid of a disease? If the intensity of effort devoted to heart procedures were re-directed to early detection, prevention, and reversal of disease, we'd have half the hospitals we now have. We'd also chop a huge chunk out of the national healthcare budget.

Lipoprotein(a) treatment alternatives

1. November 2006 William Davis (2)
A question from a reader:


Two years ago, my doctor recommended a comprehensive lipid screening because both of my parents had heart disease. My only blood component way out of line was LP (a) [lipoprotein(a)]. It was 130. According to the lab that conducted the screening, Berkeley Heart Lab, a level above 30 should be cause for concern. I was stunned that mine was more than quadruple the danger level.

I began taking two grams [2000 mg] of niacin a day in addition to the Lipitor I was already taking. The next reading, a few months later, was 87. Over a period of about 18 months, I had a total of four readings from Berkley Heart Lab. My LP (a) fluctuated in the 80-130 range – still way above normal. My doctor said there was little else I could do to control it.

That doctor has since retired. I now see another doctor who uses a different lab. My first LP (a) reading with him a few months ago was 17, which is normal. I am still taking the same amount of niacin and Lipitor and I can’t think of anything that would account for the huge discrepancy. I’m going to have another test again soon.

Is one of the labs giving erroneous readings? If so, how can I tell which? If Berkeley Heart Lab is correct, is there anything I can do about my increased coronary risk due to high LP (a)?
Tom D.

Tom's frustration on the variation of Lp(a) is due to the fact that laboratories run the Lp(a) test by several different techniques and will generate tremendous variation in values. The key is to stick to the same measure over and over from the same lab, else you'll be terribly confused and frustrated. Tom essentially should ignore the value obtained that was unexpectedly low.

Another issue: Lp(a) is a turtle. It responds very slowly. In fact, we rarely check it more than once or twice a year. Check it too soon after a treatment change and it won't fully reflect the effect. You've got to wait at least several months before re-checking.

How about treatment alternatives? They are:

--More niacin. Not my favorite choice, since niacin >2000 mg per day begins to generate more side-effects, but it is a choice. You can go to 4000-5000 per day, but only with your doctor's supervision due to liver effects.

--Testosterone for males. We use topical testosterone from Women's International Pharmacy in Madison, Wisconson. Prescription patches like Testim are also effective.

--Estrogen for females. This is less "clean" than testosterone, introducing questions about endometrial and breast cancer risk, but it is a choice.

--DHEA--A small effect but every little bit can help. We use 25-50 mg per day, depending on blood levels and only if you're 45 years old or older.

--l-carnitine--In my experience, a small effect. It requires 2000 mg per day, which is expensive. Sometimes, an expected large effect develops, so it's worth a try if it fits in your budget.

--Fibrates--These are the drugs Tricor and Lopid. I don't like these agents very much because I think they're weak, including the effect on Lp(a) reduction. But they are choices for you and your doctor.

Lastly, you can simply be guided by your heart scan score. For example, if Tom's initial heart scan score is 200, and he continues his current program and one year later his score is 300, then alternative treatments are worth considering. But what if Tom's score is 189--he's regressed his coronary plaque. Then, who cares what his Lp(a) is?

Another issue to keep in mind is that, in the presence of Lp(a), keeping LDL to very low numbers (e.g., 60 mg/dl) may added value in preventing coronary plaque growth.

Trapped in a low-fat world

1. November 2006 William Davis (2)
If you would like to...

--Reduce (good) HDL

--Raise triglycerides, sometimes by hundreds of points

--Raise blood sugar into the pre-diabetic range

--Raise blood pressure

--Accelerate coronary plaque growth

then go on a low-fat diet like the one promoted by long-time super low-fat advocate, Dr. Dean Ornish. Every day I have to educate patients that a low-fat diet as advocated by Dr. Ornish is a destructive, counter-productive process that makes coronary plaque grow and increases your heart scan score.

If you want to gain control over coronary plaque, do not follow the Ornish program or anything resembling it. The Ornish program is a dead end.

