Wheat-free 2007


Long ago, most of us made the change of reducing saturated fat in our diet. Few people now rely on butter (despite the idiotic butter vs. margarine controversy), full-fat dairy products, fried foods, and greasy meats. That's a healthy change, since saturated fat has conclusively been tied to various cancers, high blood pressure, rise in LDL, and is calorie-dense.

But if there were just one change you were to make beyond a reduction in saturated fat, a change that would translate into dramatic health benefits, it would be a drastic reduction, even elimination, of wheat products.

People do indeed eat enormous quantities of wheat flour-containing products. U.S. per capita consumption of wheat flour was 110 pounds in the early 1970s, and rose to 141 pounds in 1991. It's even higher now. 20% or more of most people's caloric intake every day is provided by wheat flour products.

Wheat containing foods are tasty and convenient. Witness the popularity of bagel shops, the goodie counter at Starbuck's, the proliferation of crackers, breads, and breakfast cereals at the grocery store. Patients are horrified when I suggest that they find a substitute for the sandwiches they eat every day. Even Mom said they were okay!

You're unlikely to hear much about this from the popular press. The wheat industry is enormous and exerts extraordinary clout, just like the drug industry. Texas alone farms 6 million acres of wheat, yielding over $2 billion for the state's economy. The "wheat chain" is complex and far-reaching: growers, processors, food manufacturers, the transportation industry, retailers, chemical producers, and on and on. Wheat futures are traded on the Chicago Board of Trade. Wheat is a major export industry for the U.S.

Of course, these are not evil people, intent on corrupting your health. In fact, most of them are probably working under the perception that they are raising a healthy product. The point is that the notion that wheat is healthy is deeply entrenched in the minds and economy of the U.S. Don't expect to hear unbiased commentary on the health effects of wheat products from most media sources.

What can you expect if you sharply reduce or eliminate wheat? The majority of people:

--Feel like a cloud has been lifted from their thinking.
--Don't experience the afternoon blah or tired feeling after lunch.
--Lose weight, sometimes substantial quantities.
--Raise HDL.
--Reduce small LDL.
--Reduce triglycerides, particularly if they start >100 mg/dl.
--Reduce blood sugar.

The reduction in small LDL can be especially impressive.

For most people, reducing or eliminating wheat is a sacrifice, a major change in food choices and even a loss of convenience. But the health benefits for most people can be dramatic.

Is vitamin D a "vitamin"?

Vitamins are crucial participants in the body's reactions and are obtainable from food. Vitamin C, for example, comes from citrus fruits and vegetables. Vitamin K comes from green vegetables. The B vitamins are found in meats, soy, dairy products, and grains. Vitamin A comes from carrots, squash, and other orange and green colored vegetables.

How about vitamin D? What foods contain vitamin D? The list includes:


Food International Units(IU) vitamin D per serving

Cod liver oil, 1 Tablespoon 1,360
Salmon, cooked, 3½ ounces 360
Mackerel, cooked, 3½ ounces 345
Tuna fish, canned in oil, 3 ounces 200
Sardines, canned in oil, drained, 1¾ ounces 250

Milk, nonfat, reduced fat, and whole, vitamin D fortified, 1 cup 98
Margarine, fortified, 1 Tablespoon 60
Pudding, prepared from mix and made with vitamin D fortified milk, ½ cup 50
Cheese, Swiss, 1 ounce 12

Ready-to-eat cereals fortified with 10% of the DV for vitamin D, ¾ cup to 1 cup servings (servings vary according to the brand) 40

Egg, 1 whole (vitamin D is found in egg yolk) 20
Liver, beef, cooked, 3½ ounces 15

(Modified from the Office of Dietary Supplements, National Institutes of Health)


You'll note that the only naturally-occurring food sources of vitamin D are the modest quantities in fish, egg yolks, and liver. All the other vitamin D-containing foods like cereal, milk, and other dairy products have vitamin D only because humans add it.

It takes me (personally) 6000 units of vitamin D per day to bring my blood level to an acceptable 50 ng/ml. To obtain this from eating salmon, I would have to eat 58 ounces, or 3 1/2 pounds of salmon--every day. Or, I could eat 30 cans of tuna fish.

If I didn't want to eat loads of fish every day, I could drink 60 glasses of milk every day. After I recovered from the diarrhea, my vitamin D might be adequate, provided the milk indeed contained the amount stated on the label (which it often does not when scrutinized by the USDA).

If vitamin D is a vitamin, how are humans supposed to get sufficient quantities? I don't know anybody who can eat 3 1/2 lbs of salmon per day, nor drink 60 glasses of milk per day. But aren't vitamins supposed to come from food?




