Tag Archives: cardiology

Quackery Promotion By Mainstream Media: Part I, Reader’s Digest and Naturopathy

As the skeptical cardiologist surveys the heart health information available to his patients and the lay public, he sees two broad categories of misinformation.

First we have the quacks and snake oil salesman. These are primarily characterized by a goal of selling more of their useless stuff online.

I’ve described this as the #1 red flag of quackery. Usually I’m inspired to investigate these charlatans because a patient asks me about one of their useless supplements.

The second category is more insidious: the magazine or internet news site seems to have as its legitimate goal, promoting the health of its readers. There is no clear connection to a product.

Web MD, which I wrote about here, is an example of this second type.  Hard copy versions of these types of media frequently make it into doctor’s waiting rooms: not because doctor’s have read and approved what is in them. These companies send their useless and misleading magazines for free to doctor’s offices, and the staff believe it to be legitimate.

How does glaringly inaccurate and often dangerous information get into media that ostensibly has as its goal promoting its readers health? Most likely, it is a result of media’s need  to constantly produce new and interesting ways for readers to improve their health.

Clearly, readers will not continue subscribing, clicking and reading such sources of information if there isn’t something new and exciting that might prolong their lives: gimmicks, miracles cures, and “natural” remedies are more alluring than the well-known advice to exercise more, watch your weight, stop smoking and get a good night’s sleep.

Reader’s Digest and Stealth Quackery

A patient recently brought in a printout of Reader’s Digest’s “40 things cardiologists do to protect their heart” which is typical of the second category.

Reader’s Digest was a staple of my childhood. My parents subscribed to it consistently and I would read parts of it. It was small and enticing. Allegedly its articles were crafted so that they could be read in their entirety during a session in the bathroom.

To this day it has a wide circulation. Per Wikipedia”

The magazine was founded in 1920, by DeWitt Wallace and Lila Bell Wallace. For many years, Reader’s Digest was the best-selling consumer magazine in the United States; it lost the distinction in 2009 to Better Homes and Gardens. According to Mediamark Research (2006), Reader’s Digest reaches more readers with household incomes of $100,000+ than Fortune, The Wall Street Journal, Business Week, and Inc. combined.[2]

Global editions of Reader’s Digest reach an additional 40 million people in more than 70 countries, via 49 editions in 21 languages. The periodical has a global circulation of 10.5 million, making it the largest paid circulation magazine in the world.

Reader’s Digest used to run a recurring educational feature on the various body parts and organs of Joe and Jane which intrigued me.

Here’s the first paragraph of “I am Joe’s heart:”

I am certainly no beauty. I weigh 340 grams, am red-brown in color and have an unimpressive shape. I am the dedicated slave of Joe. I am Joe’s heart.

The health information in this series was generally accurate but the presentation lacks the kind of sizzle that apparently attracts today’s readers.

The article my patient brought to my attention is typical of the mix of good and bad information and fluff that mainstream media can produce to attract followers:

Not So Bad But Not Clearly True Medical Advice

#1. I keep a gratitude journal. An internist “at NYU” is quoted as saying: “Studies have recently shown that expressing gratitude may have a significant positive impact on heart health.”

Fact Check: following the links provided provides no evidence to support this claim.

#2  I get 8 hours of sleep a night, every night.  This cardiologist seems to have been misquoted, because her comment is actually “getting a good night sleep is essential. I make a point of getting seven to eight hours of sleep every night…Poor sleep is linked to higher blood pressure.”

Fact Check. One review noted that:

Too little or too much sleep are associated with adverse health outcomes, including total mortality, type 2 diabetes, hypertensionand respiratory disorders, obesity in both children and adults, and poor self-rated health.

Another broke down mortality according to number of hours of sleep.

A J-shaped association between sleep duration and all-cause mortality was present: compared with 7 h of sleep (reference for 24-h sleep duration), both shortened and prolonged sleep durations were associated with increased risk of all-cause mortality (4 h: relative risk [RR] = 1.05; 95% confidence interval [CI] = 1.02–1.07; 5 h: RR = 1.06; 95% CI = 1.03–1.09; 6 h: RR = 1.04; 95% CI = 1.03–1.06; 8 h: RR = 1.03; 95% CI = 1.02–1.05; 9 h: RR = 1.13; 95% CI = 1.10–1.16; 10 h: RR = 1.25; 95% CI = 1.22–1.28; 11 h: RR = 1.38; 95% CI = 1.33–1.44; n = 29; P < 0.01 for non-linear test)

Thus, in comparison to those who sleep 7 hours, those who sleep 5 hours have a 5% increase in mortality and those who sleep 11 hours have a 38% increase in mortality.

