IndiaMedToday Nov 2019 by IndiaMedToday

NOVEMBER 2019, VOLUME 3 ISSUE 11 `200 INDIA MED TODAY

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AGENTS OF CHANGE

YOUNG LEADERS IN HEALTHCARE M NEELAM KACHHAP

DEVICE TRAIL

NOVEMBER 2019

BEYOND MEDICATION, ADVANCES IN DIABETES THERAPY

APPROACH

MEDICINE, BUSINESS AND LEADERSHIP DEVELOPMENT

EDIT NOTE www.indiamedtoday.com

NOVEMBER 2019 EDITORIAL

BOARD OF ADVISORS

Editor Neelam Kachhap editorial@ indiamedtoday.com

Dr Alexander Thomas Dr Girdhar Gyani Dr Prem Kumar Nair Dr Bhabatosh Biswas Dr Alok Roy Ramesh Kannan

ART & PRODUCTION

CONSULTING EDITOR

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Hosting Conversations with Young Leaders LEADERSHIP IS not an individualâ&#x20AC;&#x2122;s space; it is usually a collective drive where a team or groups of people excel in their shared common goal. But it sure is not as simple as that, especially not in healthcare. Our industry is people specific. Healthcare deals with highly skilled people, professionals on different levels, different departments, and specialties interacting in an intricate, complex way to achieve multidirectional goals. Leadership in healthcare is more challenging when compared to other service segments. Leaders in healthcare need to work with all the diverse forces to drive efficiency and encourage personals to achieve common goals. But here we are talking about a new breed of leaders. These young leaders like to align to a social cause and measure their goals by the substantial impact the company makes on the society without leaving profit aside. For these young leaders profits and social impact go hand in hand, they harness the better part of both to make a difference. Of late, growth of this kind of business has been phenomenal. In fact, a number of start-ups in healthcare are rooted in ideas to make a social impact while making profits. Of these and traditional business in healthcare a large percentage is led by Young Leaders.

Leadership in healthcare is more challenging when compared to other service segments. Leaders in healthcare need to work with all the diverse forces to drive efficiency and encourage personals to achieve common goals. Our cover story this issue talks about five such young leaders. With each of these leaders we had fascinating conversation about their work, visions and goals. Through this annual issue we will try to bring forth these inspiring leaders and their zealous stories. Do send feedbacks on editorial@indiamedtoday.com

rate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice. Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medical advice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

Editor M Neelam Kachhap

November 2019

NOVEMBER 2019

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CONTENTS HEALTH IT

COVER STORY

Agents of Change Young Leaders in Healthcare APPROACH

Medicine, business and leadership development New academic approaches to train next generation healthcare leaders

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UPFRONT

Can Blockchain Heal India’s Healthcare System?

04 Editorial 06 Letters 08 News roundup 41 Q&A MARKET CONNECT

Medirays Vying For Bigger Share in Radiology Market

INTERVIWE

FEATURE

Diabetic Foot Dilemma

DEVICE TRAIL

Beyond Medication, Advances in Diabetes Therapy

How are Robots changing Healthcare?

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LETTERS BRAIN ATTACK VS HEART ATTACK

suffering from Atrial Fibrillation. When suffering from Atrial

The economic and social impact created by HCG across the healthcare segment is being acknowledged in an up coming study commissioned by International Finance Corporation (IFC), a testament to our commitment to cancer patients across India. HCG’s oncology network depth and presence, uniquely positions us to address the growing cancer burden in India holistically, while delivering quality cancer care and outcomes. We are nearing completion of our capex cycle, whlist driving profitability in our new centers. We are near the inflexion point where we expect to see robust growth in operating cash flows and consequent reduction in leverage. The Company has been successful in creating scaled and specialised platforms across oncology, fertility and precision diagnostics, with Pan-India leadership, and we remain committed to driving longterm value creation for all ourstakeholders.

Fibrillation, blood clots are most commonly formed in a part

Dr.B.S.Ajaikumar, Chairman and CEO, HealthCare Global

of the heart called left atrial appendage (LAA). Closing the

Enterprises Ltd

troke is a brain attack similar to a heart attack. The difference is that while in heart attack there are blocks, in brain attack there are clots and clots happens to come from somewhere else that blocks

the brain. Symptoms include sudden stoppage of any organ or body part, tingling sensation in half of the body, loss of body balance among others. Significant amount of stroke happens because of Atrial Fibrillation or irregular beat of the heart in which only the upper chamber of heart vibrates, and the lower chamber doesn’t. I see around 3 to 5 patients in a day so in a month there are at least 90 to 150 patient

LAA is an effective way of reducing stroke risk in people with Atrial Fibrillation, a recent innovative medical technology. This is done by implanting a nail like device called occluder of the likes of Amulet inside the heart that permanently closes LAA and keeps blood clots from escaping. The whole device procedure, an one-time treatment has minimum risk and thus is more favorable compared to the blood thinner process that needs regular treatment for whole life. Sometimes, the patient might have to stop this blood thinner treatment process because of other health problems caused due to the treatment.

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. Dilip Shanghvi, Managing Director, Sun Pharmaceutical

Dr. Ranjan Shetty Cardiologist, at Manipal Hospital, Bengaluru

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X OF T MI IGH CLINICAL OUTCOME EXCELLENCE

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SEPTEMBER 2019, VOLUME 3 ISSUE 9 `200

DR. SUBRAMANIA IYER, HOD, PLASTIC & RECONSTRUCTIVE SURGERY, AMRITA HOSPITAL

INDIA MED TODAY

SMART HOSPITALS

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NORTH-SOUTH DIVIDE IN ORGAN TRANSPLANT

TACKLE

HEART FAILURE

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 AIG HOSPITALS IN INDIA JOINS MAYO CLINIC CARE NETWORK AIG Hospitals is the first health care facility in India to become a member of the Mayo Clinic Care Network, a group of carefully vetted, independent health care systems that have special access to Mayo Clinic’s knowledge and expertise. Physicians from AIG Hospitals will be able to combine their understanding of their patients’ medical needs with Mayo Clinic expertise, so patients get exactly the care they need close to home. There is no additional cost to patients. “We at AIG Hospitals are passionate about bringing world-class medical expertise, innovation and technology to India for the benefit of our communities,” says D. Nageshwar Reddy, M.D., chairman and managing director, AIG Hospitals. “Our collaboration with Mayo Clinic is a giant leap forward in empowering

AIG-Building

November 2019

our patients and physicians to access international clinical expertise and cuttingedge medical knowledge for superior clinical outcomes.” “Mayo Clinic is pleased to welcome AIG Hospitals to the Mayo Clinic Care Network,” says David Hayes, M.D., medical director, Mayo Clinic Care Network. “AIG Hospitals is committed to the health and well-being of its communities through dedicated, high-quality care. We look forward to working closely together.”

ASTER DM HEALTHCARE TO TAKEOVER NARAYANA MULTISPECIALITY HOSPITAL, WHITEFIELD

Aster DM Healthcare, one of the largest integrated healthcare service networks in the GCC and the third largest healthcare company in India, will take over the Narayana

Multiplicity Hospital, Whitefield, Bengaluru. According to sources, NH Whitefield executives and staff have been told about the takeover and are looking for alternate opportunities. The handing over formalities is expected to be completed by Dec 2019. The name of the new entity is not decided yet. Narayana Health currently runs a chain of seven network hospitals in Bangaluru located at Bommasandra, HSR Layout, Whitefield, Indiranagar, Nrupthunga Road and Mattikere.

SUPRAFLEXVSXIENCE: 2-YR DATA SHOWS TREND TOWARDS LOWER TARGET VESSEL FAILURE WITH INDIAN STENT The ultra-thin Supraflex drug-eluting stent (DES) from SMT maintained numerically lower outcomes at two years of follow-up in a

randomized trial against Abbott’s Xience stent, according to results presented at Transcatheter Cardiovascular Therapeutics (TCT) 2019 in San Francisco.Patients who got Supraflex stent in the Talent trial had target lesion failure occur among 6.9% at 720 days (vs 7.9% of Xience recipients), according to a presentation by Dr. AzfarZaman, Freeman hospital in UK. Dr Patrick Serruys, a globally renowned cardiology researcher was the chair for the TALENT trial. The findings of the TALENT trial were presented at the Transcatheter Cardiovascular Therapeutics 2019 (TCT), the largest global conference of cardiologists currently concluded in San Francisco, USA. This study was conducted in 7 countries United Kingdom, Netherlands, Poland,Spain, Italy, Hungary and Bulgaria - across 23 renowned centres with a sample size of 1435 patients. Xience is regarded as global standard in safety and efficacy for drug eluting stents. Presenting the findings of TALENT trial, Dr A Zaman, UK said, “Safety and efficacy of Supraflex SES with ultra-thin struts and biodegradable polymer were compared with Xience EES in all comers-population. Supraflex was found to be non-inferior to the Xience for DOCE (device-oriented end points) at 24 months in an all comer-population.” Padma Shri Dr Upendra Kaul, one of the leading cardiologists from India was the co-chair of the TALENT Study. Commenting on the study, Dr Kaul said, & quot; There remained a perception that stents produced outside of India were superior to homegrown devices. There were demands from Indian manufacturers to prove that their devices are comparable to those made elsewhere in robust clinical trials.” Prof. R. de Winter, MD, Academisch Medisch Centrum, Amsterdam, The Netherlands; and A. Zaman, MD, Cardiac Catheter Laboratories, Royal Freeman, Newcastle, UK, were the Principal Investigators for the TALENT trial.

