Two weeks back, former Bihar chief minister and fodder scam convict Lalu Prasad Yadav (70) suffered from a heart-related ailment and was permitted medical bail due to emergency hospitalisation at Mumbai's Asian Heart Institute. Supervising his health was Dr Ramakanta Panda, a renowned heart surgeon and Padma Bhushan awardee who had previously operated on him four years back in the 2014. This time, however, a fistula procedure was carried out and he was discharged soon after. Panda who is credited with 99.6 per cent success rate in bypass surgery and for successfully performing over 3,500 high-risk surgeries, talks to THE WEEK about a variety of issues surrounding cardiac health, including what ails the Indian heart and why coronary heart disease continues to be the leading cause of death in India.
Can Artificial Intelligence (AI) systems better predict the risk of death in patients with heart disease compared to human experts?
To predict the death, you need a huge amount of information and some form of human intervention is definitely needed. Also, for AI to be able to predict this kind of information, it needs accurate data which is unfortunately difficult to get in India. If data entered is wrong, then the entire prediction will go topsy-turvy. Yet, I will say that AI has tremendous potential but it cannot completely replace human intelligence. It can at best supplement it.
Are we using the latest technology?
We have the latest equipments on par with international standards. The moment it gets approved by a regulatory body, it is here. For instance, the medicated stent was introduced in India two years before it was introduced in the US. Because the US FDA took that much more time to approve it. Once the tech is approved, it can be made available on the spot. Technology-wise, Indian hospitals are no less than their counterparts in the West, or anywhere in south Asia. But now some of the evolving technology is experimental, and that takes time to be introduced to the public because it is a part of an ongoing research and is made available only to a select research population. India is doing very well, both in terms of medical expertise and the latest technology in the space of cardiac care.
But heart operations in India are more expensive than those in the rest of the world.
No, that is absolutely false. It is a relative number corresponding to one's income. In terms of absolute numbers, we are among the cheapest in the world. You have to understand that 70 per cent of the cost of treatment is not under one's control. This includes materials, staff, electricity and establishment expenses. That costs exactly the same amount in Singapore or Korea. In cardiac treatment, there's a fixed component and anywhere in the world you do, it wont come down. Also, the currency value matters. We think it is twice as expensive, and for them, it is one-tenth expensive. We have to look at the average income of the person.
Is coronary heart disease the leading cause of death in India?
It is. And now it is more prevalent among the young. According to research carried out between 1996 to 2009 in the US, it was found that there is a 26 per cent reduction in the number of people getting heart disease in the USA. Whereas, between 1990 to 2016, there has been a 34 per cent rise in the incidence of heart disease in India. In fact, 35 years back, when I was a student, we were taught in my college that heart disease was a western problem and not an Indian one. A lot of things have changed from then to now, and most of it is due to our lifestyle and faulty food habits. Lack of exercise and wrong food choices contribute significantly towards poor heart health. You know, very early on Indians used to eat millets. Now, millets are complex carbohydrates and take very long to digest and transform into energy. This is good for the body because when the carbs take long to break down, the sugar level in the body goes up slowly and then the insulin is secreted in the body at a very slow rate. As against this, if you have maida and other refined flour, the sugar level goes up at a very high rate and so the body secretes a lot of energy. Eat complex carbs, have small quantities, and have early dinners. According to a study done in the UK if you have your dinner before 7pm, the incidence of diabetes, hypertension and cancer goes down considerably because whatever you eat in the night gets converted into fats because there no consumption of energy at night. So please switch you food patterns and you will do well health-wise.
Paediatric cardiac surgery is very close to your heart.
Mostly the problems in infants is purely congenital and a lot of environmental and hereditary factors come into play. More than 1 lakh children are born with heart defects in India every year and we operate barely on 30000 to 40000. Rest of them die. So, the gap is wide. I have begun focusing more on babies with congenital heart defects because they have an entire life ahead of them and they deserve all the medical attention we can give. The good thing is that now the diagnosis of congenital heart defects in babies has improved considerably; echo-cardiogram machines are available even in rural areas now.
Tell us about your most memorable surgery till date.
In 2014, there was this 54-year-old gentleman who had 17 blockages in his heart arteries. Normally, a person requiring a bypass surgery has at most three or four blockages. Most of his blockages were as narrow as 1 millimetre. It was so narrow that it made it very difficult to operate and it is the narrowest I have operated so far. All other patients I have operated on till date, have had artery blockages in the range of 2-4mm. This man was denied surgery in most other places and by the time he came to us, he was not even in the position to walk. If we had not operated on him to in an emergency surgery, he would have died in two days. So we put in an artificial pump to get his heart beating and performed 12 bypasses on him in one go. This was unprecedented anywhere in the world. He is absolutely fine now and even danced at his son's wedding.
You've been a vociferous opponent of the 'commission practice' among doctors .
I have no qualms in telling you that most of the investigations doctors prescribe to their patients are for the sake of these cuts and commissions which accrue to them. For any one problem, when you visit a doctor, he or she often asks you to come back with a list of tests which may have absolutely no connection to the ailment whatsoever. So, it is this practice which is unjust to patients that I want to put an end to. Today, almost 80 per cent doctors practice this in some way or the other. In fact, India is one such country where this commission practice is carried out in such high numbers and should be completely stopped.