Coronary angioplasty is a procedure used to open blocked coronary (heart) arteries. The procedure improves blood flow to the heart muscle. The blockage usually is due to a blood clot that forms within the artery. During angioplasty, a small balloon is expanded inside the coronary artery to relieve the blockage. A shortcoming of angioplasty is that the artery frequently narrows again over time. However, the risk of this happening has been reduced with the arrival of “stents”, especially stents coated with medicines (drug-eluting stents). Stents are small mesh tubes that support the inner artery wall and prevent the dilated artery from collapsing. However, stents aren’t without risks. In some cases, blood clots can form in stents and cause a heart attack. But overall stents have been a definite advance with a view to prevent re-blockages.
When “stents” became the rage years ago few would fancy that they would come handy to health providers one day to swindle innocent patients. The government has a Telecom Regulatory Authority of India (TRAI) to regulate prices of telephony, an electricity regulator to control power prices and so on. But India has no body to ensure that stent manufacturing companies do not overcharge patients. The result is loot.
The news that stents imported for Rs 25,000 are sold to patients for Rs 1.55 lakh is really heartbreaking. “Heart patients in various parts of India pay 700% more than the import cost for stents”, revealed the first-ever cost survey by the Maharashtra Food and Drug Administration (FDA) which also showed that “the maximum retail price (MRP) itself is grossly exaggerated and left to the whims and fancies of distributors or other middle agencies”. The FDA, during a six-month-long survey, tracked companies that import stents from the West and sell them to Indian distributors. The investigation exposed “unregulated profit-mongering at each step of the supply chain”. The report said that company importing the stents itself made a profit of 120% before selling it to the distributors.
Due to such exorbitant pricing, the importing company, distributors and hospitals are minting huge profits while patients suffer. The profit percentages that are clearly borne by the patient are allegedly “used to bribe doctors to help push their products”. In spite of several complaints by alert patients, those in the know, aver that business practices have not changed as doctors and hospital managements continue to be bribed through distributors to increase sales of devices.
When contacted, Medtronic USA, Abbott as well as Johnson and Johnson which are the stent manufacturing companies declined to comment about the investigation that was carried out into the allegations of bribing by their distributor. They merely stated: “We have an extensive compliance program to assess the conduct of our employees and if necessary we take action against those who violate its policies and the law. We do not condone nor do we tolerate improper payments of any kind, and we will continue our efforts to ensure compliance with all applicable Indian and US laws.”
But the sad reality is that multi-national companies, despite what they swear under their breath do not care as long as the distributor is willing to do the bribing of doctors using the huge margin to help the company increase its market share. Few customers in India would even dream that such “reputed” foreign manufacturers have already been penalized heavily in the US, at one time or another, for bribing doctors to boost their sales.
With nobody is cracking down on such practices in India, the bribing continues unabated. A survey carried out among some Indian cardiologists finds them dodging the issue by stating that nowadays “four out of every ten stents used in Indian hospitals carry a local tag”. Indian stents offer a price advantage. But in practice, the appalling reality is that the majority of cardiologists in India show a definite preference for imported stents. Indian stents are a mere copy of the foreign ones and have little to back in terms of scientific data. It is regrettable that Indian companies (with an eye on profits alone) shy away from subjecting “indigenous stents” to rigorous scrutiny investing in research. Dr Prafulla Kerkar, who heads the cardiology department of KEM Hospital in Parel is blunt enough to say, “I have never used a stent that hasn’t been thoroughly researched. Even for the poor patients operated under the Maharashtra-government-run Rajeev Gandhi Arogya Yojana, I prefer to use an imported stent specially procured by the state government at the cost of Rs 23,000”.
What happens at our Goa Medical College? Here, as we all know, patients are lucky to get stents free of cost (independent of their income bracket!). But we are not aware whether the GMC cardiologists use indigenous or imported stents. We also don’t know as to where the GMC procures its stents from and at what cost. The answers are important because it’s patients’ lives and taxpayer’s money that are involved. Today, more than ever stents, surgical appliances, pacemakers and implantable defibrillators have come to symbolize rampant corruption in the Indian healthcare system.
In his book “A Man without a Country”, Kurt Vonnegut, wrote, “No matter how corrupt, greedy, and heartless our government, our corporations, our media may become, the music will still be wonderful…” Kurt’s words will surely gladden the hearts of profiteers and racketeers. For most of us at the receiving end, however, the “music of corruption” is awful and the vibes an injurious expensive cacophony.
(Dr. Francisco Colaço is a seniormost consulting physician.)