Instead, the crucial components of a healthy diet for plaque control are:

--Low saturated and hydrogenated fat, but not low all fats.

--High monounsaturated and omega-3 fats

--Low glycemic index (i.e., slow sugar release)

--High fiber

That simple. An excellent program to put these limits to practical use is the South Beach Diet. Or, follow the more detailed guidelines on the Track Your Plaque website (open content section).

Blame the niacin

31. October 2006 William Davis (7)
Despite the fact that niacin is:

1) A vitamin--vitamin B3

2) One of the oldest cholesterol-reducing agents around with a long-standing track record of effectiveness and safety

3) Available as a prescription drug as well as a variety of "nutritional supplements"

most physicians remains shockingly unaware of its benefits, effects, and side-effects. Most, in fact, are either ignorant or frightened of advising their patients on niacin use. As a result, I commonly have to tell my patients to resume the niacin that their primary care physician has (wrongly) stopped because of itchy feet, grumpiness, groin rash, urinary tract infections, nightmares, diarrhea, hair loss, runny nose, etc. All of these are REAL reasons doctors have advised patients to stop niacin (though none were actually due to niacin).

Is niacin really that troublesome? No, it's not. In fact, if used properly, it's among the most effective and safe tools available for correction of low HDL, small LDL and other triglyceride-containing lipoproteins, lipoprotein(a), and dramatic reduction of heart attack risk. If added to a statin agent, the heart attack risk reduction can approach 90%.

Statins are just too easy for doctors to prescribe. Niacin, on the other hand, requires a good 15-20 minutes to describe how to use it. It could generate an occasional phone call from a patient who struggles with the annoying but largely harmless and temporary "hot-flush" feeling, a lot like a hot blush. Given a choice, most doctors would simply choose not to be bothered. For this reason, I'll commonly see many, many people with uncorrected low HDLs and other patterns.

Have a serious discussion and press for confident answers if you find your doctor reflexively telling you that the wart on your thumb should be blamed on niacin.

Here are the steps we advise that really make taking niacin easy and tolerable:

1) Take with dinner.

2) Take with 2 extra glasses of water. If you experience the hot-flush later on, drink an additional 2 8-12 oz glasses of water i.e., a total of 16-24 oz). Extra hydration is extremely effective for blocking the hot-flush.

3) Take a 325 mg, uncoated aspirin. This is only necessary in the beginning or with any increase in dose, rarely chronically for any length of time.


This is not to say that there aren't occasional people who are truly and genuinely intolerant to niacin. It does happen. But those people are a small minority, less than 5% of people in my experience. Niacin is far more effective and safe than most physicians would have you believe.

Eat fish three times a day

29. October 2006 William Davis (1)
Patients commonly ask, "Why can't I get vitamin D from food? I drink milk and eat fish."

They're absolutely right: both vitamin D and some oily fish contain vitamin D. However, it's a matter of quantity. An 8 oz. glass of milk contains 100 units of vitamin D (at least it's supposed to; this is not always true). A serving of oily fish like salmon or herring may contain up to 400 units. Thus, if you ate fish three times a day like the Eskimos or the Inuit, you might obtain sufficient vitamin D to prevent the broad and alarming spectrum of phenomena associated with deficiency.

I suspect that most people don't want to eat fish three times a day, nor drink the 20 to 50 glasses of milk per day that would be required to obtain a truly healthy quantity of vitamin D.

The vocal and outspoken Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com) has written eloquently on the potential relationship between influenza and vitamin D deficiency. He and his co-authors on a recently published paper point out that the peculiar and unexplained seasonality of influenza corresponds to vitamin D levels. Read his eloquent discussion in Medical News Today at http://www.medicalnewstoday.com/medicalnews.php?newsid=51913.