These data are based entirely on observational studies so it is impossible to know if the shortened sleep is responsible for the increased mortality or if some other (confounding) factor is causing both.

My advice: Some people do fine with 6 hours and 45 minutes of sleep. Some require 8 hours 15 minutes for optimal function. Rather than obsessing about getting a specific amount of sleep time, it makes more sense to find our through your own careful observations what sleep time works best for you and adjust your schedule and night time patterns accordingly.

#3. I do CrossFit.

Fact Check. There is nothing to support CrossFit as more heart healthy than regular aerobic exercise (which the vast majority of cardiologists recommend and perform).

#4. I meditate. “Negative thoughts and feelings of sadness can be detrimental to the heart. Stress can cause catecholamine release that can lead to heart failure and heart attacks.”

Fact Check. There is a general consensus that stress has adverse consequences for the cardiovascular system. Evidence of meditation improving cardiovascular outcomes is very weak.

A recent review

Participation in meditation practices has been shown to reduce depression, anxiety, and negative mood and thus may have an indirect positive effect on CV health and well-being. This possibility has led the American Heart Association to classify TM as a class IIb, level of evidence B alternative approach to lowering BP.32

Non randomized, non blinded studies with small numbers of participants have suggested a reduction in CV death in those performing regular TM.

However, we need better and larger studies before concluding there is a definite benefit compared to optimal medical therapy.

Thus far, the recommendations have been pretty mundane: exercise, stress reduction and a good night’s sleep is good advice for all, thus boring.

Seriously Bad Advice From Quacks Mixed In With Reasonable Advice

In order to keep reader’s interest (and reach 45 things) Reader’s Digest is going to need to add seriously bad advice.

My patient had circled #34. “I mix magnesium powder into my water. If sufficient magnesium is present in the body, cholesterol will not be produced in excess.”

This bizarre and totally unsubstantiated practice was recommended by Carolyn Dean MD, ND.

What do we know about Dr. Dean?

-She was declared unfit to practice medicine and her registration revoked by the College of Physicians and Surgeons of Ontario in 1995. From quackwatch.org :

  • After being notified in 1993 that a disciplinary hearing would be held, Dean relocated to New York and did not contest the charges against her.
  • Dean had used unscientific methods of testing such as hair analysis, Vega and Interro testing, iridology and reflexology as well as treatment not medically indicated and of unproven value, such as homeopathy, colonic irrigations, coffee enemas, and rotation diets.

-The initials after her name (ND, doctor of naturopathy) should be considered the second red flag of quackery. See quackwatch.org (here) and rational wiki (here) and the confessions of a former naturopath  (here ) for discussions of naturopathy. As noted at science-based medicine:

Naturopathy is a cornucopia of almost every quackery you can think of. Be it homeopathy, traditional Chinese medicine, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine, it’s hard to think of a single form of pseudoscientific medicine and quackery that naturopathy doesn’t embrace or at least tolerate.

-She has a website (Dr. Carolyn Dean, MD,ND, The Doctor of The Future) where she incessantly promotes magnesium as the cure for all ills.

-She has written a book called “The Magnesium Miracle” (hmm. wonder what that’s about).

-She sells her own (really special!) type of magnesium (see red flag #1 of quackery).

-She writes for the Huffington Post (I’m considering making this a red flag of quackery).

-She is on the medical advisory board of the Nutritional Magnesium Association (an organization devoted to hyping magnesium as the cure for all ills and featuring all manner of magnesium quacks).

Prevention Magazine 

Reader’s Digest is not alone in allowing the advice of pseudoscience practitioners to stand side by side with legitimate sources.

For example, Prevention Magazine in its August 2017 issue highlights “35 All-Time Favorite Natural Remedies” with the subheading

“Go ahead, try them at home: Experts swear by these nondrug cures for back pain, nausea, hot flashes, and other common ailments.”

Who are these “experts”? Let the reader beware because the first quote comes from “Amy Rothenberg, past president of the Massachusetts Society of Naturopathic Doctors.”

