The Widow Maker movie, now available, is a riveting documentary revealing how a potentially lifesaving preventive imaging test is largely underutilized in the US and abroad. This test, Coronary Artery Calcium (CAC) scoring, has been available for over 20 years; crucially, it is far and away the best method to accurately assess the atherosclerotic plaque that leads to sudden cardiac death. The statistics are incredible – for example a zero scoring person of a given age has <1% chance of a serious heart event in the subsequent 10 years; someone who scores very high can have a likelihood of >20% – it’s that stark.
Inspired by self-discovery and personal health concerns, Dublin-based entrepreneur David Bobbitt has commissioned award-winning director Patrick Forbes to make this compelling movie; a great aspect is that David handed over full editorial control to Patrick and his team, making the film an independent view on the debacle. It includes Larry King describing the experiences that almost ended his career and his life, and it is professionally narrated throughout by Gillian Anderson.
Technology, politics and economics come head-to-head in a pitched battle; sadly as is often the case, money and big profits win the day. The very institutions we trust and rely on including hospitals, heart catheterization labs, cardiologists and insurance companies are relentlessly drawn to profit over prevention; thus a huge opportunity to save countless lives over the past 30 years is squandered pitifully. The film highlights throughout many sad stories of loved ones lost and families forever broken.
In the 1980’s two new technologies were developed by pioneering scientists and doctors; one was called angioplasty with stenting, the other CAC scoring – the movie reveals both from their inception to implementation. Focused on the setting of the acute coronary syndrome, stenting becomes an immediate hit for interventional cardiologists, heart ‘cath labs’ and hospitals. Unfortunately, like most medical technologies, more stents are placed in patients than necessary – the procedure is just too lucrative to avoid abuse. In fairness it was originally believed that prolific use of this new procedure would provide a degree of protection and prevention. While this was a reasonable assumption early on, no clinical trials were carried out at the time to prove its value – thus there was never any evidence to support the exponentially growing deployment.
As the response to heart disease rapidly adopted the model of ‘Just Stent It’, the prevention approach using CAC scoring to identify the truly at risk was shunned. The key problem for CAC was that it did not provide a clear path to profit; also, there was some ignorance in the cardiology world around how to effectively arrest the disease, even when it was properly identified. As a result CAC was kept out in the cold, terribly underutilized and not covered by insurance. A small group of doctor proponents known as the “Calcium Club” receive little attention, and efforts were continually made to shut them up. Used appropriately, this simple and relatively inexpensive innovation would threaten the enormous and profitable stent-driven industry.
Surprisingly Dr. Steve Nissen, chairman of Cleveland Clinic’s Department of Cardiovascular Medicine, while discussing prevention says that CAC scoring is simply “useless because we don’t know what to do with the information” Huh? Can a supposed leader in ‘preventative’ cardiology actually admit that they are clueless about how to prevent? Well not exactly. Nissen recognizes that CAC scoring can predict risk however, based on current guidelines patient advice remains mostly the same regardless of the information provided by the test. Nissen also expresses valid concerns that CAC scoring could also be used inappropriately for profit. He votes no on CAC scoring but he misses the mark; failing to address patient perspective and motivation based on test results.
In a perverse way, my interpretation provides additional clarity – primary prevention (treatment before documented events) as currently defined by the 2013 cardiovascular disease prevention guidelines including a low-fat, low-calorie diet with or without medication to lower blood cholesterol; this has indeed proven rather ineffective, because it is missing much of the emerging understanding around the damage caused by excessive carbohydrate. So in short – if primary prevention is ineffective, why screen?
Thus revealed is a gaping hole from within the chambers and institutions of modern day cardiology. There is NO CLEAR PREVENTION STRATEGY! Nissen, along with many other healthcare professionals, still struggle with how to properly implement prevention – including the appropriate use of CAC scoring. Kudos to David Bobbitt as he reverberates this message loud and clear in the movie. Towards the end, the horizon does look somewhat brighter, as CAC scoring is officially recognized as a valid screening tool in 2013.
Sadly the movie fails to address what we in the world of primary care and proponents of low carb nutrition define as true primary prevention; addressing proper lifestyle, inflammation and oxidative stress. Redefining nutrition, including the critical consumption of whole and unprocessed foods, properly addresses prevention; these regimes can tackle and greatly reduce chronic diseases and atherosclerosis itself, and I am expecting the team to address these aspects after the movie release is established. That said, Cardiovascular imaging such as CAC scoring is a key first step, to identify and motivate those who need the proper treatment – the latter will literally save their lives.
Although the movie is a little long in duration, it’s a must-watch; it is truly eye-opening and a fascinating experience. I assure you unreservedly, you can expect further great content to emerge from David Bobbitt and his team in the near future – watch this space!
I would like to graciously thank Ivor Cummins for his contributions to this post; including editing and language.