Future Medicine by MK Menon

EXPERT INTERVIEW: Dr Utpal Bhadra, Deputy Director, CCMB

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SCI-INDUCED PARALYSIS

Clinical trials get nod HEARING LOSS RESEARCH

Dr Sonali Rahul Pandit THE IDEA OF IMMUNISATION

Focus on shortcomings

WONDER LADY, WONDER DRUG

This American has the perfect drug for millions of HIV/AIDS patients and children suffering from debilitating diarrhea

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WITH THE FUTURE OF THE

HEALTHCARE INDUSTRY 21 – 23 November 2012 Dubai International Convention & Exhibition Centre Dubai, UAE @getex1

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EDITOR’S NOTE A lifeline to millions through innovations

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he global medical science industry is breaking new grounds with a healthy integration of the traditional and modern systems of healing with innovation-driven technologies, surgical procedures, and clinical solutions. In this edition of Future Medicine, we focus on three pioneering medical solutions that promise to extend a lifeline to millions across the world, and at the same time, give people a chance to get acquainted with their immune system through a user-friendly device. These breakthroughs have sounded the bugle for medical innovators across the world to pick up the gauntlet and make equally satisfying discoveries. To start with, the first medical solution is a gift of nature, an extract, called ‘Dragon’s Blood’, from a tree in the rain forests of Amazon. With this extract, an American pharmaceuticals company has developed a drug called Crofelemer, which has the potential to tackle the side effect of chronic diarrhea among millions of HIV/AIDS patients due to antiretroviral therapy. The drug, which has completed phase 3 of clinical trials, is awaiting approval by the US Food & Drug Administration (FDA). In our cover story, we have featured the enterprising lady behind the discovery of Crofelemer and dwelled upon the other healing properties of this wonder drug. The second medical breakthrough pertains to the FDA’s go-ahead to the world renowned Miami Project to Cure Paralysis to commence clinical trials for people who have recently sustained spinal cord injuries resulting in paralysis. Under the project, researchers will transplant Schwann cells, integral to sending electrical signals through the nervous system, into the spinal cord injury site of eight patients to evaluate the safety of the process. Though researchers admit that it may take 10-15 years for this experiment to become a part of the mainstream medical practice, it is certainly an initiative that gives hope to millions paralysed by spinal cord injuries. The third breakthrough is that of an ingestible medical monitor, pioneered by a California-based company. It is a digital medicine that will help people in keeping track of their drug intake and body’s requirements. Well, India isn’t lagging behind in terms of medical innovations. This time, we have featured Dr Utpal Bhadra, the Deputy Director of Centre for Cellular and Molecular Biology, who is working on a diagnostic case for predetection of cancer.

FUTURE MEDICINE I September 2012

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CONTENTS

COVER STORY Wonder Lady, Wonder Drug US-based pharmaceutical major Napo Pharmaâ&#x20AC;&#x2122;s wonder drug Crofelemer can effectively address the issue of chronic diarrhea among millions of HIV/AIDS patients and children across the world. The drug, which has completed Phase 3 of clinical trials, is awaiting approval by the US Food & Drug Administration

HEARING LOSS STUDY Dr Sonali Rahul Pandit

EXPERT INTERVIEW Dr Utpal Bhadra

26 47

LEASE OF LIFE Cure for SCI-induced paralysis

PHARMA EXPERT Vijay Chelliah

A leading scientist and Deputy Director of the Hyderabad-based Centre for Cellular and Molecular Biology, Dr Utpal Bhadra talks about the significance of RNA interference

Anorexia Nervosa Beware of crash diets

Self-perception about beauty and health can be dangerously misleading at times. Be wise and avoid crash diets. Anorexia Nervosa is an eating disorder that afflicts scores of women across the world

FUTURE MEDICINE I September 2012

SPECIAL FEATURE The idea of immunisation Immunisation is the most basic and effective way of guarding the infants against the dangers of a host of deadly diseases. Future Medicine approaches the sensitive issue of immunisation through the perspective of two renowned experts in the field and brings to light certain pressing issues that require urgent attention at the national level

World Hospital Focus

Indian Hospital Focus

Clinical Research

News & Views

Traditional Medicine

Medical Tourism

Papworth Hospital, UK

Manipal Healthcare

Mir IFCR India

GM Crops

Termite Sand Therapy

Keralaâ&#x20AC;&#x2122;s new initiative

FUTURE MEDICINE I September 2012

MEDICAL DIGEST

‘Healthcare access poor in India’ NEW DELHI: Around 70 per cent of rural Indians may not have easy accessibility to hospitals and medicines until at least 2040, according to a report by the ASSOCHAM Council on Healthcare and Hospitals. As per the report, India has an average 0.6 doctors per 1000 population against the global average of 1.23, which suggests an evident manpower gap. In terms

of healthcare infrastructure too, it lags far behind the global average. In comparison with the developed and emerging economies, India’s healthcare spending is significantly low. The report also underlines the major obstacles to healthcare accessibility, such as limited means of transportation, poor infrastructure, high cost of healthcare and gender discrimination.

TN sanctions Rs 9 crore for cancer treatment CHENNAI: Tamil Nadu Chief Minister J Jayalalithaa has sanctioned a financial aid of Rs 9.93 crore for the purchase of necessary equipment and other accessories for a cancer treatment centre at the Government Royapettah Hospital. Apart from purchase of new medical equipment and accessories, the allocated amount will be utilised for creation of 83

medical and para-medical vacancies. Also, Rs 17 crore has been set aside for construction of a building to accommodate the exclusive cancer treatment centre. Jayalalithaa also ordered expansion of the Chief Minister’s Comprehensive Health Insurance Scheme. This will enable coverage of members registered under the Farmers’ Protection Scheme.

Philippines’ breastfeeding strategy MANILA: Given that there is no replacement for human breast milk when it comes to providing the best nutrients to newborns, the Philippines’ state-run breast milk bank has intensified its efforts to collect and store breastfeed milk. The initiative is aimed at providing safe, rigorously screened donor breast milk to poor children and help working women return to their jobs immediately after giving birth to their babies. The milk, which is screened, tested and processed to ensure it does not contain viruses, harmful bacteria, medications or illegal drugs, is pasteurised and refrigerated and then sold

at around $10 for four litres to other hospitals and individuals. To help the mothers who are down with illness or medication, women who produce extra milk sell their breast milk to those in need. Studies have shown that breast milk not only reduces baby’s risk of infection and sudden infant death syndrome, but even the danger of childhood cancers. Jose Fabella Memorial Hospital, a popular maternity institution in Manila, started its first milk bank in 2007. Since then, two more of its branches in the capital have opened milk banks.

FUTURE MEDICINE I September 2012

New standards of Food Safety in China HONG KONG: China will formulate new national standards of food safety by 2015. Su Zhi, Director of Health Inspection and Supervision Bureau under the Ministry of Health, said that so far, China had formulated more than 2,000 national, 2,900 industry and 1,200 local standards that are related to food and additives. “However, problems still exist in the present standards of food safety due to the restricted development of food industry and ability of risk assessment,” Su said.

With the new standards, China will further improve the management mechanism of food safety and establish a normative and transparent working model. All related departments will be directed to study the national standards and subsequently, food manufacturers will be asked to follow the standards. The ministry will publish a report on the standards relating to more than 5,000 kinds of food as well as revise the regulations on food pollutants and pathogenic bacteria, Su added.

Dental services for needy kids at Oman MUSCAT: The American Dental Center is providing its services to orphans from the Child Care Centre in Seeb. Throughout April and May, the American Dental Center in Al Masa Mall opened its doors to about 150 children from the Child Care Centre orphanage, giving them teeth cleaning and other free dental treatments. It hopes to continue these services if it gets financial support from local individuals and businesses, said Lorraine Ignarski, practice manager at the clinic. “It’s a pretty special part of

the community that needs our care and these children at the orphanage do not receive dental care or eye care, so their visit to the American Dental Center was a first experience,” Ignarski said. While some have good dental hygiene, others require serious attention, including fillings, extractions, braces and other orthodontic care. The children will start getting the treatments after Eid, she said. A team from the American Dental Center also visited the Child Care Center and taught the children there how to look after their teeth.

FDA approves new HIV pill WASHINGTON: A new pill to treat HIV infection, that combines four medicines and only has to be taken once a day, has been approved by the US Food and Drug Administration. Stribild, which will be marketed by Gilead Sciences, contains the HIV drugs elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate. It will be prescribed to people who have never been treated for HIV infection, the FDA said in a

FUTURE MEDICINE I September 2012

statement. The drug will carry a boxed warning that says it can cause a build-up of lactic acid in the blood and severe liver problems, both of which can be fatal. In the clinical trials, common side effects included nausea and diarrhea. Serious side effects include new or worsening kidney problems, decreased bone mineral density, fat redistribution and changes in the immune system, the FDA said.

MEDICAL CONFERENCE

Europe to host first ECOP Conference BUDAPEST: The European Society of Oncology Pharmacy (ESOP) and its Organising Committee will hold the first European Conference of Oncology Pharmacy (ECOP) in the time-honoured city of Budapest, Hungary, from September 27-29 this year. With close co-operation between oncology physicians and oncology pharmacists, ECOP 2012 will offer a tremendous opportunity for exchange of ideas and debate on the ways and means to provide optimal patient care. More than 2,500 members, colleagues and partners from across the world will take part in the conclave. The primary focus of this unique European Conference is to promote the highest standards of pharmaceutical care in the management and support of patients with tumours. The latest advances in research, patient management and practice will be

showcased through keynote lectures, scientific symposia and poster sessions in two distinct tracks - clinical and practical. Professor Martine Piccart, President of the European Society for Medical Oncology, will take part in the opening lecture. Providing a great opportunity to meet, network in a convivial setting, and forge new links for future collaboration with Oncology experts from around the world, the conference promises to be a highly educational experience in every respect.

81st annual meet of Society of Biological Chemists (India) KOLKATA: The Kolkata chapter of the Society of Biological Chemists (India) will host its 81st Annual Meeting from November 8-11 this year at Science City. This symposium is being jointly organised by University of Calcutta, Bose Institute, Indian Institute of Chemical Biology (IICB), Saha Institute of Nuclear Physics (SINP), Chittaranjan National Cancer Institute (CNCI), Institute of Post Graduate Medical Education and Research (IPGMER), National Institute of Biomedical Genomics (NIBMG), Indian Statistical Institute (ISI), Indian Institute of Science Education and Research

(IISER), Kolkata, and National Institute of Cholera and Enteric Diseases (NICED). The theme of the symposium is â&#x20AC;&#x153;Chemistry and Biology: Two Weapons Against Diseasesâ&#x20AC;?. It will feature scientific sessions with oral and poster presentations. Established young investigators and leading researchers in the field of biological sciences will participate in the symposium. The objective is to provide an interactive platform for scientists engaged in biological chemistry and interdisciplinary areas. There will be plenary lectures, award winning lectures, invited lectures, and poster presentations.

Markers in Cancer 2012 to be held in Florida FLORIDA (US): The meeting of Markers in Cancer 2012 is scheduled to take place in Hollywood, Florida, from October 11-13 this year. Jointly being organised by the American Society of Clinical Oncology, the European Organisation for Research and Treatment of Cancer, and the National Cancer Institute, the goal of the meeting is to stimulate discussion

on the use of biomarkers as a tool for screening, diagnosis, and treatment of cancer. The meeting will present the latest innovations in cancer biomarkers and evaluate their practical application and clinical utility to determine optimal treatment delivery and outcomes. The meeting will include guest lectures, symposia, panel discussion, paper presentations and poster presentations.

FUTURE MEDICINE I September 2012

HEALTH STUDIES

High risk of suicide among youngsters BERKELEY (US): A recent study, conducted by researchers from University of California, Berkeley, discovered that girls aged between 17 and 24, who are diagnosed with attention-deficit hyperactivity disorder (ADHD) are up to four times more likely to attempt suicide as young women. The study, conducted among 228 girls in the 6 to 12 age group, found that 140 of them had ADHD. Of the girls diagnosed with the condition, 47 were considered ADHD-inattentive, meaning they had a hard time paying attention, but they could sit quietly. Meanwhile, 93 of the girls had ADHD-combined, a combination of hyperactive, impulsive and inattentive symptoms. The same study, conducted among the same girls five and ten years later, revealed that 22 per cent of the girls with ADHD-combined attempted suicide at least once in the 10 years, while eight per cent of them with ADHDinattentive and six per cent of them who did not have ADHD did the same. Study author Stephen Hinshaw, a psychology professor at Berkeley, also came out with shocking revelations that ADHD in girls and women carries a particularly high risk of internalising, even self-harmful behaviour patterns.

Egg yolks linked to heart disease TORONTO: Don’t go to work on an egg. Or at least not more than twice a week, particularly if you’re at risk from heart disease. According to a new Canadian research, the more egg yolks people eat, the worse will be the effect on blood vessels. Results of the study show that the build-up of carotid plaque, a waxy substance that clogs blood vessels and linked to reduced blood flow and higher risk of cardiovascular disease, is greater when people eat more egg yolks. The study, reported in the journal Atherosclerosis, assessed the effects of eating eggs among 1,200 people with an average age of 61. It showed that the carotid plaque area grew with age after 40, but increased exponentially with the number of years of smoking and egg yolk eating. “Our results suggest a strong association between egg consumption and carotid plaque burden,” say the researchers. “The effect size of egg yolks appears to be approximately twothirds that of smoking. We believe our study makes it imperative to reassess the role of egg yolks, and dietary cholesterol in general, as a risk factor for heart disease.”

FUTURE MEDICINE I September 2012

BREAKTHROUGH

Monitor body’s critical functions

on a smartphone A new smartphone, designed by an Israeli company, extends a technological module through which patients can access and use various medical applications that can help them in keeping a constant check on their body’s critical functions. It will also provide them the freedom of travel and ease of use, which is unavailable with conventional medical monitoring devices

new mobile technological solution, designed by an Israeli company, will take the global medical devices market by storm. This is a breakthrough smartphone device that will help patients in measuring blood glucose levels, oxygen saturation, stress levels, heart rate, and body temperature. The smartphone will also help people in preparing a diet chart, serving reminders on medicine intake, and measuring daily activity through embedded sensors. The smartphone will not only help patients in keeping a constant check on their body’s critical functions, but also provide them the freedom of travel and ease of use, which is unavailable with conventional medical monitoring devices. LifeWatch Technologies, based in Rehovot, has introduced the new LifeWatch V Android-based phone, the first of its kind smartphone device which offers a lot of excellent medical applications. Data and results are provided to the user and to third parties such as healthcare providers or caretakers, via email or text message. The device wirelessly interacts with a remote cloud-based environment, enabling users to take advantage of related complementary medical and wellness-related services. And it makes and receives regular phone calls. Medical information will also be sent to one of LifeWatch’s US emergency call centres. A centre is currently in development in Israel. The device is particularly useful in managing chronic conditions such as diabetes. It is particularly appropriate for children because it will enable parents to monitor health data while their children are away from home - at school or elsewhere. The stainless steel-framed phones will be manufactured by TechFaith Wireless Communication Technology of China, according to Israeli specs and industrial design, and will provide interface options in Hebrew, English, Italian, Russian, Japanese, Spanish, Portuguese, and Chinese. The device, likely to cost between $500 and $700 a unit, is expected to hit the market next year, pending approval in the EU and the US. New technology may be developed to assist the speech of those unable to communicate due to paralysis or disability, thanks to a joint study between scientists at Haifa’s Technion and UCLA who have uncovered how brain cells encode the pronunciation of vowels in speech. The scientists lauded the discovery as a potential starting point for developing neuro-prosthetic devices, or brain-machine interfaces, to decode the brain’s firing pattern for speech.

FUTURE MEDICINE I September 2012

VOICES “One of the key opportunities that we see in India is helping healthcare providers design, build and operate a modern ICT infrastructure that effectively supports the important work of care givers” Neil Jordan, General ManagerWorldwide Health, Microsoft.

“India’s healthcare system must be developed to cater to all sections, in rural as well as in urban centres. There should be more medical colleges, nursing institutions, and training schools for paramedical professions” Pranab Mukherjee, President of India

“The medical displays hold great importance in healthcare. The display is the connection between the technology and the human and it gives the best possible zero compromise support on a reasonable price to the doctor” Abel Garamhegyi, Vice-President, Growth Markets EMEAI, & Managing Director, India, Barco Group of Hospitals

Ancient Wisdom

“Achieving affordable healthcare is a key action area highlighted in the 10-year Council of Scientific and Industrial Research plan. Early detection of disease will increase the survival rate and reduce the treatment cost considerably” Dr Samir K Brahmachari, Director-General, CSIR

“A person should learn how to make a living; youth is the time for pleasure, and as years pass, one should concentrate on living virtuously and hope to escape the cycle of rebirth. ” Maharishi Vatsyayana, Author of Kama Sutra

FUTURE MEDICINE I September 2012

Dr Sejal Parag Sanghavi PERSONALITIES

Homoeopath plucks out diseases from the

root

Dr Sejal Parag Sanghavi, a homoeopathic practitioner, believes in attending to the root cause of a disease, rather than just focussing on the illness alone. Her permanent healing powers have brought her national as well as international recognition Bureau

hat should be the focus of a medical practitioner? The patient, or the disease? Experts say that the potentiality of a cure lies in the ability to eliminate the root cause of a disease than mere focus on disease mitigation or prevention. This is where the practical aspects of a treatment should be given more significance than the theoretical approaches of medical sciences. The majority of medical practitioners are known for paying attention to curing the illness alone, whereas the cause for the illness may still remain in the body. So, for complete cure, it is imperative to focus on removing the disease from the root. That’s where the traditional branches of medicine have been able to prove their efficacy. For the past 13 years, Dr Sejal Parag Sanghavi, a homoeopathic practitioner, has been successful in helping patients overcome various kinds of illnesses and diseases as well as their root causes. Dr Sejal says, “Over the last 13 years, we have treated tens of thousands of people across the world. We offer treatment for all kinds of diseases. This (Homoeopathy) form of medication has no side effects at all and that is why it is an effective alternative medication.” Dr Sanghavi has imbibed various ideas of treatment from the ancient theories of German Homoeopathy. Her treatment is based on two

FUTURE MEDICINE I September 2012

unconventional theories: “like cures like” - the notion that a disease can be cured by a matter that produces similar symptoms in healthy people; and “law of minimum dose” - the view that the lower the dose of the medication, the greater its effectiveness. What’s more, this kind of treatment is 40-50 per cent cheaper than the costs generally incurred in the mainstream medical sector. Many medical experts have vouched for Dr Sanghavi’s innovative treatment methods, saying that she has made a valuable contribution to the health sector with her permanent healing prescriptions. Alternative treatment in Homoeopathy generally begins with detailed examination of patients, including their medical history, physical, mental and emotional states, their life circumstances, and physical-emotional illnesses. Out of such data, Dr Sanghavi develops her own formula by listing the mental and physical symptoms, including likes, dislikes, innate predispositions and even body type, which results in quick diagnosis of diseases. She has a proven record when it comes to healing patients suffering from complex skin diseases, kidney failure, cancer etc. She has also gained international recognition following the introduction of her services in Rwanda and other African countries.

