"Yes, Johnnie, there really is an Easter bunny"

30. November 2007 William Davis (13)
A Heart Scan Blog reader recently posted this comment:

You wouldn't believe the trouble I'm having trying to get someone to give me a CT Heart Scan without trying to talk me into a Coronary CTA [CT angiogram]. Every facility I've talked to keeps harping on the issue that calcium scoring only shows "hard" plaque...and not soft.

I also had a nurse today tell me that 30% of the people that end up needing a coronary catheterization had calcium scores of ZERO. That doesn't sound right to me. What determines whether or not someone needs a coronary catheterization anyway?


There was a time not long ago when I saw heart scan centers as the emerging champions of heart disease detection and prevention. Heart scans, after all, provided the only rational means to directly uncover hidden coronary plaque. They also offered a method of tracking progression--or regression--of coronary plaque. No other tool can do that. Carotid ultrasound (IMT)? Indirectly and imperfectly, since it measures thickening of the carotid artery lining, partially removed from the influences that create coronary atherosclerotic plaque. Cholesterol? A miserable failure for a whole host of reasons.

Then something happened. General Electric bought the developer and manufacturer of the electron-beam tomography CT scanner, Imatron. (Initial press releases were glowing: The Future of Electron Beam Tomography Looks Better than Ever.The new eSpeed C300 electron beam tomographic scanner features the industry’s fastest temporal resolution, and is now backed by the strength of GE Medical Systems. Imatron and GE have joined forces to provide comprehensive solutions for entrepreneurs and innovative medical practitioners.)

Within short order, GE scrapped the entire company and program, despite the development of an extraordinary device, the C-300, introduced in 2001, and the eSpeed, introduced in 2003, both yanked by GE. The C-300 and eSpeed were technological marvels, providing heart scans at incredible speed with minimal radiation.

Why would GE do such a thing, buy Imatron and its patent rights, along with the fabulous new eSpeed device, then dissolve the company that developed the technology and scrap the entire package?

Well, first of all they can afford to, whether or not the device represented a technological advancement. Second (and this is my reading-between-the-lines interpretation of the events), it was in their best financial interest. Not in the interest of the public's health, nor the technology of heart scanning, but they believed that focusing on the multi-detector technology to be more financially rewarding to GE.

GE, along with Toshiba, Siemens, and Philips, saw the dollar signs of big money with the innovations in multi-detector technology (MDCT). They began to envision a broader acceptance of these devices into mainstream practice with the technological improvements in CT angiography, a device (or several) in every hospital and major clinic.

Anyway, this represents a long and winding return to the original issue: How I once believed that heart scan centers would be champions of heart disease detection and reversal. This has, unfortunately, not proven to be true.

Yes, there are heart scan centers where you can obtain a heart scan and also connect with people and physicians who believe in prevention of this disease. I believe that Milwaukee Heart Scan is that way, as is Dr. Bill Blanchet's Front Range Preventive Imaging, Dr. Roger White's Holistica Hawaii, and Dr. John Rumberger's Princeton Longevity Center.

But the truth is that most heart scan centers have evolved into places that offer heart scans, but more as grudging lip service to the concept of early detection earned with sweat and tears by the early efforts of the heart scan centers. But the more financially rewarding offering of CT coronary angiograms, while a useful service when used properly, has corrupted the prevention and reversal equation. "Entry level" CT heart scans have been subverted in the quest for profit.

CT angiograms pay better: $1800-4000, compared to $100-500 for a heart scan (usually about $250). More importantly, who can resist the detection of a "suspicious" 50% blockage that might benefit from the "real" test, a heart catheterization? Can anyone honestly allow a 50% blockage to be without a stent?

CT angiograms not only yield more revenue, they also serve as an effective prelude to "downstream" revenue. By this equation, a CT angiogram easily becomes a $40,000 hospital procedure with a stent or two, or three, or occasionally a $100,000 bypass. Keep in mind that the majority of people who are persuaded that a simple heart scans are not good enough and would be better off with the "superior" test of CT angiography are asymptomatic--without symptoms of chest pain, breathelessness, etc. Thus, the argument is that people without symptoms, usually with normal stress tests, benefit from prophylactic revascularization procedures like stents and bypass.

There are no data whatsoever to support this practice. People who have no symptoms attributable to heart disease and have normal stress tests do NOT benefit from heart procedures like heart catheterization. They do, of course, benefit from asking why they have atherosclerotic plaque in the first place, followed by a preventive program to correct the causes.

