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TRENDS

2020 A look at trends and predictions that will shape the future of healthcare

DECEMBER 2019

INTERVIWE

PULSE

THE SIMPLEST SOLUTION TOP 10 MEDICAL FOR SAFE SURGERY INNOVATIONS FOR 2020

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2020: Re-imagining healthcare AS WE conclude 2019 and we step into 2020, we have a chance to make healthcare even more efficient and affordable. This task is not easy, as the healthcare landscape today is evolving continuously, driven by technological advancements and accompanying social, financial and regulatory shifts. The government is taking bold steps to level the playing field in healthcare. First by, guiding price of drugs and equipment and secondly by moving towards price transparency through Ayushman Bharat prices. The next step for the government would be to increase allocation for healthcare to match the growing needs of the people. In addition, it needs to have quality systems in place that are at par with the private sector or better. The private industry has to pick up the clues and build sustainable business models around this landscape. Holding its process accountable to further optimize cost and enhance profits. Technology will serve as a huge enabler and married to big data will become an invincible force to reckon with. Those who understand the use of this large scale data accumulated with the large healthcare delivery providers are already putting in place instruments to harness its benefits.

Information is the new currency that hospitals are dealing with and its not only restricted to health education but in depth knowledge of the procedure and the costs are the kind of information people are looking for In all this letâ&#x20AC;&#x2122;s not forget the patient. Information is the new currency that hospitals are dealing with and its not only restricted to health education but in depth knowledge of the procedure and the costs are the kind of information people are looking for. Apart from a state-of-the-art healthcare delivery system healthcare providers need to understand how to communicate and respond to customers. In the time to come this will be the single largest factor affecting consumer behavior in healthcare. Add to this the interest of pure play gadgets in creating a more health conscious, empowered patient. Remote monitoring devices and wearable will evolve into the healthcare providers tools to deliver point-of-care services. Even bulky devices are going micro with POC diagnostic devices and handheld imaging devices. The ability to stay healthy is an advantage everyone should take notice off and not only think of the body as a healthy tool but our surrounding environment too. The climate around us is changing and will have profound effect on how we see and experience healthy body. Keeping healthy may not be easy in the future and it will definitely not be inexpensive. For now letâ&#x20AC;&#x2122;s focus on developing improved drugs and treatments for better patient outcomes. Do send feedbacks on editorial@indiamedtoday.com

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CONTENTS

PULSE

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UPFRONT

04 Editorial 07 Letters 08 News roundup 42 Events listing

Top 10 Medical Innovations for 2020 These innovations will enhance healing and change healthcare

OPINION

Medical Devices Need Separate Regulatory framework

COVER STORY

Trends 2020 A look at trends and predictions that will shape the future of healthcare

APPROACH

INTERVIWE

Short term observership program to enable Foreign Medical Graduates to clear FMG Examination

The Simplest Solution for Safe Surgery

Hand-Holding FMG Students

26 6

December 2019

Impacting 1.3 million lives every year, this NGO is working to make surgery safe for everyone. By providing training in oximetery and making pulse oximeter available to the underserved regions, Lifebox Foundation is saving lives with the simplest intervention. Dr Mansi Tara, Project Manager, South Asia, Lifebox talks about the work and its impact in Asia with M Neelam Kachhap M Neelam Kachhap.

SPECIAL FEATURE

Space Health: The New Frontier

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LETTERS EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY CERTIFICATION

The magnitude of healthcare challenges facing India is quite high. Though India’s demographic dividend will last till 2060, its pool of elderly population is also expanding, leading to demographic e are honoured to receive the European transition. Today, 9% of India’s population is over 60 years of age. In Society for Medical Oncology certification, the previous census, this figure was 6%. In couple of years, this figure which is granted only to outstanding is expected to touch 11%, which amounts to a staggering 120 million oncology centres in the world. As India’s first people. This is a huge number, and the country will be required to organ-site focused oncology care private hospital, Cytecare take care of their long-term healthcare needs in terms of regular is founded on the principle of ‘Fighting Cancer the Right monitoring and disease management process, medications, etc. The Way’. We have an oncology team comprising of world-class second phenomenon impacting Indian healthcare is epidemiological cancer specialists, renowned for their holistic approach to a transition. The disease profile facing India has totally inverted between 1980 and 2020. Forty years ago, communicable diseases group of diseases that can be cured, if diagnosed and treated accounted for 75% of the total disease burden, the rest being chronic on time. Our practice is strongly in line with the following and non-communicable diseases (NCDs). Today, NCDs constitute four pillars- Organ site focused and specialist Oncologists, 65% of the disease burden, a figure going to rise to 70% in less than Standardised Global Guidelines &Tumor Board, Patientfive years. NCDs need long-term disease and treatment management centric culture and Clinical Research. For us, each patient is as well as engagement with patients to provide healthcare. India unique, as is their treatment journey. Our mission is to make has to face this challenge of rising burden of NCDs and its unique India a global cancer care destination by creating a network demands on healthcare delivery. of centres excellence across the country. In the last couple of decades, technology has emerged in a big way. Suresh Ramu, Co-founder & CEO, Cytecare Hospitals Its impact has not been restricted to devices and medical equipment alone. The means of access to healthcare have also changed. Mobile The End of Life Care in India: A Model Legal Framework is an attempt to harmonise good medical practice with the letter of the law. Doctors in India are often technology or e-health are buzzwords today. One area in which technology can be effectively used is by improving access and afraid of acting in their patient’s best interests for fear of legal liability. Currently, end of life care decision making is symptomatic of the general dissonance between clinical availability of mental healthcare in rural areas. We already have a project running in this area which can be upscaled. This is significant ethics and legal obligations. Through the model law, our aim is to ensure that the law facilitates responsible medicine while protecting the rights of patients at the end of life. because 15% of Indians – about 200 million people – suffer from some form of mental sickness, and many of them reside in rural areas. Dr Dhvani Mehta, Senior Resident Fellow of Vidhi Centre for Legal

Dr. SD Gupta, Chairman, IIHMR University

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HEAD-ON WITH NEUROMODULATION THERAPY

Effectiveness is driving in Medical 3D Printing

OPERATIONAL & SUPPLY CHAIN EFFICIENCY

APPROACH

MAY 2019

NAVIGATING HOSPITALS

JULY 2019

BETTER PATIENT EXPERIENCES

Organ Transplantation Gaining Momentum In Northern India, But Southern India Is The Hub For Organ And Tissue Transplantation

INTERVIEW

SOMERSET INDUS CAPITAL PARTNERS INVESTS IN TWO HEALTHCARE FIRMS, DEPLOYS II FUND SEPTEMBER 2019

IMPACT

MICROSOFT APOLLO PARTNERSHIP FOR COMBATING CVD

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NEWS ROUNDUP KAISER PERMANENTE MOURNS THE LOSS OF BERNARD J. TYSON, CHAIRMAN AND CEO

FREE ICU TREATMENT AT PRIVATE HOSPITALS PROPOSES DELHI GOVERNMENT

Kaiser Permanente, Chairman and CEO, Bernard J. Tyson, unexpectedly passed away early Sunday morning in his sleep, said a release from Kaiser Permanente. An outstanding leader, visionary and champion for high-quality, affordable health care for all Americans, Bernard was a tireless advocate for Kaiser Permanente, its members and the communities. Most importantly, Bernard was a devoted husband, father and friend. “We all will miss his tremendous presence in our lives. On behalf of the Board of Directors, employees and physicians, Kaiser Permanente extends deepest sympathies to Bernard’s family during this very difficult time,” the company said. Effective immediately, the board of directors has named Gregory A. Adams, Executive Vice President and Group President, as interim Chairman and CEO.

The Delhi government recently, issued guidelines to make ICU beds available to the residents of Delhi for free, if ICUs at government hospitals are not available. The patients can receive ICU services at various empaneled private hospitals with over 100 beds and three ICU beds on a predefined rate per day if no ICU bed is available in government hospital. The government will accommodate this cost in the Arogya Kosh scheme. As per new guidelines empaneled private hospitals with 100 or more beds including a minimum of 3 ICU beds and accredited with NABH will be providing these services. These hospitals will be paid at all inclusive package rates fixed by Delhi Arogya Kosh.

SMT STRENGTHENS PRESENCE IN BRAZIL BY

ACQUIRING MARKETING COMPANY ZAREK SMT (Sahajanand Medical Technologies private Limited) has acquired majority stake in Zarek Distribuidora De Produtos Hospitalares through its Ireland subsidiary company in October 2019. Zarek is a sales & marketing company based at Rio Grande Do Sul. Zarek’s product portfolio includes interventional cardiology and endovascular products such as coronary and peripheral stents, balloons and drug eluting balloons. This acquisition will help SMT enhance its market share with an increased on-ground presence and working closely with healthcare community.

NEPHROPLUS RAISES $45 MN IN SERIES D FUNDING Nephroplus, the dialysis care provider, announced $45 Mn(Rs 323 Cr) in Series D funding led by global alternative asset manager Investcorp. To date, Nephroplus has raised 200 crore funding from investors such as International Finance Corporation, SeaLink Capital and Bessemer Venture Capital, in its push to become the largest dialysis provider in the private sector. In an exclusive interview to IndiaMed , Vikram Vuppala, Founder CEO, Nephroplus said that the funds would serve as primary capital for growth as well as secondary capital which will be used to exit SeaLink Capital and a large angel investor and partial minor liquidity for few management teammates.

CLINICAL TRIAL TO ASSESS IMPACT OF ‘DIRECT TO ANGIO SUITE’ WORKFLOW ON STROKE PATIENT OUTCOMES

Bernard J. Tyson

December 2019

Royal Philips, a global leader in health technology, announced a major clinical trial to assess the impact of a ‘Direct to Angio Suite’ workflow on stroke patient outcomes. The study will assess whether with Philips’ advanced image-guided therapy platform

Healthcare Leadership Forum

it is possible to diagnose, plan and treat stroke patients in the interventional suite without requiring an initial CT or MRI exam. The multicenter, prospective, randomized, controlled, open-label, blinded-endpoint trial will be run across eight sites and over 460 patients globally. It will begin in the first half of next year and is expected to be completed in 2022. Outcomes for stroke patients are closely tied to how quickly they receive treatment: every 30 minutes’ delay before treatment reduces the chance of a good outcome by 14% and every hour of delay ages the brain by 3.6 years compared to a normally aging brain.