In the article, Dr. Cannell explains:

"The vitamin D steroid hormone system has always had its origins in the skin, not in the mouth. Until quite recently, when dermatologists and governments began warning us about the dangers of sunlight, humans made enormous quantities of vitamin D where humans have always made it, where naked skin meets the ultraviolet B radiation of sunlight.
We just cannot get adequate amounts of vitamin D from our diet. If we don't expose ourselves to ultraviolet light, we must get vitamin D from dietary supplements...Today, most humans only make about a thousand units of vitamin D a day from sun exposure; many people, such as the elderly or African Americans, make much less than that. How much did humans normally make? A single, twenty-minute, full body exposure to summer sun will trigger the delivery of 20,000 units of vitamin D into the circulation of most people within 48 hours. Twenty thousand units, that's the single most important fact about vitamin D. Compare that to the 100 units you get from a glass of milk, or the several hundred daily units the U.S. government recommend as “Adequate Intake.” It's what we call an “order of magnitude” difference.

"Humans evolved naked in sub-equatorial Africa, where the sun shines directly overhead much of the year and where our species must have obtained tens of thousands of units of vitamin D every day, in spite of our skin developing heavy melanin concentrations (racial pigmentation) for protecting the deeper layers of the skin. Even after humans migrated to temperate latitudes, where our skin rapidly lightened to allow for more rapid vitamin D production, humans worked outdoors. However, in the last three hundred years, we began to work indoors; in the last one hundred years, we began to travel inside cars; in the last several decades, we began to lather on sunblock and consciously avoid sunlight. All of these things lower vitamin D blood levels. The inescapable conclusion is that vitamin D levels in modern humans are not just low - they are aberrantly low."


Like Dr. Cannell, I am absolutely convinced that vitamin D deficiency plays an important role in a number of illnesses, including coronary disease. The more we mind our patients/participants vitamin D status (blood levels of 25-OH-vitamin D3), the more easily we gain control over LDL cholesterol, pre-diabetic patterns, blood pressure, blood sugar, and coronary plaque. In fact, I am becoming rapidly convinced that vitamin D deficiency is an extremely important coronary risk factor.

Because I live in Wisconsin (bbrrrrr!) where seeing the sun is a cause for celebration and sun exposure is possible three months a year, I take 6000 units per day vitamin D. This is the amount necessary to raise my blood levels into the true, physiologic range of 50-70 ng/ml. My wife takes 2000 units per day, and each of my kids takes 1000 units per day, though I believe that my 14-year old son (my size now) should take more. We'll judge by blood levels.

If there is a little-known secret to reducing heart scan scores, vitamin D is that "secret".

To read more from Dr. Cannell or to subscribe to his free and very informative newsletter, go to Vitamin D Council

What if I had a cure for coronary disease?

29. October 2006 William Davis (0)
If I had a cure for coronary disease, what would it look like? What would constitute cure? Would you recognize it if I showed it to you?

In the strictest sense, "cure" means an absolute elimination of any sign of coronary plaque, as well as elimination of any and all dangers associated with coronary disease. It would also mean elimination of the factors that created coronary atherosclerotic plaque in the first place.

In a more practical sense, you could argue that "cure" means a reduction of the amount of material that constitute coronary disease along with a dramatic reduction of the associated risks (i.e., heart attack).

You might call this second, more lax definition "regression" or "reversal".

Is "cure" in the strictest sense possible? No, not to my knowledge in 2006. Yes, there are many (kooks) who claim this is possible, but there's no objective evidence of this occurring.

Regression, or reversal, however, is indeed possible. In fact, I've seen it countless times following the participants in the Track Your Plaque program. If your heart scan score goes from 1000 (a bad score with high risk for heart attack) to 750, you've experienced a large reduction in the amount of atherosclerotic plaque that is behind coronary disease. You've also reduced your risk of an "event" like heart attack to near zero (provided you remain on the program that achieved regression in the first place).

Unfortunately, with present technology regression or reversal does not mean that the original causes of coornary plaque are eliminated. They're just controlled. Fish oil, for example, powerfully reduces triglyceride-containing lipoproteins that trigger coronary plaque growth. But if you stop fish oil, the evil lipoproteins come right back and start injuring your coronaries, causing more plaque growth.

