Middle-income countries should not invest in cabg and angioplasty: the techniques are too difficult and too expensive to deploy in resource-poor settings. But that same critique was once levelled against antiretroviral therapy for hiv/aids: experts argued that the drug regimens were too complex and too expensive. It took concerted effort by aids activists to shift that consensus. Although cabg and angioplasty present a very different challenge, the parallels merit careful consideration. The inability of physicians in the uk, europe, and the usa to establish and achieve target rates for cabg and angioplasty foretells a stormy course before progress is made towards global health equity in cardiac care. The revascularisation rate in the usa is probably too high and the rate in mexico is surely too low. What rate is the right rate? The uk might represent a happy mean, but physicians still struggle to provide a convincing answer. buy generic viagra cheap viagra online buy viagra buy viagra cheap viagra online cheap viagra online cheap generic viagra viagra without a doctor prescription buy viagra online buy generic viagra No one has developed a plan to help the millions of heart attack patients each year in low-income and middle-income countries whose lives might be saved by prompt use of these interventions. Further reading brook et al. , 1988 brook rh, kosecoff jb, park re , et al. Diagnosis and treatment of coronary disease: comparison of doctors' attitudes in the usa and the uk. Lancet 1988; 331: 750-753. Pubmed center for the evaluative clinical sciences et al. , 1999 center for the evaluative clinical sciences, dartmouth medical school, and the center for outcomes research and evaluation, maine medical center. Dartmouth atlas of cardiovascular care. Chicago: aha press, 1999. English et al. , 1984 english tah, bailey ar, dark jf, williams wg. The uk cardiac surgical register, 1977—82. Bmj 1984; 289: 1205-1208. Pubmed glover, 1938 glover ja. The incidence of tonsillectomy in school children. Proc r soc med 1938; 31: 1219-1236. Pubmed iglehart, 1984 iglehart jk. From the editor. Health affairs 1984; 3: 4-5. Pubmed jones, 2013 jones ds. Fixing hearts, harming brains: the tangled history of cardiac care. Baltimore, md: johns hop.
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