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)

Comments (4) -

  • JT

    7/29/2007 7:49:00 PM |

    you could have been a radio or TV personality!  Glad you became a cardiologist and author instead though.  

    Talking about debates, I occasionally visit the many different debating boards on the internet.  Recently I entered a debate with a couple UK medical students.  The topic was over which country provides the best medical care.  I asked if CT heart scans are being performed in the UK and they replied no and had not heard of this.  

    I don’t mean to catch you up into politics too much, but if you feel comfortable answering, a couple questions I have are: Do know if counties outside of America are planning to add CT heart scannings?  If so do you believe government run health care systems are more likely to implement their use nation wide since profit isn't as large of a motivation?

  • Dr. Davis

    7/30/2007 11:48:00 AM |

    Hi, JT--

    Interesting thoughts.

    There are a number of other countries that do provide CT heart scanning, though many have, from the start, confined their interest to CT angiography. Nearly all of the CT heart scanning for coronary calcification in the published literature originated in the U.S.

    It would indeed be an interesting social observation to know whether different medical systems encourage or discourage heart scanning. Sorry, but I know of no such correlation that has been formally examined.

  • Anonymous

    7/31/2007 2:18:00 AM |

    I recently took a calcium score test at my own expense because my insurance company does not cover the test. When I asked my insurance company why they don't cover it, they referred me to their web site at

    Under the heading of Calcium Scoring, it says
    However, there is skepticism about the relationship between EBCT calcium scores and the likelihood of coronary events because of the following factors:
    - Calcium does not collect exclusively at sites with severe stenosis
    - EBCT calcium scores do not identify the location of specific vulnerable lesions
    - Substantial non-calcified plaque is frequently present in the absence of coronary artery calcification
    - There are no proven relationships between coronary artery calcification and the probability of plaque rupture.

    At the end it says: An assessment by the Institute for Clinical Effectiveness and Health Policy (Bardach, 2005) concluded: "Most consensus consider EBCT, SCT and MSCT still at their investigational stage for the following: a) detection of coronary artery calcifications as a screening method for asymptomatic subjects with coronary disease; b) detection of coronary artery calcifications in symptomatic patients; and c) assessment of coronary graft viability. No study reported that calcification measuring (plaque characterization) reduces the incidence of coronary events or death."

  • Dr. Davis

    7/31/2007 4:02:00 AM |

    So what else is new?

    Insurance companies are famous for finding every possible means to weasel out of paying for a test that leads to prevention of disease.

    Their fear: Opening the floodgates for all the people who might wish to have the test, a far larger number than those who eventually suffer cardiac catastrophes.

    This is patent nonsense. Anyone who has even begun to read the published experience in CT heart scanning, or has used CT scanning in real life practice, soon begins to realize the absolute folly of the conventional methods of heart disease detection: cholesterol (a miserable failure), stress testing (ask Bill Clinton how well it served him and the thousands of others who experienced heart attacks despite normal stress tests), or death. Take your pick.