November 28, 2006 11:43:08 pm
The report, ‘In polio dark zone UP, Urdu daily puts one more spoke in wheel’ (IE, November 16), hints at the irresponsibility of a section of the Urdu press which highlighted out-of-date research that indicated that the oral polio vaccine might cause cancer. Photocopies of the story in Aag were “widely distributed” in the Chinhat area, causing many families to reject the pulse polio vaccine for their children.
On the same day, The Indian Express carried a Page 1 report from the New York Times, ‘Angioplasty 25 hrs after heart attack no good, says new study’. Did anyone consider what damage the distribution of photocopies of this report might do?
The US study rightly stresses that “doctors should stop trying to open arteries in people who had heart attacks days or weeks ago and who are stable and free of chest pain.” The spin the headline gives to the story, however, is that angioplasty must be performed within a day of the heart attack.
The first need of anyone who has suffered a heart attack — an acute myocardial infarction (MI) — is rest. The second need is apt medication, usually thrombolysis (to dissolve the blood clot blocking the artery) and sedation. Angioplasty, when indicated, is done at hospitals with an efficient, round-the-clock cardiology department with a modern lab and X-ray department. In our country, not every patient with an MI can be treated in such a department. The quality of treatment in many government-run hospitals and private clinics is dismal but there are hundreds of very good hospitals in the suburbs and rural areas. In these modest centres, MI patients are managed safely by doctors following conservative methods of treatment.
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Last year when I was practising in rural Karnataka, a lady well into her 80s was brought to the hospital after an acute MI. We admitted her to the ICU and started proper treatment. The family knew a top physician in Chennai who recommended angioplasty. Over the phone I told him it was only a few hours since the MI, and she could not be moved 1,000 kms. “Airlift her,” he urged me.
The newspaper headline of November 16 can cause patients and their relatives to panic. Patients will be rushed to cardiac centres for “urgent angioplasty” in ambulances speeding over pot-holed roads when still unstable — that is, with severe pain, low BP and shallow breathing. There is likely to be further deterioration and death is not unlikely.
All medical and surgical decisions must be taken with a sense of responsibility towards the patient. This is not an easy thing to do in India, where a lot of misinformation, false beliefs, greed and financial constraints influence medical care. The necessity of angioplasty is best decided by a good cardiologist. However, tens of thousands recover from an MI with conservative management. It is imperative that we consider many parameters before shifting a patient a few hours after an acute heart attack. A word of caution about this would have enhanced the value of the November 16 news report.
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