M S RAMAIAH NARAYANA HEART CENTRE COMMEMORATES WORLD HEART DAY

Stent

M S Ramaiah Narayana Heart Centre– a unit managed by Narayana Health, celebrated World Heart Day by successfully performing a heart transplant surgery. Hailing from Mysore, the recipient was suffering from Ischemic dilated cardiomyopathy. He was under medical management at M S Ramaiah Narayana Heart Centre. After a thorough evaluation by the team of cardiologists and cardiac surgeons, the patient was advised a heart transplant. He had registered with Jeevasarthakate (ZCCK) 4 months ago.

WALKATHON ORGANISED BY SAGAR HOSPITAL ON THE OCCASION OF WORLD HEART DAY

Laced up in sneakers, donning the colours of heart and health, the residents of South Bengaluru stepped out in several hundreds to participate in annual walk-a-thon event held to bring awareness around heart health on occasion of World Heart Day. This mega event was sponsored and organized by Sagar Hospitals, Bengaluru. Flagging off the walk was done by guest of honour DCP VVIP IllkkyaKarunakaran along with the prominent cardiologist Dr. K S Kishore and team of doctors, and led by the team of Sagar

Hospitals. The walk began at 6:30 am with 800 plus strong walkers, from all age groups, carrying the message of ‘heart survivors’ followed by a session of health discussion while enjoying a light breakfast.

KOHINOOR HOSPITAL SUCCESSFULLY REMOVES 1.5 CM EYE TUMOUR VIA NOSE

A team led by Dr Sanjay Helale, ENT specialist and HOD at Kohinoor Hospital, successfully operated a 47-year-old man with an eye tumour by performing a minimally invasive procedure through nose. The patient’s vision has been restored, and he is back to his daily routine.47-year-old Ramchandra Malkar, a resident of Mumbra suddenly encountered swelling of the face, and redness around the eye. Later, it was revealed that there is a tumour present in his left eye which was benign. A non-cancerous (benign) tumour of the eye can be described as a growth that does no spread (metastasize) to the other parts of the body, and also the non-cancerous tumours are not life-threatening. However, the patient was referred to Kohinoor Hospital, wherein Dr Sanjay Helale gave him a new lease of life.

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NEWS ROUNDUP INCIDENCE OF PSYCHOLOGICAL DISORDERS AND CHRONIC STRESS HIGH IN MUMBAI People living with mental health disorders do not just face the psychological consequences of their conditions but are also at greater risk of suffering from cardiovascular disease, stroke as well as respiratory diseases. As we observe Mental Health Awareness Day, it is important to talk about the close interplay between mental and physical health and the need to adopt an integrated approach to treating mental illnesses. With the breakdown of traditional families, increasing migration and a growing loneliness epidemic, mental health disorders have emerged as a serious public health concern. A major nationwide survey conducted by NIMHANS estimated that around 13.7 per cent of India’s population suffered from different mental illnesses with around 10.6 per cent of them requiring immediate attention. World Health Organization estimates that around 56 million Indians suffer from depression while another 38 million are living with anxiety. With a hectic and highly stressful pace of life, Mumbai residents also face high incidence of mental health disorders. A report found that people with psychological disorders accounted for 31% of patients admitted to municipal healthcare centres in Mumbai. This was more than any other ailment. This huge mental health burden also has serious implications for physical health.

including comprehensive primary healthcare through Community Outreach Programs and Telemedicine Services to the unserved and underserved sections of society in India. Mr. Vishal Phanse, CEO, PiramalSwasthya, accepted the award at the United Nations General Assembly in New York.

BRUNO BRUINS, DUTCH MINISTER LEADS DELEGATION TO BANGALORE FOR INNOVATIVE COLLABORATION Dutch Minister for Medical Care and Sport, Bruno Bruins, Chair of the Top Sector Life Sciences & Health, Carmen van Vilsteren, Vice Minister of Agriculture, Marjolijn Sonnema and Chairman of the Top sector Horticulture & Starting Materials, LoekHermans led delegation visited Bangalore recently. The two delegations Healthcare and Horticulture & Agriculture had two day program, October 17-18,of field visits, matchmaking and seminars with key stakeholders from Karnataka. Minister Bruins and Vice Minister Sonnema met with the Deputy Chief Minister

PIRAMAL SWASTHYA RECOGNIZED WITH ‘INCLUSIVE HEALTH ACCESS AWARD’

Piramal Swasthya’s high impact platform has been recognized with USAID’s ‘Inclusive Health Access Award’ at the ‘Locally Leading the Way to Universal Health Care’ event aligned to the United Nations General Assembly’s theme of Universal Health. The award has been bestowed on PiramalSwasthya Management & Research Institute for innovations

November 2019

Bruno Bruins

of Karnataka, Dr. Ashwathnarayan C.N. and key government officials from Horticulture & Agriculture and Commerce & Industry. Life Sciences and Healthcare is a priority sector under bilateral collaboration between India and the Netherlands. Growing market opportunities in India, combined with the Netherlands’ strengths in areas such as Therapeutics and Vaccines, Medtech and Digital Health create excellent opportunities for partnerships that address shared societal challenges with smart solutions and make India a valuable partner for the Dutch LSH Sector. The affordability and accessibility of healthcare remains at thecore of partnerships between the Indian and the Dutch stakeholders. To encourage partnerships around important themes of affordability and accessibility, a Healthcare Seminar was organised at Hotel Four Seasons in Bengaluru that brought together government officials, healthcare practitioners, med-tech companies, IT companies, academic institutes and startups. The Ministerial and business delegation also visited Philips Innovation Campus, Centre for Cellular and Molecular Platforms (C-CAMP), Narayana Health City and Anthem Biosciences. Four MoU’s were signed during a Holland

Trade Reception hosted by Consul-General of the kingdom of the Netherlands in Bengaluru, GertHeijkoop.

HCG EMPHASIZES THE NEED TO OFFER PSYCHOLOGICAL ASSISTANCE TO CANCER PATIENTS AND FAMILIES On World Mental Health Day, HCG – The specialist in cancer care organised a session to bring about conscious awareness and highlight the importance to facilitate professional psychological assistance to cancer patients and their families. According to the 2019 report Cancer patients have a fourfold risk of suicide compared to the general population. There is also a two-fold increase since a previous study in 2002. This risk is potentially preventable if we address the psychological needs of cancer patients and their families. Unfortunately to meet this crying need we have only about 25-30 psycho-oncologists in India! Unmet psychological needs of cancer patients have huge clinical implications: patients drop out of treatment, have poor tolerance to treatment and treatment outcomes, including the high risk of suicide and survivorship. Therefore, international agencies such as International Psycho-oncology Society (IPOS), UICC including WHO has endorsed the emotional well-being of cancer patients as the 6th vital sign and recommend integrating psychooncology into mainstream cancer care.

AFTER 2-YS OF UNDERPERFORMANCE, HEALTHCARE SECTOR ON ROAD TO RECOVERY

The hospital sector is on a recovery path after two previous years of muted performance, marred by several regulatory measures. ICRA’s analysis of sample seven large companies reflects this robust performance trends in Q1 FY2020. Cumulatively the sample companies reported a healthy Y-o-Y ~14% increase in revenues and a 47% growth in EBITDA. This

comes against the backdrop of a Y-o-Y 10% rise in revenues in FY2019 as well as FY2018 and a muted 1% growth in EBITDA in FY2018 and an 8% increase in the same in FY2019. Further, the operating margin in Q1 FY2020 stood at a healthy 13.6%, against an operating margin of 10.5% in the same quarter last year and full year operating margins of 12.4% in FY2019.

PRACTO ONLINE CONSULT WITNESSES 88% GROWTH IN MENTAL HEALTH QUERIES

According to World Health Organization, one person dies every 40 seconds because of some form of mental disorder and only 10% of patients suffering from mental illness receive treatment in India. Still considered a taboo subject, mental illness is often swept under the carpet and patients who suffer from mental disorders are leading poor quality life in India.In a country like ours, the stigmas attached to mental health and societal pressure has led to hesitancy in seeking timely medical assistance. In light of such statistics, Practo has been striving hard to bridge the gap between the need for medical assistance for mental health and accessibility to the right healthcare professionals in India through technology.

