The Widowmaker – it could save your life ! #KnowYourScore #CAC

The Widowmaker – it could save your life ! #KnowYourScore #CAC

September 8, 2019 100 By Jose Scott


My whole life I’ve been an athlete, a husband,
an attorney. People have always relied upon me
to provide for them. On May 6, 2009, I was playing softball on a field
just like the one behind me. Sat down in the dugout
in between innings. Had no warning signs, no complaints, I didn’t feel sick
or anything like that. The next thing I know
I woke up in an ambulance with someone telling me
how lucky I was. What happened, I learned,
was that I was sitting in the dugout and I just passed over, I was clinically dead
for three to five minutes. I was told I had no pulse.
I was turning blue. Fortunately,
two mothers kept me sustainable by doing CPR on me, and I woke up in the ambulance,
and I didn’t know what happened. The ambulance driver
said to me, “You’re a very lucky guy,” and I really couldn’t figure out
why I was so lucky. Not everybody is so lucky,
every minute of every day, somebody dies of a heart attack
in America. It’s the nation’s biggest killer. More frightening than that
is that a huge number of the people who die drop dead without any warning
they’ve got heart disease. For about a third of patients,
the first event is sudden death. The reason
is the disease is silent. When I got to the hospital, they told me
there were two major blockages in my Left
Anterior Descending artery, it’s called “the widowmaker”. I had an 89% and 95% blockage, and they said it was absolute miracle
that I was still there. In two-thirds of men
and half of all women, the first sign or symptom is that they have a heart attack
or die. You don’t know you have it
until you’re dead. And it doesn’t have to be that way. Heart attacks and strokes
are absolutely preventable. The science is a slam-dunk. Unfortunately,
for some big businesses, making money takes precedence
over saving lives. They don’t want them to die, but they don’t necessarily
want them to get better. 911,
My husband’s having a heart attack! We’re gonna conduct CPR on him, okay? I’m going to tell you
what to do, okay. Okay. – Are you right next to him?
– Yeah. Put him flat on the floor
on his back. Okay. – Expose his chest.
– Expose his chest. Kneel by his side. – Okay.
– Okay. Now put the heel of your hand
in the centre of his chest, right between the nipples. Okay. Push down firmly
with only the heels of your hands 2 inches deep and do it 30 times
like you’re pumping the chest. I’m going to count,
I want you to go this fast. As fast as I’m counting, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,
16, 17, 18, 19, 20, 21, 22, 23, 24, 25… A major heart attack
lasts only minutes. One moment,
the heart is beating normally, all four chambers
moving in that familiar rhythm. Suddenly, a coronary artery blocks… The flow of blood to the heart stops. The heart starts to beat wildly. There are now only moments left
to save the victim’s life. Operator: 27, 28, 29, 30. Start again, 1, 2, 3, 4… Honey, stay with me, stay with me. 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,
16, 17, 18, 19, 20… If that attempt fails,
starved of oxygen, the heart dies
and so does the victim. – 6, 7, 8, 9, 10…
– No! Come one, come on! – 11, 12, 13, 14, 15…
– Come on! – 16, 17, 18, 19, 20, 21, 22…
– Come on! 23, 24, 25, 26, 27, 28, 29, 30. He’s gone. Come on, start again,
1, 2, 3, 4, 5, 6. Come on, I love you,
I love you, come on. This year alone, 600,000 Americans
will die like this, more than
from all the cancers combined, a quarter of these deaths without any prior symptoms
or warning. The vast majority of them,
men and women, could have been saved. Here’s how. The trail starts here
in San Francisco. Down the decades, the City by the Bay has been home to a series of world famous events, a gold rush, an earthquake,
a computer revolution, and wholly new ways
of seeing the world. The city might have
a more fundamental legacy, a way of stopping
all those needless deaths. In the ’60s and ’70s, heart doctors or cardiologists
are grappling with not one but two problems. Life is full of stress,
especially for busy executives. You’re kidding? The whole shipment,
you’re sending it back? Mr Elliott! People are dying
suddenly of a heart attack before they can get to the hospital. They’re also dying if they do make it
to the operating table because heart surgery
is largely ineffective. Surgeons naturally
want to make surgery work. One man thinks he knows how. The first heart revolution starts
not in a lab but a garage
40 miles north of the city centre. How long is it
since you’ve been here? Thirty three years. Thirty three years,
and this tree obviously, I don’t remember. This is also much larger, everything, yeah, and that’s my garage. In 1980, Julio Palmaz
is a junior radiologist, fresh off the plane from Argentina. Well, I had my cars here, and my… Workbench was right here. Yeah. I had a Triumph Spitfire, my baby,
parked right here. It was so small,
so I had place for my bench. After dinner,
I would come and start playing with wires, pliers, rubber tubes,
and all those things. Julio is fascinated
by arterial blood flow and its relation to heart disease. It was the number killer
when I was in medical school, and it still is, today,
the number one killer. The key is plaque, a sticky,
gooey substance largely made up of cholesterol. It builds up in the walls
of the coronary arteries until one day it ruptures, causes a blood clot