Dr Sejal Parag Sanghavi is a visiting Indian expert in Homoeopathy in the African medical sector. She has over 13 years of experience with modern Homoeopathic treatment and research. She had established Dr Sejal’s Modern Homoeopathy Clinic in Mumbai in 1998 to provide research-oriented treatment for a host of new generation diseases. She has treated more than 65,000 patients from the USA, Australia, Kenya, Hong Kong, the UAE, Singapore and the UK. She has also set up Dr Sejal’s Foundation in Maharashtra, a leading Homoeopathy research institute.

REALITY CHECK Indian healthcare sector

‘Public-Pvt pacts key to healthcare’ India should make up for the deficiencies in the healthcare sector by promoting public-private partnership projects, says President Pranab Mukherjee

resident Pranab Mukherjee has observed that though universal healthcare remains a distant dream, it is not beyond reality. He made this statement at the Heal Annual International Conference 2012, his first public function after being elected the 13th President of the country. The function, organised by the Federation of Indian Chambers of Commerce and Industry (FICCI), was based on the theme of “Universal Healthcare: Dream or Reality?” “The good health of its people is the very foundation of a nation. A person who is not healthy is unable to access opportunities for learning, growth, and productive work. In India, a number of rights are guaranteed to its citizens, but none of these can be utilised or enforced by persons who are sick, enfeebled and spend their entire energy on treatment and medical care,” said the President. “The government looks at scaling up expenditure of health from the current level to 2.5 per cent of the gross domestic product (GDP) by 2017 and 3 per cent by 2022. The government cannot handle healthcare issues single-handedly. We should encourage cooperation between the public and private sectors in achieving health goals,” asserted the President. However, experts feel that the expenditure on healthcare should constitute 5.5 to 6 per cent

of the GDP and requires a 10-year time-frame to accomplish it. The current healthcare spending to GDP is less than two per cent. India, according to a World Health Organisation report, spends $132 per person on health services per year, as compared to the annual spend of $639 per person by the US. China spends 5.1 per cent of its GDP on healthcare, said the latest FICCI report. Emphasising on universal healthcare, cutting across rural and urban India, the President stressed upon the need for private and public sector to join hands to improve heath services. “Some private hospitals provide world class facilities, so much so that people from Third World countries come here for treatment, giving impetus to medical tourism. At the other end of the scale is the lack of access to even basic medical care to many people,” he said. “The estimated economic loss for India due to deaths caused by various diseases in 2005 was 1.3 per cent of its GDP. With an increase in the number of non-communicable diseases, this loss is expected to increase to five per cent of GDP by 2015. Therefore, a healthcare coverage that assures access to medicines and treatment at affordable prices is an objective,” Mukherjee said, adding that mere construction of hospitals without sufficient human resources would not make the healthcare system functional and effective.

FUTURE MEDICINE I September 2012

Hearing loss RESEARCH STUDY

Finding a cure for

sensorineural hearing loss Dr Sonali Rahul Pandit, a consulting ENT surgeon based in Mumbai, was a member of a research team that successfully worked on a stem cell therapy for curing hearing loss, at the Garvan Institute of Medical Research, Sydney, Australia. In an exclusive interview with Future Medicine, Dr Sonali Pandit shares her belief that stem cells could play a vital role in treating sensorineural hearing loss, a type of hearing loss in which the root cause lies in the inner ear, or central processing facilities of the brain By Sreekanth Ravindran Tell us about the research you had undertaken at the Garvan Institute of Research. In 2008, I joined the Garvan Institute of Medical Research, Sydney, Australia, which is a premier Research Institute. I worked there as a Hearing Research Fellow in Hearing Research Group till 2010. I also pursued Masters of Surgery in Hearing Research from University of New South Wales, Sydney. I worked on the effect of olfactory stem cells on early-onset sensorineural hearing loss and the effect of tongue stem cells on noise-induced hearing loss in mice. In both the experiments, we showed statistically significant improvement in hearing in the stem cell transplanted animals as compared to the control group.

FUTURE MEDICINE I September 2012

How has the scientific community reacted to these research findings? The response from the scientific community is always cautious, but encouraging. As we all know, one experiment is not enough to come to any conclusion. The results should be reproducible. Since this field is still in its infancy, a lot more basic science

Dr Sonali Rahul Pandit, Consulting ENT Surgeon

RESEARCH STUDY Hearing loss

research needs to done. Can we treat hearing loss (both congenital and acquired) permanently? Stem cells need some cues to go to the site of damage and initiate the repair process. So, this therapy will be more promising for acquired hearing loss such as noise-induced hearing loss, hearing loss due to ototoxic drugs or agerelated hearing loss. They either can replace the damaged inner ear hair cells, or secrete some factors to help the survival of endogenous hair cells. Scientists are exploring different types of stem cells using different routes of transplantation. Few animal experiments have shown favourable results. So, the future is definitely bright. The role of stem cell treatment for genetic hearing loss is questionable. There are other modalities such as gene therapy using viral vectors to deal with genetic hearing loss and again, these still are on animal levels. How do you plan to take the research forward and what promise does it hold? I moved back to India two years ago. I completed Masters of Surgery in Hearing Research in February 2012. I am keen on taking this research forward and looking for collaboration with some premier research institutes in India. This field holds a great promise. As we all know, there is no definitive treatment for sensorineural hearing loss at present. Stem cells can be a future to treat sensorineural hearing loss. Could you share your experiences at Garvan Institute of Research and tell us where Indian

research is lacking in terms of breakthroughs? I really had a great time doing hearing research at the Garvan Institute. As we were a dedicated hearing research group, I got a chance to work with lots of intelligent and knowledgeable people. Being a surgeon, I did not have much exposure to basic science research. I had to learn many new techniques and animal surgeries, which was challenging but worth it at the end. I can only comment on hearing research in India. Doing a basic science research in the field of hearing in India is very difficult due to lack of infrastructure, funding, and expertise in this field. We are still far from breakthroughs in the field of hearing research. What is your current area of engagement? Are you exploring any other research subjects on hearing impairment? I am currently into fulltime clinical practice in Mumbai. I am attached to Kohinoor Hospital and also have my own ENT clinic. I am not engaged with any research projects on hearing impairment at present. But I am reading a lot about cochlea and its micromechanics, and stem cell science and hopefully come up with a viable research project. Dr Sonali Rahul Pandit completed her MBBS from Government Medical College, Aurangabad, Maharashtra. She did her Masters in Surgery (MS) with specialisation in Ear, Nose and Throat (ENT) from the same college. Dr Sonali then moved to Australia, where she obtained a fellowship in Paediatrics ENT from Sydney Childrenâ&#x20AC;&#x2122;s Hospital. In 2008, she joined Garvan Institute of Medical Research, Sydney, for a fellowship programme in hearing research. An MS holder from St Vincentâ&#x20AC;&#x2122;s Clinical School, University of New South Wales, Sydney, she is presently employed as a Consultant ENT Surgeon at Kohinoor Hospital, Kurla (W), and at Aaryan ENT Clinic, Tilak Nagar, Chembur, Mumbai.

FUTURE MEDICINE I September 2012

Rural Healthcare Lady, Wonder Drug COVER STORY Wonder

Counting on

Crofelemer Thereâ&#x20AC;&#x2122;s a new beacon of hope and relief for millions of HIV/AIDS patients and children suffering from debilitating diarrhea. A US-based pharmaceuticals major, Napo Pharmaceuticals, is all set to revolutionise the healthcare sector with a pioneering drug, called Crofelemer, that can effectively address the issue of chronic diarrhea among such people. The drug, which has completed Phase 3 of clinical trials, is under the review of the US Food & Drug Administration. In an interview with Future Medicine, Napo Pharmaceuticals Founder and Chief Executive Officer Lisa Conte talks about the immense healing potential of this drug that can redefine healthcare

By Sanjeev Neelakantan What made you take up entrepreneurship and enter the drug manufacturing business? It dates back more than 20 years. I was working as a venture capitalist analysing biotech companies at the time and decided to climb Mount Kilimanjaro while vacationing in Tanzania. I noticed that one of the other climbers, who was suffering from altitude sickness, was ingesting some sort of plant-based concoction he had bought from a trailside pharmacy, which actually seemed to help him. There was something about the simplicity of it (medicines safe and effective because they’ve been used traditionally for hundreds/thousands of years) and just how natural it all felt that inspired me. Both of my parents were pharmacists, so perhaps at some level, that played a role in my decision to shift career paths, but this was my real “eureka” moment. It must have been a rollercoaster ride from Shaman to Napo Pharmaceuticals. What brought about the transformation and how different are these two business models? Shaman was a natural outgrowth of the experience I had on Mount Kilimanjaro. Even the name reflects that. We started the company in an effort to discover new drugs derived from plants that, in some cases, had yielded medicines that had been used for thousands of years. The rain forests of all continents, in particular the Amazon, were a natural source, and Shaman was specifically created to seek out FUTURE MEDICINE I September 2012

this knowledge and adapt it to modern technology. Shaman was a risk-based R&D company. To accomplish what we wanted to do, we needed significant equity financing. When equity was not available due to capital market unrest, we brought in some debt, which was devastating to the company balance sheet. It turned out to be a very steep learning curve for us. Napo was created to continue all that Shaman had done and provide global access to the products we developed. Napo continued Shaman’s innovation and added a business model that focussed worldwide on every country, every population, and every channel of distribution regardless of socio-economic relevance. Most importantly, we discovered a product, Crofelemer, which has an enormous potential to address a worldwide health issue. Initially, if approved by the US Food and Drug Administration (FDA), we will address the issue of diarrhea in people living with HIV/AIDS, which is a real problem and growing with expanded use of anti-retroviral therapy in a prophylactic setting. The global potential of Crofelemer is further to address the worldwide issue of the millions of children who die each year in resource-constrained environments from dehydration associated with acute diarrhea. Our research to date shows there are no serious side effects and our product is incredibly effective in addressing this worldwide scourge of mankind. The market potential

A croton lechleri tree in Northern Peru. Crofelemer, which is developed from a compound found in these trees, may one day be used to eradicate debilitating diarrhea for millions of children around the world.(Photo Credit: Steven R King)

Healthcare Wonder Lady, Wonder Drug COVER STORY Rural

“Sangre de drago”, or dragon’s blood, is the compound used in Crofelemer. It can be found in a number of tree species in the rainforest regions of Central and South America. (Photo Credit: Michael Powers) is enormous. What’s the status of the clinical trials of Crofelemer? Is it just an anti-diarrhea drug or can it help in fighting other serious ailments? Crofelemer has completed Phase 3 of clinical trials and is awaiting approval by the US FDA. It addresses all forms of watery diarrhea. Initially, it has been submitted to address chronic diarrhea created by anti-retroviral treatment of HIV/ AIDS patients, which is a very significant market. Eventually, we hope and expect that it will be approved to treat the global problem of watery diarrhea caused by cholera and other infectious agents, which results in the deaths of millions of people, including close to two million children each year, and causes measurable morbidity in hundreds of millions more. In all our trials, there have been no significant side effects seen by this very natural product. One other indication we’ve published data on is Irritable Bowel Syndrome, IBS, for which the endpoint is patient relief of pain. This is a global issue as well, affecting the lives of up to 20 per cent of adults. Tell us something about your drug portfolio, procurement of medicinal plants and herbs, and research and development initiatives. Our discovery process starts with ethnobotanist and Western-trained physicians working with ‘shamans’ or healers in the field focussing on symptoms of diseases we’re interested in. Our second product in the clinical

pipeline is for diabetes. What are your focus areas in the emerging markets, especially India and China? Are you planning any mergers or acquisitions? Crofelemer is a product for which there is a worldwide need and application. There isn’t any population anywhere in the world that doesn’t have the problems addressed by Crofelemer. India and China, with their large populations, are specific targets where we feel the product can make a huge difference. Once approved, we are committed to making sure crofelemer will be available to all who need it. What are the challenges, especially on the patents and intellectual rights front, confronting the pharma industry? India’s compliance with the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights in 2005 was an important step towards allowing us to bring a proprietary treatment like Crofelemer to the emerging markets. What are your corporate social responsibility initiatives? The Healing Forest Conservancy is a nonprofit organisation through which we give back to the communities with which we collaborate, providing benefit sharing from our future profitability. We also sustainably harvest our raw plant material in the rain forest utilising fair trade work practices. And, we’ve established

FUTURE MEDICINE I September 2012

a B corporate subsidiary focussing on our social commitment to reach out to communities worldwide, where young children are dying needlessly, and provide accelerated development access to Crofelemer for pediatric purposes. What is Napo’s involvement in meeting the critical medical needs of the African population, who are trapped in the vicious circle of death and

poverty? We have no borders! All who can benefit from Crofelemer should have access to it and we are committed to doing everything within our power to make sure that happens. Once in a rare while, there is an opportunity for a company to develop a product like Crofelemer. It has been a long road for us. We are both near the end of this road and the beginning

A socially committed entrepreneur Lisa Conte has dedicated much of her professional life to finding ways to build high risk/high reward businesses. Her travels have taken her all over the world, from Tanzania to the Peruvian Amazon, from London to Haiti and back. For well over 20 years, she has been a pioneer in a unique segment of the biotech and pharmaceutical industries, never giving up in the face of adversity. One of Lisa’s primary interests has always been to bring about social change in the pharmaceutical industry by focussing on access to new and novel medicines for populations that must typically wait for generics to be made available to them. Early in her career, Lisa conducted risk and strategy audits for start-up companies at Strategic Decisions Group (1985-1987) and served as Vice-President at Technology Funding, Inc., a venture capital firm (1987-1989). In 1989, while on vacation, climbing Mount Kilimanjaro, she observed another climber treating a bad case of altitude sickness with a plant-based remedy purchased at a local pharmacy. Inspired by what she saw, Lisa began researching ways in which plants could be used to combat illness. What she discovered was a market that offered tremendous potential, one that she hoped to tap into by founding Shaman Pharmaceuticals, Inc., a natural product pharmaceuticals company. At Shaman, Lisa focussed her efforts on developing remedies derived from medicinal plants that could be used to treat various ailments, from diabetes to diarrhea. In November 2001, Lisa founded San Francisco-based Napo Pharmaceuticals, which brings medicinal products to the global marketplace by working together with the indigenous populations in communities throughout the world. The company’s lead drug, Crofelemer, is intended for the treatment of diarrhea, which proves fatal for as many as two million children

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each year in emerging and developing countries, and is among the side effects of anti-retroviral therapy in people living with HIV/AIDS. Crofelemer is sustainably harvested from the Croton lechleri tree found in rain forest areas. Following successful Phase 3 clinical trials, the FDA is currently reviewing the efficacy of Crofelemer. Lisa earned a Bachelor’s degree in Biochemistry from Dartmouth College and a Master’s degree in Physiology and Pharmacology from University of California at San Diego. She later enrolled in the Tuck School at Dartmouth, where she graduated with an MBA. She is the recipient of several entrepreneurship awards, including the 1994 E&Y Entrepreneur of the Year Award, and was a nominee for the 2009 BIO Humanitarian Award. She has also sat on several industry and academic boards.

Lisa Conte, Founder, Chief Executive Officer, Napo Pharmaceuticals

COVER STORY Wonder Lady, Wonder Drug

of a whole new world that will open to us and those who can benefit from our product. Again, we are committed to making that happen. Like Shaman, does Napo take part in continuing medical education programmes? Once we start generating income from the distribution of our product, we will be looking at medical education programmes. The very nature of our product is a worldwide education in itself. According to you, how well are the US companies positioned to tackle the gradual shift of economic axis from the West to the East? Napo surely recognises the significant development of emerging economies that until recently have often been considered part of the “developing world”. We are committed to focussing our business in that area as well as the traditionally higher margined West. We feel we are surely one of the first companies to bring social change to the

pharma industry with the ultimate goal of sustainably optimising profitability through local partnerships while addressing global populations and their health needs. One of the main reasons I got into this business in the first place was to help people with business practices that align financial incentives with the provision of novel medicines to all. It goes to the heart and soul of what Napo is all about. To see millions of lives negatively impacted by a disease that should be easily be treated is every bit as frustrating as it is heartbreaking because it doesn’t have to be that way. We know we have a “first in class” medicine with Crofelemer and are anxious to have it produced and distributed for the masses, so more lives do not have to be needlessly lost or impacted with suffering. This product has the potential to change the world for the better in so many different ways. People should know that help is on the way.

Red latex, used to develop Crofelemer, oozes from Croton lechleri tree. Napo Pharmaceuticals makes it a point that for every full Croton lechleri tree that is harvested, it reforests a new one. (Photo Credit: Steven R. King)

‘Breach of trust’ hurts the healer

he development of Crofelemer as a drug is the result of more than two decades of efforts on the part of Napo and dozens of other contractors and licensees who have worked to bring this drug to market. US-based Salix Pharmaceuticals became a formal party to that collaboration in December 2008, yet has not performed any of its obligations as promised, says a statement issued by Napo. Without informing Napo, Salix has filed a new drug application with the US Food and Drug Administration (FDA) for approval of Crofelemer as a botanical drug. Since 2011, Salix has refused to share any information with Napo about its filing with the FDA or their claimed characterisation of the product as a botanical drug, despite contractual

obligations and Napo’s ownership of this drug. Given this and other alleged breaches of the contract between Napo and Salix, Napo filed a suit in May 2011 to terminate the contract, which is proceeding in the New York State Supreme Court. During this period, Salix, a $3-billion company, has been selling a product, rifaximin, that many analysts believe overlaps with a market indication for Crofelemer. On Salix’s new application, Napo CEO Lisa Conte said, “We are dismayed that Salix would take action that may negate and undermine almost two decades of work on Crofelemer as a new chemical entity by proceeding with a regulatory filing as a botanical in light of the strong objections, regulatory precedents, and scientific integrity presented by Napo and Shaman.”

