All posts by william-davis

In heart disease prevention, shoot for perfection

12. April 2006 William Davis (0)

It really struck me today that it's the people who've chosen to compromise their prevention program who end up with trouble--heart procedures, heart attack, even heart failure.

Take Bob, for example. Bob is 73 years old and had a bypass operation in 2000. The procedure went well and Bob enjoyed 6 years of seemingly trouble-free life. Bob had a seriously low HDL cholesterol for which he as taken a modest dose of niacin, but was unwilling to do much more. His HDL cholesterol was thererefore "stalled" at around 40 mg. (We aim for 60 mg or greater.) We talked repeatedly about the options for increasing HDL but Bob was content with his results. After all, since his bypass operation, he'd felt well and could do all he wanted without physical limitation.

But Bob underwent a stress test for surveillance purposes (which we routinely do 5 or more years after bypass surgery). The test was markedly abnormal with two major areas of poor blood flow to his heart (signalling potential heart attack in future). Bob ended up getting 5 stents to salvage two bypass grafts, both of which showed signs of substantial degeneration.

I've seen this scenario repeatedly: A person is unwilling to go the extra mile to obtain perfection in lipid/lipoprotein patterns, lifestyle changes, and taking the basic, required supplements. Compromises eventually catch up to you in the form of another heart attack, more procedures, heart failure, physical disability, even death.

The message: Don't draw compromises in heart disease prevention. Coronary plaque is a chronic process. It will take advantage of you if you ever let your guard down.

The epidemic of small LDL

11. April 2006 William Davis (0)

Of the patients I saw in my office yesterday, virtually EVERYONE had small LDL.

Small LDL is emerging as an extraordinarily prevalent lipoprotein pattern that drives coronary plaque growth. Previous estimates have put small LDL as affecting only 20-30% of people with coronary disease. However, in my experience in the last few years, I would estimate that greater than 80% of people with measurable coronary plaque have small LDL.

If you have a heart scan score >zero, chances are you have it, too.

I call small LDL a "modern" disease because it has skyrocketed in prevalence recently because of the great surge in inactivity in Americans.

When's the last time you walked to the grocery store and back, lugging two bags of groceries? How many years has it been since you've push-mowed your lawn? All the small conveniences of life have permeated further and further into our activities. Most of us spend the great majority of our day right where you are now--on your duff.

On the bright side, small LDL in most people is reducable by simply getting up and going. But the old teaching of 30 minutes of activity per day is now outdated. This was true when the other hours of your life included physical activities, like housework or a moderately active job. However, if the other 23 1/2 hours of your day are sedentary, then 30 minutes a day won't do it. An hour or more of activity, whether exercise or physical labor of some variety will get you better small LDL-suppressing results.

For most people with small LDL, fish oil and niacin are also necessary to fully suppress small LDL to the Track Your Plaque goal of <10 mg/dl.

A great discussion on vitamin D

10. April 2006 William Davis (0)

If you need better convincing that vitamin D is among the most underappreciated but crucial vitamins for health, see Russell Martin's review of vitamin D and its role in cancer prevention. You'll find it in March, 2006 Life Extension Magazine or their www.LEF.org website at:

http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1308&query=vitamin%20d&hiword=VITAM%20VITAMER%20VITAMERS%20VITAMI%20VITAMINA%20VITAMINAS%20VITAMINC%20VITAMIND%20VITAMINE%20VITAMINEN%20VITAMINES%20VITAMINIC%20VITAMINK%20VITAMINS%20d%20vitamin%20

Our preliminary experience over the past year suggests that vitamin D may be the crucial missing link in many people's plaque control program. We've had a handful of people who, despite an otherwise perfect program (LDL<60, HDL>60, etc.; vigorous exercise, healthy food selection, etc.--I mean perfect)continued to show plaque growth. The rate of growth was slower than the natural expected rate of 30% per year, but still frightening rates of 14-18% per year--until we added vitamin D. All of a sudden, we saw dramatic regression of 7-25% in 6 months to a year.

This does not mean that vitamin D all by itself regresses plaque. I believe it means that vitamin D exerts a "permissive" effect, allowing all the other treatments (fish oil, LDL reduction, HDL raising, correction of small LDL, etc.) to exert their full benefit. So please don't stop everything and just take D. This will not work. However, adding vitamin D to your program on top of the basic Track Your Plaque approach--that's the best way I know of.

MSNBC Report: We need more heart procedures!

10. April 2006 William Davis (0)

A recent headline from MSNBC by Robert Bazell reads:

NEW YORK - Angioplasty, bypass surgery and cholesterol-lowering medications are among the many interventions that have brought a sharp decrease in heart disease deaths in recent years. But, as Dr. Sharon Hayes of the Mayo Clinic points out, there is one big problem.

“The death rates in women have not declined as much as they have in men,” she says.

The piece goes on to suggest that women are getting short-ended in the diagnosis of heart symptoms and heart attack. The solution: More testing to assess the need for procedures like bypass.

This is typical of the device and medication-dominated media consciousness: More procedures, more medication, more devices. Who's paying for advertising, after all? The money at stake is huge. But is this what you want?

Don't be swayed by media reporters with limited understanding of the real issues (at best), consciousness of who's paying for advertising (at worst). Yes, heart disese is often underestimated or misdiagnosed in women. The answer is better detection earlier in life followed by efforts to halt the process--effective, safe treatments for people's benefit, not just profit.

What role cholesterol medication?

10. April 2006 William Davis (0)

A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.

Supplement Mania!

9. April 2006 William Davis (3)

Ever hear of "polypharmacy"? That's when someone takes too many medicines. People will have lists of 15-20 prescription medicines, for instance, with crazy interactions and oodles of side-effects.

Well, how about "poly-supplments"? That's when someone takes a large number of nutritional supplements.

Let me tell you about a 45 year old man I met.

In an effort to rid himself of risk for heart disease that he felt was likely shared with his family (brother and father diagnosed with heart attacks in their late 40s), Steve followed a program of nutritional supplementation. You name it, he took it: hawthorne, anti-oxidant mixtures, vitamins C, E, B-complex, saw palmetto, 7-keto DHEA, velvet deer antler, gingko biloba, policosanol, chronium picolinate, green tea, pine bark extract, St. John's Wort, CoEnzyme Q10, papain and other digestive enzymes...He became a distributor for a nutritional supplement company to allow him to afford his own extraordinary program.

To satisfy himself that he had indeed "cured" himself of heart disease, he got himself a CT heart scan. His score: 470, in th 99th percentile. Steve's heart attack risk based on this score was around 10% per year. High risk, no question.

