Dr Ashok Seth is one of the leading cardiologists in the country who has to his credit the record of having performed the maximum number of angiographies and angioplasties than any other specialist in the whole of Asia-Pacific region. A Padmashri recipient, Dr Seth is best known for his commitment to make advanced cardiology facilities more available and accessible to the common man. Apart from the training he has given to about 300 cardiologists, he has encouraged several state governments and university medical hospitals to establish their own cath labs with angiography and angioplasty services.

He is the vice president of Cardiological Society of India and the founder
governor and honorary secretary of the Endovascular Intervention Society of India. In an exclusive interview with Joe C Mathew of Pharmabiz.com, Dr Seth talks about the growing incidence of cardiovascular diseases and his suggestions for containing the threat.

Cardiovascular diseases are predicted to be one of the major causes of death in the country in future. How serious is this observation?

Coronary artery diseases will take epidemic proportion by 2015. Half of deaths in India are likely to be caused by CAD. It will overtake infectious diseases as most common cause of disease in the country. We are predisposed to the disease six times more than the West and 20 times than the Chinese. Specific risk factors for Indians are abdominal obesity, uncontrolled diabetes, insulin resistance, high triglyceride, low HDL cholesterol, high blood pressure and smoking (metabolic syndrome). 13 to 17 per cent of the Indian population suffers from metabolic syndrome. But we have to understand that these diseases are preventable, predictable and curable.

Has the society at large realized this growing threat?What should be the role of the government in containing this threat?

While the incidence is coming down in West it is rising in India. This is due to the deficiency in our system. The government is not to be squarely blamed here. The public is at equal fault. They take preventive measures only after the disease comes. Over the past few years the trend to do exercise is increasing.
If one observes these people, you find 80 % of them are not healthy people. They have taken to exercise after they were advised by the doctors to do so. The concept of prevention is lacking.

Awareness creation is the joint responsibility of doctors, media, and also the individual. It is different from polio eradication programme, which the government is seen doing at the national level. But there are many things that the government can do. Opening greenbelts, parks, organizing joint programmes with doctors for mass education, fitness classes in schools... It has to be driven into individuals that they have to be aware of it. The society should understand the seriousness of the problem.

Do we have sufficient treatment facilities in our country? Are there enough specialist doctors?

Till 15 years ago, we had the problem of treatment facilities. The facilities available at that time were not accessible to the common public but for the rich and the powerful. From 1998 onwards it started changing. Today we have facilities. I personally trained more than 300 doctors on non-surgical techniques during this period. Now the facilities are available for common man.But the treatment is yet to be fully affordable. Here I feel the government has a lot to do. It has ensure subsidized treatment to the public.

We should remember that no country could give free treatment. In Britain where such a system is in place, the wait for the free treatment is very long. In US it's the third party insurance, which is helping common man to afford the treatment. There are many ways to subsidize treatment.
1) Government should look upon private-government partnership. Since private hospitals have the infrastructure and skills, let the government try to make use of it.
2) The 3rd party insurance companies are here. Let the government encourage them.There has to be Legislation in place, which makes it compulsory for every employer to insure his employee. This is going to make much difference. Today the employers are taking care of the medical needs of their top-level executives. But they are the ones who can afford the treatment even otherwise.
3) ESI should be better managed. Similar schemes in private sector should be encouraged.

Let every doctor do free surgeries once in a month. Tax on life saving products and imports are also issues to be looked into.

Comment on the availability of indigenous technologies and medical devices

We are not encouraging local manufacturing. People don't have confidence in Indian medical equipment or devices. There is no authority in place that can certify an Indian medical device. We should also have strict regulatory control over the manufacture of medical devices in place. Once the government ensures manufacture of quality Indian medical devices, the cost of treatment is to turn less.

We are lacking at a number of steps. Multiple approaches are needed. More and more hospitals are necessary. We are 8,000 beds short in North India alone. The irony is that this shortage exists when many of our super specialty hospitals have empty beds. This point towards the need to coordinate the resources that is at the disposal of the government and private sectors and come out with better results.

I am planning to set up an NGO whose only aim is to promote affordable healthcare in the country. It needs lot of inputs from the politicians, the employers, the government and the public in general to make healthcare affordable in the true sense. Building up an organization to help make advanced health care facilities available for the general population at a much lower cost is my agenda for the year.

What are the recent advancement in the treatment of cardiovascular diseases? How well is India placed in handling state-of-the art surgical and non-surgical procedures?

Angioplasty has revolutionized the treatment. Angioplasty and valvoplasty using radiation and laser techniques had become an in thing now because of the use of P-32 radiation stent fitted on baloon.

Drug induced stents have been proven to be simple and safe procedure. I have performed 800 angioplasty cases in Escorts during last eight months. This has brought us the credit of handling the highest number of cases taken up by any hospital in the world. More people are opting out of surgery. The cost of the treatment is expected to come down as more and more companies are entering the fray.

The increase in the number of patients coming from abroad for such treatments are also proof for India's capability in taking up such tasks. Escorts has patients from countries like Nepal, Srilanka, Bangladesh and West Asian and East African countries.