I would be grateful if you would allow me the opportunity to offer up some concluding (on my part) comments on the issue of the present lack of a cardiac catheterization laboratory in the Cayman Islands, and angioplasty.
In a recent issue of Cayman Net News, Dr. Frank Pallares attempts to take me to task over a statement I made to the Legislative Assembly on Friday, 23 March, 2007, in which I made essentially five points:
The Health Services Authority has been developing a comprehensive cardiovascular service at the Cayman Islands Hospital for some time. The HSA takes its responsibility to cardiovascular patients very seriously and contends that no patient has been put at risk by the fact that there is at present no catheterization laboratory in the Cayman Islands.
The Cayman Islands lacks the critical volume that would necessitate a catheterization laboratory, given the very considerable concomitant expenses it would give rise to. This is always a very difficult position to adopt for obvious reasons – people’s health and welfare are of paramount importance – but all organisations with finite budgets, including governments, are forced to make these difficult cost-benefit related judgement calls.
To safely operate a catheterization laboratory would necessitate a cardiovascular facility in the event of any complication occurring as a result of any invasive procedures done. Dr. Pallares attempts to belittle this notion, but having done further research on the matter, I stand by my original statement.
The Ministry and HSA welcome the fact that an eminent South Florida Cardiologist, Dr. Kevin Coy, has signed a contract with the HSA.
This will undoubtedly strengthen further the provision of cardiovascular services at the Cayman Islands Hospital.
Government and the HSA will continue to provide services that are most needed by the people of these islands, at the same time assisting through continuous, ongoing education all members of the population to understand that prevention is always better than cure and a healthy lifestyle involving, for example, a sensible diet, weight control, exercise and an avoidance of smoking, can do much in the majority of cases to lessen the likelihood of cardiovascular disease.
For the avoidance of doubt, I would like to make it abundantly clear that neither the HSA nor the Ministry has taken the decision never to provide catheterization laboratory services on island. The matter will be kept under constant review.
Finally, I was interested to be reminded that discussions and differences of opinion on cardiovascular health related issues such as this one are not, of course, peculiar to Cayman. According to an article summarized recently on CNN.com, a study led by Dr. William Boden of Buffalo General Hospital, whose results were presented at a meeting of the American College of Cardiology and published later by the New England Journal of Medicine, found that more than half a million people a year with chest pains are getting an unnecessary or premature procedure – angioplasty – to unclog their arteries; unnecessary because drugs are just as effective.
Angioplasty did not save lives or prevent heart attacks in non-emergency heart patients. In the study, only one third of the people treated with drugs ultimately needed angioplasty or a bypass.
Not surprisingly perhaps, these findings sparked a heated debate between doctors who perform angioplasties and other heart specialists, but I was particularly interested in the comments of some of these world renowned cardiologists:
‘You are not putting yourself at risk of death or heart attack if you defer, and considering the safety worries about heart stents used to keep arteries open after angioplasty, it may be wise to wait,’ said Dr. Steven Nissen, a Cleveland Clinic heart specialist and president of the College of Cardiology.
‘The new study should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial health care savings,’ Dr. Judith Hochman of New York University wrote in an editorial in the journal.
Angioplasty costs $30,000 to $40,000. The drugs used in the study are almost all available in generic form.
Dr. David Maron, the Vanderbilt cardiologist who helped to lead the study, said people should give the drugs a chance.
‘Often I think that patients are under the impression that unless they have that procedure done, they’re not getting the best of care and are at increased risk of having a heart attack and die,’ he said.
‘The study shows that is not true,’ he said.
As entities responsible for the provision of healthcare services to the people of these blessed islands, the Ministry and the HSA remain vigilant and open minded about essential services, at the same time retaining a realistic but sensitive perspective on the cost benefit implications of such services.
Also, I would like to thank Dr. Herb Ebner for his letter to the editor published in the Cayman Net News on Tuesday, 22d May, 2007. Dr. Ebner’s very learned comments and the dignified way he expressed them are well appreciated.
Anthony S. Eden – Minister for Health and Human Services