"[ Crackling ]" "[ Bat cracks ]" "My whole life, I've been an athlete," "I've been a husband, I've been an attorney." "People have always relied upon me to provide for them." "On may 6, 2009, I was playing softball on a field just like the one behind me." "I sat down in the dugout in between innings." "Had no warning signs, no complaints." "I didn't feel sick or anything like that." "Next thing you know I woke up in an ambulance, somebody telling me how lucky I was." "[ Shouting and cheering ]" "What happened, I learned, is that I was sitting in the dugout, and I just passed over." "I was clinically dead for three to five minutes." "I was told I had no pulse, I was turning blue." "Fortunately, two mothers kept me sustainable by doing cpr on me, and police officers had an automated external defibrillator in their car." "It took three shocks in order to get me aroused again." "This all happened on the field, and I woke up in the ambulance and I didn't know what happened and the ambulance driver said to me, "you're a very lucky guy,"" "and I really couldn't figure out why I was so lucky." "[ Shouting and cheering ]" "Not everybody is so lucky." "Every minute of every day, somebody dies of a heart attack in America." "It's the nations biggest killer." "More frightening than that is that a huge number of the people who die drop dead without any warning they've got heart disease." "About a third of patients, the first event is a -- is sudden death." "And the reason is the disease is silent." "When I got to the hospital, they told me there were two major blockages in my left anterior descending artery." "It's called the widowmaker." "It's a 99% and a 95% blockage, and they said it was an absolute miracle that I was still there." "Two-thirds of men and half of all women, the first sign or symptom is that they have a heart attack or die." "You don't know you have it until -- until you're dead." "And it doesn't have to be that way." "Heart attacks and strokes are absolutely preventable." "The science is a slam-dunk." "Every time I read the newspaper and I see, you know, a 45-year-old or a 55-year-old or a 62-year-old person just drop dead of a heart attack unsuspectingly, you know, it's a little disheartening because I know that that life would have easily been saved." "Unfortunately, for some big businesses, making money takes precedence over saving lives." "They don't want them to die, but they don't necessarily want them to get -- to get better." "[ Telephone dialing ]" "[ Telephone ringing ]" "911, police, fire." "911, my husband's having a heart attack." "We are going to start cpr on him." "Okay, I'm going to tell you what to do." "Okay." "Okay." "Are you right next to him?" "Yeah." "Put him flat on the floor on his back," "okay." "Expose his chest." "Expose his chest." "Kneel by his side." "Okay." "Okay." "Okay, put the heel of your hand in the center of his chest right between the nipples." "Okay." "Push down firmly with only the heels of your hands, two inches." "Okay." "Do it 30 times like you're pumping the chest." "On my count, I want you to go this fast." "As fast as I'm counting." "1, 2, 3, 4, 5, 6, 7, 8, 9, 10," "11, 12, 13, 14, 15, 16, 17, 18, 19, 20," "21, 22, 23, 24, 25..." "A major heart attack lasts only minutes." "One moment, the heart is beating normally, all four chambers moving in that familiar rhythm." "Suddenly, a coronary artery blocks." "The flow of blood to the heart stops." "The heart starts to beat wildly." "There are now only moments left to save the victim's life." "26, 27, 28, 29, 30." "Start again." "1, 2, 3, 4, 5, 6, 7, 8, 9, 10..." "[ Crying] I love you." "...11, 12, 13, 14, 15, 16, 17, 18, 19, 20." "And if that attempt fails, starved of oxygen, the heart dies..." "And so does the victim." "No!" "Come on!" "Come on!" "...10, 11, 12, 13, 14, 15..." "Come on!" "...16, 17, 18, 19..." "[ Crying ]" "...20, 21, 22, 23, 24..." "Come on!" "...25, 26, 27, 28, 29, 30." "He's gone." "Okay, start again." "1, 2, 3..." "I love you." "I love you." "Come on." "...6, 7, 8, 9, 10..." "This year alone, 600,000 Americans will die like this, more than from all the cancers combined, a quarter of these deaths without any prior symptoms or warning." "We had spent the 4th of July at our home here in east elmhurst and we had a nice family barbecue and we were hanging out, and you wouldn't think anything, it's just any normal day." "The next morning, my husband -- we have a home in fort lauderdale -- went to our summer home, and he called me when he arrived and he said "I arrived, everything's okay,"" "and I carried along my merry way to work." "I was in a meeting, and my phone kept ringing, but I ignored it." "I continued along in the meeting because you cannot answer the phone in a meeting, but then my son's number, his cellphone number, showed up on my phone, so I answered that call." "And my son told me that he received a call and that something had happened to dad." "At that point, my phone rang again, and it was the police calling, and they told me that they rushed my husband to the hospital." "Next thing I know, calls were made, and I was on board an aircraft, so I can get there." "And, um..." "That plane just never took off because just as they were about to close the doors," "I got another phone call." "The person on the other end said to me, "are you alone?"" "And I said, 'no, I'm on a plane full of people." "I am not alone."" "And they said, "you know, we're calling about your husband."" "I said, "I know, tell him I'm on my way, I'm coming."" "And they said, "no, no one told you." "He's gone."" "At that point, everything was a blur, and I got off the aircraft." "It was something I couldn't believe because there were no symptoms." "We had just spoke, and within a couple of hours, my whole life changed." "Sorry." "Alpha was slim, 6'3", occasional social smoker, but he wasn't like packs a day, and he was just healthy." "I felt like I was still walking in a -- it was a nightmare." "I mean, I thought, "this can't be happening." "Is this really real?"" "That particular day, the 4th of July, was just the best time of our life." "I mean, we just had a great time." "And the next day, that..." "It was just a memory." "In the last 30 years, more than 4 million American citizens have shared Alpha's fate, dying suddenly without any warning." "But the vast majority of them, men and women, could have been saved." "Here's how." "[ Film projector clicking ]" "The trail starts here in San Francisco." "[ Guitar playing ]" "Down the decades, the city by the bay has been home to a series of world-famous events -- a gold rush, an earthquake, a computer revolution, and wholly new ways of seeing the world." "But the city might have a more fundamental legacy, a way of stopping all those needless deaths." "In the '60s and '70s, heart doctors, or cardiologists, are grappling with not one, but two problems." "[ Telephone rings ]" "Life's full of stress, especially for busy executives." "You're kidding." "The whole shipment -- you're sending it back?" "!" "[ Breathing heavily ]" "Mr." "Elliot!" "[ Siren walls ]" "People are dying suddenly of a heart attack before they can get to the hospital." "But they're also dying if they do make it to the operating table because heart surgery is largely ineffective." "So surgeons, naturally, want to make surgery work." "And one man thinks he knows how." "The first heart revolution starts not in a lab, but a garage 40 Miles north of the city center." "So how long is it since you've been here?" "33 years." "33 years." "And this tree obviously, I don't remember, but this is also much larger, everything, yeah." "And that's my garage." "[ Laughs ]" "In 1980, julio palmaz is a junior radiologist, fresh off the plane from Argentina." "Well, I had my cars here, and my -- my workbench was right here." "Yeah." "I had a Ford Capri which was parked there, and I had my triumph spitfire, my baby, parked right here." "It was so small, so I had a place for my bench." "After dinner I would come and start playing with wires, pliers, rubber tubes, and all those things." "Julio is fascinated by arterial blood flow and its relation to heart disease." "It was the number-one killer when I was in medical school, and it still is today the number-one killer." "So it is a gigantic problem." "Julio sees it as a problem he can solve." "The key is plaque, a sticky, gooey substance largely made up of cholesterol." "It builds up in the walls of the coronary arteries, until one day it ruptures, causes a blood clot which blocks the vein, and stops the flow of blood to the heart, triggering an attack." "Cardiologists are trying to thread balloons down arteries, blow them up, and crush the clot." "But once the balloons are gone, the arteries close up again, what doctors call "restenosis,"" "and the patients die." "Julio has a simple idea -- stick a piece of metal on the balloon, a sort of scaffold, to keep the vein open when the balloon is pulled out." "It's called a stent." "The inspiration is unlikely." "Somebody came to the house and did some repair, or modification, of a wall and left a piece of expanded metal, which I dragged into the garage." "And it was sitting right there, in that corner, right next to my bench, and when I was tinkering with the stent and trying to saw the wires, that