The processed food battlefield

If you have any remaining doubts that the processed food industry is a cutthroat, go-for-the-jugular, organized effort to extract every possible penny from your pocket, even at the expense of health, take a gander at a quote from Marion Nestle's wonderful book, Food Politics.

In Nestle's description on how food conglomerate, Archer Daniels Midland (ADM), conspired to fix prices on some basic agricultural compounds, she quotes an ADM executive captured on videotape and presented in court:

"We have a saying at this company . . . our competitors are our friends and our customers are our enemies."

In other words, ADM's competitors help establish what prices should be charged for basic foodstuffs, while its customers are the ones to do battle with.

Food is a necessary commodity. You and I only need so much of it. So how does a 40 billion dollar food manufacturer extract greater and greater profits and grow their market? Motivate people to eat more. It's that simple.

Eat less? Are you kidding? Eat spinach, green peppers, beets, and other low-margin products? Get real.

Why not take 8 cents worth of wheat flour, add some sugar, food coloring, and some other enticing flavorings like high fructose corn syrup? Put it all in a cleverly illustrated package, maybe even develop an entire story line about the product, complete with clever slogans and songs and . . . ouila! You now have a food that sells for many, many times its intrinsic value.

How to make the health nuts happy? Easy: Add some fiber. Now it's healthy! And it's now part of a "balanced diet".

What if it's full of corn starch, wheat flour, and sugar of the sort that make HDL cholesterols plummet, fan the flames of small LDL, increase inflammatory measures like C-reactive protein, push people closer and closer to diabetes, and make them fat? Then be sure it's low in saturated fat! It might even qualify as "Heart Healthy" by the American Heart Association!

Processed foods have no role in the Track Your Plaque program. If you want to see your CT heart scan score skyrocket, go to your grocery store and stray into the aisles outside of the produce aisle.

But stick to the produce aisle and watch your wallet grow, your health improve, your appetite shrink, all while food processor profits plummet.

Heart Scan debate

A few years back when the book form of Track Your Plaque was first released, I did a bunch of radio and interviews to raise awareness of the book and of CT heart scanning in general.

I'd forgotten about this interview I did for National Public Radio (NPR), in which I debate Dr. Graboys from Harvard. Though I've had this debate countless other times, usually on a less formal basis, I didn't know what to expect at the start of the interview. After all, I knew of Dr. Graboys' reputation as a respected Harvard cardiologist. So I was expecting that at least he would argue that, being relatively new at the time, CT heart scanning was largely unproven in large clinical trials. (This was not entirely true then, however, as at least 1000 trials had already been performed, many of them involving thousands of participants. However, despite that much validation, the concept of CT heart scanning had still not entered the consciousness of most practicing physicians. After all, heart scanning is not part of the "crash and repair" equation that most have invested their career in.)

Heart Hawk re-discovered the debate, still on the NPR website. So here it is. When I re-listened to the debate, I was surprised at how little Dr. Graboys had to offer. He argues that examining left ventricular function should suffice as an important measure of mortality. In other words, if you have experienced a drop in the strength of heart muscle, that can be used to stratify your risk of death.

I tried to convey to the audience (NOT convince Dr. Graboys to believe, as most of my colleagues are stubbornly adherent to their way of thinking until someone tosses a big carrot in front of them) that CT heart scanning provides a means to detect coronary atherosclerosis years, even decades, before questions of mortality (death) became necessary. Heart scanning identifies disease in its early stages so that a program of prevention can be followed and tracked.

Dr. Graboys expressed concern that heart scanning devices could be mis-used to increase hospital procedures. He's absolutely right here. By that same line of thinking, say your crooked auto mechanic on the corner scams most of his customers by doing unnecessary car repairs. Does this mean that we should ban all auto mechanics from repairing cars? I hope not. I believe it does mean that we should all be educated on distinguishing scams from an honest businessman.

Same with heart scans. The key is not to ban heart scanning. We should try to educate the public and physicians to prevent these sorts of scams and decisions based on ignorance from occurring.

Nonetheless, make your own judgments.


CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play)

Break the addiction

"But, doc, I can't lose my cereal! Pretzels--you've got to be kidding me! I eat 'em every night! I can't do it. I'll be hungry all the time!"

This is a discussion I have every day. The usual suspect: A 50-some year old with HDL in the 30s or 40s, small LDL, borderline high blood sugar approaching the pre-diabetic cut-off, highish blood pressure, excess tummy. They usually struggle with energy, feelings of sleepiness, use lots of caffeine to stay alert even in the middle of the day after a sufficient night's sleep.

Not as obvious as the tremulous, pinopint-pupil drug addict, but I recognize it nonetheless: The processed food addict.

Breaking this addiction can be as difficult for some people as breaking a smoking addiction. Instead of nicotine cravings, they get insatiable hunger. Just 3 or 4 hours without their processed food "fix," and they are ravenous to satiate their impulse. Most give in and go right back to the vicious cycle.

But break the cycle--eliminate processed foods like breakfast cereals, whole wheat crackers, pretzels, cookies, granola bars, fruit drinks, low-fat salad dressings, bran muffins . . .70+% of the foods in your supermarket---and you will make an interesting discovery:

You no longer crave these foods.

Just think about it: The addictive properties of processed foods are a food manufacturer's dream. What other product besides cigarettes has an addictive quality that ensures you come back for more... and more and more.

It it just too creepy that much of the processed food industry is, in reality, owned by the tobacco industry (Altria, previously known as Phillip Morris) and RJ Reynolds. Perhaps that is the modus operandi of these corporations: Identify products that have an edge, foods or other products that possess an addictive quality. This is not true of cucumbers, for instance. What a lousy investment a cucumber grower would make!

Be smarter than Phillip Morris. Outsmart the people looking to empty your pocket and corrupt your health. Break the addiction.

Hang around the produce aisle of your grocery and use the farmer's market or your local equivalent. Look for locally grown foods. Try to keep your food as unprocessed as possible.

You will be impressed with the results.

Are we done here?

Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.

Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy.

Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart.

Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before.

I explained to Les that having normal coronary blood flow was just one aspect of the issue.

"But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"

I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack.

"With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."

So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him.

Now, if we could only transform Les into an optimist . . .

Wheat belly

You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer.

How about "wheat belly"?

That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta.



(By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.)

It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc.

How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere.

Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner.

"But that's what they told us to eat after Dan left the hospital after his last stent!"

Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc.

I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world.

As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.

Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.

You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program.

If health won't motivate them, maybe money will

As part of our ongoing effort to educate everyone about the value of heart scans and All posts by william-davis

"Get regressive"

This caught my eye:



Niaspan, prescription niacin, now sold by Abbott Laboratories, is now promoting its advantages in regressing coronary plaque:



In patients with a history of coronary artery disease (CAD) and hypercholesetgerolemia, Niaspan (niacin), in combination with a bile acid-binding resin, is indicated to slow progression or promote regression of atherosclerotic disease.



And the new slogan: "Get regressive."



Interestingly, the new marketing campaign is based on relatively old data. They base this new claim on 3 studies:



1) Cholesterol-Lowering Atherosclerosis Study (CLAS)--a 1987

CRP House of Cards

Lew has coronary plaque with a heart scan score of 393. At age 53, that's in the 90th percentile (higher score than 90% of men in his age group).

On our search for causes of his coronary plaque, we identify low HDL of 41 mg/dl, high triglycerides of 202 mg/dl, small LDL (83% of total), calculated LDL of 133 mg/dl, and severe vitamin D deficiency with a starting blood level of 25-hydroxy vitamin D of 19 ng/ml.

His c-reactive protein: 4.1 mg/dl--above the cut-off of 2.0 mg/dl that the pharmaceutical industry is targeting as a mandate for statin therapy, particularly given the JUPITER data.

