The medical common sense of being able to take medication and not give injections or fluids seems to be a bit of a bad idea at the moment, and routine procedures such as asking for a medical history and a physical examination are out of vogue, and have been replaced by the idea of being treated with 'the best' medication, undergoing the 'highest' tests, 'state-of-the-art' surgeries, and, of course, the most expensive.
Nearly 70-year-old Zhang Chunlin sat across from the reporter when he spoke obviously some shortness of breath, "Now I'm a burden to my family, if not installed at the time of the two stents, I am now at most angina pectoris, and will not suffer from a serious myocardial infarction."
One day two years ago, Zhang Chunlin and his partner went to a large hospital in Beijing for labor-type angina. After the examination, the doctor told him that the condition is very dangerous, it is recommended to install a stent in the coronary artery for treatment. Zhang Chunlin's daughter was working abroad in cardiovascular medicine. Originally, he wanted to communicate with his daughter to determine the treatment plan, but in view of the doctor's "emergency situation", he and his partner did not hesitate, decided to operate immediately. Soon, Zhang Chunlin was pushed into the catheterization room by the doctor, more than an hour surgery is completed, his body more than two stents.
Zhang Chunlin thought this was completely cured, but did not expect, just one year and two months later, he was admitted to the hospital because of heart problems, and this time the results of the cardiac imaging results show that the two stents are blocked resulting in acute myocardial infarction.
At this point, Zhang Chunlin's daughter returned home to visit her family, so he found a CD-ROM of the imaging procedure more than a year ago and showed it to his daughter. The daughter found that a section of his coronary artery was only 50% narrower, a relatively mild angina, medication can achieve good results, there is no need to install stents. Hearing this situation, Zhang Chunlin was very angry, and wanted to make the hospital responsible for his current condition through the law, "but considering that my daughter will have to go back to China for development, I think it's better to forget about it. She told me that this is the domestic hospital 'unspoken rules', I'm so messed up, she will not be able to get a foothold in the industry in the future."
The treatment of coronary heart disease includes three traditional methods: drug therapy, surgical bypass therapy, and medical intervention therapy, as well as newer therapies such as gene therapy, which is still in the early stages of research. In the 1980s, when the stent surgery-based coronary intervention technology entered China, it was hailed by doctors as a revolution in the history of cardiovascular disease treatment, and was called by patients as a technology that could "bring the dead back to life".
Xu Hao, chief physician of the National Center for Integrative Cardiovascular Diseases at China-Japan-Japan Friendship Hospital, told Beijing Science and Technology Daily that, in simple terms, cardiac stenting is to puncture a blood vessel, insert a catheter into the blood vessel, and place a cylindrical hollow metal mesh tube in the area where it needs to be placed, to hold open the obstructed blood vessel, so that the blood can circulate again. The procedure is not complicated; patients undergo the surgery under local anesthesia and are usually discharged after a few days.
But stenting is not a "once and for all" procedure, as medical professionals soon discovered, and the stent has a higher chance of restenosis, which is medically known as endothelial proliferation. The stent is a good way to open up the blood vessels, so that the original ischemic heart muscle to get blood supply, but the stent will continue to grow atherosclerotic plaque, so that the blood vessels are narrowed again.
Although the latest drug-coated stents, drug-eluting stents, can reduce the incidence of in-stent restenosis from about 20% to less than 10% and slow down cell proliferation, the problem of restenosis cannot be completely solved. Foreign studies have shown that from 1984 to 1999, the contribution of bypass and interventional treatment of stable angina to the decline in mortality was only 2%. Therefore, the attitude of doctors in some developed countries in dealing with coronary heart disease is usually that those who can be treated medically will never install a stent, and those who should install one will never install two, and that different specialists within a hospital, and specialists in different hospitals have basically the same understanding.
However, in this point, the domestic hospitals did not like the development of technology in tandem with foreign countries, and even appear backward.