INDIA HEALTHCARE LEADERSHIP FORUM LAUNCHED Indian healthcare has demonstrated phenomenal growth and is now one of the leading sectors- both in terms of revenue and employment. The Healthcare market

is projected to be US$ 372 Billion by 2022. There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of Gross Domestic Product (GDP) is rising. Keeping in mind the significant growth potential of the Healthcare sector, India Healthcare Leadership Forum, was launched with a vision to build strong fundamental of trust amongst senior healthcare leaders to enable them to deliver sustainable profitable growth.

DR B SOMA RAJU EXITS CARE HOSPITAL, JOINS AIG HOSPITALS, GACHIBOWLI

Dr B Soma Raju along with his team comprising Dr C Narasimhan, Dr D N Kumar, Dr Raghava Raju, Dr Anuj Kapadiya, Dr Rajeev Menon, Dr C Sridevi, Dr Swaroop G Bharadi, Dr Soumen Devidutta, Dr Neelkanth C Patil, Dr Sachin Yalagudri, Dr Daljeet Kaur Saggu, Dr G Kishore, Dr Anne Uday Kiran, Dr Bharat

Veeramachaneni, Dr Bhishma Chowdary, Dr Muthiah Subramanyam, Dr Vickram Vignesh R, Dr V Satyasheel Reddy, Dr Madhukar Cheerla, Dr Kaleem Akhtar Razzaqui, and Dr Vijaya Roopesh Kale, moved from Care Hospitals, Hyderabad to join AIG Hospitals along with a team of intensivists led by Dr Sarat C V Talluri. “We at AIG Hospitals are delighted to welcome Dr Soma Raju and team. We would be able to provide holistic and affordable cardiac care to our patients thanks to the rich expertise and medical knowledge of this accomplished team,” says Dr D. Nageshwar Reddy, Chairman AIG Hospitals. “Our team is thrilled and enthused to join AIG Hospitals,” says Dr B Soma Raju. “Dr Nageshwar Reddy has created one of the best hospitals in the world. We hope to work alongside the excellent team of clinicians at AIG Hospitals to provide patients with multi-disciplinary integrated care for superior clinical outcomes and an enhanced patient experience.”

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NEWS ROUNDUP FORTY ONE PER CENT OF DELHI NCR POPULATION TESTED POSITIVE FOR SEVERE HEAVY METAL TOXICITY The survey run by Daivam Wellness to find out the metal toxicity in the people of Delhi NCR revealed shocking results. Out of 165 patients, 68 patients were found positive for some kind of severe metal toxicity, making up for an alarmingly high figure of 41%. Aluminum, Mercury, Lead, Arsenic, Cadmium etc. were the most commonly found metals in these patients.

DR AGARWAL’S EYE HOSPITAL LAUNCHES 10TH FACILITY AT RAJAJINAGAR, BENGALURU Dr. Agarwal’s Eye Hospital, the pioneer eyecare specialists in the country, launched its super-specialty eye care center at Rajajinagar in Bengaluru. This is Dr. Agarawal’s 10th center in Bengaluru, making it easily accessible to patients in north and west Bengaluru. Having achieved a strong foothold in metros and Tier II cities, Dr. Agarwal’s Eye Hospital is penetrating the length and breadth of the country to address the varied eye and vision health needs of millions of people spread across different countries. The specialty hospital has over 86 centres across the country and overseas.

Singh Bambrah – Head – Assam & North East Operations, launched 7 mobile medical vans in Dibrugarh, . Oil India Limited has been conducting mobile dispensary services in the OIL operational areas in Assam and Arunachal Pradesh through its in-house healthcare team of doctors and paramedics and catering to the primary healthcare needs of poor and the needy free of cost since 1980s. However, this has also been supplemented with Project SPARSHA under which mobile health camps are conducted in remote areas, where access to primary healthcare is a challenge.

UJALA HEALTHCARE ACQUIRES CYGNUS MEDICARE FOR 130 CRORE

Amar Ujala Group, India’s leading integrated media company has acquired a majority stake in Cygnus Medicare through its healthcare arm, Ujala Healthcare, for about $18 million (Rs 130 crore), reported PTI. Ujala Healthcare will take over 10 Cygnus super speciality hospitals in Delhi and Haryana and merge its two hospitals in Kashipur, Uttarakhand and Rohtak, Haryana through primary capital.

OIL INDIA AND PIRAMAL SWASTHYA PARTNER TO LAUNCH MOBILE MEDICAL VANS

Oil India Ltd. and Piramal Swasthya partner to launch SPARSHA mobile medical units in under-served areas of Assam & Arunachal Pradesh. Shri Rameshwar Teli – Honb’le Hon’ble Union Minister of State, Food Processing Industries, Govt. of India along with Mr. Pranjit Dutta – RCE, OIL, Duliajan and Mr. Hardeep

December 2019

Ujala hospital

According to the PTI report the secondary capital will allow full exist of some angle investors and partial exit to existing institutional investors.

GURUGRAM HOSPITAL BECOMES WORLD’S FIRST TO TREAT RARE AUTOIMMUNE DISORDER THROUGH BONE MARROW TRANSPLANT In another ground breaking feat, Artemis Hospital has achieved a status that none other hospitals have. It has become the first hospital in the world to successfully treat a case of Myasthenia Gravis, a rare and complex autoimmune disease through Hematopoietic Stem Cell Transplantation (HSCT) (Bone Marrow Transplant). Myasthenia Gravis (MG) is a neuromuscular disease that leads to varying degrees of skeletal muscle weakness especially those of eyes and face. The rare autoimmune disorder results from antibodies that block or destroy receptors at the junction between the nerve and muscle. Myasthenia Gravis has an annual incidence of 20 cases per million.

BRISTOL-MYERS SQUIBB COMPLETES ACQUISITION OF CELGENE, CREATING A LEADING BIOPHARMA COMPANY

VIKRAM HOSPITAL BENGALURU LAUNCHES STATE-OF-THE-ART CARE FOR HUNTINGTON DISEASE

Bristol-Myers Squibb Company (NYSE:BMY) announced that it has completed its acquisition of Celgene Corporation (NASDAQ:CELG) following the receipt of regulatory approval from all government authorities required by the merger agreement and, as announced on April 12, 2019, approval by Bristol-Myers Squibb and Celgene stockholders. Upon completion of the acquisition, pursuant to the terms of the merger agreement, Celgene became a wholly owned subsidiary of Bristol-Myers Squibb. Under the terms of the merger, Celgene shareholders received for each share, 1.00 share of Bristol-Myers Squibb common stock, $50.00 in cash without interest and one tradeable Contingent Value Right (CVR), which will entitle the holder to receive a payment of $9.00 in cash if certain future regulatory milestones are achieved.

Vikram Hospital Bengaluru, a multi-specialty hospital launched the state-of-the-art ‘Center of Excellence’ for Huntington Disease. The first of its kind center caters to all the patients across India and abroad who have been suffering from Huntington Disease, a rare genetic disorder that causes nerve cells in the brain to break down. The clinic offers patients, expert care and support from pre-diagnosis through late stages of the disease.

UNHIE, BIRAC AND SOCIAL ALPHA ANNOUNCE INDIA ACCELERATOR PLATFORM FOR HEALTHCARE INNOVATIONS A unique programme for health innovations has been announced by United Nation’s Health Innovation Exchange (UNHIE), Biotechnology Industry Research Assistance Council (BIRAC) and Social Alpha. Conceived as the India Accelerator Platform, it aspires to unlock the potential of the Indian Medical Technologies (MedTech) and Digital Health innovations through successful adoption of 100 Indian innovations in the next five years. The accelerator is estimated to result in the opening of market access and procurement of Medical Devices and Diagnostics and Digital Health solutions worth $500 million from Indian Start-Ups during the same period.

MEDIKA BAZAAR RAISES $15 MN IN SERIES B FUNDING Medikabazaar, mumbai-based B2B online marketplace has raised INR 112 Cr ($15 Mn) in a funding round led by HealthQuad, Ackermans & van Haaren, Rebright Partners and Toppan Printing company. The company will use this funding to enhance its technological abilities, supply chain infrastructure and expanding its team. Vivek Tiwari, Founder and CEO, Medikabazaar said that the current investment will help the company grow over the next few years by establishing a larger number of distribution hubs. “So far, we have seen an extremely positive response to our efforts, and our growth over the past year is a testament to this. We are happy that HealthQuad, Ackermans & van Haaren, Rebright & Toppan, along with our existing investors trusted our vision and joined us on our journey towards building a robust infrastructure for last-mile delivery of quality healthcare across the country,” he said.

KIRAN MAZUMDARSHAW CONFERRED WITH LIFETIME ACHIEVEMENT AWARD BY ICMR

Biocon Ltd, an innovation-led global biopharmaceuticals company, is pleased to

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NEWS ROUNDUP announce that its Chairperson, Managing Director Kiran Mazumdar-Shaw has been conferred with the Lifetime Achievement Award for Outstanding Achievement in Healthcare by the Indian Council of Medical Research (ICMR) for her remarkable contribution to the field of healthcare and to the society at large.

NEW NIKE SHOES GROUND-UP DESIGN FOR MEDICAL WORKERS The company did the product testing and medical-worker insights — those on-theground athletes — at OHSU Doernbecher Children’s Hospital located in Portland, Oregon. During the sessions, the designers of the Air Zoom Pulse learned the rigors of these healthcare workers’ day-to-day efforts the company said. Nurses, for example, walk approximately four to five miles and sit for less than an hour during the course of a 12-hour shift. The work is physically and mentally demanding. The design for the Air Zoom Pulse tackles those challenges with simplicity in mind. The shoe is easy to get on and off, and equally simple to clean. The fit, cushioning and traction systems work together to secure the foot in all hospital conditions.

BGS GLENEAGLES GLOBAL, HOSTS A SCIENTIFIC SESSION ON MULTI-ORGAN TRANSPLANTATION BGS Gleneagles Global Hospital, Bengaluru hosted a scientific session on multi-organ transplantation. This exclusive scientific session by the hospital will be the first in a yearly series of continuous medical education or CME sessions that will be run by the hospital. The main objective of this day-long event was to network and share knowledge amongst the physician community in Karnataka on the various advancements in solid organ transplantation and the improvement in the outcomes after transplantation. This will benefit the doctor community as it will ensure they are better equipped to manage complex heart, liver, lung or kidney ailments and provide better guidance to their patients.

