Biotech Values

[genisi]

Thanks, Clark for your comments on the issue.

A few more points on CT calcium scoring: first, the score depends on what you're looking at - spatial distribution of calcified plaque, overall amount of calcium, the calcium density or even higher order information concerning plaque location (not only a generalized burden of calcification). Second, it also depends on who you're looking at - age (specificity tends to decrease with advanced age), a/symptomatic, other risk factors like LDL-C etc. Overall, we are in agreement that the best thing to do is the non-radiative improved Framingham model. Like Dr. Rita Redberg (University of California, San Francisco) said last Aug.:

Before subjecting healthy men and women to a test with significant radiation—2 to 7 mSv or 100 chest roentgenograms—one must be able to tell patients that there is a benefit from having this test," Redberg argues. "With no known benefit, CACS fails this essential criterion, and the harm, including cancer risk from radiation, and incidental findings prevail.

You've noted in a previous post:

It [CT calcium scoring] is actually quite common where I live. And it is in the process of being accepted by insurance companies.

From a quick search I've found that:

Aetna considers calcium scoring medically necessary for diagnostic cardiac CT angiography to assess whether an adequate image of the coronary arteries can be obtained.
...Aetna considers calcium scoring (e.g., with ultrafast (electron beam) CT, spiral (helical) CT, and multislice CT) experimental and investigational for all other indications because the definitive value of calcium scoring for assessing coronary heart disease risk has not been established in the peer-reviewed published medical literature.

And

...there is no evidence so far to support using the results of EBCT in an asymptomatic patient to select a therapy or to guide referral to invasive investigations. The clinical role of EBCT is yet to be established in terms of screening for disease or risk assessment. Electron beam computed tomography is highly sensitive, but its specificity is low.

Another one:

The USPSTF reaffirmed their position in 2009, stating that the evidence is insufficient to assess the balance of benefits and harms of using coronary artery calcification (CAC) score on electron-beam computed tomography (EBCT) to screen asymptomatic men and women with no history of CHD to prevent CHD events.