I looked at the wire mesh and I said, "why to solder?"" "I put it on my vice." "I had a vice in this corner." "And..." "I bent it together, so in other words, I closed the mesh and realized that the diamonds, the staggered diamonds, became staggered slots." "And I said, "if I make a tube, and I put..." "Staggered slots," ""then I blow it up with a balloon," "I end up with the same product as a wire mesh."" "Then eventually I had to do the real thing." "The early days of stenting, it was a pioneering experience." "Having met julio palmaz, and he came up with this slightly crazy idea, and I was working in experimental laboratories, and I offered to work with him to try to collaborate to understand what the vascular response would be" "to a metal prosthesis in animals." "And -- and that was the beginning." "But the first results of julio's invention are disastrous." "The atmosphere was marginally chaotic." "We didn't have the right equipment." "The devices were prototypes at best." "They were hand-crimped on balloons." "They were difficult to deliver to coronary arteries." "They were associated with a high frequency of blood clots, or thrombosis, in the early stages." "And the outcomes were not nearly as good as we had expected." "There was a lot of uncertainty within the medical community that this was the right thing to do." "We were heavily criticized for being cowboys, for being less critical thinkers, for being nonscientific." "So there was an overwhelming negative outcry within the general medical and cardiologic communities." "While the stent is in trouble, there's a very high-profile reminder of what's at stake." "Well, that night on the 23rd," "I was doing my CNN show -- interviewed Dr. c." "Everett koop, the surgeon general of the United States." "At the end of the interview, he asked me if I was still smoking." "I said "yes."" "And he said, "you know, you don't look good."" "I said, "I feel fine."" "He said, "I don't like the way you look." "You ought to see a doctor."" "So I said, "okay,"" "and then I went to my all-night radio show, and my guest was David halberstam, the late David halberstam -- terrific writer." "And at the end of that interview, he said," ""are you feeling okay?"" "I said, "why?" He said, "you don't look good."" "Apparently, I had a gray pallor." "So I went back home and I got off the air." "It was about 4:00 in the morning, and I had this terrible pain in my right shoulder." "I'd never experienced that kind of pain before." "I didn't have chest pain, and it was going down my arm." "And I didn't know what to do." "I called my doctor and woke him up, and he said," ""well, right side -- sounds like a gallbladder." "Why don't you go to the hospital in the morning."" "So, first thing in the morning, my producer picked me up and drove me over to George Washington university hospital." "So, I walked into the emergency room." "This man came up to me." "They have viewers in the emergency room who look at people to see how..." "And he said, "are you a heart patient?"" "And I said "no."" "And he said, "well, you don't look good."" "And that's the third time I've heard "you don't look good."" "And they came over to do some blood tests, and then they went over to a screen and they were looking at this screen and this blood test came up on this screen." "Suddenly, they turned around, the doctor and the nurses, blue light went off, and they came running towards me." "And I said to my producer," ""I don't think this is a pulled muscle."" "The doctor came right over and said," ""Mr. king, you're having a heart attack."" "And I said, "am I going to die?"" "And he said, "good question,"" "and he said, "we don't have the answer," ""but it's the right side, and that's a good sign because right sides generally do better than the left side."" "Heart-attack pain is very unusual in that, one, it doesn't go away." "It's excruciatingly hard to explain." "You just feel like someone is " "I didn't have it in my chest." "Like someone is pressing fiercely against your shoulder and won't let up." "It's like no pain you've ever felt." "I wound up with a quintuple bypass." "That was much scarier than a heart attack." "When the doctor explained to me," ""we're going to cut open your chest..."" "Oh!" "That's nice." ""And we're going to pull you apart" ""and put you on a heart/lung machine" ""and move the heart a little and do a bypass," ""which is similar to a highway with a blocked exit," ""and we're going to go around the exit." ""We'll take veins from your leg," ""and the veins will circulate around, and we hope you do well."" "I changed my life that day." "I never felt better after that." "I recovered pretty quickly." "I came home from the hospital, vowed to get healthy." "Lost a lot of weight." "Changed my diet, never smoked again." "My wife believes in the afterlife." "I don't " " I don't want to ride the bet." "[ Laughs ]" "Back in the bay area, at exactly the same time julio is dreaming up his stent, other doctors come up with a way of winning Larry's bet." "Right in the heart of haight-ashbury, the epicenter of flower power, stands the university of San Francisco, or ucsf." "The team here don't want to wait until somebody has a heart attack and rely on expensive and risky surgery to save them." "They want to prevent the attack happening at all." "Why wouldn't it make sense if we set up like we do mammograms for screening for breast cancer, why don't we do mammograms of the heart?" "There's a problem with a mammogram of the heart." "It beats too fast for a conventional X-ray to take a picture." "So Bruce travels three floors down to an eccentric but talented physicist, who has thought up a way of improving the existing technology." "The essence was, rather than rotating mechanically an X-ray tube around the body -- and that is how C.T. technology works -- to use a scanning electron beam to produce a moving source of x-rays." "These are the constituent parts of Doug Boyd's revolutionary machine, still stored in a small office in the bay." "People were skeptical." "Most people couldn't even understand the concept." "The..." "Goes in, so we're over telling you that "it couldn't be done."" "It couldn't be done." "And one day he said to me," ""Bruce, would you like to see something really neat?"" "And you invited me down to see you turn on the electron beam down there." "Oh, down in the basement of the hospital." "There was dirt on the floor." "It wasn't even a concrete floor." "Yeah." "Yeah." "Remember when we got the first beam, that was a big moment, at least for a physicist." "Well, it was considered pretty far out at the time." "No one had ever been able to produce an electron beam with that much power." "Incredibly, down in the dirt of ucsf's basement," "Doug's ray gun works." "You just put your head there and your feet down here, and then it slides the patient into the scanner." "And then an image that nobody has ever seen before..." "So, these are the coronary arteries here." "In the beginning," "I think everybody was extremely interested, and everybody would say," ""well, what's that white stuff that I see there?"" "And I say, 'well, that's calcium in the coronary arteries."" "Calcium, a crucial ingredient in our bones, and just what you don't want in your heart." "The calcium's actually part of the healing process." "When we develop deposits of cholesterol in the wall of the artery, one of the body's natural defense mechanisms is to put down calcium to try to heal this sort of bubble." "So, in and of itself, it doesn't cause the disease." "What it does, though, is it doesn't occur there unless there is plaque there." "Before the advent of Doug's ray gun, doctors had to use a complicated formula dreamt up at Harvard in the '50s to work out somebody's risk of heart attack." "Adding together weight, age, lifestyle, cholesterol, and then guess." "You can have all the risk factors and not have any coronary disease." "You could have none of the risk factors and have coronary disease." "But if you have a coronary scan, and you see calcium, you know you have disease." "It's not a risk factor." "It is looking at the disease, part of the disease process." "Very exciting." "Very exciting." "You know, the number-one killer today is heart, and number-one killer in 1940 was tuberculosis, and that was completely eliminated by X-ray screening of the chest, the famous chest film." "So, to me, being a poor physicist, it was the same." ""Let's get rid of heart disease" ""because heart attacks are completely preventable," ""so let's find out who is on the road to having a heart attack, screen them, and eliminate it."" "The new technique can pick out the patients that conventional risk analysis cannot -- thin, fit and outwardly healthy, and that's a lot of people." "In the four years after coronary artery scanning is invented, over half a million people die of a heart attack with absolutely no warning." "Thank you so much." "[ Cheers and applause ]" "California has a governor going places " " Pete Wilson." "Some talk of him as a potential president." "His key aide is Otto boss, an energetic press liaison in his mid-40s." "He was somebody important." "I do remember that." "Everybody knew him, and he was the guy behind the guy." "So if you wanted to talk to Pete, everybody knew basically