Medical science has grown ( and growing ) in an astonishing pace. Many of the inventions which were considered as major break throughs have fallen on the wayside over the years . Of course , quite a few withstood the test of time .
One of the great inventions of last century is per-cutaneous interventions inside the human coronary artery .
The concept was first conceived and executed by Andreas Gruentzig of Germany in year 1977. Now , at-least a million PCIs are done every year to tackle CAD with greatly improved knowledge base, evidence , hardware, techniques and expertise .
PTCA is an invention worth a Nobel prize . . .well , that’s what we cardiologists feel. The Nobel committee seems to think otherwise .
What could be the reasons ?
- PTCA is simply an extension of an old invention. Already the inventors of the cadiac catheterization were conferred with Nobel prize (Forssman, Cournand,Richards) . Hence , it is a sort of duplication of invention . If Gruentzig is conferred a Nobel prize the man who discovered the coronary stent (A plaque scaffolding device) will argue he too deserve a Nobel !
- What Gruentzig did was in-fact a fundamental human response by Instinct ! .When you encounter a mechanical obstruction on the road just try to overcome it . “Here is an obstruction impeding the blood flow , let me remove it” . He did this with a wire and balloon . There is not much intellectual innovation . It was delivery of a mechanical force through a wire . But what the Nobel committee should take it to account is , he did this in live human beating heart and cured of his illness most dramatically avoiding a need for surgery.
- Finally comes the vital question. What is the impact of this invention in the health of mankind. ? How many lives have been saved when compared to other modalities to treat the coronary artery disease ? *.This again is not convincingly answered especially in stable angina , for which Geuentzig originally developed this modality . One popular argument is , in terms of life saved and sufferings relived oral rehydration fluid or penicillin would beat PTCA most convincingly !
* Another possible reason is , the Nobel medical committee is probably well aware of the perennial controversy about role of Medicine vs Surgery vs PCI on the outcome CAD and the superiority of one over the other !
Final message
Whatever be the reasoning , Nobel committee has to rethink . Cardiologists all over the world would definitely agree if one man who have made a huge difference in their patient’s life , it must be Gruentzig .
It is well-known Nobel prize is given for path breaking research that break new grounds like decoding cosmic mysteries , expansion of universe , cell signalling , molecular mimicry and the stuff like that .
Still , Gruentzig definitely deserves a Nobel solely for the novelty in his procedure and in the process it helped avoid surgery in vast majority of heart patients.
Reference
http://www.nobelprizemedicine.org/
http://circ.ahajournals.org/content/93/9/1621.full
Video
http://www.angioplasty.org/video/aghero.ram
Dr.S.Venkatesan MD 