March 7, 2015

redOrbit exclusive: heart-related deaths prevented with simple scan

John Hopton for redOrbit.com - @Johnfinitum

Millions of Americans are dying unnecessarily from heart attacks because a cheap and simple test that could catch problems early has been suppressed through corporate greed, a major new documentary film claims.

The Widowmaker, narrated by Gillian Anderson, examines how a scan that identifies calcium in the heart, a sure sign of impending problems, could have had a historic impact on America’s biggest killer of both men and women, if only it had been supported. Treatment with pills and lifestyle changes could easily have been prescribed to patients who displayed warning signs, meaning a vast reduction in sudden, unexpected deaths.

Those who have supported the test, a CT scan known as coronary calcium scoring, say that it could have had an impact on public health beyond that of mammograms and equivalent to revolutionary treatment of tuberculosis in the 1940s, then the biggest killer. But the failings of a commercial healthcare system mean that the number of people who have been able to make use of it is pitifully low – something the filmmakers say is one of modern medicine’s greatest scandals.

redOrbit spoke to the film’s director Patrick Forbes and contributor Dr. Matthew Budoff, a central figure and long campaigner among coronary calcium scan advocates, about the hidden battle that has taken place in America’s medical establishment for 30 years and the test that could have saved up to four million lives.

A completely perverse market

Speaking about how the system could allow an effective prevention to go unused, Forbes said: “It seemed to me a completely perverse market. It’s insane that there is a healthcare system that prioritizes something incredibly expensive (heart surgery) over something incredibly cheap… it can’t make any sense.”

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But as the film discovers, a lot of people are making a lot of money from having patients get to the stage of reaching hospitals and having expensive surgery to put stents into arteries.

Stents are effective, but what about the one third of heart death victims who never even make it to a hospital? The film evocatively looks at people who seemed healthy but died before an ambulance ever arrived. As one of the doctors in the film puts it, people who lose out financially from the test “don’t want them to die, but they don’t necessarily want them to get better, either.”

At the same time, insurance companies do not want to cover the cheap preventative measure because, Forbes says, “if only one of them backs it, they lose out, whereas if all of them back it together they all benefit. Nobody wants to move first.”

“The politics of it are so vicious because so much money is riding on it,” he adds, pointing out that it makes sense that Europe, with less commercialized healthcare, “has a greater bias towards scanning.”

[STORY: Heart failure treatment costs will more than double by 2030]

In the US, NASA astronauts and presidents have the test, but most people don’t.

Avoiding a heart attack costs less than a good meal

For the last 30 years, UCLA’s Dr. Matthew Budoff has been part of a group of doctors referred to as the Calcium Club, who have supported calcium scanning from the start and say that it could have prevented hundreds of thousands of heart attacks every year.

Budoff says that screening of any kind “is almost a four letter word to the insurance companies… they don’t feel that they’re responsible for patients several years down the road.” Therefore, he says, “it’s now up to the individual consumer - if people want to be good about preventive cardiology, they will demand this test.”

With testing costing only around $100 each, Budoff says that: “It’s not even the cost of a good meal. You forego going to a steakhouse tonight and you get your heart scanned and find out if you’re going to live another ten years. It’s not worth fighting with the insurance company about.”

Along with medical infighting and financial conflict of interest, a lack of awareness about the test is a major issue. Budoff says that: “We need people to talk about it, write about it… it’s being withheld because people don’t know about it, not because it’s dangerous or hard to do or expensive.”

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The prevalence and profile of the test is increasing, and Budoff says that newer doctors will be more likely to recommend it because it has been part of their training. But awareness is still far too low.

Coronary calcium scans are recommended for men over 45 and women over 55, even if they are entirely asymptomatic - and even if the insurance companies don’t want to pay.


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