Wednesday, June 25, 2008

More Fear-Based Medical Marketing

I'm not sure it gets better than this:
Scanning the heart's arteries for calcium deposits accurately predicts the overall death risk for American adults, a new study suggests.

"So far, this is the best predictor we have of who will have a problem and who will not," said study co-researcher Dr. Matthew Budoff, associate professor of medicine at the Harbor-UCLA Medical Center.

He and his colleagues reported the finding in the July 1 issue of the Journal of the American College of Cardiology.

A calcium scan looks for calcification, a hardening of the arteries caused by high blood fats and calcium deposits that can eventually block blood vessels, causing heart attacks, strokes and other major problems.
I can hear it now:
"Hey Marge, hey lookie here in the Washington Post! I wanna get one of dem der fancy schmancy CT scanner gizmos to find out if I'm gonna DIE sooner than you are! Let's take $600 bucks for that fancy schmancy thing-a-ma-bob out of our retirement fund. It'd be WORTH IT!"

Sometime later, in the doctor's office...

Doctor: "Well, Mr. Jones, I see my this fancy schmancy CT scan that you'd got some calcium in your coronaries. Hmmmm. And you calcium score is 210, just like Tim Russert! So, guess what?"

Mr. Jones: "What?"

Doctor: "Well Mr. Jones, you're at increased risk of DYING!"

Mr. Jones: "Uh, what do you mean, Doctor?"

Doctor: "You heard me: you're at increased risk of DYING with all that calcium in those coronaries - you know - BAM! Just like Tim Russert."

Mr. Jones: "Any idea when, Doctor?"

Mr Jones: "Doctor, did you hear me? When will I die? I mean, won't we all die sometime?"

Doctor: "Heck, Mr. Jones, I don't know! But I can assure you that based on this fine article here in the prestigious Journal of the American College of Cardiology (you know, the same one that's also promoting their new Cardiovascular Imaging journal) that you're gonna die of SOMETHING sooner than some of the other people who don't have that evil calcium in their arteries."

Mr. Jones: "Gosh. So what should I DO about it, Doctor?"

Doctor: "Well, you know, since we're proposing that it's a RISK FACTOR for DYING, you should do the usual stuff: eat right, take tons of statin drugs, don't smoke, take your aspirin, lose weight, eat a low trans fat, high antioxidant, super-radical-consuming diet, do yoga, take mega vitamins, face East, say a few 'Hail Mary's..."

Mr. Jones: "Uh, but I was already doing that stuff..."

Doctor: "Have you had your CRP level and genes tested yet?"

Mr. Jones: "How would that help?"

Doctor: "Well, Mr. Jones, it might mean your risk of DEATH is EVEN GREATER!"

Mr. Jones: "But what can I do about it if it's positive also?"

Doctor: "Well, you know, the usual stuff... like I said... eat right, take tons of..."

Mr. Jones: "That's okay, Doctor. I've had enough. Thanks for all of your help. Hope that $300 bucks comes in handy. Don't mind me: I'll keep doing what I've been doing and get started preparing my Bucket List. Oh, but one more thing..."

Doctor: "What's that Mr. Jones?"

Mr. Jones: "You wouldn't happen to work with General Electric like those two guys who wrote that article you quoted, would you?"


Anonymous said...

My father was enrolled in Cedars-Sinai's EBCT research trial. Not sure if Berman has published his results yet. My father's Agatson score was 1500 about 6 years ago, more recently it was 2200.
He's 74 and still alive. He has read the lay literature, understands the implications and figures he'll die any time now. Therefore, no need for diet/exercise/lifestyle modification. He just hopes for the Tim Russert style of exit.
Unfortunately, I fear he'll end up with CHF and a slow heart failure demise.

I think that Budoff's influence with CT is so far reaching that just about every fellow trained at Harbor UCLA is involved somehow in CAC scoring or CTA research. (And have heard that some are not so happy to be involved in it.)


Anonymous said...

