Posts Tagged ‘cost effectiveness’

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An  article , I stumbled upon recently  discusses why American health care is  in deep trouble. There is a huge variation in the health care costs across the country. The article goes on to reveal  ,   a  simple  Appendicectomy can  cost  anywhere between 7500   to 1,70000 $  in different hospitals in USA.  (In India it costs  1000 $  in  any  star hospital !)

The fundamental flaw is   treatment  being the same ,   it is delivered in such a  fashion ,  the cost incurred is  kept ridiculously high.

It is akin to comparing  a 10 dollar  lunch to a 1000 dollar feast , both  ultimately  fulfills a  purpose ,   relive the hunger effectively

while , the later can  damage the country’s economy  in a variety of ways !


Car makers automate the industry with Robots to   reduce  the  human labor and  cost of a vehicle ,  while medical industry does the opposite   . . .  privileged few get their appendix removed with a help of metal hand  !

Final message

Modern medicine must  aim to improve the quality  of  care  with a   positive impact  at a reasonable cost . In the name of cutting edge technologies ,  it  should not raise  the medical bill in a meaningless  fashion .This is meager exploitation of  human suffering.

It is  hilarious to note  certain medical  Robots* are primarily  made to assist  surgeon  for which  no assistance is required at all !  (I heard a story about a  Robot  which responds  to voice command   and pass on a   knife  for cutting and a gauze for wiping ! What a great medical discovery !)


*  Of course  Robots (Cyber knifes )   may have a role  in some rare surgeries which require high precision  cutting  especially in  Neuro  ,  Vascular ,  oncological  surgeries.

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Medical science is  not like mathematics or economics .

  • It is about how a  bundle of human cells(organs) behave at times of adversity .
  • It is  about how our mind  takes on the body .
  • It is also   about , how the care takers  Heal/Manipulate /Manhandle  these cells at times of distress !

We know, two persons with identical injuries , sustained in a car crash one dies within an hour  , while the other with a  many fold serious injury successfully fight the trauma and walk out of hospital with victorious  .That is the fighting spirit .This  is either  inherited  are  nurtured or both.

This implies , an accidental injury may be an  external , unpredictable  event,  while the  response to  that injury is predetermined or even a predictable response !

In the name of modern science , we “the human animals” are trying to buy this fighting spirit  with money.We are made to believe ,  survival and well-being is a commodity and  can be  bought with high cost  medicines , and high cost care .

Remember  , one of the most astonishing medical  fact is , while we  may struggle to induce  swine flu  in  a laboratory on a given  individual ( Even if ,  H1Ni  viral  concentrate is  infused or inhaled  )   , an  other person gets this disease  , while simply  flying over an  infected country  . Such is the complexity  of  the host response  system in medicine .

So , it is foolish to think health can be bought or maintained  with  money power or modern hi-tech medical care .At best it can save   few lives  with  its   life supporting drugs and devices . Ultimately,    human survival  is determined  by the way we  live  and the way  our  ancestors lived and how we fight the illness.

Yogi’s  of  Himalayas lived for more than 100 years without the need for drug eluting stents and LV assist devices .

Having totally misunderstood  the concept of health and illness the world is wondering how on earth , we can reduce the escalating cost of  healthy living  (pseudo health  !)

An article in the current NEJM ponders over ,  Why in  Grand junction,  Colorado ,USA ,  the health care cost is very much lower ,  without compromising the quality of life and survival.

The answer is very simple .There is some body in that county , who  dares to think beyond  raw  science  and adds  little  bit of common sense ! Obviously he has to be rewarded and  this  model need to be replicated  elsewhere.


This article discusses the phenomenon  of  high quality , low cost medical care , but what it misses out is , the reverse could also be true !

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Pessimism, from the Latin pessimus (worst), is a state of mind which negatively colors the perception of life, especially with regard to future events.

Understanding pessimism is not that simple  . Some people argue  optimism   represents a strong mind while  a pessimism  is the domain of the weak . But it is not necessarily true.  Both pessimist and optimist are unreal , and playing the dangerous game of predicting the future. So realism is the answer .

In this era of information highways , commercial exploitation of science ,  our thought process is grossly determined by our perception of events.We hardly have an intention or time to analyse our thought process.

  • An optimist  ( Rather , unregulated optimist ! ) is a person who welcomes  any growth good or bad.*
  • A pessimist  is  a  person who welcomes only good growth.*

So how to identify good growth ? That is the million dollar question!

  • Many of the  optimists may not  bother about the final outcome of a treatment *
  • A pessimist bothers only about that .
  • An optimist  rarely asks questions, blindly accepts every thing !
  • A pessimist never believes any thing !

Actually the fundamental principle of scientific medicine lies in proving the null hypothesis null and void.Any treatment is useless until proved other wise .  So pessimist can be argued to follow true science , while  many of  the hardcore  optimists are blind believers ..

*It may be  a harsh   way of  interpreting an optimist  but  uncontrolled optimism  has played havoc in our  patients like many of the failed treatments (Some of them released prematurely into patient domain   has  killed many lives  . Power of positive thinking should be within the  realms of scientific feasibility !