For weeks after his scan, Steve admitted walking around in a daze, not knowing what to do. Years of telling himself that he had effectively dealt with his heart disease risk, now all down the drain.

When we met, I persuaded him that to think that this collection of supplements would reverse heart disease was magical thinking. We trimmed his list down to the essentials and got him on the right track.

Heart disease is controllable and reversible, but not this way. Don't fool yourself into thinking that some collection of supplements will be enough to stamp out your heart disease risk. Just like taking an antibiotic when you don't have an infection achieves nothing, so does taking the wrong supplements.

What does heart scanning mean to you?

8. April 2006 William Davis (0)

CT heart scans can mean different things to different people.

What does a heart scan mean to you? There are several possibilities:

1) A way of reducing uncertainty in your future.

2) A tool to crystallize your commitment to health.

3) A device to help you track how successful your heart disease prevention program is.

4) A trick to get you in the hospital.

5) A moneymaking tool for unscrupulous physicians hoping to profit from "downstream" testing, particularly heart catheterizations.

Like anything, heart scans can be used for both good and evil. How can you be sure that your heart scan is put to proper use--for your benefit and not someone else's profit?

Simple: Get educated. Understand the issues, be armed with informed questions.

If, for instance, you're a 55-year old female with a heart scan score of 90, active without symptoms, and you're told to have a heart catheterization right off the bat---run the other way. This is bad advice. A heart procedure like catheterization at this score in an asymptomatic woman is very rarely necessary. That decision can only be made after a step-by-step series of decisions are made by a truly interested, unbiased party. (A stress test is almost always required in this situation before the decision can be made to proceed with a catheterization.)

Unfortunately, in 2006, getting unbiased advice from your doctor is still a struggle. That's why we started Track Your Plaque---unbiased information, uncolored by drug or device company support, with an interest in the truth.

Coronary disease is drying up!

7. April 2006 William Davis (1)

I had an interesting conversation with a device representative this morning. He was a sales representative for a major medical manufacturer of stents, defibrillators, and other such devices for heart disease.

Since I'm still involved with hospital heart care and cardiac catheterization laboratories, this representative asked me if I was interested in getting involved with some of the new cardiac devices making it to market over the next year or two. "The coronary market is drying up, what with coated stents and such. We've got to find new profit sources."

Well, doesn't that sum it up? If you haven't already had this epiphany, here it is:

HEART DISEASE IS A PROFITABLE BUSINESS!

Why else can hospitals afford billboards, $10 million dollar annual ad campaigns, etc.? They do it for PROFIT. Likewise, device and drug manufacturers see the tremendous profit in heart disease.

The representative's comments about the market "drying up" simply means that the use of coated stents has cut back on the need for repeat procedures. It does NOT mean that coronary disease is on the way out. On the contrary, for the people and institutions who stand to profit from heart care, there's lots of opportunity.

Track Your Plaque is trying to battle this trend. Heart disease should NOT be profitable. For the vast majority of us, it is a preventable process, much like house fires and dental cavities.

Mammogram for your heart

6. April 2006 William Davis (0)

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.

Is your doctor using "leeches"?

4. April 2006 William Davis (0)

What if you went to your doctor for a problem and he/she promptly placed leeches on your body?

Yeccchhhh! Would you go back? I'd bet that you'd run the other way as fast as your bleeding legs could take you. Outdated health practices like "bleeding" are outdated for good reason.

Then why would you allow your doctor to approach your heart disease prevention program by checking cholesterol and then waiting for symptoms to appear? That miserable approach leads to tragedy and death all too often--ask Bill Clinton! He might as well have had leeches!

Don't allow your doctor's ignorance or disinterest impede your prevention program. Get your coronary plaque measured, then attack it from all sides by knowing all causes, hidden and obvious. That's why Track Your Plaque is such an effective program.

I often wonder why more doctors aren't using this unbelievably powerful approach to deal with heart disease. But when I see colleagues implanting stents, defibrillators, and the like for many thousands of dollars per patient, the answers are obvious. Given a choice of a rational, effective program of prevention that pays the doctor a few hundred dollars for his time, versus $2000 to $10,000 for a procedure, you can see that the temptation is irresistible for many physicians.

Quieting the insulin storm

1. November 2008 William Davis (15)

The cycle of eating, satiety, and hunger is largely driven by insulin and blood sugar responses.

For instance, if I eat a bowl of Cheerios, my blood sugar will surge to 140 mg/dl or higher (how high depending on insulin sensitivity). The flood of sugar from this Frankenfood triggers the release of insulin; blood sugar then settles back down.

The decline in blood sugar back down to normal or below normal powerfully triggers hunger. Variable degrees of shakiness, mental fogginess, and irritability also commonly occur. Most people experience this to some extent; some experience an exagerrated version called "reactive hypoglycemmia" and can suffer peculiar personality changes, irrational and even violent behavior.

Foods made with wheat or cornstarch raise blood sugar higher and faster than table sugar. Accordingly, blood sugar and insulin swing more widely with these food: highs are higher, lows are lower. People who therefore follow the standard mantra of "eat plenty of healthy whole grains" therefore experience a 2-3 hour long cycle of eating, brief satiety, and recurrent hunger. Cravings for snacks, impulsive eating, and overeating all occur during the period when blood sugar has dropped and hunger is powerfully triggered.

Eliminating this up and down fluctuation is therefore key to regaining control over appetite, losing weight, reducing small LDL and triglycerides, reducing blood sugar, and putting out the fires of inflammatory responses.

You can accomplish this by:

1) Eliminating foods that trigger the exagerrated rises in blood sugar--Wheat, cornstarch, polished rices, white and red potatoes, and candy.

2) Adding a healthy oil to every meal--a strategy that prolongs satiety and helps suppress sugar-insulin fluctuations.

The ful nuts and bolts details of this diet will be released with the New Track Your Plaque Diet. Part I has already been released; part II is coming any day on the Track Your Plaque website.

Scare tactics

31. October 2008 William Davis (0)

"You're a walking time bomb."

"I can't be responsible for what happens to you."

"Your blockage is in the artery called the 'widow-maker.'"

Familiar lines? These are the well-rehearsed warnings commonly used by cardiologists to persuade a patient to undergo a procedure (heart catheterization and all that follow).

Something happens when you hear these words about your health. Most people's resolve to explore alternatives, get another opinion, think it over, promptly crumbles when they hear these words. These particular warnings have been time-tested and are surprisingly effective.