So, beware: It is the heart scan I believe in, a technique involving low radiation and low revenue potential. CT angiograms are useful tests, but often offered for the wrong reasons. If we all keep in mind that the economics of testing more often than not determine what is being told to us, then it all makes sense. If you want a simple heart scan, just say so. No--insist on it.

Take trust out of the equation. Don't trust people in health care anymore than you'd trust the used car salesman with "a great deal."

Finally, in answer to the reader's last comment about 30% of people needing heart catheterizations having zero calcium scores, this is absolute unadulterated nonsense. I'm hoping that the nurse who said this was taken out of context. Her comments are, at best, misleading. That's why I conduct this Heart Scan Blog and our website, www.cureality.com. They are your unbiased sources of information on what is true, honest, and not tainted by the smell of lots of procedural revenue.
Tags :

Comments (13) -

  • Anonymous

    11/30/2007 8:13:00 AM |

    Hmmn - reminds me of a book I read called "Coronary: A True Story of Medicine Gone Awry," recommended by you, Dr. Davis.  Unnecessary procedures for profits.

    It's a scary world out there in medical land.

  • Anne

    11/30/2007 12:35:00 PM |

    The local heart hospital has a "Heartsaver CT" http://www.heartsaverct.com/index.aspx?CORE_ElementID=HSCT_AHH_Home

    Is this the same as the CT Heart Scan?

  • Anonymous

    11/30/2007 1:11:00 PM |

    I saw another car Bill had worked on this month.  My father and I have an auto hobby shop were we'll bang away on making our own hot rod cars and from time to time a friend or friend of a friend in this case will ask to bring a car by for inspection.  The guy has been having many problems with his hot rod and for repairs had been taking it to Bill's place.  I had an idea of what to expect.  Sure enough Bill had done it again.  Bill's scam is that he will splice a weaker gage wire into a hidden unseen area.  The weak gage can not handle the power load for long and once the wire melts and the part stops working, he explains that the engine part broke, new parts need to be ordered and of course that intales hours of labor costs.  
        

    After reading this blog it reminded me of scammer auto shops.  Hospitals have their scams too.    I wish I could walk into a doctor’s office and expect that only the best, least expensive, treatment will be offered me - but I now know that isn't the case.  I can't be lazy.  I need to educate myself in the basics of medical care to ensure I receive the best treatment for me.  Thanks for being a good teacher Dr. Davis.

  • Dr. Davis

    11/30/2007 1:23:00 PM |

    Yes, it looks like it is the real thing, a simple heart scan, judging from their comment that "There are no needles, no dyes, no injections and no exercise." CT angiograms require needles, dye, and injections.

  • Mike

    11/30/2007 3:27:00 PM |

    The CT angiogram makers are generating lots of reports on how great their machines are.

    http://www.theheart.org/viewArticle.do?primaryKey=830205&nl_id=tho28nov07

  • Dr. Davis

    11/30/2007 3:41:00 PM |

    They certainly are. Big bucks, big marketing.

    I do believe, in all honesty, that the new devices really represent great advances in diagnostic imaging. It's their mis-use and over-use that I object to. Of course, the manufacturers keep their lips closed about it because overuse drives more sales.

  • Paul Kelly - 95.1 WAYV

    11/30/2007 5:00:00 PM |

    Hi Dr. Davis,

    I've learned from reading your blog that typically 20% of TOTAL PLAQUE is calcified or "hard". Is that a steadfast rule - or is that an average? What if someone has a calcium score of zero (or close to it)? Can it be assume that that person also has very little in the way of "soft" plaque?

    Thanks!

    Paul

  • Dr. Davis

    11/30/2007 5:12:00 PM |

    Speaking generally, people with zero heart scan scores have heart attack rates of near zero (if asymptomatic).

    The likelihood of detecting pure "soft" plaque in someone without symptoms and a zero heart scan score is <5%. It does happen, particularly when certain severe risks for heart disease are present (e.g., very high LDL/small LDL). It is exceptional, however.

  • noreen

    12/1/2007 12:55:00 AM |

    Since I can't afford the current local price of a 64 slice CT scan ($1100), I've decided to get a lipoprotein breakdown to determine my risk.   I can use your "treatment" protocol of supplements to try and achieve the 60-60-60 values when I see the results.   Is this a good plan?

