"Make big money fast with CT scans"

Rather than the headline New Study Could Change Heart Disease Diagnosis And Treatment being run in Utah TV and newspapers, instead it should read:

Make big money fast with CT scans!

Is your bottom line shrinking? Have you fallen on hard economic times? Is competition from other hospitals and providers threatening your financial health?

Then we have a solution: Do a CT coronary angiogram on everybody! Look for disease in people with no symptoms, scare the heck out of them, and voila! Instant need for bypass surgery!

Ka-ching!! That'll be $100,000, please.

Do it again, and again, and again, and your hospital will be quickly in the black in no time!

And, for the savvy marketer, tell the newspapers that you're going to conduct a study to see if this approach works--even before the study gets started! Even if the study pans, you'll come out a winner because you did it in the name of "research"!

Apparently a group of cardiologists at the Intermountain Medical Center and LDS Hospital in Salt Lake City, with the financial assistance of Siemens, a manufacturer of CT scanners, is funding a 1000-patient study of diabetics, all without symptoms of heart disease, half of whom will undergo "screening" CT coronary angiograms (not heart scans) followed by bypass surgery, if "needed". The other half will receive conventional, "aggressive" medical therapy. "Aggressive" means cholesterol treatment, blood pressure control, and blood sugar control (no kidding).

The outcomes of the two groups will be compared after two years.

To understand the absurdity of this study, note that they are proposing what amounts to "prophylactic" bypass surgery, since the participants are without symptoms. Since there are no stress tests, a measurement of flow or functional capacity (exercise tolerance) cannot be factored in. Decisions will be made on the basis of severity of "blockages" in asymptomatic people, a hazardous notion that has never been shown to provide benefit. No doubt: Some diabetics with extensive disease may obtain benefit from screening, but many more will undergo what amounts to unnecessary bypass that provides no benefit. We already know from studies dating back over 20 years to the days of the original CASS (Coronary Artery Surgery Study) that putting asymptomatic people through bypass surgery willy-nilly does not reduce mortality.

Of course, the "aggressive" preventive treatment they propose is more like the least common denominator level of treatment. In fact, I would characterize the "aggressive" preventive treatment as ridiculous. Doing less would be malpractice. Much more could be done, but doing a lot more would pose a real challenge to the bypass arm of the trial.

But the smell of money drives such efforts: More CT angiograms, more hospitalization for bypass surgery. The payoff to the hospitals from this effort is likely to exceed $5 to $10 million, all money that they might not have otherwise seen. The ill-informed people in the local media gush with enthusiasm, the hospital acts like they are at the cutting edge of medical technology, the doctors pose as saviors.

All this time, real preventive efforts go unmentioned. No fish oil (28% reduction in heart attack, 45% reduction in sudden death from heart attack), no genuine diet efforts (i.e., not the diabetes-promoting American Diabetes Association diet), no effort to identify sources of coronary risk beyond LDL cholesterol (low HDL,small LDL,and postprandial or after-eating abnormalities, for instance, are prominent sources of risk in diabetics), no vitamin D. In my view, the preventive arm of the study amounts to doing virtually nothing beyond prescribing statin drugs.

Don't fall for it.

Comments (6) -

  • Anonymous

    5/31/2008 2:02:00 PM |

    Good timing for my father on this blog post.  It isn't heart disease but next week my father is driving to Chicago to have his head examined with an MRI to learn the potential of having an aneurysm. (I think I said that right, aneurysm)  I asked him why and he told me the exam is "free".  I don't much about how hospitals are run but from my experience every time I've been to one nothing was free.  If anything everything bought was 10 times normal price.  I've warned my father not to fall for scams - nothing is free dad.  My guess is this is a way for the hospital to drum up $100,000 business from the unsuspecting sucker.

  • Jenny

    5/31/2008 2:14:00 PM |

    Even more important is the danger from the high levels of radioactivity exposure caused by those scans. There was a study published that looked at the CT scan exposure of ER patients and found that the cumulative level was far over the level known to cause cancer.

    Science News report.

    CT scans should be used only when justified by a very real and present danger. And even then often X-rays would be a better choice.

  • Anonymous

    5/31/2008 3:41:00 PM |

    Just when I thought the profession could not sink lower!  This seems to be another example of the current philosophy - "sick until proven healthy."  Unfortunately, this type of doctor doesn't recognize anyone as healthy. Oy....

  • Jessica

    5/31/2008 4:53:00 PM |

    Great analysis.

    We hosted a health care forum on 14 May and during the Forum, one of the doctors said, "we're wasting money trying to prove that healthy people are healthy."

    So true.

    Asymptomatic and they're being entered into a study which includes invasive "bypass" as a clinical intervention?

    Brain dead.

  • PJ

    5/31/2008 11:36:00 PM |

    You know, that's actually terrifying.

  • jpatti

    6/4/2008 3:40:00 PM |

    I really can't *imagine* anyone signing up for this study.

    After a week of heartburn, I spent the night screaming and vomiting before an unsuccessful emergency angio.  And after all that, while on narcotics and IV heparin, I had to be "talked into" a bypass.

    I can't imagine doing it for the sake of science.