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Posts Tagged ‘ethics in cardiology’

Trying to become a truly Professional Physician !

Posted in Uncategorized, tagged , , , , , , , , on August 10, 2025|

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Post-amble

Are you a professional physician doctor ?

Honestly I am struggling to become one , it is still a long way to go.

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Be proud to be  a new generation cardiologist.

Posted in Uncategorized, tagged , , , , on March 27, 2025|

Yes, It’s not a humiliation, to get branded as a new generation cardiologist. In fact, the opposite is true. Sorry, no-blaming any one. We can’t avoid it as well. It is the wages, we are foreced to pay for sensationalised technological sins , that is Imploding in the world of medical science.

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A forbidden quote in medical science

Posted in Uncategorized, tagged , , , , , , , , , , , , on September 14, 2024|

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“World heart day” : Two conflicting messages

Posted in Uncategorized, tagged , , , , , , , on September 29, 2023|

World heart day is being celebrated every year on September 29th ,Initiated by the World heart federation with a genuine purpose, vision & goal. It has become big hit in recent times. In India, the theme has captured the imagination of the main stream media . Every one wants to propogate a message. I am not an exception. Please bear with this skewed message “One for the patients and the other for the self” !

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What is your top three high & low value cardiac Intervention?

Posted in Uncategorized, tagged , on July 19, 2023|

“Observe your thoughts,don’t believe them”
Eckhart Tolle

High value

1.Pacemaker & Defibrillator

2.Heparin in Acute coronary syndrome

3.Diuretic therapy for cardiac failure & pulmonary edema

Low value

1.PCI> 24 hrs after STEMI

2.Most CTO Interventions

3.AF ablation

Strong contenders for high value Interventions

1.PTMC

2.Thrombolysis & DAPT

3.Diet and excercise modulation

Strong contenders for low Value Intervention

1.TAVI in young & SAVR eligible population

2.Mitra clip

3.LAA appendage closure

Final message

Unfortunately, most of us are blinded (artificially though!) to quality check , outcome assessment, & comparative effectiveness with already available treatment modalities.Every cardiologist shall create their own value based list of intervention according to their conscience, and stick it on the consultation table as a ready recokner.

Counterpoint

Value is a subjective concept that can be challenging to define precisely. It may not always apply equally to every individual.Ideally, population based value assessment should give us the true value. Reality is different. In some cases, what may seem like nonsense to others can hold significant value for a particular person. This highlights the importance of recognizing diverse perspectives.

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Acute “Corona” syndrome : Glad to know plaques are also in lockdown mode !

Posted in acute coronary syndrome, Cardiology -guidelines, Cardiology -Interventional -PCI, cardiology -Therapeutics, Ethics in Medicine, Uncategorized, tagged , , on April 3, 2020|

The Country of mine with 140 crore population, is under complete lockdown mode. We are anxiously tense in one aspect, but enjoying the free time due to the peculiar “Corona effect” on cardiac emergencies.

Unable to understand you . . . please go away

What happened to our 24/7 busy CCU ? Does it happen only in my hospital? Can’t be. Let me check it right now. I called my fellow, who has since become a leading cardiologist in the nearby town.

guidelines

I have since called many of my close contacts. In both Government and private hospitals. The pooled data were analyzed in a virtual cloud memory. I am fairly convinced, our observation was indeed true.

The following can be considered as near facts.

  • There have been at least 50% minimum dip of Overall ACS cases. It even went down to 80%reduction in a few places
  • Even UA/NSTEMI showed a significant drop.
  • There was general hesitancy to do primary PCI even if it’s technically Indicated.
  • All most all STEMI were lysed. Heparin was liberally used.
  • Many patients preferred telephonic consultations.ECGs were reported over mobile platforms
  • None of the back pains & gastric pains were admitted as atypical chest pain.
  • Most cardiologists closed down their regular OPD
  • For the first time, Govt institutions were considered worthy to refer.

Why ACS Incidence nose dived?

  1. Under recognition?
  2. Under-reported ?
  3. Low Incidence?
  4. Low rate of referral?

STEMI that goes under-recognized and unreported? The consensus was, it’s less important factor as currently, very few are unaware of the Importance of chest pain and widespread availability of emergency services 108/911

Does that mean real incidence has Indeed come down?