which blocks the vein, and stops the flow of blood
to the heart, triggering an attack. Cardiologists are trying
to thread balloons down arteries, blow them up, and crush the clot. Once the balloons are gone,
the arteries close up again, what doctors call “re-stenosis” and the patients die. Julio has a simple idea, stick a piece of metal
on the balloon, a sort of scaffold
to keep the vein open when the balloon is pulled out. It’s called a stent. But the first results
of Julio’s invention are disastrous. The atmosphere
was marginally chaotic. We didn’t have the right equipment and the devices
were prototypes at best. They were hand-crimped
on balloons. They were difficult
to deliver to coronary arteries. They were associated with a high frequency
of blood clots or thrombosis in the early stages, and the outcomes were not nearly
as good as we had expected. There was a lot of uncertainty
within the medical community that this was the right thing to do. We were heavily criticised
for being cowboys, for being less critical thinkers,
for being non-scientific. So there was an
overwhelming negative outcry within the general medical
and cardiologic communities. While the stent is in trouble, there’s a very high-profile reminder
of what’s at stake. Well, that night on the 23rd, I was doing my CNN show,
I interviewed Dr C. Everett Koop, the surgeon general
of the United States, at the end of the interview, he asked me if I was still smoking. I said, “Yes.” He said,
you don’t look good.” I said, “I feel fine.” He said,
“I don’t like the way you look, you ought to see a doctor.” I said, “Okay.” Then I went to do
my all-night radio show and my guest
was David Halberstam, the late David Halberstam,
terrific writer. At the end of that interview,
he said, “Are you feeling okay?” I said, “Why?”
He said, “You don’t look good.” Apparently, I had a gray pallor. I went back home,
and I got off the air, it was about 4:00 in the morning, and I had this terrible pain
in my right shoulder. I never experienced
that kind of pain before. I didn’t have chest pain,
and it was going down my arm, and I didn’t know what to do. I called my doctor and woke him up. He said, “Well, right side? Sounds like a gall bladder, why don’t you go to the hospital
in the morning?” First thing in the morning, my producer picked me up
and drove me over to George Washington
University Hospital. I walked in the emergency room, and this man came up to me, and they have viewers
in the emergency room who look at people to see how… He said,
“Are you a heart patient?” I said, “No.” He said,
“Well, you don’t look good.” That’s the third time I’ve heard
“you don’t look good.” They came over
and took some blood tests. Then they went over
to a screen and they were looking at the screen and this blood test
came up on the screen. Suddenly, they turned around,
the doctor and nurses, blue light went off, and they came running toward me,
and I said to my producer, “I don’t think
this is a pulled muscle.” The doctor came right over
and he said, “Mr King,
you’re having a heart attack.” I said, “Am I going to die?” And he said, “Good question.” He said,
“We don’t have the answer, but it’s the right side,
and that’s a good sign because right sides generally
do better than the left side.” I wound up with a quintuple bypass. That was much scarier
than a heart attack. When the doctor explained to me,
“We’re gonna cut open your chest.” “That’s nice.” “We’re gonna pull you apart and put you on a heart-lung machine and move the heart a little
and do a bypass, which is similar to a highway
with a blocked exit, and we’re gonna go around the exit, take veins from your leg, the veins
will circulate around, and we hope you do well.” It changed my life that day. I never felt better
than after that. I recovered pretty quickly, came from the hospital,
vowed to get healthy, lost a lot of weight,
changed my diet, never smoked again. My wife believes
in the afterlife, I don’t wanna ride the bet. Back in the Bay Area,
at exactly the same time, Julio is dreaming up his stent. Other doctors come up
with a way of winning Larry’s bet. Right in the heart of Haight-Ashbury, the epicentre of flower power, stands
the University of San Francisco or UCSF. The team here don’t want to wait until somebody has a heart attack and rely on expensive
and risky surgery to save them. They want to prevent
the attack happening at all. Why wouldn’t it make sense
if we set up… Like we do mammograms
for screening for breast cancer, why don’t we do mammograms
of the heart? There’s a problem
with a mammogram of the heart. It beats too fast
for a conventional X-ray to take a picture. So Bruce travels three floors down
to an eccentric but talented physicist who has thought up a way of improving
the existing technology. The essence was
rather than rotating mechanically an X-ray tube around the body, and that’s how CT technology works to use a scanning electron beam
to produce a moving source of X-rays. Based on the constituent parts
of Doug Boyd’s revolutionary machine still stored in a small office
in the Bay… People were sceptical. Most people couldn’t even
understand the concept. The Ter-Pogossians of the world
were telling you that couldn’t be done. Couldn’t be done. One day, he said to me, “Bruce, would you like to see
something really neat?” Then you invited me down to see you turn
on the electron beam down there. Down at the basement
of the hospital? There was dirt on the floor.