  • Dr. Davis

    12/1/2007 1:47:00 PM |

    Hi, Noreen--

    I'm afraid that you may regret not getting the scan a few years from now. After you've successfully corrected lipoproteins, you may want to know if you've also successfully controlled plaque growth, the MORE IMPORTANT parameter.

    Have you thought about looking elsewhere for a scan? In Milwaukee, for instance, scans can be obtained for as little as $79. (Though the low-priced scans also come with a sales pitch for CT coronary angiography. Just say "no thanks.")

  • mike V

    12/1/2007 8:49:00 PM |

    I am 72 and pretty healthy.
    This year I have been seeing a cardio because of some nocturnal palpitations. He has subjected me to a series of tests-sleep-ultrasound-both negative, and a nuclear stress test which gave a hint of possible blockage. He recommended either an angiography or a CTA scan. I chose the latter, and was rated "normal".
    I asked if this meant normal for my age. He said "no, normal for any age, I couldn' find any trace of hard or soft plaque". Yes he is part of a large group.

    My father died of a second heart attack at 76.
    I have taken vitamin D, fish oil, magnesium, pantethine, flaxseed, co-Q10, lutein, olive oil, for some years.
    I am trying hard not to feel smug, but should I feel safe?
    We are still working on the nocturnal palpitations which seem to be dependent on sleep position.
    I have bradycardia, and no other obvious health 'problems'.

  • Harry35

    12/2/2007 12:30:00 AM |

    With regard to the 20% value for calcified plaque, if you look at figure 1 from Rumberger’s classic 1995 paper (Circulation. 1995;92:2157-2162.), it shows the plaque area and calcium areas for each of 13 hearts that were examined on autopsy. If you take the points in this graph and determine the areas for each heart, the data shows that the calcium area and calcium percentage increases with plaque area. Unfortunately the paper doesn’t say what the calcium scores were for each heart, only the calcium areas and total plaque areas. However, over the range of plaque areas of the 13 hearts, the percentage of calcium in plaque increased from 0% to 14% for the 9 hearts with with plaque areas less than 150 square mm to 14% to 28% for the hearts with the plaque areas greater than 230 square mm. So from that we can conclude that the 20% value is an average, and that the calcium percentage increases as more and more plaque accumulates.

    Harry35

  • Anonymous

    3/5/2010 5:20:16 PM |

    Sehr interessant!

Add comment

Loading
Dangerous mis-information on vitamin D

Dangerous mis-information on vitamin D

16. January 2009 William Davis (12)

Please be aware of the ignorant propagating information they have no business talking about.

This is one such example, a newsletter from pop exercise guru, Denise Austin.

Although I'm sure she means well, I have a problem with people who have little to no experience acting as experts, often simply repeating something they heard or read somewhere else. This has become particular problem with the internet, in which bad information can get repeated thousands of times, gaining a veil of "truth" through its repetition. I don't mean to pick specifically on Ms. Austin, since she joins a growing rank of pseudo-experts on vitamin D and other topics, but she provides a good example of how far wrong mainstream information can be.



Simple Steps
Do Your D!

Calcium often gets all the glory when it comes to bone health. But calcium wouldn't benefit your bones much without its partner, vitamin D!

Why? Vitamin D helps your body absorb calcium and keeps your bones strong; without enough vitamin D, the bones become weak and brittle, a condition called rickets in children, and osteomalacia in adults. Adults from 19 to 50 need 200 IU (international units) per day, while those from 51 to 70 need 400 IU daily. Those over 70 need 600 IU per day.

Unfortunately, not too many foods contain vitamin D naturally. (Tuna and sardines canned in oil are exceptions.) The good news is that many foods are now regularly fortified with vitamin D, including milk, some yogurts, margarines, and cereals. You can check the Nutrition Facts panel on packages and containers to see which products contain vitamin D. It should be listed after vitamins A and C, along with the percentage of the Daily Value that a serving of the food contains. The Daily Value (a standardized amount) for vitamin D is 400 IU, so if your milk has 25 percent of the Daily Value, it provides 100 IU per serving.

Your skin can also make vitamin D using sunlight — you need about a half hour of exposure to the midday sun twice a week to make enough. However, because of the increasing incidence of skin cancer in recent years, many experts are wary about recommending sun exposure.