you had to go through Otto." "So, it was pretty cool." "So, everybody knew me as Otto's kid, and of course, I was his first-born, so everybody treated me like a rock star." "So, trust me, it was a great life, and everybody's going," ""oh, that's Otto's kid." "Be nice to him."" "June 2nd was -- oh, gosh, it's like -- it's like yesterday." "We were actually playing baseball out here on the front street, and my mother was inside here with our neighbor, and I was called in by our neighbor," ""hey can you please come in and talk to your mom?"" "And I was a 15-year-old kid, so I was like," ""yeah, yeah, I'll come in when I want to come in."" "Then she came back out, and she was like," ""no, seriously you need to come talk to your mother now."" "She was sitting on the corner of the bed, and she basically just said that my dad had a heart attack, and he was at the hospital." "I was thinking, "okay, he had a heart attack, he'll be fine,"" "because basically in my eyes my dad was like superman, and, you know, nothing ever could really do anything to him." "We went to that hospital, and then when we got there, a doctor pulled my mother aside, and they kept going in and out, in and out, in and out." "And then my mom came out and she was very, very tearful." "I knew something was really bad because I kept going," ""when are we gonna see my dad?"" "And then long story short, the doctor sat down in front of me, about where you are, and just told me that my father had passed, and this is what had happened, and I was a little confused, one, why he was telling me" "and not my mother, but..." "They say his arteries were clogged." "He looked young." "You would have never guessed that he was 47." "He had a rocking tan because he was always playing soccer." "There was no indication that he was going to have the type of heart failure that he had." "I don't know if it's good, but I grew up fairly quickly, so I'm 15 years old, I turn 16, I'm basically an adult." "I'm no longer the kid that goes out with his friends and goes and parties and drinks and does " "I don't do any of that stuff." "I had to be a role model for my younger brother and sister and not get myself in trouble and try to be dad for them, and you know, coach little league, which I did, and take my sister to ballet and my brother to basketball." "And do all the stuff that a dad would do." "A lot of my friends like to hang out, but I really don't, just because my head's not there." "I spent more time here making sure she was good and my brother and sister were good." "And so that was basically my life for, oh, gosh, until my mid-20s." "And what about your mom?" "Um, she's okay." "I mean, you know, she's never gone on another date." "She is " " I don't think she has even ever talked to anybody about going out on another date." "I think we've told her to go out on another date, but she won't." "And if you bring it up to her now, she still will break out in tears and get very emotional." "It definitely -- it definitely messes with you a lot." "My advice to any person that's here on the planet -- just enjoy it for what it is, enjoy the ride, because you just never know." "Late '80s Florida, and the action shifts to Miami..." "Home to gianni versace, the body beautiful, Miami vice, and a soaring rate of sudden heart attacks, to the despair of one local resident." "In America and around the world, coronary disease is the number-one killer, and this is a completely preventable disease." "Arthur agatston is one of America's most famous doctors, author of the million-selling "South beach diet."" "He's also a cardiologist." "In the '80s, sinai got a new scanner, developed by Doug Boyd, and we were amazed at the images." "He loves the calcium scan, and he fixes its one remaining flaw -- by devising a way that the calcium in your body can be measured." "I called Warren janowitz, who was my radiology colleague." "Anyone who walked through was in danger of getting scanned that day." "We gave points to the density and the volume of the lesions." "The new calcium, or agatston's, score is a breakthrough." "A group of pioneering doctors leap on it and even call themselves the calcium club." "It was like "the breakfast club" -- you know, the movie about the teenagers in high school." "This was the calcium club." "Was it as much fun?" "Um..." "No. [ Chuckles ]" "It was not as much fun." "But it was much more productive ultimately." "Breathe in." "Hold your breath." "The scores go zero." "It can go as high as 4,000, 5,000." "So I call it zero, mild, moderate, extensive, and oh, my God." "Breathe in." "Hold your breath." ""Zero" is the best I can do for you." "One to 100 is called mild." "101 to 399 or 400 is considered moderate." "400 to 1,000 is considered extensive." "And above 1,000 is in the "oh, my God" category." "It was a new concept at the time." "Looking for plaque was a very new, novel idea, but as a young impressionable person, I thought it was great." "Here's the beginning of the left main coronary artery, very normal." "As we go to the next slice, though, we see plaque right here." "Every time we try to redo the experiments, we get the same answers." "It's just remarkable." "The more plaque you had, the more your risk was going to be." "It was independent of your cholesterol, independent of your smoking history, independent of virtually anything." "It was the most powerful predictor of risk." "It looks like the coronary artery scan is about to transform the hearts and lives of the nation." "This mammogram of the heart was going to be a screening test that people -- men after 45, women after 55 years old -- would get a scan, and if they had plaque, we would dive in and start treating them," "and if they were clean, then we could concentrate on other things and stay with lifestyle and diet." "What are your alternatives?" "You say to a person, "well, you're at low risk, and then if the patient dies, "oh, I was wrong." "Sorry."" "Why guess?" "Why base your decision on a score derived from a compilation of risk factors, when you can look directly at the heart and see how much plaque there is there?" "As the unexpected deaths pile up, the way forward seems clear in the battle of the stent and the scan." "The scan helps prevent heart attacks and costs only a few hundred bucks." "The stent is risky, expensive at tens of thousands of dollars, and the patient has to either have or be on the brink of having a heart attack." "But that analysis neglects the profit motive, which first attracted julio palmaz's backer, burger billionaire Phil Romano." "He came in and he had a ponytail and he had his 3-piece suit and a nice tie and well-groomed person, and had no socks." "I mean, he was a very fashionable guy." "Certainly not a person that knew anything, really, about the business of implantable devices, but intuitively, he saw potential." "At the end of a meeting, he said -- he put the thing in his hand and he was rolling it around and he said, "this looks like something I can put in a box and sell for lots of money."" "And to the dismay of his lawyer, he went ahead and said, "how much money you need?"" "1994 and money talks." "Now we're in New York, home to the world's financial center and some of its most renowned hospitals, who share wall street's moneymaking smarts." "These hospitals can make or break a technique or pill, so, stent or scan -- which is it going to be?" "With Phil Romano's money behind it, the stent is suddenly a reliable proposition, and in record time, it gets an official license." "The devices became much more deliverable, and from a technical standpoint, there were dramatic improvements, but by the late '90s, the paradigm for treating patients with coronary disease was literally just stent it." "Hospitals love the newfound certainty of the stent." "They can't do anything about people dying before they reach the hospital, but suddenly they can stop them passing on the premises." "One of the first places to "stent it"" "is mount sinai, halfway up Manhattan's Tony Upper East Side." "Samin Sharma, their star surgeon, changes his modus operandi overnight." "I did about 1,000 cases first time in 1999." "Now since then, over, let's say, the last 10 years, it has been about 1,500 to 1,600 interventions per year." "I work 3 1/2 days a week, Monday, Tuesday, and Fridays." "Like today -- today is a Friday, a typical day." "I'm to my 21st case, and I've done the 12 interventions, but I have 9 more to go." "All right, my friend, we'll be done in just a few seconds now." "What shaming Sharma is doing, again and again, is threading catheters, or thin tubes, up arteries to first take a picture of any blockage -- that's an angiogram -- and then gently maneuver a stent in place" "at the point of blockage or stenosis, open it up, and restore the blood flow." "Right there, this was a 95% blockage, and now after a stent, normal-looking artery." "All right, my friend, we are done now." "Thank you." "Crucially, this operation has a financial, as well as a medical, attraction for hospitals." "At up to 50,000 bucks a go, the profits associated with it are huge." "These cramped cath labs actually saved mount sinai from bankruptcy in the late '90s." "And as the money floods into stents, so the doctors who practice the technique become very rich." "Dr. Sharma earns