It wasn’t even concrete floor. Yeah, yeah. When we got the first beam,
that was a big moment, at least for a physicist. Well, it was considered
pretty far out at the time. No one had ever been able
to produce an electron beam with that much power. Incredibly, down in the dirt
of UCSF’s basement, Doug’s ray gun works. You just put your head there
and your feet down here. And it slides the patient
into the scanner. Then an image
that nobody has ever seen before. These are
the coronary arteries here. In the beginning, I think everybody
was extremely interested. Everybody would say, “Well, what’s that white stuff
that I see there?” I said, “Well, that’s calcium
in the coronary arteries.” Calcium, a crucial ingredient
in our bones and just what you don’t want
in your heart. The calcium’s actually
a part of healing process. When we develop
deposits of cholesterol on the wall of the artery, one of the body’s natural
defence mechanisms is to put down calcium
to try to heal this sort of bubble. In and of itself,
it doesn’t cause the disease, what it does though is it doesn’t occur there
unless there is plaque there. Before the advent of Doug’s ray gun, doctors had to use
a complicated formula dreamt up at Harvard in the ’50s to work out
somebody’s risk of heart attack, adding together weight, age,
lifestyle, cholesterol, and then guess. You could have all the risk factors
and not have any coronary disease. You could have
none of the risk factors and have coronary disease, but if you have a coronary scan
and you see calcium, you know you have disease. It’s not a risk factor. It is looking at the disease
part of disease process. A group of pioneering doctors
leap on it and even call themselves
the Calcium Club. It’s like the Breakfast Club, the movie about
the teenagers in high school, this was a Calcium Club. Was it as much fun? No, it’s not so much fun. It was much more
productive ultimately. Breathe in, hold your breath. The scores go zero. It can go as high as 4,000, 5,000. So I call it zero, mild, moderate, extensive,
and oh my god. Breathe in. Hold your breath. Zero is the best
I can do for you. 1 to 100 is called mild… 101 to 399 or 400 is considered as moderate, 400 to 1,000 is considered extensive, and above 1,000
is in the oh my god category. What are your alternatives? You say to a person,
“Well, you’re at low risk.” Then if the patient dies,
“Oh, I was wrong, sorry.” Why guess? Why base your decision on a score derived from a compilation
of risk factors when you can look directly
at the heart and see how much plaque
there is there. It looks like
the coronary artery scan is about to transform the hearts
and lives of the nation. The new technique
can pick out the patients that conventional
risk analysis cannot, thin, fit, and outwardly healthy, and that’s a lot of people. In the four years, after coronary artery scanning
is invented, over half a million people
die of a heart attack with absolutely no warning. Thank you so much. California has a governor
going places, Pete Wilson. Some talk of him
as a potential president. His key aid is Otto Bos, an energetic press liaison
in his mid 40s. He was somebody important.
