A documentary about doctors and widowmakers

[Note: A slightly modified version of this article was just published in the Feb/Mar 2016 issue of San Francisco Medicine, the magazine of the San Francisco Medical Society (MA 03/23/2016).]

An award-winning documentary entitled The Widowmaker was just released on Netflix.  It shouldn’t leave viewers indifferent, and doctors in particular are likely to be thoroughly captivated.

Cardiologists can identify the title as the nickname commonly given to a threatening plaque near the origin of the left anterior descending artery, the major of the coronary arteries of the heart.  A clot forming at that site is frequently fatal.  Since middle-aged men are more prone to heart attacks than middle-aged women, such a clot often leaves behind a widow and fatherless children, hence the name for the plaque.

Cardiologists who watch this movie will also recognize some familiar figures:  Drs. Steve Nissen, Matthew Budoff, Bruce Brundage, Martin Leon, Arthur Agaston, Shamin Sharma, Joseph Loscalzo, Julio Palmaz, Douglas Boyd, Harvey Hecht, and many other high profile clinicians, innovators, and academics are featured in a suspenseful tale of heroes and villains.

The common thread?  The history of the non-contrast cardiac CT scan, the only non-invasive test capable of reliably detecting coronary calcium, and therefore plaque, in a matter of a few minutes and at a reasonably affordable cost.  The movie shows how political shenanigans and power-plays have delayed—and perhaps derailed—the wider adoption of the scan as a clinical tool otherwise well suited for the prevention of coronary heart disease…and of widows.

The documentary takes the viewer from the San Francisco Bay Area, where the scan was invented, to Cleveland, Houston, Miami, New York City, and Boston, retracing the ups and downs in the development of this technology, and showing how it found itself pitted in a battle of influence over who controls medical opinion and who can sway the behavior of practicing physicians and patients.

Interviews of famous doctors are intertwined with poignant stories of ordinary folks (mostly wives, but also some husbands), celebrities, astronauts, and politicians, who relate their dreadful experience with heart disease and sudden coronary death.  The youngest victim remembered in the movie was 35 years old and died suddenly of unsuspected multi-vessel coronary artery disease.

While clearly building the case for the heart scan, the movie gives all key figures a fair chance to defend their position.  There are juicy quips and spats.  A memorable one-liner is given by Steve Nissen, former president of the American College of Cardiology.  Nissen, who opposed the heart scan, confidently tells the interviewer “I don’t like medical cults,” and proceeds to crack his knuckles, seemingly doing his best to impersonate Austin Powers’ Dr. Evil.

We also hear Joe Loscalzo, editor-in-chief of the prestigious cardiology journal Circulation, waxing poetic about how an elite medical journal “creates a path to enlightenment,” only to admit moments later that, in regards to the heart scan, he took the unilateral decision to block the release of an American Heart Association document endorsing its use.  His decision seemed to be based on a petty squabble over publishing rights and authority.

The movie pits the “Calcium Club,” early adopters of the heart scan, against the “Stent Cowboys,” interventional cardiologists who benefited from the financial advantage that acute care holds against preventive care.  This antagonism makes for a great script, although the storyline gets over-simplistic at times.

The personal tragedies told by victims or by surviving relatives are also very well delivered, always touching, and at times funny.  Radio and television celebrity Larry King relates his brush with cardiac death in his usual colorful manner, but many of the ordinary folks also give powerful testimonies.  I was deeply moved on several occasions.

The movie instructively reports how NASA came to its own decision on how to use the technology for the sake of its pilots and the outer space program.  The film also relates the successful efforts by the Texas legislature to compel statewide insurance reimbursement for the heart scan (a misguided move, in my opinion).  There is a surprising revelation about why insurance companies have refused to pay for heart scans, despite their compelling value in preventing costly cardiac complications.

The documentary is engrossing.  The viewer gets a behind-the-scenes look at how political the science of clinical care can be.  Although the attitude or behavior of some individual characters in the movie seems objectionable, the real villain in the story is the health care system itself, with its increasingly centralized process of decision-making which precisely enables the kind of short-sighted conduct depicted in the documentary.

The story behind the movie is also worth knowing.  One might be tempted to think that such an expensive production was funded by CT scan manufacturers, but the movie was actually conceived through the philanthropic efforts of a patient, David Bobbett, a highly successful Irish entrepreneur who owns a multinational manufacturing enterprise.

At age 50, Bobbett underwent a heart scan and was stunned to discover that he had “the arteries of an 80-year-old man.”  His entrepreneurial mind got him to wonder why this test was not more widely available, when it was so obviously valuable to him.  Bobbett inquired, discovered the unsavory reality, and decided to do something about it.  He founded Irish Heart disease Awareness, a grassroots organization promoting cardiac screening, and funded the production The Widowmaker, for which he hired Patrick Forbes, an award-winning film maker.

At the end of the movie, Matthew Budoff, a prominent member of the Calcium Club says that the saga of the heart scan illustrates the old saying about the three stages of truth: first, it is ignored, next it is ridiculed, and finally it is accepted as self-evident.  Let’s hope that the foolishness of mindlessly entrusting patient decisions to clinical guidelines designed by unaccountable technocrats will also be accepted as self-evident.

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Notes:

The documentary can found on Netflix, but is also available as pay-per-download on the movie’s website, where short clips can also be viewed.

Disclosure:  I have no financial ties to the movie or to the CT scanning industry.  I heard of the movie through a non-profit community organization, No More Broken Hearts, whose aim is to raise awareness about coronary disease screening.  No More Broken Hearts was founded by Victoria Dupuy, a widow who lost her husband Dean Dupuy in 2013.  Dupuy was a 46-year-old engineer at Apple, athletic, deemed at low risk for heart disease, and he collapsed during a hockey game from a coronary thrombosis.

I serve as medical adviser to No More Broken Hearts and have attended several community screenings of The Widowmaker.  I use the heart scan for coronary calcium scoring liberally in my practice, and I have previously advocated for its increased use in a medical journal.