APOLLO HOSPITALS DEPLOYS KRONOS WORKFORCE SOLUTION TO AUGMENT SUPERIOR CARE Committed to drive smarter care, superior patient outcomes, and hospital experience across its vast national network, Apollo Hospitals Group, Asia’s foremost integrated healthcare services provider, has selected an innovative workforce management solution from Kronos – a global leader in cloud based human capital management, to boost workforce efficiencies, and productivity.The innovative solution from Kronos Incorporated,

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NEWS ROUNDUP the global leader in workforce management cloud solutions, has gone live across Apollo’s six locations in South India, empowering its 3,000 workforce, with real-time visibility, and actionable insights, yielding quality care. Collaborative self-scheduling allows hospital staff to select their preferred schedules and make it easier to swap shifts and request time off, offering a more engaging experience that simplifies their work-life balance. These features will be extended to 15 more locations, covering about 8,000 employees during the next month.

models in the country. With three decades of experience coupled with deep technomanagerial and analytical skills, Mr. Rajesh Ranjan shall lead the organization into its next phase of growth.Wadhwani Initiative of Sustainable Healthcare (WISH), the flagship program of Lords Education & Health Society in India, works to improve the quality, accessibility and affordability of primary healthcare for under-served populations at the last mile through innovative technology and digital solutions.

KAYAKALP AWARDS: RAJESH RANJAN SINGH IS MEDICA HOSPITAL BAGS THE NEW CEO OF WISH CLEANLINESS AWARD BY Primary healthcare solutions provider GOI LEHS|WISH has announced the appointment of Mr. Rajesh Ranjan Singh as its new Chief Executive Officer (CEO) as it works to scale the impact of its innovative primary healthcare

Kolkata-headquartered Medica Superspecialty Hospital has been recognised for its dedicated efforts towards excellence in promoting cleanliness, high standards of hygiene, sanitation and infection control. The citybased private hospital has been honoured with the Kayakalp Awards constituted by the Government of India (GoI) under the category of Hospital contributing to improved quality of care. Dr. Alok Roy, Chairman of MedicaSuperspecialty Hospital received the award from Hon’ble Union Health Minister, Dr. Harsh Vardhan. Medica Superspecialty Hospital is the only multi-specialty Hospital to have received this prestigious award from Eastern India in the year 2019-20 under the Kayakalp scheme of the Centre, which is aimed at encouraging public health facilities to maintain cleanliness and hygiene.

AYUSHMAN BHARAT PRADHANMANTRI JAN AROGYAYOJANA CROSSES THE 50 LAKH TREATMENTS MARK

Mr Rajesh Ranjan, CEO, WISH

November 2019

Half a crore hospital treatments have been provided under Ayushman Bharat PradhanMantri Jan ArogyaYojana (PM-JAY), the flagship health assurance scheme of the Government of India, in just over a year. There

are 9 hospital admissions every minute across India, in the first year.PM-JAY is the world’s largest fully Government funded health assurance scheme, which was launched by Hon’ble Prime Minister ShriNarendraModi on September 23, last year. Today the scheme crossed 50 lakh treatments mark. These secondary and tertiary level treatments worth Rs. 7,901 crores have been carried out in the 32 States and Union Territories implementing the scheme. More than 60% of the amount spent has been on tertiary care. Cardiology, Orthopaedics, Radiation Oncology, Cardio-thoracic and Vascular Surgery, and Urology have emerged as the top tertiary specialities.

INDIAN NON-PROFIT YRGCARE SELECTS NETSUITE TO SUPPORT ITS MISSION TO SAVE MORE LIVES YRGCARE, an Indian non-profit that provides clinical care to individuals diagnosed with HIV and other infectious diseases, has selected Oracle NetSuite to support its mission to save more lives. Through NetSuite’s Social Impact program, YRGCARE has been able to focus its resources on helping those in need and support a growing number of patients across India by taking advantage of unified platform to streamline business processes and reduce operating costs. Founded in 1993 by the late Dr Suniti Solomon, a pioneer in India’s fight against HIV, YRGCARE has supported more than 20,000 patients ranging from small children to pregnant women and other infected adults. To bring its clinical care, education and research to more people and support expanded services for patients with hepatitis C, tuberculosis, STDs and other infectious diseases, YRGCARE has expanded from three locations across India to 15. To support its growing operations, which currently help approximately 4,000 people a year, and ensure all resources are used as efficiently as possible to support its mission, YRGCARE selected NetSuite.

ChanderShekharSibal, Executive Vice President & Head of Medical Division at Fujifilm India, Haruto Iwata, MD, Fujifilm India, Dr. Bharat Aggarwal, Director - Radiology Services, Max Super Speciality Hospital, Saket and Dr. HaritChaturvedi, Chairman - Max Institute of Cancer Care

FUJIFILM AND MAX HEALTHCARE JOIN HANDS TO TRAIN DOCTORS IN ADVANCE DIAGNOSTICS

MID-SIZE LABORATORIES CAN NOW ENJOY THE SAME EFFICIENCY BENEFITS AS LARGE FACILITIES

Max Super Speciality Hospital, Saket a leading hospital chain in North India and a pioneer in implementation of best-in-class radiology solutions, today announced a partnership with Fujifilm India, a leader in the development and application of imaging and information innovations. Witnessing the scarcity of radiologists and limited experts in breast cancer diagnostics across Asia and in India, the two brands have come together to train doctors in early detection of cancer. Fujifilm will be sponsoring an advanced fellowship in Breast imaging with Max Healthcare Hospital under the guidance of Dr. Bharat Aggarwal, Director – Radiology Services, Max Super Speciality Hospital, Saket and Dr. HaritChaturvedi, Chairman – Max Institute of Cancer Care.

Beckman Coulter, a global leader in clinical diagnostics, announced the commercial launch of its new DxH 690T hematology analyzer. Designed to help laboratories streamline workflow and maximize uptime, the DxH 690T offers all the benefits of the company’s flagship DxH 900 hematology analyzer to mid-size labs, including an industry leading 93 per cent first pass yield and the recently released Early Sepsis Indicator.

BENGALURU BASED START-UPS PANDORUM AND SHILPS SCIENCES RECEIVE RECOGNITION FROM APPLIED VENTURES www.indiamedtoday.com

NEWS ROUNDUP Applied Ventures, LLC, the venture capital arm of Applied Materials, Inc., recognized several best-in-class deep-tech start-ups at a “pitch day” event held recently in Bengaluru. Three start-ups – Pandorum Technologies (3D bioprinting), Falkonry (advanced analytics) and Shilps Sciences (single-cell transcriptomics) – were awarded cash prizes for their disruptive approaches to addressing key challenges across multiple deep-tech market inflections. The event was co-hosted by ASTRA (the Applied Start-up Technology & Research Accelerator) as part of a broader effort to explore potential investment and technology collaboration opportunities with start-ups in India.

SYNGENE REPORTS ROBUST Q2 FY20 GROWTH Syngene International Limited today announced its Q2 FY20 results. The Company posted quarterly revenue of Rs. 485 Cr, an increase of 11% from the corresponding quarter of FY19. Syngene’s Q2 FY20 business performance was primarily driven by continued growth in the Discovery Services business and consistent performance of the Dedicated R&D Centre and Development Services business.

Dr. Ashok Dhoble, Secretary General, Indian Dental Association and Mr. Rakesh Singh, MD & CEO, Aditya Birla Finance Limited. Over the past few months Indian Dental Association has been constantly working to bring the most beneficial and economical programs for dentists and patients. This partnership aims at bridging the gap between dentists and patients by making dental financing accessible, cashless, and convenient.

ASHOK BAJPAI IS THE NEW CHAIRMAN,DR RAHUL MEDAKKAR, CEO AT CONTINENTAL HOSPITALS Gleneagles Development Pte Ltd, a subsidiary of IHH Healthcare, has appointed Ashok Bajpai as the new Chairman of Continental Hospitals in India, effective 24 October 2019. He assumes the Chairmanship position from Dr Lim Suet Wun, Group Chief Operating Officer at IHH, who will be retiring from the Board of Continental Hospitals after three years as its Chairman.

Dr Rahul Medakkar has been appointed as the Chief Executive Officer. He will be taking over from Faisal Siddiqui.

FACEBOOK ENTERS HEALTHCARE WITH PREVENTIVE HEALTH TOOL IN USA

Facebook, the social media giant is developing products and partnerships that can help people connect with resources to support their health. The company said in an official post that it is working with US health organizations to offer a Preventive Health tool that connects people to health resources and checkup reminders. People can use the tool to find affordable places to receive care, set reminders to schedule tests, mark when tests are completed, and more.Preventive measures have the potential to detect disease early when it’s most treatable and, in some cases, prevent it from developing. Yet factors such as awareness, access and cost create barriers to testing for many people.

