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Controversies in Internal Medicine |

Rebuttal

Paolo Raggi, MD
Arch Intern Med. 2006;166(10):1072. doi:10.1001/archinte.166.10.1072.
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Though the arguments put forward by Dr O’Malley appear logical, the tenet on which they are based is an erroneous interpretation of the role of imaging. The core of his disputing the use of atherosclerosis imaging modalities is that there is no proof that the performance of screening tests saves lives and that it is expensive. Because most people with a cardiovascular event have at least 1 risk factor, he adds, the added benefit of atherosclerosis screening is small at best. But in fact, when were diagnostic tests ever performed “to save lives”? An IMT measurement or calcium screening cannot be charged with the task of saving human lives. They are performed to help physicians find and focus on a problem for which the solution is their sole responsibility. Tests do not save lives, physicians do. Tests are performed to define—and refine—risk assessment, then patients and physicians act on the risk. When we first determined that hypercholesterolemia was a strong risk factor for CAD, did we stop to ask ourselves whether this was a futile piece of information since no treatment was available? We first learned how and what defines risk, and we then started working on solving the puzzle.

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