I do remember that. Everybody knew him,
he was the guy behind the guy. If you wanted to talk to Pete, everybody knew, basically,
you had to go through Otto. It was pretty cool,
so everybody knew me as Otto’s kid, and, of course, I was his firstborn, so everybody treated me
like a rockstar. Everybody’s kind of like, “Oh, that’s Otto’s kid,
be nice to him.” June 2nd was… Oh, gosh, it’s like yesterday. We we’re actually baseball
here on the front street, and my mother was inside
here with our neighbour, and I was called in
by our neighbour, “Hey, can you please come in
and talk to your mom.” I was a 15-year-old kid,
so I’m like, “Yeah, yeah, lady, I’ll come in
when I want to come in.” Then she came back down
and she was like, “No, seriously, you need to come
talk to your mother now.” She was sitting
on the corner of the bed, and she basically just said that
my dad had a heart attack and he was at the hospital. I was thinking, “Okay,
he had a heart attack, he’ll be fine because basically in my eyes,
my dad was like Superman, and,
nothing ever could really, do anything to him.” We went to that hospital,
and then when we got there, the doctor pulled my mother aside. Then my mom came out
and she was very, very tearful, I knew something was really bad
’cause I kept wanting to see my dad. Then long story short,
the doctor, he sat down in front of me
about where you are and just told me
that my father had passed and this is what had happened. I was a little confused, wondering why he was telling me
and not my mother. They say his arteries were clogged. He looked young,
you would never guess that he was 47, he had a rocking tan, he was always playing soccer. There was no indication
that he was going to have the type of heart failure
that he had. It definitely messes with you a lot. So I’m 15 years old, turned 16,
I’m basically an adult. I’m no longer the kid
that goes out with his friends and goes and parties
and drinks and does… I don’t do any of that stuff. Then I had to be a role model
for my younger brother and sister and not get myself in trouble,
try to be Dad for them and, coach Little League, which I did, and take my sister to ballet
and brother to basketball, and do all the stuff
that a dad would do. that was basically my life for… actually till my mid 20s. My advice to any person that’s,
here on the planet, just enjoy it for what it is,
enjoy the ride because you just never know. As the unexpected deaths pile-up, the way forward seems clear in the battle of the stent
and the scan. The scan helps prevent heart attacks and costs only a few 100 bucks. The stent is risky, expensive,
at tens of thousands of dollars. The patient has to either have or be on the brink
of having a heart attack. That analysis
neglects the profit motive which first attracted
Julio Palmaz’s backer burger billionaire Phil Romano. He came in and he had a ponytail
and he had his three piece suit and nice tie, well-groomed person,
and had no socks. He was a very fashionable guy. Certainly, not a person
that knew anything really about the business
of implantable devices, but intuitively, he saw a potential. At the end of a meeting, he said… The thing in his hand,
he was rolling it around and he said, “This looks like something I can put in a box
and sell for lots of money.” To the dismay of his lawyer, he went ahead and said
how much money you need. 1994, and money talks. Now we’re in New York,
home to the world’s financial centre and some of its most
renowned hospitals who share Wall Street’s money
making smarts. These hospitals can make or break
a technique or pill, so stent or scan,
which is it going to be? With Phil Romano’s money behind it, the stent is suddenly
a reliable proposition, and in record time,
it gets an official licence. The devices
became much more deliverable. From a technical standpoint,
there were dramatic improvements. By the late ’90s… The paradigm for treating patients
with coronary disease was literally just “stent it”. One of the first places to “stent it” is Mount Sinai, halfway up
Manhattan’s Tony Upper East Side. Samin Sharma, the star surgeon,
changes his modus operandi overnight. I did about 1,000 cases
first time in 1999. Now since then,
or let’s say last 10 years, it has been about 1,500 to 1,600
interventions per year. I work 3.5 days a week,
Monday, Tuesday, and Fridays. Like today,
Friday is a typical day, onto my 21st case, and I’ve done the trial intervention,
but I had 9 more to go. All right, my friend, we’ll be done in
just few seconds now. What Samin Sharma
is doing again and again is threading catheters
or thin tubes up arteries to first take a picture
of any blockage. That’s an angiogram. Then gently
manoeuvre stent in place at the point of blockage or stenosis. Open it up
and restore the blood flow. Right there, this was 95% blockage. Now after stent,
normal looking artery. All right, my friend,
we are done now. Thank you. Crucially, this operation
has a financial as well as a medical attraction
for hospitals. At up to 50,000 bucks a go, the profits associated
with it are huge. These cramped cath labs
actually saved Mount Sinai from bankruptcy in the late ’90s. As the money floods
into stents, so the doctors
who practice the technique become very rich. Dr Sharma earns
over $3 million a year. I think part of the success
is also that you do the same thing all the time repeatedly. You don’t get bored? Well, if I get bored,
I’d use few more stents. If he is getting rich, the stent’s inventor
is getting even richer. Things went well for us. My wife said, “Why not get a little place
in Napa Valley and make some wine?” It got a little bit out of hand. She did find a bigger place
than we anticipate it, and we make about somewhere
between 5,000 and 6,000 cases a year. The success of the stent
propels the man who first tested, Marty Leon, into cardiac stardom. He becomes one of the richest doctors
in the US, earning millions in his hospital work and millions more as a key advisor
to big companies. He even starts his own foundation. It’s hard to say
what is in whack and out of whack. Is an orthopaedic surgeon
out of whack? Is a neurosurgeon out of whack?