So in  our  journey   to  conquer human health ,   we   may  proceed with  an optimistic mind and  a pessimistic eyes !

This understanding is all the more important in this era of contaminated science .It is a well known fact ,  now last 50 years of  planet earth has inflicted the maximum damage  to ourselves  than our ancestors did in 5000 years. That’s why we are compelled to meet at Copenhagen .(We never learn from our mistakes, that’s a different story !) .

There is definite and urgent  need for world summit  on  cleansing the medical science from  the clutches  of commerce  and ignorance . A medical green house effect, with dangerous holes in health care  is imposing on us (Another pessimistic thought . . . of course in the interest of human kind !)

World health organization ,  a sleeping giant has to be awakened on this issue

Final message:

Mankind has evolved over many millenniums ,  probably with a sole  purpose of living ,  that is reproduction and propagation of our genre without harming the environment and other species.

Unrestricted  and unregulated growth of any kind is dangerous we call it as malignancy in pathology .In science , we tend to call it a” great future ”

Our  sixth sense*  has  outgrown  miserably  out of  reality  , as have we decided to take on the nature and GOD .Now , many developing country men do not believe in death .They are fighting a losing battle against the God. And they suffer with escalating health costs of keeping the elderly ,  alive who are  knocking at the doors of heaven or hell . The same countries,  which deny funds for curable illnesses of the poor is a different story altogether !

The principle of modern medicine  would ideally  be

  • Reduce human suffering irrespective of economic status
  • Curing a illness if there is a cure
  • Prolonging life if there is useful purpose
  • Allow a good quality death if there is no cure.
  • Most importantly  , prey to god give us strength and capacity to identify which is good and which is bad for our patients  .

Read and learn for a  complete guide on optimism and pessimism

* It  is  important to recognise , the same sixth sense  has   made it possible to share our views through a great tool of  Internet  . So we should not be against the growth of science but against the misuses and wrong interpretations of it .



The traditional characters  of  a pessimist


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  1. Do 64slice MDCT  in all patients who has  a coronary event and follow it up with catheter based CAG.
  2. Use liberally the new biochemical marker ,  serum  B-naturetic peptide (BNP) to diagnose cardiac failure in lieu of basal auscultation.
  3. Advice  cardiac resynchronisation therapy in all patients  who are in class 4 cardiac failure with a wide qrs complex .
  4. As it is may be considered a  crime to administer empirical  heparin, do ventilation perfusion scan in all cases with suspected pulmonary embolism.
  5. Do serial CPK MB and troponin levels in all patients with well  established  STEMI .
  6. Open up all occluded coronary arteries irrespective  of symptoms and muscle viability.
  7. Consider  ablation of pulmonary veins as an  initial strategy in  patients with recurrent idiopathic AF. If it is not feasible  atleast occlude their left atrial appendage with watch man  device.
  8. Never tell  your patients   the  truths  about the  diet , exercise &  lifestyle modification (That can  cure most of the early hypertension) . Instead encourage the  use of  newest ARBs  or even  try direct renin antoagonists   to treat all those patients in  stage 1 hypertension.
  9. Avoid regular heparin in acute coronary syndromes   as  it  is a disgrace to use it  in today’s world. Replace all prescription of heparin with  enoxaparine  or  still better ,  fondaparinux  whenever  possible.
  10. Finally never discharge  a  heftily  insured patient   until  he completes all the  cardiology investigations  that are available in your hospital  .

Coming soon :  10 more ways to  increase cost of cardiology care . . .beyond common man’s reach

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cardiologist Is he a person who puts  a   metal coil  coated with a synthetic fungus   in  a   incidentally  detected  block  inside a  small coronary artery and sends the bill to the Insurance company ?

Is he a person in a  cosmopolitan  hospital  who opens up a    chronically   closed  coronary artery , in an asymptomatic patient  and  live telecasts  his achievement trans continentally ?

Is he a person who   checks in by  the early morning flight and  puts multiple wires in  an  aged   patient   with  class 3 heart failure and  make  him walk  20 meters extra at a cost of  1000$ / Meter ?

Is he a person living in   Wall   street  ,   who   looks  for variety of holes In  the heart and trying to occlude  it  with   exotic   devicespci ptca stent

Is he the unknown   physician   who Intervenes in the natural history of Rheumatic heart disease   and arrests   immune mediated   valve damage by giving the  monthly injections  penicillin in remote parts of our country ?

Is he the person   who   Intervenes to prevent young   persons   from  smoking and help maintain  their  coronary endothelium  enriched with nitric oxide  & arrest  the coronary epidemic ?

cardiologist 2

Is he the small town doctor  who  Intervenes  to treat a breathless cardiac failure patient  with  digoxin and frusemide  and  dramatically alleviate the  symptoms and  prolong the  life of our poor country men?

Is she the village health nurse from an inaccessible health  centre  located in a  hilly terrain ,  Intervening  successfully, by   pulling out  live babies  from  severely anemic pregnant  mothers with failing hearts ?

pci ptca cardiologist coronary angiograms

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