The problem is that vitamin D is not really a vitamin, it's a hormone. If your thyroid hormone level was low, you'd gain 20, 30, or more pounds in weight, your blood pressure would skyrocket, you'd lose your hair, become constipated, develop blood clots, be terribly fatigued. In other words, you'd suffer profound changes. Likewise, if thyroid hormone levels are corrected by giving you thyroid hormone, you'd experience profound correction of these phenomena.

That's what I'm seeing with vitamin D: restoration of this hormone to normal blood levels (25-OH-vitamin D3 50 ng/ml) yields profound changes in the body.

If there's one thing that I've come across lately that packs extraordinary potential to help us in reducing heart scan scores, it's the vitamin--sorry, the hormone--cholecalciferol, or D3.

Heart scan curiosities 3


Note the shape of the chest in this 64-year old man. The front of his chest (upper portion of scan) is concave. In other words, if you were looking at this man (shirtless, of course) face to face, his chest would bow inward, rather than the usual outward configuration. The official name for this is "pectus excavatum".





Compare this to the normal chest in the second image, in which the chest is convex. Face to face, the chest would bow slightly outward.















What does it matter? The pectus excavatum in and of itself has no importance, just a curiousity. (I personally find this surprising, given the fact that the heart actually appears squashed by the sternum, or chest wall.) However, it is commonly associated with a "floppy" mitral valve (also called mitral valve prolapse), a common congenital disorder of the mitral valve often accompanied by a slender build, loose joints, and even a nervous disposition. Occasionally, in its more severe forms, the aorta is also enlarged. (This man's aorta is not enlarged.)

So, while we can't actually visualize the mitral valve by a CT heart scan, we can surmise that he likely has a floppy mitral valve, is slender, is probably a nervous sort, and has long limbs with loose joints. He probably required braces as a child, since many people have a phenemenon of "crowded teeth". The roof of his mouth, or hard palate, probably unusually high up in the mouth. He probably has a "weak chin", meaning a less prominent protuberance of his chin. His fingers and toes are likely unusually long and slender.

It could mean that some attention and exploration of how floppy his mitral valve might be could be useful, e.g., an ultrasound or echocardiogram. He might even require oral antibiotics at the time of any oral or some gastrointestinal procedures, since floppy valve are more susceptible to blood infections when potentially "dirty" orifices are instrumented.

All that from a heart scan!

Gratitude

The holidays and the end of the year may be a good time to reflect on how grateful we should be for having the freedom to discuss the ideas we share on this Blog, the Track Your Plaque website, online and offline.

Although I rant and rave against the status quo in heart disease, the shameful profiteering of my colleagues and hospitals, the cut-throat marketing practices of drug and device manufacturers, I am truly grateful that, in the U.S., I have the extraordinary freedom to say these things. You have the freedom to agree or disagree and none of us pays a price for truth.

I've been reflecting myself a great deal on this idea of happiness and gratitude being a critical component of coronary plaque regression and dropping your heart scan score. (See The Heart Scan Blog from earlier this week.) The more I think about this, the more I think that it is indeed true: Harboring anger and resentment, regrets, irritability, all those petty emotions that most of us know are not good for us, erode our chances for success in dropping your heart scan score.

We could rationalize it this way: Anger and other negative emotions are adrenaline-driven states, also characterized by activation of the "sympathetic" nervous system. (Despite its name, the sympathetic system is not sympathetic, as in compassionate; its the "fight-or-flight" activator that accelerates heart rate and blood pressure.)

Happiness, contentment, and gratitude are "parasympathetic" states characterized by slower heart rates, deeper respiration, greater variation in beat-to-beat heart rates (a powerful predictor for health and the basis for the HeartMath program of Lew Childre), lower blood pressure, and even a subtle change in brain waves. In other words, happiness is not just a mental and emotional state, it is a constellation of physical phenomena.

Even though I pick on Dr. Dean Ornish for his stubborn adherence to the outdated low-fat mantra, I do agree with him on the value of happiness. His book, Love and Survival, articulates this concept. Ornish has even said on several occasions that it wasn't the diet that was most important but the connection and warmth that was created by the comraderie created by participation in the Ornish Program group sessions.

I am personally grateful that the concepts I promote are gaining a following and that I can say so without fear of prosecution. I am grateful that Track Your Plaque followers are not just sharing our concepts, but obtaining genuine and powerful health advice that will help keep them home and healthy, away from hospitals, procedures, and the dangers of heart disease.

I hope you share in my gratitude and are thankful for all the truly wonderful things that surround us. I wish you all a wonderful holiday and long, healthy life filled with gratitude.

A Track Your Plaque failure

We recently had a man suffer a heart attack after beginning the program. Let me tell you the details.

