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Lunch at the Tribeca grill with: Dr. Samin K. Sharma, M.D.

Published by The New York Sun on 2005-06-13

Samin Sharma of India is never going to have to deliver curries again.
"Those were the days," he said over a lunch of pasta.

He made $3 an hour in those days, when he came to New York to practice cardiac surgery from his native Jaipur in India's western state of Rajasthan. He'd already graduated at the top of his class in the national qualifying exam. But no hospital in the city would give him a job unless he was certified by New York State. While he prepared for the test, he took a job delivering curries for an Indian fast-food outlet.

That was barely two decades ago. Now, from his base at the Mount Sinai
Medical Center, the 47-year-old Sharma performs more angioplasties annually than virtually any other cardio-vascular physician in the world - in excess of 1,300 a year, or a third of the procedures done at the "cath lab" that he heads.

He also makes several million dollars a year.

"Heart disease continues to rise in America," Dr. Sharma said, noting that last year more than 13 million Americans had cardiac problems.

Some 700,000 of them died, making heart disease second only to cancer in annual fatalities. More than 1 million angioplasties are performed in America each year, three times the number of bypass operations.

And as America continues to attract immigrants, particularly from Asia, medical studies - including a seminal one conducted by Dr. Sharma - show that South Asian men, in particular, are most vulnerable to heart disease. Of more than 5 million immigrants of Asian origin since 1970, 1 million are from South Asia, including India.

"They are getting heart disease at younger and younger ages," Dr. Sharma said. "Why is this so? It's the change in lifestyle when they come to America. They don't check their cholesterol regularly. Many don't exercise regularly. And many cannot cope with the increased stress of trying to make it in America."

A large number of his patients are Asians. (Disclosure: this reporter was treated by Dr. Sharma several years ago.) They come to him not only from all parts of America, but also from abroad, particularly India, because of his record as a cardio-vascular interventionist.

In such an "intervention," Dr. Sharma inserts a catheter into a patient's body - usually through the groin - moves it to areas in the heart vessels where there's significant blockage, drills away the plaque, and often inserts medicated stents to prevent restenosis, or recurrence of blockages.

Such "procedures," as they are called, typically cost $20,000, and rarely involve more than an overnight stay at the hospital. Heart bypass surgery, on the other hand, can cost more than double, and usually requires a patient to be hospitalized for a week. Dr. Sharma's unit last year contributed more than $150 million in revenues to Mount Sinai's overall budget of more than $1 billion.

Because angioplasty is getting more and more sophisticated, and the in-hospital death rate is under 1% -- compared to 2.4% for bypass surgery - patients opting for it are increasing in numbers, according to the American Heart Association In New York state, the number of angioplasties last year was 50,000, a 20% increase from 2003. But the number of heart bypasses was 17,000 in 2004, down 8,000 from the previous year.

But angioplasty has lately drawn its share of controversy. In an article published recently in the Journal of the American Medical Association, two physicians from Centro Cuore Columbus Hospital in Milan said their research showed that two of the most popular medicated stents caused serious side effects, including death. Of the 2,229 angioplasty patients in the Italian study, 29 developed blood clots, and 13 died, after the procedure.

The study identified those stents as Cypher, manufactured by Johnson & Johnson's Cordis division, and Taxus, made by Boston Scientific. A third popular stent made by the Guidant Corporation wasn't included in the research. The increasing use of stents has made it into a $5 billion-a-year industry in America.

Dr. Sharma acknowledged that even though he takes on "very high-risk cases," angioplasty is often not advisable for patients whose left main artery is severely blocked. The state's Department of Health says that Dr. Sharma has the best record in New York in angioplasty since 1994.

"But overall, angioplasty is safe, causes much less trauma than bypass surgery, and these coated stents block the stimulation of muscle cells - that is, they help prevent blockages from recurring," he said.

His technique has been so effective that physicians from across the country attend his regular "live" seminars on angioplasty. In these seminars, Dr. Sharma explains his method while a video camera in the operating theater transmits the scene to dozens of locations.

One of those locations is in his native Jaipur, where Dr. Sharma contributed $1 million of his own money to open a heart center late last year. Some 15% of patients are given free care through Dr. Sharma's philanthropy. He travels to India four times annually, and to other places in Asia and Europe, to lecture on angioplasty.

He's also instituted a training program under which American surgeons go to India to teach. Dr. Sharma also arranges for Indian physicians come to Mount Sinai to work with him on angioplasties; these internships generally last three months.

"This is payback time for the homeland," Dr. Sharma said. "America has given me the opportunity, and the means, to extend a helping hand to the place where I was born. My self-confidence, my basic training, my faith, all comes from my homeland and my upbringing. Just as I can never forget that America has given me a platform, I can never forget where I came from. Just as I can make a difference in patients' lives here, I can help people back in the mother country."

Pranay Gupte,
Senior Writer and Global-Affairs Columnist

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