"The Widowmaker" Poses Important Health Industry Questions

Posted by: Larry Sobal on Thursday, June 15, 2017
The Widowmaker Poses Important Health Industry Questions

 

I’ve had a copy of the medical documentary The Widowmaker on my iPad for a few weeks and finally had a chance to watch it during a recent flight. The 1 hour 36 minute film, which was produced in 2015 by Patrick Forbes, is focused on the fact that more than 700,000 Americans die of heart disease each year and that for an unfortunate third of them, the first major symptom is sudden death.

Cardiologists and others with a knowledge of heart disease will identify the title as the name given for when plaque forms near the origin of the left anterior descending artery, the major of the coronary arteries of the heart. A clot forming at that site, and the heart attack it causes, is often fatal if left untreated or goes undetected, a not so uncommon situation since the build-up of coronary artery plaque is usually asymptomatic.

Because middle-aged men are more prone to heart attacks than middle-aged women, such a clot often leaves behind a widow and children, hence the name for the plaque. However, it’s important to note that heart disease is the No. 1 killer of women, causing 1 in 3 deaths each year. That’s approximately one woman every minute!  So the reality is that the dreaded “widowmaker” condition does not discriminate between men and women.

The fact that heart disease has been America’s #1 killer for decades serves as the backstory of what is portrayed as a hidden battle being fought inside America’s medical establishment that pits heart attack prevention against high-profit procedures, namely cardiac catheterizations and the use of stents to open clogged arteries and open heart coronary artery bypass surgery. The film covers the issue from both sides—the supporters for use and validation of Coronary Artery Calcium Scoring screening and conservative medical therapy as suggested by the Courage Trial versus those that see Calcium Scoring and medical therapy as flawed and strongly advocate that stenting or heart bypass surgery is more valid.

In many ways the film paints a disturbing, but in my opinion accurate, picture of the often contentious conflict of whether to focus on preventative or invasive care in treating heart disease. It shows how insurance companies, physicians, inventors, health policy makers and venture capitalists all have a very passionate and personal stake in certain decisions that play out in what real world treatments are (or aren’t) endorsed and/or performed. While the story leaves you open to make your own decision, it does imply that the current status of this hotly contested issue is condemning certain heart attack victims to death, in some cases because of a lust for profits and greed.

The film paints a disturbing, but in my opinion accurate, picture of the often contentious conflict of whether to focus on preventative or invasive care in treating heart disease.

Cardiologists who watch this movie will recognize some familiar high-profile colleagues, including innovators and academics who are featured in a suspenseful tale that sometimes confuses the heroes and villains. If there is a common thread to the story, it is the

history of the development of the Calcium Score test and its validity in reliably detecting coronary calcium, and therefore plaque, and its ability to rely on numeric calcium scores as the most effective assessment of future risk for an acute coronary event. Just as interesting, the film shows how battles of influence are waged over who controls medical opinion and who can sway the behavior of practicing physicians and patients.

Aside from its fascinating insight into medical ethics and politics, the film might lead you to believe that it was funded by manufacturers of either CT Scanners (used for conducting Calcium Scoring) or plaque fighting big pharma (in support of conservative medical therapy). But the reality is that documentary was actually conceived through the philanthropic efforts of a patient, David Bobbett, a highly successful Irish entrepreneur who owns a multinational manufacturing enterprise. It tells the story of how, at age 50, Bobbett underwent a heart scan and was stunned to discover that he had “the arteries of an 80-year-old man.”  Bobbett inquired, and was disheartened to discover the political battleground that determines if (and where) calcium score exams are offered. He decided to do something about it, including personally funding the production The Widowmaker, for which he hired Patrick Forbes, an award-winning filmmaker.

The stories in the movie are highly entertaining and well done, but what I find really thought provoking (beyond the debate between preventive versus invasive treatment for heart disease) are the following questions:

  • How do we balance the fact that the majority of our health industry is geared toward treating people after they already have a disease instead of putting more resources into preventing disease?
  • How do we ensure that insurance coverage decisions, clinical research and endorsements by influential agencies and journals, are done in a truly objective manner and without influence and bias from financial agendas, personal opinions or politics?
  • How do we reconcile the data released last month in JAMA indicating a 50 percent drop in the cardiovascular disease (CVD) mortality rate among Americans between 1980 and 2015 with the knowledge that there is still unexplained variation in treatment of cardiovascular diseases in the U.S., particularly across racial, gender, geographic and socioeconomic segments?

Throughout the film there is a constantly-counting ticker, reflecting the number of deaths per year from heart attacks—the number going up and up and up. This was impactful, as virtually all of us have been touched in some way by heart disease. I suggest that the The Widowmaker be on your short list of films to download if you have not already seen it. It does what a good documentary should do, which is to offer an array of opinions and leaves it up to you to decide on the political, ethical and moral questions it raises. Leave me a response if you have watched it, or after you watch it, to let me know what you thought.

 

Illustration: Lee Sauer


 

Larry SobalLarry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.

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Comments

Brenda, Thank you for sharing your story. You are in a unique position to assess the benefits of both Calcium Scoring as an asymptomatic early detection process and the Cath Lab as an interventional tool. In his case, they appear to have complimented each other. I commend your hospital for making the Calcium Scoring test affordable.
Posted by: Larry Sobal on June 20, 2017 @4:08:43 am

I thought it was an excellent discussion. I am a Cath Lab Director with 20 years in the lab. About a year ago my husband had some palpitations so we started down the standard cardiology treatment path. He passed an exercise stress test and an echo with flying colors. His cardiologist is a fan of our hospitals $75 calcium screening test. His calcium score was over 700...we then went for a nuclear stress test which he also passed. In the end we can to the cath lab. The FFR in his LAD was 0.67, his RCA was 99%. Needless to say I'm a big believer in the Calcium Score these days.
Posted by: Brenda Myers on June 19, 2017 @7:04:43 pm

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