According to the "News with Views" of the Voice of China of the Central Radio and Television Corporation, the "big dive" with the price of heart stents from 13,000 yuan to 700 yuan recently brought this medical device used in heart surgery into the public eye. While heart patients cheered the price drop, experts in the field of cardiac surgery issued a fierce voice against the abuse of cardiac stents, pointing out that stent fee reduction does not mean the end of excessive medical treatment, and the underlying logic of maximizing patient well-being has not yet been realized.
Hu Dayi, the father of Chinese cardiac stents: Cardiac stents have their application boundaries, and abuse occurs for a variety of reasons
The famous cardiologist Hu Dayi is known as the "father of Chinese coronary stents", and the so-called "coronary stents" are heart stents. As early as 1989, Hu Dayi participated in China's first heart stent interventional surgery, and after the advent of the "double antibody" drug, he became the doctor with the largest promotion of cardiac stents in the country. Hu Dayi, who spoke to the Voice of China's "News Has a Point of View", said that stents themselves are "not bad technology", but they should be mainly used in cases of acute myocardial infarction. It is contrary to common sense to regard stents as a panacea for patients with stable conditions, and even to deceive patients that "if stents are made, myocardial infarction can be saved at any time" at any time.
Hu Dayi (Photo provided by the interviewee issued by the Central Broadcasting Network)
"The bracket is a metal foreign body." Hu Dayi said, "It is a hidden danger to put in the blood vessels, how can it prevent myocardial infarction!" Hu Dayi believes that the way to prevent myocardial infarction depends more on stopping unhealthy lifestyles, "quit smoking, exercise moderately, and eat healthy." "Risk factors such as hypertension, diabetes, and dyslipidemia need to be properly controlled." This is the measure of prevention, not the stent. Hu Dayi said.
Hu Dayi analyzed that the reason for the current "abuse of cardiac stents" is that the operating model of public hospitals is that they attach great importance to the indicators linked to economic interests, and regard this as one of the indicators of assessment, affecting the diagnosis of medical staff. The second is "the congenital defects of Western medicine", "Western medicine is always drawing boundaries, not considering the whole of people." You must consider whether the patient has other symptoms, stable and unstable condition, and what are the causes of chest pain? Hu Dayi believes that many doctors ignore people as a whole from a purely biological point of view. The third is that capital enters the medical treatment and becomes a huge promoter of medical treatment. "Everyone is overly superstitious and worships biomedical technology, because the narrow blood vessels do expand after the stent goes in, but we only see part of the effect, and we don't see his endless troubles."
Through the Voice of China's "News has a point of view", Hu Dayi introduced some new research in the field of cardiac stent surgery. In two similar comparative studies at home and abroad, cases of introduction of stents and cases of optimized drug therapy were studied through long-term follow-up, and finally the results of no significant difference in the total mortality rate (myocardial infarction, sudden cardiac death) between the two groups were finally obtained. According to Hu Dayi's suggestion, for patients with stable conditions, eliminating symptoms through medication, exercise, and rehabilitation treatment will be "more noninvasive, lower cost, and better effect." ”
For the current domestic medical science, Hu Dayi talked about the "mixing" of information on various platforms, and this information will even mislead the work. Hu Dayi believes that the focus of science popularization at present lies in its "public welfare" and "scientific nature", "telling the broad masses of the people about the real knowledge and research results in a truth-seeking manner." ”
In the face of the pressure of speaking out about the "abuse of heart stents", Hu Dayi admitted frankly, "I don't feel lonely, there are many doctors and patients who support me and sympathize with me." He said that behind him is common sense, evidence, is fifty years of medical experience, and China's medical reform will only get better and better, many things may not be achieved overnight, but the experience worth promoting has emerged.
Chief Physician of Cardiac Surgery: The judgment of widespread abuse of cardiac stents may be too arbitrary, and price reductions are theoretically beneficial to eliminate abuse
Sun Hongtao, chief physician of the Department of Cardiac Surgery at Fuwai Hospital, said in an interview with the Voice of China's "News Has a View" that Hu Dayi said that the problem of cardiac stent abuse "does exist in some areas", but "from the official statements and attitudes, it should not exist." To say that coronary stent abuse is widespread in China is perhaps too arbitrary. ”
As for whether the centralized purchase of cardiac stents can eliminate the abuse of stents, Sun Hongtao said that the sharp drop in prices will theoretically help restore the essence of medical treatment, "from the perspective of fully following the principles of medicine, it should be conducive to controlling the phenomenon of indiscriminate stents." At the same time, Sun Hongtao believes that the specific clinical operations need to be further observed.
Sun Hongtao said that the installation standard of cardiac stents is a "medical problem" and "academic problem", and controversy is normal. At present, Hu Dayi advocates that this criterion is that the blood vessel is narrowed by up to 70%, and those who are stable or asymptomatic can not let go. Sun Hongtao said that Hu Dayi's proposition is a more inclined choice in the medical community.
Sun Hongtao said: "Fundamentally preventing and treating coronary heart disease, or maintaining heart health, needs to start from the details of life, such as smoking, drinking and exercise. Diet and even sleep habits can lead to differences in the incidence and mortality of coronary heart disease. ”
Hospital Management Research Expert: Let doctors be pure doctors, healthy China needs to advocate value medicine
Dr. Zhuang Yiqiang, former deputy secretary-general of the Chinese Hospital Association and director of the Management Research Center of Guangzhou Elippi Hospital, said in an interview with the Voice of China's "News has a point of view" that the abuse of cardiac stents "should exist, but the degree is not easy to say." He believes that the deep problem behind it is the profit-seeking behavior of doctors. Zhuang Yiqiang said that in the triangular relationship between doctors, patients and medical insurance, doctors have the richest information and technical resources, and there is a situation of "information asymmetry", and it is difficult for patients to refute doctors' suggestions. Zhuang Yiqiang believes that the profit of doctors is caused by the government's "difference allocation" to public hospitals, and in the case of a small proportion of allocation, the pressure of hospital income generation increases, so it has an indirect impact on patients.
"The main thing is to get doctors back to being pure doctors. The doctor's ultimate goal is to save the patient's life, for the patient's health, not to put the stent for the sake of the stent. Zhuang Yiqiang believes that China's current hospital management tends to be more factory, enterprise, and process, and medicine is a natural science, but "medical service is a sociology, which is related to patient perception, medical experience and views on doctors." ”
"The next step in our medical reform direction is to promote the combination of medical and preventive treatment along the healthy China." Zhuang Yiqiang said that the combination of medical treatment and prevention, "In addition, the last thing is to promote value medicine, not how many surgeries you have done and how many stents you have put in." ”
Producer: Guo Jing
Reporter: Yang Chang
Editor: Liu Hongwei Wang Yixia