“You don’t mess with the cardiology lobby. They will lambaste you on the news, go in front of Congress, and create commercials claiming that the insurance industry is harming patients by getting between them and the patient. And they have lots of money and a very sophisticated operation. We just give them what they want.”
-paraphrased statement that the medical director of a large insurance company said to me when I asked why they pay so much for cardiac procedures that don’t work.
When Democrats like Sanders and Warren struck against Kennedy as being unqualified for the job, wearing their political badge on their chest and refusing to discuss issues that they believe are settled science, they also demonstrated their ignorance for the true drivers of our health care system’s dysfunction. Kennedy isn’t the problem. In fact, he is willing to discuss solutions. The problem is twofold: the powerful industry (mostly drug company) cooptation of our health care infrastructure, and the proliferation of specialists who are overpaid by convincing patients and insurance companies to toss obscene amounts of money toward interventions that we know don’t work. If Warren and Sanders want universal health care, they can’t do it if they cling to the myth that our health care system is healthy. That it can just be expanded to everyone without changing it. That its strings are not pulled by people seeking to profit off fear and deception. Had a Cardiologist been running for HHS Secretary, you can be sure that they and their colleagues would have extolled that doctor’s virtues and approved her without hesitation. And yet, cardiologists, as well as so many other specialists, are the problem. They are the ones we must reassess and revalue. To simply accept their beneficence is to doom our healthcare system to perpetual agony.
So let’s talk about Cardiologists, not because they are alone in their dissemination of self-serving perfidy, and not because all of them engage in such base actions, but because they exhaust the lion share of our healthcare dollars normalizing myths that are harmful. Cardiologist are the seventh highest paid specialty in the nation, earning on average $600,000 a year—a number that does not consider the lower-paid academic and part-time docs who drive down the average salary; most earn close to $1 million a year—to take care of arguably the most basic organ in the body. The heart is a pump. It has a simple electrical system driven by our own pacemaker, some valves to control the direction of blood flow, blood vessels to feed it, and that’s about it. When it comes to complexity, there is nothing easier for the first-year medical student to master.
And yet, their status is like that of the prophets. Not only will insurance companies not dare to challenge their self-serving scripture that necessitates huge expenditures despite little to show for it, but the public has also accepted their role as smart and compassionate healers. Their wealth is derived from performing tests and procedures on vulnerable patients—stress tests, echocardiograms, carotid ultrasounds, catheterizations, stents, to name a few—that science has clearly shown to be ineffective and even dangerous. They are also the most prolific medicine prescribers in the country, latching onto every new drug introduced by Big Pharma and declaring these drugs to be necessary for survival. They lobby congress more than any other group, achieving high reimbursement by wooing those they pay and preaching a faith that has become normalized despite its misleading liturgy.
No one dares question what they say because most Americans have willingly become part of their cult. That is because cardiology lobbies spend their time and energy not saving lives but glossing their own Teflon. They spread fear to the populace and offer pragmatic—if self-serving and ineffective—solutions that seem to make sense. Don’t we all know someone who had a stent and is alive today? Don’t we all feel good when our cholesterol numbers and our stress test results look good after taking all those drugs? As in all faith-based institutions that spread fear and then pose as saviors, true facts melt beneath the warmth of their promises. If our healthcare system is ever going to shift gears and help people rather than being the pawns of doctors and drug companies, we must look at this religion in the face and see it for what it is.
We will dissect this through two lenses. First, let’s explain why what cardiologists peddle is deceptive, why people listen to it, and why insurance companies pay for it. And second, let’s explore how we can fix this problem. Once we tackle cardiology—the field that even insurance company executives are afraid to cross—then the rest of our healthcare mess will easily fall into place.
Taking on cardiology puts us face to face with the medical system’s greatest triumph, something that occurred in 1911 when the AMA and its corporate allies subsumed the entire healthcare system and transformed it into a profit generating behemoth that remains with us today. Patients are sliced into measurable numbers and discrete organs, specialists “fix” what they declare to be aberrant measurements, and people are told that there is a singular truth bereft of nuance to which they must comply or they will die. The system has constructed what Noah Harari (in his book Nexus) calls intersubjective realities: fictions and myths that are molded into truths by trustworthy players as a means of controlling people. That, in turn, lets those who seek to profit from deception to declare themselves to be absolutely right, while anyone who challenges their gospel is framed as a threat to our nation’s health.
