Failure to diagnose

I picked up a hospital publication today. Featured prominently on the cover was a glossy photo of an attorney and his wife, both smiling.

The headline: "Atorney grateful for the lifesaving work of the ______ Hospital."

The story detailed the near-tragic story of how this 59-year old man was exercising at his local gym, only to lose consciousness after stepping off one of the exercise machines. Bystanders--hospital employees, as luck would have it--checked the man's pulse: none. They performed CPR. Ambulance called, blah blah blah.

Severe coronary disease discovered, extensive atherosclerotic plaque in all three coronary arteries, a 12-inch chest incision later and he and his wife are eternally grateful for the fine work done at X hospital. And so they should be for a job well done.

But wait a minute. After the urgent hospital dust settled, did anyone ask the one crucial question: Why wasn't this man's far-advanced heart disease identified? Why did he have to die and be resuscitated before his disease was recognized?

If this man was an indigent, homeless alcoholic . . . well, perhaps it would be no surprise. Health is neglected in this population. But a successful attorney?

Detecting hidden coronary atherosclerotic plaque simply isn't that tough. In Milwaukee, $199 would have diagnosed his disease unequivocally.

Unfortunately, we still have to set off drumrolls and crash cymbals to even begin to get the attention of the practicing physicians around us who continue to fail to diagnose hidden coronary disease. I wouldn't be at all surprised to hear if this man had a $4000 nuclear stress recently that was normal. Why would a nuclear stress test be normal? Easy: Wrong test.

The hidden message: The failure to diagnose paid somebody and some hospital over $100,000. So, why bother detecting disease before the payoff?

The profit motive in all this is all too obvious. The only other explanation is the enormous, repetitive, and systematic stupidity of the conventional approach to heart disease detection. You have the solution, at least for you and the people around you, in a CT heart scan and in the Track Your Plaque program.

Copyright 2007 William Davis, MD

Comments (6) -

  • Anonymous

    9/27/2007 3:24:00 PM |

    Traveling through the internet, it is easy to find all kinds of conspiracy theories.  Most are wild and crazy, full of half truths, and fairly easy to see through as being created for political reasons or just entertainment.  But every once in awhile one is found to be true.    The health care system does not want to change the current cardiac system because of money. I would go as far as to say I believe health care professionals discourage people to even care for their heart on their own.

    Thank you very much for blogging about your experiences on cardiac prevention.  At the moment practicing prevention seems to be at the grass roots level, but I hope with continued success, over time that will change.  I've never been much of a cause person, but feel getting the word out on cardiac prevention is important - I forward your blog to friends and family so they can learn how best to take care of their heart.  To quote our 16th President "You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time."

  • WCCAguy

    9/27/2007 4:01:00 PM |

    Dr. Davis,

    Having become acquainted with the TrackYourPlaque program in the last several weeks, the issue you raise in this post is one I'm extremely puzzled by.  It's this:

    Why are almost all cardiologists and virtually all general practitioners virtually clueless about the few simple elements you outline in your book and in the TrackYourPlaque program?

    The importance of getting a heart scan score, figuring out why plaque is accumulating with lipid testing, and doing something about high scores with diet, exercise, and supplements ought to be pretty easy to explain to just about everyone.

    So, why aren't more physicians doing it?

    Your post today essentially says that it's all about the money.  That may be true but I keep thinking that there has to be another reason.  Can so many people dedicating their lives to the health of others really have been waylaid, consciously or without thinking, into ignoring what amount to best treatment practices?

    That video from the Charlie Rose show last week on Heart Disease is now up.  CT scanning is mentioned briefly but nuanced lipid analysis warranted not a word.  And this, mind you, was a conversation among physicians friendly to prevention.

    My second viewing of that session made more clear a point you repeatedly make.  Cardiologists are worried about costs of scanning and also about CT scans that show artery narrowing resulting in unnecessary procedures being done.

    Meanwhile, in the same conversation, the point is made that most heart attacks don't occur at artery narrowing junctures.

    Here's a link to the video.  It's video #9.

    The video from 00:14:00.000 to 00:20:30.000 is an interesting window.  CT scans are discussed during 00:29:00 to 00:31:00.

    If you watch from 00:47:00.000, Steven Nissen gets around to making your point that money plays an enormous role in outcomes.

    But if you're suffering from coronary artery disease, this is a maddening video to watch.

    -   Not a single mention of the importance of calcium score.

    -   Not a single mention of blood lipid subfraction analysis.

    -   Not a single mention of treatments for the lipid subfraction measurements that are closely linked to heart attack.

    This cardiologists are among the most well informed in the country and yet the tying together of diagnostic technology (CT scans), causal analysis (lipid analysis), and preventive measures (diet and supplements) is never put together coherently.

    The token prevention cardiologist on the panel speaks at such a general level that anything said is of no use.  Seems to me that she is completely unaware of the kind of preventative measures that the TYP program entails.

    Seems to me that if this discussion is the best cardiology has to offer the field is in a sorry state indeed.

  • thomas

    9/27/2007 4:03:00 PM |

    Our community, like others I bet, is planning to build a "heart hospital". We already have three hospitals. Once, and soon I hope, your approach becomes mainstream, we might need only a "heart trailer". If I was a wealthy philanthropist, I would fund more research in this area, including things like apo A1 Milano. Thank you for everything, Dr. Davis.

  • Dr. Davis

    9/27/2007 6:37:00 PM |

    It's maddening, isn't it?

    I actually practiced in Cleveland until 1994. Back then, the town was focused on building procedural volume, obsessed with that path, in fact. That same bias persists.

    One of the perverse realities of all of medicine, but cardiology moreso than other areas, is it's not worth pursuing unless a large profit-potential can be extracted. ApoA1 Milano, for instance, was indeed pursued by Steve Nissen. But this will likely carry a cost of about $2500 per dose for a multiple dose course.

    The Track Your Plaque-type approach doesn't make anybody a lot of money. (It did pay for a meeting we once had over dinner.) Such are the economic realities.

    All you and I can do is keep agitating. I am confident that, at some point, truth will win out.

  • G

    11/15/2007 4:48:00 AM |

    Didn't even Charlie Rose avoid U.S. cardiologists? I recall that he went to Europe for his heart (valve?) surgery...  was that 2001? Had a baby that year so everything's a fog!

  • Dr. Davis

    11/15/2007 12:12:00 PM |

    Ironically, I believe it is this approach, i.e., prevention of heart diseaes a la Track Your Plaque, that would save the U.S. untold sums of money, billions of dollars. Of course, that money would then be denied to hospitals, the medical-industrial complex that supports modern medicine, and my colleagues. It's the same reason that the oil industry has not contributed to development of the 100 mpg automobile.