Unlike many other conditions, heart disease does indeed result in catastrophic events without warning. Unlike, say, cancer, heart disease can wreak damage suddenly. That's all true.

What bothers me is the vigor with which the opportunity for hospital procedures is pursued.

The thinking is that hospitals procedures = saving a life. In the vast majority of people, this is nonsense. Procedures like heart catheterization, stents, bypass, do save lives if someone is in the throes of a catastrophe. The problem is that most people who undergo procedures are not in the midst of catastrophe and have every hope of avoiding it altogether with some simple efforts towards prevention.

Imagine this conversation: "Yes, Mr. Smith, you do have heart disease, Even though you have no symptoms and your stress test is normal, I believe that we should 1) identify the causes of your heart disease, then 2) correct them. Of course, if you don't want to engage in this prevention process, then there may be a point at which heart procedures may be necessary. But I believe that you have great hopes of avoiding them and avoiding heart attack."

Self-Directed Testing

28. October 2008 William Davis (3)

In the last Heart Scan Blog post, I listed the poll results on success vs. failure in trying to obtain requested blood work through doctors. The results of that informal poll revealed that a substantial number of people encounter resistance to one degree or another in trying to obtain blood tests.

But the world of self-directed testing is growing. In addition to your ability to circumvent your doctor by getting your own blood work done, you can now:

--Obtain many imaging tests on your own--Heart scans can be obtained without your doctor's involvement, for instance. The ultrasound screening services, like that offered by Lifeline, mobile services that provide carotid, abdominal aorta, and osteoporosis screening services; full body scans, and others.
--Identify and treat some conditions--Internet information has gotten quite powerful to assist individuals in recognizing when a condition might be present. (However, this is also a landmine for trouble if not properly used.)
--Genetic testing--While just in its infancy, direct-to-consumer genetic testing is now offered by two outfits that I'm aware of.
--Unusual laboratory tests--e.g., heavy metals, omega-3 fatty acid content, cancer markers.

One drawback to the emerging world of self-directed testing: There is no insurance coverage. However, this will become less and less of an issue as time passes, since it is clear that most Americans will need to bear a greater portion of healthcare costs in future, since some conventional services may even be rationed for cost containment; higher copays and the emergence of medical savings accounts, providing the individual with more control over how healthcare dollars are spent; competition in self-directed healthcare services, which will reduce costs. Imagine, for instance, several more direct-to-consumer services to obtain blood tests appear. They will need to compete on price and service.

While my colleagues are terrified of the potential for abuse of such tests, my reaction is the opposite: I am enormously excited by the potential for individuals to seize more and more control over their health.

Of course, with greater freedom comes greater responsibility. But the long-term net result will be, in my view, a healthier, more satisfied healthcare consumer with reduced healthcare costs.

Self-testing

26. October 2008 William Davis (9)

Here are the results of the latest Heart Scan Blog poll (84 respondents):

When you ask your doctor to perform a specific blood test, does he/she:

Do it without question?
38 (44%)

Do it but express reservations?
25 (29%)

Do it very grudgingly?
13 (15%)

Refuse outright?
9 (10%)

I was encouraged that 44% of respondents are/were able to obtain the blood work they requested without resistance. Sadly, however, the majority do either encounter reluctance or outright resistance.

Why would your doctor impose barriers to your ability to obtain laboratory tests? Well, several potential reasons:

1) He/she feels that they are charged with your health safety, and you might be led down a misleading, potentially dangerous path.

2) He/she feels that the tests are truly unnecessary and that you will be wasting the money of the "system."

3) He/she doesn't understand the tests, or is unfamiliar with them.

4) He/she feels that the doctor should be in complete control, not you. How dare you try to usurp the doctor-as-dictator of your health!

In reality, number 1 is understandable but rarely occurs. I have indeed have had requests, though rare, for outrageously inappropriate tests for the issue at hand, usually due to a misinterpretation of some information by the patient.

I'm not sure how often number 2 truly is. For instance, it is not uncommon for the doctor to have an ownership stake in the laboratory. There are several large primary care groups in Milwaukee who are notorious over-users of laboratory tests, with extraordinary batteries of dozens of tests every few months on the flimsiest reasons , clearly motivated by . . . money. On the other hand, there are physicians who do consciously try and order tests rationally and cost-effectively. I suspect that this is a minority.

I feel quite confident that number 3--your doctor's ignorance--is probably the most common reason he/she is reluctant or refuses to allow you access to a test. Most respondents I suspect are referring to many of the tests that I have been advocating, such as lipoprotein testing, lipoprotein(a), and vitamin D blood levels. I am uncertain how any of these could be construed to be dangerous. But ignorance of the value of these tests is rampant and resistance is nearly always based on not having explored these issues and having no appreciation for their importance. Of course, the beleaguered primary care physician is, no surprise, inundated by so much information across such a wide range that he/she has become expert at nothing, barely able to even deliver the full scope of genuine up-to-date primary services any longer. My colleagues, the cardiologists. . . well, you know my feelings about their attitudes: If it doesn't make money, then why should I bother? Devote months or years studying something that doesn't ring the cash register?

I see this dilemma as yet more evidence of the growing disenchantment with the doctor-as-gatekeeper model, the centuries old paternalistic "I will tell you what to do and you will do it." It worked when the doctor was educated and had access to knowledge you could never realistically obtain because you couldn't read, or you were too poor to afford books and education, or because medical information was made privy only to select people.

It's not that way anymore: The information you have access to is the same information my colleagues and I have access to: a level playing field. Along with the changing rules of the game, the game itself must eventually change.

I believe that people should have access to self-testing. Indeed, there is a growing industry of direct-to-consumer laboratory testing, such as that offered by Life Extension and LabSafe . For the most part, these offer tests without potential insurance reimbursement.

But the landscape is changing: We are just beginning a new age of self-empowerment, self-directed healthcare.

Whenever I say this, some people are angered that the majority of people will be too lazy, stupid, or poor to join the movement. What I am not saying is that we should agitate to make the system a patient-only directed process and completely remove the doctor. What I am saying is that the patient should and will play an increasingly important role in determining the content and direction of his/her care, especially as the patient becomes far more knowledgeable about issues relevant to his/her health.

The new tools of health measurement

If there were a new mantra of the new science of insight into health and long life, it would be “measure, measure, and measure.”

Never before in history have we had access to the analytical, laboratory, imaging, quantifying health tools that we have today. We can locate, scan, measure, all down as far as the level of basic codons of the genetic sequence.

