Indeed the question is who benefits when I undergo stenting for my heart attack? I thought the answer is obvious - Me! If the answer is so obvious, I would not have posed this question in the first place.
To the uninitiated, STENT is a way of making sure that blood flows once again in the vessel (coronary artery supplying blood to a portion of the heart in this instance). This is based on a sound principle that the heart attack is indeed caused by the sudden stoppage of the blood supply to the heart muscle in the first place. (A reduction usually happening slowly not amounting to a sudden block would result in a less dangerous 'warning signal'of ( the possibly oncoming) heart attack - known as 'Angina pectoris (meaning 'chest pain'). The process of removing the block and preventing a further block is done using 'clot busters' - chemicals that dissolve the clot. However these on their own cannot prevent this from happening again. It is precisely for this purpose permanent measures are undertaken to make sure that that enough blood flows through the arteries of the heart once again - these procedures are called 'revascularisation' procedures. An angiogram ( dye injection to visualize the arterial tree oft he heart ) is done first. This helps in making sure that there is a block ( or many blocks) in the first place and the size and location of these blocks. Depending on the feasibility, the patients are taken up for the medical procedure of Angioplasty (by which the blocks are removed) and stenting is done to make sure the vessels which have been opened up are prevented from getting blocked again.There are many types of shunts available - the ordinary ones wich keep the artery open ; the drug eluting ones which hopefully prevent the blockade from happening once again by having a small dose of anticancer drugs which are known to slow down the cell multiplication ( the basic principle of treating cancer anyway). These are many times more expensive than the ordinary stents. Then there are the so called 'vanishing stents' which are supposed to merge with the arteries and keep them open longest. These are priced highest - in fact, many times more than the ordinary ones.
Now we come to the basic point - HOW ARE THE STENTS PRICED? Basically there are 2 priciples of pricing anything - 1. The costs incurred. 2. The exclusivity. It is the neighbour's selling price that often determines the cost of the item most of the times. Thus a logical balance is struck - depending on the demand and supply position. This delicate balance is sometimes offset by EXCLUSIVITY of the product and the SERIOUSNESS OF THE SITUATION. In the case of stents BOTH these factors operate. This gives a free hand for the manufacturers to grossly overprice the product. This is what exactly happened to the 'Vanishing stents' sold by Abbot in India. The customers were royally fleeced to the core because there were no rivals. The worse news is that it has been found that even the so called vanishing stents get blocked many times defeating the basic purpose. Now we come to the point - the unsuspecting client is made to pay for the CONCEPT which has NOT been proved! You might ask me the question how on earth is this possible because even the drugs undergo extensive trials and attempts are made to obtain adequate proof before these are used on the patients. How then the stents get away? Brings us to a glaring fact that there is NO NEED to conduct trials before the DEVICES are used on human beings - and believe me, stent is one such device. How then can we remedy this seemingly iremediable problem where the ABBOT COMPANY MAKES HUGE PROFITS WHETHER THE END USER ( THE PATIENT WHO SUFFERED A HEART ATTACK) LIVES OR DIES OR BENEFITS OR NOT.The Abbott company DOES NOT EVEN MENTION THE MRP which has to be compulsorily mentioned by even products like toothpaste! I discussed this issue with legal authorities and patients who had suffered. I felt very sad after I was made to know that there is NO LIMIT ON THE MRP OF PRODUCTS CREATED BY ESEARCH for which there are no alternatives. I then understood that the ball is in the court of the consumer - the patient and addresssed may fora on this and related topics. No one saw the urgency in the issue till a kit or kin of theirs developed a heart attack and there was no time for these discussions.
When I almost gave up, I found a good news on the newspapers today that the MRP OF THE DEVICES HAS TO BE COMPULSORILY MENTIONED. Now there is some kind of a hold on the companies like Abbott. I am not for a moment saying that they are the only ones in this dirty game. There are many other devices like pacemakers, intra cardiac defibrillators, artificial joints, ocular implants, heart valves, disposable syringes and many more items manufactured by many companies. Now some sort of regulations will come int place. It has been also mentioned that attempts are being done to notify these products as drugs and compulsorily bring them under the Drugs and Cosmetics act1940. If this happens, their prices will be monitored and regulated making the whole process fair to all concerned including the stake holder - the patient. Therefore with this single act of the government, there will be more people benefitting fairly when a person undergoes stenting!
