is a false negative stress test really a great way to die that sounds sort of
like a confusing statement followed by clickbait unfortunately clickbait to me
is something that really doesn't have much meaning and it's not in the video
well this has meaning people die from it all the time
so I recently did a video on the death of Tim Russert his was one of the more
recent examples of how you can have a totally negative stress test the patient
feels such relief oh I'm fine I'm good now and then dies a couple of weeks a
couple of months later in Russert's case it was six weeks later now why did this
happen it was a ruptured plaque that ended his life in a wrestler in case you
don't remember him he was very very popular host of Meet the Press he was
very passionate about doing research and one of his quotes was "The highest
purpose of the press is to hold government accountable" so he was really
good at finding old clips of high-profile government officials that
were not consistent with their current activities and then asked them to
respond to that in front of the press in front of the cameras so America enjoyed
watching their favorite love-to-hate politicians squirm in front of the
cameras The New York Times said his docs when they were interviewed didn't
know he had plaque that's not true they knew he had plaque and so did he he had
a positive coronary calcium score a score of 210 in 1998 ten years before he
died Dr. Michael Newman his internist and Dr. George Bren were interviewed and
they did say though the autopsy showed a surprising amount of plaque so why
didn't they know about that plaque here's a very cogent point that was made
by someone else who's a cardiologist obviously very concerned about this issue
is Carl Lavie in the Ochsner Revue he said given that he passed the
stress test six weeks before the plaque in his LAD left anterior descending
probably never exceeded 50% now what does that mean and why did he say that
well that's a it's a well-known fact for cardiologists
maybe not so well-known among patients or they wouldn't be asking for our
stress test so much this is from the Princeton Longevity Institute and it
makes a really good point about my question which I'll get to in a minute
so if you're doing a stress test in order to get a positive stress test you
have to have over 50% plaque occlusion of the artery in other words this little
red thing where the blood is flowing is down to less than 50%
well most heart attacks as in 68% of them occur in people with less than 50%
occlusion so that brings up the question why are we still doing stress tests
there are few men II people have had many ideas Atul Gawande put a lot of
this started a lot of this in his article in New Yorker magazine
2009 "The Cost Conundrum" basically he's saying docs see patients as a cash
machine and they was true especially in McAllen Texas the highest cost for
Medicare in the country and it looked like it was the highest cost for
Medicare in the country and the lowest per capita income Docs were treating
patients like a cash machine but even go one day said this and I know that's true
we all know that sometimes that's true but I've made a living out of
supervising docs and I can tell you doctor like people some are good some
are bad most of them got into it because they wanted to help so you see this
little quote up here I think this becomes an issue more and more and more
when we're looking at this problem "When there are multiple solutions to the same
problem it's because none of them really work" how many solutions are there to
finding a risk for a heart attack there's four types of stress test alone
the stress EKG, stress echo, nuclear stress tests, and a drug-induced stress
this while all the different ones
drug-induced test is you could say is for a different problem but the other three
just don't work as we just saw but I don't think it's because docs I don't
think it's necessarily because docs are seeing patients as a cash machine as I
said some are here's the issue Docs want to help and when there's a
serious problem they seriously want to help and what kind of problem is more
serious than prediction and preventing a heart attack thank you for your interest
My name is Ford Brewer I started off as an ER doc then I became very
frustrated with the fact that most things that bring people into the ER
were preventable like heart attack and stroke I went to John Hopkins to get
training and ended up running the program there in prevention there I
trained dozens of docs and again that was three decades ago since then I've
trained thousands of docs and even more importantly supervised those docs and
even most importantly helped thousands of patients prevent things like heart
attack and stroke waiting for it for the disease and hoping for a cure for this
kind of devastation doesn't work come to Louisville on November 8th and 9th we
have a boot camp type of environment for two days where you learn all the things
that you didn't learn from your doc in terms of heart attack stroke prevention
things like cardiovascular inflammation how to detect it how to measure things
like insulin resistance the number one cause of inflammation how to detect it
how to measure it how to stop it how to manage it you also get you can get the
labs there for that event if you'd like and get a complete evaluation in
addition you get an arterial scan called a CIMT to get the right one of those is
fairly difficult so I'm looking forward to seeing you there Thanks