The health-inquiring public has so far been permitted just a tip-of-the-tongue taste of these quantitative phenomena in such things as cholesterol values (“know your numbers!”) and blood pressure. Women now discuss their bone density scores over coffee, men their PSAs (prostate specific antigen).

But a curious irony has emerged: Like early 20th century males uncomfortable with women battling for suffrage, healthcare professionals, themselves comfortable with measurements and numbers, are distinctly uncomfortable when some of the same information falls into the hands of the healthcare consumer.

These phenomena play out in especially dramatic fashion in the world of heart health. The public now has broad access (many without a doctor’s order) to an extraordinary array of health measurement tools that can potentially yield enormous benefits for prevention of the most common conditions, information that can be applied by tracking over time.

Measures like heart scan scores, vitamin D blood levels, lipoprotein(a)--measures that most doctors have little or no interest in obtaining, yet they serve crucial roles in maintaining and tracking your health.

The new paradigm is emerging: the tools are getting better and better, they are becoming more accessible.

Increasing sales, growing the business

23. October 2008 William Davis (7)

I continue my portrayal of the fictional hospital, St. Matthews. Though fictional, it is based on real facts, figures, and situations.

Despite their success, administrators at St. Matthews’s Hospital continually fret over how to further expand their enterprise.

Market share can be increased, of course, by competing effectively with other hospitals, but that can be a tough arena. After all, St. Matthews’ competitors deliver pretty much the same services, and draw areas for patients overlap. The last thing the hospital wants is the appearance that heart care is a “cookie cutter” process, the same everywhere. In fact, this trend has hospital administrators wringing their hands. Two competing hospital systems in town recently launched multi-million dollar ad campaigns employing some of the same aggressive tactics St. Matthews’ marketers used successfully in past.

If St. Matthews is going to grow, new markets will need to be explored. What other strategies can a hospital system use to continue climbing the growth curve?

St. Matthews’ hospital administrators have drawn a number of lessons from other businesses. How about squeezing more procedures out of the population you already take care of? That’s an age-old rule of business: your easiest sales come from repeat customers. A former stent patient is going to “need” annual nuclear stress testing ($4000), more stents (about $25,000–39,000 per hospitalization), CT angiogram ($1800–2400), bypass surgery ($84,000), and so on. “Check-up” catheterizations, though clearly of little or not benefit to patients, are silently encouraged, yet another example of the bonanza of repeat procedures possible.

The lesson that “once a heart patient, always a heart patient” has been honed to an art form in business practices at St. Matthews and other hospitals like it. If you enter the system through your primary care physician or cardiologist, there’s an excellent chance you’ll end up with several procedures, diagnostic and therapeutic, over the ensuing years. Accordingly, St. Matthews provides a very attentive after-discharge follow-up program, complete with access to friendly people, phone centers, “support groups,” and even an occasional festive get-together, all in an effort to ensure future return to the system.

All in all, the St. Matthews Hospital System is a hugely successful operation. It provides jobs for thousands of area residents and provides high-tech, high-quality healthcare. Like any business—and no doubt about it, St. Matthews is a business with all the trappings of a profit-seeking enterprise—it grows to serve its own interests. The tobacco industry didn’t grow to its gargantuan proportions by doing good, but by selling a product to an unsuspecting public. So, too, hospitals.

Curiously, hospitals like St. Matthews continue to operate under the sheltered guise of not-for-profit institution with the associated tax benefits, ostensibly serving the public good. This means that all end-of-year excess revenues are re-invested and not distributed to investors. But non-profit does not mean that individuals within the system can’t benefit, and benefit handsomely. Under St. Matthews’ non-profit umbrella, many businesses thrive: 35 pharmacies, extended care facilities to provide care after hospital discharge, drug and medical device distributors, even a venture capital arm to fund new operations. The financial advantage conferred by “non-profit” status has permitted the hospital to compete with other, for-profit businesses, at a considerable advantage. For this reason, attempts have been made over the years to strip them of what some believe is an unfair advantage; all have failed.

While profits may not fall to the bottom line, money does indeed get paid out to many people along the way. Executives, for instance, pay themselves generous salaries and consulting fees, often from several of the entities in this complex business empire. Physicians are brought in as “consultants” or are awarded “directorships” for hundreds of thousands of dollars per year—Director of Research, Director of Cardiovascular Services, etc. Don’t forget the $3.7 million dollar annual salary paid to the CEO.

Hospitals and doctors have a vested interest in preserving this financial house of cards. They will fiercely battle anyone or anything that threatens the stream of cash. During a recent meeting of important doctors at St. Matthews Hospital, one cardiologist bravely voiced his concern that bypass surgery was performed too freely on too many patients in the hospital. The doctor was promptly and quietly asked to remove himself from the meeting. Several days later, he received a letter announcing his dismissal from the committee.

The silent conspiracy conducted by hospitals and cardiologists serves their own purposes better than the good of the public. Under the guise of good works, hospitals continue to promote strategies which are, for the most part, outdated, inefficient, inaccurate, and expensive. But that’s the rub. Expensive to you and your insurance company means more money for the recipient: your hospital and cardiologist, and the powers that support them. All this occurs while the real solutions that are of benefit to the public continue to be overlooked, hidden in the shadows.

Top Doctor

23. October 2008 William Davis (2)

Dr. Robert Connors is the hospital’s most prized cardiologist.

Practically a fixture in the cath lab, he generates more revenues for the hospital than any of his colleagues. Last year alone, he performed over 1500 procedures, bringing in $18 million dollars to the cath lab, $27 million to the hospital. Dr. Connors is very good at what he does: 55-years old, he has been involved in high-tech heart care since the “early days,” 25 years ago, when hospital procedures really took off.

During his career, he has personally performed over 25,000 heart procedures and has built a reputation as a skilled operator of complex coronary procedures. Because of his skills, he enjoys a vigorous flow of referrals for procedures from dozens of primary care physicians. His skill has also earned him referrals from cardiologist colleagues who seek his abilities for difficult cases.

On any day, Dr. Connors typically schedules up to 12 procedures. His entire day is spent in the cath lab, usually from 7 am until 6 pm. He meets many patients for the first time on the catheterization laboratory table as staff shave their groin, preparing for the procedure. Much of the procedure itself is not even performed by Dr. Connors, but by one or another cardiologists-in-training, a “fellow,” or member of the fellowship the hospital proudly maintains as a clinical teaching institution. Nor will Dr. Connors talk to most patients at the close of the procedure. He leaves that to either the fellow or a nurse. Dr. Connors views himself as a procedural specialist, not someone who has to take care of patients. He gave up seeing patients in his office over 10 years ago.

