Saturday, July 12, 2008

Dangerous Thinking about CT Radiation!

I recently completed a web-based Continuing Medicial Education (CME) course on emerging strategies to combat heart disease. It was full of the standard fair of old school risk factor treatment and some novel approaches on increasing HDL. Pretty typical stuff not worth mentioning. But what really caught my attention was a comment left by - how can I say this nicely (why start now) - A DANGEROUS IDEOLOGUE! Here it is.

"In all of the discussions of risk factors there is an avoidance of primary causation. The Japanese A-bomb Life Span Study has linked ionizing radiation with an increase in cardiovascular events. Radiation in co-action with chemicals has been implicated in genetic effects in utero but few investigators have done studies in this area. Cardiologists should place less reliance on drug therapies and begin to focus on these primary causes."

Lynn Howard Ehrle, M. Ed., Senior Biomedical Policy Analyst, Organic Consumers Association and Cahir, 41-member International Science Oversight Board (an OCA project)"

As readers of my blog know I too am no fan of drugs and embrace prevention wholeheartedly. However, Mr. Ehrle has gone overboard in my not-so-humble opinion. My reading of his earlier literature leads me to believe commenters of his ilk are anti-radiation ideologues who can suffer no level of radiation exposure.

Does radiation, at any level, impose a risk as Mr. Ehrle implies in his published offerings impugning CT scans (e.g. heart scans)? Of course it does. But so does crossing the street or driving your car to the store. The only real question is does the risk outweigh the benefits? None of us would buy into the notion that we should stay in our homes refusing to cross a street or drive a car. Why attack CT scans in this manner? Heart disease is the number one killer of U.S. adults. If people were dropping over dead because of CT radiation induced heart disease (for which their is little direct evidence) at a similar rate as naturally induced heart disease Ehrle might have a point.

The real danger here is the spectre of old-school "cut and drug" cardiologists grasping at Ehrle's rhetoric to assail modern prevention strategies that employ CT heart scans (I am speaking here of CT calcium scoring not CT angiography which appears to be of dubious benefit at this point). Should we avoid unecessary radiation whenever possible? Absolutely! Should we continue using CT heart scans? Absolutely! It is a risk/reward decision we must all make individually. As for now, it seems imprudent to throw the baby out with the bathwater.



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