If that sounds complicated, it’s not. For instance, we knew before COVID hit our shores that masks would not work, and every study and every bit of our experience has put an exclamation point on that reality. But masking has been made into an intersubjective reality that cannot be challenged, as it is supported by the media we trust, politicians we like, and our trusted medical community. To maintain the fictive power of masking, those in charge create an oppositional binary, whereby they are smart and scientific, and anyone who challenges them is a misinforming anti-science nutjob. By making the world binary and proclaiming a singular truth, and by demonizing any heretic who dares question that truth, doctors have created a flock of true believers willing to fight for the myths that they have come to worship, and to fight for the prophets who claim to be their champions.
Cardiologists tapped into this power long before masks helped to allay our fear of COVID and lead us to the highest COVID deathrate in the world, something mask proponents believe to be inconsequential. First they spread fear (you will get a heart attack based on our tests), then they offer simple solutions that they hide beneath a cloak of faux science (lower your cholesterol with all these drugs, take blood thinners, get stents and more tests, and you will be saved). The insurance companies—certainly, not saints themselves—must comply because if not, the cardiologists will call on their flock to demonize them and assign them to alterity. That’s how the medical game works. That’s why we’re spending $4 trillion dollars a year, have among the worst outcomes and lowest lifespan in the world, and most Americans praise our doctors as the good guys, following their script as they would follow the liturgy at church. This is the church of science, a desecration of true scientific principles (telling the truth, discussing issues openly, accepting uncertainty and nuance) in favor of quick and dogmatic fixes. Enter the cardiologists!
The Deception of the Gospel of Cardiology:
In areas of the world where people live the longest and are healthiest, virtually no one gets stress tests, measures cholesterol, has stents placed, takes statins or blood thinners, or spends much of their time seeing doctors. In fact, during the last 20 years when cardiology spending leaped to overtake all spending in healthcare (costing the nation more than the entire military budget), overall longevity and specifically cardiac longevity has declined while the burden of chronic cardiac illness has accentuated. We are being deceived into spending all our money and putting faith in people who are actively helping us to die faster and to suffer along the way. I have proven this in mine and my friend Alan’s new book, A Return to Healing, laying out the facts and buttressing these facts with incontrovertible evidence. The science has spoken, and cardiologists clearly fall in the realm of pseudo-scientists and snake oil salesmen. But their Teflon image, promoted by their religious-like aura and a media bought off by medical lobbies and drug companies, blinds us to this reality. It’s hard for most people to believe that they could be so very wrong, especially when they sound so convincing and caring. Here are some of their myths:
• We know that EKG’s—given an F by the US Preventive Task Force as causing more harm than good—should never be done on an asymptomatic patient. Do cardiologists do these regularly? Yes, and somehow we thank them for it. We know beyond the shadow of a doubt that the use of stress tests, carotid ultrasounds, and echocardiograms done in people without justifying symptoms lead to over-treatment and harm and save no lives. We know definitively that measuring and treating cholesterol prevents no heart attacks and does not allow us to live longer, while causing often debilitating side effects. Almost every sliver of testing done in a cardiology office does no more than convince you to get more tests, take more drugs, and get more procedures. None of it actually helps you; that is a scientific fact. And yet, by preaching their necessity beneath a cloak of fearmongering, these white-coated saviors convince us of their value, and we comply because we’re afraid not to. Science falls prey to dogma and false promises of salvation. Do the cardiologists believe what they are selling (all they can offer in their defense are drug-company designed protocols and calculators) or are they subconsciously doing it because they know it generates huge profits? Who knows. But the fact is, all of this testing and treating is base and harmful, as well as draining our system of much needed money that should be funneled elsewhere.
