Once in a while, you hear or read some cardiologist make a set of statements that are so astonishing that they merit special comment and to be called out.
And there’s even more of a need to highlight the statement when that cardiologist’s professional colleagues fail to do so.
Such is the case in a recently begun thread at the “ClubwebMD” forum at TheHeart.org.
A cardiologist in that thread (who I won’t name but can be found by the diligent using Google) uttered something that boils down to the title of this post.
“My patients are too poor or too stupid to get the best cardiac care.”
At the outset, let’s grant that this cardiologist deserves at least some credit for being honest. Or maybe you think I’m exaggerating. No doctor, not even a FACCer, would make this point so baldly, right? (I use the designation “FACCer” as shorthand for describing a Fellow of the American College of Cardiology with whom I am particularly taken.)
Well, how about we do this? I’ll provide the verifiable online quotations and commentary and then you decide whether my interpretation of his remarks in this post’s title is a fair one.
Deal? Ok then, follow me after the jump for more…
(image courtesy of thechaly.wordpress.com)
We’ll get to an exact quotation of the statement made by the cardiologist. But first a bit of introduction.
Dr. William Blanchet had been making the case that CAC scanning was a tremendous technology for doing heart attack and CAD risk assessment in asymtomatic patients and that Tim Russert’s death might have been avoided had he had followup CAC scans. Our own Dr. Davis also chimed in from time to time in the discussion and blogged about the discussion here and has also discussed Blanchet several other times.
Then along comes this brilliant cardiologist who writes as follows…
Lastly, I practice in a largely rural area of South Carolina, not in upscale/liberal/superior Boulder. Furthermore, unlike Dr. Davis, I don’t charge a $39 three month introductory fee for my patients to use my website extolling the various tests and treatments (this thread has been one big plug for you people). My patients could never afford to pony up for an EBCT much less annual followups. Also, I don’t think that my patients will go for the Paleo Grain Free diet that BG suggests (surely that’s a joke). Wikipedia defines it as a widely criticized poorly conceived idea.
Let’s put aside the idiotic insinuation that Dr. Davis is taking advantage of heart disease patients by making huge amounts through Track Your Plaque program subscriptions. Anyone who knows anything about costs associated with running the kind of site that TYP is and actually knows something about TYP knows this is nonsense.Let’s focus on the other idiotic phrases in his statement.
My patients could never afford to pony up for an EBCT much less annual followups.
EBCT Coronary Artery Calcium scanning has been shown to be the very best predictor of heart attacks in dozens, if not hundreds, of studies, with two more published in the last few weeks described here and here. But never mind that, this FACCer says his patients are too poor to afford to get the very best heart attack risk assessment test performed on themselves.
So what is this FACCer’s CAD risk assessment regime all about? Well, he tells us in another post in the same thread:
I search and I search and I can’t find a reason to do EBCT… except maybe one time, in Framingham intermediate risk patients, but then I could do ABI’s [Ankle Brachial Index] nearly for free on those patients.
Now, never mind that by the time an ABI test picks up on plaque in the peripheral arteries, the coronary arteries are already plaque filled. And never mind that Dr. Blanchet had already made this exact point earlier in that thread. This FACCer’s mind is made up.
He’s not going to tell his patients about what the best CAD risk assessment test is that they can take because they’re too poor, he says, to make an intelligent judgment. You see, they can’t make an intelligent judgment about personal and family budget priorities. I assume that because he believes they’re too stupid to weigh the value of their own lives or the lives of their loved ones vs. other life expenses they may have.
You see, this FACCer believes he’s doing his patients a favor by not telling them about best ways to reduce the risk of CAD.
And as for the best diet advice for CAD risk? Even if more and more scientific evidence has led Dr. BG and others to believe that a sort of “Paleo Grain Free diet” is best to fight heart disease, he’ll just use Wikipedia as his source of information to evaluate it. Why in the world ought that not to be “good enough” for his patients? It’s not like they’re smart enough to get on the web and figure it out for themselves right?
The fundamental issue here is really simple. This FACCer believes his patients are too poor, too stupid, and/or not well enough informed to find out that when they see him with potential CAD risk they are likely not getting the best care.
July 15th, 2008 at 1:39 am
Yikes!
I do not know what to say in response to Dopey Doc’s drivel! Comparing an ABI to an EBCT is like comparing a gnat to fighter jet. If Dopey Doc cannot find info regarding the efficacy of calcium scoring then he/she is deaf, dumb, and blind. So let me get this straight, if a test is not available to everyone, then no one should get it?!
Regarding Track Your Plaque, all the basic program stuff is free (and Davis’ patients get a free membership for the asking). A continuing membership to get the rest is a whopping $6.65 a month! You tell me where you can ask as many questions as you want of a practicing cardiologist for that price (plus all the other stuff you get)!
I have personally invested a great deal of time helping get the TYP website going and developing content. Other members like BG and you also contribute fantastic info, comment, and time. I do it to save my own life and my son who also has my affliction. I do it to honor the sacrifices and premature deaths of my mother, grandfather and uncle who had their heart attacks before TYP was an option. My guess is you and everyone else donate your efforts for similar reasons.
Davis busts his ass for free (I’ve seen the financials - he is actually still in the hole) doing all he does after putting in a full day as a practicing cardiologist. His office staff and nurses also chip in. Personally, I hope Davis makes a fortune so he can quit his practice and devote ALL of his time to TYP members which is what he would REALLY like to do!
This Dopey Doc can go to hell if he/she thinks I and my son are going to follow to their cardiac slaughterhouse.
HeartHawk