Lew instead eliminates wheat and other small LDL-provome? I know when I'm in traffic in a car or on a bicycle, it often feels like I am at the mercy of hordes of people in a hurry, the soccer Moms on cell phones, applying makeup and eating, the hormonal teenager, the occasional drunk. Living in the midst of it must be demoralizing, a sense that you are lost in a sea of uncaring humanity stripped of individuality. When I look outside my den window right now, I see the lawn that I cut and water and the flowers and evergreen trees I've planted over the years. It provides a sense of life, belonging, and earth. What if instead I saw anonymous cars buzzing by, dozens of unfamiliar faces every minute, none of which plays any palpable role in my life?

--This simple observation will add to the healthy-consciousness and Green movements, since it is just one more piece of evidence that congestion and urbanization do indeed take their toll. In an obtuse way, I think this is one step closer to increasing disillusionment over the "over-processing" of human experience: processed foods, depersonalization and alienation in neighborhoods and homes, the dissolution of the American family.

Lastly, notice how the conversation about CT (in this case, EBT) heart scanning has seamlessly worked its way into conversation? Just ten years ago, a long-winded explanation would have been required in press reports on just what CT heart scanning was. Now, the information is presented and--well, we all know what heart scanning is, right?

A small study but one that comes at an important time. Good things will come from this one study. It will work its way into discussions about where to locate schools, how to situate homes in relation to heavy traffic, it will help "legitimize" this wonderful tool called heart scanning. How many medical tests beyond blood work can be easily performed in 4500 study participants?

I always like to take some simple observation and see how it fits into developing trends. Few studies or other human-generated experiences by themselves change the world. Instead, it happens in little incremental bits and pieces.

Digging for the truth

I remain continually amazed how difficult it can be to gain an understanding of what is true and what is not true. I am particularly worried about the messages provided by agencies that stand to make enormous gains by persuading us to believe their version of the "truth".

For a moment, let's strip away the charitable covers of some financially-motivated organizations and see what they really look like:


Hospitals: The dream of hospitals is to shift the proportion of patients towards those with the most profitable diseases in well-insured patients. Heart disease is among the best paying diseases. HOSPITALS WANT YOU TO HAVE HEART DISEASE.

Doctors: Many (though not all) want to deal with diseases that pay well. Implanting a stent can pay several thousand dollars. Putting in a defibrillator can likewise pay handsomely, even better than stents. DOCTORS WANT TO STEER YOU TOWARDS PROCEDURES THAT REIMBURSE GENEROUSLY. Talk is cheap and pays poorly. Heart scans? Useless, since they're cheap. CT angiography? Now we're talking! $1800 dollars is a lot more interesting than $200 or so for a simple heart scan. CT angiograms also lead to catheterization, stents, hospitalizations.

Drug manufacturers: The holy grail for drug manufacturers is a chronic condition that is present in large numbers of people. An antibiotic, for instance, is a drug manufacturers waste of time: Short courses of treatment in relatively few people. Cholesterol drugs, blood pressure drugs, drugs to modify personality or some aspect of behavior--these you take for years, decades, or a lifetime, and millions are persuaded they need them. DRUG COMPANIES WANT CHRONIC CONDITIONS (WHETHER OR NOT THEY'RE DISEASES) IN PEOPLE WHO SURVIVE FOR A LONG TIME, NOT SICK PEOPLE.

Supplement manufacturers: What don't we need in the eyes of sellers of nutritional supplement? While a program like Track Your Plaque makes liberal use of supplements in a focused and, I believe, rational way, supplement sellers want you to take dozens or preparations of dubious value: milk thistle, hawthorne, ribose, hoodia, silymarin, hydroxycitric acid . . . Unlike the larger ambitions and bigger money of the pharmaceutical industry, the supplement industry is often driven by the momentary craze and the quick payoff. THE SUPPLEMENT INDUSTRY IS LOOKING FOR SUCKERS.

