Excessive Heart Procedures Makes New York Times Headline

18. August 2006 William Davis (0)

One example of flagrant cardiac procedure excess has made New York Times headlines:


Heart Procedure Is Off the Charts in an Ohio City
The number of angioplasties performed in Elyria is so high that Medicare is starting to ask questions.

(The full article can be accessed through the New York Times website at http://www.nytimes.com/2006/08/18/business/18stent.html?pagewanted=2&ei=5094&en=b81be5f43f98a99b&hp&ex=1155960000&partner=homepage)



Cardiologists in little Elyria, Ohio, about a 30-minute drive west of Cleveland, do more coronary angioplasties and insert more stents than any other location in the U.S.--four times more than the national average, three times more than the Cleveland average. They perform even more than the recently-indicted cardiologist in Louisiana, who performed twice the national average of procedures.


The Times article, part of a series about financial incentives in medical care, provides a responsible and incredibly balanced report on the situation in Elyria. I have to give them credit, because from the eyes of a colleague (myself), this looks like blatant and extreme profiteering: "cathing for dollars".

I find it outrageous that this group of cardiologists claims that they have some special insight into heart care that justifies this extraordinary reliance on heart procedures. There's bound to be variation in practice patterns, but this is so outside the norm that I believe criminal behavior will be exposed. In fact, I believe that even the "norm", or average, rate of procedures is also excessive.

This is symptomatic of the perverse equation in heart disease care. If there's money to be made in major heart procedures, who wants to bother with prevention? Programs like the Track Your Plaque program present real potential to stop coronary heart disease in its tracks for many, if not most, participants--but don't expect to hear about it from your cardiologist. Don't expect to hear about it from the increasingly hospital-employed primary care physician.

Hopefully, media exposure like that in the New York Times is just the beginning of a public re-analysis of not only what's wrong with medicine today, but recognition of the tremendous power in preventive strategies when everyone stops being so enamored with hospital-based procedures. CT-based heart scanning that ignites your heart disease prevention program is your way to dodge the mainstream obsession with procedures.
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End-stage vitamin D deficiency

End-stage vitamin D deficiency

6. December 2007 William Davis (7)
Let me paint a picture:

A 78-year old woman, tired and bent. She's lost an inch and a half of her original height because of collapse of several vertebra in her spine over the years, leaving her with a "dowager's hump," a stooped position that many older women assume with advanced osteoporosis. It's also left her with chronic back pain.


(Image courtesy of National Library of Medicine)

This poor woman also has arthritis in her knees, hips, and spine. All three locations add to her pain.

She also has hypertension, a high blood sugar approaching diabetes, and distortions of cholesterol values, including a low HDL and high triglycerides.

Look inside: On a simple x-ray, we see that the bones of her body are unusually transparent, with just a thin rim of bone at the outer edges, depleted of calcium. Weight-bearing bones like the spine, hips, and knees have eroded and collapsed.

On an echocardiogram of her heart (ultrasound), she has dense calcium surrounding her mitral valve ("mitral anular calcium"), a finding that rarely impairs the valve itself but is a marker for heightened potential for heart attack and other adverse events. Her aortic valve, another of the four heart valves, is also loaded with calcium. In the aortic valve, unlike the mitral valve, the collection of calcium makes the valve struggle to open, causing a murmur. The valve is rigid and can barely open to less than half of its original opening width.

If a heart scan were performed, we'd see the coronary calcification, along with calcification of the aorta, and the mitral and aortic valves.

Obviously, it's not a pretty picture. It is, however, a typical snapshot of an average 78-year old woman, or any other elderly man or woman, for that matter.

This collection of arthritis, osteoporosis, coronary and valve calcification, high blood pressure, abnormal cholesterol patterns, and pain is not unusual by any stretch. Perhaps you even recognize someone you know in this description. Perhaps it's you.

Look at this list again. Does it seem familiar? I'd say that the common factor that ties these seemingly unrelated conditions together is chronic and severe deficiency of vitamin D. Vitamin D deficiency leads to arthritis, osteoporosis, coronary and valve calcification, high blood pressure, abnormal cholesterol patterns, and pain.

Should we go so far as to proclaim that aging, or at least many of the undesirable phenomena of aging, are really just manifestations of vitamin D deficiency? I would propose that much of aging is really deficiency of vitamin D, chronic and severe, in its end stages.

My colleagues might propose a 30- or 40-year long randomized trial, one designed to test whether vitamin D or placebo makes any difference.

Can you wait?
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Comments (7) -

  • Darren

    12/6/2007 5:43:00 PM |

    So I'm not a cancer patient but would the same 1,000 IU's / 30lbs of bodyweight be a good guideline for us as well?  

    Also he mentions blood calcium test monthly - how much of a concern is potentially elevating blood calcium for a 4K-6K IU/day intake of D3?  Would K2 reduce or increase blood calcium?  I'm just not sure it's practical for most people to get a monthly test...

  • chickadeenorth

    12/7/2007 5:12:00 AM |

    Wow interesting reads about Vit D.

    Could you help me understand more why the Vit D in softgel is better than the dry??Mainly absorption??

    Also why check the calcium levels monthly along with the 25(OH)D??

    I will support this newsletter, thanks once again.

  • Dr. Davis

    12/7/2007 11:48:00 AM |

    Softgels are oil-based; tablets are not. You can therefore force the tablet D to be absorbed by including a lot of oil, e.g., a teaspoon of olive oil. However, the absorption tends to be erratic, in my experience. Softgels are very consistent.

    We do not advocate monthly calcium levels.

  • Anonymous

    12/8/2007 1:00:00 PM |

    Just a commentary on the article,  I'm a believer in your program and as such have been telling everyone about it that will listen.  I'm a male, and I've found that convincing other males of TYP has been relatively easy.  Most guys I know now follow the TYP program somewhat to a degree.  Females I know though have been a tougher sale.  And I believe this lack of interest in TYP by females I know has probably been caused by  differences in how males and females relate to each other.

    I distribute your blog postings and this one apparently hit a cord with females.  I heard from a friend that his wife is now raiding his vitamin D bottle.  Another two female relatives have called wanting to know what vitamin D to use and where to buy.  As funny as this sounds, I think the new found interest in TYP by females I know is because of the female orientated subject in this blog.

  • Dr. Davis

    12/8/2007 1:27:00 PM |

    Interesting observation!

    Maybe there's a lesson for us to learn from your observation.

  • buy jeans

    11/3/2010 6:18:21 PM |

    In other words, the findings of this substantial observation suggest that the ranges of TSH usually regarded as normal contribute to coronary events, cardiac death, as well as lipid patterns. While several other studies have likewise shown a relationship of higher TSH/lower thyroid function with lipid abnormalities and overt heart disease, no previous study has plumbed the depth of TSH to this low level and to such a large scale.

  • Tammy Regis

    8/5/2011 8:19:10 PM |

    I like all what you wrote except you make no mention at all about muscle tissue.  Her pecs and abdomals are locked short while her neck and spinal muscles are locked long.  There is a direct mind / body connection here that Western medicine has still not caught on to.  Anyone can take a moment to think of something sad or worrisome, and take note of their posture change when they think of something happy or exciting.  A lot of people are walking dead.

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