So take a closer look at milk, yogurt, cereal, and margarine selections when you're doing your weekly shopping, and stock up on brands that are fortified with vitamin D. Challenge yourself to consume one source of vitamin D at least three days in the coming week! If you cannot eat or do not like any foods that contain vitamin D or are fortified with it, talk with your health care provider ASAP about taking a supplement. Your bones will thank you for it!



Let me list the mistakes in this piece:

Adults from 19 to 50 need 200 IU (international units) per day, while those from 51 to 70 need 400 IU daily. Those over 70 need 600 IU per day.

This is the same non-information that was the advice originally offered by the Food and Nutrition Board based on a best guesstimate due to lack of data. It is clear from newer data that doses required for full restoration of vitamin D are in the thousands of units. (My personal dose for full restoration of vitamin judged by serum levels of 25-hydroxy vitamin D is 8000 units per day.)

The information coming from the Food and Nutrition Board is about as good as the information coming from the USDA (you know, that "government" agency meant to represent the interests of ConAgra, Cargill, and Big Farming) and the American Heart Association (that represents consensus opinion from data 20 years out of date and now arm-in-arm with Big Food like General Mills, Kraft, and Nabisco). These agencies and the advice they offer has, over the past few years, become increasingly irrelevant and outdated. It is the Information Age, in which ulterior motives are becoming more readily exposed, yet they still operate by the rules of the Industrial Age and deliver a message that serves their own purposes.

Ms. Austin fell for it.


The good news is that many foods are now regularly fortified with vitamin D, including milk, some yogurts, margarines, and cereals.

First of all, what is a "diet expert" doing advocating industrial foods? Cereals, in particular, are among the worst foods on the supermarket shelves, whether or not they are fortified. Candy bars can be fortified, too; that doesn't make them any better for you.

The vitamin D added to these foods is, more often than not, the ergocalcferol, or D2, form that is woefully ineffective. And the dose added is trivial, usually in the 100-200 unit range per serving. The same goes for the milk, an inadequate source that we don't even factor into total intakes because of the low quantity.


Your skin can also make vitamin D using sunlight — you need about a half hour of exposure to the midday sun twice a week.

Nope. This might be true for a young person below age 30 in a southern environment. It is NOT true for the majority of people in northern climates and anyone over age 30 or 40, since we lose most of the capacity to activate vitamin D in the skin as we age. A deep, dark Florida tan does not necessarily mean that vitamin D has been activated. See A tan does not equal vitamin D. Here in Wisconsin, where, despite this darn cold winter, does enjoy wonderfully warm and beautiful summers, the average vitamin D dose need ranges from 4000-8000 units per day in summer, slightly more in winter.

By the way, it is not calcium that is instrumental to bone health. It is vitamin D. Calcium is the passive bricks and mortar of bones, while vitamin D is the bricklayer, the determinant of calcium's fate, the master control of bone health. Calcium supplementation becomes almost immaterial when vitamin D is restored.

I praise Ms. Austin for her hard work, trying to help fat Americans lose weight. But please ignore her advice on vitamin D, along with the numbing repetition of this mis-information that will likely propagate from other exercise gurus, dietitians, and pseudoexperts.
Tags :

Comments (12) -

  • Cristy

    1/16/2009 3:39:00 PM |

    What would be your recommendation to ensure adequate vitamin D intake for my children who are 7 and 9?

  • Jessica

    1/16/2009 6:30:00 PM |

    Thanks for posting this and continuing your efforts to provide the public with GOOD information about D and health in general.

    Most doctors don't "get it" when it comes to Vit D, so I don't expect Ms. Austin too either.

    I'll stick with www.vitamindcouncil.com, my own research, and your site. Thats my vitamin D package.

    P.S. A local pharmacy began carrying the 5,000 D-3 capsules! And, one of our patients is a pharmacist for a national chain and during a visit last week, we asked about the possibility of his pharmacy carrying 5,000 IU D3 and he said, "not a problem!"

    We'll see!

  • Anonymous

    1/16/2009 7:26:00 PM |

    I have a quick question: do we have any clue why we lose the ability to get vitamin D from sunlight after 30 or 40? And is this the same for everybody? Is there a way you can slow down the downhill slide? Thanks a lot.

  • Jenny

    1/16/2009 8:43:00 PM |

    The messages seems to be getting through in my area: every time there's a sale in the vitamin department, the larger dose Vitamin D pills vanish!