Food manufacturers: The holy grail for the food industry are foods that have high markups, are convenient (e.g., eaten right out of the box or package), and are purchased repeatedly. Even better, if a health claim can be added, it can ride the current wave of the public's health consciousness. Thus, Cocoa Puffs can be labeled "Heart Healthy". How about foods that have addictive potential and virtually ensure repeat sales? Eat some and you want more within 2-4 hours! As nutritionist Marion Nestle says, the mantra of the foods industry is "Eat More". It is my firm conviction that the epidemic of obesity in the U.S. is not due to laziness, video games, and computers. It is the fault of food manufacturers. FOOD MANUFACTURERS WANT US FAT AND HUNGRY AND WANT US TO STAY THAT WAY. What pays better, a 110 lb vegetarian woman who shops at the farmer's market and buys locally produced foods, or the 260 lb glutenous and always-hungry woman who fills her supermarket shopping cart with 15 cents worth of flour and sugar priced at $4.59 (cleverly disguised as a healthy breakfast cereal), instant mixes, convenient meals, energy bars, and chips?

Government agencies: User fees for the FDA paid by drug companies have caused the FDA to be beholden to drug company pressures. The USDA, charged with crafting the food pyramid, was created to support the farm industry and distributors of their products, not to disseminate public health. The food pyramid is the watered down end result of food industry lobbying and threats, not the scientific advice of nutritionists. GOVERNMENT AGENCIES SERVE INDUSTRY FIRST, THE PUBLIC SECOND.

Health websites: Read popular websites like WebMD for information and the conversation quickly steers towards drugs. "Natural treatments for cholesterol" talks about reducing saturated fat and then gushes about the wonders of statin drugs. Guess where 80% of WebMD's revenues come from? Yup, the drug industry. The same goes for many magazines, TV shows, and other media. MEDIA IS OFTEN THE TOOL OF BIG INDUSTRY.



I'm sounding like a conspiracy theorist. I don't believe that I am, but I am skeptical of the messages we often receive from the media, advertisements, news reports, websites, etc. It's left to you and me to use our judgment and decide what is truth and what is someone's version of a message crafted towards their hidden agenda.

I am hoping that the real truth will grow through a wiki-like phenomena driven and supervised by a collective knowledge that we all contribute towards. That will happen, most likely, on the internet. Just as Wikipedia overtook the revered Encylopedia Britannica in the blink of an eye at far less cost yet with greater depth and equivalent accuracy, so will it happen in health information. I'm uncertain of the eventual form this health-wiki will take, but it will shatter many smug and deeply-entrenched powers that at present continue to profit from mis-information.

Vitamin D and inflammation

We already know that vitamin D reduces inflammatory processes, since several markers, including c-reactive protein and IL-6 have previously been shown to drop substantially with vitamin D. Inflammation underlies coronary atherosclerotic plaque growth, as well as plaque rupture that triggers heart attack.

A German group has now shown that the important inflammatory marker, tumor necrosis factor (TNF), is also reduced by vitamin D supplementation. Many studies have implicated increased TNF levels in promoting cancer.

In this study, a modest vitamin D dose of 3320 units (83 micrograms) was given vs. placebo. The 25-hydroxy D level reached in the treated group was 34.2 ng/ml (85.5 nmol/L), which resulted in a 26.5% reduction in TNF compared with 18.7% reduction (?) in the placebo group.


Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers.

Zitterman A, Frisch S et al.

BACKGROUND: High blood concentrations of parathyroid hormone and low concentrations of the vitamin D metabolites 25-hydroxyvitamin D [25(OH)D] and calcitriol are considered new cardiovascular disease risk markers. However, there is also evidence that calcitriol increases lipogenesis and decreases lipolysis.
OBJECTIVE: We investigated the effect of vitamin D on weight loss and traditional and nontraditional cardiovascular disease risk markers in overweight subjects.
DESIGN: Healthy overweight subjects (n = 200) with mean 25(OH)D concentrations of 30 nmol/L (12 ng/mL) received vitamin D (83 microg/d) or placebo in a double-blind manner for 12 mo while participating in a weight-reduction program.
RESULTS: Weight loss was not affected significantly by vitamin D supplementation (-5.7 +/- 5.8 kg) or placebo (-6.4 +/- 5.6 kg). However, mean 25(OH)D and calcitriol concentrations increased by 55.5 nmol/L and 40.0 pmol/L, respectively, in the vitamin D group but by only 11.8 nmol/L and 9.3 pmol/L, respectively, in the placebo group.


(Calcitriol = 1,25-dihydroxy vitamin D.)