Finding The Truth

It’s getting harder and harder for the lay public to sort out real from fake health stories and advice.

When seemingly legitimate news media and widely followed sources like Reader’s Digest and Prevention Magazine  either consciously or inadvertently promote quackery, the truth becomes even more illusive.

Readers should avoid any source of information which

  1. Profits from selling vitamins and supplements.
  2. Utilizes or promotes  naturopaths or other obvious quacks as experts in health advice.

IamJoesfootingly Yours,

-ACP

How To Spot a Quack Health Site: Red Flag #1, Primary Goal Is Selling Supplements

During the process of compiling the Cardiology Quackery Hall of Shame, the skeptical cardiologist has recognized that the #1 red flag of quackery is the constant promotion of useless supplements.

Such supplements typically:

-consist of “natural” ingredients

-are a proprietary blend of ingredients or a uniquely prepared single ingredient, and are only available through the quack

-have thousands of individuals who have had dramatic improvement on the supplement and enthusiastically record their testimonial to its power

-have no scientific support of efficacy or safety

-despite the lack of scientific data, the quack is able to list a series of seemingly valid supportive “studies”

-aren’t checked by the FDA

-apparently cure everything from heart disease to lassitude

I received an email today from a reader complimenting me on my post on the lack of science behind Dr. Esselstyn’s plant-based diet. The writer thought I would be interested in the work of a  Dr. Gundry.

I found on Dr. Gundry’s website an immediate and aggressive attempt to sell lots of supplements with features similar to what I describe above.

Dr. Gundry’s bio states “I left my former position at California’s Loma Linda University Medical Center, and founded The Center for Restorative Medicine. I have spent the last 14 years studying the human microbiome – and developing the principles of Holobiotics that have since changed the lives of countless men and women.”

Need I mention that “holobiotics” is (?are) not real.

Bonohibotically Yours,

-ACP

After writing this, I googled “red flag of quackery” images in the foolish hope that I might find a useable image. Lo and behold the image I featured in this post turned up courtesy of sci-ence.org. Here it is in all its glory, courtesy of Maki

2012-01-09-redflags2-682x1024

 

 

 

Skeptical Thoughts From The Dentist Chair: Part I, The Questions

The Skeptical Cardiologist found himself lying in a  dentist chair one day having his  teeth poked, prodded, scraped, rubbed and polished, when fears of the adverse consequences of these procedures suddenly overwhelmed him.

Previously I had considered routine dental cleaning a necessary annoyance, something that I guiltily avoided, primarily because of the time wasted and discomfort associated with it. But as I lay with my mouth open, a series of questions erupted in my consciousness.

Perhaps this anxious skepticism was related to the writing and thinking that I have done about the downsides of routine annual electrocardiograms or routine stress testing after stents. It has become clear to me that the risk/benefit ratio of any annual medical evaluation should be questioned.

The hygienist introduced herself (we’ll call her Donna), put away her crossword puzzle book, guided me back to the exam room and told me that she was going to do an X-ray.  I wasn’t asked if I wanted an X-ray or explained the purpose of it, but dental radiography now seems to be the norm. Perhaps I am given one every time I visit a dentist because I go infrequently, much less than annually, and dental insurance tends to  pay for an annual X-ray. The dental offices probably assume if it is free, no sane patient will reject it.

More and more, I have become concerned about the radiation from medical radiologic procedures (see my discussion on the radiation from coronary calcium CT scans here). The  hygienists are always careful to put a lead apron over my groin and around my neck, which makes me feel a little better, but I can’t help but wonder…what is the yield of the x-ray in a patient with no symptoms, what is the risk of developing oral cancer from the procedure, if performed every year? And what is the probability that something will be identified that is not really a problem, which may lead to more testing or procedures?

These concerns are similar to ones that we face daily in cardiac testing (and for PSA and mammography), but unlike stress testing and breast cancer screening, there seems to be little scrutiny of the value of the routine annual dental x-ray.

Donna placed a bib around my neck and I noticed that she was wearing medical gloves and that she was preparing a device covered with plastic to stick in my mouth. That’s nice, I thought, good sterile technique! However, adjacent to the part of the device covered in plastic, was metal that was uncovered and I saw her touch that, then manipulate the plastic and put that in my mouth.  I began worrying about transmission of hepatitis or HIV virus from a previous patient which was now being inserted into my mouth.