FUTURE MEDICINE I September 2012

E-mail: mail@aryavaidyasala.com / avsho@sancharnet.in

Tel: 0483-2808000, 2742216, Fax:2742572, 2742210

AYURVEDA - THE AUTHENTIC WAY

LEASE OF LIFE Cure for SCI-induced paralysis

Eight patients to undergo Schwann cell transplant In what is being seen as a big stepping stone to finding cure for those suffering from spinal cord injuries-induced paralysis, the US Food and Drug Administration has given the world renowned Miami Project to Cure Paralysis the go-ahead to begin a revolutionary Phase 1 clinical trial to evaluate the safety of transplanting human Schwann cells to treat patients with recent spinal cord injuries. Found mainly in the peripheral nervous system, Schwann cells are essential to sending appropriate electrical signals through the nervous system Bureau

pinal cord injury is a severe medical condition that quite often leads to paralysis. Millions of people across the world suffer from one or other form of paralysis because of spinal cord injuries. No perfect cure for paralysis associated with spinal cord injuries exists today. But there’s hope now. The Miami Project to Cure Paralysis, a Center of Excellence at University of Miami Miller School of Medicine, US, has received permission from the US Food and Drug Administration (FDA) to begin a revolutionary Phase 1 clinical trial to evaluate the safety of transplanting human Schwann cells to treat patients with recent spinal cord injuries (SCI). Found mainly in the peripheral nervous system, Schwann cells are essential to sending appropriate

electrical signals through the nervous system, and Miami Project scientists believe that they are key to finding cures for paralysis. In what will be the only FDAapproved cell therapy-based clinical trial for sub-acute spinal cord injury in the United States, investigators plan to transplant a patient’s own Schwann cells at the injury site in the hope of ascertaining safety that will allow further trials to proceed. “We believe the announcement is just as important to our field as man’s first step on the moon was to the space programme,” said neurosurgeon Dr Barth Green, MD, Co-Founder and Chairman of The Miami Project. “When we started The Miami Project, the short-term goal was to improve the quality of life of people living

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with paralysis, but the long-term goal remains reestablishing function and finding a cure. Today the scientists, clinicians, and technicians who have made this day possible have taken a giant leap forward. The hundreds of millions of dollars and incalculable hours of bench and clinical work invested in this goal have been well spent.” Led by W Dalton Dietrich, PhD, the Schwann cell clinical trial team at The Miami Project is composed of a multi-disciplinary group of basic science and clinical faculty members, scientific staff, and regulatory personnel focussed on advancing the trial. “Obtaining clearance from the FDA to initiate this important Phase I clinical trial is a vital step for the field of SCI research, and for the Miami Project team that has been working diligently on this therapeutic concept for more than a quarter of a century. This trial, when completed successfully, will lay the critical foundation for future cell-based therapies we plan to target SCI,” said Dr Dietrich, Scientific Director of The Miami Project. The clinical trial will enrol eight participants with an acute thoracic SCI. Newly-injured patients brought to the trauma center would have to meet the stringent criteria and agree to participate in further screening within five days of their injury. At that point, the participant will undergo a biopsy of a sensory nerve in one leg to obtain his or her own Schwann cells. The Schwann cells will then be grown in a culturing facility for three to five weeks to generate the number of cells necessary for transplantation, and to undergo the strict purification process. By the time the Schwann cells are surgically transplanted into the injury site, participants will be 26-40 days post-injury. All procedures will be conducted in Miami at University of Miami Hospital, Jackson Memorial Hospital, and The Miami Project to Cure Paralysis. Each participant will be followed intensely for one

The clinical trial will enrol eight participants with an acute thoracic spinal cord injury. Newly-injured patients brought to the trauma center would have to meet the stringent criteria and agree to participate in further screening within five days of their injury

FUTURE MEDICINE I September 2012

The clinical trial team comprises a group of basic science and clinical faculty members, scientific staff, and regulatory personnel. year after receiving the transplantation surgery, and their neurologic status, medical status, pain symptoms, and muscle spasticity will be evaluated. It is expected that it could be at least two to three years from the time the first subject is enrolled until the final subject is one year post-transplantation. All participants will continue to be monitored for years under a separate clinical protocol. This Phase I trial is the foundation upon which The Miami Project will develop future trials targeting different types of injuries, times post-injury, and therapeutic combinations. The Miami Project has developed lifeenhancing SCI programmes used by hospitals and clinics across the nation and around the world. For example, male fertility for paraplegics and quadriplegics was a research effort and is now clinical practice; the monitoring of a patient’s spinal cord in the operating room was a concept, and is now an FDA-approved reality; the use of functional electrical stimulation in rehabilitation of paralysed or partially paralysed muscles is now FDA-approved and effective because of work by The Miami Project; the use of computerised walking systems is now FDA-approved; and the use of cooling to protect the nervous system is now an approved and commonly used practice in cardiology and vascular surgery and is rapidly being advanced in the areas of

LEASE OF LIFE Cure for SCI-induced paralysis

All procedures will be conducted in Miami at University of Miami Hospital, Jackson Memorial Hospital, and The Miami Project to Cure Paralysis. Phase I trial is the foundation upon which The Miami Project will develop future trials brain and spinal cord injury due to the work of The Miami Project.

Goal of the clinical trial

The goal of every phase I clinical trial is to demonstrate safety. The Miami Project has designed a clinical trial that will minimise risk and maximise

evaluation of safety. Is this a first step in the cure for paralysis? No. This is a Phase 1 safety study. The spinal cord is a very complex organ, after all it, in combination with the brain, controls every single aspect of our body. Hence, when the spinal cord sustains damage, people lose more than just the ability to walk. Aside from the loss of movement and sensation, almost every single SCI results in the loss of bladder and bowel control. Depending on where the injury occurs, there may be additional impairments in sexual function, loss of the ability to regulate body temperature and blood pressure, reduced breathing and coughing capacity, and inefficient metabolism of food. Inside the spinal cord, there is a multitude of damage. Firstly, there is primary damage. In regard to traumatic injury, the primary damage is a direct result of the impact of whatever caused the injury (examples: fall, gunshot, car crash, etc). Secondly, waves of biological events are triggered by the primary damage that ends up causing secondary damage. The main contributor to the secondary damage is the immune system. The end result is that the spinal cord tissue that was not damaged by the primary impact ends up dying. Thirdly, cells die in and around the injury site. These include motor nerve cells (motoneurons), sensory nerve cells (sensory neurons), relay nerve cells (interneurons), and multiple types of support cells called â&#x20AC;&#x153;gliaâ&#x20AC;? (astrocytes, oligodendrocytes). Fourthly, individual nerve fibres (axons) running up and down the spinal cord get severed. The cell bodies of these severed axons are located away from the injury site and often remain alive; however, they can no longer communicate. Fifthly, inhibitory scar tissue develops around the injured area. It does not make sense then, to expect one intervention to repair all the different types of damage that occur and restore all of the different functions that are impaired. Schwann cells are one component of a multi-faceted cure.

Age groups targeted in the trial

The patient should be aged between 18 and 50 at the time of the spinal cord injury.

Injury levels included in the trial

T3 to T11, ASIA Impairment Scale grade A.

Who will be included in the trial?

Both men and women are eligible for the trial. However, the first eight people who meet all of the inclusion criteria, agree to participate, and undergo transplantation of their Schwann cells will be the participants.

Will the people included in this trial be able to receive hypothermia?

FUTURE MEDICINE I September 2012

No. That would confound the interpretation of the results of this trial.

What do we hope to learn from this study?

Safety. Firstly, the Miami Project researchers hope to demonstrate that they can insert a needle into the centre of the spinal cord injury site without causing any damage. Secondly, they hope to demonstrate that transplanting one’s own Schwann cells into the thoracic cord does not cause additional damage.

How long will it take to complete this trial?

It could take two to three years from the time of enrolment of the first subject until the final subject is one year post-transplantation.

Why does it take so long to complete the trial? There are many reasons: • Only about 25 per cent of all spinal cord injuries are between T3-T11 and, of those, many sustain additional trauma during the accident, which will exclude them from this particular trial. • For the first two subjects, there is a onemonth waiting period between the time of transplantation surgery and enrolment of the next subject; this leads to a gap of about twoand-a-half to three months between enrolments.

•

Realistically, it could take seven-and-a-half to nine months to enrol and transplant the first three subjects in the trial. After that, we can enrol one subject each month. So, in the best case scenario, it could take 12-15 months to get all eight subjects enrolled and transplanted. Each subject will be followed for one year following the transplantation procedure to analyse safety. Therefore, it could take two to two-and-a-half years from enrolling the first subject to collecting the final data from the last subject. The data will then need to be analysed and submitted to the FDA.

Ultimate objective

The Miami Project is committed to moving basic science discoveries forward into clinical trials for people living with spinal cord injury. Being based within an academic institution, University of Miami Miller School of Medicine, we are driven by factors different from corporations in the business world. Our goal is to translate safe, promising discoveries to clinical trials where they can be thoroughly evaluated and ultimately approved by the FDA for medical use.

Why does this trial include only acutely injured people?

The main reason the Miami Project is doing new injuries first is because it had more animal data in that setting, allowing it to seek FDA approval faster. Getting faster FDA approval means going into people faster, which means finding out about human safety faster.

Will the trial eventually include chronically injured people?

Schwann cells growing in a tubule.

FUTURE MEDICINE I September 2012

This specific clinical trial will not include chronically injured people. The Miami Project is currently conducting more animal chronic transplantation preclinical studies and will soon begin a combined exercise and locomotor rehabilitation study for chronically injured people to determine the minimum exercise and rehabilitation needed to prepare people for transplantation surgery and to ensure that they are neurologically stable. It will take all of that data and design another clinical trial specifically for people with a chronic

LEASE OF LIFE Cure for SCI-induced paralysis

injury. It will submit that in addition to safety data generated by the acute trial to the FDA for approval.

Participation in the trial

If you have a loved one who has had a thoracic spinal cord injury less than five days ago, call the Miami Project Education Department at 305-2437108 for information and preliminary screening. Think of this as a building block to developing the most effective treatments for people living

with SCI. The best way for anyone to get access to these treatments quickly is to keep healthy and in very good condition so that he/she can qualify for clinical trials as they become available. For treatments to go all the way through multiple clinical trials and become mainstream medical practice, it could take 10-15 years or more depending on the intervention being tested. Participating in clinical trials helps the Miami Project move the field forward faster.

W Dalton Dietrich, Scientific Director of The Miami Project to Cure Paralysis; Barth A Green, Cofounder and Chair of The Miami Project; Nick Buoniconti, Co-founder of The Miami Project; and Marc Buoniconti, President of The Miami Project.

The guiding force

f courage is grace under fire, Marc Buoniconti ranks among the bravest men you’ll ever know. A 1985 spinal cord injury left him unable to move a muscle below his neck. Yet, each day he moves people; moves them to understand the tragedy of paralysing spinal cord injury and to join him in finding its cure. The son of legendary All-Pro and Hall of Famer linebacker and former Miami Dolphin Nick Buoniconti serves as President for The Miami Project to Cure Paralysis and The

Buoniconti Fund to Cure Paralysis, The Miami Project’s fundraising arm. “Back in 1985, all we had was (MD, Co-Founder and Chairman of The Miami Project) Dr Barth Green’s dream, my family’s determination, a lot of hope, and a tonne of hard work ahead of us,” said Miami Project President Marc Buoniconti. “To be at this point today, receiving FDA authorisation for this Schwann cell trial, is so rewarding to me, my family, and everyone who has ever stood by our side and supported this important work. This is another of the many monumental steps we’ve undertaken these past 26 years that will lead us to our ultimate goal of curing paralysis.”

FUTURE MEDICINE I September 2012

Papworth Hospital, UK WORLD HOSPITAL FOCUS

Pioneers of cardiac care Papworth Hospital is one of the UK’s leading and largest specialist providers of cardiac surgery, including Coronary Artery Bypass Grafting (CABG) and the UK’s largest valve repair/replacement centre. The hospital was founded in 1917 as a sanatorium and hospital for the treatment of tuberculosis. From the 1950s, surgical facilities developed, beginning with thoracic (chest/lung) surgery and expanding to cardiac surgery. Today, Papworth is the UK’s main heart/lung transplant centre Bureau

hen it comes to cardiothoracic services, Papworth Hospital in the UK is in the forefront of providing innovative treatments for heart and lung patients across the country. Papworth, one of the UK’s leading centres in coronary angiography, angioplasty and stenting, undertakes high volumes with a lower complication rate than other peer group hospitals. It is also a leading centre for intervention in structural heart disease, including closure of septal defects and transcatheter treatment of valve disease. The hospital is one of the first centres in Europe to offer Transcatheter Aortic Valve

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Implantation (TAVI). It is recognised as one of the UK’s leading centres for Electrophysiology (EP) and also a major centre for device implantation, including pacemakers, biventricular pacemakers and implantable defibrillators. Papworth Hospital is one of the UK’s leading and largest specialist providers of cardiac surgery, including Coronary Artery Bypass Grafting (CABG) and the UK’s largest valve repair/ replacement centre. The hospital was founded in 1917 as a sanatorium and hospital for the treatment of tuberculosis. From the 1950s, surgical facilities developed, beginning with thoracic

WORLD HOSPITAL FOCUS Papworth Hospital, UK

(chest/lung) surgery and expanding to cardiac surgery. Today, Papworth is the UK’s main heart/ lung transplant centre.

Thoracic services

Papworth is an internationally recognised specialist centre for the treatment of diseases of the chest. It is a major centre for thoracic surgery using latest research and techniques. The hospital offers one of the largest services in Europe devoted to the treatment of chronic lung infections. Its Adult Cystic Fibrosis Centre has gained national and international reputation for its contribution to research. Papworth Hospital is one of the UK’s leading specialist centres for the diagnosis and treatment of pulmonary vascular diseases. It is the only UK hospital to offer Pulmonary Endarterectomy (PEA) surgery for pulmonary hypertension. Papworth Hospital is the largest national centre for the provision of ventilator support and sleep medicine. The centre, which features a ‘sleep clinic’, is the largest in the UK.

Transplant services

Papworth Hospital is the country’s main adult heart and lung transplant centre. Known for having performed the UK’s first successful heart transplant in 1979, the world’s first heart-lungliver transplant in 1986, and the UK’s first beating heart transplant in 2006, Papworth Hospital is globally renowned as a clinical and research centre of excellence. Papworth Hospital pioneered the use of invasive monitoring and hormone resuscitation for multiorgan donors, which has become the gold standard in donor management.

Radiology services

Papworth Hospital’s radiology service has a key role in the diagnosis of all cardiothoracic conditions. The service uses state-of-the-art imaging technology and facilities include a CT and MRI scanner. The Radiology Department images over 50,000 patients each year.

Theatres and Critical Care Services

The Theatres, Critical Care and Anaesthesia Directorate (TCCA) supports all surgical activity across the hospital. Papworth has a theatre suite with five theatres and a recovery unit. A seven-bed High Dependency Unit (HDU) extension to Critical Care was completed at the beginning of January 2010. These additional beds will bring the total number of critical care beds to 32. There are five operating theatres with adjoining anaesthetic rooms on the first floor of the surgical unit. Each theatre

is equipped to carry out the full range of cardiac, thoracic and transplant operations. Three theatres have facilities for remote viewing of operations, in the lecture theatre, by visiting surgeons or staff from other hospitals. There is a four-bedded recovery area adjacent to the five theatres.

Critical Care

The 32-bed critical care area (CCA) comprises eight cardiac recovery (CRU) beds dedicated to the care and treatment of patients for the first 24 hours following open heart surgery. The remaining 24 intensive care beds provide a flexible level of care for patients who require ongoing and more complex treatment and support. As a tertiary and national referral centre, the unit also admits patients needing treatment for heart failure, and following transplant and pulmonary thrombo-endarterectomy (PTE) surgery. In addition, it treats patients with cardiothoracic emergencies like aortic dissection and chest trauma.

FUTURE MEDICINE I September 2012

the hospital. The hospital resuscitation service is coordinated from the anaesthetic department. Another consultant runs a pain clinic. An ongoing and broad range of active research programmes is also a common element of the department and a specific anaesthetic research unit runs various research studies. There is particular interest in research into the development of blood substitutes, the acute management of pulmonary hypertension, cardiac pharmacology and various outcome studies related to cardiac surgery. The department has been a key player in the creation and development of national and international associations of doctors interested in the perioperative management of patients undergoing cardiothoracic surgery. Every other year, a national meeting involving all cardiothoracic anaesthetists from the United Kingdom is organised by the department in one of the Cambridge colleges.

Sterile Services

A nursing team of more than 180 nurses, led by two matrons and 11 sisters/critical care practitioners (CCPs), provide continuous specialist care. Medical care is led by dedicated consultant intensivists and supported by a multidisciplinary team. This team includes referring and specialist consultants, specialist nurses, physiotherapists, pharmacists, and dieticians.

Anaesthesia

The consultant anaesthetists are all specialists in providing anaesthesia for patients undergoing cardiothoracic surgery. The department accommodates a regular rotation of trainee anaesthetists of varying grades from other hospitals in the region and is a renowned international centre for training in anaesthesia for cardiothoracic procedures. Consultant anaesthetists with a specific interest in critical care (intensivist) lead the daily care of all patients admitted to the critical care area, working closely with all other specialists within FUTURE MEDICINE I September 2012

The Sterile Services Department is responsible for the disinfection of all re-usable medical devices for the operating theatres, wards and various other departments, including critical care and radiology as well as external customers. The department uses automated wash/disinfectors and utilises steam and gas plasma sterilisation techniques. Using a Health Edge Traceability System, it tracks all instruments and related products throughout the decontamination/ sterilisation process and to its subsequent use. The department is the first in the area to have achieved both national and European accreditation for carrying out tasks of sterilisation and decontamination of re-usable medical devices. It is also accredited with BS ISO 9002:2000, BS ISO 13485: 2003 and Directive 93/42/EEC (sterilisation aspects only) for the disinfection, inspection, assembly, moist heat and gas plasma sterilisation of single instruments, instrument trays and procedure packs.

Technical Support Services

The Technical Support Service Department is responsible for the maintenance of the majority of the medical equipment used at Papworth Hospital. Every piece of equipment, which the Trust owns, is registered on a database so that a full working history can be maintained on each item. The department is staffed by a manager and technicians with expertise in electronic and mechanical engineering. Technical Support Service is registered with ISO 9002.

TECH TRENDS IN MEDICINE

New App can save your skin, literally!

Navigation aid for visually impaired MASSACHUSETTS: The visually impaired may no more require the assistance of canes or dogs. They can navigate on their own with the help of a device named “EyeRing”, the innovation of a group of researchers from the Massachusetts Institute of Technology. The device can help the visually impaired to independently identify objects. Worn on the finger, this cameraequipped ring is designed to capture an image and send it to a smartphone for processing. The moment the person wearing the EyeRing points the ring at an object and takes a snap, an app on the phone will utter the word, or describe the object before him. “EyeRing is a wearable intuitive interface that allows a person to point at an object and learn more information about it,” say the researchers. The EyeRing is a system made up of a ring, a smartphone, and an earpiece.

TOKYO: If you want to make sure your skin looks healthy and young, there is an app that can help you conduct regular face check-ups. Japanese company Fujitsu Laboratories’ new product, “Color Frame”, analyses your skin condition using your smartphone and a small colour wheel. You have to place Color Frame on your skin to match the lighting conditions and take four photos of your skin. The app checks three factors of the skin condition: dullness, spots, and pore size. Thus, you can monitor the progress of your beauty regimen and see if there are any fluctuations.