Knowing your vitamin D blood level is crucial, as individual need for vitamin D varies widely from one person to the next. You can get your vitamin D tested at home by going to Grassroots Health or the Track Your Plaque Marketplace.

Even monkeys do it


It all started back in the 1960s, when ape-watching anthropologists, Drs. Jane Goodall and Richard Wrangham, observed chimps foraging for a specific variety of leaf, which they consumed whole while wrinkling their noses in presumed disgust. Subsequent study showed that the leaves contained a powerful anti-parasitic compound.

A similar observation followed in 1987 by Dr. Michael Huffman from the University of Kyoto. During his year of living in the jungles of Tanzania, he observed chimpanzees in their native habitat. On one unexpected morning, he observed a female chimp, Chausiku:

“Chausiku goes directly to and sits down in front of a shrub and pulls down several new growth branches about the diameter of my little finger. She places them all on her lap and removes the bark and leaves of the first branch to expose the succulent inner pith. She then bites off small portions and chews on each for several seconds at a time. By doing this, she makes a conspicuous sucking sound as she extracts and swallows the juice, spitting out most of the remaining fiber. This continues for 17 minutes, with short breaks as she consumes the pith of each branch in the same manner.”

Dr. Michael Huffman’s description of Chausiku documents a fascinating example of animal self-medication what some call "zoopharmacognosy."
In this instance, the chimpanzee, weak, clutching her back in pain, and listless, was ingesting the leaves of the plant, Vernonia amygdalina, to purge an intestinal parasite. She recovered by the next morning.

Vernonia leaves have since been found to contain over a dozen potential anti-parasitic compounds. Chimps in this region commonly suffer infestations of parasites like Strongyloides fuelleborni (thread worm), Trichuris trichiura (whip worm), and Oesophagostomum stephanostomum (nodular worm). They have somehow stumbled onto a treatment that they administer themselves.

Chimpanzees have inhabited earth for over 6 million years. Who knows how long they and other primates have practiced some form of self-medication.

If chimpanzees can do it, I believe that we, as human primates, can also practice a similar form of self-directed health--homopharmacognosy?



Image courtesy Wikipedia

Cath lab energy costs

In honor of Earth Day, I thought I'd highlight the unexpectedly high carbon costs of activities in hospitals, specifically the cardiac catheterization laboratory.

A patient enters the cath lab. The groin is shaved using a plastic disposable razor, the site cleaned with a plastic sponge, then the site draped with an 8 ft by 5 ft composite paper and plastic material (to replace the old-fashioned, reusable cloth drapes). A multitude of plastic supplies are loaded onto the utility table, including plastic sheaths to insert into the femoral artery (which comes equipped with a plastic inner cannula and plastic stopcock), a multi-stopcock manifold that allows selective entry or removal of fluids through the sheath, a plastic syringe to inject x-ray dye, plastic tubing to connect all the devices (total of about 5 feet), and multiple plastic catheters (3 for a standard diagnostic catheterization, more if unusual arterial anatomy is encountered).

All these various pieces come packed in elaborate plastic (polyethylene terephthalate or other polymers) containers, which also come encased in cardboard packaging.

Should angioplasty, stenting, or similar procedure be undertaken, then more catheters are required, such as the plastic "guide" catheters that contain a larger internal lumen to allow passage of angioplasty equipment. An additional quantity of tubing is added to the manifold and stopcock apparatus, as well as a plastic Tuohy-Borst valve to permit rapid entry and exit of various devices into the sheath.

Several new packages of cardboard and plastic are opened which contain the angioplasty balloon, packaging which is usually about 4 feet in length. The stent likewise comes packaged in an 18-inch or so long package with its own elaborate cardboard and plastic housing.

At the conclusion of the procedure, another cardboard/plastic package is opened, this one containing the closure device consisting of several pieces of plastic tubes and tabs.

If the procedure is complicated, the number of catheters and devices used can quickly multiply several-fold.

By the conclusion of the procedure, there are usually two large, industrial-sized trash bins packed full of cardboard, plastic packaging, and discarded tubing and catheters. The trash is so plentiful that it is emptied following each and every procedure. None of it is recycled, given the contamination with human body fluids.