AUTOMATED WEARABLE ARTIFICIAL KIDNEY MAY IMPROVE PERITONEAL DIALYSIS

Peritoneal dialysis performed with an automated wearable artificial kidney can

effectively remove toxins from the blood of patients with kidney failure. The findings come from a study that will be presented at ASN Kidney Week 2019 November 5-November 10 at the Walter E. Washington Convention Center in Washington, DC. Researchers are testing the potential of an Automated Wearable Artificial Kidney (AWAK) device for peritoneal dialysis (PD) treatments, which would allow dialysis to be performed on-thego, overcoming the challenge of long hours of therapy and connection to large dialysis machines. A sorbent-based regenerative technology in the AWAK PD therapy allows for high dose dialysis to be delivered with a low volume of dialysis solution. The technology regenerates and reconstitutes used dialysis fluid into fresh fluid while removing toxins.

DOCTORS CALL FOR DIGNITY IN PAY BY GOVERNMENT A General Body Meeting of the Hospitals and Clinical Establishments Board, National Medical Forum was held at 72 Ansari Road , Daryaganj . It was also attended by all the representative organization like DMA ,Nursing Home Forum , Association of Healthcare providers India (AHPI) ,Voluntary Hospitals Forum and Others. It was unanimously released that the charges for consultation provided by the CGHS and other empanelled organizations is extremely low, not compatible to the amount of responsibility being carried out by the physician in writing the prescription. Rupees 300 as indoor consultation and rupees 150 as a outdoor consultation are an insult to the professionals who are accepting this meager amount.

MEDTRONIC INTRODUCES MAZOR X STEALTH EDITION FOR ROBOTICASSISTED SPINE SURGERY IN INDIA Nike Air Zoom Pulse

December 2019

India Medtronic Private Limited, whollyowned subsidiary of Medtronic plc announced

Mazor X Stealth Edition

the launch of the Mazor X Stealth Edition that offers a fully-integrated procedural solution for surgical planning, workflow, execution and confirmation of spine surgeries. Surgeons at Indian Spinal Injuries Centre, New Delhi, have successfully performed the first minimally invasive spine surgery in India using the Mazor X Stealth Edition Robotic-Assisted Spine Surgery System. The global surgical robotics market has a vast potential, and it is expected to grow to US$9.3 billion by 2025 from US$4.9 billion back in 2016 with a CAGR of 11.4%1. In India, with a rapidly growing senior population, the spine surgery rate is expected to rise. The Surgical Robotics Market in India is predicted to witness a remarkable increase from US$129.9 million in 2016 to US$372.5 million in 2025, growing at a CAGR of 19.2%.

CLEVELAND CLINIC DEVELOPS CALCULATOR TO ESTIMATE 10-YEAR RISK OF DIABETES COMPLICATIONS Patients struggling with type 2 diabetes and obesity are faced with the decision of whether to receive usual medical care or undergo weight-loss surgery. Now, a new risk calculator

developed by Cleveland Clinic researchers can show these patients their risks of developing major health complications over the next 10 years depending on which course of treatment they choose. The research was presented as one of the Top 10 studies at the ObesityWeek 2019 international conference in Las Vegas.

FUJIFILM INDIA LAUNCHES THE ‘NEVER STOP’ BRAND CAMPAIGN Fujifilm India Private Limited, a pioneer in imaging technologies, announced the launch of its latest brand campaign for its globally proclaimed “NEVER STOP” in India. The digital film focuses on communicating the company’s diverse array of business operations as well as its corporate mindset committed to take on new challenges with best-inclass technologies in different sectors. The new film titled, ‘Never Stop’ highlights Fujifilm’s long-standing relationship with the Indian consumers and the brand’s constant focus towards revealing new technologies while cementing its position as a market disruptor. It illustrates how the company is commitment to continuously evolve its technology and build expertise in areas like healthcare, high-functioning materials, and imaging solutions.

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NEWS ROUNDUP AMIDST RISING CHRONIC LIFESTYLE ILLNESSES COUNTRY GETS ITS FIRST FUNCTIONAL & BIOREGULATORY MEDICINE CENTRE Daivam Wellness, a company focused in the areas of pro-active well-being, longevity, mindfulness, and health consciousness, has kick started operations in Gurugram, with the launch of its Functional Bio-regulatory Medicine Center for Chronic Disease Reversal. The center will facilitate reversal of various diseases and illnesses and promote the concept of holistic living through preventing future sicknesses, in order to enable people tolive a happy, fulfilled, and healthy life in the most nature inspired method. The key methodology deployed by the center revolves around “The Daivam Way”, which not only treats the symptoms of any disease, but focuses on finding the root causes of the imbalances and sufferings of the mind and body. Further, Daivam follows a long-term scientific evidence-based approach to ensure one remains in perfect health throughout their lives.

THE GEORGE INSTITUTE AND MANIPAL ACADEMY JOIN HANDS TO PROMOTE PUBLIC HEALTH RESEARCH The George Institute for Global Health in India (TGI) and the Manipal Academy of Higher Education (MAHE) have joined hands to promote public health research in India and to build the capacity of budding researchers to do cutting-edge research in the area. The partnership is focused on addressing real-world health challenges through the development and testing of innovative solutions that bridge the gap between research and policy.

KARNATAKA’S FIRST STROKE CARE AMBULANCE LAUNCHED BY SPARSH HOSPITAL

Sparsh Hospital, one of the leading super speciality hospitals in Bengaluru, has started the first ever Stroke Care Ambulance service in Karnataka. This is the first-of-its-kind service in Karnataka which will aid the patient in getting treatment right from the get-

go. The helpline number is 080 – 61222000 and the service has been available for use 24/7 from 9th November 2019 across Bangalore.

SUN PHARMA REPORTS Q2FY20 RESULTS, GROSS SALES AT RS. 7,949 CR NET PROFIT AT RS. 1,064 CR

Sun Pharma reported consolidated profit at Rs 1,065 crore in the July-September period, significantly better than a loss of Rs 269.6 crore in the same period last fiscal. The consolidated revenue grew by 17.1 percent year-on-year to Rs 8,123.3 crore, backed by India and the rest of world sales. Emerging market sales rose 3 percent to $201 million year on year, but the US numbers remained unchanged at $339 million. At the operating level, earnings before interest, tax, depreciation and amortisation (EBITDA) jumped 16.9 percent to Rs 1,790 crore, while margin remained flat at 22 percent YoY. Other income fell 42.8 percent year-on-year to Rs 200.8 crore, impacting the bottomline. Dilip Shanghvi, Managing Director of the Company said, “Our Q2 and H1 performance demonstrates sustained growth momentum and is in-line with our full-year guidance. We continue to focus on cost savings and efficiency improvement to align our generic business with the changing industry dynamics. Simultaneously, we continue to progress on building our global specialty business. In the US, we recently launched Cequa while Ilumya continues to gain traction. The recently released long-term follow-up clinical data for Ilumya demonstrates sustained response for patients over four-year period with very good safety profile. We are excited about the long term prospects of Ilumya.”

CYTECARE CANCER HOSPITALS RECEIVES ESMO ACCREDITATION (L-R) - Sanjay Sachadeva, Dr. Anand Burnam and Dr. Alok Chopra

December 2019

European Society for Medical Oncology (ESMO), the leading European professional

The newly innaugurated Medanta Hospital in Lucknow

organisation for medical oncology, has presented Cytecare Hospitals in Bengaluru with ESMO accreditation as a Designated Centre of Integrated Oncology & Palliative Care. Cytecare is the first cancer hospital in India to receive this prestigious accreditation within 3 years of inception . The accreditation was presented during the 6th ESMO world congress at Barcelona, Spain in September 2019. The ESMO Designated Centres of Integrated Oncology and Palliative Care accreditation programme was initiated in 2003 to recognise cancer centres that achieve a high standard of integration of medical oncology and palliative care. The ESMO accreditation is valid for three years.

TATA PROJECTS COMPLETES 1000-BED MEDANTA HOSPITAL, LUCKNOW

TATA Projects Limited, one of India’s fastest growing and most admired infrastructure companies, recently completed and handed over Lucknow’s 1000-bed Medanta hospital which was thereafter inaugurated by the Chief Minister of Uttar Pradesh. This is a super speciality hospital with total builtup area of 1.4 million sq ft, includes two basements, lower ground floor, upper

ground floor and 11 upper floors. Dr Naresh Trehan, Chairman and Managing Director, Medanta said, “Medanta was envisioned as a synthesis of the wealth of traditional knowledge of the east and advancements of modern medicine. It is actively contributing to advancements in medical science and is expanding its footprint of patient-centric medicine in cities like Lucknow.”

GLOBAL HOSPITAL, PAREL LAUNCHES NEURO CRITICAL CARE AND STROKE UNIT

Global Hospital, Parel, Mumbai has launched a dedicated Neuro Critical Care and Stroke Unit with modern ventilators and with latest invasive and non-invasive facilities for monitoring of vital functions. The Neuro Critical Care and Stroke Unit is designed to address the clinical needs of neurological and neurosurgical patients to improve their outcomes and a committed team of intensivists, pulmonologists, infectious diseases specialists, nephrologists and cardiologists will provide support round the clock in this Neuro Critical Care and Stroke Unit. Neurological disorders can be termed as the diseases of the brain, spine, and nerves that connect them.

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NEWS ROUNDUP SINGAPORE – KARNATAKA COLLABORATE IN MATERNAL AND CHILD HEALTH Healthcare leaders and specialists across Karnataka and Singapore mark the successful conclusion of three-year collaboration between the two countries on antenatal and child healthcare in Karnataka at a healthcare symposium. The three-year capacity building initiative has successfully trained nearly 180 Indian healthcare professionals across the Southern Indian state and as a result, at least 100,000 pregnant mothers and newborns have benefited from better quality healthcare services .

CARESTREAM UNVEILS GLOBAL BUSINESS OPERATIONS CENTRE IN INDIA

Carestream Health India Pvt. Ltd, the global leader in medical imaging announced the establishment of a Global Business Operations Centre in Mumbai, India that will be housed at

Carestream India’s corporate office. The company relocated their corporate office to a new location in Mumbai, which opened on November 18. The new office will consolidate all corporate sales, service and support functions. Various members of Carestream’s senior leadership team from the USA attended the unveiling of this new customer focused operation.

was jolted out of her normal life. Teaching, bending, and doing other household chores became a distant dream. Even after consulting various medical professionals, her condition didn’t improve. However, Wockhardt Hospital came to the patient’s rescue, and gave her a new lease of life.