Tooth tattoo to check infection LONDON: Researcher Michael McAlpine and his team at Princeton University have come up with tooth tattoos that can quickly detect bacterial infection. The tooth tattoo, made of grapheme, can sense the presence of bacteria in the mouth to tell what’s taking toll on your health. The sensitive tattoo sensors detect bacteria in small concentrations which helps in quicker diagnosis. The material of the tattoo - grapheme - is a one-atom thick layer of carbon with thoroughly constructed peptides on its surface that picks up the bacteria. The graphene is printed onto water-soluble silk and implanted onto the surface of the tooth. Once in place, the silk dissolves, leaving the sensor. The sensor also features radio frequency identification tag for extra monitoring. When bacteria attaches to the peptides, it results in small electric current in the graphene, which can be picked up by the antenna to diagnose the infection.

FUTURE MEDICINE I September 2012

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Asia’s Largest Circulated Education Magazine www.educationinsider.net

EXPERT INTERVIEW Dr Utpal Bhadra

Demystifying the RNAi process in gene silencing Dr Utpal Bhadra is a leading Indian scientist and Deputy Director of the Centre for Cellular and Molecular Biology (CCMB), Hyderabad. His team narrowly missed the Nobel Prize in Medicine six years ago, when it was awarded to Americans Andrew Fire and Craig Mello for their discovery of silencing genes by a method known as “RNA interference” or RNAi. Dr Bhadra, whose team is a pioneer contributor to the RNAi process, had been working with University of Missouri before joining CCMB as a senior scientist. In an interview with Future Medicine, Dr Bhadra gives a clear view on the concept of gene silencing and its wider implications in the field of medical science, especially disease prevention and mitigation By Sreekanth Ravindran What is gene silencing and how does it help in disease prevention? In true sense, gene silencing is a process within a live cell that controls the activity of the genes. Historically, it is known by other names - co-suppression, posttranscriptional gene silencing (PTGS) and quelling. Only after this apparently unrelated process was Utpal Bhadra, Deputy Director, CCMB fully understood did it become clear that they all described the common RNAi phenomena. In 2006, RNAi received the quickest Nobel Prize since its discovery in C. elegans and our group is a pioneer contributor of this process. Disease therapy based

on genetic material is now a reality and the technology of gene silencing often sounded as RNAi. Today, we are banking on an allele RNA-based drug, which is now being readied for clinical trials. Following are the list of a few targets (of diseases): • Therapy and readymade vaccine development for RNA and DNA viruses, including HIV, HPV of hepatitis encephalitis, bird flu infection and polio. • Different types of cancer, diabetes, auto-immuno diseases, and readymade therapy for arthritis. • Validation of only candidate for drug development. • Improvement of crops, animal husbandry, and other non-edible plant improvement. • Production of viral resistant small animals against bird flu, virus resistant fish, cattle, buffalo and 21 other animals. Can you explain the process of RNA interference? How far have we reached in terms of administering solutions through this process? RNAi is a remarkable process where a small double stranded RNA silenced the homogenous gene, although

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the first hint about the inducible silencing process was noticed only a few years ago. The real breakthrough in mechanism understanding came from the landmark paper by our group and colleagues (Cell 90: 479-490, 1997; Nature 391: 806-811, 1998). RNAi is well-preserved in many live forms. It is more than just a resistance to genetic invader or cell infection. It is a readymade resource for blocking the activity of any genes at any point of time in a specific part of the human body. It is so sporadic that a few years back, nobody knew its name but it claims the best

very significant role in heterochromatin formation and assembly of different heterochromatin company. We are pinning hopes on a readymade solution for rapid cell division, which is essential for a possible therapy for different cancers, since rapid cell division plays a critical role during tumour formation. What have been your significant contributions to the medical field thus far? RNAi has very significant contribution in the medical field to test the different candidate

technology award for this century. We are very close to administer the RNAibased therapeutic solution for preventing different diseases, especially eye diseases, including macular degeneration. Several drugs are in the clinical trial phase. We are very close to the full-fledged solution of preventing different genetic disorders on the basis of gene-based therapy through RNAi. You are known for having unravelled the role of RNA interference in heterochromatin formation in higher eukaryotes. Please explain the significance of this finding? A new role of RNAi in DNA and protein packaging in the chromatin is required for the formation of condensed target of heterochromatin. Basically, the chromatin is broadly classified either in eukaryotes or heterochromatin. Heterochromatin has gene poor-region, which is mainly required for healthy division of cells during mitosis and meiosis. A disruption of heterochromatin causes the unequal division of different chromosomes. In Science paper (2004), we found that RNAi has a

genes that are therapeutic in nature. It helps in providing different therapeutic agents against different diseases. RNAi is also responsible for genome-wide screening for identifying the novel candidate gene and their validation during the drug development. It has a tremendous impact on advanced molecular diagnostics and other areas. RNAi has a defence mechanism when employed in different viruses, as it can neutralise the different invaders within the host cell. So, it is also important to protect the genomic integrity and genome control. It protects cell and other cellular organelles against genome destruction. In the medical field, it has a huge impact because it has given the potential clue as to how to develop a new therapy. Has any progress been made in the gene silencing technique to prevent Japanese encephalitis and AIDS? What are the challenges? Throughout the world, the gene silencing technique was used to protect against HIV or

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EXPERT INTERVIEW Dr Utpal Bhadra

Dr Utpal Bhadraâ&#x20AC;&#x2122;s current engagements include genome-wide screening for detection of novel host genes that interact with different pathogens. AIDS, but the polymorphology of the viruses is one of the major challenges. Using the RNAi tools, we can identify the genes which are directly or indirectly related to the infection on Japanese encephalitis and AIDS. Identification of this component may definitely help prevent this disease/infection. Is cloning possible in India under the given regulatory framework? And is the Centre for Cellular and Molecular Biology (CCMB) involved in any such project? Yes, cloning is possible in India under the given regulatory framework. Recently, Pashmina goat was cloned by some group in Kashmir. CCMB is working on cloning for sustaining different endangered species of animals. But my group is not involved in this process. You have been working on a diagnostic kit for predictive diagnosis of cancer. Whatâ&#x20AC;&#x2122;s the progress on that front? Yes, we are working on microRNA-based diagnostic case for pre-detection diagnostics of cancer. microRNA has a tiny small RNA which is very dynamic in nature. It has both synthesise-anddestruct function, once the action of microRNA is completed for a particular process. Different cancerrelated microRNA also express in different tissues in different timeframes. It is dynamic in nature at each and every time period before the pre-detection and during/after detection of a wide platform of microRNA profiling. That will tell us as to what is

the level of progression of diseases and also predict the susceptibility of a disease in different patients. Do you think a more liberal patent regime can enable an increase in the delivery of medical solutions? I believe that a more liberal patent regime can enable us to increase the delivery of medical solutions. But we have to be ethical and honest in this system. The way the modern hospitals are behaving is the ideal scenario for a liberal patent regime and patient treatment in India. What are your current areas of engagement? Genome-wide screening for detection of novel host genes that interact with different pathogens. Production of siRNA based on different infectious diseases, and a novel therapy of cancer using RNAi. We are also engaged in epigenetic gene regulation and genome control to understand as to how the RNAi is involved in different cellular processes and auto-immuno and stress conditions. What is your message to the youth aspiring for a career in science and technology? I feel that science in India is a very competitive field. But competition leads to corruption and politics. We basically divert from science to narrow interests. So, the administration flaws are one of the major hindrances in the progress of research in the country. If we can prevent these administrative flaws, science would be the prime profession in India.

FUTURE MEDICINE I September 2012

FUTURE MEDICINE I August 2012

IMMUNISATION The Right Prescription

The idea of

immunisation Immunisation is the most basic and effective way of guarding the infants against the dangers of a host of deadly diseases. Despite its successes, the national immunisation programme is found to be deficient on many counts. Future Medicine approaches the sensitive issue of immunisation through the perspective of two renowned experts in the field and brings to light certain issues that require urgent attention at the national level. After all, if there are no sound measures to safeguard and guarantee an infant’s basic right to life, especially those among the poor, how can the government ever claim of being successful and vigilant on the health front?

everal early observations in scientific medicine led to the concept and practice of vaccination. Microbial causation of diseases was discovered in late 1800s in France and Germany. Several diseases caused by different microbes may look alike, clinically, but laboratory diagnostics distinguish them by specific microbial cause, in medical parlance ‘aetiology’. Another observation: one attack gave protection against a second attack of disease of same aetiology. The body milieu had become ‘immune’. An observation made in England a century earlier was that milkmaids who had cowpox (mild self-healing blisters, aetiology vaccinia virus) were completely immune to smallpox; this was confirmed by clinical trial. Vaccination protected against smallpox. Both vaccinia and smallpox viruses share antigens and cross-immunity is protective. Today, we define immunity as the response of the immune system (tissues and cells) to antigens. Immunity and protection are no longer synonymous. Originally, ‘vaccination’ meant cowpox inoculation, but later, it became generic for all antigeninoculations to induce immunity. Since induction

of immunity is the purpose, vaccination and immunisation are used synonymously. Immunity prevents disease but does not usually protect against infection per se. Infection in immune individuals remains subclinical and results in much less shedding of microbes into environment than non-immune (naive) persons with full-blown disease. With less shedding, the incidence of infection would fall among the unimmunised, provided the majority is immunised. This indirect effect in the unvaccinated is ‘herd effect’. The proportion immune is called ‘herd immunity’. Herd effect is exhibited only for human to human transmitted infections, which can even be eliminated locally or eradicated globally by constructing high herd immunity plus herd effect. Immunisation against microbes shared between vertebrates and humans (zoonoses) will not give herd effect. What are vaccines made of? You may ask: the immune system in the body is designed to respond to microbes that enter the body and threaten to cause disease; then why should body react to killed microbes, structural subunits of microbes, or even microbial polypeptides that we

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inoculate as vaccines? We can understand how live vaccines (attenuated or non-virulent) may stimulate the immune system, but why should other inert molecules stimulate the immune system? Only recently have we understood this mystery. When body encounters infection, white cells and their allies break them down. Immune system reacts to these broken-down molecules. Artificially brokendown molecules, or killed microbes, mimic Nature and function as vaccines. What kind of vaccine works best in a given infectious disease – live, killed or sub-unit –is learned by trial and error. There are specialised cells, mainly ‘dendritic’, that have evolutionarily derived receptors that recognise microbial molecular patterns. They are both first line defence and presenters of antigens to immuno-competent lymphocytes, which get activated to produce antibody or cell-mediated responses and memory cells that respond with greater speed and vigour if the antigens appear again. Adjuvants enhance dendritic cell functions and increase antibody response. Thus, vaccines must contain microbial antigens and excipients for stabilising antigens; in some cases, they are also spiked with adjuvants. Adjuvants tend to elicit inflammation at inoculation site.

Immunisation in healthcare and in public health

The two essential attributes of vaccines to pass the regulatory scrutiny are ‘efficacy’ and ‘safety’. We can assume that every licensed vaccine is effective and safe. That is correct, up to a point but need to be qualified. Both efficacy and safety are not absolute but relative to the risk and severity of the disease the vaccine is meant to protect. Smallpox was a dreaded disease but predictably protected against by vaccination. The vaccine was not completely safe; roughly, for 1000 smallpox deaths averted, by preventing 10,000 smallpox cases, one vaccinated person died due to severe vaccinia virus disease. The risk was well worth taking. The best option was to eradicate smallpox and discontinue vaccination. Two other live vaccines have similar relative but not absolute safety – yellow fever and poliovirus. Eradication of smallpox was an eye-opener. Hitherto vaccines were used for personal protection in healthcare. Smallpox eradication proved vaccine to be a powerful tool of intervention in public health. That idea gave birth to the WHO’s Expanded Programme on Immunisation, launched in 1974 to popularise ‘healthcare’ vaccines in ‘public health’ mode. India adopted it in 1978 and later, renamed it universal immunisation programme (UIP). Interventions in public health, including UIP vaccines, must be given without user fees, but non-UIP vaccines in healthcare mode have to be purchased.

Vaccines not included in public health

Today, we have many newer vaccines that are highly effective and very safe. In India, they have FUTURE MEDICINE I September 2012

been licensed and are in popular use in private sector healthcare. Let me cite two examples: chickenpox and hepatitis A vaccines. Both are effective and completely safe. Both target diseases are endemic in India with periodic epidemics. Both are popular for personal protection among those who desire good health of their children and can afford the cost. Neither vaccine is included in UIP, not on account of efficacy or safety issues, but on account of lack of understanding of epidemiology, ethics and economics. The UIP budget will not accommodate newer vaccines that are more expensive than the traditional UIP vaccines – DPT, OPV, measles and the lately added hepatitis B and Haemophilus influenzae b (Hib). UIP budget remains woefully inadequate as the decision-making process remains pathetically primitive. India is rich, but our health budget is like in the poorest countries of the world. Vaccines against chickenpox and hepatitis A (and many more like them) are good value for money. Imagine a youngster dying of a preventable disease such as fulminant hepatitis A or chickenpox encephalitis/Reye syndrome/Gangrene/secondary bacterial septicaemia. Aetilogy was infection but

IMMUNISATION The Right Prescription the risk factor was non-immunisation. Because they are not in the UIP list, many believe they are not needed, effective, or safe.When we know how to prevent disease but we do not, we become the risk factor of that disease. Not including licensed vaccines against endemic/epidemic-prone diseases in UIP is unethical and serves false economics. If the government does not want to provide free vaccine for everyone, why not give them only to those who are below poverty line? Should not the health insurance fund be used to prevent common communicable diseases by immunisation? Medical profession and its Associations and Academies are in healthcare enterprise and have conflicts of interests with public health. Why should they advocate for inclusion of newer vaccines in UIP? Private immunisation is lucrative business for the doctors. The less are immunised, the more is our income. Public health is a means to social equity in disease prevention. UIP need not immunise rich children, but should provide more vaccines to the poor, who bear the brunt of unpreventable diseases. The rich purchase pneumococcal conjugate, rotavirus, rubella, papilloma virus and typhoid

vaccines in addition to hepatitis A and chickenpox vaccines. The government creates the rich-poor divide in disease incidence. Even human rights organisations and other advocates of child health fail to raise their voices against inequity.

Epidemiology, ethics and economics of vaccination

Epidemiology distinguishes between ubiquitous and geographically restricted infectious diseases. The former are human to human transmitted, mostly via respiratory route without food or waterrelated outbreaks â&#x20AC;&#x201C; examples include bacterial (diphtheria, whooping cough, tuberculosis, Hib and pneumococcal diseases) and viral (measles, rubella, mumps, polio, chickenpox). They can be prevented only by immunisation, not by sanitation and hygiene. Immunisation against them should be universal in national public health. (Tetanus, although not respiratory transmitted, is ubiquitous as soil everywhere may contain spores, mostly derived from animal faeces. Tetanus vaccination is already universal.) Geographically restricted infections are transmitted through vectors or vehicles or directly or indirectly from vertebrates â&#x20AC;&#x201C; zoonoses. We have several vector-borne viral and protozoan diseases. Pathogens shed faecally and inoculated via contaminated food/water include bacterial (cholera, enteric fevers, shigella dysentery etc.) and viral (hepatitis A and E). Such diseases can be controlled by sanitation and hygiene and in some cases also by immunisation. Not preventing by immunisation is bad enough; inadequately disinfected water supply contributing to them is criminal negligence. Ethics and our Constitution agree that health protection is a human right. All prevalent ubiquitous vaccine-preventable diseases must be controlled so that everyone enjoys the benefit of protection as a RIGHT, irrespective of social factors. All rich countries follow this principle, but we flout it under the excuse of lack of resources: a clear example of false economy. If treatment is deficient, the healthcare-giver is liable for punitive action for negligence. In public health, when death or disease occurs due to policy, programme or implementation deficiency, those in power are equally guilty of negligence. People in government service cannot speak up for fear of vindictiveness. Those in private sector need not speak up for they are in healthcare. Media will not fight for this cause for want of ideological mission.

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The rich get all vaccines. Only the poor suffer on account of poverty, ignorance and governmental non-accountability. The government does not collect reliable data on the burdens of diseases and aetiology-specific death. So it can be argued that they are low and the expenditure to prevent them, too high. They can play cost-benefit and cost-effectiveness arguments without sufficient information, with the intention of not increasing health budget. We have a traditional behaviour of saving but not investing. Expenditure for immunisations is not only humanitarian but also investment with high future returns. Disease prevention improves child survival and cognitive brain functions. Healthy people create more wealth. Humans are not only consumers but also productive

capital. Mine may be a voice in the wilderness, but now let Future Medicine readers magnify it. Will policymakers hear? T Jacob John, FNA The author worked at the Christian Medical College, Vellore, and is retired. He was National President of Indian Association of Medical Microbiologists (1994) and Indian Academy of Pediatrics (1999). Currently, he is Chairman, Child Health Foundation, Delhi. Opinions expressed here are his own and need not reflect that of any organisation with which he was or is associated.