• Wait, what if a stress test discovers a blockage? Doesn’t that save your life? Absolutely not. We know that finding a blockage and then fixing it with a stent saves no lives but causes an increase in debilitating strokes and bleeds. And we know too that once you get that stent, you’re tossed on several potentially harmful drugs and you are now tied to the cardiology leash, submitting to a lifetime of more testing, drugging, and stenting. It may feel good to think that a stent put in a 90% blockage saved you, it’s tempting to believe that Joe next door is still alive because he had all those stents and is on all that medicine, but facts don’t support this. Every study of stenting shows no benefit and the potential to cause disastrous harm. Every one of them.
• What about fixing cholesterol? Shouldn’t we get that LDL below 70 and go on high dose statins and other medicines to drive the number down like the cardiologists—and their precise calculators—assure us? Absolutely not, and again studies are clear and unanimous about this. Cholesterol as a measurement is irrelevant. Only if cholesterol sticks to blood vessels is it dangerous, and high and low cholesterol stick with equal frequency. What causes it to stick? Inflammation. What lowers inflammation? A good diet (not low fat as most cardiologist still preach to the chagrin of the entire nutrition community, but rather low sugar and high fiber) and exercise. How do we measure inflammation? We can’t. But measuring cholesterol is a deception that leads people down dangerous roads, from over-medication to over-testing to false reassurance. We know that statins help a few people a little bit, those at high risk of coronary artery disease who are under 80 years old. But the vast majority of statins are prescribed to those over 80 and who don’t have coronary artery disease. This deception helps cardiologists gain the trust of patients (due to measurable drops in their cholesterol and assurances that they will live longer because of that) who now will submit to other snake oils peddled by these white-coat saviors. It starts with measuring cholesterol, and soon enough you’re getting yearly stress tests, multiple stents, and are on a dozen drugs. That’s the power of faith.
• Blood thinners for afib and aggressive lowering of blood pressure are also part of the cardiology liturgy. Studies show significant nuance in both; blood thinners cause more strokes and deaths than they prevent much of the time, and lowering pressures too much is both disabling and dangerous. But these prophets will insist otherwise, declaring that you comply to their one-right-answer dogma or you will most certain suffer the consequences: strokes, death, eternal damnation. This snags you into their domain. It’s hard to turn away from such absolutist and frightening declarations.
• By creating an intersubjective reality whereby measuring and testing and drugging and stenting is necessary for survival, and then demonizing all who dare question the gospel, cardiologists have sucked obscene amounts of money from the healthcare system for their own benefit, while deceiving most Americans into willingly falling prey. When confronted with fear, a drop in cholesterol level feels good and opens you up to more deception.
How the Cardiologists have cornered the trust and profit market.
So, yea, almost nothing they say is true. But they use two weapons to sell it to you. One is fear, the very engine that drives our health care system. By tossing fear at you—you will get a stroke, you will get a heart attack, you will die unless you do as we say—and dismissing any downsides of their aggressive interventions, they make you too scared to say no. And then there’s the oppositional binary. We are cardiology experts, we care, we can show you measurable progress, don’t listen to the dangerous others, believe us or you will die! It’s a simple and effective formula. There is no nuance in the cardiology office. It’s our path to health, or their path to death. They use calculators, algorithms, the alure of numerical improvements, and simple dogmatic arrogance to prove their point. But their ability to capture your submission to their one-right-answer dictates dives far deeper than that.
• Did you know that most cardiologists own their own machines? A nuclear stress test done in their office not only generates a hefty fee for them directly (usually over $2,000 for a test that takes them 15 minutes to interpret), but also a facility fee that can be as high as $15,000 per test. And then if you get a cath or stent, the dollars keep flowing in. If you have complications from their meddling, well, that will lead to more procedures, more drugs, more profit. It’s quite a perverse incentive. And yet, they carry on as though they are thoughtful, scientific, and caring. That’s why they want you to get the stress test every year, even if they sell it as though they are caring and scientific souls. All good swindlers act the same way. Most, though, don’t wear white coats dipped in Teflon.
• Then there’s self-referral, one of the demons that bankrupts our system. When you see them for anything, maybe you just want to talk about staying healthy, they refer you to themselves. They refer you to their partners who do expensive stress tests that they have convinced insurance companies to finance at a rate that is about 10 times higher than anywhere else in the world. If that’s abnormal, they refer you again to themselves to do a catheterization and even a stent, also at a steep cost that insurance pays for. So, yea, you pay nothing, and thus you don’t question their motives. But self-referral is a path to abuse, and cardiologists are masters of that deceit.