The Track Your Plaque program is the closest thing I know of to a "cure" for coronary disease, that is, "cure" in the sense of regression or reversal. Perhaps in future we'll have a "cure" in the strict sense. Until now, this program is the best there is.

Alternatives to fish oil capsules

27. October 2006 William Davis (2)
Occasionally, someone will be unable to take fish oil due to the large capsule size, excessive fishy belching, or stomach upset. The easiest solution is usually just to try a different brand, e.g., Sam's Club (Makers' Mark brand) enteric-coated.

However, sometimes liquid fish oil preparations may be preferred. Here'a list of products we've used successfully. All cost more than plain old fish oil capsules, but fish oil is so crucial to your heart scan/coronary plaque control efforts, that it really pays to search out alternatives.



Liquid fish oil alternatives to capsules:

Liquid fish oil--e.g., Carlson's liquid fish oil. Most liquid fish oil comes flavored either lemon or orange.



Frutol--A very clever re-formulation of fish oil that makes it water-soluble and non-oily. The Pharmax company has put their fish oil into a fruit flavored base that tastes pretty good and is not too expensive.
Go to www.pharmaxllx.com for more information. Unfortunately, I do not believe it's available in stores.





Coromega--another non-oily preparation, though available in some health food stores. Coromega comes in little single-serving foil dispensers. It tastes kind of fruity (though I personally like the Frutol better for taste and consistency). It's kind of pricey ($1.40 per day for two packets).



Regardless of what preparation you choose, you can determine the dose needed by adding up the EPA+DHA content. For the basic prevention effect, the starting dose for the Track Your Plaque program, you need a total of 1200 mg per day of EPA+DHA. Higher doses, e.g., 1800-2400 mg per day, may be required for correction of high triglyceres or postprandial (after-eating) abnormalities.

Ignoring your heart scan is medical negligence

26. October 2006 William Davis (0)
I continue to be dumbfounded that many doctors continue to pooh-pooh or ignore CT heart scans when people get them.

I can't count the number of people I've seen or talked to through the Track Your Plaque program who've been told to ignore their heart scan scores. The most extreme example was a man whose physician told him his heart scan score of nearly 4000 was nothing to worry about!


A real-life story of a retired public defense attorney whose heart scan score of 1200 was ignored, followed two years later by sudden unstable heart symptoms and urgent bypass prompted us to write this fictitious lawsuit. Though it's not real, it could easily become real. To our knowledge, no single act of ignorance about heart scans has yet prompted such a lawsuit, but it's bound to happen given the number of scans being performed every year and the continued stubbornness of many physicians to acknowledge their importance.



Major Malpractice Class Action Lawsuit Looms for Doctors Who Ignore Heart Scan Tests

It's been several years since new medical discoveries have debunked old theories regarding heart disease and heart attack and have verified the efficacy of CT heart scans for detecting both early and advanced heart disease. Doctors who fail to keep apprised of these finding or refuse to change their practice for financial reasons put themselves at risk for becoming defendants in a major malpractice class action lawsuit. The plaintiffs will be a growing class of persons who were debilitated by avoidable heart attacks and heart procedures and the heirs and estates of those who have died.
Milwaukee , WI (PRWEB) November 29, 2005 -- This press release outlines a template for a potential class action lawsuit that may be on the horizon for the medical industry. The class of plaintiffs for this theoretical action remains latent but is growing on a daily basis. However, it requires only one such plaintiff to find an attorney who recognizes the scale and magnitude of the potential damages and move forward on a contingency basis. In real terms, this class could include 80% of those who had a heart attack, underwent a heart procedure, or subsequently died. According to the latest American Heart Association statistics, this number is estimated to be a least 865,000 persons and the entire class could easily be 10 times that number. Using a conservative estimate of $500,000 in damages per class member, the total damages could exceed $400 billion.

The plaintiffs, defendants, third parties, and facts surrounding the following moot complaint represent an actual incident. The names, specific health information, and dates have been changed to protect potential litigants.

