Indian Doctors bent on Stent

Unnecessary stent usage worries doctors across India

Unnecessary stent usage worries doctors across India
Stents, the scaffolding devices inserted into blood vessels to keep them open, are used if the patient has more than 70% block of an artery.
Lured by freebies and kickbacks from stent manufacturers, an increasing number of doctors are using the device even on heart patients who don't need them.

So blatant has this practice become that in Hyderabad, eminent cardiologist Dr D Seshagiri Rao, head, department of cardiology,(Nims), was caught red-handed on Monday while accepting a bribe of Rs 1.6 lakh from a stent supplier. He was arrested.

Stents, the scaffolding devices inserted into blood vessels to keep them open, are used if the patient has more than 70% block of an artery. But doctors confide that stents are used even when the block is less than 30%. This not only inflates the bill, but increases the risk of a heart attack, say cardiologists. In fact, a study byNational Heart and Lung Institute in the US found that 1-2% of people who have stented arteries develop a blood clot at the stent site which can cause a heart attack or stroke.

"When stenting was introduced, it was hailed as a medical breakthrough, but patients are now being advised to go through the procedure even when the clot can be treated through aggressive medical intervention or through a bypass," says Dr B Soma Raju, chairman of CARE Hospitals, Hyderabad, and a pioneer in this treatment.

Dr Sai Satish, an interventional cardiologist at Apollo Hospitals, calls the trend "criminal." "Last year I received at least four patients who were advised to go in for angioplasty when the problem could have been remedied through medication. We need a system to check this," he says.

According to unofficial estimates, around 3,00,000 stents are used in India every year. At present, three kinds of stents are available: bare metal stents (BMS) which hit the market in the late 1980s, drug eluting stents (DES), which are coated with a drug and the more recent bioabsorbable stents which dissolve in the artery after a year.

While DES accounts for 70% of the market, BMS accounts for 25% and the more expensive bio absorbable stents, 5%, say stent manufacturers. "It is a booming industry. Previously most of our stents were imported but now competition within the country is stiff. In Chennai, there are close to 20 stent suppliers," says Suresh Kumar of SNK Cardio Stents Enterprises. International giants like Abbott and Johnson & Johnson are active players in the Indian market.

Stent suppliers claim that hospitals buy stents in bulk at reduced prices and sell at a high rate to patients. "We sell a bare metal stent for around Rs 20,000. Doctors charge patients Rs 35,000 for it," says a stent supplier in Chennai.

Several cardiologists admit that doctors get incentives from the manufacturer for every stent used. "It is difficult to detect the practice, but once found, the doctor's license is immediately cancelled," says cardiologist Dr K K Aggarwal, vice president-elect of the Indian Medical Association. "The patient should take an informed decision," he says. "It is advisable to go for multiple tests to assess the block before giving consent for the procedure."


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