That's just one procedure. The amount of trash generated by these procedures is staggering, much of it plastic. I don't know how much of the U.S.'s annual plastic trash burden of 62 billion pounds (source: EPA) originates from the the cath lab, but I suspect it is a big number in total.

So if you are truly interested in reducing your carbon footprint and doing your part to be "green," avoid a trip (or many) to the cath lab.

Wag the Dog

What if the system to provide heart care has already gotten as big as it should be?

Worse (for hospitals), what if it’s already far larger than it needs to be? Can the system continue to increase revenues if they’ve already attained titanic proportions and outgrown demand? After all, darn it, there are only so many sick people around.

Hospital administrators might have to face an unpleasant choice: downsize to strip excess capacity and suffer the consequences in a competitive market, or . . . fabricate demand for their services.

Like the Dustin Hoffman and Robert DeNiro characters in the movie, Wag the Dog, about how two media-manipulators divert public attention away from a Presidential sex scandal by fabricating a war, spin is everything. It’s enough to sidetrack public attention from a scandal, obscure a truth, send us on a useless detour.

If healthcare for the heart isn’t driven by need, but many still desire to reap the benefits of the procedure-focused system, why not increase the perceived need?

That’s precisely the course that many hospital systems have chosen to follow. If the market you serve has been tapped to its full potential, then grow the market.

Imagine if a company like General Motors were to operate this way. In 2006, for instance, GM sold 9.1 million automobiles. If GM executives were to decide that they’d like to outstrip Toyota by boosting sales by 10% to 10 million, how would they do it? They would first have to determine whether it was feasible to grow demand for their product. If deemed possible, the company would need to ramp up manufacturing capacity to anticipate increased demand. If they miscalculate, GM could be stuck with a costly surplus and have to swallow the costs, maybe selling leftovers at a loss. (We don’t mean to pick specifically on GM; they’re a fine company as far as we’re concerned. This is just a hypothetical illustration.)

But what if a company could concoct some sort of scheme to persuade the car-buying public that they just had to have their cars or trucks? In other words, they could, in effect, create demand for their products.

As perverse as it sounds, that is exactly what occurs in healthcare for heart disease. The system long ago exceeded the necessary level of infrastructure to maintain a high-quality level of care accessible to most Americans. Instead, it continues to grow through a distortion of perception, delivering more services of increasing complexity to larger and larger numbers of people.

The size of the market is therefore a manipulable thing, something that can be massaged and cultivated. There are a variety of clever ways to exaggerate the need for heart procedures.

Why not raise the alarm for heart disease every chance you get? When a local sports figure survived a heart attack here in Milwaukee, St. _____ marketing department was right there, broadcasting the process in TV ads after his recovery. What could be more American than baseball, apple pie . . . and St. _____ Hospital? After his hospital discharge, the 57-year old local icon was shown on the sidelines with his team, back on the job, and at home with family, all beaming, just three months after a bypass operation. “I received only the very best care at St. _____ Hospital. They treated me like family. St. _____ doctors and nurses are the best!” Predictably, a two-month long spike in hospital testing followed filled with people worried whether they, too, might be in imminent danger. Several local cardiologists boasted of the many sports figures who came through the stress testing and heart catheterization labs, though virtually all checked out to be fine.

Though it can serve a legitimate purpose in some situations, stress tests are the ultimate example of a heart scam built on the perception of danger. Pull people in with promises of reassuring them whether or not they have heart disease, only to provide murky results that usually do no such thing. The pitfalls of the test are turned to advantage. The all too common equivocal or mildly abnormal result can be converted into a hospital procedure. (Imagine you could perform such alchemy on the uncertain calculations on your income taxes.)

With millions of stress tests performed every year and the push to perform more and more screening tests, the market has, in effect, been expanded—even though no increase in the disease itself has actually occurred.

Beware: As the scramble for heart patients intensifies, you are going to feel like you are being pulled closer and closer into the jaws of this hungry monster called the American cardiovascular healthcare machine.