Money, money, money, money

I've been asked the question numerous times:

Why aren't heart scans more popular?

First, let me qualify by saying that heart scan have indeed grown in popularity over the past decade. I think the real question is:

Given the enormous usefulness of CT heart scanning to detect hidden, asymptomatic coronary atherosclerotic plaque, why haven't they more readily been incorporated into conventional medical practice?

That's easy: There's no money in it.

Say, for instance, your doctor orders a heart scan and somehow receives a $1000 for the test. Scan centers would be scanning 100 people a day, falling over themselves to do scans.

This would be similar to a heart catheterization. Order a catheterization, do 30 minutes of work, and get $1000. Or, order a nuclear stress test. Depending on how its done and where, $1800-4000 is paid by the insurer.

Order a CT heart scan and how much is paid to the doctor? Usually nothing. At most, a nominal fee might be paid if the doctor reads the scan.

With heart scans, there simply is no big payoff.

We learned the implications of this situation 10 years ago when I was trying to help my friend, Steve Burlingame, the owner of Milwaukee Heart Scan. (I am NOT and NEVER WAS an owner.) Steve was trying to let everybody know about this great new $2 million dollar heart scan device in the Milwaukee area.

The first few years were tough for Steve: Carrying the substantial expense of this device while doctors essentially gave the technology the cold shoulder. It simply did not fit into the financial equation. Why change the way things were, particularly when there was virtually no financial reason to do so? To counter this, Milwaukee Heart Scan followed the model many other scan centers have followed and marketed directly to the public.

I see this as yet another example of why people need to take control of health care away from doctors and hospitals, the current controllers of the system who are providing a disservice to the public they are supposed to be serving. These institutions, for the most part, serve their self-serving financial interests, not your health interests. It's the same equation that drives food manufacturers to make more and more processed carbohydrate foods that they sell for substantial markups, not green peppers and cucumbers that make little money.

I regard heart scans as among the greatest self-empowering tools in health ever conceived. It was that way in 1997; it remains that way in 2007.

Comments (3) -

  • Anonymous

    10/3/2007 5:41:00 PM |

    I personally get the word out on how heart scans are superior to regular cholesterol testing in predicting future heart health to family and friends.  Honestly many times I'm greeted with skepticism, "if a CT scan is so great, why hasn't my doctor recommended one?"  When that happens, your blogs are a wonderful tool to me in convincing them of there importance.    

    Many place doctors on a very high pedestal, too high I believe, and so in this case I find it bad that doctors do not make money on CT heart scans.  I do not have anything against people making money in an honest manor and if it takes some cash to change a few more healthy care providers’ ways on heart scanning, I'm in favor of it.

  • JoeEO

    10/3/2007 7:41:00 PM |

    Dr Davis,
    You are creating an "Army of Davids"! The phrase is from a book written by Glenn Reynolds (aka ). The premise of the book is that "a society that's rich and free will have citizens who-entirely on their own-develop a wide range of skills."

    That is what we are doing here (and at we are learning to manage and diagnose and treat our various lipid profiles and tracking our levels of coronary artery disease (plaque).

    I think I mentioned this in a post on typ's member forum, but I still can't understand why every person in the US who is taking a statin is not also taking niacin. If the your sites didn't exist I doubt I would have found out about the HATs study until I had a coronary event (if then)

    Now I am empowered (it is a little scary!) and have the ability to find out detailed information about my condition and the ways I can address that condition thanks to you Dr Davis!

    We live in amazing times...


    Joe E O
    P.S. Here the whole title from
    An Army of Davids: How Markets and Technology Empower Ordinary People to Beat Big Media, Big Government, and Other Goliaths (Hardcover)
    by Glenn Reynolds (Author)

  • Dr. Davis

    10/3/2007 8:30:00 PM |

    Thanks, Joe. It is an exciting time for immense change.

    Would you recommend Reynolds' book?