Despite its increasingly apparent potential usefulness, ECP is hardly taking the cardiology world by storm. In fact, it seems that for most cardiologists ECP is not even on the list of potential treatments for coronary artery disease. Why is that?
There are several possible reasons. Let us dispense with the most obvious first, namely, that ECP doesn’t pay well. A series of 35 treatments costs 50,000 to 60000 Rupees. That’s not chicken feed, but keep in mind that we’re talking about 35 hours of therapy over 7 weeks, which involves not only the doctor’s time but also the time of office staff, nursing personnel, etc., etc. Still not a terrible return, but when you consider that a cardiologist can often bill that much by spending a morning in the cath-lab, well - - -. Then there’s the fact that ECP remains somewhat intellectually unsatisfying.
To your average cardiologist, there’s no reason at all that anyone should have thought it would work in the first place – that temporarily providing counterpulsation would have lasting effects. And the fact that it apparently does work is merely blind luck, and leaves investigators scrambling ridiculously to explain why it does. This is a less than satisfying way to advance science. In addition, to most cardiologists, ECP is logistically difficult. To accommodate patients for ECP, they would not only have to purchase expensive equipment, but also would have to radically change the organization of their offices, their office staff, and their space.
Finally, and most importantly, ECP has nothing in common with what cardiologists do. Cardiologists study and treat the heart, for goodness sake. They stress it, image it, measure it, pace it, shock it, stent it, ablate it, revascularize it, and bathe it in drugs. What they do takes years of specialized training and expertise, millions worth of high-tech equipment, and tremendous manual dexterity, and it brings them significant prestige, even within the medical community. Now they’re supposed to drop all that? In order to attach fancy balloons to peoples’ legs, throw a switch, watch them bounce around for an hour, then say, “See you tomorrow?” That’s not cardiology. That’s glorified physical therapy. This, in Dr. Rich’s estimation, is the real reason the average cardiologist is completely ignoring ECP, as if it doesn’t even exist.
They simply can’t believe anyone really expects them to do this. In any case, you may need to raise your cardiologist’s consciousness. If you have coronary artery disease that has proved difficult to treat, then you need to bring ECP up yourself. Once enough patients show themselves to be aware of this new therapy and to be expecting it, suddenly ECP will no longer be beneath cardiologists, and they’ll eagerly find a way to incorporate it into their practices.