Jerry's heart scan score 781, age 53. Multiple lipoprotein abnormalities: HDL 32 mg/dl, triglycerides 279 mg/dl, nearly all of his LDL was in small particles with an "effective" LDL (LDL particle number), and very high IDL. So Jerry added fish oil 6000 mg per day, niacin, and vitamin D to the statin drug prescribed by his primary physician. Jerry added oat bran, ground flaxseed, and tried to eat fish at least once per week.

However, Jerry continued to smoke. He'd smoked for 40 years (!), up to 2 packs per day, and just reasoned that it was too late to quit. He also continued to indulge in the packaged, processed foods that were part of his convenience story business.

Jerry's stress test was normal--no chest pain, normal EKG, normal images of blood flow, though he was somewhat breathless, likely from his lung disease from smoking.

Two months into his program, he abruptly experienced severe crushing pain in his chest. Because he was traveling, he ended up in a small local hospital. A failed angioplasty led to urgent coronary bypass surgery.

Jerry's alive. Now he's a non-smoker. He's got the pursed lips and peculiar breathing pattern that smokers get, but he's breathing.

Lesson: In the face of the most powerful program for heart disease known, it can still be overpowered by Twinkies, Hoho's, pretzels, chips--and cigarettes.

The new year is approaching. Be grateful for another year of healthy life and commit to a new year of even greater health. If you're a smoker, there's no choice: you've got to quit.

Are you more like a dog or a rabbit?

Dr. William Roberts, editor of the American Journal of Cardiology and cardiovascular pathologist, is a perennial source of clever ideas on heart disease.
In a recent editorial, Dr. Roberts comments:








"Because humans get atherosclerosis, and atherosclerosis is a disease only of herbivorers, humans also must be herbivores. Most humans, of course, eat flesh, but that act does not make us carnivores. Carnivores and herbivores have different characteristics. (1) The teeth of carnivores are sharp; those of herbivores, flat (humans have some sharp teeth but most are flat for grinding the fruits, vegetables, and grains we are built to eat). (2) The intestinal tract of carnivores is short (about 3 times body length); that of herbivores, long (about 12 times body length). (Since I am 6 feet tall my intestinal tract should be about 60 feet long. As a consequence, if I eat bovine muscle [steak], it could take 5 days to course through those 20 yards.) (3) Body cooling for carnivores is done by panting because they have no ability to seat; although herbivores also can pant, they cool their bodies mainly by sweating. (4) Drinking fluids is by lapping them for the carnivore; it is by sipping them for the herbivore. (5) Vitamin C is made by the carnivore's own body; herbivores obtain their ascorbic acid only from their diet. Thus, although most human beings think we are carnivores or at least conduct their lives as if we were, basically humans are herbivores. If we could decrease our flesh intake to as few as 5 to 7 meals a week our health would improve substantially."



You can always count on Dr. Bill Roberts to come up with some clever observations.

I think he's right. Some of the most unhealthy people I've known have been serious meat eaters. Most of the vegetarians have been among the healthiest. (I say most because if a vegetarian still indulges in plenty of junk foods like chips, crackers, breakfast cereals, breads, etc., then they can be every bit as unhealthy as a meat eater.)

Should you become a vegetarian to gain control over coronary plaque and other aspects of health? I don't believe you have to. However, modern livestock raising practices have substantially modified the composition of meats. A steak in 2006, for instance, is not the same thing as a steak in 1896. The saturated and monounsaturated fat content are different, the pattern of fat "marbling" is different, the lean protein content is different. Meat is less healthy today than 100 years ago.

Take a lesson from Dr. Roberts' tongue-in-cheek but nonetheless provocative thoughts. Pardon me while I chew on some carrots.

Are happy people more likely to reduce heart scan scores?

I was talking to Darryl, a patient today: 71 years old with a heart scan score of 378, as well as an enlarged aorta (4.5 cm).

We had identified numerous lipoprotein abnormalities 12 months ago and advised him on a program for correction. His patterns included small LDL, high triglycerides, sky-high IDL (VERY important when you have an enlarged aorta), and lipoprotein(a). Blood pressure was also high, another crucial fact to correct when the aorta is enlarged.

Anyway, Darryl corrected lipoproteins to perfection: basic lipids were substantially better than 60-60-60; lipoprotein(a) was reduced well into the desirable range; IDL was eliminated; blood pressure was 108/64. Repeat heart scan score: 354.

There's nothing spectacular about Darryl's story, except that, despite these issues, Darryl was a happy man. He smiled throughout our conversation. He has told me on several occasions how grateful he is for the life he has.

Darryl is not wealthy. He retired around 4 years ago and fills his day with helping his wife, walking outdoors, helping out at his church, and contributing to the care of his grandchildren. Through all this Darryl is incurably, unfailingly, and irrepressibly happy.