over $3 million a year." "I think part of the success is also that you do the same thing all the time, repeatedly." "You don't get bored?" "If I get bored, I do a few more stents." "[ Chuckles ]" "If he is getting rich, the stent's inventor is getting even richer." "Things went well for us." "My wife said why not get a little place in napa valley and make some wine?" "It got a little bit out of hand, and so she did find a bigger place that we anticipated, and and we got into more than just making wine for us." "We make about somewhere between 5,000 and 6,000 cases a year." "The success of the stent propels the man who first tests it," "Marty Leon, into cardiac stardom." "He becomes one of the richest doctors in the U.S., earning millions in his hospital work and millions more as a key adviser to big companies." "He even starts his own foundation." "You know, it's hard to say what is in whack and out of whack." "Is an orthopedic surgeon out of whack?" "Is a neurosurgeon out of whack?" "Is a cardiac surgeon out of whack?" "Is an interventionist out of whack?" "I-I mean, these become philosophical discussions about..." "You know, how medicine is practiced." "In a fee-for-service environment," "I think there is certainly going to be high-end physicians who make a great deal of money, and that's fine." "But for all the stent's apparent success, financial and medical, it still does nothing for those people who die before they can get to a hospital." "By the mid '90s, the cumulative total of asymptomatic deaths has risen to a staggering two million." "What is the address of the emergency?" "I need an ambulance quick." "What's the address?" "We were just sitting talking, and my wife fell on the floor." "Okay, what's - quick." "I don't think she's breathing." "Okay, I'm sending paramedics to help you now." "Stay on the line." "I'll tell you exactly what to do next, okay?" "Yeah." "Kneel next to her and look in her mouth for food or vomit." "No, there's no food." "Okay, nothing in her mouth." "I want you to place your hand on her forehead, your other hand under her neck, and tilt her head back." "Yeah." "Put your ear next to her mouth and tell me if you can feel or hear any breathing." "Okay, hang on." "Okay." "No, I can't." "Oh, God almighty." "Hurry!" "Okay, they're on their way." "You're doing fine." "For these people, the scan offers the only hope." "But the medical establishment shun it." "The nation's top doctors pour scorn on the claims the calcium club make for their new technique, most vociferously, the one man they expect to support it," "Steve nissen, the most prominent preventionist in the U.S., based at the world-famous Cleveland clinic." "Well, I'm not a fan of it." "To date, no one's been able to show that knowing how much calcium is in the arteries actually allows you to change the outcome for patients." "So, it tells you who is at risk, but it doesn't tell you what to do for them." "I would say that there are some people who still believe the world is flat." "But clearly it's not." "We know that it identifies high-risk patients." "We know that treating high-risk patients saves lives." "Therefore identification of the high-risk patient will save lives." "Look, I don't like medical cults, and these things happen all the time." "You know, these cults develop, and when they're not based upon what I consider to be the most solid science, then it does bother me." "The kind of outcome data that they are asking for has not been provided for any other technology." "For instance, there has never been a study that shows that the use of a stress test saves lives, or the use of an echocardiogram saves lives." "I call it the deadly double standard, which means applying criteria to coronary calcium that have simply not been applied to any other preceding technology." "But this was an argument that was as much about money as medicine." "Cardiologists thought the scanner was an expensive waste of time, while the calcium club argued they could save hospitals money by predicting who really needed surgery." "During the late 1990s, the Mayo clinic was reporting about 50% of its coronary angiograms were normal." "That's the equivalent to saying "unnecessary."" "The Mayo clinic is still a major research center with excellent researchers, the best in the world." "And the Mayo clinic had done some research studies showing that coronary calcium could predict who needs a coronary angiogram and who doesn't." "So, the researcher said, "well, we have this test" ""with almost a 100% accuracy" ""for predicting who should have an angiogram" ""and who shouldn't." "Why don't we offer this to our patients?"" "And the administration shut it down because the cath lab generates 25% of the revenue for the Mayo clinic, and that would have been cut in half if they started not doing unnecessary angiograms." "With money and medicine against them, the calcium club get desperate and do something dumb." "They try to defy their opponents and reach out to the man and woman in the street by advertising." "There was a period of time when, in Southern California, there were billboards that were put up that said," ""buy your husband or your wife a calcium scan for Valentine's day."" "Perfectly healthy people were being encouraged to get these tests for payment, and that's not my idea of the way medicine should be practiced." "It's a disaster, enraging their opponents and alienating their last supporters." "Well, I gave a presentation in Chicago." "Chicago, at the time, had advertising going on, on the radio, in the newspapers, and I presented our data, which at that time was probably close to 2,000 patients." "The data was, I thought, excellent, but nobody really cared about the data or the science behind it." "Everybody was more or less incensed about the advertising, so I kind of almost got booted off the stage." "Scanning is booted off the stage too, into the wilderness." "The authorities won't endorse it, so insurers won't pay for it." "Very few doctors will use it." "But all the while, people are dying without any warning -- by the late '90s, over 2 1/2 million unexpected, unanticipated deaths." "Steve was a..." "Warm -- the warmest -- guy, friendly, caring, easygoing, good-natured." "You know, he would just have..." "He has the patience and the heart of gold to listen to people and care about them, and..." "He was full of empathy." "When we met, I was 20." "He was 23." "He had his own clothing store, active clothing wear store, and I had to come in to get my matching headband for my aerobics outfit." "[ Chuckles ]" "And he did not have the color I needed, so I came back, and we hit it off." "Four days prior, we had just gotten back from Cancun, Mexico." "We were there for a week." "We had a relaxing time, you know, just a fun getaway, just he and I, no kids." "Our daughters were two and five, so it was nice to get away from the kids." "He came home from work about 6:00 that night, rushing to get out." "It was his first league basketball game of the year, so he put on his Jersey, and rushing..." "He gave me a kiss goodbye, and..." "That was at about 6:30 at night." "At 10:00 that night is when I got the phone call from the manager at the gym that said," ""your husband's had an accident."" "So I said, "oh, what happened now?"" "Thinking he just, you know, broke his ankle or sprained something." "And he said, "well, his heart stopped, and they can't start it."" "You know, it's surreal driving to a hospital not knowing if your spouse is going to be..." "Alive or not or in a vegetative state or not." "And, you know, you make like..." "You're making deals with, you know -- with God, like..." "I said, "I want him to be alive, but I want him to be healthy." ""I don't want him to be a vegetable." "That wouldn't be any kind of quality of life for either of us."" "Sure enough, I got to the hospital, ran in, and the emergency-room doctor told me that they could not resuscitate him." "And he was dead." "And I asked to see him." "He was, like, still sweaty from playing basketball and still tanned from Cancun, and..." "Yeah." "He just..." "You know, it was like a joke." "I said, "okay, I'm here." "Joke's over, you can wake up."" "And no, he didn't wake up." "[ Chuckles ]" "Steve ate well, he did not smoke, and he worked out." "So who knew he was actually carrying around four clogged arteries." "...7, 6, 5, 4, 3, 2, 1, zero, and liftoff!" "Like Steve Cohen," "NASA's astronauts are outwardly extremely fit and health-conscious." "For just when it looked like coronary artery scanning was dead, salvation in the most unlikely place -- space." "We've long known that cardiovascular disease is the greatest risk that we face." "Especially given our population, most astronauts are middle-aged males." "The consequences for us are dire." "We're talking about people dying in space." "The agency had had a real scare in 1971 with Apollo 15." "Oh, boy, it's beautiful out here!" "At the time, NASA hailed it as the most successful mission so far." "Looks like pristine material, all right." "On the surface of the moon, commander David Scott and lunar module pilot Jim irwin did three moonwalks, collected a vast array of moon rocks, and drove a lunar rover for the first time." "This is really a rock-and-roller ride, isn't it?" "But out of sight of