Dr. Connors’ procedural enthusiasm gained him the attention of drug and medical device manufacturers. Because Dr. Connors lectures widely and advises colleagues, his comments can dramatically alter perceptions of the value of a technology. He has, on many occasions, catapulted an unpopular device to most-asked-for among colleagues, bringing millions in revenues to the manufacturer. One particularly lucrative arrangement he made around 10 years ago involved a “closure” device, a $400 single-use plug used to close the access site made during heart catheterizations. By swaying his colleagues at St. Matthews Hospital, 50 orders per day (one per procedure) tallied $20,000 every day, $7.1 million dollars per year for the manufacturer. Although he’d used other devices on the market, the 5,000 shares of stock he was offered encouraged him to issue glowing comments to colleagues on the superiority of this specific brand of closure device. Now over 90% of all catheterizations at St. Matthews conclude with the device manufactured by the company in which Dr. Connors maintains partial ownership.

Negative comments, on the other hand, topple other products when Dr. Connors sees fit to pan them. For this reason, device and drug manufacturers run straight to Dr. Connors to gain his good graces as soon as possible after a product is released into the market. Because the competition is just as likely to do the same, it has often come down to a bidding war, the company providing the most lucrative arrangement most likely to win.

Thus, Dr. Connors proudly boasts of how many times he has flown to Hawaii, Europe, and other exotic locations at industry expense. He also boasts of how, for $100,000 paid to him for a “consulting fee,” he can overturn the choice of products lining hospital shelves. As the hospital’s annual budget for coronary devices will top $84,000,000 this year, device manufacturers regard the sum paid Connors as a profitable investment.

Despite his lofty status in the hospital, Dr. Connors has long expressed a love-hate relationship with St. Matthews. While he enjoys his work and has made a more than comfortable income, he has long felt that the hospital administration didn’t truly appreciate his contributions. Five years ago, he therefore demanded that he be made “Director of Research.” After all, he had hired a nurse to help him coordinate enrollment of patients into several device trials brought to him by medical device manufacturers. When he encountered an initial lukewarm response from hospital administrators, he threatened to take his “business” elsewhere to a competing hospital. St. Matthews’ administrators gave in. They provided him with the title he wanted, along with $100,000 annual “stipend.”

True story, though names have been changed to protect the guilty.

Is Dr. Connors just an “outlier” among colleagues who toe a more conservative line? Or does his brand of commercial enterprise in hospital heart care represent the ideal that they seek, brazenly and ambitiously seeking to expand the procedural solution to heart disease to the exclusion of patient care and real human interaction?

Disease Engineering

20. October 2008 William Davis (0)

Imagine you contract pneumonia.

You have a fever of 103, you’re coughing up thick, yellow sputum, breathing is getting difficult. You hobble to the doctor, who then fails to prescribe you antibiotics. You get some kind of explanation about unnecessary exposure to antibiotics to avoid creating resistant organisms, yadda yadda. So you make do with some Tylenol®, cough syrup, and resign yourself to a few lousy days of suffering.

Five days into your illness, you’ve not shown up for work, you’re having trouble breathing, and you’re getting delirious. An emergency trip to the hospital follows, where a bronchoscopy is performed (an imaging scope threaded down your airway) and organisms recovered for diagnosis. You’re put on a ventilator through a tube in your throat to support your breathing and treated with intravenous antibiotics. Delayed treatment permits infection to escape into the fluid around your lungs, creating an “empyema,” an extension of the infection that requires insertion of a tube into your chest through an incision to drain the infection. You require feeding through a tube in your nose, since the ventilator prevents you from eating through your mouth. After 10 days, several healing incisions, and a hospital bill totaling $75,000, you’re discharged only to be face eights weeks of rehabilitation because of the extreme toll your illness extracted. Your doctor also advises you that, given the damage incurred to your lungs and airways, you will be prone to more lung infections in the future, and similar situations could recur whenever a cold or virus comes long.

A disease treatable by taking a two week, $20 course of oral antibiotics at home has been converted into a lengthy hospital stay that generated extravagant professional fees, testing, and costly supportive care. You’ve lost several weeks of income. You’re weak and demoralized, frightened that the next flu or virus could mean another trip to the hospital.

Such a scenario would be unimaginable with a common infection like pneumonia, or it would be grounds for filing a malpractice lawsuit. But, as horrific as it sounds in another sphere of healthcare, it is, in effect, analogous to how heart disease is managed in current medical practice.

First, you’re permitted to develop the condition. It may require years of ignoring the telltale signs, it may require your unwitting participation in unhealthy lifestyle choices. Palliative treatments that slow, but don't stop, the progression of disease are prescribed like cholesterol drugs. The process then eventuates in some catastrophe like heart attack or similar unstable heart situation, at which point you no longer have a choice but to submit to major heart procedures. That’s when you receive your heart catheterization, coronary stents, bypass, defibrillators, etc. and you're proudly declared a "success" of medical technology.

Of course, none of these procedural treatments cures the disease, no more than a Band Aid® heals the gash in your leg. The conditions that were present that created your heart disease continue, allowing a progressive disease to worsen. At some point, you will need to return to the hospital for yet more procedures when trouble recurs, which it inevitably does.

A coronary bypass operation costs, on average $85, 653 (AHA 2008 Update; based on 2004 data). That doesn't include the $25,433 cost for the heart catheterization performed by a cardiologist to provide the surgical roadmap of your coronary arteries. If there are any complications of your procedure, then your hospital bill may total a substantially higher figure.

$85, 653 is just the upfront financial pay-off. Over the long run, your life is actually worth far more to the cardiovascular healthcare system because no heart procedure yields a permanent fix. In fact, repeated reliance on the system is the rule.

In fact, over 90% of people who enter the American cardiovascular healthcare system do so through a revolving door of multiple procedures over several years. It is truly a rare person, for instance, who undergoes a coronary bypass operation, never to be seen again the wards of the hospital because he remains healthy and free of catastrophe. A much more familiar scenario is the man or woman who undergoes two or three heart catheterizations, receives 3,4, or 6 stents, followed a few years later by a heart bypass, pacemaker, defibrillator, as well as the tests performed for catastrophe management, such as nuclear stress test, echocardiogram, laboratory blood analysis, and consultation with several specialists. Re-do bypass surgeries--a 2nd, 3rd, or 4th bypass--now comprise 25% of all bypass procedures.

The total revenue opportunity is many-fold higher than the initial 80-some thousand dollars, but instead totals hundreds of thousands of dollars per person.