The Ministry of Health medical risk monitoring and early warning expert group member, Beijing Kang Sheng Law Firm, director of the Department of Medical Affairs, Wang Heping told reporters, now the heart stent surgery in the country is very ubiquitous, he has been in contact with a number of similar disputes. 2010, a tertiary care hospital in Beijing, a 70-year-old male patient put 11 stents, the second day after the operation, the patient died, the check! The reason is coronary artery stenosis, originally put the stent is to expand the blood vessels, but put too much, but blocked the blood vessels.
In October 2009, a tertiary care hospital in Beijing gave a stenting procedure to a patient surnamed Cao at the same time as a cardiography examination, which was incomplete. Many of the stents were unable to pass through the patient's blood vessels during the surgery, but the doctors did not take remedial measures, but continued to harden in eight stents. Because the operation took too long, the patient suffered cardiogenic shock and died on the seventh day after hospitalization. A cardiovascular hospital in Chengdu, a patient put 17 stents "deeds" let many industry insiders are very surprised to hear.
Hu Dayi, chairman of the cardiovascular division of the Chinese Medical Association and director of the cardiac center at Peking University People's Hospital, also said that putting in a stent that shouldn't be put in is lifelong and one of the most serious forms of overmedication, and that it brings mental stress, medication side effects, and inconvenience to the patient when undergoing other surgeries, and will not disappear over time. For example, some patients will feel localized discomfort in the heart for a year after the stent is put in, and they will have to take clopidogrel for a year after the placement and aspirin for life to fight blood clots, both of which irritate the gastrointestinal tract and pose a risk of bleeding. He himself has encountered a number of "back to the furnace" patients, some of them do not meet the indications for intervention, but was placed in one or even more stents, because of the postoperative medication is not taken on time, thrombosis, leading to more serious myocardial infarction.
In 2008, there were about 188,000 patients receiving coronary intervention in China. The relevant person in charge of the Ministry of Health has said of this figure: "This does show that coronary intervention technology has been popularized and promoted, but we do not know how many of these cases are not in accordance with the norms. For example, the use of drug-eluting stents in patients with a low risk of restenosis and a high risk of bleeding is neither reasonable nor safe. The potential problems with drug-eluting stents require further study. It is indicated for most patients but not for all, but many hospitals do not care about this."
As for why the abuse of cardiac stents occurs, experts analyze that it is undeniable that some hospitals take it as an economic growth point, and doctors attach great importance to the benefits of stent surgery. A stent, which is only a few millimeters in diameter and weighs less than one ten-thousandth of a gram, costs 20,000 to 30,000 yuan for a domestic one and more than 30,000 yuan for an imported one, while the follow-up treatment after the operation is also a cost.
Wang Heping told reporters, medical equipment into the hospital before and after a whole chain of interests, must be given to the hospital and the implementation of the operation of the doctor a certain amount of rebates, rebates are one-on-one single-line contact, manufacturers directly to a doctor, which is the industry's unspoken rules. And according to the different equipment and suppliers, the amount of rebates vary. At present, in many large hospitals in China, how many stent surgery each year are climbing, because the more you put, the more you show gains, and even many hospitals will give the relevant departments each year to put the stent of the target, requiring that the year put the stent of the number of cases to be reached.
In 2002, the drug-eluting stent developed by Johnson & Johnson, CYPHER, was the first to be marketed in Europe, and was then allowed to enter China, where it was priced at 36,000 yuan, of which the distributor's profit space The profit margin for distributors could be up to 50%. At one time, the proportion of this stent used in China was as high as 98% of the total number of stents used. Following the heart stent into China, there is also the paclitaxel stent (TAXUS) developed by Boston Scientific, which chooses the direct sales method and sells at only 18,000 RMB cheaper than the heart stent. However, the paclitaxel stent, which usually has a market share of 60% to 70% in other countries, has had almost zero sales in China for half a year.
In addition, Wang Heping also said that academic requirements are also an important reason for the proliferation of stents. At present, China's regulations, doctors personally stent surgery to reach a certain number before publishing an academic paper, because a small sample size for the case of the paper, the scientific research value is very small. The publication of papers is also linked to the evaluation of titles, for example, must be published in the national core journal of more than three papers in order to assess the senior title, so doctors need a large number of stent samples.
Putting in stents that shouldn't be there is lifelong, one of the worst forms of overmedication