Dr. Wes,
as a private practice cardiologist with no financial interest in GE or any other imaging companies i would like to chirp in with my support for calcium scoring. in the high risk patient you describe who is already on medical therapy it does not have a role, but in the patient with no known CAD, DM or vascular disease it can be enormously useful. many asymptomatic patients skate by for years and decades with borderline BP and lipids. they don't want to take a medicine unless necessary. the calcium score can serve as a huge wake-up call and tell them that while they are asymptomatic they do have CAD and need aggressive treatment. not only does calcium scoring give prognostic data, but more importantly it tells us whether the patient has coronary artery disease, something which a stress test often will not.
prior to calcium scoring patients could get a more expensive nuclear stress test, get a totally normal scan, and the patient and the MD still have no idea what the status of the patients coronaries is.
also of note your quote of $600 is quite exaggerated. our group charges $99.

Anonymous said...

but in the patient with no known CAD, DM or vascular disease it can be enormously useful.
Do you have any evidence that doing this test on general public with no know desease is going to save lives? You support subjecting healthy people at low to medium risk of heart desease to the risk of 1) radiation 2) dye allergy 3) false positives leading to additional tests that might actually have risks without ANY EVIDENCE WHATSOEVER that benefits of this would outweight the risks. How many people would you need to scan to extend the life of one person? Will the absolute risk reduction in this case be higher than extra cancer from radiation?

Tests aren't risk free. I bet when you recommend this test to lot to medium risk population you forget to mention that. I'd also bet that you forget to mention the ABSOLUTE risk reduction they can expect. Do you also mention that USPSTF doesn't recommend it?

You may know cardiology, but you clearly don't understand epidemiology or the fact that plural of anecdotes from your personal practice isn't data.

IVF-MD said...

In response to the debate between the two preceding anonymous posts, presenting information as facts rather than as recommendations or opinions allows the consumer to make his/her own choices. Rather than saying, "this is a great test for someone with no cardiac risk factors" or saying "this is a horrible test because of the potential costs and risks", if we just present it as "this is what the test looks for" and "knowing your score may help you make some important lifestyle decisions" allows the consumer to research on his/her own and gather information from a variety of sources, so that they can decide accordingly. I do agree that something unproven should not be subject to mandated coverage, but rather be a consumer choice. So rather than take my tax money or my insurance pool money to pay for this test, it's best left to the consumer to decide whether the information obtained by testing is really worth $99 out of their pocket.

Anonymous said...

Yeah, yeah. Statins. All I've seen them do is destroy short term memory, destroy normal sleep patterns and God knows what else they did to mu Mumma for the 6 months she took them until I told her to stop.

ALL of the data (ALL OF THE DATA) that 'suggests' that statins have value have been done by... Guess who?

You folks must own a lot of stock in those pharmaco's.

Thanks Dr. Wes for injecting some needed sense into what is being said concerning 'testing'.

My Dad, had all (and I mean ALL) of the flash point death signals for heart failure.. He died at 94 years old. He did not die of heart failure, but of kidney failure... (Yes, I know that 'the plural of anecdote does not equal data - I know this far better than YOU do, anonymous doc.)

You think I am just some bozo off the street? No, I am a bozo who used to (help) design this sort of 'study'. (my Ph.D. is in Statistics) Let me tell you that I have some stories that would curl your hair - all from the NIH! That sewer of bad science.

I will reiterate this for those that have never heard it:

Science is NOT about truth, it is about:

1. Academia: grants
2. Pharmacos and device mfgs: profits
3. NIH (etc): funding.

I applaud Dr. Wes for not just jumping on all the device and pharmaco band-wagon that haul themselves over the backs of the innocent and always ill-informed medical consumer.

I've pulled myself out of the sewer that is NIH and now work in software... Ahhhh, so much cleaner... I can sleep at night. Mostly.

Anonymous said...

No offense to Budoff, but when I slang statins, that kid spoke for every pharm company, including competing drugs simultaneously. Whatever it takes to pay the bills. I did one event with him, where every MD and spouse got a "free" CT scan, paid for by me of course.