ADITYA BIRLA FINANCE LIMITED IN PARTNERSHIP WITH INDIAN DENTAL ASSOCIATION LAUNCHES ‘EASY EMI FACILITY FOR DENTAL TREATMENTS’ AT WORLD DENTAL SHOW 2019 Aditya Birla Finance Limited (ABFL), the lending subsidiary of Aditya Birla Capital Ltd., in partnership with Indian Dental Association (IDA) has launched an easy EMI facility for dental treatments at 11th World Dental Show 2019, to make dental treatments more accessible and convenient in the country. The occasion was graced by the presence of

November 2019

Ashok Bajpai Group Head of Operations Integration, IHH Healthcare

Dr Rahul Medakkar, CEO at Continental Hospitals

FIRST ASIAPACIFIC HOSPITAL TREATS PATIENTS WITHRAYSTATION AND RADIXACT Thailand’s Lopburi Cancer Hospital, a center of excellence for cancer treatment, is the first in the Asia-Pacific region to clinically use the combination of RaySearch’s treatment planning system RayStation® with Accuray’sRadixact® Treatment Delivery System.Lopburi has a focus on innovation and has been designated a national center of excellence for cancer treatment. Today it provides specialist treatment to patients in twelve provinces around the country. The hospital selected RayStation as its treatment planning system in 2015, largely due to the system’s automated breast planning capabilities and unique multi-criteria optimization. Since its implementation, RayStation has enhanced the clinic’s workflows, reduced calculation times and ensured consistently high-quality treatment plans.

ONCOSTEM DIAGNOSTICS SUCCESSFULLY COMPLETES VALIDATION STUDY IN EUROPEAN COHORT OncoStem Diagnostics, an oncology focused company that enables personalised cancer treatment, has successfully completed its firstever single center, blinded validation study in Europe. The study, conducted in association with Valld’Hebron Institute of Oncology (VHIO), Spain, involved retrospective validation on a set of 290 patient samples with an accuracy of 96%. The result of this study was on par with the accuracy seen in the previous studies conducted by OncoStem diagnostics.

NEW DIALYSIS SYSTEM TO PREVENT BLOOD CLOTTING WITHOUT THE USE OF BLOOD THINNERS

Fresenius Medical Care North America (FMCNA), the nation’s leading provider of kidney care products and services, announced today that the U.S. Food and Drug Administration (FDA) has granted breakthrough device designation to a new hemodialysis system, currently in development, that aims to prevent blood clotting without the use of blood thinner medication in most patients.

APOLLO HOSPITALS’ UNIQUE INITIATIVE TO PROVIDE BEST TREATMENT PLAN FOR CANCER PATIENTS Cancer is the second leading cause of death globally and was responsible for over 9.6 million deaths in 2018 alone. The global burden of cancer has risen to 18.1 million new cases and cancer is having a major impact on society across the globe. According to the World Health Organization, one in 5 men and one in 6 women worldwide develop cancer during their lifetime and one in 8 men and one in 11 women die from the disease. However, a timely diagnosis and adequate treatment can help a person beat cancer.

OMNIVISION ANNOUNCES GUINNESS WORLD RECORD FOR SMALLEST IMAGE SENSOR

OmniVision Technologies, Inc., a leading developer of advanced digital imaging solutions, today announced from MD&M Minneapolis that its OV6948 is the winner of the Guinness World Record for “The Smallest Image Sensor Commercially Available” with its size of 0.575mm x 0.575mm. Derived from this ultra small imager, the company also announced its OVM6948 CameraCubeChip™–a fully packaged, wafer-level camera module measuring 0.65mm x 0.65mm, with a z-height of just 1.158mm.OmniVision developed these innovative medical imagers to address the market demand for decreased invasiveness and deeper anatomical access.

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NEWS ROUNDUP Additionally, these imagers can address the many challenges posed by reusable medical imaging equipment, including crosscontamination risks and inefficiencies due to high maintenance costs.

TRANSASIA - ERBA GROUP TO ENTER THE RS. 300 CRORE MOLECULAR DIAGNOSTICS SPACE IN INDIA Transasia Bio-Medicals Ltd., India’s leading IVD Company today announced that it will soon be foraying into the Rs. 300 crore Indian molecular diagnostics space. It unveiled the MX 16, a fully automated nucleic acid extractor, at the 50th Union World Conference on Lung Health and TB in Hyderabad. The MX 16 has been developed by Erba Molecular, a UK subsidiary of the Transasia-Erba group. The new system will offer an easy-to-use and lower priced molecular TB test in India, with the goal of replacing traditional smear microscopy. The system will be particularly beneficial to India, which has the highest burden of TB and drug-resistant TB: one in four TB patient globally are in India. Also, 89% of affected individuals in India are in the productive age group 15-69, which makes it a critical national health issue to be addressed. Though TB incidence in India has been declining at 1.7% annually since 2016, it is estimated that it needs to fall by 10% annually to reach the Government’s 2025 goal of ending TB in the country. Currently a significant number of TB patients remain undiagnosed for long and out of those diagnosed, only 65% of cases in India are treated. According to the Tuberculosis India Report 2019, there has been a 16% increase in cases compared to 2017, further raising the need for early, simple and accurate diagnostics, which is a crucial element of any successful strategy to address TB in India. To this effect, Molecular testing has been included in first ever Essential Diagnostics List announced in 2018 by the WHO, further stressing the need for timely diagnosis of TB.

November 2019

Transasia-Erba team at the Union World Conference for Lung Health and TB

Announcing the foray, Suresh Vazirani, Chairman & Managing Director, Transasia-Erba International group said, “Erba Molecular in UK is among a handful of companies in the world having state-of-the-art, proprietary molecular diagnostic technology. The unveiling of MX 16 and our upcoming entry into the molecular diagnostics segment in India, is part of our commitment to bringing the best in IVD globally to benefit the Indian public. We have also been careful to ensure the forthcoming MX 16 system offers better sensitivity compared to others in the space, with a target price which is significantly lower, to ensure access to early, accurate TB diagnosis. With 21.5 lakh cases reported in 2018 and many more that remain undiagnosed, I personally think it is the right time for us to introduce our molecular range and we look forward to partnering with the health ministry for a TBfree India.” In his comments, Dr. Laurence Tisi, President, Erba Molecular, said, “Our technology makes molecular diagnostics less complex and replaces the age-old smear microscopy method for TB detection. With 75% reduction in processing time and the ability to run 16 samples concurrently, MX 16 allows for faster Turnaround Time (TAT). It is fully automated, with a protocol incorporating a unique kill step that enhances lab worker

safety during sample preparation. The new solution from Erba will help deliver easy and faster diagnosis, a big benefit in densely populated countries like India.” He further added “We are also planning to bring in Nex-Gen sequencing and other advanced technologies which extracts genetic information from patients and helps to plan treatment needs. The presence of large patient pools suffering from infectious diseases like TB and HIV has created an immense unmet need for superior diagnostic technologies. With current tests prone to delivering false results because of lack of sensitivity, we are working on a comprehensive suite of molecular testing products for other infectious diseases and cancer markers which will use the same MX 16 platform.” Vazirani further added, “Emerging markets like India are the main focus of Transasia-Erba group as they face a higher burden of TB and the challenge of drug resistance. MX 16 being a flexible Molecular platform, we plan to add more menus in the future to make it a comprehensive molecular solution. Our ambitious goal is to offer TB test automation at under US$10. The initial response has been highly promising. The team at Transasia-Erba group is truly proud of developing a solution that directs the power of molecular testing to the increasingly important battle of a TB-free future.”

EVENT REPORT

1st Govt & Indian Manufacturers Conference on Comprehensive Regulation of Medical Devices AiMeD & BCIL Conference supported by DoP asks for ending confusion by regulating all medical devices by an incredible regulatory framework Team IMT A FIRST of its kind joint conference “Comprehensive Regulation of Medical Devices” was organized by Association of Indian Medical Device Industry (AiMeD) & Biotech Consortium India Limited (BCIL) supported by Department of Pharmaceuticals (DoP) on 5th Oct, 2019 at New Delhi. Rajiv Nath, Forum Coordinator, AiMeDand Dr Purnima Sharma, MD, BCIL welcomed all the guests from Government, Industry, Academia & Indian Medical Device Industry Associations and apprised the members about the key challenges being faced by the Indian medical device industry for suitable policy interventions by the Govt. to uplift the sector. Dr Vinod Paul, Member, NITI Aayog during his inaugural speech emphasized on the need for integrated efforts to promote innovations and development of indigenous medical devices for having a vibrant domestic medical devices industry for the society. He assured full support of NITI Aayog to ensure that the intent of domestic industry to provide access to safe, effective and quality medical device to the patients are kept in all Govt. policies. Dr VG Somani, Joint Drugs Controller, CDSCO said, “Regulations need to encourage

– Make in India & Made in India. To improve Brand value, credibility and acceptance of Made in India Medical devices, all Medical Devices need to be regulated at one go and not item by item.”

