PCI and coronary stents are revolutionary concepts , still , they may not be great life saving devices . . . though the collective cardiology wisdom may seem to suggest so !
The ideal way to describe a stent could be “Its a metal coil , if inserted properly in certain population of severely obstructive forms coronary artery disease may save some lives in acute situations or give relief to pain in non acute situations”
*While the true benefits for the patient population is unsure . . . it’s absolutely certain stents confer highest quality of life to the manufacturers and their chain of associates including the Noble professionals !
I wonder , what would be his comment about ubiquitous stents that rule the current era !
Learnt cardiologist’s will know the true life saving potential of these stents (In the way its been currently used ) Their conscience will also tell how Inappropriate and Indiscriminate usage of stents has possibly injured or consumed more human lives , that may even beat the number of lives saved .(Oh, Its a wild, rude statement friend!)
I sincerely believe the move by Government of India to control the stent price ( to enable all our countrymen to get it) . . . as if “stents are the only staple diet” for heart patients is ill-founded and dangerous .
What the Government may not be aware of is . . .This 45000 crore omnipresent stent industry is playing havoc in the life of patients not only financially but also biologically to harm their blood vessels.
It is near foolish to tackle the scourge of human beings -Atherosclerosis, a diffuse medical disease with a lesion specific intervention .This is especially true when we want to tackle it in population based approach . Yes, some super rich and elite get sophisticated stents thinking that they are privileged .Please understand rich tend to suffer more with technology. Often times non affordability is also a bliss for the poor .(You can’t write any rubbish man !)
Who will tell this to our policy makers ?
Never ape the private sector health care , states must have different priorities.There are Infinite number of studies that very clearly reveal medical management and life style modification is the sure and successful way to tackle CAD.(I think I need not dwell into this as evidence is explicit .)
Meanwhile, let me give one example of the futility of innovation and perils of premature release of half baked science .While one section of Industry is coming out with stents made up of exotic new metals , simultaneously other group is innovating and experimenting the exactly opposite , how to get rid of the metal ie bioreabsorable stents. Mind you, one of the latest generation stents was severely reprimanded in a Landmark trial ABSORB 2 and 3. Its a comical irony some of the hospitals and cardiologists feel bad to miss this red flagged stent that are taken out of their cath lab because of price cap. ( A pat for the Govt for this !)
Its a multi billion dollar Industry (Note : there is no pardon for Indian companies to exploit either !) trying to disseminate a commercially motivated concept intelligently including the stake holder Government in their loop. The move to liberalise stent usage is most unfortunate thing as the Govt has inadvertently increased the risk of abuse .Let the new age Indian not be proud about “Stent for all ” movement since the Govt will ultimately have to shell out for this imperfect therapeutics through public insurance .
Final message
Though capping the price of the stent by Government do carry some sense . . . ultimately I feel its a trap . It’s akin to let loose a dubious modality in public domain within easy reach . Already the companies want to increase per capita metal consumption. That process will only get accelerated now.In a country where bulk of the ACS patients not even get prehospital Aspirin, we talk about primary PCI for all.It is a shocking medical economic hijack played in day light by a new generation thrombolytic called TNK -TPA is able to jack up the cost of coronary care with marginal benefits based on dubious off shore studies. I guess , very shortly the thrombolytic warrior Streptokinase is likely to be declared as endangered species and perilious for STEMI patients.If Govt really wants to tackle population based emergency cardiac care they should first upgrade country wide taluk or municipal level hospital with 24 h coronary care facility with trained doctors who can save more lives than the combined efforts of socially concerned corporate care takers.
Some one should tell the Govt, cath labs would never come into the scheme of things for mangaing ACS in bulk of our country men.The Law makers and the corridors of power should be “forced to realise” there is an urgent & broader issue to be addressed.Its not only in cardiology but in all walks of health delivery system. How to prevent “contamination of medical science by pseudo cost effective scientific interventions fueled by corporate greed ? They should start sensitizing the young medical professionals in medical schools that will help the Noble profession remain Noble !
Postamble
Its heartening to note Govt of India is Indeed taking some harsh steps to make drugs and devices affordable in a fair manner .The new authority National pharmaceutical pricing authority (http://nppaindia.nic.in/ ) has clear targets and are in hot pursuit towards righteousness in health care. Still, they have to be very watchful and work in tandem with medical council of India since commerce masquerades as science , price control alone is not a solution and there needs to be body regulating the true Indications as well .
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Dr.S.Venkatesan MD 
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