Plaintiff, through his attorneys, brings this action on behalf of himself and all others similarly situated, and on personal knowledge as to himself and his activities, and on information and belief as to all other matters, based on investigation conducted by counsel, hereby alleges as follows:

NATURE OF THE ACTION

1.Plaintiff brings this class action on behalf of himself and all other persons who suffered physical damages or mental distress as a result of receiving a medical diagnosis indicating they had no identifiable heart disease, elevated risk for heat attack, or who were prescribed medications not suited to treat their heart disease once detected.

2.Substantial and irrefutable medical evidence has established that cardiac stress testing is an ineffective method for detecting heart disease of the type that is the root cause in over 90% of all heart attacks and other complications of heart disease that result in death or debilitating injury. A readily available and well-publicized test known as “CT heart scanning” is capable of detecting virtually all heart disease of this nature. It has also been established that simple cholesterol testing often fails to detect persons like likely to develop serious heart disease and prevents them from receiving common treatments capable of reducing or eliminating the source of their undetected heart disease. Readily available blood testing techniques exist that are capable of detecting non-cholesterol related sources of heart disease.

3.The medical community has made significant investments in outdated methods of detecting and treating heart disease. They rely on the revenue streams generated by providing these treatments to persons whose heart disease has progressed to the stage that intervention is required to prevent death or debilitation. Any change in diagnostic or treatment methods resulting in the prevention of heart disease would require substantial investments in new technologies and would severely reduce the market for current treatments. Plaintiffs believe this is a motivating factor in the neglect and willful suppression of readily available technology capable of detecting and preventing heart disease and represents gross medical malpractice.

SUBSTANTIVE ALLEGATIONS

On January 23, 1999, Plaintiff underwent a CT Heart Scan which was interpreted by a cardiologist at the ABC Scan Center . Plaintiff received a report from the Scan Center cardiologist indicating that his “calcium score” placed him in the top 1% for heart attack risk among men in his age group. The report also included the comment “Patient has a high risk of having at least one major stenosis (50% or greater blockage) in his Left Anterior Descending (LAD) artery and is urged to consult with a physician regarding this finding.”

On March 3, 1999 Plaintiff presented Defendant with the results of the January 23, 1999 CT Heart Scan. Defendant told Plaintiff to disregard the CT Heart Scan Results and ordered a physical including a stress test and cholesterol blood test.

On April 1, 2005, Plaintiff had a heart attack and a subsequent coronary angiography that confirmed multiple obstructive coronary plaques in his LAD. Plaintiff received an emergency balloon angioplasty to relieve his acute condition. Substantial damage to plaintiff's heart was incurred before emergency angioplasty could be instituted.

On April 3, 2005, per Defendant's recommendation, Plaintiff underwent open heart surgery to insert three bypasses in his LAD to resolve substantial obstructive heart disease, the same artery identified as having likely obstructive heart disease over 5 years earlier via CT heart scan.

On July 7, 2005, Plaintiff independently obtained additional blood testing not ordered by Plaintiff and was found to have several additional blood abnormalities not discovered by Defendant that are known to contribute to the development of heart disease and were readily treatable using lifestyle changes, nutritional supplements, and prescription drugs.

As early as September, 1996, the American Heart Association (AHA) issued a “Scientific Statement” to health professionals acknowledging the strong link between heart attacks and high calcium scores in asymptomatic patients. Extensive studies and references have confirmed the ineffectiveness of stress testing to reveal early heart disease in asymptomatic patients.

Plaintiff alleges that Defendant failed to utilize readily available medical tests and protocols to identify, aggressively treat, and potentially delay, halt, or reverse advanced heart disease that later resulted in extensive physical and emotional trauma to the Defendant.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff herein demands judgment:

A. Declaring this action to be a proper class action maintainable pursuant to Rule 23 of the Federal Rules of Civil Procedure and declaring Plaintiff to be a proper Class representative;

B. Awarding damages against each defendant, joint and severally, and in favor of Plaintiff and all other members of the Class, in an amount determined to have been sustained by them, awarding money damages as appropriate, plus pre-judgment interest;

C. Awarding Plaintiff and the Class the costs and other disbursements of this suit, including without limitation, reasonable fees for attorneys, accountants, experts; and

JURY DEMAND

Plaintiff hereby demands a trial by jury.