the cameras, once irwin was back in the command module, instruments appear to show all the symptoms of a serious cardiac event." "After anguished debate, mission control realized that breathing the oxygen of endeavor's cabin and living in zero gravity, irwin might as well be in a hospital intensive-care unit." "Then on August 7th, they looked into the fireball created by the heat of their re-entry into the earth's atmosphere at 25,000 Miles per hour." "The mission made it back safely..." "[ Cheers and applause ] ...but a few months after he landed," "Jim irwin had a massive heart attack." "We became aware of coronary calcium scoring probably in the early 2000s." "There were a number of us who were interested in improving our risk predictions." "But they are beaten back by the top doctors who counsel NASA." "Some of the best cardiologists advised against it." "They thought that it had no value." "But it isn't only astronauts who are at risk from pressure and stress." "We're here outside New York presbyterian hospital." "In just a couple of hours, president Bill Clinton, former president, is scheduled to undergo surgery to bypass diseased vessels in his heart." "In 2004, former president Clinton checks himself into hospital with chest pain, only to discover he has chronic heart disease and needs an immediate quintuple bypass." "But many people are asking, how could a former president who gets regular checkups end up so suddenly with heart disease?" "Clinton bragged last night that he had aced his stress test for four or five years in a row." "I just had the pleasure of meeting past president Clinton last Thursday, and he told this story about how he went through five treadmills while in office." "He was cleared five times, told he was doing great." "They stopped his cholesterol medication." "He actually told me he had a calcium scan that was abnormal, but his doctors didn't really do anything with it, and ultimately he needed a five-way bypass." "He did very well initially on the South beach diet, went back to his high-school weight, did a lot of exercise, was on a statin." "And he stopped the statin, is my understanding, because he lost weight, but he clearly, for the amount of calcium he had at a fairly young age, there was a genetic component, and genetic components," "you have to go beyond, often, lifestyle, and treat with medication." "And I think had he stayed on medication, it would have prevented any future events." "Such is the shock of Clinton's operation, the white house decides that all future presidents will have a coronary artery calcium scan." "The stakes are simply too high not to." "So, is scanning on the comeback trail?" "Maybe." "At exactly the moment" "Clinton's life is hanging in the balance, so too is the fate of coronary artery scanning." "The setting is Boston, or more accurately, Cambridge, just across the Charles river, home to the world's most famous university." "In fall 2004, scanning is on the verge of qualified national approval right here." "A committee of the American heart association has passed it, and their findings are about to be published as a statement in circulation, the house journal of cardiologists worldwide." "I like to think that circulation, in all high-quality journals, provide, if you will, a path to enlightenment." "If you consider our workplace, we sit in a sort of forest of knowledge, and we want to achieve enlightenment." "So the question is, how do we traverse the forest?" "And I would suggest that what a well-edited journal does is that it provides some guidance to the right path." "But unfortunately, one member of the calcium club can't contain his excitement that his technique is about to win through." "We had a statement coming out." "It was approved by the American heart association, a scientific statement saying that calcium scoring was useful and appropriate and had adequate scientific data behind it." "Well, I'd just become editor of circulation." "I was surprised and troubled to find as I was flying to Europe for a meeting, reading the wall street journal, that I was quoted as the editor, as having pointed out that the American heart association" "was about to support the use of coronary calcium." "The American heart association, and certainly the journal circulation, never advocates the use of a particular strategy for diagnosis or for therapy." "We try to report information as we find it as objectively as possible." "When I returned home," "I also found an envelope addressed to me in which it was pointed out that the American heart association was about to support the use of coronary calcium screening, and that as a cardiologist," "I might wish to..." "Purchase a device." "Given those events, I decided to withhold publication." "I actually was driving down to San Diego, and I got a phone call from him telling me that he was pulling the whole statement after it was already approved and in press." "I was caught off guard by this first challenge to my editorship." "And second, the embargo was broken as a consequence of their premature publication." "So both of those issues, I found very upsetting." "He wrote that we violated the spirit of the embargo, which, up until that point, there was no such thing, and if you did a search on it, there was no such language to that effect," "and there was no embargo on the document." "The previous document, which was very negative, the first author of that, Dr. o'Rourke, did three formal interviews before the document ever came out." "I make one offhanded comment to wall street journal, and they use it as an excuse to pull the whole document." "So it really was, again, just obviously politics and bad personal decisions." "It was challenging because it forced me to make a decision that I knew would have some at least short-term consequences for the community that was most affected by it, namely, the folks interested in imaging." "Joe loscalzo's decision leaves scanning still in the wilderness and the stent completely dominant as the main means of treating heart disease, even though the unexpected deaths are still piling up -- by the end of the year, well over 3 million." "Then over at NASA, something happens..." "Again." "We had a couple of individuals who were involved in our various flight operations and had acute coronary syndrome events." "One of the individuals was one of our pilots, and then one of our international partners had an acute coronary syndrome event on the ground prior to a mission, in both those cases, we got lucky." "But we can point to them and say," ""look, here is what happened, and this highlights why our current paradigm is letting us down."" "The evidence defeats the skepticism of NASA's outside advisers." "When the chips are down, the scan wins." "From 2006 on, all potential astronauts have to have a zero score or they don't get in." "All existing astronauts are to be scanned, too, and allowed a small amount of calcium." "Colonel Gregory Johnson is a NASA star, pilot on two shuttle missions, and before that, usaf's top test flyer." "I love to fly." "I love being an astronaut." "It's like a wonderland, Alice in wonderland -- you walk through the looking glass, and you're in this environment that is unreal, and you return from it, and it's like it was a dream." "Both times -- even now I think about what it was like when I was in space, and it was a dream." "Everybody wants to go back." "Today Greg's going to find out whether he can go back." "He's about to have his calcium scan." "On one hand, I want to know exactly what's going on in my body." "But on the other hand, it's the old dilemma between the fighter pilot who wants to stay flying and what the doctors can discover." "Breathe in and hold your breath." "Breathe." "That's it." "There's a telltale white flash." "Colonel Johnson has a small amount of calcium in his heart." "I really, really want to fly airplanes, and I really, really want to fly in space, but even more I really, really want to live, so..." "I hate to tell you, but 10 out of 10 people die of something." "[ Laughs ]" "Greg could go back to space, though NASA doctors feel there is a risk of a coronary incident which might rule him out of any future mission." "Then he gets a tempting earthbound job offer and decides to resign." "This is his penultimate flight." "I'm going to really miss it." "I've been flying for 28 years." "It's been my life." "There's only been about a 9-month stretch in my entire last 28 years that I haven't been current in some sort of jet, so it's been -- it will be a real change for me." "I'll have to figure out how to get some flying on the side," "I think, but it's been a way of life." "So, scanning has a beachhead in space, but can it turn the tide back on earth?" "Well, astronauts and earthlings aren't so different." "Well, the family history has always been horrible." "It goes back a few generations." "I have the disease, and it's extremely aggressive." "My body cannot synthesize the good cholesterol you need or rid itself of the bad cholesterol." "My first open-heart surgery was at the age of 38, and my second one would have been about 51." "René has a double bypass in 2007, which saves his life." "The surgery's prompted by a scan which shows a 90% blockage in one artery." "After two conventional tests, an