‘More diseases must be covered under the UIP’ The Universal Immunisation Programme (UIP) had performed quite well in the first decade of its introduction in India. Between 1985 and 1995, the coverage levels for various vaccines reached 70-85 per cent and the incidence of various vaccine preventable diseases (VPDs) rapidly declined in the country. However, since then, there has been a decline by 15 to 20 per cent in the coverage of different vaccines. The National Family Health Survey (NFHS) I, II and III and other surveys by independent agencies such as the UNICEF have revealed that the coverage levels may be lower by as much as 15-40 per cent as compared to reported levels of coverage in the UIP. Indeed, there are a few states in India that have efficiently running UIP and several that do not. There are multiple reasons for this. In an interview with Future Medicine, Convenor of the Indian Academy of Pediatrics (IAP)’s Committee on Immunisation Dr Vipin M Vashishtha talks on a range of issues - from the IAP’s contributions to the national immunisation programme to the twin problems of shortage and high cost of vaccines, and the shortcomings in terms of high coverage

FUTURE MEDICINE I September 2012

IMMUNISATION The Right Prescription

How has IAP been helping the government in carrying out the immunisation programme across the country and how has it brought about an improvement in the process? About 15-20 per cent of immunisation is provided by practising pediatricians i.e. IAP members of the country. That way, IAP is directly contributing to the routine immunisation programme of the country. Apart from issuing guidelines on immunisation schedules to the practitioners, IAP is also issuing recommendations to the Government of India on many technical aspects of immunisation, including introduction of any new vaccine in the country. IAP is represented in the NTAGI (National Technical Advisory Group on Immunisation) also and is the sole technical body to provide inputs on various vaccination issues. Further, IAP is also involved in imparting training not only to its members through various programmes, such as ASOV, SOV, and IAPVAC, but also to the programme managers/ health professionals associated with the universal immunisation programme (UIP) on various technical issues related to immunisation in the country. IAP also holds regular brainstorming sessions, consultative meetings, and updates in tandem with WHO, UNICEF, and ICMR. Apart from these functions, IAP is also helping the government in curbing misinformation campaigns against immunisation. What kind of vaccines are administered under this process? Is the cost of vaccines an area of concern? IAP members are providing all the Expanded Programme of Immunisation (EPI) and new, nonEPI vaccines to the children. These vaccines include BCG, OPV, DPT, Measles (all EPI vaccines), and Hib, Hepatitis-B, Hepatitis-A, IPV, Rotavirus, Pneumococcal, Varicella, MMR, Tdap, HPV (all non-EPI vaccines). Apart from this, IAP has given

instructions regarding usage of certain vaccines like Influenza, Rabies, Cholera, JE, Meningococcal, PPSV, etc in certain special situations or under certain high-risk individuals. Yes, cost is an area that directly affects the usages of the vaccines, particularly the newer ones. IAP is now in consultation with vaccine manufacturers to convince them in reducing the inflated margins for the vendors and doctors so that the newer vaccines can be made more affordable. Is there a problem of unavailability of vaccines and lack of enough storage facilities? Not a persistent problem, but yes, at times, we face shortage of vaccines, both EPI and non-EPI. There is not much problem as far as storage facility is concerned. In fact, the public sector has adequate vaccine storage and cold-chain facilities across the country. Even at PHC/CHC level, adequate equipment are available. However, shortage of power supply and manpower are recurring problems. What are the problem areas and shortcomings of the national immunisation programme? According to the Coverage Evaluation Survey (CES) 2009, a nationwide survey, covering all states and Union Territories of India, conducted between November 2009 and January 2010 by UNICEF, the national fully immunised (FI) coverage against the six vaccines included in UIP in the age group of 12-23 month old children was 61 per cent, whereas it was 54.1 per cent and 47.3 per cent as reported by the District Level Household and Facility Survey (DLHS-3) (2007-08) and the National Family Health Survey-III (2005-06) respectively. In a recent study conducted in 225 villages in 12 districts spread across the Western, Central and Eastern regions of Uttar Pradesh, lack of faith in vaccination at the family level, particularly among family elders, lack of vaccine-related knowledge, fear of side effects of vaccination, lack of family support,

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lack of knowledge of the place and day of immunisation, uncertainty of service provision, and limited counselling by health workers were found to be major barriers to achieve high routine immunisation (RI) rates. Less than 20 per cent of women were aware that vaccinations can protect a child against whooping cough, TB and diphtheria. Nine per cent of women and 11 per cent of accredited social health activists reported non-availability of the Auxiliary Nursing Midwife (ANM) on the scheduled immunisation day as a reason for no or partial immunisation. There are some other challenges to achieving high RI rates and they include inadequate delivery of health services (supply shortages, vacant staff positions, lack of training); lack of accountability, inadequate supervision and monitoring; lack of micro-planning at district level; general lack of intersectoral coordination resulting in missing opportunities to improve immunisation coverage and quality; lack of support for ANMs from other staff at the health centres; parental time constraints and parental non-acceptance of immunisation. The above barriers are further compounded by a weak vaccine preventable diseases (VPD) surveillance system in the country. There is a lack of disease burden data on many important VPDs in India that results in the perception that they are not an important public health problem. How can we solve the issue of inadequate coverage? Focus should be on increasing demand for vaccination by using effective information, education, and communication and bringing immunisation closer to the communities. The immunisation services provided at the fixed sites should be improved. There should be better monitoring and supervision, and district authorities should be made accountable for the performance of RI in their district. The number of immunisation ‘delivery points’, especially in rural and remote areas having poor access to health facilities, should be increased. ‘Immunisation booths’ should be constructed at every locality in urban areas, particularly in slums, and the local municipality board members should be made accountable for their

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performances. Large and varied cadres of volunteers, including, for example, local medical practitioners, pharmacists, chemists, retired nurses and other health personnel can be recruited to offer immunisation services. Proper training, including maintenance of cold chain and basic minimum education on vaccines, must be imparted to all of them. Complete immunisation should be made mandatory to get admission in school by appropriate legislation. Incentives in cash and kind may be offered to those families having fully immunised kids. UIP can seize the opportunity and establish a surveillance system for all important childhood infectious diseases. Are there cases of vaccine-derived polioviruses and circulating vaccinederived polioviruses in India? If so, how can we overcome these conditions? Probably you mean cases of VAPP (vaccine associated paralytic poliomyelitis) and cVDPVs (circulating vaccine-derived polioviruses). Both these are due to certain weaknesses of oral polio vaccine (OPV) and the only way to address this issue is gradual withdrawal of tOPV (trivalent OPV). The removal of OPV should be in gradual manner. At first, the type 2 virus should be removed from trivalent OPV. Wild type 2 has been eradicated from the globe since 1999, and majority of cVDPVs are due to type 2 (contained in tOPV) only. Hence, there is no need to keep type 2 virus

in the vaccine, but the ‘switch’ from trivalent OPV to bivalent OPV should be preceded by use of IPV (injectible polio vaccine) to provide protection against circulating type-2 vaccine viruses. Do you think any new disease/infection should be brought under the ambit of the immunisation programme? Yes, there are many diseases like Rotavirus Diarrhea, Pneumococcal and Hib Pneumonia against which effective vaccines are available globally, but due to economic reasons, they have not been introduced in the national immunisation programme. There is a huge burden of morbidity and mortality caused by pneumonia and diarrhea in the country. Typhoid is another neglected disease which causes huge morbidity amongst both children and adults. Again, good vaccines against typhoid are available and I think this disease should also be targeted for control. There are some other diseases like dengue, RSV (Respiratory Syncitial Virus) Bronchiolitis, and E coli induced diarrhea, where no vaccines are available right now. But they are essentially vaccine-preventable and need to be controlled. Malaria is another disease responsible for recurring outbreaks in many parts of the country. It is an area where global efforts to develop an effective vaccine are still proving to be futile. And, lastly, we have the highest burden of TB in the world. A more effective vaccine is urgently needed.

IMMUNISATION The Right Prescription

The what, how and why of immunisation A teacher of pediatrics has come out with a book on immunisation that helps in understanding the basics of this healthcare initiative through simple nuggets of information, instructions, and guidelines

n keeping with the needs of medical students and general practitioners, Dr Sheeja Sugunan, Assistant Professor of Pediatrics at Government Medical College, Thiruvananthapuram, has penned a handbook called “Immunization: Guidelines and Applications”. Given the confusion over the basic principles of immunisation in the light of availability of numerous guidelines on the same subject, Dr Sheeja has made a commendable attempt at clearing the air by listing out the imperatives after a thorough study of various applications recommended by expert medical bodies. The book, both concise and thorough, gives practical instructions in administration of vaccines, reflecting the clarity of a resourceful teacher. In the introduction part itself, the author says that immunisation coverage in the whole of the country is not uniform. “DLHS3 (district level health survey) estimated that Uttar Pradesh had 30 per cent while Goa had 90 per cent immunisation coverage. In order to decrease the under five mortality, India needs to further strengthen its immunisation coverage as vaccine preventable diseases still continue to be an important cause of mortality in the under five population.” The key general recommendations she has enlisted are as follows:

Vaccine Spacing • • •

Two live injectable vaccines must be separated by a minimum of four weeks Killed vaccines can be given any time before or after any vaccine Two doses of the same vaccine must be separated by minimum four weeks ideally (exception being Rabies)

Multiple Vaccines •

Any number of vaccines may be given on the same day

•

Multiple vaccines may be given in different anatomic sites. If needed, more than one vaccine may be given in the same limb, separated, if possible, by one inch so that local reactions do not overlap.

Vaccination Sites •

Intramuscular: Antero lateral thigh (junction of middle and lower third) – preferred site for children below two years. • Deltoid (above 12 months) • Subcutaneous: Outer triceps (above 12 months) • Intradermal: left deltoid (BCG) Dr Sheeja has also dealt with the variables between various immunisation schedules. She says the National immunisation schedule aims to provide maximum benefits with limited resources. Priority is given to diseases which are more common and more debilitating. It aims to immunise maximum children against the prevalent diseases in a schedule, that is simple and easy to follow for the doctors and health workers alike and requiring minimum number of visits of the patients to the healthcare system. The Indian Academy of Pediatrics’ immunisation schedule, she says, recommends the vaccines which could ideally be given to a child if there were no economic constraints. It doesn’t take into account the age group specific prevalence of the diseases in India. In the American Academy of Pediatrics schedule, the vaccines are mostly recommended when they are most immunogenic, as the incidence of vaccine preventable diseases are considerably low in America. Moreover, it takes into account the disease pattern in various age groups there, says Dr Sheeja. She has made the book more interesting and educative by providing insightful information on various aspects of immunisation.

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Vijay Chelliah PHARMA EXPERT

Pharma Inc a force to reckon with by 2020

With more than 23 years of experience in the pharma industry in various capacities, Vijay Chelliah is quite an expert in the field. In an interview with Future Medicine, Chelliah, the Founder and Chief Executive Officer of Bengaluru-based Grace Management Consultants, speaks about the potential of India to become an important location for clinical trials By Dipin Damodharan Can you explain the new trends in the Indian pharmaceutical sector? The most significant trend that I can think of is the establishment and upgradation of research and development (R&D) wings by pharma companies such as Sun Pharmaceuticals, Cipla, Cadila, Piramal Healthcare, Ranbaxy and a few others. As a result of this, our companies have not only become outsourcing partners in the area of manufacturing but in R&D FUTURE MEDICINE I September 2012

as well. India has become an important location for clinical trials. There is an increase in investment from domestic and multinational players. The trend has also initiated investments in R&D, Manufacturing and Healthcare even in non-metro markets. What about the growth of the Indian pharma sector in the coming five years? Indiaâ&#x20AC;&#x2122;s domestic pharma market was valued at approximately $12 billion in 2010. It showed a strong

PHARMA EXPERT Vijay Chelliah

growth of 21.3 per cent for the twelve months ending September 2011. I strongly believe, considering the present trends, that the Indian industry has the potential to grow at a rate of around 15 to 20% CAGR for the next five years. In fact, some experts believe that in 10 years’ time, the Indian pharma sector would grow to anywhere between 50 and $74 billion. I will not be surprised if some Indian speciality products enter the markets of developed countries on popular choice. In any case, India will become a major global player by 2020. How can the pharma sector contribute to the overall growth of the country? By focussing on the following points, the pharma sector can contribute tremendously to the growth of the nation: •

Becoming even more self-dependent

•

Going deep into the area of R&D

Some experts believe that in 10 years’ time, the Indian pharma sector would grow to

a case in point. What about the Indian pharma sector and the global market? We need to be happy to note that the Indian pharma industry is the world’s third-largest in terms of volume and ranks 14th in terms of value. According to the Department of Pharmaceuticals, Government of India, the total turnover of India’s pharmaceuticals industry between 2008 and September 2009 was $21.04 billion. Exports of pharmaceutical products from India increased from $6.23 billion in 2006-07 to $8.7 billion in 2008-09, a combined annual growth rate of 21.25 per cent. It has continued to grow. As I have already mentioned, the Indian pharma players need to take up strict measures to counter competition from MNCs. This is possible with the right type of commitment and resilience. In fact, the company Medopharm, where I worked for almost two decades, is today exporting generics to over 55 countries. This is an indication of

$74 billion

•

Making available high quality generic products to the Government & Non-Government Hospitals so as to provide health solutions to people at reasonable rates

•

Being single-minded in churning out quality speciality products not only for the international market but the domestic market as well

•

Strategising marketing approaches to the needs of the international market

•

Training and developing highly skilled and committed personnel on a continuous basis, especially in the area of R&D, Marketing, Manufacturing and so on

•

Following healthy business practices

•

Working towards building a healthy nation without believing that a healthy nation will deter the growth of the pharma sector.

•

Refusing to be carried away by MNC offers for new products/tie-ups without understanding its long-term implications on the health of the people of India. Nimesulide, besides a few other drugs, is

how avenues are created by sheer will and commitment. Medopharm is just one of the many examples of how far the players in the pharma sector have travelled. I even recollect that in 1983, when I had approached the Singaporeans for promoting my products, they openly expressed their lack of trust in Indians for providing quality products. But today, the scene is reversed. Let us upgrade ourselves, our infrastructure, and our services to international standards. We need to be honest, we need to be extremely skillful and competent, and we need to be strategic. The world is Indian pharma sector’s playing field. Play and win! What are the challenges before the Indian pharma industry? Investments in R&D are not adequate. More Indian companies need to take up this area seriously by utilising grants offered by the Government. Poor infrastructure facilities for controlling spurious and counterfeit drugs is another concern. Acquisitions, alliances, patent laws, the common man’s access to medicines at affordable prices, dearth of talents and experience (quality professionals) are some of the other challenges before the Indian pharma sector.

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CAREERS AND COURSES Biomedical engineering

Be a vital part of the

clinical process The demand for biomedical engineers is high, given the growing need for more sophisticated medical equipment and procedures. Biomedical engineers are specialists who can develop and run various equipment and machines ranging from artificial kidneys and other organs, surgical devices like magnetic resonance imaging machine, laser system for eyes to basic instruments that are necessary for the diagnosis and treatment of a disease Bureau

biomedical engineer combines techniques of engineering with medical science in order to produce devices or deliver clinically sound solutions to solve the health-related issues of the common man. A trained biomedical engineer gets to work with doctors, nurses, therapists, and technicians, while assisting them in the application of engineering equipment for provision of medical services. Biomedical engineers are specialists who can develop and run various equipment and machines ranging from artificial kidneys and other organs, surgical devices like magnetic resonance imaging machine, laser system for eyes to basic instruments that are necessary for the diagnosis and treatment of a disease. Biomedical engineering is usually taught at undergraduate and post-graduate levels in engineering colleges. Diploma courses are also available in this specialised field. To pursue an under-graduate course in the field, a candidate should pass the ten plus two examination with science subjects as electives; To pursue biomedical engineering at the post-graduate level, one should have completed BTech, BE, MSc, or equivalent in Biochemistry, Biophysics, Biotechnology, Ceramics, Chemistry, Electronics, or Medical Instrumentation. After the completion of a particular course in the

field of biomedical engineering, one can choose to be a specialist in Bioinstrumentation, Biomechanics, Biomaterials, Clinical Engineering, Medical Imaging, Rehabilitation, Tissue Engineering, and Systems Physiology. Biomedical engineers get opportunities to work in diverse fields related to medical equipment manufacturing, orthopaedic and molecular cellular engineering. Hospitals employ biomedical engineers in large numbers to facilitate the use of medical equipment. They can perform extensive research to develop new equipment that are useful in the medical industry. Biomedical engineers are also eligible to be employed in medical research institutions, government regulatory agencies, hospitals, industrial firms and teaching institutions. The role of a biomedical engineer includes: â&#x20AC;˘ using computer software and mathematical models to design, develop and test new materials, devices and equipment. This can involve programming electronics, building and evaluating prototypes, troubleshooting problems, and rethinking the design until it works correctly; â&#x20AC;˘ liaising with technicians and manufacturers to ensure the feasibility of a product in terms of design and economic viability;

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Specialisations •

•

Bioinstrumentation involves use of engineering principles and methods, including computers, in developing devices for diagnosis and treatment of disease. Biomechanics applies principles of mechanics to understand and simulate medical problems and systems such as fluid transport and range of motion. Prosthetic organs such as artificial hearts, kidneys, and joints are examples of devices developed by biomechanical engineers. Biomaterials involves development of natural living tissue and artificial materials for use in the human body. Choice of materials with appropriate properties is critical to design of functional organs, bones, and other implantable materials, which may include alloys, ceramics, polymers, and composites. Clinical engineering involves development and maintenance of computer databases, inventorying medical equipment and instruments as well as purchase of medical equipment used in hospitals. Clinical engineers

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conducting research to solve clinical problems using a variety of means to collate necessary information, including questionnaires, interviews, and group conferences; • liaising closely with other medical professionals, such as doctors and therapists, as well as with end-users (patients and their carers); • discussing and solving problems with manufacturing, quality, purchasing and marketing departments; • assessing the potential market for products, or modifications suggested by health professionals or others; • keeping up to date with new developments in the field, nationally and internationally. There are several institutes across the country that impart high standards of education and training to the aspirants in order to develop them as proficient biomedical engineers. Some of the prominent institutions are Indian Institute of Technology, Kharagpur (West Bengal), Banaras Hindu University Institute of Technology (Uttar Pradesh), Osmania University Biomedical Instrumentation Centre (Andhra Pradesh), Model Engineering Colleges (Kerala), College of Engineering and Technology, (Karnataka), All India Institute of Medical FUTURE MEDICINE I September 2012

•

may work with physicians to customise equipment to the explicit needs of a hospital, or a medical procedure. Medical imaging combines electronic data processing, analysis, and display with understanding of physical phenomena to identify and characterise health problems such as tumours, malformations and the like. Magnetic resonance imaging (MRI), ultrasound, and other techniques are commonly used. Rehabilitation engineering focusses on enhancing the independence, capabilities, and quality of life of individuals with physical impairments. This specialty may involve development of customised solutions to address highly specific needs of individuals. Systems physiology focusses on understanding - at the microscopic and submicroscopic levels - how systems within living organisms function, from pharmaceutical drug response to metabolic systems and disease response, voluntary limb movements to skin healing and auditory physiology. This specialty involves experimentation and modelling using mathematical formulations.

Sciences (New Delhi), Dr BR Ambedkar Centre of Biomedical Research (New Delhi), and Indian Institute of Technology (Mumbai). Employment of biomedical engineers is expected to grow much faster than the average for all occupations through 2018. The ageing of the population and the focus on health issues will increase the demand for better medical devices and equipment designed by biomedical engineers. For example, computer-assisted surgery and molecular, cellular, and tissue engineering are being more heavily researched and are developing rapidly. In addition, the rehabilitation and orthopaedic engineering specialties are growing quickly, increasing the need for biomedical engineers. Along with the demand for more sophisticated medical equipment and procedures is an increased concern for cost efficiency and effectiveness that also will boost demand for biomedical engineers. However, because of the growing interest in this field, the number of degrees granted in biomedical engineering has increased greatly, leading to competition for jobs. While the median annual earnings of a biomedical engineer could range between Rs 2.5 lakh and Rs 5 lakh in India, overseas salaries can even reach as high as hundred thousand dollars.

