Dr Biswaroop Roy Chowdhury’s book, Heart Mafia, talks about how some doctors wanting to make quick money are performing bypass surgeries and angioplasty without looking at the third option. Propagators of non-invasive surgery tell SHAlINI SAKSENA that with hospitals getting 40% of their profits from the cardiac department, natural bypass therapy is completely ignored
July 2005: A 60-year-old Delhi University professor was told that if he didn’t go for a bypass surgery, there was 90 per cent chance he will suffer a massive heart attack. The professor had no choice but get himself admitted to a heart institute in the Capital. The doctor told him that after the surgery his life would be back to normal. Nine years down the line and he continues to be on a very strict diet. He can’t eat his favourite foods — ice cream and mithai. And is advised strenuous exercises to keep his heart fit. For the professor, life has taken an ugly turn ever since the surgery. He feels he was leading a better life before it happened.
August 2007: Sixty-eight-year-old Government employee didn’t have any major health issues till his thyroid started acting up. It was during a routine check that a blockage in the heart was discovered. He was rushed to Delhi. The cardiologist told him that three of his arteries were blocked — one 70 per cent, the other two 60 per cent. While he was not keen on a bypass surgery, his family insisted upon it. A day later, he underwent surgery. The doctors told him he will be allowed to go home in a week’s time. But he was in the ICU for three weeks. Once home, his problems didn’t ease. It has been seven years since the surgery, there is constant pain in both legs from where the arteries were taken. Instead of feeling fit, he feels burdened.
Such cases, where the patient has undergone a surgery and never fully recovered are dime-a-dozen. Today, heart attack is the No 1 cause of death across the globe. India is leading with 60 per cent of the world’s heart patients (WHO). Among heart diseases, deaths due to blockage of coronary artery disease is very high. Doctors tell you that heart blockages can be between 30-80 per cent. “logically heart attacks should take place due to a 80 per cent blockage but in reality heart attacks takes place because of 30-50 per cent blockages. That’s because 80 per cent blockages are stable whereas those between 30-50 per cent are fragile and can rupture anytime due to many reasons leading to a heart attack. When a doctor treats a blockage he only treats 80 per cent of the blocked arteries. The treatments that a doctor recommends for the blockage is either a bypass surgery or angioplasty,” Dr Biswaroop Roy Chowdhury, author of Heart Mafia, says.
Interestingly, both these procedures don’t ensure a lifelong cure. Within 12-18 months a patient may have to go for these procedures again because the arteries may get clogged up again. So the patient becomes a permanent customer of the hospital. According to the Archives of Internal Medicine 2012, Cochrane Database-2013 — “No benefits were seen in the patients who have undergone bypass surgery or angioplasty than those who didn’t opt for these procedures.”
So, what is the solutionIJ “Once a person has been diagnosed with a heart condition he must look for an alternative. Natural bypass also known as Collateral Circulation has been approved and acknowledged by the American Heart Association. In this, our heart makes its own bypass in case of any blockage. This happens when a patient is kept on a special lifestyle therapy diet plan. This does not require any hospitalisation. The death rate on operation table is zero and so are the complications,” Dr Biswaroop explains, adding that few doctors will tell you that there are alternatives to surgery or angioplasty.
“It is all about the money. While a bypass costs around Rs 3-Rs 5 lakh and involves a week’s hospitalisation, an angioplasty procedure (AP) costs around Rs 1.5-Rs 2 lakh and hospitalisation of two to three days is a must. The death rate on operation table during bypass is two per cent and rate of complication is 100 per cent. Whereas in the AP, death rate on the operation table is one per cent and the rate of complications is almost 100 per cent. These vary depending upon the problems involved during the procedures and the hospital one goes to. The more swanky the set-up, the more money one will end up paying,” Dr Biswaroop tells you.
Something that a 77-year-old retired Government official found out much to his horror. For four stents — American made which are supposed to be the best, better than the ones recommended by the CGHS and the European brands — he ended up paying Rs 11.96 lakh. This included the cost of his stay in the ICU, the room stay, doctor’s visits, the actual procedure and medication for his five-day stay. “A layman doesn’t know medical jargons. So, when he or his family is told that he will die unless surgery or stenting is done, they have no option. The hospitals get 40 per cent of their total revenue from their cardiology department by performing unnecessary heart bypass surgeries and angioplasties completely ignoring and hiding the third option of natural bypass,” Dr Biswaroop says, adding that it is only in 0.005 per cent cases that a patient may actually need bypass or angioplasty. In other cases, natural bypass is enough to cure the patient.
All that he has to do is follow a strict diet plan for a month in a year to clear any blockages. No refined oils or sugar, no animal products — this means no milk, butter, curd, paneer, chicken, fish, meats, etc. The person has to eat at least 50 per cent vegetables, 35 per cent fruits and the rest is cereals like wheat and protein like daal. “However, one must consult a doctor before going on this diet. The body’s vitals need to be checked and a proper diet chart mapped out depending on any other medication that the person may be taking. The important part is that people should know that surgery is not the only answer, that there are alternatives which are better. And that most doctors recommend surgery because they want the hospital to make money,” Dr Biswaroop says.
While Dr Rajneesh Kapoor, a leading cardiologist and director of Interventional Cardiology at Medanta-The Medicity, Gurgaon agrees that people must be educated, he doesn’t agree that all surgeries are conducted just to make money. “It is wrong to say that heart surgeries are conducted without going into the case history of the patient. No doctor will do so just to make a profit on the patient’s ignorance. Each case is carefully examined. It is only after much deliberation that a decision is reached. And then also, the patient and his family is given all the options — the pros and cons of each procedure, in this case bypass or stenting. In fact, doctors today, ensure that any question posed by the patient is answered,” Dr Kapoor tells you.
