CANCER OF THE CORONARIES: ARTERIAL PLAQUES

CANCER OF THE CORONARIES: ARTERIAL PLAQUES

Medicine seems to be practiced in the way the health system rewards it.

A recent article in the NY Times showed how a cardiologist can double his income from 200K to 400K by doing heart imaging, called CT angiograms.

If you are covered by Medicare and visit an aggressive cardiologist for a check up but have no symptoms of any heart problems, he might suggest you get a CT angiogram to see if you have any plaques.  Of course, everyone of Medicare age will. 

 

This test gives you  more radiation than 1000 conventional chest X-rays and have other risks. (See our related blog CT scan radiation, 6.15.08 .) 

Since you have plaques you now are told a nuclear stress test will you how much blood is flowing through your coronaries.  You then are told that you require a couple of stents, costing  you 14K,  to prevent an impending heart attack.  If not that, at least you should get another $1500 CT scan next year.  Don’t worry; Medicare will pay for it out of its $800 billion dollar annual budget.

The facts are that the CTangiograms fails to tell you which plaques are stable and which are likely to rupture.  Clinical trials show also that stents are of no benefit to patients who have no symptoms or chest pain.  They do relieve chest pain but do not prolong your life.  No chest pain, no need for a CT angiogram, says Dr. Redberg, Univ. California cardiologist.

Most asymptomatic patients who visit a conservative cardiologist who does not own a one million dollar CT scan, will place you on a diet, exercise program, cholesterol lowering drug and other drugs.

Now that CT scans are in the marketplace, there is no way to get evidence of its value.  The lack of evidence that CT scans have any benefit, has not stopped Medicare from paying for it.  Once the FDA approves a device, Medicare rarely demands evidence that helps the patient. 

It surely benefits the aggressive cardiologist by providing an additional source of income.

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