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Manipal Healthcare INDIAN HOSPITAL FOCUS

Optimal patient care is the Groupâ&#x20AC;&#x2122;s core mantra

Driven by the core values of clinical excellence, patient centricity, and ethical practices, Manipal Healthcare has come to be known as one of the finest healthcare providers in Asia in a wide spectrum of services, including secondary and super-specialty care, rural maternity homes and child welfare centres. Today, the hospital chain intends to expand its reach to tier 2 and tier 3 towns across the country Bureau

anipal Healthcare is one of Asiaâ&#x20AC;&#x2122;s largest hospital chains with internationally renowned hospitals in its ambit. The Group comprises 15 hospitals, including eight medical FUTURE MEDICINE I September 2012

colleges. The multi-stream healthcare facilities provided by this hospital chain covers the entire spectrum, ranging from secondary to super-specialty care and rural maternity homes to child welfare

INDIAN HOSPITAL FOCUS Manipal Healthcare

Corporate Affairs Minister Veerappa Moily hands over the Golden Peacock Lifetime Achievement Award for the Year 2011 to Padma Bhushan Dr Ramdas Pai, Chairman, Manipal Education and Medical Group. The award has been instituted by the Institute of Directors, an apex organisation of company directors in India. centres. The Group holds a special place in the healthcare industry of India, particularly in South India. A social seed sown more than five decades ago, it is the country’s third largest healthcare group with a network of 15 hospitals and three primary clinics, providing comprehensive care that is both curative and preventive in nature for a wide variety of patients not just from India, but also from across the globe. The focus at Manipal Hospitals is to develop an affordable tertiary care multispecialty healthcare framework through its entire delivery spectrum and further extend it to homecare. According to Dr Ramadas Pai, Chairman of the Manipal Education and Medical Group, the ethos of Manipal Hospitals is its belief in the credo of its triad of core values, namely, “Clinical Excellence, Patient Centricity, and Ethical Practices”, which have helped the Group in becoming one of the best and most trusted healthcare providers in the country today. “Our Clinical Excellence is rooted in our excellent team of doctors/medical specialists, who are well-versed with the latest advancements in their respective field of medical expertise. This is further complemented by our teams consisting of highly trained nurses and paramedical people,” he explains. At Manipal Hospitals, patient centricity is a key tenet. A total ‘patient first’ approach

is emphasised at all outpatients departments, irrespective of the late hours or even holidays. Besides, the Group’s unwavering and unflinching belief in ethical practices, along with a string of social initiatives through the Manipal Foundation and other associated NGOs, has enabled the chain to extend quality and affordable healthcare to the lesser privileged sections of society. Manipal Hospital, Bengaluru, a flagship hospital of Manipal Healthcare, has set a benchmark for itself by offering quality healthcare, since its inception in the year 1991. Today, it treats about 1300 patients per day with 600-bed strength and is growing substantially at the rate of 27 per cent to 30 per cent every year. One of the most preferred and recognised healthcare facilities by pharmaceutical companies for drug trials, this hospital in Bangalore is NABH accredited and ranked among the top 10 multispecialty hospitals in Asia. It was also rated as the best recommended super-specialty hospital in India by an independent organisation called Voluntary Organisation in the Interest of Consumer Education, two years ago.

Technological advancements

Manipal Hospital has installed a flat panel cathlab in India and other advanced technologies like twin gradient MRI (1.5 Tesla) and a 64-slice CT, which are among the recent additions to its assets. Manipal Hospital also conducts bone

FUTURE MEDICINE I September 2012

marrow transplants through a clinical collaboration with University of Minnesota. “We are at the leading edge of technological advancements in the medical world. This, along with state-of-the-art infrastructure and facilities, the finest minds in the country and a genuine desire for providing the best healthcare, drives us to deliver pathbreaking care for our patients on a day-to-day basis. From the smallest to the most complex medical problems, we pride ourselves in the way we deliver healthcare,” says Dr Pai.

Manipal Foundation and Corporate Social Responsibilities

The Manipal Foundation has been providing challenging global opportunities in Education and Healthcare to committed, talented and needy youth, besides preserving and promoting culture and traditions that make for a wholesome community. It fulfills this objective by offering Indian and international students a variety of scholarships and fellowships to pursue their ambitions in the fields of Education and Healthcare. According to Dr Pai, the Group has set up Manipal Foundation to cater to the funding needs of the poor and it has already spent around five crore to provide subsidised treatment to the poor patients. Apart from these, the hospital chain also offers free treatment to the patients at an adopted village, Jakkur, near Bengaluru every week. Nearly 1500 poor patients are provided free beds and consultation for various ailments every year.

Looking ahead

With its quaternary care facility located in the heart of Bengaluru city, five tertiary care, nine secondary care and three primary care clinics across five states, Manipal Hospitals today successfully operates and manages 4,900 beds and caters to around two million customers from India

FUTURE MEDICINE I September 2012

and overseas every year. The Hospital Group, which has added six hospitals including the ones at Salem, Vijayawada, and Visakhapatnam, plans to start a super-specialty unit in interventional neuro-radiology. The process of finalisation of projects in New Delhi, Mumbai, and Kolkata is also on the anvil. “Though our flagship is Bengaluru’s Manipal Hospital, which offers personalised care to a wide cross-section of society by harnessing latest technology, we are planning to provide quality and affordable care in South India’s rapidly changing healthcare environment. We have emerged as a landmark destination for people not only from the metros, but also from city suburbs and rural areas and emerging cities of the country,” Dr Pai adds. Like other major hospital chains, Manipal Hospitals, which has a significant presence throughout South India, is all set to explore the vast and obvious opportunities offered by the comparatively smaller cities. This Rs 500-crore hospital chain has been trying to perfect a formula to succeed in tier 2 and tier 3 towns. Though 11 of the chain’s 15 hospitals are in emerging towns, it is only in recent times that it began trying to carve a niche in this market. Of late, the hospital’s management has decided to shift the business focus of Manipal Cure and Care, its wellness chain, from preventive care, wellness and beauty to playing the role of a family physician.

International Patients

Overseas patients have been increasingly visiting Manipal Hospital, Bengaluru, for superspecialty treatments. The hospital’s special departments, including Cardiology, Neurology, Andrology, Liver and Digestive Diseases, are well-equipped with world class doctors and most modern equipment to cater the needs of medical tourists.

RESEARCH & DEVELOPMENT Clinical trials

Grooming future experts in clinical research, trials Mir IFCR India, an internationally accredited clinical research training and educational organisation, has a tie-up with Punjab Technical University and affiliation with Campbell University, North Carolina, USA. It offers training in basic principles, ethics, biostatistics, and data management in clinical research and trials By Tony William

ir IFCR (InterEd Faculty of Clinical Research) India is an internationally accredited clinical research training and educational organisation based in the heart of Kochi city in Ernakulam district of Kerala. Founded three years ago, the institute trains about 120 highly skilled specialists in clinical research every year and provides them excellent placement opportunities in companies of national and international repute. “We have a 100 per cent placement record. There is immense scope in the clinical research industry. Though many of the companies are not engaged in clinical trials in India, a horde of data management firms come to India, widening the demand and scope for medical writings. Indian firms receive a lot of backoffice contracts from the USA and European countries,” says Dr Shaji T George, Director Mir Lifescience Pvt Ltd, which manages Mir IFCR India. “Data Management of clinical trials and research differs from BPO services as only highly specialised professional doctors are capable of providing quality medical writings. It is a highly professional job which requires deep knowledge in regulatory aspects, ethics and so on. We train professionals in these areas and give them the edge,” Dr Shaji adds. About Mir IFCR India Mir IFCR India has a tie-up with Punjab Technical University and affiliation with Campbell University, North Carolina, USA. It offers training in basic principles, ethics, biostatistics, and data management in clinical research and trials, says Dr Shaji. In a short span of three years, Mir IFCR India has become a leading educator in the field of clinical research training. Its scholars are well-placed in India, the US, the European Union, and Australia, among other countries, as standard clinical research specialists. It motivates research scholars to come up with basic

life solutions, with the health of an individual as the foundation for service. Backed by a highly competent faculty, many of whom are accomplished industry experts with rich work experience in the US and the EU, scholars of Mir IFCR India provide a unique and valueadded exposure to students. The institute also receives visiting professors from the USA. Mir IFCR India enrols and prepares graduates in the fields of Medicine, Pharmacy, and Dentistry. It also has life science programmes for post-graduates in the fields of Biotechnology, Microbiology, Biostatistics, Genetics, Biochemistry, etc. The PG programme in Clinical Research and Regulatory Affairs in India is offered in association with Campbell University. Those with BSc in life science disciplines, BSc Nursing, BTech (Biotechnology/Bioinformatics), BDS, MDS, BPT, MPT, BPharm, MPharm, and MSc are eligible to apply for various programmes at the institute. Mir IFCR India also offers work and study programmes with specialisations in regulatory affairs, clinical biostatistics, clinical data management, and pharmacovigilance. The study programme includes a sixmonth clinical practicum covering in depth the standards and guidelines of the US Food and Drug Administration (FDA), the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), the Good Clinical Practice (GCP), the Good Manufacturing Practice (GMP), the Good Laboratory Practice (GLP) and the Indian Council of Medical Research. The core courses covered under the syllabus include research methodology, ethics, project management, clinical epidemiology, computer applications, Trade Related Aspects of Intellectual Property Rights/Intellectual Property Rights, and biotechnology. Since research in areas like oncology, neurological disorders, cardiology, diabetes, among other major diseases, are of paramount

FUTURE MEDICINE I September 2012

Students of Mir IFCR India undergoing training. importance to leading pharmaceutical, research, and healthcare groups, the project works at Mir IFCR India accord priority to such subjects. Every scholar must complete a six-month clinical internship at Mir Life Sciences at Bangalore or a leading research centre/medical school in India, where Phase I- IV clinical trials are an integral part of the programme. During the internship, strong emphasis is given to a judicious application of modern and ancient principles of management, including human resource management in a multinational corporate environment. Today, the clinical research and trials industry is one of the fastest growing industries with revenue of more than $400 million. Fabulous opportunities await students who wish to pursue a career in the clinical research and trials sector. Clinical research comprises four phases. In phase I, a new drug may be tested on a group of patients for identification of safe dosage levels and possible reactions. In phase II, the efficacy of the drug in a larger group is evaluated. In phase III, the effectiveness of the drug is compared with commonly used treatments. In phase IV, the drug is made available to the general population after inspection of the possible long or short-term side effects of the drug. Mir IFCR India ensures ample training in all these four phases, enabling students to get the best jobs in the industry, says Dr Binny Krishnankutty, a former student of Mir IFCR India who is currently working with Dr Reddy’s Laboratories Ltd, Hyderabad. “With the training from Mir IFCR, I gained managerial abilities with a sound theoretical backing,” testifies Dr Binny. Harish Sankarankutty, another former student of Mir IFCR India, is currently working as Senior Clinical Research Associate & Trainer in GlaxoSmithKline Pharmaceuticals, Bengaluru. He says the greatest advantages at Mir IFCR India are that of knowledge sharing and the spirit of collective excellence. “It’s not just the excellent course structure and the dedicated FUTURE MEDICINE I September 2012

faculty, but also the advice and constant motivation that enabled me to realise my true potential. Mir IFCR India has helped me a lot in developing my personality and soft skills, boosting my confidence levels,” he adds. Mir Lifescience is a part of Mir Group, one of the leading and fastest growing business houses in South India engaged in diverse business sectors such as Real Estate, Project Management & Consultancy, Tourism, Hospitality, International Trade, Life Science Infrastructure, Energy Solutions, and Education.

Clinical research and trials in India

Large multinational companies find India as a suitable place to do research due to various reasons. The large patient pool, available at economical costs with no compromise on quality, makes it a viable hub. “The cheapness factor is not the most important factor for MNCs looking at India for research. India also maintains international quality along with a large patient base. If the research gets delayed because of dearth of patients, it would mean delay in introduction of a drug to the market, resulting in revenue loss. That is the major reason why MNCs have a liking for India. Eli Lilly, Aventis, Novartis, AstraZeneca and Pfizer do clinical trials in India. Since 2005, companies like Johnson & Johnson, GSK, Merck, Amgen, Eisai and Bristol-Myers Squibb have set up shop here. Smaller companies have also begun to look at India as a preferred location for trials,” adds Dr Shaji. The increasing global expenses in research and development, protracted drug development time periods in other countries, availability of world class processing infrastructure for biostatics and bioinformatics and large generic drug manufacturing facilities in India are some of the factors helping the country maintain a lead in the field of clinical research and training. According to estimates, the Indian clinical trials industry reported a turnover of $300-400 million in 2011. The lack of clarity on regulation and delay in sanctions are holding up further development. Hope India will make the necessary amendments and stand up to the challenge.

EMERGING TECHNOLOGY Proteus Digital Health

Digital medicine with body sensors gets FDA approval US-based health solutions company Proteus Digital Health has been able to raise as much as $70 million from pharmaceutical behemoths in a very short span of time, with the launch of a groundbreaking digital health solution that can help people in managing their medicine intake by providing comprehensive data on the human body’s key functions as well as its need for medical support Bureau

alifornia-based Proteus Digital Health has finally received 510(K) approval from the United States Food and Drug Administration (FDA) for its Ingestible Event Monitor (IEM) medication adherence technology. A 510(K) is a premarket submission made to FDA to demonstrate that the device to be marketed is safe, effective, and substantially equivalent to a legally marketed device. This approval comes in the wake of a recent World Health Organisation (WHO) research finding which estimates that as much as 50 per cent of medications are improperly prescribed, and more than half of prescription pills are not taken properly by majority of patients. The Proteus medication adherence platform consists of two core technologies which work in tandem to provide a passive body area network to capture detailed and “personalised context-aware data”, according to imedicalapps.com, an online publication for medical

professionals. The first technology is the Ingestible Event Monitor (IEM), previously dubbed the ‘Raisin’, which is embedded into pills and activated by stomach acid upon digestion. IEM sends a signal through the skin which logs both the time when the user takes the pill and the unique identifier for that particular medication. The second core technology is a battery-powered adhesive sensor worn on the skin outside the stomach which receives and logs the signal from the IEM, as well as continuous readings of the patient’s heart rate, temperature, activity, and rest patterns in an effort to collect as much context data as possible. The disposable sensor’s battery will last for up to seven consecutive days and is available in a variety of flexible materials which allows it to form fit any body type. Proteus was awarded a patent in January this year, entitled “Body Associated Receiver and Method” (US

FUTURE MEDICINE I September 2012

Patent 8114021), which describes both the wearable and ingestible sensor technologies and related sensor devices used to create digital communication networks within, on, and around the human body for health-related and other applications. This was the company’s 41st issued patent, though they have more than 500 patents for digital health technologies pending in the US and other countries. “We worked very closely with the FDA to (find a regulatory pathway) to get this through. It took a lot of creativity,” said Arna Ionescu, director of customer experience at Proteus, while speaking at the mHealth Leadership Summit in Boston soon after the FDA’s announcement. According to the company’s website, the ingestible sensor has been used by test subjects over thousands of days in clinical trials with no serious adverse events reported, and seven independent review boards have approved the company’s studies. When it comes to the cost of the system, Proteus punts on the details, stating that total cost varies based on the “context in which the system is used”. Since Proteus does not manufacture products for direct distribution to patients, but rather licenses their intellectual property to third-party manufacturing and distribution partners, the ultimate cost to the consumer will likely hinge on a multitude of factors ranging from the type of medication being tracked to the value-added services built on top of the licensed sensor technology. So far, the company has struck at least four major deals to license its wearable sensor to be used as part of body area network products developed for distribution in the US, Europe, and Japan. The first big deal for the digital health start-ups came in 2010 when they received a $24-million investment from Novartis as part of an exclusive worldwide agreement for the pharma giant to license their sensing technology for organ transplantation, as well as reserved options related to oncology, cardiovascular, and clinical development. The second major deal came in early 2012 when the company announced it had reached agreement with Chicago-based design firm Avery-Dennison to develop a “peel-and-stick” version of its wearable sensor, which was ultimately branded “Metria”. Avery has since secured a deal to have Metria become the centerpiece of a new product line launched by Body Media at this year’s Consumer Electronics Show, which Body Media plans to deploy in corporate wellness programmes, remote elderly care and safety, and remote monitoring for a variety of non-specific health conditions. Features of the “peel-and-stick” Metria sensor include track key lifestyle indicators such as calorie burn, steps taken, activity levels, and sleep patterns through multiple sensors that collect more than 5,000 data points per minute. Enable that data to be uploaded to a computer or mobile device for use as a guideline to determine the need for behavioural FUTURE MEDICINE I September 2012

modification to promote weight loss and other wellness efforts. It should be worn on the back of the left tricep, providing an inconspicuous solution similar to a large bandage with no wires required to transmit data. It can remain in place for up to seven days even while showering and exercising through use of Avery Dennison Medical Solutions’ splash-proof adhesive chemistries and production technologies. In 2011, Proteus reached a deal with Lyolds Pharmacy to bring their products to the UK and other European countries under the brand name Helius. This was the first deal to include the Ingestible Event Monitoring technology, which received formal CE Mark approval for distribution in Europe in 2010. Recently, Proteus announced that it had entered into an exclusive worldwide license and collaboration agreement with Otsuka Pharmaceuticals of Japan, developer of popular anti-depressant Abilify, to develop and commercialise a new category of medicines based on Otsuka’s pharmaceutical products and Proteus’s sensor-based biofeedback technologies. Otsuka will have exclusive rights to develop commercial products in two defined therapeutic areas of high unmet need, as well as a non-exclusive license to utilise Proteus technology in its clinical and R&D activities. Finally, Proteus announced that they had closed $17.5 million of a possible $50-million Series E round, bringing the total capital raised to nearly $70 million. Strategic investors who have participated in Proteus funding rounds, and are among the company’s strategic R&D partners, include Medtronic, ON Semiconductor, and Kaiser Permanente.

BRAINSTORMING SESSION NASEC Kochi 2012

Summit sizes up heart disease prevalence The results of a survey conducted to determine the prevalence of coronary artery disease (CAD) and risk factors of CAD were brought to light at the National Conference on Epidemiology of CAD at Kochi. Adults aged between 20 and 79 in urban and rural settings of three geographical areas of Kerala were analysed under the survey Our Correspondent

bout 70 doctors with expertise in the field of preventive cardiology and public health attended a day-long National Conference on Epidemiology of Coronary Artery Disease (NASEC) at Kochi last month. The experts held discussions on the changing scenarios in the epidemiology of coronary artery disease (CAD). Dr Mohandas K, Vice-Chancellor, Kerala University of Health Sciences, inaugurated the conference. Organised by the Kerala chapter of the Cardiological Society of India, the main objective of the conference was to highlight the results of a survey conducted to determine the prevalence of CAD and risk factors of CAD. Adults aged between 20 and 79 in urban and rural settings of three geographical areas of Kerala were analysed under the survey. Fourteen doctors presented their papers on the cross sectional survey, highlighting different risk factors and precautions for cardiovascular diseases. The programme highlights also included five research

papers presented by eminent persons from the field of medicine. Among the major risk factors of CAD that were presented through the survey included a report by Dr Prabhakaran D, entitled “Why do we need a life course approach to prevent cardiovascular diseases in India”, Dr Rajeev Gupta’s “Hypertension as a gateway for cardiovascular risk in India”, Dr Thankappan’s “Community-based interventions for the prevention and control of cardiovascular diseases”, Dr Ramankutty V’s “Population Registry of Lifestyle Diseases – A prospective cohort study from Kerala”, and Dr Sivasankaran S’s “Lowering of blood pressure in pediatric age group – need of the hour”. Being the first multicentric study in the country, the Cardiological Society of India Kerala Chapter Coronary Artery Disease and its Risk Factors Prevalence Study is the first such initiative involving urban Kerala, more particularly, the northern and middle parts of the state. Providing a window into the future with regard to the epidemiology of CAD, experts of national and international eminence helped participants gain an in-depth understanding of the problem and encouraged scholars to undertake more such research initiatives. While the welcome address was made by Geevar Zachriah, Coordinator, NASEC Kochi 2012, the presidential address was given by Dr Tiny Nair, President, CSI Kerala Chapter and Chairman, Organising Committee, NASEC Kochi 2012. Dr Deb PK, PresidentElect, Cardiological Society of India, Dr Nair DV, Senior Teacher and Cardiologist, Kochi, and Dr Santhanu Guha, General Secretary, Cardiological Society of India, were felicitated at the conference. Dr Jabir A, General Secretary, CSI Kerala Chapter, and Organising Secretary, NASEC Kochi 2012, delivered the vote of thanks.