It made me think back through all the other people who've also had great succes in their Track Your Plaque program. It struck me that, for the most part, they too were a happy bunch: generally optimistic, happy, not overly stressed nor prone to extremely stressful responses to stressful situations. All seem to also be grateful for the good in their lives, though most had no more money than the average person and had their share of difficulties in life. In fact, I can only recall one person who reversed coronary plaque who was an angry, pessimistic personality. Just one.

Could it be that happy, optimistic people are more likely to reverse coronary plaque? It would, after all, be consistent with all the other observations that type A personalities have more heart attack, etc.

Anyway, this is just an informal observation but one that seems very consistent. Track your plaque--and be happy!

Don't overdo the vitamin D

As time passes and I advise more and more people to supplement vitamin D, I gain increasing respect for this powerful "vitamin". I am convinced that vitamin D replacement is the reason for a recent surge in our success rates in dropping CT heart scan scores. I believe it is also explains the larger drops we've been witnessing lately--20-30%.

But vitamin D can be overdone, too. Too much of a good thing . . .

Despite being labeled a "vitamin", cholecalciferol is actually a hormone. Vitamins are obtained from food and you can thereby develop deficiencies because of poor intake. Deficiency of vitamin C, for instance, arises from a lack of vegetables and fruits.

Vitamin D, on the other hand, is nearly absent from food. The only naturally-occuring source is oily fish like salmon and sardines. Milk usually has a little (100 units per 8 oz) because milk producers have been required by law to put it there to reduce the incidence of childhood rickets.

A woman came to me with a heart scan score of nearly 3800, the highest score I've every seen in a woman. (Record for a male >8,000!) She was taking vitamin D by prescription from her family doctor but at a dose of 150,000 units per week, or approximately 21,000 units per day. This had gone on for about 3-4 years. This may explain her excessive coronary calcium score. Interestingly, she had virtually no lipoprotein abnormalities identified, which by itself is curious, since most people have some degree of abnormality like small LDL. Obviously, I asked her to stop the vitamin D.

Should you be afraid of vitamin D? Of course not. If your neighbor is an alcoholic and has advanced cirrhosis, does that mean you shouldn't have a glass or two of Merlot for health and enjoyment? It's a matter of quantity. Too little vitamin D and you encourage coronary plaque growth. Too much vitamin D and you trigger "pathologic calcification", or the deposition of calcium in inappropriate places and sometimes to extreme degrees, as in this unfortunate woman.

Ideally, you should have your doctor check your 25-OH-vitamin D3 blood levels twice a year in summar and in winter. We aim for a level of 50 ng/ml, the level at which the phenemena of deficiency dissipate.

"It must have been the statin"

After four years of trying, Randy finally reduced her heart scan score. It not only dropped, it plummeted. After four previous scans that showed 25% or more increases, she'd finally dropped her score 23%. (I Blogged about Randy's case a few weeks ago.)

Randy also works for a cardiologist. When she told him that she had reversed her coronary plaque and reduced her heart scan score by 23%, he said, "It must have been the statin agent."

Randy was indeed on a statin drug at a low dose. But she also had taken great efforts in exercise, food choices, fish oil, and vitamin D. In fact, her score had progressed dramatically while she was taking the drug. Put simply, it was not the statin.

But that is the mindset of the conventionally thinking cardiologist. Stent, bypass, or statin drug--what else is there? Even with crystal clear evidence for coronary plaque regression, they refuse to acknowledge that tools that are not in their everyday consciousness could have achieved so spectacular a result.

Given a choice, 9 out of 10 cardiologists would rather put a stent in and walk away $2000 richer for an hour of work. Don't allow them to have this choice. Take control now.

Statin Drugs May Help the Healthy:
Cholesterol-Lowering Statin Drugs May Benefit People Without Heart Disease


That's the headline on WebMD, reporting the findings of a recent study published in the Archives of Internal Medicine. In reality, it wasn't really a study at all, but a re-analysis of previously published data, a so-called meta-analysis.

Nonetheless, the University of Toronto group re-analyzed the results of several studies, pooling data on 28,000 people, none of whom had known coronary disease. The results were similar to the results of the studies that were reported individually: a 29% reduction in heart attack and other "events" in people taking statin drugs.

What's surprising to me is this notion that statins, or any other treatment for that matter, prevent heart attack in people without heart disease. This is idiotic. Of course they had coronary heart disease. You can't have a heart attack in the absence of coronary disease. (There are very rare exceptions, like cocaine users, who experience coronary spasm from the drug).

What the study shows is that people with unrecognized heart disease experienced a reduction in heart attack. What it also means is that many, many people truly without heart disease were unnecessarily treated. As you'd predict, the drug manufacturers love this sort of broad, untargeted use of their drugs. It's an approach that brings in billions of dollars of revenues. The article on WebMD, in fact, was accompanied by three ads for various cholesterol drugs on this single page story.