EKG, and a stress test had said he was completely fit." "I have a very low opinion of an EKG." "I've had two ekgs that were..." "Absolutely told me I was fine when I wasn't, when I was, in fact, very near death." "So, to me, I tell people, "if you're going to rely on EKG, you might as well just flip a coin."" "Sophistication now with cat scans and getting the calcium scoring and these other things is just really critical." "Five weeks after his surgery, rené starts a crusade." "He's a Texas senator." "[ Gavel bangs ]" "[ Speaker's voice echoes ]" "Our Texas constitution says we get sworn in at noon." "Dead-up 12:00 noon like a cowboy movie." "And I wanted to send a message out there." "He drafts a bill that will force insurers to pay for the screening of all texan men over 45 and all women over 55." "It's really hard to rock the foundation of the insurance industry and even public opinion on a lot of things." "But I felt the only way was to mandate these tests." "I was facing very powerful business interests, a divided medical community, insurance companies, and those are probably the three most powerful groups except for maybe some oil and gas people in Texas." "Mr. speaker, members, can I get your attention?" "Please for just a second everybody?" "He's also taking on America's number-one heart doctor." "Steve nissen is just finishing his term as President of the American college of cardiology." "Yeah, there were some questionable characters that were trying to promote this, and of course, you know, Texas, while it is part of the United States, seems to operate with somewhat different character than some parts of the country" "and..." "Almost anything goes in Texas." "And I was certainly not in favor of that." "Doctors came up to me saying," ""this is just a bill to help a couple of vendors out."" "I said, "no, doc, let me tell you my story" ""and why I believe in this." ""It saved my life, and if it saved mine, it can save others."" "You called them shameless self-promoters." "Yeah, I think I probably used a term like that." "I've not been known to mince words when it comes to that sort of approach to medicine." "They may have thought it was best, but certainly had other motives, as well." "Any tool that helps us detect it is worth it, particularly as inexpensive as this test is." "All those in favor, say "aye," all those opposed, "nay."" "Ayes have it." "House bill 1290 is passed." "After two years of furious debate, victory." "René oliveira's bill passes in both Texas houses to the intense and enduring disbelief of its opponents." "Having passionate true believers does not make a test worthwhile." "And so I would say that the test has actually been a huge failure." "Well, um, he's an idiot, and he's probably still in dinosaur times in terms of his thinking." "As long as he stays in Cleveland, that's good because we don't need his opinions in Texas, because I know what I did has saved a lot of lives, and I'm proud of that." "[ Singing in Spanish ]" "But in a tragic irony, one of the men you'd expect to have the test doesn't -- rené's brother Tony." "Well, just a few weeks ago, my youngest brother, who I call my baby brother, died of a massive heart attack, leaving a young widow and leaving children." "That night, he told his wife he was feeling a little heartburn, so he took some alka-seltzer and then some other over-the-counter stomach remedy, and he died within a few minutes." "It was very hard because when my father died of a heart attack," "I had to be part of raising him." "So he was my baby brother, but he was also almost like a son, and best friends." "I can't take his phone number off of my cellphone." "I don't think I ever will." "You know, there's times when I feel I can still call him and ask him to help me with something." "And -- and -- and he's gone." "And he should have known better." "I loved him." "I miss him." "And if I talk too much about it," "I'm going to start crying, so I won't." "But..." "He could have saved himself." "Tragedies like Tony's notwithstanding, by the mid 2000s, texans, presidents, and astronauts are getting scanned, but that's it." "Across the U.S., doctors prefer to intervene after an attack with a stent, rather than prevent it with a scan, despite the fact that the unexpected death toll is by now over 3 1/2 million." "Almost unnoticed, a huge medical trial has been under way for nearly a decade." "Code-named "courage,"" "it's the first major test of the stent's effectiveness." "So, courage came up with this idea to look objectively at whether medications could equal or exceed the effect of stents in people with stable ischemic heart disease." "2,000 people are selected, all of them with at least one blocked artery." "Half of them are given a stent and statins -- the new heart wonder pill." "The other half, just statins." "Watching is one of the men who's long argued that medicine can beat metal." "My intervention is medication." "So I know that the intellectual satisfaction and the medical satisfaction I get is trying to avoid an intervention in making people feel better." "So you, in other words, are sitting on the sidelines." "What are you thinking?" "That's very good." "So, now you're putting me on the sidelines." "I prefer not to think of myself as being on the sidelines." "I would prefer to look at myself as being actually at the forefront, and I feel that if done right, what I can do is impart quality of life " "I'm a huge quality-of-life guy -- preventing interventions, complications such as heart attack and stroke and perhaps death, and I think that's a very noble, appropriate thing to do." "2007, the doctors report their findings." "One of the most widely used medical procedures is being called into question tonight." "Nearly a million Americans every year have stents implanted." "It costs on average about $36,000 dollars, and tonight a blockbuster study questions whether it's worth it." "The results of the courage trial are a complete shock." "Stents, which pry open clogged arteries, may not be as effective at preventing heart attacks and death as previously thought." "Pills and exercise alone are every bit as effective as the stent." "Not only that, but stents don't make you live any longer." "Without mentioning names, there was a " "I was on an airplane coming back from the acc meeting when courage was presented, and a very well-known interventionist was on the plane, sitting two rows in front of me, and out loud made a comment that I'm trying to ruin his career," "and I'm trying to "put him out of business."" "The message that came out from the trial, in the media, in the newspapers, as if the stent was bad." "That's the problem, but if you tell me, what would I use instead?" "Or why's the stent harmful?" "Answer is no, it just didn't do better than medical therapy." "Did you discuss the matter with him?" "Yes, I did, with an audience, regrettably, and..." "On the airplane, and I think at the end of the time, the score was 70-30 in favor of me, but..." "Actually, medical therapy fared surprisingly well, and in the past, I believe medical therapy has been regarded as an inferior treatment strategy." "Medical therapy is all you need, and every time we do another study like this, the interventionists say, "oh, it was done on a Tuesday," ""and now we do most of our stents on Wednesday,"" "or, "now we use our left hand to twist the stent in" ""and they did it mostly with their right hand, so it's no longer valid."" "They come up with stupid arguments against courage and all the other trials." "Despite interventionists' continued resistance to change, more and more alarming personal stores are emerging, backing up the courage findings." "One day I was playing softball." "I play for a woman's league in bayonne, New Jersey." "I was playing on a 90-degree day, and we were playing the woman's championship and played a great game." "We won the championship." "But all through the course of the day," "I felt like I ate a soft pretzel, and it got stuck in my chest." "I actually asked my aunt," ""what can I buy to actually make me belch?"" "And she said, "buy a ginger ale."" "I bought a ginger ale, and it felt like the pretzel got bigger." "So I wanted to go home." "So, after our celebration, I left the pizza restaurant." "Happened right there where the doors are." "When I walked out, I actually got sick." "I was going home, and my family wanted me to go to a hospital." "If I went home, I would have died in my sleep." "I..." "Had a..." "I went to the hospital." "They said I had a heart attack and that they were going to admit me to the ccu unit." "They gave me a Nitroglycerin patch." "As soon as they put the patch on me, I went into cardiac arrest." "They shocked me back, and they rushed me out to another hospital, Saint barnabas." "They gave me two stents that night." "When I woke up, they said, "you're going to be okay,"" "and I said, "well, I'll be okay if you can tell me I can go to Ireland in August."" "I went to Ireland for vacation." "My aunt was turning 70, and it was a childhood dream, and then the doctor said in September that I would have to go in and get another two stents." "And I got that done at Beth Israel in Newark." "And on the table, they couldn't do the two stents." "I was having another heart attack, and they did a