ANGIOPLASTY & BYPASS SURGERY

Bypass Surgery/Angioplasty – Money or Hype!

Bypass Surgery and Angioplasty are probably the most over performed surgeries in the world today. Though the efficacy of these surgeries are still in question, every hospital today wants to add this facility for patient. The Cardiologists and Surgeons recommend these surgeries left and right with so much confidence as if these are the most authentic operations with no chances of failure. Though these are the most expensive surgeries, the failure rate is very high – still they are favorites of the performing Cardiologists (called Interventional Cardiologists) and Surgeons. These surgeries have been so much hyped that many common people have started believing them to be the “State of Art” treatments. Every third or fourth patient meeting me to learn our lifestyle program – is a failed patient of these surgeries. Every second of these operated patients suffers from complications or side effects of one kind or other. I wonder why people still not been able to discard these operations? Why?

The cause of these grossly over performed, unnecessary surgical procedures are not the disease or treatment effectiveness but “huge minorities gains to those who operate or the hospitals where the operations take place.” Gross over pricing of these operations – leaving a lot of scope got profits (as compared to any other operative procedures) has led to this extra-ordinary push up to these surgical procedures. The margin is so big (average about one lac per patient) that every other negative point has been nullified. When one type of procedure fails – a new similar procedure will be developed. The names of the operations are changed ; slight changes are made to develop a new-named operation. This makes people to believe that the new lure is so much that the show not only goes on and on but flourishes too.

With 5 crore heart patients in this country the market of these operations is so big that the scope of expansion is also enormous. In the recent days I have noticed that every month one or two hospitals in the metro cities are starting Bypass/Angioplasty hospitals – they also want to have their share of income. At the present day about 50,000 Bypass operations and another 60-70 thousand Angioplasties are being performed in India per year. With such a demand supply ratio-the availability of patients is not a problem the hype is on. Most of the patients are scared when they reach heart hospitals – all they need to do is to convince the patients or pressurize them to undergo these operations. All the money is made. When it has become business money is main consideration.

The hype about bypass surgery and angioplasty is so much that in many societies getting a Bypass operation done is considered prestigious for the patient. The hospitals also match this hype by providing five star facilities. If you visit some of these up-market Bypass/Heart Hospitals – you can make the difference between the Hotel and Hospital with difficulty. In a metro city a five-star hotel was recently taken over by a heart institute to open a deluxe heart hospital. They will certainly recover the cost of the investment very soon – at about 100,000 per operative procedure.

I do not intend to hurt, insult or criticize any particular invasive cardiologist or heart surgeon. I condemn the whole system by the bypass surgery or angioplasty and the increased trend of business activity associated with them. The same opinion is expressed by many authorities in Medical Science.

WHICH SHOULD BE THE SUBSTITUTE – LIFESTYLE OR BYPASS/ANGIOPLASTY?

Most of my visitors ask me this question – which one is the substitute? Initially or before visiting the heart hospital people believe that lifestyle changes should be the first choice, but once they are inside these heart institutes, the belief changes. They suddenly start believing that Bypass Surgery (CABG) or Angioplasty (PTCA) is/are the only answer. Only those who decide against a bypass or angioplasty need lifestyle changes. These days the interventional cardiologists and bypass surgeons have suddenly succeeded in introducing this belief in the heart patients.

What is wrong unnatural, less scientific and gives short-term results has been taken as the first choice. The treatment which is more scientific, non harmful, rational and given long-term results has been looked down upon. Thanks to the non-interfering cardiology community who are not protesting and is a silent onlooker. The credit goes to the interventional cardiologist (who perform angiography, angioplasty) and by-pass surgeons whose aggressive approach has so far succeeded. Many of the cardiologists have also been blindly helping them.

If I give an estimate even to a blind supporter of bypass and angioplasty he will also agree to my argument. The WHO estimated the number of heart patients in India as 5 crores in 2001. In the next ten years the worsening lifestyle is supposed take this number to about ten crores. To prevent this, shouldn’t we advise lifestyle changes to these 5 crore people, who are yet to get a heart problem, but heading towards it? And if that is so, then why should the other 5 crore who already have heart disease be left behind, when such lifestyle changes can arrest the progress of the disease or even reverse it? (heart disease means a blockage of more than 70% in one or more of heart arteries).

If the bypass surgeons and angioplasty doctors still do not relent from their position lets think of another option. Let them first take on the task of operating all these 5 crore patients. With an approximate annual capacity of 100,000 per annum (inclusive of both bypass surgery or angioplasty) in the whole of India they will have to work non stop for about 10 years to finish the lot! Still there will be twice the number of new patients. By that time most of the operated patients will be back with reblockages. Can they still ignore the lifestyle changes? All these people need is a lifestyle change as the first choice.

Lifestyle change is superior, preferable, long lasting, non-invasive treatment of coronary heart disease. CABG/PTCA are in no way comparable to lifestyle changes; not even a substitute.

Immediate and symptomatic relief for the heart patient can always be achieved by using allopathic drugs. If the blood pressure, blood sugar and angina are to be controlled SAAOL would not hesitate to use medicines. To prevent an impending heart attack – use of blood thinning agent is also a part of SAAOL. But all these heart patients must also change their food habits, manage stresses and exercise with proper guidance. We have seen, with accurate lifestyle changes Bypass Surgery and Angioplasty can be easily avoided.

Once a heart patient  reports to a hospital, even with an emergency a modern heart institute should ideally take care of the emergency with drugs and supportive instrumentation- and then give them adequate lifestyle advice. Only those who refuse to follow lifestyle advice should be allowed to go for bypass or angioplasty.

Being a strong advocate of lifestyle changes but surrounded by the operation hungry heart specialists, many a times I start wondering, whether I am going in the wrong direction. Many of these cardiologists make me feel that advising lifestyle changes to the heart patient is entirely a wrong proposition. But when I start using my common sense and rational thinking. I know how wrong that momentary thought was.

 

Hope you liked this blog!

This article is written by Dr. Bimal Chajjer (Best heart doctor)