What motivation can there possibly be to 1) identify coronary disease early, when in its asymptomatic stage, then 2) identify its causes, then 3) correct the causes, and finally 4) shut off the disease? You and I can accomplish this with a few hundred dollars of cost, perhaps a few thousand over many years (to cover costs of fish oil, vitamin D, niacin, and whatever else it takes to stop the expression of the disease). Nobody therefore profits substantially from your prevention effort--except you.

Then what if nobody told you that heart disease could be managed this way? That's what I mean by "disease engineering."

Dr. Steven Gundry on The Livin' La Vida Low-Carb Show

20. October 2008 William Davis (4)

I stumbled on a great interview with cardiothoracic surgeon, Dr. Steven Gundry, on Jimmy Moore's Livin' La Vida Low-Carb Show. (Or, cut and paste: http://www.thelivinlowcarbshow.com/dr-steven-gundry-part-1-episode-179/)

Dr. Gundry has some fun ways of looking at eating and health. I found his comments on the activation of genes (discussed at a very light, non-scientific level) useful. He argues that when humans consume sugar-containing foods, the signal received by the body is that winter is approaching and it's time to build up fat stores in anticipation of the food shortages of cold weather. He finds parallels for this phenomenon in other species. Of course, for humans, winter (in the form of extended calorie deprivation) never comes. In fact, you might argue that, given our excessive reliance on grains, corn, and sugars, that we are, in effect, always in anticipation of a winter that never comes.

I've not read Dr. Gundry's books, but I found this light interview a lot of fun.

Does fish oil ADD to statin therapy?

18. October 2008 William Davis (9)

Yet another patient came to my office today saying, "My primary doctor said that I should stop taking fish oil. He say's that I don't need it because I take Crestor."

The woman was in tears, confused and frightened over a potential disagreement between her doctors.

Is this true? If someone takes a statin drug, like Crestor, Lipitor, Zocor (simvastatin), pravachol, or lovastatin, they don't need to take anything else because the statin drug is so powerful that it eliminates risk?

No. Not even close to the truth.

First of all, let's accept that virtually the entire body of statin drug literature--hundreds of studies, billions of dollars spent--was paid for by the drug industry. It's no news that studies paid for by the sponsor are likely to favor the sponsor. Imagine Ford sponsored a study of Ford vs. GM cars vs. Toyota, paying $10 million to fund the effort. Guess who is likely to come out on top? "Studies show that Ford makes the best car in America." (Sorry, I don't mean to pick specifically on Ford. It's just a widely-recognized brand.)

So that means that the statin literature likely overestimates the benefit of statin drugs. Even so, it's clear from the hundreds of studies performed that the best we can hope for by taking statin drugs is a reduction of heart attack and death from heart attack of 30-35%--best case. That doesn't sound like elimination of risk to me.

What are the incremental benefits of adding omega-3 fatty acids from fish oil added to statins? The best data originate with the JELIS Trial (Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis), in which 19,000 Japanese participants (who already have a high omega-3 intake from diet, usually ranging from 1800-3000 mg per day) experienced a 19% reduction (relative reduction) in cardiovascular events.

GISSI Prevenzione demonstrated a 28% reduction in heart attack, 45% reduction in death from heart attack with fish oil.

Omega-3 fatty acids from fish oil also:

--Reduce triglycerides dramatically
--Accelerate after-eating clearance of digestive by-products, i.e., they correct post-prandial abnormalities
--Modify the character (fragmentation potential, structural strength) of plaque
--Raise HDL modestly

If you buy your fish oil from Sam's Club, Costco, or other discounter, a healthy dose of fish oil might cost you $3 per month. Compare that to the $120 per month average cost of a statin agent. Why is there even a discussion over this?

Sadly, the doctor on Main Street, U.S.A, is the unwitting puppet of the pharmaceutical industry. The pretty drug company representative with nice legs and a cute smile promises lunch, dinner and . . who knows what else? Wink. The fifty-something, hairline-receding doctor can't resist. "Of course I'll prescribe your drug!"

Don't kid yourself: The drug industry knows precisely how to manipulate the behaviors of the deliverers of their products.

So, do statin drugs make omega-3 fatty acids from fish oil irrelevant? Absolutely not.

It's all about trying to inch closer and closer--not to reduction--but to elimination of risk for heart disease.

HDL: “H” is for “happy”

16. October 2008 William Davis (10)

What role do emotions play in HDL cholesterol?

I’ve often observed a peculiar phenomenon: People who come to the office or hospital in the midst of a difficult emotional situation-e.g., stress at home, financial struggles, hospitalization (usually an unhappy occasion)- can show dramatic drops in HDL cholesterol. Not uncommonly, HDL drops 20 or more mg/dl.

Take Agnes’s case. Agnes had to go to the hospital for an elective procedure, one she’d been dreading for months. Previously, Agnes had been proud of the fact that she’d incrased HDL from 42 mg/dl range all the way up to 71 mg/dl. She accomplished this dramatic increase by eliminating wheat and cornstarch from her diet (which helped her lose 24 lbs), taking vitamin D and omega-3 fatty acids from fish oil, exercise, 2 oz of dark chocolate per day, and a glass of red wine with dinner.

Although I wouldn’t have bothered checking a cholesterol panel for such a procedure, the hospital had a checklist that included a cholesterol panel regardless of necessity. (Such checklists are common in hospitals, meant to ensure that certain basic issues are not overlooked.)

Agnes’ HDL: 29 mg/dl-a 42 mg drop.

Agnes will recover and her HDL will rebound, but the same effect can occur with other stressful situations, such as death in the family, financial worries, marital stress, etc., as well as physical illness.

Interestingly, the opposite may also hold true: Low HDL may increase risk for depression and stress. A study from Finland of 124 depressed persons, for instance, showed a 240% increased likelihood of depression in those with lower HDL cholesterols.

In other words, there seems to be a curious interdependence between HDL and emotions.

Why? Does it represent the indirect effect of adrenaline, cortisol, or other “stress hormones”? Do factors that relate to low HDL, such as unhealthy diet full of carbohydrates and physical inactivity, also tend to cultivate depression?

It certainly seems to be a chicken-egg situation, with one often leading to the other.

Moral of the story: Maintaining a sense of optimism and engaging in activities that bring you satisfaction and enjoyment can help raise HDL, as can strategies such as those followed by Agnes. Avoiding unnecessarily stressful situations can help. HDL is important, since higher levels are associated with much reduced risk for heart disease . . . and perhaps depression.