I began thinking that if one case of hepatitis is created by a routine dental visit, that probably negates the benefits, if any, of the thousand patients that had their teeth cleaned and didn’t get hepatitis.

After irradiating my teeth for unclear reasons, Donna began preparing her pointy metal probes, picks, and claws for the “cleaning.”

As she began picking, clawing and scraping away at my teeth, I began to wonder if this could be more harmful for me than helpful. What if this process was somehow damaging the enamel of my teeth and making it more likely that I would have problems?

I worried about my tongue: what if it I wasn’t positioning it in the right spot? Could it be hit by one of her picking devices, causing me to bleed, which would then cause the multiple bacteria now swarming in my saliva to gain entry into my bloodstream, perhaps landing on a heart valve and causing an infection, endocarditis, that would then result in a need for valve replacement surgery?

Periodically she would squirt a liquid into my mouth and then ask me to close my lips around the plastic sucking device. How well had the sucking device and the squirting tool been cleaned before the last patient and how I could I possibly verify this? I had to put my complete trust in this dental hygienist who I had never met before. I didn’t know what her training was.  I didn’t know what her level of compulsiveness with regard to germ transmission was.

Did I want her to be very aggressive with the cleaning or superficial? Which was better? Previously, I have had both approaches and I’m usually thankful for the brief, superficial variety.

Donna announces that she will be “polishing” my teeth and the dreaded rotary brush, coated with nasty paste is applied. What are the component of the paste? Is it likely to fly off into my lungs and set up a nidus for an inflammatory nodule?  If I swallow it will its toxic contents be absorbed into my blood stream and destroy my liver?

At the very instant that she is done, the dentist enters the room and greets me with a hand shake; he is an affable, fifty-something fellow in  casual dress. I have revisited this dentist a second time because he didn’t find anything amiss the first time I visited him.

I have an intense distrust of dentists, as I have found their “cavity detection rates” differ wildly. (I went to the same dentist in Louisville for 5 straight years and he gave me rave reviews about my teeth. My first visit to a different dentist (highly recommended by a mysophobic ex-wife), resulted in the identification of several (asymptomatic) cavities and subsequent fillings – the first cavities I had had in twenty years. I left her and went back to the guy who never found cavities. (Interestingly, one who studies cavities is termed a cardiologist).

Donna told me that I have some build up of tartar. I ask her to define it and she tells me tartar is plaque on the teeth that has become calcified. I ponder the similarities between the development of calcified plaque in the coronary arteries and the teeth. About ten years ago cardiologists felt there was a connection between ginigivitis and coronary atherosclerosis, possibly mediated by inflammation, but this has mostly been discredited.

I ask Dr. Watley what the significance of tartar and plaque is. He seems a little taken aback and launches into a description of what “some say:” bacteria build up in the plaques around the gums and launch themselves into the blood stream,  landing on heart arteries, pancreas, and spleen.  At first I think he must have forgotten that I am a cardiologist, but then he asks me what I think of his theory;  I tell him there is little scientific support for it. He admits that his other cardiologist patient doesn’t believe it either.

I ask him what the value of a routine cleaning is.  He says “Donna, what do you think? Donna, clearly nervous, talks about preventing bacteria from building up.

I ask “Is there any evidence that annual cleaning is better than another interval?” He says that those who get cleaning every 4-6 months do much better than those who don’t. No doubt!!!

Dentists, like cardiologists, benefit financially from having exams done on a regular basis.  It’s hard to get unbiased information from your dentist or cardiologist, or an organization run by dentists or cardiologists, on the value of routine cleaning or cardiac testing or the frequency at which examinations or testing should be performed.

In Part II of this post, I’ll present the scientific evidence, if any, to answer some of the questions I’ve posed above.

Despite my distrust of dentists, I want to make it very clear that I am not a RABID anti-dentite.

 

 

 

Are SSM and HealthFair Cardiovascular Screenings Promoting Wellness or Unwellness?

IMG_5657My patients and I continue to receive mailings from SSM Health Care (here in St. Louis), informing us that they have “partnered with HealthFair to deliver ultrasound tests of the heart and arteries” in our neighborhood.

If you are considering getting these, I recommend reading my  previous post on them (Shoddy Cardiovascular Screenings are more likely to cause harm than good). Also, I recommend this summary (which points out in well-referenced detail that these are not recommended by major preventive organizations) from a blogger who writes eloquently on the lack of benefit of wellness programs.