Dr Vinod Paul and Dr VG Somani allayed apprehensions of the medical device industry and assured to regulate all medical devices in a phased manner rather than item by item in a stipulated time frame starting with voluntary

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EVENT REPORT registration for manufacturers and importers and voluntary compliance to medical devices rules while an eco-system is built up with infrastructure along with adequate team of competent officers. The opening session threw light on the Need for Comprehensive Regulation of Medical Devices in India. Rajiv Nath, Forum Coordinator AiMeD pointed out the need to regulate all Medical Devices under a Patients’ Safety Medical Devices Law to protect patients and aid responsible manufacturing. “The manufacturers have been confused with informally choosing of products and notifying them as drugs. They seek a predictable and comprehensive regulatory framework that allows for adequate transition and is predictable. Only then will investments speed up as they get discouraged to be regulated as Drugs,” said GurmitChugh, Jt. Coordinator, AiMeD. The first technical session on Comprehensive Regulation of Medical Devices highlighted the current state of the beleaguered Indian Medical Devices domestic industry. The urgent need for the Govt. to expedite steps to end the 80-90 per cent import dependence forced upon us and an ever increasing import bill of over Rs 38,837 Crore, expedite steps for patients’ protection, stronger quality andsafety regulations, price controls to make medical devices and quality treatment accessible and affordable and ethical indigenous manufacturing viable . MSME dominated medical domestic manufacturing took a hit post GST as imports become 11 per cent cheaper and shoot up 24 per cent. Imports of medical devices are up by record 24 per cent at INR 7450 Cr fromINR 31386 Cr in 2017-2018 to 38,837 Cr in 20182019. GST on medical devices is in favour of imports and is detrimental to make in India. MSME sector has been worst hit with huge job losses. Voicing the concerns of Domestic Medical Devices Industry, Rajiv Nath, Forum Coordinator AIMED said “Medical Devices are not Drugs though both are medical products

Novemberber 2019

but differ in approach in marketing. We have been specifically seeking Trade Margin Caps on Devices notified as Drugs but from 1st point of sale in Supply Chain, which as per us is when 1st sale takes place and GST is applied 1st time e.g. when goods enter country (on the CIF import landed price for imported and Ex-factory price for Indian). “This will maintain parity between Indian & overseas manufacturers.” He further added.“GoI needs to take policy decisions to give at least a level playing field, if not a strategic advantage to domestic manufacturers while safeguarding consumers,” he explained. The panel discussion during the first technical session “Opportunities and Challenges for Patient Safety and Incentivizing Quality Assurance Standards” raised the issues of patient safety, quality concerns and compensation mechanism. The second technical session on Defining Strategy Consumer Protection & Affordable Access via Price Control and Ethical Marketing spoke mainly of Excessive MRP: Stifling India’s Medical device growth Story. Rajiv Nath during his presentation suggested Price controls can be done in a calibrated manner through:  1% GST Cess on MRP as a Tax based disincentive on all Devices;  Capping Trade Markups to a Rational Level on some Devices;  Price Caps on a few priority Devices A pro-active policy formulation to regulate Medical Device differently than Drugs should permit free market dynamics to succeed and keep regulations simple ,protecting Consumers and Incentivizing Make in India. The panel discussion during the second technical session focused on “Achieving Affordability and Access to Quality Medical devices through Price Control and Ethical Marketing”. Priority issues raised during the conference are:  Need to Regulate all Medical Devices under a Patients’ Safety Medical Devices Law to protect patients and aid responsible manufacturing.  Need to protect Consumers from exploitatively

high MRP in Medical Devices by rationalized price controls and aid ethical marketing.  Need to encourage employment and Make in India of Medical Devices and address 80-90% import dependency by a predictive nominal tariff protection policy as done for mobile phones to ensure a vibrant domestic industry & competitiveness and price stability driven by competing domestic players.  Need to incentivize Quality in Healthcare Products in public healthcare procurements by preferential pricing for Q1 e.g. ICMED (QCI’s Indian Certification for Medical Devices) instead of L1 (lowest price) to ensure patients access acceptable quality.  Govt. must ensure importers of Medical Devices are not kept out of the move to cap Trade Margins. A pro-active policy formulation to regulate Medical Device differently than Drugs should permit free market dynamics to succeed and keep regulations simple, protecting consumers and incentivizing Make in India. “We stress these are vital and strategic to meet the health-for-all National agenda of PM Modi and aligned to the Health Policy 2017, to make quality healthcare accessible and affordable for common masses and to enable placing India among the Top 5 Medical Devices manufacturing hubs worldwide and end the 80-90% import dependence forced upon us and an ever increasing import bill of over Rs 38,837 Crore. Pseudo Manufacturing & Unethical marketing is harming consumers and disallowing manufacturing to succeed in India by well-meaning investors. We can repeat the success story of mobile phones by replicating the same strategies.” said Nath. “The Indian Medical Device Industry is very hopeful that right from trade margin rationalization to ensuring a separate set of legislation and regulatory framework to govern the medical device sector and everything in between will be looked afresh and hastened up by Modi Govt. to galvanise the domestic medical device manufacturing sector,” concluded Nath.

COVER STORY

AGENTS OF CHANGE

YOUNG LEADERS IN HEALTHCARE M NEELAM KACHHAP

November 2019

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COVER STORY

e are at a crucial turning point in the evolution of healthcare delivery in India. With rising healthcare concerns and awareness regarding treatment solutions, today’s empowered patient is putting increased pressure on healthcare provider for better healthcare delivery. On the other hand, the government is actively looking at ways to bring down the cost of care by engaging at different levels like regulating prices and investing in healthcare infrastructure. In fact, Ayushman Bharat, the National Health Protection Scheme which recently crossed 50 lakh treatments mark, is said to be the game changer in the Indian healthcare landscape. And finally the whole healthcare landscape in India is exploding with new innovations and ideas that have the potential to make a positive change in the world. Amidst this challenging environment,

November 2019

like a silver lining to the cloud, are the leaders who are working effortlessly to give a new perspective to healthcare delivery and are leading businesses to new heights. Just as Jeff Thompson, MD, author and CEO emeritus at Gundersen Health System, says the goal of leadership should be to move everyone forward – people, organizations and communities – instead of focusing on moving one individual forward. This new breed of Young Leaders are bringing about change in not only the top lines of their companies but also in the lives of the people who depend on them. The Leading Light There have been many pathfinders in healthcare who have brought paradigm shift not only in the way healthcare was delivered but also perceived in India. Some of them are very well known in the industry like Late Dr G. Venkataswamy, former chairman of Aravind Eye Hospitals; Dr Prathap C. Reddy, Chairman, Apollo Hospitals; Dr Devi Shetty

(Chairman & ED, Narayana Health) and Dr Arvind Lal, Chairman & Managing Director of Dr. LalPathLabs, LateNarindraNath, founder HMD Group; Dr Y.K. Hamied, Non-Executive Chairman Cipla; and Dr HabilKhorakiwala, Founder Chairman, Wockhardt to name a few. These visionaries have not only created successful business but most importantly affordable and accessible healthcare in India. Inspired by this generation of leaders we see a new wave of young leaders. These exceptional young leaders are the ones who are moving the needle on some of the most pressing challenges in healthcare today. They believe in the vision of their founders and are working to communicate the vision and motivate others to pursue that vision. These leaders are committed to their growth trajectory but remain concerned about some of the roadblocks that they have to navigate in order to make healthcare available to all. Through this feature we bring forward five such exceptional “Young leaders”.

Bhargav Kotadia, Managing Director, Sahajanand Medical Technologies Strategic, multi-tasking, ambitious and responsible are some of the traits that come to your mind when conversing with Bhargav Kotadia, the Managing Director of SMT (Sahajanand Medical Technologies). SMT is one of the largest medical stent manufacturers in the world, with a presence in over 60 countries. Bhargav deepened his involvement with the Sahajanand Group by the start of 2013. He initiated a structural transformation of the group while implementing best-practices, which would enable strategic and long-term success for the companies under the Sahajanand Group. Simultaneously, Bhargav made his teams pursue product developments, cost efficiencies and business growth. In the coming years, he plans to make SMT one of the leading cardiovascular devices companies in the world. His dream is to make India the center of Medical devices innovation & manufacturing for the global markets.

eadership is the ability to create the right platform and environment for the team; to develop steps to setting the vision and the direction for the entire company. The challenge is to create the right environment so that we can attract the best talent to fulfill the vision and the direction of the company. To build the right set of tools the right set of philosophies which aligns with the culture of the company is our goal. On Challenges Scaling up, I think, is the biggest challenge for us. To manage the scale, manage that momentum of a company like SMT is huge. We have got the right product the right ingredients and we need to grow from where we are today to the global scale which is our ambition. All of this while making sure that for our life saving devices quality is not compromised. This will continue to be the challenge for us for the next 4 to 5 years. Advice to Remember At a very young age both me and my sister were taught that the mission in our life is to make the world a better place. It does not matter what path you take to achieve this but in the end, what you do should make a positive difference in the society. This has given direction and meaning to â&#x20AC;&#x2DC;whatever we do we strive to work towards it and try to live itâ&#x20AC;&#x2122;. Future Plan Our focus is on scaling up and for the next five years we would like to replicate the success we had in India, globally. We are present in 60- 70 countries across the world and our aim is to gain greater penetration in these global markets in the next five years. Beyond this, we would like to expand our product portfolio. Currently we are focused on stents but we would like to look at other equipment and devices that the surgeons use in vascular surgery.We would like to use the infrastructure and network that we have established to expand beyond just coronary stents. Over the next five years we would be expanding across the vascular domain

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COVER STORY

Dr Sheriff M Sahadulla, Executive Director and CMO, KIMSMD Dr Sheriff Sahadulla has over 16 years of experience managing several hospital Medicine programs and serving as the Medical Director of leading hospitals in USA. After he obtained his MD from Tufts University School of Medicine, he went on to do his residency in Internal Medicine at the University of Michigan. Dr Sahadulla has held various administrative positions including Medical Director of the Hospitalist Program at Falmouth Hospital and St Joseph Hospital. He has also been the Vice-Chairman of the Department of Internal Medicine at Falmouth Hospital and a Clinical Instructor at Tufts University.