What if only people with heart disease, as identified by CT heart scan scores, were treated? You would indeed witness an even larger reduction in heart attack risk, because the group receiving treatment both has the disease and is thereby at greater risk. Treatment should yield even greater risk reduction than treating broad groups who superficially appear to not have heart disease.

Ignore this nonsense about statin drugs reducing heart attack risk in people without heart disease. If you don't look for it, you won't know you have it. Once again, you can be lots smarter than the media. Get a heart scan and find out if your risk is worth reducing.

The Myth of Prevention: Letter to the Wall Street Journal

The Myth of Prevention: Letter to the Wall Street Journal





The June 20-21, 2009 Wall Street Journal Weekend Journal featured a provocative front page article written by physician, Dr. Abraham Verghese:

The Myth of Prevention

While eloquently written, I took issue with a few crucial points. Here is the letter I sent to the Editor at Wall Street Journal:


Dear Wall Street Journal Editor,

Re: Dr. Abraham Verghese’s article, The Myth of Prevention in the June 20-21, 2009 Weekend Journal.


I believe a more suitable title for Dr. Verghese’s article would be: “The Myth of What Passes as Prevention.”

As a practicing cardiologist, I, too, have witnessed firsthand the systemic “corruption” described by Dr. Verghese, the doing things “to” people rather than “for” them. Heart care, in particular, is rife with this form of profit-driven health delivery.

There is a fundamental flaw in Dr. Verghese’s otherwise admirable analysis: He assumes that what is called “prevention” in mainstream medicine is truly preventive.

Dr. Verghese makes issue of the apparent minor differences between preventing a condition and just allowing a condition to run its course. Prostate cancer screening is one example: Men subjected to repeated screenings have little length-of-life advantage over men who just allow their prostate to suffer the expected course of disease.

What if, instead, “prevention” as practiced today is nothing more than a solution that has been adopted in mainstream practice to suit yet another doing “to” strategy than doing “for”? In the prostate cancer example, PSA and prostate exam screenings often serve as little more than a means of harvesting procedures for the local urologist.

That’s not prevention. It is a prototypical example of “prevention” being subverted into the cause of revenue-generating procedures.

I submit that Dr. Verghese has fallen victim to the very same system he criticizes. His views have unwittingly been corrupted by the corrupt profit-driven system he describes.

What if, instead, prevention were just that: prevention or elimination of the condition. What if “prevention” of prostate cancer eliminated prostate cancer? What if heart disease “prevention” prevented all heart disease? What if this all proceeded without regard for profit or revenue-generating procedures, but just on results?

Dr. Verghese specifically targets heart scans or coronary calcium scoring, a test he likens to “miracle glow-in-the-dark minnow lures,” calling them “moneymakers.” Yes, when subverted into a corrupt algorithm of stress test, heart catheterization, stent, or bypass, heart scans are indeed a test used wrongly to “prevent” heart disease.

But what if the risk insights provided by heart scans prompt the start of a benign yet effective “prevention” program that inexpensively, safely, and assuredly prevents--in the true sense of the word--or eliminates heart disease? Then I believe the differences in mortality, quality of life, and costs would be substantial. Such strategies exist, yet do not necessarily include prescription drugs and certainly do not include the aftermath of heart catheterization and bypass surgery. Yet such programs fail to seize the limelight of media attention with no new high-tech lifesaving headline nor a big marketing budget to broadcast its message.

The problem in medicine is not prevention and its failure to yield cost- and life-saving results. It is the pervasively profit-driven mindset that keeps true preventive strategies from entering mainstream conversation. It is a repeat of Dr. Ignaz Semmelweis’ late 19th-century pleads for physicians to wash their hands before delivering babies to reduce puerperal sepsis, ignominious advice that earned him life and death in an asylum. We are essentially continuing to deliver children with unwashed hands because there is no revenue-generating procedure to clean them.

No, Dr. Verghese, the economic and medical failings of preventive strategies are not at fault. The failure of the medical system, in which everyone is bent on seizing a piece of the financial action for himself, has resulted in the failure to support the propagation of true preventive strategies that could genuinely save money and lives.

President Obama’s goal of cultivating preventive practices in medicine can work, but only if the profit-motive for “prevention” does not serve as the primary determinant of practice. Results-driven practices that are applied without regard to profit have the potential to yield the sorts of cost-saving and life-saving results that can reduce healthcare costs.


William Davis, MD
Milwaukee, Wisconsin
Medical Director, The Track Your Plaque Program (www.cureality.com)
Blog: http://heartscanblog.blogspot.com

Comments (20) -

  • Matt B.

    6/25/2009 1:28:37 PM |

    Dr. Davis,

    Well written.  I wish you were on President Obama's panel last night becuase this information needs to filter his way.