FUTURE MEDICINE I September 2012

GM crops NEWS & VIEWS

India is yet to overcome

GM food dilemma

Staunch supporters of genetically modified (GM) food argue that in order to meet the productivityrelated deficiencies in the food bowls of the developing world in a realistic manner, scientists need to usher in a second green revolution with increased use of GM food technology. However, organic farming experts have bulldozed the argument by saying that there is more than enough food in the world and that the hunger crisis is often caused by problems in food distribution and politics. Besides, these experts have also warned the people of the serious health issues associated with GM food By Dipin Damodharan

FUTURE MEDICINE I September 2012

NEWS & VIEWS GM crops

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Food is the biggest business in this world. Whoever controls food production can control anything on this earth. To control the food business, one needs to control the seed and agrochemical businesses,” says Dr Pushpa Bhargava, the father of Genetic Engineering in India. The debate on the useability of genetically modified (GM) crops and food items died down with the Central government placing a moratorium against application of GM technology in certain crops and food items in 2009. But the issue is back on the boil. How and why? Bhargava recently revealed that 70% of imported food products are genetically modified in the USA. While access to safe and healthy food is a basic right of every citizen, the fundamental problem facing India is that the country neither has a single laboratory to test GM food products nor a comprehensive legislation banning use of imported GM food. Bhargava’s revelation has once again paved way for yet another round of discussions on whether India has to make a fresh case for GM food crops or snub it totally. What are GM crops? Genetic modification involves the insertion or deletion of genes. In other words, genes are artificially transferred between organisms that could be conventionally bred on the premise that the process would result in high yielding varieties of crops. The first commercially grown, wholly genetically modified food crop was a tomato,

which was modified to ripen without softening, by Calgene, a subsidiary of Monsanto in the early 1990s. Today, GM crops are cultivated in around 331 million acres across the world. Most of the GM crops are grown in North American countries. Considering the health and environmental problems, certain varieties of GM crops were banned in some parts of America as well as France, Venezuela, and Hungary. Since 2002, there has been considerably high cultivation of Bt cotton in various parts of India. The political controversy over GM crops came to the limelight only after Bt brinjal, the first genetically modified food crop in India. Succumbing to the intense opposition from environmental organisations, activists and the public, the then Union Environment Minister Jairam Ramesh announced in February 2010 the government’s decision to put a moratorium on the release of Bt brinjal till independent scientific studies establish the long-term safety of the product.

Studies and controversies

The question we are concerned with is whether the GM crops can be a panacea for world hunger problems. A group of GM followers argue that in order to meet the productivity-related deficiencies in the food bowls of the developing world, scientists need to usher in a second green revolution with increased use of GM food technology. However,

According to reports, as of today, 6.5 billion people are living on earth, and we produce food for 11.5 billion people. From this figure, it is evident that the problem is not with production, but with distribution of food crops

FUTURE MEDICINE I September 2012

organic farming experts have bulldozed the argument by saying that there is more than enough food in the world and that the hunger crisis is often caused by problems in food distribution and politics. Dr Yoosaf, Associate Professor, Department of Biotechnology, Calicut University, points out that the cultivation of GM crops will eventually lead to the annihilation of original/natural varieties. To substantiate his point, Dr Yoosaf, who was a Research Associate with ICAR (Indian Council for Agricultural Research), cites the example of Mexico, where a natural variety of Maize was completely wiped out because of Bt Maize. Dr S Usha, Director of Thanal, an NGO in Kerala, blames politics for the GM crops propaganda. “Actually, the GM crops are increasing the agrarian crisis. The claims of high productivity cannot be true. If so, the suicide of cotton farmers in Vidharba wouldn’t have happened,” says Dr Usha. She says that the only beneficiaries of GM crops are multinational companies like Monsanto, which supplies the GM seeds. Dr Usha’s is not an isolated viewpoint. There are many global research studies, including some undertaken in India, that echo Dr Usha’s argument. In countries like America, there exists a strong view that GM crops actually reduce productivity. The US Department of Agriculture even admits that productivity of GM corn and GM soya is less than that of the normal varieties. The Genetic Engineering Approval Committee (GEAC) is the regulatory authority, under the Ministry of Environment and Forest, for approval of GM crops in India. Surprisingly, GEAC and ICAR support the commercial cultivation of GM crops. Yet, they have not conducted any in-depth scientific studies on the issue. The Inter-Academy report on GM crops, prepared by the Indian Academy of Sciences, the Indian National Academy of Engineering, the Indian National Science Academy, the National Academy of Medicinal Sciences and the National Academy of Sciences (submitted in September 2010 to the Ministry of Environment and Forests), happened to be a disgrace to Indian science. It endorses the commercial cultivation of GM crops, but the conclusion was based on a previous study conducted by someone. In the words of famous agriculture policy analyst Devinder Sharma, one can understand the hollowness of that report. “It is no better than the introductory write-ups any graduate student of biotechnology would come out with. In fact, I have a collection of a large number of papers/analysis written by graduate and postgraduate students who seek my comments/views. I would rate their papers much higher than the InterFUTURE MEDICINE I September 2012

Academy report.” According to reports, as of today, 6.5 billion people are living on earth, and we produce food for 11.5 billion people. From this figure, it is evident that the problem is not with production, but with distribution of food crops. That leaves us with one simple question, what’s the benefit of genetically modified highly unsafe food crops?

Health problems of GM food products •

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Children in the US and Europe have developed life-threatening allergies to GM food products (allergenicity) Direct health effects in terms of toxicity Specific components contain toxic properties The stability of the inserted gene is doubtful Nutritional effects associated with genetic modification Unintended effects from gene insertion

HEALTH TIPS

Nine ways to get a grip on your mental make-up It’s important to stay positive and healthy to maintain the rhythm in life. In this respect, the biorhythms play a vital role in shaping the building blocks of our daily life. Even slight imbalances in the biorhythms can effect a major change in the quality of life. So, what should we do to strike a fine balance between the physical, emotional, and intellectual cycles? In this edition, we have listed out nine ready reckoners for those who are desperately trying to get a grip on their life •

Stay connected with the world

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Make time for leisure

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Nurture and maintain strong relationships with others while you make steady efforts to enrich your life. The quality of your personal relationships makes a great effect on your well-being. After all, well-being is directly linked to happiness and satisfaction in life. Try to find enough time for leisurely activities. If you are able to sustain your interest in certain hobbies and creative works, it will not only give you a chance to enjoy life at the fullest, but also provide you a much-needed emotional outlet. Keep your body and mind pleasant by reading books, gardening, or taking part in creative endeavours in the field of art, or performing arts.

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Share your interests

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Contribute to your community

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Deal with stress effectively

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Get enough rest and refreshment

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Seek help from others

Keep yourself active

Active participation in every aspect of life is the key to happiness. A balanced diet will help you maintain a healthy body. You don’t necessarily have to go to the gym for exercise. Instead, go for swimming, brisk walking, or other such activities that can tone up the body. The physical vitality has a direct bearing on the mental health. So, keep fit and feel good. Challenge yourself To achieve various goals in life, we keep acquiring new skills. The challenge lies in doing things in a different way, especially at the workplace. It is good if you can keep yourself perched on the learning curve all through life. By enhancing your knowledge, you can stay mentally fit and come up with the necessary skills and confidence required for the accomplishment of a job. It will keep you on a progressive path.

Always mingle with a group of people with whom you can share your interests, ideas, and feelings. If you are part of a group of people with a common interest, it will give you a sense of belonging. So, be part of a sports club, a band, a dance class, a theatre, choir group, or a book or car club. It can boost your mental energy. Manage your time for a social cause that you really care about. You can contribute to the community and feel good about yourself. Improving the life of others can always bring you happiness and satisfaction. Stress is something that can turn life topsy-turvy. It can make you feel uncomfortable or distressed all the time. Only a balanced lifestyle can help you manage stress in a better way. If you are being eaten up by worries, make sure you have sufficient time for relaxation through breathing exercises, yoga, or meditation. You should have sufficient sleep to be able to take on the challenges of a new day. So, go to bed early on a daily basis and do not take worries with you. Or else, you may feel mentally and physically fatigued through the day. Refresh your mind by making healthy, quality conversations with others. Everyone’s life is filled with one or the other kind of tension/stress/problem. Yet, you can seek others’ help in times of distress. The perspective of a significant other can make a huge difference.

FUTURE MEDICINE I September 2012

OXYGEN THERAPY

Dr Wasim Mohideen

Breathe easy and detox your system

xygen is the essence of life. You can live for a few weeks without food, a few days without water, but only a few minutes without oxygen, a maximum of five minutes to be precise. That’s why oxygen is extremely important for life. Pure oxygen is even more important. Why do we feel so nice during a beach holiday or when we are in a place filled with trees? In fact, yoga and pranayama too focus on breathing, which is to make the body utilise oxygen to its best capacity. Let’s face it, we do not have the purest of air around us. Nature has given us an oxygen percentage of 21 per cent. Unfortunately, if you take the percentage of oxygen in air today, it will not be 21 per cent. What is alarming is that the percentage of carbon dioxide is higher due to all the pollution. And when this balance of oxygen against carbon dioxide is altered, the purity of the air is compromised. As a result, the absorption of oxygen in your body is also compromised. Once the optimum absorption of oxygen is compromised and your body is not getting its due, the wonderful healing and preventing properties of your body are the first to get affected. So, what would normally take a few minutes to heal will take a day and what normally takes a day will take a few days and so on. This also applies to the preventing capacities of your body, so your body will not focus on giving you great skin and hair, but use the oxygen for the more important functions. That is where hyperbaric oxygen, delivering pure

FUTURE MEDICINE I September 2012

oxygen under a high pressure, offers extremely good number of benefits. But just sitting in an oxygen parlour is not going to make you healthy. That is why a number of oxygen paroles shut down after a few months of operations. Oxygen, like other aspects of wellness, is a part of a holistic therapy which focusses on lifestyle issues and, together with other lifestyle changes, makes a big impact on your wellness goals. So, where does hyperbaric oxygen find its uses? Injured Athletes are very high users of hyperbaric oxygen since high pressure oxygen has proved to be wonderful in healing injuries. Children with autism have shown improvements over a period of time following usage of high pressure oxygen. It is also popular for its use against ageing. There are times when people have suddenly had clear skin, making them look a few years younger, after oxygen therapy. It is also used for smokers’ detox. With a 30 per cent higher pressure, the tissue penetration of oxygen is higher, and with the higher pressure, the flushing out of toxins from the lung is better, which is extremely important for smokers’ detox. High pressure oxygen can also be used for a normal detox. You can take a book and read or listen to your favourite music or get your acupuncture while inside the oxygen machine, if the particular machine is soft body. In a hard body oxygen chamber, nothing can be taken inside due to the risk of fire. Some of our patients very easily ask to be put under high pressure oxygen without being examined. Like every medical procedure, oxygen should be used with caution, only after the oxygen therapist’s approval. Going under pure oxygen for about ten days consecutively once in a while is a wonderful feeling. But the best benefits for oxygen come when it is combined with a structured detox programme, or as part of other wellness programmes. These are times when your body needs to be prepared to make the best use of oxygen. (Dr Wasim Mohideen is the Director of Basil Wellness Studio, a centre for preventive and wellness medicine. He is a doctor who has been trained extensively in wellness in the US, the UK, and Sri Lanka, and he writes for various newspapers and magazines. Celebrities and CEOs are among his clients.)

WHERE TO STUDY China

Learning medicine right from the

art of Qi

With low-cost study packages and quality education, Chinese medical universities are emerging as the popular choice of international students. The provision of English medium MBBS programmes, liberal admission procedures, special scholarship schemes, recognition of degrees by major medical bodies across the world, and the availability of a wide choice in terms of the number of medical universities in China are some of the features that will please MBBS aspirants

Bureau

hina is fast becoming the most favoured medical study destination in Asia. With about 50 quality medical universities, approved by the Chinese Ministry of Education, in its panel of institutions, China MBBS is a leading professional international education

counselling centre offering a cutting edge, value-added study package to overseas students. China has English medium medical schools, recognised by the Medical Council of China and the World Health Organisation (WHO). With more than 10,000 overseas medical

FUTURE MEDICINE I September 2012

students, China is gradually becoming increasingly popular for its medical universities. The approved universities have the authority to grant a Masters to international students in Basic Medicine and Clinical Medicine (First-level Subjects) and provide internships in affiliated hospitals with Grade III, Level A. With highly experienced and qualified faculty members, Chinese medical universities offer English medium MBBS programmes lasting six years. Though English is the medium of programme instruction, international students are required to study Chinese to be able to communicate to patients in clinics. Some medical schools require foreign students to pass the HSK test (Chinese language proficiency) before graduation. Most of China’s medical universities are ranked among the top 500 universities in the world and highly reputed for being at the forefront of modern medicine. The medical degree awarded by universities here is valid throughout the world. They are even recognised by the Pakistan Medical and Dental Council, the Medical Council of India, the Saudi Commission for Health Specialties, the Medical and Dental Professions Board, Health Professions Council of South Africa, the Professional and Linguistic Assessment Board in the UK, and the United States Medical Licensing Examination. Students from Chinese medical universities are eligible to sit for the screening test conducted by the National Board of Examination in the respective countries. As compared to universities and colleges in the US, the UK, Europe, India and Pakistan, it is easy to get admission in a top ranking Chinese medical university. Furthermore, the entrance requirements for a bachelors in medicine are much easier to meet than in other countries. The expenses incurred in an MBBS programme in China is 70% cheaper as compared to similar programmes in the US and the UK. The US MD programme (equivalent to MBBS)

costs around $160,000-200,000. This excludes four years of Pre-med study. While a student can complete a comprehensive MBBS course from any of the China’s medical universities in six years at a cost ranging between $30,000 and $50,000. The charges of tutoring in the universities in China have been subsidised by the Ministry of Public Health. All in all, it is very economical for international students to study in China. With its rich culture and customs, China is pitching itself as a study destination that can offer quality education in an atmosphere of peace and social harmony.

Eligibility for MBBS course in China • •

• •

•

A student should be aged between 18 and 30. H/she must have studied Physics, Chemistry and Biology as electives and obtained minimum 50 per cent in aggregate in the 12th standard from any recognised Council/Board of India or abroad. H/she must have studied and passed English as a compulsory subject. H/she should have good moral character, obey the laws of the Chinese government and regulations of the university concerned and respect Chinese social customs and habits. There may be special requirements/stipulations in the case of each university.

List of documents required • • • • • • • •

Notarised copies of 10th standard marksheet and passing certificate Notarised copies of 12th standard marksheet and passing certificate Notarised copies of Admission Letter Notarised copies of Caste Certificate (If reserved category student) Copy of the passport 20 recent coloured photographs Physical Examination Record (if required) English proficiency test certificate for students from non-English-speaking countries

China’s ten best medical universities

Scholarships available for international students

• • • • • • • • • •

• • • • • •

Capital Medical University Tianjin Medical University Hebei Medical University Dalian Medical University China Medical University Jilin University Harbin Medical University Fudan University Tongji University Southeast University

FUTURE MEDICINE I September 2012

•

Dalian Municipal Government Scholarship Jiangsu Government Scholarship Guangxi Government Scholarship Liaoning Government Scholarship Zhejiang Provincial Government Scholarship Shanghai Municipal Government Scholarship Hubei Provincial Government Scholarship

TRADITIONAL MEDICINE Termite Sand Therapy

There’s only one cure for

Ooru Sthambam

Ever heard of a muscular disorder called Ooru Sthambam? This is a disorder often misunderstood as arthritis, leading to wrong prescriptions and treatments. For Ooru Sthambam, there’s only one cure – that of termite sand therapy, a healing technique that has been a part of Ayurvedic science since ancient times Lakshmi Narayanan

t times, even the seemingly disgusting creatures can be of immense help to you. In this case, we are talking about the very sight of the swarming termites. Well, you would stop cussing the moment you realise that they hold a great potential for curing one of the most common ailments among adults in India – excrutiating pain around the thighs because of muscular contraction. Deemed to be a centuries old therapy in the traditional branch of Ayurveda, the healing technique involves the sand created by termites.

Though there are no documents on this mode of therapy, Ayurvedic practitioners rely on this ancient technique to treat patients suffering from Ooru Sthambam, or muscular contraction around the thighs. This muscular disorder is often misdiagnosed as a symptom of arthritis by allopathic medical practitioners. Ayurvedic practitioners say that this health condition is one of the most complicated cases even in this age of advanced medical science, as practitioners fail to diagnose it at the right time.

FUTURE MEDICINE I September 2012

Ayurveda experts say that the only remedy for Ooru Sthambam is a therapy using termite sand and mustard oil. What is Ooru Sthambam? Ooru Sthambam is a rare disease which affects one out of 1,000 people. It affects the thighs, and patients generally develop a frozen feeling in the thigh region due to the contraction of muscles, disordered circulation of blood to legs and other body parts, and congestion of cells in the body. Ayurveda experts also hand out a major educational information while speaking of Ooru Sthambam, that the panchakarma treatment in Ayurveda is contraindicated (a condition or factor that serves as a reason to withhold a certain medical treatment) for this disease. The pain and freezing sensation around both thighs gradually spreads to the knees, and over a period of time, if the condition remains medically unattended, it will be hard for the patient to walk perfectly, causing disruption in his daily activities. “There are many Ooru Sthambam patients across the world who have undergone many checkups and treatments but in vain. Many of the patients have been suffering from this condition for more than 20 years. So, proper diagnosis of the disease is essential,” says Dr Anish Kurias, Chairman, Earth Hospital, Bengaluru, and an expert in termite sand therapy. About termite sand therapy Termite sand is applied around the thighs along with mustard oil. As compared to other treatments, it has a quick effect in terms of curing this dangerous body disorder. The speciality of termite sand is that it can be used only for this treatment. Termite sand has no medical application on its own. However, when it is mixed with mustard oil in the right proportion, it becomes a perfect medical concoction. Though mustard

oil is the main healing agent here, it cannot give a good result when combined with any other sand types. Once Ooru Sthambam is diagnosed, termite sand therapy can be applied under the guidance of an Ayurvedic physician. A Dr Anish Kurias, Chairman, paste made out Earth Hospital, Bengaluru of equal quantity of termite sand and mustard oil along with water should be applied on the affected area. The patients should continue the therapy until he develops a burning sensation. Normally, the therapy can last from four days to three months, depending on the intensity of the disease. The duration of the therapy is roughly 25 minutes a day. Generally, it starts showing best results within the time span of one week. There is no need for administration of any tablet or other medication during the treatment. Besides, termite sand is easily available all over the world, irrespective of geographic features.