Viren Shetty, Executive Director and Group COO, Narayana Health Viren Shetty, Executive Director and Group COO, Narayana Health wants to make Narayana, the largest healthcare provider in the world. Envisioning bed strength of 30,000 by 2020, Viren took over the mantel of COO recently and is responsible for identifying new growth opportunities for Narayana Health. He is also extensively involved in devising cost-optimization measures, a distinctive characteristic of operations at Narayana Health. He has been responsible for identifying new growth opportunities for the Group Companies. Mr. Viren Shetty was responsible for designing and commissioning some of our large units including Mazumdar Shaw Medical Centre and the NH Multispecialty Hospitals in Jaipur and Ahmedabad. Viren joined Hospital Engineering Services department of Narayana Health (then NarayanaHrudayalaya) in 2004. As the network of hospitals grew and was ready to be supplemented with more projects, Viren actively streamlined the supply chain across the network and strategizing the groupâ&#x20AC;&#x2122;s growth.

November 2019

Jatin Mahajan, Managing Director, J Mitra & Company Jatin Mahajan is the managing director of J Mitra & Company, and the person responsible for spearheading the phenomenal growth and international forays of the company. He has steered the company to its present glory – regional leader, exporter to over 45 countries, and more than 55 patents. Jatin is a well-established name in the medical fraternity as a promoter of excellent quality medical diagnostic test solutions for the detection of various infectious diseases. His cost-effective, safe, and international-standards compliant products are used by most of the big names, and his clientele reads like a who’s who of the medical diagnostic fraternity. It is his drive for quality and excellence that has resulted in the company bagging more than 55 patents in this industry, and the title of “India’s Patent King” by Wall Street Journal. A regular speaker at Industry forums like ASSOCHAM, AIMED and Voice of Health, Jatin is an MBA from the renowned International Management Institute, New Delhi

On Leadership Leadership is not just a title; effective leadership is when you empower your teams to take action together. On Challenges When my father, Lalit Mahajan started the company way back in 1969, all diagnostic requirements were managed through imported solutions. As the economy grew and liberalisation happened, we realised that the rules and regulations in the country were not completely in favour of home-grown companies. When the reigns of the company shifted to me, I undertook the onerous task of taking the company fully global, to carve out newer markets so that the onset of relatively cheaper (though at times, lesser quality products) imported diagnostic products would not hamper our growth. It was a huge challenge. Advice to Remember I’m a strong believer in social and business ethics. This is one aspect that has been the foundation of the company, and if I were to focus on one aspect, then this is the one that has resulted in placing us at the helm of the business in our category. If your ethics are unflinching, then the cosmos conspires to make you a success. Future Plans The potentials are huge, and we are very optimistic that our growth rate would continue to increase. A lot of our initiatives in the last couple of years have completed their gestation period, and have now started bearing fruit. The outlook is very positive – the future is bright!

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COVER STORY On Leadership For me, leadership primarily boils down to effective people management. It involves Succeeding through the talent of people i.e. identifying the perfect fit between individuals and their job. Secondly, I believe leadership is also about motivating people to give their best without even making them feel that you have encouraged them to deliver. Making each individual develop a sense of ownership for the organization’s vision is the biggest success that a leader can achieve. Lastly, leadership is being decisive. No one can prophesize whether a decision is right or wrong before the outcome is achieved. Leaders must be capable of making informed decisions considering all the facts at their disposal, follow on their instincts and be agile enough to course-correct as the results start developing. On Challenges India is such a vast country with varying levels of economies and preferences in its different parts. Developing products which appeal to all the regions of the country including the metros and the remote tier 3 & 4 cities, at a price point which is affordable to all of these areas is, I believe, a key challenge that we face. Another challenge, in the medical devices manufacturing space, is the regulatory environment of India which provides very little leverage to the manufacturers who manufacture it in the country. The regulatory environment also leads to a volatile competitive landscape and high price pressures. Purchasing medical furniture is a capital expenditure and with the recent decline in the GDP numbers and a bit of downfall in the overall economy, we see hospitals not keen into taking up larger expenditures. Advice to Remember Many of my mentors and elders have given me a lot of advice on how to pursue my vision and the one advice which has been a constant theme across the years was to be empathetic. Only when you are empathetic towards your own people, your customers, your shareholders and the society as a whole, you’ll be able to ensure that your vision comes to fruition. A lot of people think that leading a group means pushing the people and barraging them day-in and day-out so that they give their best. However, I believe that when you are empathetic towards your fellow teammates, you can get the best out of them. Being empathetic towards our consumers helps in designing products that are best suited for their needs. Being empathetic towards society helps you create value not only for your shareholders but for the community as a whole. Future Plans I think the future of healthcare is very bright in India. I strongly believe that India is ready for the next wave of healthcare revolution which is going to come from the Tier 2, Tier 3 and even Tier 4 cities and that is where our efforts at Midmark India are currently focused. We intend to expand our footprints rapidly across the country and also work on improving our global footprint which is again a key component for our future.

November 2019

Sumeet Aggarwal, Managing Director, Midmark India Sumeet Aggarwal leads Midmark India Private Limited and has been its Managing Director since 2016. Midmark India is a subsidiary of Midmark Corporation, USA and is the leading manufacturer of hospital furniture in India. Sumeet has worked in the Healthcare industry for more than 15 years and has been associated with Fortis Healthcare, the World Economic Forum and Deloitte consulting in the past. An MBA degree holder from Insead, Singapore with a Bachelor’s from the University of Arizona, Sumeet has been recognized by the Asian American Business Development Centre amongst the Outstanding 50 Asian American in Business and has also been conferred with the Global Achievement Award by the Alumni Association of the University of Arizona! A member of Young Professional Organization’s (YPO) Global One forum and member of NATHEALTH governing council, Sumeet is considered to be a thought-leader and a sought after resource in the Indian Healthcare Industry.

MARKET CONNECT Medirays Vying For Bigger Share in

Radiology Market

How has been the response from the radiologist fraternity to your business? We are humbled to have such a supportive install base, whether it is in India or overseas. Customers believe in Medirays brand because of our reliability and our focus on building relationships through the products we sell. One may judge this by looking at our install base, especially doctors who have been our customers for more than a decade.

edirays Corporation, Mumbai based imaging company has taken giant leaps to make its presence felt in the radiology market. Riding on technology and business innovation, the company has seen phenomenal growth in the past couple of years. Ready with a new set of radiology equipment, Medirays is bullish on conquering the Indian Radiology and imaging market. Ravikumar, President and Rajesh Nair Vice President, Medirays Corporation talk about how the company is paving the path to excellence in the radiology segment.