Is it mainstream or alternative?

24. May 2006 William Davis (0)

A question I get about once a week: "Is your program a kind of alternative medicine?"

Our program for control and reversal of coronary plaque using CT heart scans applies an eclectic panel of tools to achieve its goals. We use high-tech methods like lipoprotein analysis and CT heart scans; nutritional supplements like fish oil, vitamin D, and l-arginine; diet strategies and "functional foods" (using foods as a therapeutic tool); and conventional medication.

I don't consider this approach "alternative" in the sense that it uses unmeasurable or spiritual strategies. But I don't consider it mainstream, either, since current mainstream practice of heart disease prevention is far less rigorous with far less satisfactory results.

I think I can sum up the Track Your Plaque approach by saying that we use tools that work. Our measure of success is whether or not your heart scan score is stopped or reduced--that's hard to fudge. You can call it what you will, but I call it the best program for heart disease prevention I know of, alternative or mainstream.

Want to see someone turn diabetic?

24. May 2006 William Davis (0)

If you want to witness the transformation of someone into a pre-diabetic or diabetic, put them on a low fat diet.

Dr. Dean Ornish's program, detailed in his books, Dr. Dean Ornish's Program for Reversal of Heart Disease and Eat More, Weigh Less , are woefully outdated in 2006. Yet the low fat notion continues to show up in the consciousness of people I talk to about heart disease reversal.

"I'm already on a low fat diet. Do you think my heart scan score has reversed?"

Highly unlikely. What Dr. Ornish (as a non-cardiologist, by the way) failed to recognize is that what he did manage to reverse in a small number of people is something called "endothelial dysfunction", but he did not reverse or shrink coronary plaque.

Given the limitations of technology when the Ornish concept got its start, it appeared as if reversal was obtained. In reality, all his approach accomplished was a relaxation in tone of abnormally constricted arteries, thus giving the appearance of reversal. Increased artery tone, or endothelial dysfunction, is extremely common when atherosclerotic plaque is present.

Any cardiologist will tell you that there are many ways to reverse endothelial dysfunction: exercise, weight loss, cholesterol drugs, drugs for high blood pressure, fish oil, hormonal therapy, vitamin C, l-arginine, etc. There is nothing special about a low fat diet.

In fact, Track Your Plaque followers will recognize that a low fat diet is, in fact, potentially harmful, particularly when low HDL or small LDL is part of your pattern.

Let's bury the outdated ideas of the Ornish low fat diet once and for all. It doesn't work. All it may do is confuse you and set you back from your real coronary plaque reversal program.

Inulin: A fiber for weight loss

23. May 2006 William Davis (10)

Here's an interesting product that seems to be gaining some popularity for weight loss: Inulin.

Not to be confused with "insulin", with which it is completely unrelated, inulin is a naturally-occurring plant fiber. It's found in broccoli, asparagus, celery, etc. Like beta-glucan from oats or pectin, inulin is a so-called soluble fiber, a fiber that assumes a gel-like consistency when exposed to water.

Inulin has the effect of increasing satiety, or the sensation of fullness. This cuts your craving for foods. I've tried it recently and I prefer it over glucomannan, another soluble fiber for satiety.

The people at Stonyfield Farms have been adding inulin to their yogurts from some time. The nutritionist at the company tells me that there's 2-3 grams of inulin per 6 ounce container of their yogurt.

You can also find inulin as a supplement that you can add to foods, available from some health food stores and online supplement companies. I came across a neat product called Fiber Choice that's now being distributed widely throughout the U.S. I tried their Weight Management version. It was a delicous strawberry taste. The label says take two chewable tablets twice a day, but I found that two tablets three times a day somewhat better. It's best taken around 30-60 minutes prior to each meal and it causes you to be fuller with less food. One caution: It'll cause loads of gas, especially in the beginning. For that reason, you might try starting with a smaller dose, or start on the weekends when you have the option of some privacy!

More info on the Fiber Choice product can be found at their website, http://www.fiberchoice.com.

Disclaimer: I have no relationship with the manufacturer of this product. I'm simply passing on some thoughts on my experience with this interesting possibility for weight loss.

Will you recognize the truth when you see it?

23. May 2006 William Davis (0)

Do you ever wonder that, if the truth were given to you, that you'd recognize it as such? Or would you dismiss it as just another bunch of nonsense?

After all, you and I live in the Information Age. It means that we have access to mountains of information like never before in human history. But it also means that the truth is often drowned out by an avalanche of mis-truths, sales pitches and marketing, and just plain nonsense.

This struck me the other day when I was talking to a patient.

64 years old with a high heart scan score placing her at significant risk, she looked confused. I'd just described the multitude of causes of coronary plaque that we'd uncovered. The heart scan alone had been a shocker.

"I don't understand. My doctor told me that I had nothing to worry about. I've known him for years and he knows me really well. He did a stress test. That was fine. I don't get all this other stuff you're telling me--lipoprotein whatever..."

Despite my efforts to help her gain an understanding of our intensive approach, she just became increasingly more frustrated. "I just don't think I can do this."

That's the last I've heard from her. As far as I know, she's returned to the comfort of her family doctor who has reassured her over the years. And perhaps there's some good in that. But I do fear for the day when, unexpectedly, she suffers some catastrophe that we told her was coming sooner or later unless real preventive efforts were started.

You could say that she failed to recognize the truth when it was given to her-- boldly, unadorned, and with far greater scientific certainty than the casual reassurances she was accustomed to. But, unfortunately, that's all that some people want.

Don't neglect the basics in your heart disease reversal program

23. May 2006 William Davis (0)

Carl loved new ideas and novel approaches. You could tell by the sheer number of nutritional supplements he took. His list had grown to 18 different supplements over the past two years.

Carl came to me for coronary plaque regression. Lipoprotein analysis did uncover several previously unsuspected abnormalties, most notably small LDL particles and lipoprotein(a). In addition, Carl's LDL cholesterol ranged between 111 mg-156 mg and he was clearly hypertensive, with systolic blood pressures consistently around 150-160. (Recall that people with Lp(a) are more prone to hypertension.)

Carl was more than willing to have his lipoprotein(a) reduced. We did so with niacin and testosterone and the level dropped to near zero. Likewise, we corrected his small LDL pattern with niacin, fish oil, and a reduction in processed carbohydrates.

But Carl really resisted doing much about his LDL cholesterol and high blood pressure. I got the sense that these "boring" issues simply didn't interest him. After all, LDL cholesterol and blood pressure were the stuff of TV commercials and the popular conversation propagated by drug companies.