US PATENT TO STEMPEUTICS TREATMENT STORY: FOR STEMPEUCEL FOR RARE SPINAL DEFORMITY TREATING CRITICAL LIMB CONGENITAL ATLANTOISCHEMIA (CLI) Stempeutics Research, a group company AXIAL MALFORMATION A team led by Dr Abhay Nene, Spine Surgeon at Wockhardt Hospital, Mumbai Central, helped a teacher by successfully performing occipito-cervical fusion (OCF), a surgery for correcting the instability of joints due to Congenital Atlanto Axial Malformation, and dislocation of first cervical Vertebra over 2nd cervical vertebra. Mrs Amrit Kaur, a school teacher from Kolkata Calcutta Emmanuel School complained of frequent headaches, neck pain, right arm pain, gait imbalance since a year. Her life became miserable and she

of Manipal Education and Medical Group, announced that the United States Patent and Trademarks Office (USPTO) issued notice of allowance to grant the US patent for ‘Management of Critical Limb Ischemia (CLI) using Pooled Mesenchymal Stromal Cell product Stempeucel®”. Stempeucel® for the treatment of CLI is a breakthrough treatment option which directly addresses the root cause of the disease, unlike other drugs that typically treat the symptoms and not the disease itself.

SUN PHARMA AND ASTRAZENECA ENTER INTO LICENSE AGREEMENT FOR NOVEL ONCOLOGY PRODUCTS IN CHINA

Vincent Chan, President -Asia Pacific at Carestream Health.

December 2019

Sun Pharmaceutical Industries Ltd. announced that it has entered into a licensing agreement with AstraZeneca UK Ltd. to introduce certain novel ready-to-use (RTU) infusion oncology products in China. The agreement will help to bring cost-effective and quality drugs to patients in China. As per the terms of the agreement, Sun Pharma will be responsible for development, regulatory filings and manufacturing the products covered in the agreement while AstraZeneca will exclusively promote and distribute these products in China. The initial tenure of the agreement is 10 years from the first commercial sale of the said products in China. The financial terms of the agreement are confidential.

Mr. Arvind Kumar (Marketing Manager Alniche Life Sciences), Mr. Michael Duck (Executive Vice President, Informa Markets Asia), Mr. Karan Arora (Director International Business Alniche Life Sciences), Mr. Vijay Chauhan (Head-BD Alniche Life Sciences) and Ms. Insha Khan (Manager- International Marketing & Corporate Affairs Alniche Life Sciences).

ALNICHE LIFE SCIENCES WINS AWARD AT CPHI INDIA PHARMA AWARDS 2019 AlnicheLife Sciences, a specialty healthcare company,has won New Product Launch Award for CompliProunder the category of Excellence in Pharmaceutical Brand Management.In this category, another brand Ketoalfa was one among top brands nominated.Thisprestigious pharma award was presented by Executive Vice President, Informa Markets Asia, Mr. Michael Duckat New Delhi India. CPhI- India Pharma Awards are one of the most admired recognitions in the Pharmaceutical industry. This year’s awards included 12 categories that span the entire industry to recognize their innovations, technologies and strategies. Alniche in collaboration with DPSRU(Delhi Pharmaceutical Science and Research University)has developed CompliPro, the first ready-to-use Right-Quantity & High-Quality

Protein Oral Supplement to compensate protein losses during dialysis. The product distinguishes itself from existing options of Protein powders by offering Ease of intake, No hassle of reconstitution and Easy on gut (no heaviness or flatulence). “This award marks a momentous milestone forAlniche and signifiesthe beginning of Indian Pharma industry focusing on academia - industry collaboration and introducing products that are suited for Indian masses”shared Mr. Girish Arora, Founder & MD Alniche Life Sciences. He further added, “we are delighted that CompliProis recognized by the Pharma industry which reinforces Alniche mission “Inspired by value, Driven by vision”.

FIRST-IN-HUMAN STUDY OF NEXT-GENERATION ANTI-CTLA-4 ANTIBODY FOR TREATMENT OF SOLID TUMORS

Harbour BioMed (HBM) announced the start of the first clinical trial of its next-generation fully human anti-CTLA-4 antibody (HBM4003) for the treatment of patients with advanced solid tumors. This trial is the first with a fully human antibody based on heavy chain only antibody technology (HCAb). HBM4003 has shown potential for increased antitumor activity based on enhanced antibody dependent cell toxicity (ADCC) mediated Treg depletion and a favorable safety profile resulting from reduced half-life.

HANDS-FREE ROBOTIC SYSTEM CLEARED BY FDA FOR PERCUTANEOUS INTERVENTIONAL PROCEDURES XACT Robotics™ Ltd. recently announced that its first robotic system was cleared to market in the U.S. for use during computed tomography (CT) guided percutaneous interventional

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NEWS ROUNDUP procedures. XACTâ&#x20AC;&#x2122;s technology is the first hands-free robotic system combining imagebased planning and navigation with insertion and steering of various instruments to a desired target across an array of clinical applications and indications.

300-GYNAECOLOGISTS FROM VIZAG DISCUSS RECENT ADVANCES IN FERTILITY TREATMENTS

Oasis Centre for Reproductive Medicine, a unit of the Sadguru Healthcare Services Pvt. Ltd recently organised an ART conclave at Vishakapatnam. Around 300 Gynecologists came together to discus and create awareness of the various advance treatments and their outcomes in the presence of experts from around India. The ART (Assisted Reproductive Techniques) Conclave was organized by Oasis Fertility in association with Obstetrics &

Vaughan Gething inaugurating SIMS SCTU

December 2019

Gynecology society of Vishakhapatnam(OGSV) & Indian Society for Assisted Reproduction (ISAR)- AP Chapter.

(cancer of the bone marrow itself) and also non-malignant disorders like Thalassemia and Sickle cell anemia.

SIMS HOSPITALS LAUNCHES STATE-OFTHE-ART STEM CELL TRANSPLANT UNIT

CHILD HEALTH IMPRINTS RAISES US$2.3 MILLION IN PRE-SERIES A FUNDING

The SRM Institutes for Medical Science (SIMS) Hospitals, launched a standalone dedicated Stem Cell Transplant Unit, at its Vadapalani facility in Chennai. Inaugurated by the Honâ&#x20AC;&#x2122;ble Minister for Health and Social Services, Wales, UK, Vaughan Gething AM, the Stem Cell Transplant unit with a state-of-the-art facility will provide effective life saving treatment for life threatening malignant and non-malignant disorders. SCT will help patients afflicted with resistant malignancies like leukemia (blood cancer), lymphomas (malignancies of the lymph nodes) and multiple myeloma

Child Health Imprints (CHIL), the Singaporebased company focusing on neonatalclinical care improvement, announced that it has raised US$2.4 million in Pre-Series A funding. The round was led by Health X Capital, with participation from Enterprise SG and other HNIs. CHIL is one of the rare technology companies which is committed to improving clinical outcomes in Neonatal ICUs using IoT and digitization. It also has significant potential to enable remote real time management of NICUs located far out especially in emerging Asia, which are facing specialised skill shortages.

COVER STORY

TRENDS

2020 A look at trends and predictions that will shape the future of healthcare

M NEELAM KACHHAP www.indiamedtoday.com

COVER STORY

to view telehealth as a standard of care option for primary t is that time of the year again, when we look ahead care virtual consultation. In the next 2-3 years, telehealth will and share trends and predictions for the next year have full regulatory approval and clinician support. This is for the health care ecosystem. As the year draws to with regard to US Healthcare market but is quite viable for an end, there are a number of predictions for 2020 South-East Asian market and India. and the next decade. Some of the common and In her blog ‘Top 8 Predictions That Will Disrupt obvious trends emerging currently are in the areas Healthcare in 2020’ she recently outlined eight trends which of machine learning and technology innovation. would impact the US healthcare market. Artificial Intelligence has made its mark in healthcare and Another interesting point Das makes is regarding what’s more the clinicians and the providers have not only healthcare consumerism. Das says patients/consumers acknowledged but have accepted its usability in delivering demand a retail-like buying experience for availing quality care. The only hiccup that now needs to be addressed healthcare services and products. The is the cost of technology and whether we can build “Retailization” of the healthcare industry financial or payment models to incorporate this THE VISION FOR into the insurance system. HEALTHCARE FOR is largely driven by empowered patients. Digitization of products, services, and The use of big data, advanced technology and 2020 AND BEcommerce models is democratizing current augmented reality resonate with many experts as YOND WILL NOT healthcare systems, manifesting the concept they each draw their list of trends to look out for. JUST FOCUS ON According to Reenita Das, Partner and Senior ACCESS, QUALITY, of the “Comparison Shopping” consumer mindset. Indian healthcare providers have Vice President of Healthcare and Life Sciences at AND AFFORDFrost & Sullivan, the vision for healthcare for 2020 ABILITY BUT ALSO to brace themselves for this comparison shopping wave as it is going to dominate not and beyond will not just focus on access, quality, ON PREDICTIVE, and affordability but also on predictive, preventive, PREVENTIVE, AND only the private sector but public sector as and outcome-based care models promoting social OUTCOME-BASED well. Deloitte’s Healthcare and Life Science and financial inclusion. CARE MODELS Predictions 2020, brings forward more such Das predicts, among other things that by the PROMOTING SOend of 2020, progressive health systems will start CIAL AND FINAN- trends. Written by Karen Taylor, Director

CIAL INCLUSION

December 2019

ASIAN HEALTHCARE MARKET WILL GROW BY ALMOST $200 BILLION BETWEEN 2016 AND 2020, TO A TOTAL VALUE OF $2,660 BILLION. IN 2019 ALONE, GROWTH IN THE ASIAN HEALTHCARE MARKET WAS PROJECTED TO BE 7.2% DUE TO MAJOR INCREASES IN HOSPITALS, HOME CARE AND MEDICAL TOURISM

UK Center for Health Solutions; Hanno Ronte, Partner Monitor Deloitte and Simon Hammett, Lead Partner, EMEA & Uk, Healthcare & Life Science; lists 10 internal and external parameters shaping predictions. Some of these are: Health consumers; healthcare delivery systems, Big Data, wearable and mHealth applications; pharmaceutical commercial models and impact of behaviours on corporate reputations. One of the things that stand out in Deloitt’s predictions is the new business models in emerging markets. While the traditional pharmaceutical markets in the US, Japan and Western Europe remain the main markets for drug companies, new markets requiring new business models are gaining ground notes the report. The focus on Brazil, Russia, India and China (BRIC) is now being challenged by new emerging markets in Latin America, Vietnam, Indonesia and Africa. These are proving an even bigger surprise, incubating new business models and leading in the development of new drugs the report says. Another important observation in the Deloitte report is about healthcare delivery models of the future. The report predicts that in 2020, the home will be the center of healthcare delivery where much of the medical care takes place. The report says that healthcare delivery is no longer confined to clinicians in the clinic or hospital. The ubiquity of digital communications means that many doctor-patient contacts are now virtual and deliver care to the patient in their home.