HealthFair’s financial model involves partnering with hospitals like SSM to promote these unnecessary screenings performed in mobile vans that travel to settings like Walgreen’s out in the community. The hospital system pays HealthFair (typically an “undisclosed amount”) to put the SSM name on their promotional flyers.  SSM does not provide any review of the quality of the studies performed.

SSM benefits by having its “brand” spread around and when abnormalities are detected on the exams, these patients are then provided with the names of SSM physicians.

Both SSM and HealthFair benefit in this relationship by identifying as many abnormalities as possible. It doesn’t really matter to either if the abnormalities detected are real or important. The bottom line is getting more patients into the SSM system, getting down stream referrals and testing and adding to the SSM bottom line.

Steven Weinberger, MD executive vice president and chief executive of the American College of Physicians. and two co-authors wrote in the Annals of Internal Medicine journal,  calling hospital involvement without disclosing potential downsides “unethical.”

“Because of a lack of counseling by these companies about the potential risks of an “abnormal” test result, the consumer is initially unaware that this may open a Pandora’s box of referrals and additional testing to monitor or treat these abnormal findings. Our medical system and society bear the cost of poor coordination of care and additional testing and treatment to follow up on unnecessary “abnormal” screening test results (10). That most of these tests are not medically indicated in the first place is left undisclosed to the consumer, nor is there a discussion of potential adverse consequences or additional costs.”

The Particular Dangers of Screening Echocardiography

In my previous post I warned in particular of the dangers of getting a screening echocardiogram, a test which I have spent my professional lifetime studying, writing on, teaching and interpreting.

I’ve also discussed in detail how easy it is to botch an echocardiogram and what to look for to guarantee that you are getting an accurate study.

Let me provide another example of how a poorly performed and/or interpreted echocardiogram can lead to a lifetime of unnecessary anxiety and inappropriate testing.

I saw a patient in my office recently who was changing cardiologists because of dissatisfaction with communication. Reviewing records from the prior cardiologists, I saw that an echocardiogram was performed in 2012 and read as showing enlargement of the aortic root and pulmonary hypertension.

A greatly enlarged aorta or aortic aneurysm can rupture or tear resulting in sudden death. It’s a very serious condition, consequently once enlargement of the aorta is identified, we counsel patients on appropriate activities, screening of relatives, and follow them lifelong with tests to monitor the size of the aorta.

I reviewed the echocardiogram which was performed in the cardiologists’ office and it was clear that an older echocardiographic technique called M-mode had been utilized, and that the measurement was invalid. When I repeated the echocardiogram in my hospital’s echocardiography laboratory, it was normal (we have a very rigorous quality assurance program and review on a regular basis with the sonographers and physicians best practice for recording and measuring the aorta by two-dimensional recordings).

Pulmonary hypertension (elevation of the pressures on the right side of the heart) can also be a sign of very severe and life threatening cardiac or pulmonary problems. If diagnosed, it typically requires extensive testing with associated risks. Like aortic root enlargement, it must be followed carefully, lifelong.

Pulmonary hypertension can be measured reasonably accurately by a well done echocardiogram utilizing a combination of Doppler flow measurements and imaging of the inferior vena cava.  Because of the critical importance of getting these measurements right, I have devoted numerous educational conferences to reviewing them with our sonographers and reading physicians.

In the case of my patient (and I presume, numerous patients undergoing less rigorously performed screening echocardiograms) the initial echocardiogram did not truly show pulmonary hypertension and the echocardiogram I did confirmed this.

The Profit Factor

Ultimately, these types of screenings done in the name of promoting wellness, are being done for money.

HealthFair is strictly in it for profit; they want to get as many patients as possible paying for these screenings. Their bottom line is not enhanced by spending time and money on guaranteeing that good equipment, trained sonographers and experienced physician readers are involved.

SSM is only interested in getting more patients funneled into their system. They are paying HealthFair to identify abnormalities and therefore, abnormalities will be found. SSM in this relationship is going against good medical practice and recommendations of national medical organizations in order to make money.

A program that on the surface is promoting wellness, therefore, in the final analysis may be promoting unwellness.