    And the oil based D3 is showing up everywhere, too.

  • baldsue

    1/16/2009 11:39:00 PM |

    My gynecologist has got it wrong, too.  When I told her I was taking 3000IU of vit. D per day she snorted and said, "I think you mean 300".  I said, "No, 3000" and I explained that I had been deficient.  She said "There's just too much hype about D these days."

    Eeeeeeeeeeeeeeeek!

  • Peter Silverman

    1/17/2009 12:40:00 PM |

    If you still think the vitamin D gelcaps work and the tablets don't, why don't you mention it more often: a lot of people take the tablets because they're cheaper, thinking they're getting the benefit.

  • TedHutchinson

    1/19/2009 3:29:00 PM |

    For Cristy
    http://www.vitamindcouncil.org/newsletter/2008-october.shtml
    Dr Cannell talks about the idea amount for children here.

    For anonymous. Vitamin D3 is made from the cholesterol in our skin. As we age our skin gets thinner and their is less cholesterol near the surface for the UVB rays to turn to  vitamin D3. You may find Dr Davis's previous blog on the topic interesting.
    http://heartscanblog.blogspot.com/2008/07/vitamin-d-and-programmed-aging.html

    Re  Peter Silverman some of us, who regularly get our 25(OH)D tested, use dry powder Vitamin D3 5000iu capsules do find, if we consume them with food, that we can attain and maintain a reasonable 25(OH)D status using these cheaper capsules.
    Dr Davis finds the oil gel generally more reliable and so you pays your money and takes your choice. but vitamin d3, whatever form can be found very cheaply so cost/saving should not be the first priority.

    But all skinflints here may be interested in the GRASSROOTS VITAMIN D TESTING TRIAL.
    http://www.grassrootshealth.net/d-action
    Sign up now for a 25(OH)D test from zrt labs for just $30 every six months for the next 5 years.
    These tests normally cost $75 and the vitamin D council were doing them for $ 65.00
    So hopefully those who save money will think about a donation to support the Grassroots site
    http://www.grassrootshealth.net/

  • Anna

    1/25/2009 9:57:00 PM |

    Ted, thanks for the grassroots Vit D info.  Turns out the administration of this study/PR campaign is right in my own backyard (metaphorically speaking).  I'm going to help the administrator stuff test kit envelopes (saving them $1000s in mail  stuffing services) and get the word out in the local vitamin stores and "health food" stores, etc.

    Even though my family can get our levels tested through our HMO network, covered by insurance, I signed up the entire family for this study, because I feel strongly about helping them to get the data they need about Vit D levels and health conditions.

    Cristy, I started my 75 pound 10 yo old on 3000 iU of Vit D3 (Carlson brand) when the school year started (more indoor time), based on the Vit D Council's weight/dose recommendations.  We had a need to get a blood sample for something else in December and I requested a 25 (OH)D at the same time.  It was 72 ng/ml, perfect!  I'll probably reduce or stop the Vit for the summer months, though, as he's outdoors a lot.  

    BTW, we are in coastal San Diego County, where nearly all the middle aged (or older) adults I know who get tested are in the very low reference range (30s) or lower (my husband and I test so far in the 40s with some D3 supplementation, so we raised our dose in line with the Vit D Council's recs, too).  

    So sunny mild climate means little if one's indoor or sun-avoidance lifestyle has little sun exposure (or age).

  • Anna

    1/25/2009 10:00:00 PM |

    Oh, just noticed, there's an error in that d*action / Grass Roots Health link.  It's .org, not .net.

    http://www.grassrootshealth.org/

  • Anonymous

    8/16/2010 10:18:50 AM |

    It is such hell trying to work without the help of a nutritional doctor. I have been helped to regain my health by a nutritional approach but the GMC don't like that and my wonderful doctor was targeted and now I have to try and manage my health on my own. It is not very satisfactory to put it mildly

  • Osiris

    8/16/2010 10:58:34 AM |

    I don´t discuss my supplements with MDs most of them are totally ignorant and are brainwashed

  • buy jeans

    11/3/2010 9:08:22 PM |

    The vitamin D added to these foods is, more often than not, the ergocalcferol, or D2, form that is woefully ineffective. And the dose added is trivial, usually in the 100-200 unit range per serving. The same goes for the milk, an inadequate source that we don't even factor into total intakes because of the low quantity.

Add comment

Loading