Light the fuse of heart disease

26. October 2006 William Davis All posts by william-davis

Why health care costs are ballooning

28. March 2008 William Davis (7)
Have you ever wondered to what degree health care is driven by a profit motive?

A doctor advises you to undergo a procedure. Is that advice motivated solely by concern for your health and welfare? Or, does the generous financial compensation peculiar to procedures bias your doctor’s decision?

The billboard on the highway advertises a hospital heart program. Is it meant to raise awareness of lifesaving services? Or, is it the same as an ad for a casino or hotel chain, a marketing tool for generating business?

At one time or another, we’ve probably all shared a suspicion that healthcare is occasionally motivated by money: over-priced prescription drugs, hospitals charging higher prices to the uninsured, the three-minute doctor’s visit for $200.

Direct-to-consumer drug advertising has brought aggressive drug sales tactics front and center to the public’s attention. “Ask your doctor about . . .” is the mantra of countless 30-second spots appearing several times an hour on national television. Direct-to-consumer drug advertising has provided the American public with a $4.5 billion reminder that there’s money to be made in the world of prescription drugs (U.S. Government Accountability Office). And there’s certainly a load of money to be made. A 2003 Harvard and Massachusetts Institute of Technology study showed that, of every dollar spent on consumer drug advertising, $4.20 was recovered through increased sales (Impact of Direct-to-Consumer Advertising on Prescription Drug Spending; Henry J Kaiser Family Foundation). A $53,000 ad run three times during the Oprah Winfrey Show is money well invested for a drug manufacturer.

The knotty issue of medical errors has recently captured attention. Unintentional medical errors—-nurses administering the wrong medication, doctor misdiagnoses or amputating the wrong leg, unrecognized medication interactions—-are an estimated $29 billion headache. Former Secretary of Health and Human Services, Tommy Thompson, reported that up to 98,000 lives are lost every year as a result of errors in healthcare delivery.

No doubt, these are all enormous problems that plague our healthcare system.

But I am going to make the case for a much larger problem. The magnitude of this problem dwarfs that of medical errors. It’s not an issue of neglect, nor is it committed in error. It is built on intentionally committed acts, systematically conducted on a massive scale, and sustained by the participation of many. It is a plague of unprecedented proportions on the health care system. It requires the willing participation of parties at multiple levels, from lone medical practitioners, to hospitals, to multi-billion dollar medical device and drug manufacturers, even to institutions like the FDA and American Heart Association.

The problem is the bizarre situation that has evolved in health care for the heart. I specify health care for the heart, not heart disease, because actual disease is not always part of the equation. Astonishingly, much of the inflated cost of heart care is based on the feared specter of heart disease, the implied threat of heart disease, the possibility, sometimes vanishingly remote, of heart disease based on some harbinger of risk. Sometimes the disease itself is nowhere in sight.

The system thrives on a culture of fear, an open ticket to over-testing and profligate spending. Ads cleverly admonish you to “Do it for your family”. Nuclear stress testing alone generates $18 billion of costs. Yet this test is normal in 80% of people tested. Worse, the 20% of “abnormal” stress test results are not always indicative of genuine disease, they are “false positive,” and are a big part of the reason that 30% of heart catheterizations fail to show disease. “My arteries checked out okay!” relieved patients will declare?-but there may have been no reason to have pursued a costly test like catheterization in the first place. But the system makes far better sense when you understand that nuclear stress tests and heart catheterizations are the bread and butter of cardiologists and hospitals, and the ticket to more financially rewarding procedures.

This approach evolved in the 1960s, when coronary heart disease itself was impossibly difficult to diagnose until a catastrophe like heart attack declared itself. But in the 21st century, coronary heart disease is easily, inexpensively, and safely detectable, decades before heart attack risk looms over your life. Yet murky, risk-based tests like stress tests and cholesterol testing continue to dominate the practice of “heart disease detection” in real-life practice.