However, he tells you that some doctors recommend only surgery as a means to make money for the hospital. But such instances are few. “We have some of the best cardiac surgeons in the world. Foreigners come to India for treatment. Doctors really don’t need to stoop so low just to make money. People come from other countries not only because we have the best doctors but also because the cost of such surgeries is much cheaper,” Dr Kapoor says.
Other doctors tell you that money plays an important role but it is all from the patient’s end. Not everybody can afford to go in for a bypass surgery or a single stent that costs around Rs 3 lakh. In such a case we do recommend that instead of bypass they can go in for stenting that has been recommended by CGHS. It is for approximately Rs 30,000. However, Dr Biswaroop disagrees. “Why else would some doctor boast of performing 50,000 heart surgeriesIJ Why would a doctor perform an angioplasty in just 16 minutes with the intention of creating a world recordIJ Why would a doctor implant a stent on a 104-year-old risking the patientIJ And why would a doctor say that he has done 20,000 angiograms which are unnecessary, unreliable and life threateningIJ These are all profit-making diagnostic procedures,” Dr Biswaroop asserts.
Dr Yugal Mishra director, cardiac surgery at Fortis Escorts Heart Institute & Research Centre tells you that there are certain guidelines that have been laid down by the American College of Cardiology/American Heart Association 2007. All doctors follow these guidelines when it comes to treating a person with a heart condition. “Cardiologists are gatekeepers of a person’s health and once a patient comes to us there is a panel of three doctors — cardiologist, heart specialist and a heart surgeon — come together and decide on the course of action that needs to be taken. Also, the cases where patients have had post-operative problems are rare. Since 2002, heart surgeries have undergone a sea of change. We are now in the era of minimal operation. Gone are the days when the rib cage had to be opened and the heart put on machine while the surgery was conducted. Today, heart operations are done on a beating heart. This has reduced complications,” Dr Mishra opines.
“It is not about cheaper surgery, it is about how doctors are randomly conducting bypass whether a patient needs it or not. Once a person has had a surgery, it means regular trips to the hospital besides the exorbitant cost of the surgery. If a patient is cured permanently, how will this help the hospitalIJ It is the patient who has no knowledge who ends up paying. Why will a doctor recommend natural bypass where, the hospital will only end up earning say Rs 1,500 as opposed to Rs 5 lakh,” Dr Biswaroop who has been advocating natural bypass therapy for 20 years, tells you.
Dr Bimal Chhajer at Saaol Heart Center an ex AIIMS cardiac physician and a pioneer in non-invasive cardiology in India tells you that cardiologists, interventional cardiologists and the heart surgeons have been exploiting the heart patients for decades to make money. “This is because the margin in such surgeries is high. There is a nexus between the manufacturers and doctors and it is the patient who ends up paying his entire life’s savings. Instead of telling the patient what leads to a heart disease, what they should do so that the blocks do not come up and what kind of food they should take to stop or reverse the disease, doctors are operating on these unfortunate heart patients or putting them on anti-angina medicines,” Dr Chhajer says.
And the reason this is happening is because the number of heart patients has increased and so is the number of deaths due to heart attack. When the heart patient reaches the hospital, the doctors create a fear psychosis that a heart attack is a minute away. In the panic response most of the patients and their relatives agree for an operation.
However, this can be avoided if people educate themselves. “People should know what causes a heart attack and that operation is not the only solution,” Dr Chhajer says.
The rulebook
Simple risk factor scoring is the first step of preoperative cardiac risk evaluation.
Cardiac testing for the presence and extent of coronary artery disease is only recommended in patients with three or more clinical risk factors scheduled for high risk surgery.
Stress-induced myocardial ischaemia, as a functional marker of coronary artery disease, is an important risk factor for perioperative cardiac events.
left ventricular dysfunction occurs frequently in the elderly and interferes with perioperative management, such as the starting dose of beta-blocker therapy.
Secondary prevention of complications of atherosclerotic disease, such as lifestyle changes and medical therapy should be initiated prior to surgery, as interventions improve both perioperative and late outcome.
Patients on chronic beta-blocker therapy should continue medication during surgery.
In beta-blocker naïve patients in whom these blockers are recommended, a low-dose started at least one week prior to surgery is recommended. The dosage should be given to achieve heart rate between 60 and 70 beats per minute.
In patients on perioperative beta-blocker therapy tachycardia should lead first to the treatment of an underlying cause, for example hypovolemia, pain, blood loss or infection, rather than simply increase the beta-blocker dose.
Statins with a long half-life or extended-release formulations are recommended to bridge the period immediately after surgery when oral intake is not feasible.
Discontinuation of aspirin therapy should be considered only in those in whom it is foreseen that haemostasis is difficult to control during surgery.
Prophylactic coronary revascularisation in cardiac stable patients is rarely indicated to get the patient through operation.
Timing and type of preoperative coronary intervention options should be discussed with the treating surgeon and anaesthesiologist, as anti-platelet therapy (aspirin and/or clopidogrel) influences perioperative management.
Postoperative prevention of hyperglycemia (targeting levels at least below 10.0 mmol/l (180 mg/dl) with intensive insulin therapy is recommended after high-risk or complicated major surgery requiring admission to ICU.
— These guidelines have been propounded by European Society of Cardiology guidelines
