On Friday June 13 the sad news of Tim Russerts passing reached me. As everyone else, I liked Tim an extraordinarily nice man, a great journalist. Sundays will never be the same without Tim on Meet the Press!
In a couple of days the talk turned to the question that occurred to me immediately: why? Tims cardiologist reviewed his heart disease risk factors including blood pressure, cholesterol. They did not mention whether Tim had advanced heart imaging allowing the assessment of the state of his arteries; I assume he had not had such an exam. We measure blood pressure and cholesterol levels annually! Technology now also makes it possible to see and measure blockages in the arteries which is assumed to have ended Tims life. Again, I assume this was not done; that is the tragedy!!! Todays medical imaging has reached such technological heights that Tims doctors would have been able to see the state of his arteries if he had undergone a Cardiac CT Angiography (CCTA). Blockages do not form overnight. Someone with high risk factors should be prescribed an imaging procedure that maps the status of the coronary arteries. (I and my wife had a CCTA and I know that I have a 40% blockage and changed my lifestyle and medication accordingly.)
CCTA (and other medical imaging procedures) allow us to see inside our bodies and see trouble coming. Imaging is not cheap; it takes a multimillion dollar machine to be able to take pictures of my arteries. It costs a thousand dollars or so to buy a CCTA exam. Is it worth it? It was worth it to me.
I write about this because I work for the Medical Imaging & Technology Alliance (MITA) and am close to this issue. I feel that if Tim would knew that he might help others he would want me to write this. Some might say that I have a conflict of interest because the more CT scans are done the more CT scanners MITA member companies sell. That is not my reason but if you believe so stop reading.
Decisions, whether or not a CCTA is prescribed or recommended, are made based on dollars and cents not on medical sense. This is one of the reasons that CCTA is not publicized, prescribed or recommended. The collective and individual interests clash. Individual members of the public are entitled to know the capabilities. We are not told this because we may demand it. Those that would choose to proceed on their own are not educated.
Another negative force is the crusade of a few purists who believe that the radiation dose from a CCTA examination may cause cancer. There is no proof that it does or when. I believe that cancers may take decades to develop from medical imaging if they do at all. An imminent blockage in the artery can kill you in a year. What is the prudent individual decision? I made mine and had a CCTA almost three years ago ..I wanted to know! At 62, I am more concerned about dying in a heart attack next year than in the small unproven likelihood of getting cancer 20 years from now. I will have another CCTA in a couple of years (probably on the same schedule as the $800 colonoscopy I regularly have.) If I live and work a year or two longer as a result, it is the best return on a $1,000 investment in a CCTA.
I am angry because Tims life might have been saved. We will never know. I am angry at the FDA because they warn against unproven radiation risks from CT scans but they do not present both sides of the coin. I am angry at the purists, the medical physicists who calculate the total radiation to the US population but do not emphasize to the public about the individuals risks and benefits. I am angry at the insurance companies because they are the driving force behind limiting the use of medical imaging in order to save money. And I am angry at myself and my own Association, my own employer, because we are not more forceful in bringing the facts to the people and hence not empowering them to make informed decisions for themselves.
Tim would want us to talk about this because it could help many others. I hope that Tims close friends will also start asking these questions. If Sally Quinn brings light to these issues she can save more lives than 100 heart surgeons combined. Tim would have like that.