Make no mistake: This problem is huge. The cardiovascular health care system has mushroomed into a gargantuan profit-generating mechanism, far larger than is required to deliver essential heart care. In 2003, over $431.8 billion was spent in the U.S. on cardiovascular health care, $151.6 of this on coronary disease alone (American Heart Association, Heart Disease and Stroke Statistics—2007 Update). The U.S. Department of Health and Human Services projects that total health care spending will double to $3.6 trillion by 2014, consuming 18.7 percent of the nation's economy, much of the increase due to expanding cardiovascular costs.

Most tragically, the system has grown through the exploitation of trust. The faith we have in doctors, hospitals, and the institutions and people associated with healthcare has been subverted into the service of profit. Many practitioners and institutions have chosen to operate under the guise of doing good but instead capitalize on the public’s willingness to accept as fact the need for a major heart procedure and all its associated costly trappings.


Copyright 2008 William Davis, MD

Heart scans know no race

27. March 2008 William Davis (0)
The New England Journal of Medicine just published a new analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) database authored by Dr. Robert Detrano of University of California-Irvine.

As we would expect, the study confirmed the ability of heart scans and coronary calcium scoring to predict heart attack. This study is unique, hovever, in including Hispanics, Chinese Americans, and African Americans in its 6722 participants.

The analysis confirmed that coronary calcium scores yielded similar information, regardless of race. It confirmed that people with a zero heart scan score had a nearly zero risk of cardiovascular events; it also confirmed that higher scores (e.g., >300) yielded much greater risk over the 4 years of observation: 7.73-fold greater risk for people with scores 101-300; 9.67-fold greater for scores >300.

One of the media reports on the study can be viewed on HeartWire

Bill Sardi's Knowledge of Health website and blog also has an insightful commentary.

To those of us who have used heart scans in thousands of people, the MESA results come as no surprise, having seen these phenomena played out every day in real life. Although similar results have been previously shown in a number of other smaller studies, Detrano's analysis of MESA does serve to further validate these concepts. It also serves to deliver the message more broadly into the mainstream media message.

No surprise whatsoever: Coronary calcium scores obtained through heart scans represent a measure of the disease--coronary atherosclerosis--itself. It is not a risk factor that may or may not be associated with development of coronary atherosclerosis. Thus, when heart scan scores are held up in comparison the cholesterol, LDL cholesterol, c-reactive protein, or any other risk measure, heart scan scores outshine all these measures by enormous margins as predictors of your future.

Want to know what your uncorrected heart disease future could be? Consult your heart scan score. Not your cholesterol panel.


Copyright 2008 William Davis, MD

Heart Scan Frustration

27. March 2008 William Davis (4)
Ideally, you get a heart scan and your doctor sits down with you and provides a rational, insightful discussion on what the results mean.

Is heart attack in your future? If so, when? Are blockages present? What is the role of other tests like stress tests and heart catheterizations? Do CT coronary angiograms add any important information? What is the role of cholesterol? Can diet or nutritional supplements impact on heart scan score?

But what happens if you are unable to get the answers you desire? What if you get brusque responses, or your doctor just doesn't know? Or what if there is a clear conflict of interest or the possibility of financially-tainted advice? ("You need a heart catheterization right away or you'll die of a heart attack!")

One example of this process was posted by a frustrated Member of Track Your Plaque who found that answers were virtually unobtainable from his/her doctors:

I underwent a heart scan a few weeks ago, based on a recommendation from a doctor. I assumed that, since I was paying for it, and I requested it, the results would be fully explained to me.