Tell us about Medirays Corporation’s inception. It started way back in 1983 when Ravikumar started a company called ‘Electromed’. At that time, the market was for X-ray and fluoro systems. Electromed used to provide refurbished x-ray machines of GE and Siemens to the Tier 2 and Tier 3 cities. Medirays was founded in 1999 and our vision was to create a state-of-the-art refurbishing facility with focus on providing cost-effective system and best in class, after sales services. Briefly tell us how Medirays started evolving and the company position at that time? Medirays continued with providing quality refurbished X-ray and Fluoro imaging systems. As year passed by, we upgraded our range of products and included Ultrasound scanners, CT scanners, Permanent MRI and then Supercon MRI systems through the years. What were your initial business challenges and how you overcame them? Our main challenge was to be a complete independent service organisation. As we upgraded our products, we realised that the circuit boards

and GE 1.5T MRI systems. After the restrictions imposed by AERB on imports of used CT scanners, we started talking to companies regarding collaboration for new CT scanners. At present, our product basket includes: • New 32 and 64 slice CT scanners from SinoVision • Open 0.5T, 0.4T and 0.36T permanent magnet MRI from Wang Dong Medical (WDM) • Refurbished GE 1.5T MRI systems. • Refurbished GE CT scanners ( procured from India through AERB)

and components which drive these products, are not openly available in the market and were also quite expensive to procure. In order to overcome this challenge and provide a cost- Ravikumar effective after sales services, we build our own ‘Circuit board and power supply repairs lab’ in our facility. For these labs, we procured state-of-the-art circuit board repair and programming workstations and workbenches. We hired engineers specifically for this purpose and enrolled them into training programmes. Through this lab, we now have achieved close to 80 per cent success in repairing circuit boards of CT and MRI systems. Currently, what is Medirays’ product portfolio and offerings to the industry? We filtered our product ranges to refurbished GE multi slice CT scanners, Hitachi permanent MRI

What according to you are the key elements that define product success? The company’s principles, people, customers, markets are all drivers of Rajesh Nair growth and it starts with keeping a happy working team in your organization. Tell us about your overseas business, which countries do you export and what is the nature of technology demand there? A few years back, we started our exports business in Africa, and through years, a few customers from Middle East and South East Asia countries have been added to our customer base. Most of these countries demand cost-effective imaging solutions. Since we have a good refurbishing facility, we also offer training to our dealer engineers so that their team can also do ground level servicing of these products, with spares support from our side. What are the potential market opportunities that you foresee for Medirays in the near future? We see a technical collaboration to introduce good quality, cost-effective imaging products, backed by our well-acknowledged service support could be a good opportunity for Medirays. In order to make the product competitive both in terms of quality and price, we are planning to get them through ‘Make in India’ initiative.

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APPROACH

Medicine, business and leadership development New academic approaches to train next generation healthcare leaders University of Pennsylvania School of Medicine

TRAINING HEALTHCARE leaders is a need not an option. As the complexity of diseases and disorders evolve, healthcare delivery has to keep pace and more healthcare leaders are required to navigate these emerging challenges. A perspective study published in the New England Journal of Medicineurges medical schools to focus their efforts on training more physician leaders to master the diverse skills needed to navigate emerging challenges in the field. “Academic medicine has been somewhat complacent in the face of the disruptive forces in health care, and as a result, the gap between the physicianleader workforce and the needs of our system has only widened,” says J. Larry Jameson, MD, PhD, executive vice president of the University of Pennsylvania for the Health System and dean of Penn’s Perelman School of Medicine. “Health care systems need a new prescription to close this leadership gap. Given the societal impact of health care, we need to accelerate the development of skills that are not typically acquired during traditional medical training.” New Challenges Historically, physician leaders have been chosen based on their national prominence and excellence as master clinicians, star researchers, and revered educators. While these credentials remain important, they aren’t sufficient in the current health care climate, the authors write.

26 November 2019

Today’s physicians practice in an era of changing payment models, rising costs, IT advances, and emerging technologies and therapies that are reshaping the delivery of patient care. Dynamic changes have also come with ongoing health system mergers and market consolidation. To lead effectively in this environment, doctors need not only sharp clinical expertise, but also opportunities to hone their communication, team building, and decision making skills, and gain knowledge of finance and business. Jameson and co-author Caryn Lerman, PhD, vice dean for Strategic Initiatives and the John H. Glick, MD Professor in Cancer Research in the department of Psychiatry in the Perelman School of Medicine, suggest health systems focus on three strategies to create this new wave of leaders: rigorous mining of diverse talent pools to identify the most promising emerging physician leaders; building pipelines of future leaders with targeted leadership development to enable progressively increasing responsibility; and deliberate onboarding processes to integrate new leaders and assure alignment across missions and with the institutional culture. Professional Development Training in finance and business planning and personnel management should be central to professional development, as many physician leaders may manage budgets similar to those

of medium-sized businesses, for example, and work in organizations which are among the largest employers in their community. “Given the high rate of turnover among physician leaders, such as department chairs and deans, we can no longer afford to neglect the skills that are essential for leaders to succeed,” they wrote. “We believe there is a need for a new generation of leaders who can promote strategic and cultural alignment in the face of rapid change.” Executive Education Program At Penn, the Perelman School of Medicine has joined with the Wharton School to create an executive education program which launched in 2019 for health care and academic medical leaders from across the nation and world. The program provides targeted leadership development experiences and practical skills to enable today’s and tomorrow’s leaders of health systems and academic medical centers to adapt to a rapidly changing environment. Beginning with its first four-day course in March 2019, the program provides a strategic toolkit to cement the ability to lead at a time when science, technology, and economics are reshaping the practice of medicine and altering the field’s economic landscape. The next course is on April 16 – 19, 2020.

The new endeavor joins the Penn-Wharton MD/Master of Business Administration (MD/ MBA) program, which is designed for medical students interested in integrating their medical course work with training in managerial, financial, and technical expertise in the health care field. Quality Residency Another example is Penn Medicine’s Healthcare Leadership for Quality Residency Track. This two-year training pathway for future physician leaders is one of only a few in the country to offer a pathway for residents aspiring to be leaders in health care quality, patient safety, or informatics. So far, more than one hundred residents have participated in the program. To help meet the challenges of an increasingly complex landscape, the authors say, health systems should make leadership development an organizational priority - an emphasis which will also pay off in improved patient satisfaction and clinical outcomes. “The 21st century physician leader must be equipped with a new tool kit of skills for the leadership agility necessary for them to respond proactively to rapidly changing environments,” Lerman says. “Leadership development should be an organizational priority, preparing today’s medical students and physicians to thrive in a continuously evolving era of health care.”

Academic medicine has been somewhat complacent in the face of the disruptive forces in health care, and as a result, the gap between the physician-leader workforce and the needs of our system has only widened

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HEALTH IT

Can Blockchain Heal India’s Healthcare System? Ishiqa Multani, President-Sagar Group of Hospitals, Advisor- Dayananda Sagar University

November 2019

WITH A POPULATION of more than 1.3 billion people, India faces multiple challenges when it comes to the secure and efficient storage of patient health data. The linguistic, geographic, ethnic, and religious diversity of the nation can make it difficult for healthcare providers to track data and communicate with one another. When information is not shared effectively and accurately, patient health is put at risk. Inefficiency when it comes to patient data also creates opportunities for fraudulent activity which weakens the strength of our healthcare system as a whole. To reduce inefficiencies and provide a common standard of data storage and sharing, a common record keeping system using Blockchain ledger technology may represent a solution to the daunting challenge. A blockchain system uses cryptography to compile a growing list of records— known as blocks— which contain transaction data and timestamps to preserve all relevant information. The nature of this technology prevents entered data from being modified while still enabling parties with access to these records to enter new information as it occurs. In other words, blockchains can record history of activities in digital blocks that are tamperproof. This would create a secure and easily accessible permanent patient files which,

using password protection, records the data of every person opening or accessing patient files. A Blockchain system could, conceivably, track each patient’s visits to healthcare providers, the results of those visits, and information about all prescriptions, insurance claims, and any other relevant data. Not only would access to this information help to keep healthcare providers informed about their patients, thus increasing patient safety, but an accurate and detailed record would help to limit healthcare fraud. The nation of Estonia recently transferred the health records of all of its citizens into a Blockchain-based system with great success. The question remains: would Blockchain work on the large scale required by virtue of India’s population size? Currently, many health providers in India use the Electronic Health Record (EHR) program to record and track patient health information. While this is definitely a step in the right direction, there is no standardization in the codes and vocabularies used by India’s various health institutions—essentially, this lack of uniformity ensures that different institutions are unable to communicate effectively with one another. If India was to implement a common healthcare Blockchain enabled platform, every single patient in India would be provided with their own unique identity through this network. India has already taken a right step in digital direction by successfully implementing the national digital identity system- Aadhaar. As for blockchain based healthcare platform, clinical data would be stored within Blockchain

using a standardized reporting form that also utilizes EHR data and content. It remains to be seen whether Blockchain can operate efficiently at the scale required by India. In addition, securing data-related citizens are critical. As we have seen with the EHR system currently in use throughout our nation, the lack of a uniform IT system for healthcare has created huge inefficiencies and potential for error. In addition, despite India’s reputation as a hub for IT professionals, we still lack the basic digital infrastructure necessary to use Blockchain in many areas of the country. Clinics and hospitals which still handwrite patient information and only use physical files rather than digital are not yet prepared to jump feet-first into the Blockchain environment. This is an issue that must first be addressed before we can look to Blockchain as a realistic solution. Nevertheless, India is known for the

innovation and skills of its IT professionals, and just because Blockchain has not been tested at the large scale does not mean it is impossible. Collaboration between India’s government and software companies could lead to the creation of a healthcare specific Blockchain system which is designed to accommodate the needs of large and diverse nations such as India. The possibilities represented by Blockchain adoption are exciting and achievable. India can create a unified digital health system that will improve patient health and the overall efficiency of our healthcare system. This endeavor will require strong leadership and collaboration from all sectors, including the government, the IT industry, and our nation’s healthcare providers. By working together towards the common goal of improve healthcare technology, India can mark itself as a true innovator in digital technology.