  • Anonymous

    6/25/2009 2:10:54 PM |

    The problem for government, the same one it now faces with the finance industry, is how to regulate away the profit motive in a capitalist system. How does the government force physicians to care about their patients and not their wallets? Maybe the only hope is to make these motivations the same thing through shifting incentives, but true prevention's payoff is people living longer, which is impractical to measure, so difficult to reward. It's easier to harness individual motivation to live longer and healthier, ironically, through government educating the public about physicians' and the food and drug industries' profit motives and as such the failures of the government's basic capitalist principles. -keith.

  • Dr. William Davis

    6/25/2009 2:45:48 PM |

    I believe one way to approach the outsized appeal of procedural "solutions" to health is to make reimbursement more on a par with non-procedural solutions.

    In other words, if I put in a stent, I get around $2000. If I coach a patient on how to avoid a stent, I might get between $59 and $178. (Remember that what physicians are paid is not personal payment, but payment to cover costs of operating an office, malpractice costs, etc., all the costs of doing "business.")

    That means that practicing prevention is a way to lose a bunch of money, not sustain a viable practice. Putting in plenty of stents, or putting in knee prostheses, defibrillators, or other procedures will buy you a vacation home in Aspen and a country club membership.

    So the root problem is the perverse excessive reimbursement for procedures, the poor reimbursement for "cerebral" functions like prevention.

  • Anonymous

    6/25/2009 3:06:08 PM |

    Dr. Davis,
    This is Billye once again. You said it all.  I watched the President last night being questioned on the tube about health care.  Not one question was asked relative to the curative power of a Low carb-high fat healthy diet.  As I mentioned before, in just a short nine months I reversed my obesity, diabetes type 2, and stopped most of my medications for heart disease including Staten's.  During a commercial a statistic was flashed on screen that said the following: Heart disease,   diabetes, and obesity was 50% of all health care costs.  I must be living in a parallel universe along with you and a few other brave doctors.  It's amazing how the propaganda job that has been perpetrated on the  American public, which as you know first started with Dr. Ancell Keys fifty years ago and has led to the healthy eating dogma, which continues today, has lemming like led us all over the cliff to bad health.  This has to be stopped and be reversed. Only then will health care become affordable.

    Billye

  • Wil

    6/25/2009 3:26:18 PM |

    Excellent letter Dr. Davis.  I hope the WSJ will publish it.  Allow me to also suggest that you send a copy to the Obama administration and your congressional representatives in Wisconsin.  I plan to forward a copy of your letter to our congressional representatives in Delaware.  

    You have identified a most important issue that is a crucial aspect of the needed reform in our medical services / medical insurance system.  Thank you for that and for all the great info on your blog.

    DT

  • Scott Moore

    6/25/2009 6:02:46 PM |

    Your wonderful post gave me some incentive to write my own letter to the editor. I thoroughly enjoy reading every one of your posts; keep up the good work.

    Here's my letter; you may not agree with the details but I believe you would appreciate its spirit.

    Dear Wall Street Journal Editor,

    While I can see Dr. Verghese's point about the corruption of the system, I think he is missing the broader point about prevention because he is part of the system. Many of our most vexing medical problems can be prevented with non-medical, non-chargeable (or minimally-chargeable) practices:

    * What if the cold and flu season could be made a thing of the past by something as simple as people monitoring their blood level of vitamin D in order to keep it at least 65 ng/ml and took over-the-counter Vitamin D3 gelcaps as a supplement? And what if these gelcaps cost less than $5 per month?
    * What if type II diabetes could be "cured" without medicine but simply by eliminating (or drastically reducing) wheat (bread and pasta), sugar, and potatoes from our diet? This would have been investigated deeply except for the "problem" that the medical profession can't make money off it.
    * What if total cholesterol had very little to do with heart disease? Monitoring it would have very little preventative effect, statins (the world's most profitable drugs) would have their associated revenues cut by 90% or more, and the whole manufactured food industry would have to change their ways -- just as with the diabetes problem above, think of all of the "heart healthy" foods and advertising campaigns that would have to change. What if heart disease could be monitored and predicted better through coronary calcium scans, levels of HbA1c, and the ratio of triglycerides to HDL? What if heart disease could be prevented by lowering our sugar intake and taking inexpensive fish oil supplements? This would mean that doctors would have to retract much of what they have told us for the last 35 years, tell us that they have been wrong, and that they are now right. This is a difficult set of tasks, and one that would challenge their very credibility --- and would reduce their income and the income of the pharmaceutical industry.

    As you might guess, all of the above have been supported by research though the medical industry has been slow to share these findings with us. Prevention isn't a myth --- prevention according to profitable medical practices is the myth.

    Sincerely,

    Scott Moore

  • Anonymous

    6/25/2009 6:31:31 PM |

    Dr. Davis,

    Along the same lines, I think the biggest problem is that the government funds the pharmaceutical to perform ALL the research. As long as the drug industry does all the research, we will never see huge strides in preventative solutions.