This means that online and video consultations, with regulatory compliance will become the cornerstone of healthcare delivery. Apart from this eICUs that have not yet had a large uptake in markets like India will see new light. Mariana Roy, Director, Business Development & Intelligence, Global Health Intelligence sheds light on the Asia Pacific in her blog ‘Asia Pacific Healthcare Market Outlook for 2020 and Beyond’. She predicts that the Asian healthcare market will grow by almost $200 billion between 2016 and 2020, to a total value of $2,660 billion. In 2019 alone, growth in the Asian healthcare market was projected to be 7.2% due to major increases in hospitals, home care and medical tourism. One surefire sign that the growth in the Asia Pacific healthcare market is real and long-lasting is the fact that the existing hospitals are continuing to grow and expand, and new hospitals are still being built at a rapid rate. Indeed, the Asian market has moved along the development path with universal healthcare and digitalisation penetrating most of the markets. In India, universal healthcare has disrupted the care delivery market however; it still has to pass a few hurdles and setbacks. While regional merger and acquisition (M&A) deals and partnerships continued, a number of new healthcare providers have emerged. These new stakeholders are piloting new technology, financing products, marketplaces, and tieups with innovators and providers to access new population segments.

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COVER STORY

Looking Ahead Towards Growing Market Healthcare investors predict trends that will shape the industry in 2020

Prem Pavoor, Partner, Eight Roads Ventures

he year 2019 stacks up against the years behind it as another period of intense growth and transformation. Trying to ride it’s opportunities was exhilarating but draining, rather like trying to handle a growing teenager. Here are the trends which continue to shape our healthcare landscape, and which deserve continued scrutiny as we enter our ‘20s.

December 2019

The domestic pharmaceutical opportunity The Indian pharmaceutical market is witnessing a period of flux. Approximately 25 per cent of the market, by volume, is currently under price control. Recent regulations have proposed a cap on trade margins and policies appear to favour a “generic generic” (versus the current “branded generic”) landscape. In response, Indian pharma companies are beginning to create overthe-

We also see a large potential play with the opening of counter brands to diversify away from their generic, the Chinese generic market, and several Indian companies, physician-detailed portfolios. These factors will continue to cause price-led market working to capitalise on this. erosion. An increased emphasis on safety has led to the culling of 400+ irrational drug combinations, further Healthcare services and the role of shrinking the market. The new national insurance scheme, technology Ayushman Bharat, should however, contribute positively Price controls on medical devices and the Ayushman to volumes through increased access. Companies with Bharat scheme dominated the headlines in the services differentiated products and business models can leverage sector throughout 2019. Launched in September 2018, Ayushman Bharat is the world’s largest state-funded health this opportunity to drive growth. insurance programme. Increasing patient awareness, In our own portfolio I would point to: aided by mobile phone penetration is also contributing  Our partnership with Cipla to establish an early mover in consumer health products, Cipla Health, built on the to the increased demand for secondary and tertiary care. Our partner companies, Core Diagnostics (an strong thesis that Indian consumers will increasingly oncology focused diagnostics provider), Cygnus (a Tier II demand wellness and prevention, not just cures. town-focussed hospital chain), and Trivitron Healthcare  The rapidly rising footprint of Specsmakers, a South India, value-driven opticals retail chain, is another (one of the largest manufacturers and distributors of manifestation of this expanding consumer healthcare medical equipment) benefit from these trends. While a greater focus on profitability and length of stay by private market. hospitals, as well as on hospitalisation cost by patients, is  Plasmagen Biosciences, is one of very few providers of blood-plasma therapies to hospitals, creating driving demand for out-of-hospital, home care services, like those provided by Medwell Ventures/ differentiation through its product THE INDIAN Nightingales. offerings. PHARMACEUTIWe continue to see the healthcare We remain excited by the long-term CAL MARKET IS services market, both on the demand and potential of Indian pharma, as evidenced by WITNESSING A supply side, incorporate technology at an our partnership with Pharmeasy, which is PERIOD OF FLUX. unprecedented pace. This is proving to be now the country’s largest online pharmacy. APPROXIMATELY of tremendous benefit to patients, payors 25 PER CENT OF and providers, and is nourishing innovation The export pharmaceutical THE MARKET, BY in preventive health, information access, market VOLUME, IS CUR- healthcare delivery and diagnostics. Export prospects have continued to present RENTLY UNDER Carestack leverages strong Indian R&D and challenges this year, primarily because of PRICE CONTROL engineering talent to power dental practices increased competition and price declines in in the US. eKincare, a health benefits portal the flagship US market. It’s been interesting to see some of our partner companies grow rapidly, despite helping corporates optimize their healthcare spends and these challenges through innovative models and offerings: administer real health outcomes, recently adopted an AI powered solution to predict and warn against health risks.  Eywa Pharma using a “front-end first” strategy to pursue rapid market share growth in the US and UK, Looking ahead supported by select, strategic infrastructure.  Our early investment, Laurus Labs (now listed), We see an unprecedented growth in innovations emerging leveraging its global cost leadership on pharmaceutical out of India - whether in therapeutics (both for the India actives to achieve traction in high volume formulations. and US markets), devices, diagnostics or healthcare technology. Fundamental to this has been the availability  Caplin Steriles, a partnership with Chennai-based Caplin Point Laboratories, building leadership in of capital for early stage companies through government manufacturing injectable products where stringent grants. The rising number of start-ups in India continues to FDA regulations still skew global supply demand. bear testament to the entrepreneurial capabilities that  Richcore Lifesciences and Ashish Life Science exist in our country, as well as the demand for high-quality participate in the export opportunity through highly differentiated focus areas - biologic products healthcare products and services from an increasingly aware consumer base. and animal pharmaceuticals, respectively.

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COVER STORY

Indian Healthcare â&#x20AC;&#x201C; Today and the Future Healthcare investors predict trends that will shape the industry in 2020

Abhishek Sharma, Founder and CEO, Foundation Holdings

have been investing in healthcare and education for over a decade and the opportunities available in the Indian healthcare market today are phenomenal. The industry has seen 25 healthcare companies (valued at less than US$150 million) IPO since 2015. Indian healthcare market has become an established and proven return-generating asset class for investors. Investment and private equity exits have improved in value and volume. As per Bain & Co. exits

December 2019

from private investments in healthcare grew in value from US$1.5 billion in 2016 to US$1.8 billion in 2017, while 2016 saw 22 exits, 2017 saw 24 exits. The stars are aligned over healthcare in India for the past 18 months. The industry is booming and will continue to flourish with a number of Indian citizens returning home from reputed Western corporations. This new influx of managerial talent pool will ensure the continued growth of the industry. Furthermore, the regulatory environment

monitoring consumption or staffing, is at the top of the agenda for Indian healthcare providers today. In fact, the Indian healthcare market is evolving and new operating models are being unlocked. Changing demographic, operational, financial and regulatory considerations have given rise to single-specialty healthcare delivery. Providers are focusing on delivering better care by unbundling from multi-specialty hospitals. By focusing on a single specialty, it can be both more costeffective for the healthcare provider as well as simpler for the population to navigate. The eye healthcare market in India is one such single-specialty on the rise. As per Bain, one third of the world’s blind population resides in India with an Growing Market From a socio-economic view point and as stated by addressable market of 600 million people. The private eye Bill and Melinda Gates Foundation, a robust primary healthcare market is projected to reach US$11.9 billion healthcare system ensures reach across diverse segments by 2023 with a compounded annual growth rate (CAGR) of society, including the most vulnerable ones. The Indian of 25 percent between financial years 2015 and 2023. healthcare market today is at ~USD 173 billion and is Its upward trajectory is due to the rising proportion of expected to grow at 15 per cent per annum to reach USD ageing population, high prevalence of eye disorders, innovative models for improving 300 billion by 2022. Growth is expected to INVESTMENT penetration of medical facilities, increasing be driven by increasing population, disease AND PRIVATE disposable income and growing insurance burden, insurance coverage and income EQUITY EXITS penetration. levels. Demand has outstripped supply with HAVE IMPROVED Foundation Holdings has recently headroom opportunity for private providers IN VALUE AND entered the eye healthcare and single to grow with current bed density of 7.5 per VOLUME. AS PER specialty space in India through its US$ 10,000 capita vs global benchmarks of 27.5 BAIN & CO. EXITS 43 million acquisition of a stake in ASG and physician availability of 0.75 per 1,000 FROM PRIVATE Hospital Pvt. Ltd. Founded in 2005 with vs global benchmark of 4.0. A healthier INVESTMENTS a mission of making the best eye care population leads to a more productive IN HEALTHCARE solutions available to every individual, population, which in turn increases the GREW IN VALUE ASG Eye Hospital currently has a network workforce and quality of output. In India, only 1.4% of the GDP is spent on healthcare – as a FROM US$1.5 BIL- of 33 hospitals across 13 states in India, in LION IN 2016 TO addition to medical centers in Kampala, benchmark, The US spends 8.3% and China US$1.8 BILLION Uganda, and Kathmandu, Nepal. spends 3.1%, while the WHO advises to spend IN 2017, WHILE I strongly believe that healthcare 5%, therefore gaps and opportunities still 2016 SAW 22 and education will drive human capital, exist. The growth witnessed in the market is and transformational driven predominantly by healthcare providers EXITS, 2017 SAW innovation 24 EXITS opportunities for today’s youth. India trying to close the supply-gap. and the GCC region are compelling Over time, there has been a shift in the causes for majority of deaths in the Indian population. markets for companies in these sectors that are As of 2016, approximately 60 per cent of deaths were poised for exponential growth. Combined, the markets due to non-communicable diseases. Such diseases are comprise a US$4 trillion ecosystem that provides preventable or at least controllable to an extent. While tremendous investment opportunities. We are witnessing healthcare providers are striving to cater to the needs of an increased focus on guaranteeing consistent returns the population, the fact will remain that the majority of across the board through increasing operational value. hospitals are overburdened. Against such a stark backdrop, By continuing to focus efforts on making healthcare more one thing is clear: To manage costs with quality, designing accessible and affordable, India will reap the benefits for operations at hospitals, whether it is pricing, procurement, years to come. has seen positive developments with several initiatives such as Ayushman Bharat roll-out of mandatory health insurance in India to provide coverage to 100 million families. Support from the government to high growth and innovative healthcare companies in the form of inexpensive land/facilities, grants and tax cuts will foster the development of the healthcare industry further. Significant amounts of capital are being pumped into the industry. The healthcare industry will continue to grow and improve rapidly. I often tell people the healthcare industry is living in dog years – each year is equal to seven normal years.