Is a cardiac surgeon out of whack? Is an interventionist out of whack? I mean, he’s become philosophical,
discussions about… how medicine is practiced. In a fee-for-service environment, I think they’re certainly
going to be high-end physicians who make a great deal of money,
and that’s fine. For all the stent’s
apparent success, financial and medical, it still does nothing
for those people who die before they can get
to a hospital. By the mid ’90s, the cumulative total
of asymptomatic deaths has risen to a staggering
two million. What is the address to the emergency? I need an ambulance quick. What’s the address? We were just sitting and talking,
my wife fell on the floor. Okay, what’s… Quick, I don’t think she’s breathing. Okay, I’m sending paramedics
to help you. Now stay on the line, I’ll tell you exactly
what to do next, okay? Yeah. I want you to place
your hand on her forehead, your other hand under her neck,
and tilt her head back. Yeah. Put your ear next to her mouth
and tell me you can feel or hear any breathing. – Okay, hang on.
– Okay. No, I can’t. O god almighty, hurry. Okay, they’re on their way. You’re doing fine. For these people,
the scan offers the only hope. The medical establishment
shun it. The nation’s top doctors
pour scorn on the claims the Calcium Club
make for their new technique, most vociferously, the one man
they expect to support it, Steve Nissen, the most prominent preventionist
in the US, based at the world famous
Cleveland Clinic. Well, I’m not a fan of it. To date, no one’s been able to show that knowing how much calcium
is in the arteries actually allows you
to change the outcome for patients. It tells you who’s at risk, but it doesn’t tell you
what to do for them. I would say
that there are some people who still believe the world is flat,
but clearly it’s not. We know that it identifies
high-risk patients, we know that treating
high-risk patients saves lives, therefore, identification
of the high risk patient will save lives. Look, I don’t like medical cults. These things
can’t happen all the time, these cults develop. When they’re not based upon what I consider to be
the most solid science, then it does bother. The kind of outcome data
that they’re asking for has not been provided
for any other technology. For instance,
there has never been a study that shows that the use
of a stress test saves lives or the use of an echocardiogram
saves lives. I called it
the deadly double standard, which means applying criteria
to coronary calcium that have simply not been applied
to any of the preceding technology. The authorities won’t endorse it, so insurers won’t pay for it,
very few doctors will use it. All the while,
people are dying without any warning. By the late ’90s, over 2.5 million unexpected
unanticipated deaths. Eight, seven, six… Three, two, one, zero, and liftoff. Like Steve Cohen, NASA’s astronauts, are outwardly extremely fit
and health conscious. Just when it looked like
coronary arteries scanning was dead, salvation in the most unlikely place,
space. We’ve long known
that cardiovascular disease is the greatest risk that we face, especially given our population, most astronauts
are middle-aged males. The consequences for us are dire. We’re talking about
people dying in space. The agency had had a real scare
in 1971 with Apollo 15. Oh, boy, it’s beautiful out here. At the time, NASA hailed it as the most successful mission
so far. Looks like drifting material,
all right. On the surface of the moon, Commander David Scott
and Lunar Module pilot Jim Irwin did three moon walks, collected a vast array of moon rocks, and drove a lunar rover
for the first time. This is really a rock
and roll ride, isn’t it? Out of sight of the cameras, once Irwin
was back in the command module, instruments appeared to show all the symptoms
of a serious cardiac event. After anguish debate, mission control realised that breathing the oxygen
of Endeavour’s cabin and living in zero gravity, Irwin might as well be
in a hospital intensive care unit. Then on August 7th, they looked into the fireball created by the heat of their re-entry
into the earth’s atmosphere at 25,000 miles per hour. The mission made it back safely. A few months after he landed,
Jim Irwin had a massive heart attack. We became aware
of coronary calcium scoring probably in the early 2000s. They are a number of us who are interested in
improving our risk predictions. We had a couple of individuals who were involved
in various flight operations have acute coronary syndrome events
prior to a mission. In both those cases,
