Sorry I’ve been away for a couple days.
Without meaning to, I got myself into a bit of a fracas over at Club webMD’s TheHeart.org forum.
You see, I’m that “John Q Public” who made a simple post at that forum about whether dramatic improvements in patient outcomes are possible for cardiovascular disease. Dr. Davis has written some about this whole mess at his blog.
My first post in that forum thread merely said (free registration required for medical professionals including media professionals. Hey, I’m a “medical media personality” aren’t I on account of this blog?):
Fascinating, isn’t it, that there appear to be two doctors, William Blanchet in this forum and Dr. William Davis, FACC, of TrackYourPlaque.com that both claim to have dramatically reduced risk of heart attack among their patients and/or actual calcium plaque score regression and BOTH are ardent proponents of CT Calcium Scoring?
Well, one thing led to another and I was asked never again to post to the forum. So, I won’t.
I must admit though, I’m kinda pissed. Not with the Club. No.
Look, the trouble maker here was Dr. William Blanchet, a doctor of Internal Medicine in Boulder, Colorado. If anyone’s to blame for the trouble, it’s him.
You see, Dr. Blanchet initiated the forum thread and wrote that:
Yes, I have seen a dramatic reduction in coronary events [because I leverage CAC scoring in my practice]. Of 6,000 active patients, 48% being Medicare age and over, I have seen 4 heart attacks over the last 3+ years. 2 in 85 year old diabetics undergoing cancer surgery, one in a 90 year old with known disease and one in a 69 year old with no risk factors, who was healthy, and had never benefited from a heart scan.
… SNIP …
Yes, a 90% reduction in heart attacks in my patients compared to the care I could provide 5 years ago when I was doing a lot of stress testing and referring for revascularization. Much better statistics than expected national or regional norms.
I was struck by the fact that Dr. Blanchet sounded just like Dr. Davis in his unstinting advocacy of CAC scanning to assist in reducing patient risk. Even more than this, Dr. Blanchet wasn’t even a cardiologist but a doctor of Internal Medicine.
Dr. Blanchet sounded so much like Dr. Davis that I wondered for a bit if Dr. Davis might be moonlighting under an assumed name at TheHeart.org Forum. I got clear after a while though that he wasn’t, in fact, Dr. Davis.
So I couldn’t resist making that single sentence post above that suggested something important might be going on here. If two doctors were saying that CAC scoring was critical to the dramatic improvement in life and death outcomes for their patients, then, maybe this was something to talk a bit more about.
After all, as of November 18, 2007, it’s an indisputable fact that, at WebMD’s TheHeart.org forum, there has been virtually NO serious discussion of the possibility of stopping or reversing coronary plaque growth.
I wanted to hear the topic debated. So, I raised the question above in my post.
Well, things just got worse from there. What I didn’t know is that Dr. Blanchet is a trouble maker. So when I raised the question, it was as if I had poured gasoline on a fire already raging. Dr. Blanchet began to go on and on about the scientific evidence in support of the contention that CAC score scanning is the most meaningful way to gauge the risk of coronary artery disease. And that this risk score can be leveraged to put an end to a whole lot more of life and family tragedies that are occuring because of cardiac-related death.
Well, then he wouldn’t stop with his whole “scientific evidence” shtick. I guess that’s what made me wonder a second time about whether he really was Dr. Davis incognito. Because, if you’ve read Dr. Davis for any length of time, you know he’s always going off the deep end with the whole “an incredible amount of today’s tragedy of coronary disease can be averted with CAC scoring” broken record.
Well, I was asked to identify who and what I was and I did that. Turns out that TheHeart.org forum is intended for discussion of issues by medical professionals only. Therefore, I’ve been told that if I post again in that forum, my account access–which is free to anyone registering as a medical professional including medical media professionals–will be cancelled.
Now, Drs. Blanchet and Davis appear to have a problem with this. I don’t. I think it makes sense that there be a forum on the internet for discussion by medical professionals only. So, I won’t post there any more.
How about if I do this? How about I just editorialize about the goings on over at the Club webMD Heart Forum at this blog from time to time?
Oh, and I guess I should confess that I’ve also copied the entire text of that forum thread just in case anyone attempts to change the historical record of the thread. It is a thing of beauty.
P.S. I tracked down Dr. Blanchet and he promptly called me right back. It was just more of the same old stuff that appears not to be very interesting to the good docs at Club webMD… things like… “scientific evidence”, “CAC scoring”, “leveraging this technology to avert life and family tragedies”. That whole shtick.
I’m thinking that Dr. Blanchet’s mania on this topic might make for an interesting HeartCipher blog interview at some point. I’ll see what I can do.
Meanwhile, Dr. Davis has already agreed to do an interview with yours truly.
I’m going to get these guys on the record in a way that only yours truly, aCipher at the HeartCipher blog, can.
November 20th, 2007 at 4:37 pm
Does anyone know what kind of treatment plan Dr Blanchet uses other than CAC scoring?
Don Howard
November 21st, 2007 at 2:03 am
Don,
I use coronary calcium imaging to identify which patients are at riks (who often would have been missed by traditional risk factor assessment). I initiate intervention based upon individual assessment however a statin, omega-3 fatty acid source, exercise, and healthy diet is usually part of the answer. If HDL cholesterol is low, I will start niacin immediately.
I then repeat the heart scan anywhere from 12 to 36 months later (depending on how concerned I am about the patient’s individual risk) and alter therapies if the calcium burden increased more than 14% on an annualized basis. If the plaque burden is increasing, I will add niacin, Zetia, high dose omega-3 in the from of Lovaza, and sometines bile salt sequestrats. In addition, I try to get the blood pressure as low as I can without creating symptoms.
The result is that the plaque burden stabelizes in almost all of the patients by the 3rd scan, and most importantly, heart attacks and strokes are rare indeed in my practice.
November 21st, 2007 at 1:30 pm
The impression that Dr. Blanchet and John Q. Public left me with from the Heart.org Forum is that, when debating those of the conventional ilk, their arguments crumble when presented with the data.
Curiously, the abundant heart scan data does not get read as closely as the revascularization, stent, statin studies, when-to-implant-a-defibrillator data, and the like.
By the way, Dr. Blanchet, I would urge you to consider thinking about vitamin D normalization. I know it sounds wacky, but the results are astounding. Check 25-OH-vitamin D3 levels and you will be shocked at the proportion of patients deficient, often severely, in vitamin D. I try to achieve serum levels of 50 ng/ml. Michael Holick of Tufts is principle author on a number of relevant studies, as are Robert Heaney of Creighton and Reinhold Vieth of Canada.
November 22nd, 2007 at 12:57 am
[…] In my last post I wrote about a fracas going on over at a forum site for doctors. […]
November 24th, 2007 at 9:01 pm
Just want to say to both Dr Davis (I have been on his blog recently) and Dr Blanchet that what they are doing is incredibly important!
If I hadn’t had some non-cardiac chest pains that took me to a cardioligist who knew about EBT scans - I would be an out-of-control freight train heading for a procedure…of