The global atherosclerotic burden,(the substrate for STEMI) in the society is nearly constant. Still, the incidence of ACS has declined dramatically in the lockdown period. This conveys an important message and compels a search (research)

The plaques that are waiting to rupture in the population somehow getting a reprieve. Mind you, the presence of a risky plaque in LAD alone won’t cause a STEMI. It needs a trigger. The day to day physical stress, spikes of catecholamine, emotional swings, traffic pollution etc. The only plausible explanation appears to be the vulnerable patients along with their plaques are also locked up inside its Intimo-medial home. (Armchairs and bed rests can not only treat STEMI , they can prevent it too !)

Why the incidence of NSTEMI /UA has also come down?

Again, the same factors might operate. But, more likely self-stabilizing pseudo / Low-risk ACS is a distinct possibility.

A significant chunk of UA /?CSA/suspected NSTEMI patients come from referrals by GPs.The biggest pool of cases for cath labs comes from this group of noncardiac/Atypical chest pain syndromes*. Which shows some Incidental (In)significant lesions that subsequently becomes a cardiac emergency.

Since they have reduced their consultations the numbers have quite significantly reduced.

*Chronic CAD masquerading as ACS is not a forbidden concept

Final message

We are taught some important lifetime lessons in cardiac practice by this 20 nm, lifeless RNA particles.

1. The bulk of the ACS in the society is triggered by the day to day stress of the fast and furious “Just do it” world. The mitigating effect of social lockdown on physical and emotional stress on plaque dynamics on the incidence of ACS will be a big research subject in the coming months.

2. More importantly, It has exposed the existence of one more hidden epidemic in the community “manufactured coronary emergencies” propagated by a resistant cardio tropic virus that has disseminated deep into evidence-based cardiology. Let us cleanse this virus too after finishing off the Corona.

Postamble

It’s just a crazy opinion from a scribbling, blogger. However, I am sure, It’s only a matter of time, great journals like NEJM, JAMA, and Lancet will be screaming the same truths in a more palatable evidence-based manner.

Meanwhile, I can see early signs of restlessness(withdrawal) among us waiting for early release from the lock-up and resume the customary mode of evidence-based cardiology practice.

As I complete this write up . . . .surprised to find this report from TCT MD. Similarities if found, could only be coincidental.

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What is Interventional cardiology ? I don’t know , . . I am in pursuit of a curious new definition !

Posted in Uncategorized, tagged , , , , on February 2, 2019|

Let me see how many find sense in this Nonsense !


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Dear Government of India, please leave the coronary stents alone ! They are(not) our staple diet !

Posted in Ethics in Medicine, Future cardiology gadgets, innovations in cardiology, tagged , , , , , , on February 18, 2017| Leave a Comment »

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 !

stents-india
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 !

sir-william-osler

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 .

Visit the site for more Info

http://nppaindia.nic.in/

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A crazy cardiology tweet and a wish !

Posted in bio ethics, tagged , , on February 27, 2015| Leave a Comment »

I was recently asked to suggest a topic for debate on STEMI in  a major Indian cardiology conference. I wished , this is what we  should be mulling  over, with a set of  virtual  guest lectures and special invitees from heaven ! Plenary  session : State of the Art  STEMI care             Time :  11.AM ,  Speaker : Dr Hippocrates Topic : Aren’t  we erring   on either side of the  Noble profession ? Moderator:  Dr. William Osler Chairperson :  Dr .Harvey Cushings, Dr,Sir Thomas Lewis ,Dr Paul Wood , Excerpts : “While , vast number of  our country-men’s  culprit artery doesn’t even get that  mandatory  Aspirin on time . . . an urban rich  man’s  distal non-culprit artery  is decorated with a fancy  bio-vascular scaffold making  that innocuous lesion vulnerable in the process as well !  Aren’t  we erring   on either side  in the  Noble profession ?

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Say “nay” to ICUs, we need more Intensive “human care” units !

Posted in bio ethics, cardiology-ethics, tagged , on January 26, 2015| Leave a Comment »

As I was mulling about  the misplaced  priorities  in modern health delivery  , today’s (25-01-2015) edition  of  “The Hindu” , India’s National newspaper carries an exact article by Dr B.M.Hegde .

No doubt  ,his articles are constantly criticized  by the scientific community for  the simple reason, he is forcibly  trying to add wisdom to science !

 

 

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