    Like you said, most pharmaceutical corporations are more interested in houses in Aspen than they are in looking at things like fish oil and vitamin D, vitamin K and diet adjustments. I can just picture a CEO of a company thinking: "Mmmm...should we use millions of government funds to do research on a new drug, or should we use that money on clinical trial using vitamin D, K, iodine and diet adjustments?" So sad.

  • scall0way

    6/25/2009 7:48:04 PM |

    Interesting article and response. Some of the comments on the article are interesting too, and some make me want to scream, like the one saying:

    " Dairy and meat products do serious health harm... People who live a "raw vegan" eating lifestyle never get diabetes and almost never get cancer or heart disease. Of course people who have high cholesterol will be much more likely to have heart disease. Animal fats solidify on the walls of the bloodstream, clogging them. Plant fats don't do this. Animal protein turns on cancer growth like fertilizer."

  • Kent

    6/25/2009 8:23:13 PM |

    Dr Davis,

    In light of your thoughts that "prostate exam screenings often serve as little more than a means of harvesting procedures for the local urologist", I wanted to get your thoughts on possible similar motives for heart scans.

    I don't have an ebt scan location in my city, however, there is a "hospital" in Oklahoma http://www.integris-health.com/INTEGRIS/en-US/Specialties/HeartCare/HeartHospital/Prevention/EBT+Heart+Scans/ that offers them for $50. Should there be concerns over the extreme low price? Obviously, they are not making their money from the scans. With these scans being offered at a hospital who is well known for "heart procedures", would you feel comfortable with them doing heart scans? Is there a reasonable chance that they could "over read" or alter a scan in order to suggest other procedures?

    Thanks,
    Kent

  • kris

    6/25/2009 9:12:22 PM |

    Dr. David,
    I think the root of the problem starts much early. The amount of time that it takes to complete medical studies and earn degree to become a doctor is lot more than most of the other professions. The whole process kind of justifies a doctor to feel better than the “others”, hence deserve to make more money than the “others””.

    Even the selection process and courses are design only to give favor to the person with great memorization skills not the person who can put two and two together. Even though that there is always a luck of the draw that some individuals are good at both but the ratio suffers. With today’s changing technology, with computers and all that should be able to change the path to the doctor’s degree with open book exams and let the best of the best graduate, not the memorization and nothing else.
    The real “deserving doctors” who really care about humanity, have slim chances to get through the current system. Nor does the current financial commitment is helping them in any ways.

    My older son always good in studies good at memorization always over 95% in biology and it looks like that he can make it all the way to the medicine. But when it comes to the common sense, he has to be explained in a written book fashion. The younger son, not good at the memorization but when it comes to the common sense he is better by miles. He can see and look at the things at the same time but I do know that he can never be a doctor under the current system and he doesn’t have the patience to go through it.
    Older one is already discussing about what the doctors make and how secure the profession is in here in Canada. I may have an idea that when and if he becomes one, what kind of doctor he will be.
    It is hard to change one’s nature. The current system attracts certain kind of nature to get selected as a doctor. Therefore we are seeing the results.

  • homebray

    6/26/2009 3:39:14 AM |

    How to create a virtuous cycle in health care will be a difficult task.

    I'm trying to think of an example on which we could a model --- not easy.  At first I thought dentistry, they are big on preventions with 6 month cleanings and all.  But in the end they are treating the mechanics of your teeth, in a way similar to maintaining a car extends it's life.  They don't (or at least I've never seen one) address underlying issues that lead to problems with the teeth.

    Maybe the closest I can come up with is obstetrics where the prevention is practiced in the form of pre-natal care. Of course the pay day for the doc comes on the big day.

    Can insurance reward doctors for positive outcomes? The heart patient who avoids the need for emergency procedures for examples? I can't see a way for this to work, you don't want doctors who refuse to treat unhealthy patients because there won't be a big pay day.

    Taking the money out of profession would also seem to work against the end goal. You loose the incentive to innovate.

    it's a quandary.

    Dr Davis, perhaps you are leading the way in your practice?

  • Anonymous

    6/26/2009 9:29:23 AM |

    Your letter was excellent.

    And you are right -- what passes for "prevention" in medicine today is nothing but lead-generation.

  • Dr. William Davis

    6/26/2009 2:34:36 PM |

    Great suggestions.

    I don't have the answer to how the system should be changed. But I think that the inequities of outsized procedural payoffs that persists is a source of much of the overuse. It fuels a system of hospitals growing beyond their needs, abuse of procedures, and excessive costs.

    That much at least needs to change.

  • homebray

    6/26/2009 3:43:09 PM |

    Maybe Docs could get paid for positive outcomes or procedures but not both -- -kind of like a wash sale in the stock market.