Late on a Friday afternoon, the radiologist who intrepreted it called me and said I would be receiving a report, and so would the doctor. I asked that she explain them to me. She said their policy was to give the report to the doctor and let him explain them. She did say I was in the 90th percentile for my age--and that 10% had a worse score. I asked where do we go from here, and she said, if you're not having symptoms, maybe lifestyle changes, but YOUR DOCTOR will let you know. I asked for a copy of the films and reports, and was told YOUR DOCTOR can request them. I called back a little later and she was gone. It was starting to sink in that I must have a terrible score. In the meantime, I did what I should have done before I went for the scan---looked up information on the internet, and read about calcium scoring. This website [Track Your Plaque] hadn't showed up in my Google search, so a lot of the information was useless.

I did manage to get the score of 186, with the breakdown per artery from someone at the clinic, but only after I insisted I paid for the test, I have a right to the information. 'Course having a score per artery didn't really help---what did it mean? ie: if a 72, how did that correlate to any blockages? Was it a big lump...or spread along the wall throughout the artery.

I had an appt. the following Tuesday with THE DOCTOR---a very busy doctor. After an hour and 1/2 wait in a crowded waiting room, I got to see him. We discussed briefly another issue, and he started walking out. I followed him out and said I wanted my full l5 minutes of time allotted in their scheduling, which seemed to irritate him.

I followed him into his office and said, WHAT ABOUT THE HEART SCAN? What do the numbers mean? He responded that he didn't know, he'd have to see the films, but don't worry--you're probably ok, and I should get a thallium stress test anyway. He said he couldn't intrepret the numbers, or give an opinion on where the plaque was or how it was configured.

I then went to the interventional cardiologist that afternoon and the thallium stress test was scheduled. I asked about the HEART SCAN, and again, no acknowledgment. I asked if he would get the films and explain the results, and again no acknowledment as he was walking out the door.

After this lengthy saga.....MY QUESTION IS....since this is a test you can order yourself (literature at center made mention of the tests you can get without a doctors request)......WHO IS THEIR FIDUCIARY RESPONSIBILITY TO WHEN IT COMES TO EXPLAINING THE RESULTS?

I learned more on this website [Track Your Plaque], and the emailed book then I did dealing with two doctors and the center itself. Thinking back, there was nothing but a brochure on the test at the center. No "Track your Plaque" stuff.



Day 2
I called the scanning center and relayed my dilemma. I was put in touch with another radiologist--a very informative one, who appeared passionate about heart scans as a preventive test. He compared them to mammograms. He hadn't heard about the "Track Your Plaque" program but was going to check it out. He said people varied in their responses to the test results, as well as doctors/cardiologists as to the next step. (ie: lifestyle changes..the next test, etc). He seemed to feel blockages of more than 50% for many cardiologists would indicated angioplasty and stenting.

I'm going back to review the films with him later this week. He wasn't that concerned with the 101 reading on the right artery. The 72 on the left he had concerns with and indicated the CAT test [CT angiography] would offer more as far as how much was there, and approx. blockage, and could be a baseline to compare to in the future. He said some cardiologists would go right to angioplasty...some to a CAT which is more conservative...some might watch and encourage lifestyle changes. He said the Heart Scan doesn't show soft plaque. He also said the internist who referred me was one of only a few in the city that felt strongly about the heart scan---and probably used it to take further action via a referral, and just didn't have time to discuss it, with the way medicine is run these days.



This Member's frustrated post pretty much sums it up:

1) Doctors don't seem to have the time nor motivation to be bothered about offering advice that leads to prevention of disease.

2) The tendency is to always ask, "Are heart procedures necessary?", not "How did this happen?" or "What can we do about this to keep it from getting worse?" How about diet, supplements, and other tools to use at home?

The obvious uneasiness of the radiologist, the last physician this Member spoke with, can just as easily lead to boneheaded advice: Maybe getting a stent isn't such a bad idea. Maybe a CT angiogram is an absolute necessity.

I hear comments like this every day. It is the reason why I continue to plug away at this program and try to set things straight.

By the way, subscribers to our Track Your Plaque Newsletter just heard about our latest success story, Roy, who dropped his heart scan score over 500 points. If you are yet not a newsletter subscriber, click here.


Copyright 2008 William Davis, MD