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APPROACH

Hand-Holding FMG Students Short term observership program to enable Foreign Medical Graduates to clear FMG Examination

26 December 2019

QUITE A SIGNIFICANT number of students of Indian origin do pursue and complete basic undergraduate Medical Education in many countries outside India. It is mandatory for these graduates to pass the Foreign Medical Graduates Examination to enrol into the Medical Council of India and become eligible to practice in India. Unfortunately the percentage of students clearing the Foreign Medical Graduates Examination is hardly around 20 Per cent and the reasons could be many. The result is that thousands of such doctors in our country are unable to pursue their profession and this is a great loss of trained manpower to our country simply because they are unable to pass the FMGE examination. In order to enable such Foreign Medical Graduates to equip themselves both in theory and practicals to face the Foreign Medical Graduates Examination successfully, it is proposed to create a comprehensive observership programme for the students.

Through the support of a technology partner, theoretical training will be imparted, incorporating webinars and the students will also be assessed through mock tests. An academic committee under the chairmanship of Dr. Naresh Shetty along with other experts, a few of whom would also be from across the country to give a national perspective, would set about creating the curriculum and certifying the same regarding content, quality appropriateness to the objective of enabling the Foreign Medical Graduates to successfully clear the FMG examination. In addition this committee will also take into consideration the fact regarding the introduction of NEXT examination which will then replace the Foreign Medical Graduate Examination as per the National Medical Commission. The academic committee will create the course and the Technology partner will help in delivering the course which will also be periodically monitored.

Details of the proposed observership program The course duration is six-months. The course will be final year centric with emphasis on Medicine, Surgery, Obstetrics and Gynaecology and community medicine especially relating to Indian data. The Foreign Medical Graduates who have enrolled for the program will also get a chance during the training to work as physician assistants and gain practical knowledge.

Four organisations will be involved in offering this program; 1. Association of healthcare providers India [AHPI] 2. M.S. Ramaiah Medical College 3. Association of National Board Accredited Institutions 4. Technology Partner Timeline the first course to begin by January 2020.

It is mandatory for these graduates to pass the Foreign Medical Graduates Examination to enrol into the Medical Council of India and become eligible to practice in India. Unfortunately the percentage of students clearing the Foreign Medical Graduates Examination is hardly around 20 per cent and the reasons could be many

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ย ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ฦฌ ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย วฆ ย ย ย ย ย ย ย ย ย ย วก ย ย ย ย ย ย ย ย ย วก ย ย ย ย ย วฆย ย วฆย ย ย วฆย ย ย วก วก วก วก วก ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย วฆ ย ย ย ย ย ย ย ย ย ย ศ ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย ย

+91 80 4288 8888

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PULSE

Top 10 Medical Innovations for 2020 These innovations will enhance healing and change healthcare HEALTHCARE HAS been constantly evolving and it is anticipated that the up-andcoming innovations in the field of medicine will significantly transform and improve care for patients worldwide. Here is a list of innovations that a distinguished panel of physicians and experts from the Cleveland Clinic have selected as those that are going to revolutionize healthcare in 2020.

Divya Ramaswamy

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PULSE

Dual-Acting Osteoporosis Drug With more than 200 million sufferers worldwide, osteoporosis predominantly affects individuals over the age of 50. With the condition, the loss of bones occurs silently and progressively until there is a fracture. This revolutionary drug that has received FDA approval recently- a dual-acting drug called ‘romosozumab’ offers osteoporosis patients great control in the prevention of broken bones. It is a humanized monoclonal antibody that inhibits the action of ‘sclerostin’ a regulatory factor seen in bone metabolism.

Expanded Use Of Minimally Invasive Mitral Valve Surgery Since 2013, mitral valve repair using minimally invasive surgeries have been done for patients suffering from mitral regurgitation who cannot have open-heart surgeries. But in a majority of individuals getting this surgery suffer from defective mitral valves that lead to regurgitation. The expansion of such a minimally invasive method helps such patients get relieved of their symptoms. The transcatheter repair device not only helped reduce hospitalizations but also allcause mortality.

Tafamidis To Treat Transthyretin Amyloid Cardiomyopathy (ATTR-CM) ATTR-CM - the most under-recognized cause of cardiac amyloidosis which accounts for about 10% of elderly patients with heart failure. It is a progressive, potentially fatal disease where the amyloid protein fibrils get deposited in the walls of the heart’s left ventricle and cause stiffening. This new drug called ‘Tafamidis’ helps prevent the misfolding of the protein deposition and reducing mortality risk significantly. FDA-approved in 2019, this is the first-ever medication to treat this disheartening cardiovascular disorder.

New Oral Immunotherapy For Peanut Allergies Being one of the most common food allergies worldwide, peanut allergy has

30 December 2019

been a terrifying reality for parents. Although the standard epinephrine treatment has helped reduce the severity and risk of accidental exposure, it is not adequate to quell the ever-lasting anxiety. The new FDA-approved treatment ‘Palforza’ is a form of oral immunotherapy helps desensitize one’s immune response to peanuts.

Closed-Loop Spinal Cord Stimulation For Chronic Pain This breakthrough has great potential for helping individuals with chronic pain maintain the condition. Ever since the first medical neuromodulation procedure in 1967, researchers have been working to improve and perfect it. And after umpteen iterations, the closed-loop stimulation has been used to treat several pain conditions and improve functional capacity as well as their quality of life. The technology allows the spinal cord stimulation device to communicate with the neurons in the spinal cord and adjust the stimulation dose as needed. It not only delivers and maintains a therapeutic electric dose but also helps prevent over-stimulation of the dorsal column.

Biologics To Treat Orthopaedic Repair Orthopedic medicine and surgery have seen several advances over the recent decades with the advent of improved understanding of tissue healing, biomechanics and pathogenesis of musculoskeletal diseases. Despite this, there is still much to be explored, particularly in the field of regenerative medicine and orthobiologics. Biologics have been found to be potential at replacing or harnessing the body’s own power and promote healing process. This phenomenon is finding its way into orthopedic care, paving the way towards the possibilities of expedited improvements. For example, Chitosan, a linear polysaccharide, has been shown to help with soft-tissue healing.

Antibiotic Envelop To Prevent Infections in Cardiac Implantable Devices With about 1.5 million individuals worldwide receiving cardiac implantable devices every year, the infections around those devices have

been on the rise. Such Infections that occur after the placement of cardiac implantable electronic devices are linked to substantial morbidity and mortality. There is very limited evidence on prophylactic strategies, except the use of preoperative antibiotics to prevent such life-threatening infections. The new antibioticembedded envelopes that encase cardiac devices are found to be effective in preventing infections. The TYRX Absorbable Antibacterial Envelope, Medtronic is an absorbable singleuse envelope that is designed specifically to hold a CIED when it is implanted in the body cavity. It is constructed using a multifilament knotted mesh which is coated with an absorbable polymer mixed with rifampin and minocycline which elutes the antibiotics into the local tissue for a minimum of one week. The envelope is completely absorbed in about 9 weeks.

Bempedoic Acid for Lowering Cholesterol Levels in Statin-Intolerant Patients Being the leading cause of heart diseases, high cholesterol affects about 25-30% of the adult Indian population. The most common type of dyslipidemia in the country is characterized by high LDL cholesterol, low HDL cholesterol and high triglyceride levels. The standard treatment has been statins and fibrates. However, muscle pain has been reported to be one common side-effect of statins. And the new approach is to use bempedoic acid that not only lowers LDL-cholesterol levels but also avoids those adverse effects. It acts by inhibiting ATP-citrate lyase.

Olaparib and Bevacizumab. The PARP inhibitors are drugs that block the repair of broken DNA and helps delay the length of time before the cancers returned. After several decades of studying different chemotherapy approaches, this is the first time there is a substantial and meaningfully prolonged progression-free survival for patients with ovarian cancer.

Drugs for diastolic heart failure Heart failure alongside preserved ejection fraction (HFpEF) is termed as â&#x20AC;&#x2DC;diastolic heart failureâ&#x20AC;&#x2122;- a condition in which an individualâ&#x20AC;&#x2122;s ventricular heart muscles contract normally but fail to relax the way it should. A breakthrough to treat this condition is SGLT2 inhibitors- a class of drugs that treat type-2 diabetes that has been explored in HFpEF. Though they are currently under clinical trials, SGLT-2 inhibition with empagliflozin seems to have met an exploratory +endpoint of statistically significant reduction in heart failure.