If you have had one of these echocardiographic screenings and had an abnormality detected, I would be happy to review the initial recordings and provide my opinion on their accuracy.  I would do this gratis as the skeptical cardiologist in the interest of research and knowledge, not to accumulate patients or revenue.

-ACP

 

My MOC Status Has Changed!

I am Board Certified by the American Board of Internal Medicine (ABIM) in both Cardiovascular Disease and Internal Medicine.

Recently the ABIM has changed the rules and started a Maintenance of Certification (MOC) Program which is chock-full of useless forms, fees and tests.

I, and thousands of other doctors have rebelled against this program, recognizing that there is no evidence it will improve doctors care, patient outcomes or overall quality of medical care but that it will fill the coffers of bureaucrats and bureaucratic institutions and fritter away valuable time we could be spending on patients.

I did not pay my several hundred dollar fee the ABIM demanded for 2015.

MOCAs a result, I received this morning an email from ABIM telling me that “your MOC status has changed”. I logged in and found that I was listed as “Certified, Not Participating in MOC.”

I’m still the clinical cardiologist I was yesterday and I still spend hours weekly reading about the latest developments in cardiology that impact clinical care, teaching residents, and giving conferences but I wonder what the ramifications of this will be.

Dr. Wes, a cardiologist who has been a vociferous opponent of MOC is alerting physicians that one ramification is that the SGR bill the Senate is considering would tie doctor evaluations to MOC status.

You can read his comments here. He includes sample letters to send to Congress.

If the federal government puts their weight behind sanctifying MOC, then all physicians will be forced to participate.

I strongly all urge all physicians to consider weighing  in on this with your local congresspeople.

-ACP

Reporting From the American College of Cardiology Meetings 2015: Let the Science and Marketing Begin!

As part of his relentless pursuit of cardiologic knowledge, the skeptical cardiologist is in San Diego preparing to report on the 64th annual Scientific Sessions of the American College of Cardiology.

At last year’s meetings in Washington, DC, there were over ten thousand physicians attending, about two-thirds of whom were in clinical practice and one-third primarily involved in research.

These cardiologists will be listening to the latest presentations on scientific findings in cardiology and reviewing the best practice and guidelines in clinical cardiology.

They will also be interacting with almost three-hundred exhibitors. The exhibitors consist of companies that want to sell their wares to cardiologists.

Here is an interactive map of all the exhibitors in the “expo.”

If you move your cursor over the largest rectangle in the map you see that this 7800 square foot space belongs to Astra Zeneca, a British multinational pharmaceutical and biologics company. Astra Zeneca sells drugs in a lot of areas but I know that their major focus here at the ACC meeting will be on their new anti platelet drug known as Brilinta (ticagrelor).

They have been aggressively promoting this to cardiologists at my hospital through a combination of company sponsored dinner talks and pharmaceutical rep office lunch visits. When I began using the app for the ACC2015 meetings one of the first things to pop up was a stealth advertisement for this drug.

I moved my cursor over one of the smallest boxes I could find and up popped United Biologics, Inc. who have 100 square feet. Apparently they are “engaged in designing and manufacturing silicone replications of human vasculature, including common pathologies.”

I will be posting about the science and the marketing that goes on here over the next few days.

I’ll focus on the areas I am an expert in, including echocardiography and imaging, along with the new developments in fields like atrial fibrillation, valvular heart disease, prevention of coronary disease and heart failure that can help my patients.

If any of my readers have a particular topic you would like me to report on, let me know.

Yours in skepticism, ACP

Addendum: I have been to lots of ACC meetings in cities like Dallas, Atlanta and Orlando. The convention centers are usually located in very boring parts of the downtown area and are not particularly aesthetically pleasing. The San Diego convention center on the other hand is wonderful.IMG_3406

It is immediately adjacent to Embarcadero Marine Park, a very nice section of the harbor with boats and walking trails and exotic vegetation.

IMG_3396

The building itself it a joy to behold, an architectural gem with features suggesting sails and spires from the nautical world. I can’t wait to get inside and start learning.

HealthTap: Telemedicine or Terrible Medicine?

The skeptical cardiologist  is evaluating an online medical service called HealthTap. I first started getting inundated with emails from Dr. Geoffrey Rutledge, Chief Medical Officer of HealthTap in 2013. They started off saying:

“I’m delighted to personally invite you to be featured for free as a Top Doctor on HealthTap, where you will be recognized for your experience, expertise, and compassion. All you have to do is sign up.”