we got lucky. From 2006 on,
all potential astronauts have to have a zero score
or they don’t get in. It isn’t only astronauts
who are at risk. We’re here outside
New York Presbyterian Hospital. In just a couple of hours, President Bill Clinton,
Former President is scheduled to undergo surgery to bypass diseased vessels
in his heart. In 2004, Former President Clinton checks himself into hospital
with chest pain only to discover
he has chronic heart disease and needs an immediate
quintuple bypass. Many people are asking,
how could a former president who gets regular checkups end up
so suddenly with heart disease? Clinton bragged last night that he had aced his stress tests for four or five years in a row. I just had the pleasure
of meeting president… past President Clinton last Thursday. He told this story about how he went through five treadmills while in office,
he was cleared five times, told he was doing great, they stopped
his cholesterol medication, he actually told me
he had a calcium scan that was abnormal, but his doctors
didn’t really do anything with it, and ultimately,
he needed five-way bypass. Such is the shock
of Clinton’s operation. The White House decides that all future presidents will have a coronary artery
calcium scan. The stakes are simply
too high not to. Is scanning
on the comeback trail? Maybe. At exactly the moment Clinton’s life
is hanging in the balance, so too is the fate
of coronary artery scanning. The setting is Boston, home to the world’s
most famous university. In fall 2004, scanning is on the verge of qualified
national approval right here. A committee
of the American Heart Association has passed it, and their findings
are about to be published as a statement in circulation, the house journal
of cardiologists worldwide. I like to think that Circulation and all-high quality
journals provide, if you will, a path to enlightenment. If you consider… If you consider our workplace, we sit in a sort of forest
of knowledge and we want to achieve enlightenment. The question is
how do we traverse the forest? I would suggest that
what a well-edited journal does is that it provides
some guidance to the right path. Unfortunately, one member of the Calcium Club can’t contain his excitement that his technique
is about to wind through. We had a statement coming out, it was approved
by the American Heart Association, a scientific statement saying
that calcium scoring was useful, appropriate, and had adequate scientific data
behind it. Well, I’d just become
editor of Circulation. I was surprised and troubled to find as I was flying to Europe
for a meeting and reading the Wall Street Journal that I was quoted as the editor… As having pointed out that the American Heart Association
was about to support the use of coronary calcium. The American Heart Association and certainly the journal Circulation never advocates
the use of a particular strategy for diagnosis or for therapy. We try to report information as we find it
as objectively as possible. When I returned home, I also found an envelope
addressed to me in which it was pointed out that the American Heart Association was about to support the use of coronary calcium screening and that, as a cardiologist, I might wish to purchase a device. Given those events,
I decided to withhold publication. That previous document
which was very negative, the first author of that, Dr Roarke, did three formal interviews before the document ever came out. I make one offhanded comment
to Wall Street Journal and they use it as an excuse
to pull the whole document, so it really was, again, just obviously politics
and bad personal decisions. Joe Loscalzo’s decision leaves scanning
still in the wilderness and the stent completely dominant as the main means
of treating heart disease. Even though the unexpected deaths
are still piling up, by the end of the year,
well over three million. Met Margaret on the southeast side of Cleveland,
Ohio, which pretty much borders
the beginning of the suburbs. I was 11 years old
at that particular time, Margaret would have been 13. We actually came together when I came back
from the Marine Corps. I decided to go back
to the old neighbourhood just to see who was hanging out. The only person
who was standing there when I got there was Margaret. She was standing in her front yard,
watering her mom’s roses, and I walked up and said, “Hey!” The rest is history. In 2006, I trusted in God, we were enrolled in Pacific Lutheran Theological Seminary
in Berkeley, California. Oh, boy, here comes the sun. My name is Margaret Monroe, and I’m a second year student at Pacific Lutheran
