How to Build Your Own Public Health Crisis: Just Add Numbers

BY ANISH KOKA, MD (13)

Because I’m that guy, I took a poll at the recent family barbecue.

“Heart disease—who has it worse? Men or women?” I asked. The answers came quickly. My mother-in-law and sister-in-law said, “Women.” My father-in-law, arms crossed, said confidently, “Men.”

My mother-in-law remembered hearing about how heart disease affected women more than men during the February American Heart Association (AHA) “Go Red for Women” campaign. Apparently, the message wasn’t heard by the men at this family gathering. They were moved by stories of men—fathers, brothers, friends—they knew who died from heart disease. We are taught that facts should trump feelings, evidence should trump anecdotes, and at first glance it would appear the men are too in touch with their feelings.

It is the mission of advocacy organizations like the AHA to raise awareness. Charts like this one are widely disseminated and used in countless presentations on the topic:

Figure 1

The graph demonstrates that over the last few decades the number of women dying from heart disease has been significantly higher than men dying from heart disease. In the year 2000 alone the gap is the most impressive, with 70,000 more women dying than men. The problem with this chart is that it is completely misleading.

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The Strange Case of India’s National Coronary Stent Policy

BY ANISH KOKA, MD (1)

It is commonly believed that deliberate, careful price regulation by enlightened technocrats trumps the haphazard and chaotic regulation of prices imposed by the free market—especially when the market is subject to greed and corruption.

A most interesting case study challenging that belief comes courtesy of the largest Democracy in the world: India.

In 2017, an arm of the Indian Government, the National Pharmaceutical Pricing Authority (NPPA) took action to control the price of coronary stents in India by capping their retail price. The problem that stimulated this action was their exorbitant price that made them unaffordable to many Indians.

The retail prices of US made drug-eluting stents ranged from Rs 80,000 – 150,000 (~$1000 – ~$2000), while the price of Indian made drug-eluting stents ranged from Rs 45,000 – 90,000 (~$600 – ~$1200). Considering that a good job for 90% of the Indian labor force pays about Rs 180,000 per year, these prices put most coronary stents out of the reach of a vast swath of the populace.

What regulators knew, however, was that the price point at which coronary stents were being imported into India was a fraction of the price being charged to Indians. The up-charge had everything to do with what happened after the stent was brought onto Indian soil: The Indian subsidiary of the US stent manufacturer would sell its product to a domestic distributor that would then employ all means necessary to ensure their stent was chosen by cardiologists to be implanted.

Narcissistic Innovation: Electric Scooter Companies are Content to Kill You

By JASON CHUNG

While spending time in Austin, TX over the holiday break, I finally took the plunge and tried out an electric scooter.  Through my Uber app, my phone’s GPS located a suitable vehicle, made me agree to an entirely too long User Agreement and charged my VISA $1.00 for the first five minutes (and $0.15/minute after that).

It was fun.  It was economical.  It solved my dilemma of how to get around relatively expediently without a car.  It was also a potential death trap.

With the capability of reaching up to 20 mph and provided without training, helmets or health insurance, electric scooter companies appear comfortable extolling the virtues of their “disruption” regardless of potential negative health and safety externalities.  And it’s not as if these negative effects are merely speculation – though statistical injury data is still sparse given the newness of this type of transportation service, interviews with emergency room physicians show that “[i]njuries are coming fast and furious” with injuries ranging from broken bones, lacerations, blunt head trauma and even death.

Image result for electric scooter bird
Pictured: Rider on electric scooter.
Not pictured: Helmet or other appropriate safety gear.

The conduct of electric scooter companies betrays the elitist singlemindedness of some of the tech community.  When faced with legitimate public health and safety concerns, electric scooter companies haven’t taken a step back and re-examined their approach.  Instead, relying on the tried and true appeal to caveat emptor or “buyer beware”, electric scooter companies appear content to download public health and safety risks to other actors, such as their customers, health systems and governments, as long as they keep getting funding and expanding.

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