Carl's follow-up heart scan, however, finally persuaded him: a 24% increase in one year, likely due to the neglect of the basic issues.

I liken Carl's case to being like the teenager with a new car who polishes the paint to a bright finish, puts new wheels and tires on it, spruces up the interior with various doodads--but then fails to change the oil. Sometimes it's the most basic issues that can diminish your success.

Issues like LDL cholesterol and high blood pressure aren't the most glamorous, but they do count in your coronary plaque control program.

Is your doctor a hospital employee?

21. May 2006 William Davis (0)

There's a disturbing trend that's growing--silently but rapidly.

In Milwaukee, three hospital systems compete for the local health care dollar. To gain more control over revenues and the routing of patients, the hospitals are aggressively hiring physicians to work for them. I've witnessed many of my cardiology colleagues, primary care doctors, and a substantial number of procedural specialists enticed by the offers made by hospital employers.

This phenomenon is not unique to Milwaukee but is being used in many, perhaps most, major cities in the U.S.

This means that physicians are employees of the hospital. That way, employee-physicians are obliged to use only the hospital system that employs them. In the old days, your doctor could use any hospital he/she desired, depending on the quality, location, facilities, etc. Now, many physician-employees are given no choice but to use the hospital that pays their salary.

That by itself is not necessarily bad. But combine salary with incentives for bringing in patients for hospitalization and procedures--that the rub. In other words, physician-employees are incentivized to generate more revenue for the system, just as employees in many other industries.

If you're a salesman for an insurance company, your job is to bring in more business. If you're a worker on an auto production line, you're expected to meet certain quotas. These same principles are now being applied to many physicians.

How does this affect you? Well, if your physician--especially procedure-driven specialists like cardiologists, general surgeons, orthopedists, etc.--is a hospital employee, BEWARE! Do you really need that procedure, or is your doctor suggesting you have a procedure because it will add to his track record?

Prevention? In this model of health care, why bother? It certainly doesn't pay for a hospital to keep you well. Then why should your physician-employee?

Be careful who you're dealing with. If your physician is a hospital-employee, don't bet on getting preventive care. It's more likely you're that just a future source of revenue when it's time for your bypass operation, hip replacement, carotid endarterectomy, etc.

What more powerful argument is there for increased self-empowerment and information for health care consumers?

Take a walking vacation

20. May 2006 William Davis (1)

If you're planning a vacation, why not consider a walking vacation?

The concept is really taking off. All you need is a pair of comfortable shoes and an interesting locale. More and more services are popping up to help you plan fun and interesting destinations and itineraries. One such catalog can be found at http://walking.about.com/od/tours/a/walkingvacation_3.htm

Lengthier walks may require some advance planning and toting some supplies. Don't forget the water!

From a health viewpoint, a walking vacation sure beats the heck out of a cruise that packs on 12 pounds of extra weight from the 24-hour a day buffet. If you're in the midst of a weight loss effort, several hours of walking through interesting locales and scenery can make it effortless.

There's loads of neat places to visit from a walker's perspective. One interesting website is www.waterfallwalks.com that lists trails that provide spectacular views of waterfalls.

Another variation on this theme is biking vacations. My wife and I are trying to set the time aside for a biking tour of wineries in the French countryside. That's our kind of multi-tasking!

"Expanded indications for implantable defibrillators"

19. May 2006 William Davis (0)

So reads the headline on a magazine I received recently (along with thousands of my colleagues) from a major hospital system.

It goes on to say: "In January 2005, indications for implantable cardioverter-defibrillators (ICDs) were substantially broadened [emphasis ours] to include most patients with a left ventricular ejection fraction (EF) of 35% or less. This change translates into a 2- to 3-fold increase in the number of Medicare beneficiariries eligible for ICDs."

Ka-ching!!! Hear the money piling up in the bank?

The device manufacturers are constantly churning data and lobbying for reimbursement to expand the use of their devices to more and more people. Defibrillators in particularly are generally a $25,000 to $50,000 opportunity for the device manufacturer alone, not counting the costs incurred at the hospital for implantation.

Beware. As reimbursement for stents and other procedures diminishes, expect a sudden "demand" for more and more people to get implantable defibrillators. Better yet, stay away from the whole issue by preventing your heart attack.

Get a heart scan--but then don't delay taking action!

19. May 2006 William Davis (2)

I just came from one of the local hospitals after having performed a heart catheterization on a patient I met earlier this week.

Jack had gotten a heart scan a year ago with a score of 246, placing him in the 76th percentile. The "event" rate with this percentile rank is around 3% per year--not very high but enough to pose risk over a long period.

Jack chose to ignore his score. After all, the pressures of work at the University, maintaining his home and yard, etc. consumed all his energies. He came to my office--now one year after his scan--and told me about the chest pressure he was getting. Initially, his chest pains occurred with extended walking. In the past week, however, Jack was experiencing chest pressure with just walking 30 feet.

This pattern of increasing symptoms is called "accelerated angina", meaning that Jack was rapidly heading towards a heart attack. So I advised a heart catheterization in near future.

Jack's catheterization showed extensive plaque including a 50% blockage in the mainstem artery and 90% in the artery to the front of the heart (left anterior descending artery). Jack is going to have a bypass operation tomorrow.

What if Jack hadn't ignored his heart scan from a year ago? Well, I'd be very confident in saying that he would not be undergoing bypass surgery tomorrow.

The lesson: Don't dilly-dally on taking action to keep your plaque from growing. While it's not an emergency, it can easily become one if you choose to ignore your scan.

Feel that nudge in your back?

17. May 2006 William Davis (0)

You feel that nudge in your back? That's your local hospitals competing for your bypass surgery business.

Just this morning while watching a morning news show, I saw three advertisements for hospital bypass surgery programs. One ad featured a man in his 50s telling his story:"The cardiologist determined immediately that I needed a triple bypass operation. My family and I are very grateful to _____ hospital!"

In what other field is failure celebrated so prominently? When I see these ads, I hear "My doctors failed to provide early detection and then prevent what became a life-threatening condition, even though heart disease is a chronic process that requires decades to develop." What if our man said instead,"I had a heart scan and my score was high. So I was shown why I had so much plaque. They then showed me how to control and even reduce the amount of plaque I had. I'm living safely and symptom-free without need for surgery or procedures."

Of course, the hospital is out $60,000-100,000 for the surgery. How else could they afford ad campaigns costing several million dollars a year? See these advertisements for what they are: Marketing generated by profit-seeking businesses competing for your dollars--lots of them.