Go to your corners

There's a heated debate being waged on the Heart Hawk Blog

Dr. Melissa Walton-Shirley authored an editorial entitled It Should Be the Right of All Americans to Have Primary Percutaneous-Based Intervention for Acute Coronary Syndrome .

Heart Hawk's response:

Dr. Walton-Shirley feels the best use of time, talent, and money is to build more cath labs and train more people in how to use them so that IF you have a heart attack, you stand a better chance of being pulled back from the brink of death. Unfortunately, you have to first let people get so sick that they are about to die. My position is to use those same resources to prevent such disasters from happening in the first place. Take your pick. You cannot spend the money twice.

I am no stranger to "direct angioplasty," meaning performing immediate coronary angioplasty (with stenting) for heart attack. Since 1990, I have personally performed hundreds, perhaps over a thousand of these procedures, particularly when I was younger and my practice was procedurally-focused. But, after a few years, I quickly recognized the futility of this approach. Yes, you might have aborted a heart attack ,perhaps even saved a life at the brink of death. But wouldn't it have been better to have prevented the entire episode in the first place?

In my mind, putting a cath lab on every corner, as Dr. Walton-Shirley suggests, is like having a fire truck on every street to prevent a house from burning down. It's an enormously expensive proposition that provides no incentive to prevent fires. Why not spend the money on preventing the fires?

Expanding access to cath lab procedures is putting the fox in the henhouse. Procedures yield money--big money--for hospitals and cardiologists. Guess what happens when you build facilities that exceed the need? Yes--the number of procedures grows, whether or not they were needed.

In my view, Dr. Shirley-Walton's opinions are symptomatic of the profit-driven, procedurally-focused quick-fixes that divert money that would be far better spent on effective dissemination of preventive practices.

Comments (4) -

  • Anonymous

    9/20/2007 1:32:00 PM |

    Thank you! Sadly, many physicians are becomming a parody when it comes to "procedures". I've heard a neurolgist (family friend) fret, "I went into the wrong field; I end up spending time examining patients instead of doing procedures and can't make any money! I should have gone into orthopedics." Pitiful. In some practices the push for procedures is as bad or worse than the old "publish or perish" dilema of academia.

    Who suffers? The patients. And the clinical skills of the physician.

  • Dr. Davis

    9/20/2007 5:55:00 PM |

    Well said!

  • wccaguy

    9/20/2007 8:04:00 PM |

    Hi Dr. Davis,

    Charlie Rose, just last night, hosted a round table of cardiologists to discuss heart disease.  Hopefully it will be available for viewing on the web.

    Among the participants was a President emeritus of the American Association of Cardiology (Steven Nissen).

    The discussion was all about quick resuscitation(sp?) and providing "2nd chances" in crisis situations, high cholesterol, blood pressure, etc.

    The themes you devote yourself to were essentially undiscussed.  No discussion of nuanced lipid analysis, CT scanning, or advances in understanding of the potential positive impacts of food and supplements.

    It is precisely that kind of amorphous discuss of heart disease risk which is so depressing.

    I'll see if I can find a link to an archived video to get your feedback.

  • wccaguy

    9/20/2007 8:25:00 PM |

    Here's the link to the Charlie Rose show page that should contain yesterday's discussion of heart disease once the video is put up.  Video #8 is already up.  The Heart Disease video is #9.