PARP Inhibitors for firstline maintenance therapy in Advanced Stage Ovarian Cancer Women with advanced-stage ovarian cancer now have two FDA-approved options for maintenance therapy after first-line treatment:

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INTERVIEW

The Simplest Solution for Safe Surgery Impacting 1.3 million lives every year, this NGO is working to make surgery safe for everyone. By providing training in oximetery and making pulse oximeter available to the underserved regions, Lifebox Foundation is saving lives with the simplest intervention. Dr Mansi Tara, Project Manager, South Asia, Lifebox talks about the work and its impact in Asia with M Neelam Kachhap Tell us about lifebox Foundation? Lifeboxis a global charity, registered in the US, UK and Ethiopia, which aims to improve the safety of surgery and anaesthesia. Founded and chaired by Dr Atul Gawande, our work is based on the WHO Surgical Safety Checklist. We aim to enable healthcare providers all over the world to implement the Checklist in their hospitals through three pillars of our work: Improving Anaesthesia Safety, Reducing Surgical Site Infection and Promoting Teamwork. We aim to achieve our goal through tools, training and partnerships. Under each pillar we have programmes that we are actively implementing in Central America, Africa and South Asia. You have travelled across India and seen many hospitals. What is the reality of access to safe surgery in India? There is a huge disparity in access to quality healthcare between rural and urban areas of India. The challenges faced at every level of rural healthcare facilities whether Primary Health Centers, District Hospitals or Tertiary and Teaching hospitals vary. Although the common challenge that we have seen across all levels is lack of workforce, most hospitals also struggle with their postoperative

32 December 2019

surgical site infection rates. Strong hierarchies exist in the operation theatres which acts as a hindrance to effective teamwork and communication and in functioning Primary Health Centers, one of the biggest challenges is lack of patient monitoring during and post minor surgical procedures. Why did you choose the Pulse Oximeter as the hero of your interventions? A pulse oximeter is the most crucial piece of equipment used by anaesthesiologists to monitor patients while they are under general anaesthesia or sedation for a surgical procedure. This equipment helps identify early warning signs of hypoxia (lack of oxygen in the body), which helps in rectifying the situation before it is too late. The use of a pulse oximeter along with the WHO Surgical Safety Checklist is known to reduce perioperative complications by 60 per cent. In 2009, it was estimated that 77,000 operation theatres across the world lacked access to this life saving device. Of these, 15,000 operation theatres were in India. Lifebox was then founded by Harvard School of Public Health, Brigham and Womenâ&#x20AC;&#x2122;s Hospital, The Association of Anaesthetists of Great Britain and Ireland and World Federation Societies of Anaesthesiologists to bridge this gap in oximetry.

Dr Mansi Tara

What is the current status of use of Pulse Oximeter at Indian OTs? In our experience, most government hospitals operating under general anaesthesia are equipped with multipara monitors but some may struggle to provide comprehensive monitoring in post-operative wards and recovery. As we move to Primary Health Centres, some lack access to oximeters even at centres which are performing minor surgeries. Pls tell us about your work in India and neighbouring countries? Lifebox has been working in South Asia since 2012. One of our first programmes on pulse oximetry donation was launched in Nepal in partnership with their national anaesthesia society and Nick Simons Institute. Lifebox started work in India and Bangladesh in 2016. Since then we have donated nearly 1000 oximeters in these countries. These donations are accompanied by a one day workshop for doctors, nurses and support staff. This

Lifebox is a global charity, registered in the US, UK and Ethiopia, which aims to improve the safety of surgery and anaesthesia

workshop teaches the basics of oximetry, introduction to the WHO Surgical Safety Checklist and hypoxia management.

Lifebox pulse oximetry workshop in Dhaka, Bangladesh

www.indiamedtoday.com Photo Credit Siemens Healthineers

INTERVIEW Lifebox has also introduced teamwork based programmes in India in the past year. We are working with surgeons, nurses and anaesthetists to improve teamwork and communication in the operation theatre and supporting the team to use the WHO Surgical Safety Checklist effectively. The workshops organised by Lifebox are unique in that they bring the entire multidisciplinary operation theatre team together for continued learning which makes learning more effective, changes easier to implement, and ultimately improves outcomes for patients.

Lifebox pulse oximeter donation in Champawat, Uttarakhand, India

Simulated learning during a teamwork based workshop; SAFE OR, at Tata Memorial Hospital, Mumbai, India

What is the impact of your work in these geographies? By providing hospital and health centres with pulse oximeters, Lifebox is impacting over 1.3 million lives every year. Apart from making surgery and recovery safer for patients through this live-saving device, the impact of our programme is also seen in training teams together. There are strong hierarchies in the operation theatre. Through our teamwork based workshops and advocating for the use of the Checklist, Lifebox is addressing the gaps in communication and processes that are often the cause of a mishap in the OT.

34 December 2019

Tell us about your partners helping you in your mission? Lifebox derives its strength from its partnerships. Globally, we work closely with national anaesthesia and other professional societies, as well as ministries of health, hospitals, clinical advisors and other NGOs. In South Asia, we have partnered with the national anaesthesia society in Nepal, Bangladesh and India. In India, we have also partnered with Indian Society of Perinatology and Reproductive Biology (ISOPARB), private hospitals such as Apollo, government teaching hospitals, Tata Memorial Centre and other NGOs such as CARE and Jan SwasthyaSahyog in nine states of the country. Lifebox has also developed a championsâ&#x20AC;&#x2122; network in India which is formed by individuals who volunteer their time with us for organising or teaching as faculty on our workshops. We are funded by private donors and foundations and are always looking for new philanthropic partners to help support our work. When is the next activity planned in this geography? Having spent three years implementing programmes in rural and urban areas in India, we are aware of the need to address

In 2009, it was estimated that 77,000 operation theatres across the world lacked access to this life saving device. Of these, 15,000 operation theatres were in India

issues around safe surgery in the region. We are expecting to launch a new programme around surgical site infection reduction in 2020. We are also launching our teamwork based workshop in Bangladesh in March 2020. Apart from implementing new programmes, our established oximetry and teamwork based workshops will continue to take place in the region, as per need. What are your plans for this program in the next year? In the coming year, we plan to introduce workshops from all three pillars of our work in India, with a focus on Maharashtra. Since we are a need based and context specific organisation, we will pilot and adapt our workshops for the Indian context, guided by the local expertise of our partners.

Simulation based Checklist implementation session at Dr. S. C. Government Medical College, Nanded, Maharashtra, India

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OPINION

Medical Devices Need Separate Regulatory framework Rajiv Nath, Forum Coordinator, Association of Indian Medical Devices Industry (AiMeD)

December 2019

THE VAST majority of India’s medical devices, nearly 80 per cent import dependent, are unregulated for quality and safety. While many of these products may have regulatory certifications in other countries, the reality is that a considerable number of them are being exported from countries that do not regulate their exports. The medical devices market in India is over $15 billion (Rs.105,000 Cr) and projected to grow to $50 billion by 2025 and is the fourth-largest in Asia. Thirty years have gone by since the 1st medical device was regulated as a drug in 1989. A comprehensive regulatory framework is nearly in sight with the Draft MEDICAL DEVICES (Safety, Effectiveness & Innovation) Bill from NITI Aayog to be shortly proposed as a Separate Law. Our policymakers in Health Ministry were surprisingly undecided and seemed to be in no urgency to usher in a ‘Patient Safety Medical Devices Law to protect patients, even after the recent ICIJ implant files or J&J incident, or the most recent ban on Trans-vaginal Pelvic Mesh by USFDA. As Moh&FW had been surprisingly very reluctant to draft a separate law preferring to attempt to amend the Drugs Act and CDSCO has a conflict of interest to empower itself the industry watchers are waiting with anxiety the details of the Draft Medical Devices Bill that Niti Aayog is reportedly working upon in consultation with other stakeholder departments and ministries to address the regulatory vacuum & the national patient safety concerns. Devices do need to be regulated but the

2nd draft and 2nd final notifications recently issued by MoH&FW on October 18th , has indicated notifying all medical devices that are engineering products as ‘medicines’ under the Drugs & Cosmetics Act from December 2019 but the roadmap being defined in cover note from the Under Secretary does not entail migrating these to a separate ‘Medical Devices Act in due course (as being drafted by Niti Aayog) and seems to be an independent parallel action. This uncoordinated announcement is causing huge confusion and apprehensions amongst domestic manufacturers especially of Medical Electronics as while one notification talks about a reasonable transition period of 3-4 years another notification to regulate ultrasound equipment gives only one year and there’s no mention of a separate Act. At present only 24 out of over 6,000 medical devices are regulated by being notified as drugs Devices are engineering items and not drugs It’s imperative to have a separate law as devices are engineering items and not medicines — a MRI or CT Scan machine by no stretch of the imagination can be called a drug, and, so, continued attempts to regulate devices as drugs is illogical and incorrect unless assured that it is a temporary measure. A beginning was made to correct the anomalous situation with the introduction of the Medical Device Rules in 2018.These Rules have risk proportionate controls correlating to the risk classification of devices. Similarly, the law and penal provisions need to be risk-proportional as you can’t have

the same penalty for a manufacturing failure of a pair of spectacles as for a contact lens or for an intra-ocular lens. Patient safety is more complex with devices where the same are a shared responsibility of the manufacturer, medical practitioners, product user and the regulator. The Drugs Act itself needs reforms as it does not uniformly and equitably regulate quality from state-to-state in the absence of a national singular regulatory authority and there is no point of replicating this limitation for devices too. The recent J&J episode showed the limitations of the Drugs Act and the Drugs Controller was initially seen to be handicapped to discipline overseas manufacturers. Medical Devices has failed to attract investors to put up factories. Why? Can a competent builder from Mumbai, experienced enough to make a 90-storey building, risk starting the construction of a 70-storey one in Gurgaon if the building by-laws there donâ&#x20AC;&#x2122;t permit construction of over 36 floors only under hearsay that said by-laws are under amendment or will he wait? Similarly, medical devices manufacturers need to know the legal requirements, in a predictable manner. This will attract overseas and Indian investments. Presently, investors shy away from an unpredictable, incomplete and

incorrect regulatory environment. This will also attract investments not only in manufacturing but in the much needed supportive eco system of Testing Laboratories and Certification Bodies and competent Quality Assurance personnel and Regulatory experts. In the absence of regulations, domestic manufacturing suffers as a surgeon is unsure of trying an unregulated device from a start-up on a live patient. Medical Devices need a Competent Regulatory Body Policymakers while beginning to view devices and drugs differently, need to ensure these are of high quality and are safe, must consider regulating devices under the ministry of health as done for food. Food is not regulated under the Drugs Act or under DCGI, or the CDSCO, but has a FSSAI with a Secretary level chairman and CEO. While many of the manufacturers of the 24 categories of already notified devices are ok to be regulated under a familiar CDSCO but wish it to revamped with a medical devices specific division and appropriately needed competent staffing by engineers & scientists, a vast majority of the manufacturers of devices that are currently not regulated prefer to seek a separate national regulatory body which will not view Devices from the prism of Drugs , as

The medical devices market in India is over $15 billion (Rs.105,000 Cr) and projected to grow to $50 billion by 2025 and is the fourthlargest in Asia