Theological Seminary. Her first week in onco, she preached
for the hospital community and was on her way back
to the supervisor’s office. She had a massive coronary,
and she died. Truly, my whole life
stopped at that moment. More women die of heart disease
than men in the States every year since 1983, so it’s a huge problem among women. Five times as many women
die of heart attack as breast cancer, yet very few women
have any knowledge of that or any inkling of concern
about heart disease compared to breast cancers. When we talk about
the mammogram of the heart, that’s at least five times
more important to women than the mammogram of breast. Across the US, doctors prefer to intervene
after an attack with a stent rather than prevent it
with a scan despite the fact that the unexpected death toll
is by now over 3.5 million. Almost unnoticed, a huge medical trial
has been underway for nearly a decade. Codenamed COURAGE, it’s the first major test
of the stent’s effectiveness. Two thousand people are selected, all of them with at least
one blocked artery. Half of them
are given a stent and statins, the new heart wonder pill,
the other half, just statins. 2007,
the doctors report their findings. One of the most widely-used
medical procedures is being called
into question tonight. Nearly a million Americans every year
have stents implanted. It costs, on average, about $36,000. Tonight, a blockbuster study question is whether it’s worth it? The results of the “COURAGE”
trial are a complete shock. Stents
which pry open clogged arteries may not be as effective in preventing
heart attacks and death as previously thought. Pills and exercise alone are every bit
as effective as the stent. Actually, medical therapy
fared surprisingly well. In the past, I believe,
medical therapy has been regarded as an inferior
treatment strategy. Medical therapy is all you need. Patients need to understand
that the treatment is good cholesterol management,
blood pressure management, diet, lifestyle,
what I call the ABCs, aspirin, blood pressure,
cholesterol, diet, and exercise. You don’t need the stent. S is way down the alphabet. We’re not going to get there. If they have chest pain
at some point, we can put in a stent. A stent neither improves
their outcomes, doesn’t reduce their heart attacks, nor does it improve their mortality. Well, the family history
has always been horrible. It goes back a few generations. I have the disease,
and it’s extremely aggressive. My body cannot synthesise
the good cholesterol you need or rid itself of the bad cholesterol. My first open heart surgery
was at the age of 38, and my second one
would have been about 51. René has a double bypass in 2007
which saves his life. Surgeries prompted by a scan which shows a 90% blockage
in one artery. After two conventional tests
and EKG distress test had said that he was completely fit. I have a very low opinion of an EKG. I’ve had two EKGs that… absolutely told me I was fine when I wasn’t, when I was,
in fact, very near death. Sophistication now with CAT scans, getting the calcium scoring and these other things
is just really critical. Five weeks after his surgery,
René starts a crusade. He is a Texas Senator. He drops a bill
that will force insurers to pay for the screening
of all Texan men over 45 and all women over 55. It’s really hard to rock the foundation
of the insurance industry and even public opinion
on a lot of things. I felt the only way
was to mandate these tests. Respected members,
can I get your attention please just for a second, everybody? He’s also taking on
America’s number one heart doctor. Steve Nissen
is just finishing his term as President of the American College
of Cardiology. Yeah, there were some
questionable characters that were trying to promote this. Of course, Texas, while it is part
of the United States, seems to operate with somewhat
different, character than
some parts of the country. Almost anything goes in Texas. I was certainly
not in favour of that. Doctors came up to me and said, “This is just a bill to help
a couple of vendors out on this.” I said, “No doc, let me tell you my story
and why I believe in this. It saved my life, and if it saved mine,
it can save others.” Yeah, I think you called it
shameless self-promotion. Yeah, I think I probably
used a term like that. I’ve not been known to mince words when it comes to
that sort of approach to medicine. Any tool that helps us detect it
is worth it, particularly, as inexpensive
as this test is. – All those in favour say aye.