• Most cardiologists I know see the world in black and white. There is no nuance. They use calculators and other devices engineered by drug and device manufacturers to convince them and you that you need all that they peddle. Do they even know where all this calculated evidence comes from? Unlikely. Why would they when such calculators lead you down the very road they pave with profit. When I questioned some cardiologists and showed them oppositional data, they hung up on me and called a nut-job in front of my patients. One of my good friends—a thinking cardiologist who did very few tests—was basically driven out of my state by the cardiology community and had to relocate. The truths these people uphold push patients into the path of a speeding bus, and when the bus hits them, they thank the doctors for being so caring and scientific. Yes, cardiologists are that good at what they do! Science as a religion is quite an effective tool. Why believe someone like me who talks in the language of uncertainty and nuance when you have a priest telling you to give your body to them and you will be saved? That is both their power and danger all wrapped up in one.
How to Push Back against the Popular Religion of Cardiology:
When we wrote our book, Return to Healing, the doctor reviewers were overall very complementary. But one of them said: why are you so hard on the cardiologists? Even those who assail the profit-driven falsehoods that fuel our healthcare system still have a place in their hearts for cardiologists. Many still believe in treating cholesterol, using blood-thinners without discussion, driving down blood pressure, and placing stents. They don’t question the obscene money that cardiologists derive from self-referral and inflated costs of procedures. We can show facts all day, but cardiologists will counter them by saying: just believe me, unless you want to die, because I am the expert. It’s a very frustrating pit that we doctors who actually care are stuck in.
The reason I pick on cardiologists in this blog and in our book is not because they are the only specialists who feed on fear and turn it into profit, the only doctors who compliantly follow what the drug-company protocols tell them to do because it is in their own self-interest, but they are best at it and squander the most amount of our collective money doing it. To expose their perfidy and to fix it would help us repair the entire system. Here are a few ideas how we can do it.
• Eliminate self-referral. If a cardiologist wants you to get a stress test or stent of echo, they must refer those tests to someone not associated with them, likely an interventional radiologist. They cannot profit from their own decisions.
• Cut down the reimbursement for procedures. One nuclear stress test generates more profit for a cardiologist than a week of seeing patients provides to a thoughtful, caring primary care doctor. How absurd is that? Cardiologists should not be earning money by doing unnecessary tests and procedures, and the only way to stop that is to dramatically reduce procedural reimbursement. That can be done tomorrow if Medicare takes that road.
• We must ensure that drug company advertising stops, that drug company lobbying stops, and that all protocols and “calculators” used by doctors such as cardiologists employ data from reliable sources. We need a database that can be used by doctors and patients to arrive at the truth, as messy and nuanced as that truth is. Yes, it hurts to know that blood thinners cause as many strokes as they prevent, it’s far more palatable to hear that they will prevent strokes and cause no problems, but that’s not reality. We need to have access to true data regarding all the medicines these doctors toss at us, all the tests they insist on doing, all the fixing they promise will save us. Groups such as Cochrane have complied reliable databases of tests and procedures for decades and they can easily construct calculators and protocols that all people—doctors and patients—can access. It’s time we insist on the truth.
• Doctors and doctor organizations hold our sacred trust. We can’t let them lobby congress, work with drug companies, and spread false information to the public. This is a recipe for disaster. All of this must be stopped.
Finally, we know that the path to good health lies in lifestyle changes. Let’s teach doctors about diet and exercise and pay them more to keep people healthy then to pretend to fix them with highly reimbursed snake oils. Let’s focus on prevention, not sick care. And let’s stop measuring quality through the bogus metrics of number-fixing. We don’t care what your cholesterol is. We only care how inflammatory you are, and although not is not measurable, a caring and well-trained doctor knows when it’s time to get you off the inflammation train and how to do that. That’s who deserves to be in the top 10 of highest-paid doctors. That’s who will help you and the system. A few tweaks, open eyes, and trust in science will land us on a patch of longer life, less disease, and far lower costs. For that to happen, we must push cardiologists and so many other specialists off their high-paying Teflon pedestal and return this nation to healing.
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