    That way you can't put off a procedure until after pay day and then do the procedure and collect twice.

    I don't know, Obama needs to do some clever thinking.

  • kris

    6/26/2009 6:14:48 PM |

    I think most of the things that we talk here on the heart scan blog should be a part of the high school curriculum. after all education builds nations. no education is more important than taking care of one's own health. it doesn't have to be unnecessary, no reason, medicine school language. it can be done in an easy make sense beginners language. first prevention is the people themselves should be educated enough to take care of their own bodies. doctors should only be in necessary extreme cases.

  • Wil

    6/26/2009 9:58:31 PM |

    Dr. Davis, your WSJ letter inspired us to write to our congressional reps today.  We included the full text of your letter to the WSJ editor in our own letter, copied below.  Best regards.

    "TO:

    Michael Castle
    Thomas Carper
    Ted Kaufman

    June 26, 2009

    Re:  Medical Care / Medical Insurance Reform

    Gentlemen:

    We will try to keep this message as brief and straightforward as possible.  Very simply, our country badly needs a publicly sponsored medical insurance plan available to all of our fellow citizens at a reasonable cost.  Otherwise we will continue to have the situation where too many families either have no insurance or inadequate coverage.  Our country cannot allow this state of affairs to continue.  We need the public plan feature as part of any “health care” reform so as to provide competition with the private medical insurance industry; an industry which is driven solely by profit for its executives and stockholders.  Clearly, the industry with all its “unhealthy” Wall Street influences cannot be trusted to act in the public interest and, in truth, their business model guarantees they will not.   In fact, the whole idea of profit-driven medical care / medical insurance monopolized by shareholder-owned corporations such as pharmaceutical, medical device and insurance companies is just plain wrong, in our opinion.  

    Our country’s present system for the financing and delivery of medical care has not made American citizens healthier and has given rise to perverse incentives that have made the system outrageously costly and unsustainable.  This must be stopped and Congress must act now in the interests of American citizens and not on behalf of the above-mentioned vested interests that, over time, through lobbying and large campaign contributions, have corrupted public policy and the legislative process.  We hope that any senator or congressman who in the past (or presently) has been accepting campaign contributions from any of these industry “players” will return those contributions and publicly announce that they will no longer accept such contributions.  

    It is our view that each member of Congress needs to begin to think very differently about the way medical services are provided.  As part of the overall reform process we all must ask what it is that will lead to better incentives and more efficient methods for improving the health and well-being of our fellow citizens.  To that end we draw to your attention a recent letter from Dr. William Davis, a practicing cardiologist from Milwaukee, Wisconsin, to the Wall Street Journal.  Dr. Davis has raised a crucial issue that all policymakers should be thinking about as they address medical care reform.  His letter reads as follows:

    [Dr. Davis, here we inserted the text of your WSJ letter]

    Mike, Tom and Ted:  We hope each of you will think seriously about these matters after severing whatever ties you may have to the vested interests that will spend millions on their lobbyists and on stealth advertising to prevent meaningful reform from being enacted by Congress.

    Sincerely,
    etc.

  • Dr. William Davis

    6/27/2009 12:41:23 AM |

    Hi, Wil--

    Well said.

    If enough of us stand up and shout, perhaps we can eventually out-shout the voices of Big Pharma, the hospital lobbies, and preservers of the status quo.

    I believe that we need to continue to fight, including opposing this crazed notion that prevention is a waste. Unintentionally (?), Dr. Varghese has performed the country a grave disservice.

  • Tanya

    6/27/2009 7:37:15 PM |

    Dr. Davis,

    Did the WSJ publish your letter?  I took a look at their site and it looks as though it wasn't picked up.

    Can I humbly make a suggestion?  I've spent a lot of time in politics and therefore know the value of getting into the Letters page.  It is very important to keep letters fairly short.  Long letters are not often published.  Your perspective is so important and you write very well, that it would be a shame if your letters are not published simply because newspapers need to include a number of letters and to do so on no more than one page.

  • Dr. William Davis

    6/27/2009 7:39:14 PM |

    Hi, Tanya--

    No, it looks like they didn't.

    Thanks for the helpful suggestion. Next time!

  • Trinkwasser

    7/14/2009 4:09:37 PM |

    Be careful what you wish for, here's our (UK) Government's view of prevention

    http://www.nhs.uk/Change4Life/Pages/default.aspx

    sponsored by Kelloggs and Tescos

    http://www.satfatnav.com/

    sponsored by Unilever

    http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Eating-well-with-Type-2-diabetes/A-healthy-balance/

    our only Diabetes Charity's opinion

    sponsored by

    http://www.diabetes.org.uk/Get_involved/Corporate/Acknowledgements/

    money doesn't talk, it SHOUTS

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