Results • • • • •

It completely cures Ooru Sthambam Increases blood circulation Strengthens the muscles Empowers the affected body parts It can completely cure diseases among patients with a history of the particular condition for 15-20 years

Rare treatment for rare disease

he traditional way of curing Ooru Sthambam is a blessing for thousands of patients. As it is a rare disease, it had been very difficult for physicians to diagnose it in the early days. Today also, the situation is almost the same. There is sufficient proof on the identification of such a disease in Ayurvedic texts. Ayurveda states that it is one of the most dangerous diseases. In all other disciplines of medical science, Ooru Sthambam is often misunderstood as some other disease and a wrong treatment is generally prescribed for cure. But it is a proven fact that the only known medicine to this disease is the termite sand therapy of Ayurveda. But owing to the absence of documents pertaining to this healing technique, this therapy did not receive

FUTURE MEDICINE I September 2012

national or international recognition until recent times. However, Ayurveda experts cite enough evidence to prove that Ooru Sthambam has always been treated with termite sand therapy since ancient times. Dr Anish Kurias, Chairman, Earth Hospital, Bengaluru, and an expert in termite sand therapy, once received a patient from Uzbekistan who had been suffering from Ooru Sthambam for 15 years. She had failed to get it diagnosed at the right time. By the time she had come to consult Dr Kurias, she had developed difficulties in walking. After the application of termite sand therapy for a time span of less than a month, her life was back on track, proving that this treatment can cure a disease that may have originated a decade ago or even before.

PHARMA ROUNDUP

Defensive play

ill the global economic slowdown affect India’s pharma sector? While prudence calls for a wait and watch approach, Sandeep Singhal of Emkay Global Financial Services is of the view that the pharma sector would have to resort to a better defensive play than the IT and FMCG sectors. “We conducted some study which showed that when the GDP is contracting, by staying well on the defensive, the earnings can be protected. Our take is that the pharma sector can protect its earnings because this is one of the essentials. You stop taking medicine only in an extremely hopeless situation, when you are not left with any money,” Singhal told a business TV channel.

Recruitment freeze

he economic crunch has forced companies to take a cautious approach in their recruitment initiatives. A survey on recruiters from the pharma sector revealed a drop in the overall hiring sentiments. At least 51 per cent recruiters are expecting to add new jobs in the second half of 2012, which is 16 per cent lower than what was predicted in a survey conducted in January 2012. Back in January, none of the recruiters had predicted a hiring freeze. But now, 11 per cent of recruiters are saying that hiring will come to a halt in the next six months, while 59 per cent of them said that the increment would range between 10-25 per cent. Talent crunch is another important issue faced by recruiters in the pharma sector as 73 per cent said that it is very difficult to find suitable talent.

Meda signs agreement with Jazz Pharma

eda, an international specialty pharmaceutical company, has signed an agreement with US-based specialty pharmaceutical company Jazz Pharmaceuticals to acquire a portfolio of six pharmaceutical products focussed on women’s health for $95 million in cash. The products included in the sale are Elestrin (estradiol gel), Gastrocrom (cromolyn sodium, USP), Natelle One (prenatal vitamin), AVC cream (sulfanilamide), Gesticare DHA (prenatal multi-vitamin), and Urelle (urinary antiseptic). Net sales for these products in 2011 totalled $30.4 million. As part of the transaction, Meda will offer positions to about 60 Jazz Pharmaceuticals employees who directly support these products. Jazz Pharmaceuticals expects to recognise a nonrecurring gain on the sale in the fourth quarter of 2012.

FUTURE MEDICINE I September 2012

Medical Tourism Kerala

Kerala aims to be a

global

Hub of health tourism

By Dipin Damodharan

At a time when more and more people are faced with stress and hectic lifestyle -related illnesses, Kerala has positioned itself as a premium wellness and healing destination with a bouquet of novel therapies. With its unique health solutions, the state has the potential to become a global medical tourism destination

FUTURE MEDICINE I September 2012

y injecting a fresh dose of positivism across industries through a series of infrastructural development initiatives and growthcomplementing policies, Kerala is inviting global investors to be a part of the new wave of innovations. Among other sectors, tourism and health are key areas where the United Democratic Front (UDF) government hopes to optimise value and growth through investment-friendly policies and emerge as a global health tourism hub. According to the CII-McKinsey report, the medical tourism industry in Kerala is expected to be worth $4 billion by 2017. Kerala has a lot of potential to become a global health destination. “Every region in the country has a natural tag attached to it. Kerala has an image of a tranquil place which has a natural healing and calming effect on people. Ayurveda

is the science of this healing aspect of Kerala. In a world where people are increasingly inviting stress and hectic lifestyle-related illnesses, Kerala is a natural choice (for healing solutions). Given its resources and expertise, it is easy for Kerala to position itself as a health destination,” K Jayakumar, Chief Secretary to the Government of Kerala, tells Future Medicine. “The sky and the earth of Kerala have a quality not seen everywhere. It is not about treatment for any ailment. It is about reconnecting. The new world has an inner longing for silence and calm. That is the affinity for wellness and Kerala can contribute enormously towards this,” says Jayakumar. Logistical preparedness only drives home the assurance that the state is highly dependable in terms of quality healthcare. “Last year, more than 50,000 foreign patients visited some hospitals in Trivandrum,” says

Shaffi Mather, Economic Advisor to the Kerala Chief Minister. “Many of the institutions in the healthcare sector are excellent. They maintain global standards. Significantly, the treatment cost for various diseases in Kerala is ten times lower than several other countries. Kerala can easily attract medical tourists from the Middle East, the Africa and Asia,” says Shaffi. Shaffi, entrusted with the implementation of various projects proposed by Sam Pitroda, Mentor to the State of Kerala, says that the state government has concrete plans to make Kerala the global hub of Ayurveda. Better medical facilities, comparatively low healthcare costs, and the opportunity to simultaneously enjoy the pleasures of tourism while attending to health issues are some of the factors that attract foreign patients to Kerala.

Medical tourism “Every region in the country has a natural tag attached to it. Kerala has an image of a tranquil place which has a natural healing and calming effect on people. Ayurveda is the science of this healing aspect of Kerala. In a world where people are increasingly inviting stress and hectic lifestyle-related illnesses, Kerala is a natural choice (for healing solutions). Given its resources and expertise, it is easy for Kerala to position itself as a health destination,” K Jayakumar, Chief Secretary to the Government of Kerala FUTURE MEDICINE I September 2012

The term “Medical Tourism” is a buzzword in Kerala’s developmental agenda. According to Mary Tabacchi, a spa industry veteran and pioneer in spa education, health tourism or medical tourism is any kind of travel to make yourself or a member of your family healthier. According to a study on medical tourism, conducted by IIM-Calicut, the advantages of Kerala in this sector are: Nobody can beat Kerala cost-wise Kerala doctors and nurses are accepted all over the world We are known as compassionate people (even Thailand lacks this) Kerala Hospitals give many consultancies under

Medical Tourism Kerala

$4 one roof Offers eco-friendly environment NRIs all over the world function as ambassadors for Kerala Some NRIs based in the US function as entrepreneurs facilitating medical tourism to India and Kerala NRI travel agents operate in the medical tourism sector, arranging to and fro travel, treatments, and sight seeing tours As Kerala is famous for its alternative medical therapies, it can offer medical treatment for various ailments as part of leisure packages at luxurious tourist resorts. In addition to this, the general perception among foreign tourists, that Kerala has an excellent network of hospitals (both in public and private sector) offering international standard treatments at affordable prices,

only improves the prospects of medical tourism. Both modern medicine and traditional medicine equally attract foreign patients. The major sections in modern medicine include Cardiac Care, Orthopaedics, ENT, General Surgery, Cosmetic Treatment, Urology, Ophthalmology, Fertility Treatment, Neuro Surgery, and Dental Care. Traditional medicinal treatments include Ayurveda, Homoeopathy, Siddha, and Naturopathy. The medical tourism sector is expected to bring in $2 billion by the end of this financial year. In 2006-07, it could rake in only $333 million. The sector has recorded phenomenal growth ever since. According to a study, medical tourists from Germany, France, Switzerland, and the US prefer Ayurveda treatment, whereas medical

billion

Medical tourism industry in Kerala is expected to be worth $4 billion by 2017

The medical tourism sector is expected to bring in $2 billion by the end of this financial year. In 2006-07, it could rake in only $333 million. The sector has recorded phenomenal growth ever since tourists from West Asia and the UK prefer modern medicine. The state hopes to increase the revenue from medical tourism to $4billion by 2017.

FUTURE MEDICINE I September 2012

Anorexia Nervosa SPECIAL STORY

Beware!

Crash diets can make you crash By Lakshmi Narayanan

I won’t eat… I am on dieting… I don’t feel hungry… I want to maintain my body at all costs… These kind of comments are quite common among a sizeable section of teenage girls across the world. They are ever-ready to give up anything to maintain their external beauty and slim physique. But most of them do not know that this may make them susceptible to Anorexia Nervosa, an eating disorder that afflicts scores of women

he craze for food shouldn’t be so much that you turn into a glutton and a victim of obesity. But it also does not mean that you should starve yourself or deprive the body of key nutrients just because you want to look slim and trim all the time. The condition of being grossly under weight is more dangerous than being obese. As a matter of fact, the number of people with eating disorders is increasing at an alarming rate with each passing year. Today, if you compare the number of people suffering from under weight problems with that of obesity, you would be

FUTURE MEDICINE I September 2012

surprised to know that the idea of staying thin and lean has landed a high percentage of women, especially teenage girls, in a critical health problem called “Anorexia Nervosa” and that it is gradually becoming a bigger disease burden than obesity. So, what is Anorexia Nervosa? It is an eating disorder, especially among young women, characterised by a set of immoderate food restrictions, the irrational fear of gaining weight, and a distorted self-perception of the body. Anorexia Nervosa usually develops during adolescence and early adulthood. It’s much

SPECIAL STORY Anorexia Nervosa

more than a physical disorder. Its root cause is associated with a psychological disorder. Restriction of food intake causes metabolic and hormonal disorders, which slowly turns the human body into a sack of bones and skin. Annually, 20 per 10,000 women across the world are affected by Anorexia Nervosa. Only two per 10,000 men are affected by this disorder. However, men are more likely to be under diagnosed, misdiagnosed and under-referred. Many victims of Anorexia Nervosa have a family history of eating disorders, mood swings, and depression. People with low self-esteem and confidence about their external appearance become emotionally weak and starve themselves either out of depression, or in the earnest hope that this may improve their appearance. It is not known whether a neurobiological vulnerability predisposes to Anorexia Nervosa, or if this is associated with maintenance of symptoms once the illness develops. Further research is needed to examine the degree to which abnormalities are a consequence of starvation or are caused by an Anorexia Nervosa Endophenotype. Cultural, social, and interpersonal elements can also trigger the disease.

What causes Anorexia Nervosa?

Wrong perception about body shape and size is the root cause of Anorexia. Along with low intake of food, beauty conscious youngsters refuse water and other liquid diet. People with Anorexia typically weigh much below the expected weight for their age, sex, and height. A normal BMI (Body Mass Index) for an adult is 20-25. Above that you are overweight, and below that you are underweight. Adults with Anorexia have a BMI below 17.5. Besides low intake of food, Anorexic people vomit secretly after eating. They try hard to hide their thinness by wearing baggy clothes. They like food, but are ready to starve themselves to the brink of exhaustion. It is the consequences of eating that frighten them. Anorexia Nervosa is mainly of two types: Restricting type of Anorexia and Purging Type of Anorexia. Restricting type of Anorexia refers to weight loss due to restriction of calories (following drastic diets, fasting, and exercising to excess), whereas Purging type of Anorexia means weight loss, or points to use of laxatives and diuretics.

Health risks due to Anorexia

Anorexia not only makes one lean, but can also cause many other physical disorders that have the potential to eventually lead the person

to death. Irregular periods: It damages their reproductive system. Irregular periods are a main feature of this disease. As the hormone levels can be affected by a poor diet, patients may face a discontinuity in periods for three or more cycles. Periods may even stop altogether, especially if the patient starts having eating problems at a young age. Some people with Anorexia are even unable to have a baby. Chemical Imbalances: It lowers the level of potassium in our body, which may cause tiredness, weakness, abnormal heart rhythms, kidney damage, and convulsions. Low level of calcium in body will lead to muscle spasms. Osteoporosis: It is a state where the bones in the body get thin. It is caused by lack of calcium and vitamin D in body. Later, it causes cracking of bones. The risk of getting osteoporosis increases if a patient’s periods have stopped. Oestrogen in the body protects bones from osteoporosis. But the levels of oestrogen reduce when periods stop. Anemia: Most Anorexia patients are anemic with low level of hemoglobin, hormones, and blood level in the body. Depression: Some patients develop clinical depression which can make treatments ineffective and useless. Slowly, they lose hope in medicine, treatment, and finally, in life. Problems with hair, skin and teeth: Breaking of teeth, hair fall, and swelling in some body parts are usually common.

Symptoms of Anorexia Nervosa Anorexia controls life and emotions • • • • • • • • •

Pretending to eat or lying about eating Rapid, drastic weight loss with no medical cause Cutting food into small pieces and moving them around the plate, instead of eating Going to the toilet right after meals Using pills to make themselves urinate (water pills or diuretics) Exercising all the time, irrespective of bad weather, poor health, or busy schedule Dry yellow skin Confusion/slow thinking, along with poor memory/judgment Extreme sensitivity to cold

FUTURE MEDICINE I September 2012

Treatment for Anorexia Nervosa

Treatment for this disease is a great challenge because patients never admit that they have eating disorders. People often enter treatment only once their condition turns serious. The one and only objective of treatment is to help patients regain weight in accordance with their age and sex. A weight gain of one to two kilogrammes per week is considered a safe goal. It demands a longer hospital stay, increase in social activity, reduction in physical or stressful activities, and preparation of proper schedules for eating. One main problem encountered

during treatment could be the continuance of weight loss. Therefore, patients require regular physical monitoring. Multivitamin and mineral supplements are the main part of treatment. Only by maintaining a healthy diet can patients survive this disease. No medicines or tablets can act as a life-saving agent. “Treatments like cognitive behavioural therapy (CBT), cognitive analytic therapy (CAT), interpersonal psychotherapy (IPT), and focal psychodynamic therapy can bring about good results,” says Dr Sarah Jarvis, an expert physician on Anorexia in the UK.

Anorexia in the fashion industry Isabelle Caro before & after Anorexia

he problem of Anorexia Nervosa in the global fashion industry received wide attention when 28-year-old French model Isabelle Caro was afflicted by this disease, which eventually caused her death. Caro was at the peak of her career when she fell sick. She began her career as a model at the age of 13. Since then, she had been following a strict diet to maintain slimness for the ramp. She put herself on self-imposed starvation. She limited her diet to two little chocolate squares and four corn flakes a day. In 2006, she was hospitalised due to severe Anorexia. Caro soon slipped into a coma, though she regained consciousness later. At the age of 24, the 5.6 feet tall model weighed 24 kilogrammes with a BMI of 9.2. According to health experts, a woman of this age must weigh 50 kilogrammes

FUTURE MEDICINE I September 2012

and have a BMI of 22. Her case shook the entire fashion industry. Though she lost her beauty and physical vitality, she soon became an icon of the anti-anorexia campaign. In 2007, Caro took part in a now-famous ad campaign, known as ‘No-lita’, or No Anorexia. The photos of her anorexia-affected body in the ad shocked everyone. She wanted to tell everyone how destructive eating disorders can be. At the time of her death in 2010 due to Anorexia Nervosa, she weighed just 33 kilogrammes. She suffered a lot because of respiratory problems, tiredness, and a severe skin disease. Though her anti-Anorexia campaigns have evoked favourable responses worldwide, the danger of Anorexia still lurks in the fashion industry.

INSPIRATION Dr K P Hegde

God’s own

healer of the

heart Known as the first nun to become a DM Cardiologist in India, Sister Dr Annie Sheela is a humanitarian who can move mountains to bring succour to the sick and needy By Shalet James

ith a mind filled with the word of God, constant prayers on her lips, and selfless dedication to the sick and needy, cardiologist Sister Dr Annie Sheela, MBBS, MD, DM, has the power to motivate even a stonehearted person. Sister Dr Annie’s day begins in the wee hours, as early as 3 am, with prayers at the Teresian Carmelites Convent Chapel. After that, Sister Annie rushes to the P S Mission Hospital at Maradu in Ernakulam district of Kerala. She is known as one of the best and the first nun to be a DM Cardiologist in India. Born and brought up in a religious atmosphere in Ernakulam, Sister Dr Annie always made it a point to attend a mass on a daily basis and start her day on a positive note by seeking the blessings of the almighty. A very studious student since childhood, she was very passionate about completing her graduation in medicine. This ultimately led her to complete Cardiology after her ordination. Today, as the Associate Director and Cardiologist of P S Mission Hospital, Sister Dr Annie is the most sought after heart specialist in the city. She humbly attributes the success of P S Mission Hospital to the support and encouragement from her colleagues at Teresian Carmelites. Sister Dr Annie, who completed medicine from St John’s Medical College, Bangalore, was an expert in finding out cardiac lesions even during her studies. “As God’s person, my prime objective is to serve the patients in the best possible way. I am happy that I have been able to wholeheartedly dedicate myself to the medical profession,” says Sister Dr Annie.

She is famous for implementing a series of noninvasive/non-surgical therapy, called EECP, through which many ischemic and heart failure patients have been cured. Sister Dr Annie is now looking forward to the introduction of a new method of comprehensive disease prevention treatment and rehabilitation module for cardiology, which includes yoga, meditation, diet regulation, and alternative medicine. She plans to implement this programme within two months and give a new face to cardiac treatment. “This programme will benefit patients both mentally and physically and will give them a totally different experience of innovative treatment,” says Sister Dr Annie. “She is a very compassionate, supportive and sincere person. She was the one who saved my life. I still go to her for consultations. I truly believe that Sister Dr Annie has miracle in her hands,” says Jayakumar, a heart patient. Talking about the alarming rise in the number of heart patients in the city, Sister Dr Annie points out that the present food habits and lack of exercise are the main causes for this disturbing rise in such cases. “Nowadays, children are also prone to heart attacks. To resist this, parents should encourage children to adopt healthy habits,” she says. With a clear intent to provide clinical excellence and quality service to the suffering humanity, Sister Dr Annie joined the Cardiology Department of P S Mission Hospital in 2006. Since then, her love for god and humanity has guided her in her professional and personal endeavours.

FUTURE MEDICINE I September 2012