Ceiling the price of stents alone will not suffice

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Will provide a way forward in addressing patient distrust on hospitals

New Delhi, 14th February 2018: Prices of expensive drug eluting cardiac stents have been further slashed by the National Pharmaceutical Pricing Authority (NPPA) and the cost of basic metallic stents have been marginally increased. After several rounds of consultation with various stakeholders, the price of drug-eluting stent (DES) have been slashed by Rs 1,710 (from Rs 29,600 to Rs 27,890) while the price of bare metal stent (BMS) has been increased by Rs 400 (from Rs 7,260 to Rs 7,660). In an order, the NPPA said that the trade margin has been capped at 8%, making the current rates valid till 31st March 2019.

Under the order, all manufacturers of coronary stents, selling branded or non-branded, at prices higher than the ceiling price, shall revise the price of all such stents downward not exceeding the ceiling price. It also mandates hospitals to provide a clear break-up of the prices levied for other items used in medical procedures.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Stents are medicines and included in the drugs and cosmetics act. They have been put under NLIM and are, therefore, an essential item under price capping. This is definitely a move in the positive direction. Also, with the capping of prizes of stents there should also be simultaneous capping of all the accessories used along with stents including all types of angiography catheters, pacemakers and other cardiac devises”

Adding further, Dr Aggarwal, who is also Vice President, CMAAO, said, “This price reduction and the indication to hospitals to provide a price break up will help in curbing unethical practices such as charging more from patients for procedure, treatment and post-care, to recover their losses due to reduction in stent prices. Further, it will help in removing the public agony and mistrust over doctors and hospitals. Currently, the entire medical fraternity is under scanner for all wrong reasons and for acts committed by a certain section. Such steps will help dispel these doubts and fears in the minds of people.”

A coronary stent is a tiny wire mesh tube that is placed inside an artery in order to remove any blockages and widen it so that blood flow is uninterrupted. It is also used to support weak arteries which have difficulty in maintaining blood flow. Stents that are not coated with drugs are called bare metal stents. There is another category of stents which elute an anti-proliferative drug to prevent cell proliferation — known as “medicated stents” or drug eluting stents (DES). Both are widely used.

The 7-year itch: Redefining a relationship

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Boy meets girl…girl meets boy…sparks fly and they live happily ever after. This is the classic notion of romantic love, but which happens only in fairy tales.

Real life relationships don’t just happen. Every relationship evolves over time and has to work its way through five stages before it settles down to last a lifetime. These five stages, in order of their appearance, are:

Euphoria
Reaction
Adjustment
Liking
Love
The first phase in any relationship is that of euphoria. Everything appears rosy in this first flush of love. All flaws are overlooked and the relationship is wonderful and easy. Both partners feel great, light and on the air. The amphetamine-like substance called phenyl-ethylamine is the neuromodulator in this phase.

The excitement soon starts wearing off and then reality hits. This is the phase of reaction wherein both partners start reacting to each other’s behavior and lifestyle. Disillusionment sets in. Arguments begin to occur. It is during this stage that most break-ups occur. The reactions are based on release of adrenaline and noradrenaline.

The phase of reaction is dependent on the changes in our needs. Every person has five types of needs and they are Physical, Mental, Intellectual, Egoistic and Spiritual Needs. Physical needs are needs for physical and sexual intimacy; mental needs are to share one’s emotions and need for a shoulder when in the need of a cry; intellectual needs are the needs to discuss about future, decision making etc.; egoistic needs are the needs to acquire power and spiritual needs are the needs to acquire inner happiness. Husbands and wives who fulfil all the above needs of each other are called “made for each other”.

Next is the phase of adjustment. The two partners start adjusting to reality and start accepting each other’s differences. They are able to overcome the power struggle in the relationship.

Both phases of reaction and adjustment may carry on for up to 7 years. During this period, both partners are compelled to stay with each other and they start adjusting to each other’s needs and lifestyle. It is not an easy time for many. This is also the time when a relationship is redefined.

Liking develops by the 7th year. This is the phase when the two partners learn to trust each other and start feeling dependent on each other. They are able to deal with and resolve their differences bringing to an end all the misunderstandings that have so far plagued their relationship.

The last phase is phase of love or soul-to-soul relationship ‘soul mate’. This phase may start decades after the marriage and is the basis of 25th, 50th & 75th marriage anniversary. People in this phase of marriage are totally dependent on each other and cannot face separation. If one person dies, the other may go into depression and also die within a short period of time. The neurochemicals involved in this phase are endorphins.

These five stages apply to not just romantic love, but also to every relationship, be it with your job, friends, coworkers etc. It is unconditional love.

Which stage are you in your relationship?

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA