You've mentioned before about the medical communities bias toward procedural medicine. If hospitals were to change their position and embrace a preventive bias for heart disease treatment, (early detection, and then addressing with appropriate supplements, drugs, and diet.) any ideas on how much savings for the nation could be had?

Our analysis suggests $634 million per 100,000 people would be saved if they were to engage in a simple program of prevention using heart scans.

Our analysis and rationale can be found at http://trackyourplaque.com/library/fl_hh005bankrupt.asp.

Dr. Davis: I fully agree that legislation is not the answer to this unfortunate practice. I favor freedom for physicians, and an informed public. Government regulation can and will ruin the practice of health care and incentives for new medical techniques and approaches. For those who think the government can be helpful, take a look at Medicare.

I had a “drive-by” angioplasty done in 1999 and a “drive-by” angiogram done in 2000 by the same cardiologist. He told me that I had 90% blockage on one of my main arteries after he performed the first angioplasty. Few years later, a neurologist told me that I actually suffered from panic attacks, not heart attacks. I always wonder how an experienced cardiologist could mistake a panic attack as a heart attack, not once but twice.

"To a man with a hammer, everything looks like a nail."

It holds true in medicine, unfortunately. Especially when each swing of the hammer pays thousands of dollars.

I have often thought that one underlying force that drives this phenomenon might be the fear of lawsuits.  Being a lawyer, I hate to bash the legal profession, but I know that once the person is on the cath table and any blockage is found that some interventional cardiologist somewhere might choose to stent, some doctors may feel the need to practice defensive medicine.  Even before they get to the cath table this is probably an influence.  In other words, say this patient died of a heart attack soon after this hospital visit (which as we all know, could happen even if the symptoms were unrelated to his plaque burden).  If the hospital had not done the procedure (especially since they have an entire crew of people sitting around all day long just waiting to do these), it's possible that some other intervention-oriented cardiologist might be found who would testify that the standard of care these days is to do the angiogram, and that had this been done, it's quite possible, even likely, that the blockage could have been opened up and death avoided.  (Even though we know that this is speculative and depends on how close to this visit the heart attack occurs, as far as the likelihood that this might be a life-saving procedure.)  The further out the heart attack occurs, the less compelling the causation argument.  But I gotta believe that there is defensive medicine being practiced in some of these situations.  And the trouble is, it's the very state of the treatment attitude that contributes to this result, i.e., the fact that unexpected heart attacks are as common as they are, and the proliferation and ready availability of cath labs, so that they are viewed as routinely available.

Hi, Warren-

Yes. I agree absolutely.

In fact, I believe this is exceptionally common. So common that it's become acceptable standard of care.

Often the appearance of doing something is better than the appeareance of doing nothing, regardless of how ineffective the treatment is.