Over the years, this job has plunked me down inside hurricanes, riots and battlefields, but I never felt remotely close to death until I stepped into a pleasant office building on a sunny morning in Beverly Hills, Calif.
I was there to interview David Agus, the kind of doctor you visit if you are very rich and very sick. As a world-renowned oncologist, his client list has included the likes of Lance Armstrong and Ted Kennedy, and he is credited with keeping Steve Jobs alive longer than anyone thought possible.
He’d just written a book called “The End of Illness,” which reached No. 1 on the New York Times bestseller list by admitting that medical science may never cure our worst diseases. But Agus promises that illness can be prevented with a mixture of common sense and cutting-edge technology.
To help illustrate his belief in high-tech medicine, I volunteered to take a battery of tests, including a full-body CT scan, to peer into every nook and cranny. It was all very fun and interesting right until the moment we stepped into his office and he pointed to a screen on the wall.
“The unfortunate truth is that you do have some heart disease now,” he said. “These lesions in significant arteries in the heart can cause heart attacks in the near term. So when we read in the paper about the 45-year-old who went jogging and died of a heart attack. These are the things we worry about.”
First came the sudden realization that my little girl has never been to a funeral. Then came the guilt. Because until that moment, I’d spent my 44 years choosing the most grease-laden item on every menu, while avoiding doctors at all costs and remaining willfully ignorant about my family’s health history.
But at that moment I vowed to change, convinced that this was the assignment that saved my life.
But now I’m not so sure.
In the months since, a number of doctors have informed me that my “moment of enlightenment” with Dr. Agus was a good example of bad medicine.
“When I saw that interaction, I’d say it broke my heart,” said Dr. Richard Besser, former acting head of the Centers for Disease Control and chief medical editor at ABC News. ”He may truly believe that seeing that white spot in an artery around your heart means that you could drop dead from a heart attack. But, you know, the experts in cardiology I talk to say that there’s just not the data to support that. You know, as we get older, we all get plaque forming in our hearts.”
Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, agreed.
“You have minimal calcium,” he wrote in an email after seeing my results. “In my view, performing a calcium scan on an otherwise healthy, 44-year-old man in not medically acceptable.”
After four other doctors supported these concerns, I realized I’d fallen into a raging debate over the value of full-body scans and what they are really able to find in the heart. Because of the radiation exposure and the chance a “false positive” could send a patient into a spiral of costly and potentially dangerous procedures, neither the American Heart Association nor the FDA recommends this test for people without obvious symptoms or genetic risk.
This was news I never received before taking the scan. And afterward, aside from describing mid-jog heart attacks, Dr. Agus never put my calcium score in context. A month later, I came across an article by Dr. Paul Grayburn in the New England Journal of Medicine that said a coronary-artery calcium score “below 100 indicates low risk, and a score above 300 indicates high risk.”
My score was 49.
When “The End of Illness” came out in paperback, I couldn’t help but notice that Dr. Agus had devoted much of his new foreword to my case, using me as an example of the power of preventative technology. So there was much to discuss when we sat down together for the first time since our initial encounter.
“Looking back with 10 months’ distance,” I asked Agus, “do you believe that test saved my life?”
“I believe that test put an intervention into place where you’ve changed your behavior and what you’re doing – so that there’s a good chance that it did save your life,” he replied. “We picked up heart disease that existed in a young 40-year-old. Most 40-year-olds don’t have it. You did. And so you can argue the technology and the means to do it. But we picked up something that could save your life.”
This episode demonstrates the tug-of-war within medicine, with one side determined to drive patients to the latest technology and another taking a more cautious approach until decades of data make sense of it all. Caught in the expensive and frustrating middle are countless patients who just want a straight answer.
“It is incredibly confusing, because you’re going to hear different opinions from different doctors,” Besser said. ”And basically, what people want is the truth. And the truth is a moving target.”
While Besser and others take issue with Agus’ fondness for tests and anti-inflammatory medications, he agrees with his resistance to a routine regimen of vitamins and supplements. And no doctor could ever argue with the core advice in “The End of Illness”: Eat healthy, sleep well, move throughout the day and know your family’s health history.
It took a $1,300 ride in a radioactive doughnut for me to take that common sense to heart.
The good news is, you can have it free.