Editorial: SHAPE is skating on thin ice

It’s hard to argue with a concept like heart attack prevention. So when an organization like SHAPE (The Society for Heart Attack Prevention and Eradication) comes along, it’s easy to overlook some of the troubling details of the group in the interest of the greater common good. When SHAPE published its own guidelines independent of the AHA, ACC, or NHLBI, and when SHAPE endorsed legislation to mandate insurance reimbursement for MI screening, my initial impulse was to overlook the nagging sense that something was wrong (why is a small, self-selected group publishing guidelines? do we really want legislators to decide what medical procedures should be reimbursed?). It was hard not to feel that at least the group’s heart was in the right place.

But the nagging questions have never gone away.

The fact that its founder, a former physician and researcher at the Texas Heart Institute, now works in industry, and runs a company that makes a product to screen vascular health, is troubling, even if it is fully disclosed on SHAPE’s website. The fact that SHAPE claimed a nonexistent AHA endorsement for the Texas bill backed by a utorrent search engine was also unsettling. The constant and shameless self-promotion, the cheesy graphics and design of the website, gave the enterprise the feeling of a late-night infomercial for snake oil.

The snake oil connection is now more apparent.

Yesterday I received an email invitation from SHAPE for a luncheon event next week in Houston, Texas, featuring Peggy Fleming, the famous ice skater. Beneath her prominent picture on the invitation is the caption: “Peggy Fleming with KANEKA QH(TM)”. And the text on the invitation includes this:

“With her family history of heart issues, Peggy Fleming, former U.S. Olympic Gold Medal Figure Skater, is teaming up with Kaneka QH(TM) and SHAPE in Houston to launch a national campaign to increase heart health awareness.”

Finally, at the bottom of the invitation is this disclosure:

This event is sponsored by
Kaneka QH(TM)
Diagnostic Cardiology of Houston, P.A.

Keneka QH is ubiquinol (CoQ10).  Amerejuve offers free consultations for laser hair removal for men and women, skin and facial rejuvenation, and other similar procedures. Diagnostic Cardiology of Houston encourages people over the age of 50 to have a “screening” exam for cardiovascular disease, often at their own expense.

In other words, we’ve left the realm of evidence-based medicine and entered into entirely different territory. You could call it the territory of snake oil salesmen, or you could call it modern American medical capitalism giving the people what they want, but it seems clear to me that these companies should have no significant say in public health policy to reduce heart attacks. SHAPE has sought to help frame the agenda of modern medicine and has sought  to play a significant role in educating cardiologists and others about heart attack prevention. So why is SHAPE helping to promote a commercial product, and accepting sponsorship from dubious enterprises? Even more troubling: why are prominent thought leaders like Valentin Fuster, PK Shah, and Pam Douglas involved with this organization?

The problem isn’t with Peggy Fleming: if she can help spread the word about heart disease then I’m ready to skate with her anytime. But SHAPE, it seems to me, is skating on very thin ice, and if it doesn’t shape up it will soon be time for SHAPE to ship out.


  1. Sanjay Maroo, M.D. says

    I read the SHAPE guidelines last year without going in to details of commercial attachments of the group and I was really impressed about the explanation and examples given in that. But when today I read the “Editorial: SHAPE is skating on thin ice”, a doubt came in to my mind about the hidden agenda under the motive. But still I think it is good to explore the vascular health and its relation to CVD, independent of other risk factors and if positive relation is found we should explore the pathology of vascular health. This may help us to target the real factors.
    One more thing I believe is, if one is interested to public health they need financial support, i think there should be provision in AHA,NHLBI, ACC like organizations to support and explore fully such new work before it gets published. This may encourage experts to come forward without worrying financial support to share their ideas, experiences and expertise. Ultimately science and patients may get benefited.

  2. James Ehrlich, MD says

    I strongly disagree with most of your sentiments and the attitude it represents.

    The fact of the matter is that most cardiologists are doing stress tests and other inappropriate procedures on asymptomatics which rewards them handsomely using equipment that their practice owns.

    The consensus documents authored by experts in nuclear cardiology or echocardiography are written by individuals who make their living doing these procedures.

    The fact of the matter is that early detection technologies (coronary calcium, carotid IMT, etc) are not covered primarily due to the antagonism shown by more interventionally oriented cardiologists who have dismissed major advances in preventive imaging that are indeed evidence based. It is absolutely necessary to market these procedures and to do what the SHAPE group is doing—try to influence legislature based upon real science in an environment that is hostile to individual risk assessment.

    Cardiologists have plenty of tools that will find highly reimbursable lesions–significant stenosis. I applaud the efforts of the SHAPE group that has tirelessly promoting the technologies that are far more valuable to society and which outrageously are still not covered.

    The Ice is very solid from my point of view–it is the attitude of the author and many cardiologists that is growing thin.

  3. Steve Kirk MD (Neurology) says

    I found this editorial very naive and somewhat petty, leasing what they perceive to be gray areas and blooming them erroneously into matters of ill repute. I cannot go into the literature here, but the areas of stroke prevention and heart prevention (both areas I am interested as the underlying pathophysiology often overlaps) have much debated literature and evidence. Guidelines often lag behind the latest evidence and cautiously guide in a conservative manner. Much of the guidelines are not based on as much on evidence but on standard of care which is NOT always based on the combination of evidence and economics. The guidelines of SHAPE are indeed evidence-based, and are progressive, and importantly, are taking the concern of economics and assess to care for a wider group of people into consideration, which this editor seems to not have much insight into. And as for sponsorship, they are being a responsible young organization by responsibly noting all of it. And what sponsorship they note is in line with the current evidence for patient care as expressed in the literature. I am disappointed with this editor’s assessment. It is premature. SHAPE is currently on solid ground, only growing more solid by all accounts.


  1. […] Published March 21, 2009 Uncategorized In response to a CardioBrief editorial posted earlier this week that was highly critical of SHAPE, I received a letter from a lawyer who is  a member of SHAPE’s board of directors. Although […]

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