Posted in bio ethics, cardiology -Preventive, medical quotes, Two line sermons in cardiology, tagged cardiology ethics, conflicts of interest, doctors honesty, future of medicine, hippocrates oath, medical auditing, medical bio ethics, medical commerce, medical economics, medical ethics, medical research, moral education for medical students, motivated research, physician behavior, stemi primary pci, teaching ethics for doctors, unethical medical practices on April 14, 2014|
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Tree of life : When professional morality suffers a mortality . . . human health becomes a causality !
Greatest threat to the future of human health is . . .
- Not from exotic infectious agents , bird flu or mosquito fevers
- Not from epidemic of cardio vascular disease
- Not from thousands of published diseases in ICD code
- Not from aging population and failing vital organs
- Not from lack of availability of life saving drugs and devices
- Not from lack of hospital beds.
- Not from good sanitation
- Not from hunger and poverty
- Not from lack of para medical workers
- Not from lack of health awareness and education
But from . . .
- The way health care is administered in this planet .
- The way noble professionals are created .
- The way trivial health issues prevail over major health crises that wallop the health budgets.
- The way by which medical morality is systematically destroyed
- The way “concept of health” is sold as a buyable commodity by insurance companies.
- The way medical journals churns out junk articles in the name of research.
- The way corporates indulge in delirious pursuit to increase bed occupancy rate of their patient ware houses (Also called Hospitals)
- The way greedy drug companies aim to increase the per capita drug consumption of ill informed homo-sapiens by discovering pseudo drugs for pseudo illness
- The way health insurance policies are misused
- The way rich spend billions for reconstructive cosmetic surgery while the poor die for want of basic medicines !
Link to a wonderful article on moral education for our kids in medical school !
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Posted in Uncategorized, tagged acc.aha, acs, angioplasty, bmj, circulation, cypher, des, drug abuse, ethics, europcr, evidence based cardiology, long stent, medical auditing, nejm, nstemi guidelines, pci, primary pci, ptca, rescue pci, scai, sirius, sirolimus, stemi guidelines, stents, sub acute stent thrombosis, taxus, tctmd, thrombolysis on January 18, 2009|
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Drugs are poisons , whenever it is administered without valid purpose. it can enter human body in many ways (Oral, intravenous, percutaneous etc ) And now we have another route namely intracoronary !
In quest for prevention of restenosis, many of the anti cancer drugs are now delivered directly inside the coronary arteries .These drugs are secreted like a sustained release tablet from the drug coated stents.These drugs are expected to prevent restenosis within the stented segment.But, after years of intense debate and research , we realised that , drugs eluted from the stent could damage the distal coronary vascular bed and coronary microcirculation.( And thus came the epidemic of acute stent thrombosis ! )
The tender and sensitive coronary microvasculature is constantly exposed to these powerful anticancer and immmunosuppresive drugs .It is a great surprise , no body thought of this dangerous drug -coronary artery interaction ! It required the genius of Renu virmani and others to point out this.
But still , the cardiology community by and large , fails to consider this an important issue.This is proven by the fact, usage of DES is still increasing and used mainly as an off label indication.
Read this land mark article from circulation
Questions that need to be answered
- What is the long term effects of drugging a coronary artery ?
- Is no reflow or slow flow more common after DES , because of the adverse drug reaction in the distal vascular bed ?
- If a patient with DES undergoes a CABG later what would be the impact of the drug on the graft ? Will the functional vasodilatation affected ?
A drug , to get a legal clearance it has to undergo hundreds of rigorous tests . Finally it is cleared for that specific indication for which it is tested .Just because a drug is cleared for one purpose ( Paclitaxel for malignancy ) it does not mean it is safe to use for any other purpose for which it is deemed to be useful . Exactly the opposite is happening in the the field of interventional cardiology . No body wondered to think what would be the effect of these drugs on the normal coronary endothelial cells and vasculature.Is it not a crime , without analysing this particular issue , dozens of drug eluting stents have been released in the market . And now, sounds of crying foul is heard world wide !
Let us thank , the so called negative forces in cardiology for making this an issue . In science , the watch dogs should bark at times of danger not wag the tail !
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Posted in cardiology -Therapeutics, tagged ACE INHIBITORS, Add new tag, ARBS, cardiology, drsvenkatesan, drug trials, drugs, ebm, emprical medicine, ethics, evidence based cariology, futile medicine, jama, lancet, medical auditing, nejm, ONTARGET, pharma industry, TELMISARTAN on July 27, 2008|
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Peer review of an article even in major journals never scrutinise the “Aim of a study ” . However big is the journal, they seem to bother only about the authors, materials, methods, and statistical analysis. If only they peer review an article , right from the “Aim of the study” like ,
- Who asks the research questions?
- Who defines the aim of the study ?
- Who decides which drug to be compared with which drug ?
- Who steers the steering commitee of a trial ?
If only , we could answer these questions without bias , pharma industry and their regulators would have , far more better image than what they have now !
A typical example for , the aim of the study to be wrong , is the “ONTARGET’ study on telmisartan.
Here they ( Who ? ) raised an inappropriate question of “Non inferiority” of one drug with other without any valid reason to compare these two drugs that will benefit the man kind !
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