To the uninitiated, STENT is a way of making sure that blood flows once again in the vessel (coronary artery supplying blood to a portion of the heart in this instance). This is based on a sound principle that the heart attack is indeed caused by the sudden stoppage of the blood supply to the heart muscle in the first place. (A reduction usually happening slowly not amounting to a sudden block would result in a less dangerous 'warning signal'of ( the possibly oncoming) heart attack - known as 'Angina pectoris (meaning 'chest pain'). The process of removing the block and preventing a further block is done using 'clot busters' - chemicals that dissolve the clot. However these on their own cannot prevent this from happening again. It is precisely for this purpose permanent measures are undertaken to make sure that that enough blood flows through the arteries of the heart once again - these procedures are called 'revascularisation' procedures. An angiogram ( dye injection to visualize the arterial tree oft he heart ) is done first. This helps in making sure that there is a block ( or many blocks) in the first place and the size and location of these blocks. Depending on the feasibility, the patients are taken up for the medical procedure of Angioplasty (by which the blocks are removed) and stenting is done to make sure the vessels which have been opened up are prevented from getting blocked again.There are many types of shunts available - the ordinary ones wich keep the artery open ; the drug eluting ones which hopefully prevent the blockade from happening once again by having a small dose of anticancer drugs which are known to slow down the cell multiplication ( the basic principle of treating cancer anyway). These are many times more expensive than the ordinary stents. Then there are the so called 'vanishing stents' which are supposed to merge with the arteries and keep them open longest. These are priced highest - in fact, many times more than the ordinary ones.
Now we come to the basic point - HOW ARE THE STENTS PRICED? Basically there are 2 priciples of pricing anything - 1. The costs incurred. 2. The exclusivity. It is the neighbour's selling price that often determines the cost of the item most of the times. Thus a logical balance is struck - depending on the demand and supply position. This delicate balance is sometimes offset by EXCLUSIVITY of the product and the SERIOUSNESS OF THE SITUATION. In the case of stents BOTH these factors operate. This gives a free hand for the manufacturers to grossly overprice the product. This is what exactly happened to the 'Vanishing stents' sold by Abbot in India. The customers were royally fleeced to the core because there were no rivals. The worse news is that it has been found that even the so called vanishing stents get blocked many times defeating the basic purpose. Now we come to the point - the unsuspecting client is made to pay for the CONCEPT which has NOT been proved! You might ask me the question how on earth is this possible because even the drugs undergo extensive trials and attempts are made to obtain adequate proof before these are used on the patients. How then the stents get away? Brings us to a glaring fact that there is NO NEED to conduct trials before the DEVICES are used on human beings - and believe me, stent is one such device. How then can we remedy this seemingly iremediable problem where the ABBOT COMPANY MAKES HUGE PROFITS WHETHER THE END USER ( THE PATIENT WHO SUFFERED A HEART ATTACK) LIVES OR DIES OR BENEFITS OR NOT.The Abbott company DOES NOT EVEN MENTION THE MRP which has to be compulsorily mentioned by even products like toothpaste! I discussed this issue with legal authorities and patients who had suffered. I felt very sad after I was made to know that there is NO LIMIT ON THE MRP OF PRODUCTS CREATED BY ESEARCH for which there are no alternatives. I then understood that the ball is in the court of the consumer - the patient and addresssed may fora on this and related topics. No one saw the urgency in the issue till a kit or kin of theirs developed a heart attack and there was no time for these discussions.
When I almost gave up, I found a good news on the newspapers today that the MRP OF THE DEVICES HAS TO BE COMPULSORILY MENTIONED. Now there is some kind of a hold on the companies like Abbott. I am not for a moment saying that they are the only ones in this dirty game. There are many other devices like pacemakers, intra cardiac defibrillators, artificial joints, ocular implants, heart valves, disposable syringes and many more items manufactured by many companies. Now some sort of regulations will come int place. It has been also mentioned that attempts are being done to notify these products as drugs and compulsorily bring them under the Drugs and Cosmetics act1940. If this happens, their prices will be monitored and regulated making the whole process fair to all concerned including the stake holder - the patient. Therefore with this single act of the government, there will be more people benefitting fairly when a person undergoes stenting!
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