double bypass." "And I woke up on a respirator." "I was knocking at the door." "I was there." "They lost me twice." "I came back." "So, I got nine lives." "I thought about my mum." "She passed away in the same hospital." "I thought it was going to happen to me." "I'm sorry." "It's just -- it brings back memories." "Despite her appalling experience," "Sandy was in fact one of the lucky ones." "She was able to have a bypass, and it saved her life." "But put too many stents in, and you can't." "The reason it's killing the patients is because, once you have that stent, you can no longer have a bypass because you can't graft onto a place that has a stent in it." "So, bypass surgery works." "Bypass surgery is fantastic." "But a guy who has stents all over his coronaries can't have bypass grafts." "So he dies." "Patients need to understand that the treatment is good cholesterol management, blood-pressure management, diet, lifestyle -- what I call the abcs." "Aspirin, blood pressure, cholesterol, diet, and exercise." "And you don't need the stent." ""S" is way down the alphabet, and we're not going to get there." "If they have chest pain at some point, we can put in a stent, but a stent neither improves their outcomes, doesn't reduce their heart attacks, nor does it improve their mortality." "Courage's findings and the slow emergence of ever more stent horror stories beg a wider question -- why are doctors prescribing so many stents to so many people?" "We've done stories here at the times about individuals who went in to get what they thought was one or two stents, and came out with five or eight stents." "There is an area where these interventions are critical." "There are people who are very sick who need these devices, who actually do benefit from these devices." "But what invariably occurs is that devices that were intended for extremely sick patients get kind of pushed downstream, if you would, into healthier and healthier and less-sick patients." "The benefit to any hospital is that they are paid on the basis of procedures." "The more procedures they do, the more money that they make, so the whole development of intervention was to generate procedures." "The profit motive is common to the entire medical system." "What is remarkable about stents is the way their development was and is in the hands of a very small number of people." "Off the back of the New York times stories, the senate starts a formal investigation and pretty soon, concentrates on one man." "Dr." "Marty "device maven" Leon." "So, interventional cardiology is truly alive and well." "It's a great time to be an interventionist." "Marty Leon is a one-man stent industry." "That means, Gary, that we should put a stent in now." "Is that what you're saying?" "Right." "He operates, he advises, and he runs the world's most important cardiology conference, t.C.T." "Dr." "Leon is incredibly smart." "He has figured out a way to sort of sit at the sort of center of the spider web of stents by running this conference." "And what that allows him to do is to serve as the gatekeeper for which type of products end up being most widely used by doctors." "Now, other wires that could be used in this case, for instance, you could use a roadrunner wire, would be a thought." "It's a very stiff wire." "You could use the meditech platinum plus wire." "The tech wire is very stiff." "We've used that for stenting." "He became involved in every step." "You know, it became, "I helped develop it." ""I helped promote it." ""I organized conferences at which it's displayed." ""I'm involved in the clinical trials for this device." "I'm involved in the publications for a device,"" "and so there's this tremendous vertical integration to the point where you might wonder why is he not involved in the metallurgy or the mining for the materials?" "There was so much money coming in that you began to question," ""is this man a doctor or is this man a businessman?"" "You sort of had to ask those various questions, like, "what is this guy's job?" ""Is this guy's job to treat patients?" "Or is this guy's job to create income for Marty Leon?"" "Why should a doctor receive compensation at certain milestones, which are basically," ""okay, if you put this in enough patients" ""or if this device gets into enough patients, you'll get a sweetener."" "And to me, those kinds of payments..." "Are extraordinarily troubling." "Do you think that the ability for doctors to have relationships with companies warps in any way their choice of device?" "Uh, it's a very interesting question." "I think that there are a couple of ways to respond to this." "I think..." "Without physicians participating in the inventive process and in the innovation process, most therapies, like stents, like transcatheter valves, like almost any development in the history of cardiovascular medicine would never have occurred." "So the physician input into the creative, inventive, innovative process, to me, is fundamental." "And creating disincentives and creating an environment that prevents that from happening," "I think is in our collective worst interest." "I would like to ask Dr. Leon a question." "I'd like to ask him if it would be fine with him if he went to his financial investment adviser and gave that man his millions of dollars, which he's taken, and gave money to his financial investment adviser," "and that investment adviser did not tell him that when he advised him to invest in shell oil company, for instance, that as a financial adviser, he was getting 15% back from shell." "I think he would have problems with that." "I think he would wonder and begin to think in his head," ""is my financial adviser working for me, or is he working for shell oil company?"" "Conflict of interest is a real phenomenon and is something we have to be sensitive to." "But having been completely vindicated of any wrongdoing, the initial reports and the initial accusations remain, but the righteous vindication is a quiet event." "If Dr. Leon thinks he's been vindicated, then I think that that is " "I'm sure that that is an opinion that Dr. Leon holds." "The debate grips the nation." "In 2009, congress passes an act, the sunshine act, that requires doctors to disclose all major donations and conflicts of interest." "It bears repeating, this is no idle piece of political theater." "Over four million people have died unanticipated, unexpected deaths since the stent and the scan were first invented." "Met Margaret on the southeast side of Cleveland, Ohio, which pretty much borders the beginning of the suburbs." "I was 11 years old at that particular time, and Margaret would have been 13." "We actually came together when I came back from the marine corps." "I decided to go back to the old neighborhood just to see who was hanging out." "And the only person who was standing there when I got there was Margaret." "She was standing in her front yard, watering her mom's roses." "And I walked up and said, "hey."" "And the rest is history." "I like to think that I was good guy, but you couldn't tell that by my actions." "I'm a man's man." "I'm in the marine corps." "I had a 30-year tenure in the steel industry, played sports, played hard sports." "I became that irascible reprobate, drinking, drugging." "I..." "Just made so many crazy mistakes and injured a lot of people, particularly Margaret, who always stood at ground zero." "She would always tell me, "you know what?" ""I will always love you." "I meant that." ""You will be the only man I will ever love," ""but that doesn't mean" ""that I don't hate what it is you're doing." "I don't hate you, but I hate what it is you're doing."" "God put me to work in 2002 about three months after my job in the steel industry came to an end." "And in 2006, I trusted in God." "We gave up everything in our life." "We were enrolled in pacific lutheran theological seminary in Berkeley, California." "Oh, boy, here comes the sun." "[ Laughs ]" "My name is Margaret Monroe, and I am a second-year student at pacific lutheran theological seminary." "Her first weekend on call, she preached for the hospital community and was on her way back to the supervisor's office, and she had a massive coronary, and she died." "And, uh, truly, my whole life stopped at that moment." "I've never experienced anything, as far as the depth of pain and grief that overwhelmed me, and it's not because of nostalgia or wistful-memory-type things." "It is the truth -- she was the very best part of me." "More women die of heart disease than men in the states every year since 1983, so it's a huge problem among women." "Five times as many women die of heart attack as breast cancer." "Yet very few women have any knowledge of that or any inkling of concern about heart disease compared to breast cancer." "So when we talk about the mammogram of the heart, that's at least five times more important to women than the mammogram of the breast." "With heart deaths stubbornly high and stent overuse discredited, you'd think the mammogram of the heart would be on its way back, but you'd be wrong." "We are going to put a stent in now." "Okay, give me a 2.25." "There's one last key opponent -- the insurance industry." "They won't pay for the test." "Ironically, the headquarters of giant health insurer kaiser permanente are just across the