– Aye. All those oppose nay. Ayes have it,
house bill 1290 is passed. After two years of furious debate,
victory. Renè Oliveira’s bill passes
in both Texas houses to the intense and enduring
disbelief of its opponents. Having passionate true believers
does not make a test worthwhile. I would say that the test
has actually been a huge failure. Well, he is an idiot, and he is probably
still in dinosaur times in terms of his thinking. As long as he stays in Cleveland,
that’s good ’cause we don’t need his opinions
in Texas ’cause I know what I did
that has saved a lot of lives, and I am proud of that. You’d think
the mammogram of the heart would be on its way back, but you’d be wrong. So we’re going to put a stent
there now. Okay, give me a 2.25. There’s one last key opponent,
the insurance industry. They won’t pay for the test. Ironically, the headquarters of giant
health insurer Kaiser Permanente are just across the bay
from the offices where the very first scanners
are installed. In the early 1980s,
the Kaiser board come calling. We met with the Kaiser executives, of course, most of them
came in to be scanned. Some of the Kaiser researchers did some excellent research on coronary calcium screening,
published research. That didn’t mean they’d payout
for their policyholders to have one. They said, “We’re not interested because our typical patients
are only in the plan for five years or less. This is a long-term
cost savings. The cost savings
will go to our competitor.” No need to single out
one particular health maintenance organisation, all the insurance companies told us basically the same story that their patients are not
long-term holders of that plan, so if they reduce
the cost over the long term, it means nothing to them,
it only goes to their competitor. We contact
the big insurance companies, Kaiser and the rest, to find out why they will still pay
for a $50,000 dollars stent but not, unless you’re very lucky,
a 100 buck test. They won’t talk. Then one man is brave enough
to break the wall of silence. He’s been the public face
of two of the big five as their media spokesman. The system is not set up
to reward prevention. The system is set up so that doctors are well compensated
for treating conditions, so are pharmaceutical companies. We mainly have a disease industry
in this country. There is just not nearly enough attention paid to trying to help
keep people from getting sick, congestive heart failure, the kinds of illnesses
that require stents, being put on maintenance drugs, and having expensive care
for the rest of their lives, they don’t want them to die but they don’t necessarily
want them to get better. By 2012, despite the fact that most insurers
still won’t pay for it, more and more people
are going for a scan. After sewing up a big business deal
in the US, Irish entrepreneur David Bobbett
went to have a medical check-up, part of it, a coronary artery scan. He had the shock of his life. My arteries
were that of an 86-year-old. So here is a 51-year-old who exercises every day,
is careful what they eat, my parents lived into the ’80s, I’ve done all of the things you were supposed to do
to be healthy. The following day, I had to go
into do an angiogram where they found
I had one totally blocked artery, I had another artery
that was 70% blocked, and I had a huge level of disease
right throughout my system. The shock of it, the shock of suddenly
going from one day feeling absolutely perfect with no reasons of any issue at all to a situation
that 75 out of 100 people at your level of calcification is going to either be dead
or have a heart attack in the next 10 years. Today,
he’s going to be scanned again. Told he could die at any moment, he spent the last two years on the most punishing of fitness
and food regimes. I’ve done everything I can do
and the score will be the score. My mathematical mind says
it was 900. 1,100 will be okay, 1,200 will be reasonable, and over 1,200 score
would be very disappointing. Remember to leave your arms
above your head for the entire test. Now take in a deep breath. – Plenty of white there.
– There is. In your LAD there… You know there’s a huge level
of plaque there? So you just wait to see what the result is, you know. That’s all we can do. – Hi.
– Hi. All right, so,
just to sort of compare… Your total score is 1,028
and previously, 906. Now there’s a little bit
of motion artefact. And so Dr Kennedy thinks this is a little
artificially increased. When we look at
the number of lesions, that’s something else
that you can look at if there’s little bit of motion. So in the past, you had 28
and now you have 33, which really isn’t very different. Yeah. This is good news. I’m very happy with that. I’m very happy ’cause I worked… You would not believe
how hard I worked. I’ve really worked on everything. The disease has barely advanced. David’s still
in a very high-risk group. For now,
there is real hope he can make it. The fact that I could be around like any father
wants to be with his kids, the fact that I was… My daughters
that are just so special, that I would be there… When they got married
or when they were that bit older, that I’d see my grandchildren,
that gave me hope, that really was so important why I wanted to fight this
as hard as I did. Without the shock of that first scan, David might not have changed
his life around, might not have been here today
for his family. Now the hope
he has can be shared by millions. For all the problems of the way
medicine is run this country, the ultimate obstacle
in the scan’s path is that it lacks official approval. Then, in October 2012,
after all the years of opposition, the American Heart Association
finally relent and issue a statement saying that coronary artery scanning
is beneficial. Hold your breath. Yes, I feel vindicated. I’m just happy
that we were working on something that turned out
to be valuable. Well, there’s this old saying that, “Truth passes through three stages. First it is ridiculed.
Then it is violently opposed. Finally, it is accepted
as being self-evident.” The data really
does speak for itself. When
the American College of Cardiology and American Heart Association
signs off on it and says it’s reasonable to use it, then the remaining naysayers are just a voice wandering
in the wilderness. We could have gotten there. In a perfect world, we could have gotten there
in three to five years. We’d have all gotten behind
in the beginning. Say what? Well, how many lives do you think
would have been saved if we’d done it in 1990
what we’re doing now in 2013? The answer is? A lot. In the 30 years since coronary artery scanning
was invented, over 4 million people have died
without any warning. That’s the equivalent
of half the population of New York City dropping dead. Most of these people
could have been saved.