"Average amount of heart disease for age"

2. July 2008 William Davis (4)
A 72-year old woman came to my office after a complicated hospital stay (unrelated to heart disease). She'd undergone a CT coronary angiogram and heart scan as part of a pre-operative evaluation prior to a surgery for a non-heart related condition.

The heart scan portion of the test (I was impressed they even did this) yielded a heart scan score of 212. The CT coronary angiogram portion of the test revealed a 50% blockage in one artery, a lesser blockage in one other artery.

The cardiologist consulting on the case advised her that the amount of coronary disease detected was insufficient to pose risk during her surgical procedure. He also advised her that she had "an average amount of disease for age." He thought that nothing further was necessary since she was "average."

Say what?  

What if I told you that you have an average amount of cancer for your age? After all, cancers become more common the older we get. Who would find that acceptable?

Then why should ANY amount of coronary atherosclerotic plaque be "acceptable for age"? Coronary plaque is a degenerative disease that poses risk for rupture. While it is indeed common, by no means should it be acceptable.

I would bet that this same cardiologist would be from the same school of thought that would be eager to advise heart catheterization, stent, and other procedures--revenue-generating procedures--should she have a heart attack appropriate for age.

I wish that I could tell you that this silly comment was provided by some peculiar, "everyone-knows-he's-crazy" doctor. But it was not. It was a solidly mainstream physician. He pooh-poohs nutrition, laughs when asked about nutritional supplements, thinks anyone complaining about symptoms less than a full-blown heart attack is a baby. He is respected by the primary care physicians, lectures on the advantages of prescription medications. In short, he is your typical conventional cardiologist.

This is the way they think. I know, because I was one of them. Thankfully, something banged me upside my head one day (my Mother's sudden cardiac death) and tipped me off to the painful irony of the conventional approach to heart disease.

There is NO amount of coronary disease appropriate for age. This notion is a remnant of the paternalistic, "I-know-better-than-you" attitude of the last century of medicine.

The 21st century promises a new age.
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Comments (4) -

  • Anonymous

    7/2/2008 11:58:00 AM |

    Thank you for writing about this. Thank you for thinking and acting like you do.

    Best regards

  • ethyl d

    7/2/2008 4:51:00 PM |

    Dr. Davis: this sentence that ended your blog--"This notion is a remnant of the paternalistic, 'I-know-better-than-you' attitude of the last century of medicine"--brought to mind something I read recently in Angie's List, which apparently in a previous issue had asked readers to rate the care received by their doctors, and reported the ratings in an article. In the next issue Angie's List published the letters of several doctors who wrote in to express their outrage that patients would have the audacity to critique the care they received, since they believe said patients are incapable of accurately evaluating whether they received competent care or not. The attitude conveyed in their letters dripped with contempt for people who in their estimation are too stupid to assess the care they receive. I fear a lot of doctors really do believe they are an elite breed apart, towering over the ignorant rabble. All I can say is that, thanks to you and to Dr. Eades, I am a lot better prepared to assess the care of my own doctor, and counter her assimilated commonplaces about nutrition and heart disease. I wish I had known when my parents were still alive what I know now. I couldn't save them from their doctors, but maybe I can save my husband and myself.

  • Anonymous

    7/2/2008 10:23:00 PM |

    "The 21st century promises a new age."
    Taking into mind what ethyl d said: what are the med schools teaching nowadays? Last time I worked in a hospital it was same old, same old. That was eight years ago. The med schools' resistance to change (or not) will make the difference, I think.
    And thank you for this blog. It is an invaluable service.

  • Anonymous

    7/4/2008 6:10:00 AM |

    an old joke:

    Q: What do you call the guy at the bottom of his medical school class?

    A: Doctor.

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(Lack of ) Quality of nutritional supplements

(Lack of ) Quality of nutritional supplements

16. May 2007 William Davis (0)
In my last post, I blogged about how we must not confuse marketing with truth. They are often two different things.

A patient I saw today was absolutely convinced that his fish oil was the best available in the world: purer, uncontaminated by mercury or pesticides--"not like that other crap on the shelves." I asked him how he knew this. "They say so," he proudly declared.

Do you recognize this? He fell for the marketing. While there may be some truth in the manufacturer's claims, you can't believe it from the mouth of the manufacturer. True judgements about quality and purity have to come from an independent source like Consumer Reports, Consumer Lab, or the FDA.

But the FDA doesn't regulate the quality and purity of nutritional supplements. On the positive side, this has allowed supplement manufacturers to keep costs down, not having to navigate arcane and complex regulatory restrictions.

On the negative side, a fair number of supplement manufacturers get away with 1) producing supplements that fail to contain the stated amounts of ingredients, occasionally containing none of the essential ingredient(s), 2) contain contaminants like lead, and 3) make extravagant and often unfounded claims like "superior", "more effective", and "purer". (DHEA, for instance, is a particular landmine of poor quality. I recently suggested that a patient take DHEA; despite consistently taking 50 mg of a specific brand for several months, the blood level of DHEA-S didn't budge one bit--there was likely little or none in the capsule.)

The Fanatic Cook at http://fanaticcook.blogspot.com has posted some very insightful discussions on this issue and the proposed FDA regulations of supplements. They're worth perusing.

I really wish regulation weren't necessary and that the industry could have policed itself. But it clearly has failed and perhaps federal oversight is not such a bad thing, as long as the FDA regulations restrict themselves to oversight over quality and purity and not to efficacy. It's the efficacy regulation that could hogtie innovation in supplement development.
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