Do you know about the inexpensive, non-invasive heart test that could possibly save your life? Chances are, you don't. Most insurance plans don't cover it. Some prominent cardiologists discount its effectiveness and many hospitals and cardiac interventionalists would prefer to pretend it doesn't exist. But if the makers of the documentary, "The Widowmaker" have any say, this will soon change.
This documentary, directed by Patrick Forbes ("Wikileaks: Secrets and Lies"), discusses the epidemic of heart disease and two vastly different approaches to its treatment. According to the CDC, Cardiac Disease is the number one cause of death in the United States, by far. Over 610,000 Americans died of heart disease in 2013. And as this film's narrator Gillian Anderson tells us, for many sufferers of Coronary Artery Disease, the first warning sign of the disease is also the last: it's the heart attack that may kill you. With no symptoms, your arteries may right now be nearly completely clogged. You could be fit and, by all outward appearance, seemingly healthy, with normal EKGs and stress tests. And yet you could be just weeks, days, or even minutes away from sudden cardiac arrest. What can you do about it?
There are a couple of options: you can have an expensive invasive procedure known as a cardiac angiogram. For this test, doctors stick a catheter into your veins to inject a radioactive dye that will allow X-rays to identify any blockage within the arteries leading to your heart. If this doesn't sound too appealing, you could also opt for a cardiac CT scan for coronary calcium (aka "cardiac calcium scoring" test). This is an inexpensive non-invasive 3D X-Ray scan of the chest which reveals any traces of calcium in the arteries leading to the heart. Deposits of calcium in the arteries occur when there is artery-clogging plaque present, even though the plaque itself does not show up on a scan. Find the calcium and you've found the plaque.
As shown in the documentary, the coronary calcium scoring test was developed around the same time as the coronary stent, in the same part of the country: northern California in the late 1980s. But the paths the two technologies have followed are remarkably different. A coronary stent is a tube of metal mesh which interventional radiologists use to prop open a blocked artery, thereby preserving blood flow to the heart, and preventing a heart attack.
If the calcium scoring test is the hero of this documentary, then the angiogram and stent are the villains. While angiograms can identify arterial blockage very effectively, and a stent can at least temporarily allow the blood to keep flowing to the heart, the cost and invasiveness of the procedure prevents most people -- even those with risk factors of cardiovascular disease -- from ever getting the procedure done. Meanwhile, the calcium scoring test is arguably just as effective at identifying coronary blockage and heart disease as the angiogram, but with a 15-minute, non-invasive scan. How is it possible that the calcium scoring test isn't considered as essential as an annual mammogram or routine blood work? Why is it still virtually unknown and not covered by insurance? The film-makers would say, "it's all about the money."
Also, an angiogram with stent insertion can generate up to $50,000 for the hospital and doctor doing the procedure, depending on the location and the number of stents used. Hospitals -- and interventional radiologists -- have literally millions (if not billions) of dollars at stake by recommending a less expensive alternative. The film goes so far as to say that Mt. Sinai Hospital in Manhattan was saved from bankruptcy by the cardiac stent. One of the cardiologists there racks up over 1,500 procedures a year, to the tune of $3,000,000+ in personal income. And yet, right across town at Lennox Hill Radiology, you can get a calcium scoring test for $99 (I know, I've had it done twice).
The film also exposes clear economic ties between leading cardiologists and stent manufacturers. One doctor who runs a major cardiologists' conference is paid directly by stent manufacturers based on the volume of that company's annual stent sales. When the ties to a particular device maker are so strong, can that cardiologist still remain objective in his or her recommendations to patients or hospitals? But perhaps the most damning argument against the widespread use of stents is a comprehensive study, published in 2012, which suggests that the use of stents with medicine (statins) is no more effective than medicine alone at preventing future heart attacks and cardiac-related deaths.
The movie is effective at identifying the importance of the cardiac calcium scoring tests though it sometimes borders on melodramatic. It tugs at the heart strings with recordings of 911 calls from those whose loved one has just suffered a heart attack. It also includes several testimonial videos from those who have survived a heart attack (or family members of those who did not). These folks had no idea that their loved one (or they themselves) were at risk. According to the film, Bill Clinton received a high score on a calcium scoring test during his presidency, but this result was discounted by his doctors as Clinton appeared by many other measures to be in good cardiac health. Yet, not long after his presidency, Clinton had to undergo quintuple bypass surgery, due to massive arterial blockage.
Where the movie falls down a bit is in clearly identifying the two different camps and the alternatives. The calcium scoring test itself is not a treatment: it's simply a diagnostic tool. If your cardiac calcium score is high, it means you have arterial blockage and need to take action. Action normally involves a medical treatment such as the cholesterol-lowering statin drugs and/or blood-thinning aspirin, an improved diet and increased exercise.
Also, in the film, they use terms that laymen may not immediately identify. They talk about "interventionalists" - those who physically intervene in the body with surgery or invasive procedures in order to treat conditions, vs. "the folks interested in imaging" - those who believe that non-invasive imaging tests (like the cardiac calcium scoring test), combined with lifestyle changes and drug treatments are enough to identify and treat cardiac disease. And they discuss "medical treatment" which we might assume involves any type of medically related treatment (surgery, procedures or drugs), but really refers to treating the disease with medicine (drugs), as opposed to using invasive procedures.
I think a clearer definition of these terms when they are first used -- perhaps with a pause, black screen and dictionary-style definition in white text -- would have been a better way to set the stage between the two camps and define the most relevant terms. But, with these minor gripes aside, the film is an important one, which I plan to recommend to all of my friends to watch. All said, its heart is in the right place. After all, how many movies can actually save your life?
Watch it Now:
| Movie title | The Widowmaker |
|---|---|
| Release year | 2015 |
| MPAA Rating | NR |
| Our rating | |
| Summary | Watch this movie, save a life, maybe your own. Yes, really. |
