How medicine, money and mindset are killing our communities

Dr Warrick presented his speech at both the TEDxUniversityofMissouri event in the USA and the TEDxDocklands event in Melbourne. It has been viewed by a global audience of almost 20,000 and recognised as top-performer by the TED franchise. Both events were held in February, prior to the COVID-19 pandemic.

Dr Bishop said he wanted to travel far and wide to highlight how the current heart attack risk assessment is failing some people, and how we can bring precision to individual risk assessment. 

“A number of years ago, a man came into my office for a heart check. Based on current assessment at the time, I gave him a 6% chance of heart attack in the next five years. In medical practice, this is considered low risk and not worthy of therapy commencement,” said Dr Bishop.

“Two years later he was dead on the side of a road, after suffering a heart attack during a fun run.”

Luckily, that man was able to be revived, with Dr Bishop offering assistance, who by chance was driving along the same road at the time.

However, Dr Bishop said it made him realise that the current heart attack assessment was not good enough and that he, as a cardiologist, needed to do better.

“What I failed to realise, and explain to my patient all those years ago, was that the 6% risk in five years actually represented the rate of heart attack for 100 men with the same characteristics as his, over a five year period,” he said.

“It does not tell us which six will have a problem. It’s like being in a choir with 100 men aged 50, and knowing that six of you will die in the next five years, but you just don’t know which six.”

So is there a way to pinpoint which six will be affected?

Yes, according to Dr Bishop.

Cardiac CT imaging allows cardiologists to look into an individual’s heart and see the health of their arteries. They can then identify high risk individuals, mitigate the risk and ultimately save lives.

It seems a simple solution so why isn’t the procedure widely available?

Dr Bishop said cardiac CT imaging lies in the perfect storm of medicine, money and mindset.

Firstly, medicine requires a scientific base in order to bring new therapies into practice. Ethical and practical considerations have blocked cardiac CT scanning from the randomised trials dictated by modern medicine. This means there is not enough of a scientific base to make it a mainstream therapy.  

Secondly, doctors, hospitals and medical clinics have to make money if they are to stay afloat, and are therefore geared towards cure, rather than prevention. Prevention literally falls in a ‘blind spot’ as it just doesn’t pay the bills.

“Doctors are paid a lot of money to cure sick people; which is good for us, not so good for patients,” said Dr Bishop.

Thirdly, the mindset of the public can be hard to change. They know what the standard procedures are and can be reluctant to try something new.

Dr Bishop said a cardiac CT scan is like a mammogram for the heart. It looks inside, literally at the health of the arteries, and indicates a high or low risk for heart disease.

“Just as with breast cancer, or a mole check, this is a simple scan that picks up abnormalities early, which will always lead to a better outcome,” said Dr Bishop.  

Heart attack kills more than nine million people globally every year and Dr Bishop believes it is time to start preventing, rather than trying to cure, this highly avoidable condition.