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OPINION reportedly envisioned in the NITI Aayog draft Bill. The government should stick to earlier assurance given to the industry by the MOH&FW in 2016 of four steps—starting with the Medical Devices Rules (MDR), initially experimenting with a few electronic devices under the MDR, the MDR to be amended as per experience gained after 6 months of introduction and the simultaneous drafting of a Medical Device Bill to be reviewed by us and other stakeholders and passed by Parliament and the MDR to accordingly be tweaked in order for it to migrate to an eventual Medical Devices Law. The National Accreditation Board of Certification Bodies is already accrediting certification bodies for voluntary quality assurance (the Indian Certification for Medical Devices (ICMED) scheme) under the QCI (Quality Council of India). Incentivizing ICMED certification by the QCI will help

NOVEMBER 2018, VOLUME 2 ISSUE 11 `200 INDIA MED TODAY

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SPECIAL FEATURE AMERICAN ACADEMY OF EMERGENCY MEDICINE CEO’S PERSPECTIVE DR. HARISH PILLAI, CEO – ASTER HOSPITALS & CLINICS INNOVATE PROTEMBO CEREBRAL PROTECTION SYSTEM

What Ails

EMERGENCY MEDICINE in India

Lack of standardisation, fragmented training landscape and distrust relation among doctors NOVEMBER 2018

M Neelam Kachhap

Indian manufacturers in capacity building for voluntary compliance to quality standards, thereby ensuring global competitiveness and enabling the smooth transition to mandatory compliance under the proposed draft Medical Devices Bill from Niti Aayog. A strong and fair regulatory environment will help the Make in India campaign by encouraging the growth of this industry. Right from trade margin rationalization to ensuring a separate set of legislations and regulatory frameworks to govern the medical device sector and everything in between needs to be looked at afresh to galvanize domestic manufacturing. If we are serious about placing India as a top global medical devices manufacturing hub, then one needs to understand that piecemeal reforms will not work and continuing to attempt to regulate Devices as Drugs under Drugs Act without an assurance of migrating to a separate legislation will do more harm than good to MakeinIndia campaign.

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December 2019

SPECIAL FEATURE

Space Health: The New Frontier ON JULY 20th, 1969, we took a huge stride forward in our attempt to explore the far reaches of the universe. The space race was won when Apollo 11 landed on the Moon after a frenzied couple of years from Sputnik, Able the Rhesus monkey and Baker the squirrel to Neil Armstrong and Buzz Aldrin.

Dr. Rohan D’Souza

Mercury Rising: Space Health is starting to heat up Fast-forward 50 years, the modern age space race seems just as frenetic. NASA is no longer the only powerhouse when it comes to space travel. Billionaires like Jeff Bezos and Elon Musk are funneling their brainpower and financial clout into space travel, with SpaceX, Virgin Galactic, Blue Origin and Boeing all gunning to make this dream a reality. Start-ups too are seeing increasing traction with venture capitalists poured $3.25 billion into space technology companies in 2018 according to the Seraphim Space Index with V.C. firms like Space Angels and Hemisphere ventures leading the charge. The Human Body in Space It’s naive to think that the spacecraft alone is going to make this reality. One key component to achieving this goal is keeping human beings safe in those extreme environments, which is easier said than done. Human physiology and disease pathophysiology vary considerably beyond the outer reaches of our atmosphere and our understanding of these changes remains rudimentary at best. A first-of-itskind study was recently reported on in which two twins were recruited understand the changes in space. Scott, an astronaut, traveled to the International Space Station and stayed there for a year, while back on Earth, Mark, his

40 December 2019

genetically identical twin, served as a control. Some of the changes included lengthening of telomeres, inversion, and translocation of chromosomes and thickening of the retina, etc. of which over 90% of genetic changes reversed on returning to earth. The Space Health Innovation Conference, 2019 The recent conference by NASA’s Translational Research Institute for Space Health (TRISH) and the University of California, San Francisco Medical Center (UCSF) in November centered on astronaut health and the risks in outer space. The speakers included an illustrious array of astronauts, medical doctors, researchers and start-up founders working on space health solutions among others. Key Talking Points The topics covered were extensive but I thought I would touch on some of the key areas which are the focus for research and innovation. Altered Gravity Field: Going from Earth’s gravitational force to weightlessness at zero-G and to one-third of Earth’s gravity, as it is on Mars, is not an easy transition. The effects are seen on spatial orientation, head-eye, and hand-eye coordination, balance, and locomotion. Other pressing issues include the demineralization of bones, with density dropping at over 1 per cent per month leading to kidney stones and osteoporosis. This is compounded by fluid shifts and a decrease in muscle mass, all of which can affect an astronaut’s performance. Social confinement: Space is not a friendly place! Astronauts spend long periods of time together, isolated from friends and family in a closed confined metal tube floating through

space. The dysfunctions in circadian rhythm and frozen meals don’t help either, although both sound an awful lot like my experience in grad school so far! Radiation exposure: The radiation exposure is over ten times higher in The Space Station compared to here on Earth where the planet’s magnetic field and atmosphere offer protection from harsh cosmic radiation. Radiation exposure increases cancer risk, degenerative effects (such as cataracts) and acute and/or chronic central nervous system dysfunctions, often manifesting as altered cognitive function, reduced motor function, and behavioral changes. Radiation sickness can result in nausea, vomiting, anorexia, and fatigue. Food and pharmaceuticals also face the risk of losing their nutritive value and efficacy with radiation exposure. Hostile Environment: The sheer number and breadth of possible risks and tremendous including exposure to cosmic dust,

decompression sickness, carbon monoxide poisoning, altered immune responses (such as activation of viruses like Epstein Barr virus), solar flare related radiation exposure etc.! Takeaways 1. Investment in Space Tech and Space HealthTech is increasing and is a worthwhile consideration for innovators to consider, especially since this is not a crowded competitive space, Yet! Possibly sources of funding include TRISH, NASA and the ISS . 2. Physiology in space and earth are different and so not all solutions that work on Earth will fare as well in space. 3. The translational possibilities of Space HealthTech have been tremendous in the past: LASIK, Ventricular Assist Devices, Cochlear implants etc. As Konstantin Tsiolkovsky so poignantly put it, “The Earth is the cradle of humanity, but mankind cannot stay in the cradle forever.”

NASA is no longer the only powerhouse when it comes to space travel. Billionaires like Jeff Bezos and Elon Musk are funneling their brainpower and financial clout into space travel, with SpaceX, Virgin Galactic, Blue Origin and Boeing all gunning to make this dream a reality

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EVENTS AHPI GLOBAL CONCLAVE 2020 Date: 7-8 Feb, 2020 Location: Ramaiah Medical College,

Auditorium City: Bengaluru Organizer: Association of Healthcare

Providers, India (AHPI) Click: http://ahpi.in/ahpi_global_conclave/

index.html Contact: Shikhar Gupta - Assistant Director 9540859694

ealthcare has firmly become political agenda and that makes it receiving dueattention by policy maker sand powers that be.Government will be promoting social welfare health insurance schemes, it will bringe normous pressure on hospitals to financial sustain owing to inherently lowre imbursement models.

Hospitals will be expected to partner the government led initiatives forclean drinking water, nutrition, clean environmentan duse of tele-health in screening for NCDs. It will give push for hospitals to be truly LEAN, GREEN and SMART. Allinall, healthcare is going to be in new AVATAR in next decade. The AHPI conclave will capitulate all dimensions of this AVATA Rand how it will impact all stake holders including Patient, Provider, Payer, Pharmaceuticals, Medical Technology and Government/Regulating Bodies etc. The conclave will also encompass the unique blend of 6th edition of ’ AHPI AWARDS for Excellence inHealthcare’ in defined categories and will be presented over Galad inneroneve of 7th February 2020.

MEDICALL 2019

ARAB HEALTH 2020

Date: Dec13-15, 2019 Organiser: Medexpert Business City: Mumbai Contact: Mr.KSundararajan, 91-7305789789 Click: info@medicall.in

Date: Jan 27-30, 2020 Venue: Dubai WTC City: Dubai Click: www.arabhealthonline.com Organiser: Informa Markets Contact: ahcongress@informa.com

Medicall is India’s largest B2B trade fair for medical devices and hospital supplies. Approx. 750 exhibitors and 15,000 trade visitors from over 20 countries, among them physicians, but also biomedical engineers, sales people, decision makers, consultants and hospital owners, are represented at this important industry event. In addition to the presentation of the best and the latest medical and medical-technical equipment, software, supplies and other devices the market has to offer the fair mainly serves as a platform to exchange knowledge and experiences among renowned industry experts. Various conferences and innovation awards in different categories complement the event.

For 45 years Arab Health has brought you the latest innovations in healthcare. From stateof-the-art imaging equipment to the most cost-effective disposables; developments in surgery to advances in prosthetics, Arab Health continues to be at the heart of healthcare in the Middle East. As the largest collection of healthcare product manufacturers and service providers under one roof, Arab Health is your onestop shop for all your healthcare sourcing and procurement needs. With thousands of products to explore, coming in from more than 66 countries, make sure you don’t miss this essential business medical event in Dubai. The show is free to visit. Arab Health prides itself as the leading

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December 2019

healthcare business platform in the Middle East. Connecting manufacturers and service providers with clinicians, procurement professionals, dealers and distributors is the primary goal of the event. Leverage the success of the show and make key business contacts by utilising our multiple channels to connect you to the region’s healthcare industry.

MEDICAL FAIR INDIA 2020 Date: Mar 5-7, 2020 Venue: Bombay Convention & Exhibition

Center City: Mumbai Organiser: Messe Düsseldorf GmbH Contact: JoshiS@md-india.com MEDICAL FAIR INDIA is India’s leading Trade Fair for the medical and healthcare industry. For the last 25 years, Medical Fair India has been successfully addressing the various needs of Hospitals, Health Centres& Clinics. The main segments on display at MEDICAL FAIR INDIA 2019 include: medical products and devices, laboratory technology and diagnostics, clinic and health centre furniture, and the health IT segments now so on trend the world over as well as mobile health solutions.

CRITICARE 2020 Date: Feb 26-27, 2020 Venue: Hyderabad International Convention

Center City: Hyderabad The 26th Annual Conference of “Indian Society of Critical Care Medicine”, CRITICARE 2020, will have exciting and informative scientific programme that will be broad and varied, encompassing plenary lectures, breakout sessions and workshops by renowned National & International experts. The programme will feature streams with a wide variety of topics, taking into consideration conference theme, ‘PRECISION IN INTENSIVE CARE” enabling visitors to tailor the programme specifically to their own interests and clinical practice, as well as information packed Pre Congress Workshops.