bay from the offices where the very first scanners are installed." "In the early 1980s, the kaiser board come calling." "We met with the kaiser executives." "Of course, most of them came in to be scanned." "And some of the kaiser researchers did some excellent research on coronary calcium screening, published research." "But that didn't mean they'd pay out for their policyholders to have one." "They said, "we're not interested" ""because our typical patients" ""are only in the plan for five years or less," ""and this is a long-term cost savings." "The cost savings will go to our competitor."" "And no need to single out one particular health-maintenance organization." "All the insurance companies told us basically the same story, that their patients are not long-term holders of that plan, so if they reduced cost of the long term, it means nothing to them." "It only goes to their competitor." "We contact the big insurance companies -- kaiser and the rest, to find out why they will still pay for a $50,000 stent, but not unless you're very lucky, a hundred-buck test." "But they won't talk." "Then one man is brave enough to break the wall of silence." "He's been the public face of two of the big five as their media spokesman." "I was a journalist, a newspaper reporter, for some time, but then I got into public-relations work and I realized toward the end of my career that something had happened to what I was doing for a living that I was " "it just dawned on me that in many cases," "I was doing the exact opposite of what I was trained to do as a journalist, which was to try to find truth and, as best I could report it, to do that." "It sounds contrite, but I did look in the mirror and say, "what happened to you?" "How did this happen to you?"" "The system is not set up to reward prevention." "The system is set up so that doctors are well-compensated for treating conditions." "So are pharmaceutical companies." "We mainly have a disease industry in this country." "We've got a healthcare system that's out of control, spending an incredible amount of our national wealth, not making people better." "We developed a system that's based upon putting out the fires -- taking people in with chronic diseases and doing all these things to them." "There is just not nearly enough attention paid to trying to help keep people from getting sick, from getting congestive heart failure, from getting the kinds of illnesses that require stents, and being put on maintenance drugs," "and having expensive care for the rest of their lives." "They don't want them to die, but they don't necessarily want them to get better." "Well, that's where the money is." "It's like the Willy Sutton law." "It's Sutton's law." "When asked Willy Sutton, "why do you rob banks?"" "He said, "that's where the money is."" "So the insurance companies are following Sutton's law." "You don't get to be c.E.O. Of a company because you've saved lives." "The cliché runs that the darkest hour is before the dawn." "2012 proves the cliché is right." "Despite the fact that most insurers still won't pay for it, more and more people are going for a scan." "After sewing up a big business deal in the U.S.," "Irish entrepreneur David bobbett went to have a medical checkup, part of it a coronary artery scan." "He had the shock of his life." "My arteries were that of an 86-year-old, so here is a 51-year-old who exercises everyday, is careful of what they eat." "My parents lived into the 80s." "I'd done all of the things you were supposed to do to be healthy." "The following day I had to go in to do an angiogram, where they found I had one totally blocked artery and I had another artery that was 70% blocked and I had a huge level of disease right throughout my system." "And the clear suggestion was I was either going to have stents put in or a bypass." "The shock of it, the shock of suddenly going from one day feeling absolutely perfect, with no reasons of any issue at all, to a situation that 75 out of a 100 people at your level of calcification" "is going to either be dead or have a heart attack in the next 10 years." "Today he's going to be scanned again." "Told he could die at any moment, he's spent the last two years on the most punishing of fitness and food regimes." "I've done everything I can do, and the score will be the score." "My mathematical mind says, "it was 900." ""1,100 will be okay." ""1,200 will be reasonable, and over a 1,200 score will be very disappointing."" "Remember to keep your arms above your head for the entire test." "Now take in a deep breath." "Plenty of white there." "There is." "[ Speaking indistinctly ]" "You know there's a huge level of plaque there, and so you just wait to see what the result is, you know." "It's all we can do." "Hi." "Hi." "All right, it's nice to meet you." "Okay, nice to meet you, too." "All right, so, just to sort of compare, your total score is 1028, and previously 906." "Now, there's a little bit of motion artifact, and so Dr. canady thinks this is a little artificially increased." "When we look at the number of lesions -- that's something else that you can look at if there's a little bit of motion -- so, in the past you had 28, and now you have 33," "which really isn't very different." "And so this is good news." "I'm very happy with that." "I'm very happy with that." "I've worked -- you wouldn't want to believe how hard I've worked." "I've really worked on everything." "Listen, great." "I just got my number, 1,025." "So, 1,025." "Yeah, it's very good." "Yeah, yes." "So I'm delighted, absolutely delighted." "The disease has barely advanced." "David's still in a very high risk group, his arteries still very much blocked." "But for now, there's real hope he can make it." "The fact that I could be around like any father wants to be with his kids." "The fact that I was..." "My daughters that are just so special, that I would be there when they got married or when they were that bit older, that I'd see my grandchildren, that gave me hope." "That really was what really was so important why I wanted to fight this as hard as I did and I would fight because it was important to me." "Without the shock of that first scan," "David might not have changed his life around, might not have been here today for his family." "But now the hope he has can be shared by millions." "For all the problems of the way medicine is run in this country, the ultimate obstacle in the scan's path is that it lacks official approval." "Then, in October 2012, after all the years of opposition, the American heart association finally relent and issue a statement saying that coronary artery scanning is beneficial." "Breathe in." "Hold your breath." "Yes, I feel vindicated." "I'm just happy that we were working on something that turned out to be valuable." "Well, I mean, so, you know, there's this old saying that," ""truth passes through three stages." ""First it is ridiculed, then it is violently opposed, and finally it is accepted as being self-evident."" "So, I think we went through the ridicule stage " "I think Bruce took most of the heat -- and then we got the violent-opposition stage, with some people who have now been proved incorrect and now have retreated, and now where I think we're finally being accepted" "as being self-evident." "The data really does speak for itself." "And when the American college of cardiology and the American heart association signs off on it and says it's reasonable to use it, then the remaining naysayers are just a voice wandering in the wilderness." "We could have gotten there -- in a perfect world, we could have gotten there in three to five years if we'd all have gotten behind it in the beginning." "And to what?" "Well, how many lives do you think would have been saved if we'd done it in 1990, what we're doing now in 2013?" "And the answer is?" "A lot." "In the 30 years since coronary artery scanning was invented, over 4 million people have died without any warning." "That's the equivalent of half the population of New York City dropping dead." "And most of these people could have been saved." "People just need to be so careful and listen to their body and feel the changes going on." "It is a such a sneaky, deadly disease that can take you so fast, and people need to be more vigilant about it." "If they don't care that much about themselves, do it for the people you leave behind." "I'm going to start giving him mouth-to-mouth." "He's turning black." "Stay on the line with me." "Are you with him now?" "Yes, he's right next to me." "Okay, how old is he?" "61 -- 62 and perfect health." "Is he conscious?" "No, he's not." "You need to roll him over." "I'm going to be 80, so I've outlived my father by many, many years." "I'm able to get back to play softball, which I've done." "I've was able to play softball with my son in a father-and-son league on the exact field where I had the arrest, and that completed my recovery." "When I turned 50 this past year, I joined aarp, and people say, "wow, how come you're so excited?"" "I said, "people don't have that privilege, and I have that privilege so I consider myself very fortunate."" "Here's the best tip I can give anyone -- if you think your food is bad for you, you're right." "Okay, you're right." "If it tastes real good, you're probably really right."