Health Tap allows patients to submit questions online which are answered by some of the thousands of doctors signed up. In addition, patients can get a “virtual consult” for 99$. James Hamblin in the Atlantic has written a nice piece describing the experience of the virtual consult with HealthTap from the patient’s perspective.

Beginning in November, 2014, Dr. Rutledge told me via email

“You still have time to achieve Top Doctor Awards, but the deadline for participation is now just a few days away! Sign up for free today, and you can be recognized in just 4 days with prestigious Top Doctor, Top General Internist, Most Influential Doctor, and Thought Leader Awards in the Fall 2014 Top Doctor Competition. You are eligible for each of these awards at the national, state, and regional levels.”

How could I resist competing for one of these meaningless but prestigious awards? After all, as Dr. Rutledge told me

Winners of Top Doctor Awards will be featured on HealthTap+ to 64,000 U.S.-licensed doctors and many millions of patients who visit HealthTap+ each month. As an awardee at the state or national level, you will receive a certificate to display in your office that highlights your achievement to your patients, a prominent badge for display on your online profile, and a virtual plaque that you can post on your blog or website.

Over the Thankgiving break I signed up to become a HealthTap doctor. I’ve been evaluating it since then and have found it to be an extremely annoying and tiresome program which utilizes high pressure marketing schemes and motivational techniques that are reminiscent of a video game.

The first thing i did after signing up was to look at the questions that patients were posting on the website. I answered two questions that were cardiology related. On one of the questions the information I gave was incorrect. I had two doctors “agree” with my answer and got two thank you  clicks from patients.

I then went trough a training session via video with a person from healthTap on the use of the Virtual Concierge app. I have yet to utilize this to actually interface with a real patient.

docscorehealthtap trophiesAs a result of my actions my DocScore on HealthTap  has skyrocketed from 50 to 85!

I unlocked “The Catalyst Trophy”and “The Chain Reaction Trophy”!

According to HealthTap I have helped 3080 patients and my patient satisfaction score is 5.0!

Spending two minutes answering 2 questions online, one incorrectly, sure pays off in the world of virtual medicine! This is a lot easier than seeing real patients.

 

I usually get a couple of emails from HealthTap per day saying meaningless marketing things like :

This is a time of year for helping others, showing your gratitude, and taking on new personal initiatives for growth. HealthTap+can help you accomplish your goals. With the exciting launch this year of HealthTap Concierge, we’ve demonstrated a simple, yet powerful way you can benefit from the latest state-of-the-art technology to boost your income and enjoy the flexibility of practicing from anywhere, at anytime, with no cost, hassle or overhead. With HealthTap Concierge, you can grow your practice, or relieve the load on your already too-busy practice.

HealthTap really wants to me sign up my own patients and show them the “magic of virtual care.”  :

In celebration of the holidays, we are thrilled to partner with you to help your patients. From now until December 26th, we’ll waive all charges for initial Virtual Consults that you give to your patients if you’d like to share this gift.

Giving the gift of a free consult is a great way to welcome your patients to your new Virtual Practice and show them the magic of virtual care.  

Tell your patients they can see you for a free virtual consult if they visit your Virtual Practice and schedule a consult with you by December 26. All they have to do is enter this special gift promo code when they make their appointment: 
firstfree-c9txs

Since I can’t imagine how this will help my patients I haven’t solicited any virtual patients. I’m pretty sure, however, that, I could improve my DocScore and unlock a few more trophies if I did.

I could really improve my standing if I started handing out kudos to other doctors who in turn would give me votes for various things like my bedside manner or my skill in “eat healthier.”

healty eaterThis doctor is first in the St. Louis Region for “being inspiring” and 4th nationally for varicose veins based on 155 doctor votes. I wonder how many of those votes were from doctors that know anything about him. There is no way to know unfortunately.

This is reminiscent of liking somebody on Facebook . A lot of the attempts by HealthTap to motivate me to do stuff on their site reminds me of social media and/or video games.

When I play Rock Band it is always satisfying to unlock trophies and get higher point scores and on Facebook I’m pleased when a lot of people “like” my posts.

I don’t think such meaningless trophies and likes and high point scores translate to any meaningful guarantee of quality, expertise or knowledge in the world of medicine. It seems to me that those doctors who participate a lot in HealthTap must have a lot of time on their hands (perhaps because they have no real patients to see) and/or they are seeking to merge their need to play and succeed at video games with their medical training.

I’m sticking to my real practice of cardiology where I can touch and see my patients, listen to their heart and lungs, follow up on the recommendations I’ve made and get to know them over time. I find this to be very satisfying and fulfilling .

This particular style of telemedicine to me is terrible medicine.

If HealthTap is the future of medicine, count me out.

I Am Not A “Leading Physician of the World” or How Not To Find a Cardiologist

.The other day I received a letter from the “International Association of Cardiologists”. They informed me that I had been named one of “The Leading Physicians of the World”.  My initial reaction to this was “Great! Somebody has finally recognized my mad doctoring skills.”

However, being the skeptical cardiologist I am naturally suspicious of any organization with which I am totally unfamiliar,  bestowing honors upon me.  I decided to look further into this organization since it is likely that patients may be making decisions on what doctors to see based on these types of “honors.”

How Do You Pick a Cardiologist?

It is extremely hard for the average patient to decide which cardiologist they should see. Reputation does not always correlate with competence.  A good bedside manner doesn’t mean a doctor knows what is he doing. There is no way to view doctors’ quality of care statistics. Cardiologists who order lots of tests might seem to be on top of things but are the tests really indicated? Bad doctors can come from really good training programs and great doctors can come from weak training programs.

A useful starting point is to look for a cardiologist board-certified in cardiology and with FACC after their name. The American College of Cardiology (ACC) is our main organization and becoming a fellow in the college (FACC) means you have successfully completed a credentialed cardiology training program.

What does an honor like “Leading Physician of the World” mean?

I called the telephone number in the letter and began a fascinating conversation. After a few superficial questions about what kind of practice I was in, how long I had been in practice, and what my specialties were, the woman congratulated me on being a “very successful physician” and told me I had been honored as one of “The Leading Physicians of The World” and would accrue all the benefits of this status.

Benefits including publication in the “Leading Health Care Workers of the world” book and a listing in the “find a top doc” registry.

What followed was a classic high pressure marketing spiel.  The best level, it seemed, for me was the “Diamond Level.” For only $969 up front, another $199 when my biography was published, and a monthly fee of  $34.95,  I would be featured in the prestigious diamond section of the book.  The other benefits of the diamond section were a free gift and a companion airline ticket voucher worth up to $550. Cardiologists, she told me, usually went with this level because the airline ticket voucher was “cost-effective “.

When I said “I am not interested in paying any money” she told me that the Platinum level at $769 up front would then be a better fit. This continued through multiple precious metal levels and declining fees with associated smaller page listings until it became apparent that there was no level that did not require the monthly $34.95 fee and I ended the conversation.

After this experience it has become clear to me that this organization  exists entirely to make money and the honors it bestows and its publications are meaningless. Doctors recognized by this organization are not necessarily special, leading, or at the top of their profession, they just elected to pay for a meaningless honor (or they mistakenly considered it an honor) perhaps in the hopes that it would generate more business.

Personally, I would be embarrassed to have such a listing and as a patient I would shy away from doctors who are paying for it.

The  website for The Leading Physicians of the World is very slick and professional looking and states that the purpose of the organization is

“The Leading Physicians of the World was founded on the idea that personal achievement is deserving of recognition and reward. Through a variety of benefits offered LPW honors our selected physicians through massive multi media exposure in an effort to place consumers in the hands of the right doctor.”

and that physicians are

“Selected for their experience, forward thinking, and highest quality of care, The Leading Physicians of the World, are the most distinguished and desired medical professionals from every specialty.aaa (sic)”

In reality, this organization is a sham, there is no attempt to assess the “forward thinking” or “quality of care” of the physicians listed, the only thing that matters is the dollars the doctors paid.

The other benefit that I was offered if I paid up was a listing in “findatopdoc.com”. This website performs a search for doctors by specialty and by location and claims that you can make an instant appointment with the top docs identified in the search. Three cardiologists in the St. Louis area came up. When I clicked to make an appointment, the button was inactive.

Finding a good cardiologist is a very difficult process. I’ll write more on this in future posts. It is unfortunate that companies like “The International Association of Cardiologists”, “The International Association of Health Care Professionals” (and all of its International Associations of ____) and “findatopdoc.com” are  preying on patients who are looking for guidance in the process.