A Blockchain system could, conceivably, track each patient’s visits to healthcare providers, the results of those visits, and information about all prescriptions, insurance claims, and any other relevant data

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INTERVIEW

Digitisation is a key topic for us André Hartung, Executive Vice President Computed Tomography and incoming President Diagnostic Imaging and Peter Seitz, Executive Vice President Surgery, Siemens Healthineers AS A PART of its strategy for India, Siemens Healthineers recently integrate manufacturing, technology and innovation functions at Bengaluru. In this regard, the company has setup a new manufacturing facility that is collocated with its R&D center to better leverage synergies while developing offerings aligned to the future needs of its customers. At the inauguration of the facility, André Hartung, Executive Vice President Computed Tomography and incoming President Diagnostic Imaging and Peter Seitz, Executive Vice President Surgery, Siemens Healthineers spoke to M Neelam Kachhap about the company’s India strategy. How do you see the India market as compare to the other markets for high-end medical devices? André Hartung: This is one of the most dynamic markets in the world. If you look globally you see markets that are growing in the range of 2-3 % per annum. However when you look at India you see double digit growth in the range of 10-12% and if India continues with this momentum it might as well become the third largest market for our business. The importance of India for us has been increasing steadily. What is the market perspective that you see for the mobile C-arm in India? Peter Seitz: Size of market is a little difficult for me to answer. To make forward-looking statements about how many equipment we are

30 November 2019

going to sell is difficult but what I can say is there is a significant market for all our products including this portfolio that we see today. From the global market of mobile C-arms India has the potential of around 10% of the market. The biggest markets are United States and China. India especially in terms of mobile C arms has a huge potential. In the last couple of years this (C-arm) has been used for versatile imaging of orthopedic trauma, spine, pain management, gastro and urology surgeries. So in orthopaedic surgery I would expect a significant higher growth in the mobile C-arm market in India than we would see in more established markets. For this product alone in India we are talking about triple digits growth in unit sales. What is your strategy and plans for India with this new manufacturing facility? André Hartung: One aspect of course is to start off with Somatom-go production. We have selected a product that is pretty well suited for the market in India because It was designed for the customers in India. From the quantity point of view we sell more Somatom-go in India then in other countries. The global installation base for Somatom-go is 1000 units and there India is the strongest, about 300 to 350 units are in India. There are two reasons for this. One we understand how the supplier landscape has developed for the Hi-Tech medical devices in the last couple of years. We know that a large number of suppliers have moved in from

other industries into this area like precision mechanics. It would be interesting for us to see a partnership possibility. Additionally, we want to have more focused client management here. For example product management somebody would look into the product development and business development part in the Indian market and also see if there are opportunities for the products. We have similarities in the markets where we intend to invest more with India so we can have like a local for global model. We will look at markets like Africa but the main difference in India is that the infrastructure is well developed; the talent pool is good with very high educational level. And you said youâ&#x20AC;&#x2122;ll also export from this facility? Peter Seitz: This facility is too new. We have not started exporting from here yet but from

the beginning it has been the plan to produce from here for global sales. Which markets would you be targeting? Peter Seitz: For mobile C-arm first we will look at the emerging markets; South East Asia, Africa and Latin America. But from the feedback we are getting so far this product has the potential to grow beyond the emerging markets as well. This is because in the more developed markets there is a need for high value products which are easy to use. The main reason why we have built this product here is not because we have a good cost position but this is a product that is really easier to use then the product we have had earlier. This (Innovative touch-and-play concept) actually is a need that every single market has. For example surgeons in Germany could use something like this. A surgeon would say â&#x20AC;&#x2DC;look I am not doing 50 hi-end endovascular

If you look globally you see markets that are growing in the range of 2-3 % per annum. However when you look at India you see double digit growth in the range of 10-12% and if India continues with this momentum it might as well become the third largest market for our business Photo Credit Siemens Healthineers

AndrĂŠ Hartung, Executive Vice President Computed Tomography and incoming President Diagnostic Imaging and Peter Seitz, Executive Vice President Surgery, Siemens Healthineers inaugurating the new facility.

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INTERVIEW We sell more Somatomgo in India then in other countries. The global installation base for Somatom-go is 1000 units and there India is the strongest, about 300 to 350 units are in India

32 November 2019

procedures a day I am doing two orthopedic surgeries a day and I don’t have any imaging equipment for that; equipment that is easy to use and has good imaging quality.” So they can use our mobile C-Arm. So I would not be surprised if there is more demand from different parts of the world for this product (mobile C-Arm).

but for our industry where the quality and precision is of utmost importance and also there is a lot of regulatory issues; 3-D printing uptake is not much.

From growth perspective what are your expectations from this market? André Hartung: See our growth relies also on the investment of infrastructure in healthcare in India. There is a message that there will be more investment in the public system. In addition, the private sector is facilitating healthcare to a very high degree. We would expect that in the next couple of years there would be a strong move in the public health sector as well.

But today there are companies using FDA approved raw materials and certified process for making machine components. What about such companies? Peter Seitz: Yes, with US FDA approved 3D printed parts and components, it’s only a matter of time before we see a wider uptake of 3D printed parts globally as it has huge benefits for global logistics concepts. As we already have today few main service hubs worldwide. Not all the parts that we ship from these hubs are sourced locally. We have some parts that are entirely sourced from Germany and are then distributed to service hubs so it could make logistics potentially faster.

Would you be using 3D printed parts in manufacturing at this facility here? Peter Seitz: This technology (3D printing) is very beneficial from logistic point of view,

It is your aim to reach your customer faster isn’t that why you started manufacturing in India? Peter Seitz: That is one of the reasons yes but

since we are not only shipping in India but we are looking at global shipment, its not correct to say we started manufacturing here just for that. Typically the lead times, when a customer orders a C-arm worldwide, are almost the same 3-6 months. In this case of course the Indian customers ordered we could deliver faster when we shifted from the factory here. I think speed is not the number one criteria why we came here I think it is really for the expertise. What about pre-owned equipment? Are there any provisions in this factory to refurbish existing equipment? Peter Seitz: This factory is too new for that, since we have started manufacturing early this calendar year. And we have not yet established a pre-owned process. I guess it’s just matter of time. Typically, for most of a business and products, since many years we have established process to take equipment back refurbish it and then sell it with the same guarantees and warranties as the new equipment. But we typically refurbish it at the factory where it has been manufactured, where you have the engineers and all the expertise. Since this factory is only shipping for a very short time and this product is also new and has been in the market for the past seven months we don’t have any equipment which is coming back. What about equipment already existing in the markets that have been shipped from other manufacturing hubs? Can these be refurbished here? Peter Seitz: I think it is very realistic that this factory here which is designed in two floors one for CT and one for mobile C-arms can have refurbish process. The shop floor for mobile C-arms would be capable to refurbish mobile C-arms as well. Infact, it is a mid-term perspective to have refurbished program here. Today the factory is simply too new for that. As I mentioned I have responsibility at the moment for three factories; one in Germany and one in Shanghai and the other two are already doing it.

What else finds prominence in your scheme of things? Peter Seitz: Entire topic of digitization is a key topic for us. Yes, we have now started the manufacturing of the Cios Fit-a multidisciplinary mobile C-arm, a basic product, just for the beginning, but I think this is only the first step. The mechanical innovation and engineering is one step but the future of these procedures is to assist the surgeon or the interventionist with analyzing the data and with machine learning to really have guidance within the procedure about what to do better. Already, today we are at the brink of creating something amazing. We are already putting all the patient information together to simulate a digital twin and simulate and analyze if the procedure is already good enough. At the moment we’re trying to make all this data available to the surgeon to plan the procedure and to perform the procedure. But I think with all the data that is out there; adding all the pool of data with machine learning in the near future would allow us to give intraprocedural guidance. A simple example is most of the good cars today have parking distance control, where before you hit anything behind your car the car warns you. In surgery this does not happen yet. We have navigated procedures but I think it is almost no brainer that in a few years from now a surgeon will get either a visual or an acoustic warning like ‘don’t cut further or you would be hitting a vessel’. This type of expertise where an algorithm analyses the anatomy where the surgeons is operating and gives intra-procedural advice for example there is an 80 per cent likelihood that if you continue to cut further then you hit a vasculature. This is something that would absolutely transform the surgical procedure. We have started to work on this. We have several procedures that we are working on. We are working on algorithm for different procedures. Like in cardiac therapies ablation procedures for treatment of atrial fibrillation where you set ablation marks, induce scar tissue this could be useful.

It’s only a matter of time before we see a wider uptake of 3D printed parts globally as it has huge benefits for global logistics concepts

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SPECIAL FEATURE

Diabetic Foot Dilemma Dr. Govind Singh Bisht, Principal Consultant – Podiatry (Foot care), Max Super Specialty Hospital Panchsheel Park, New Delhi

THE HUMAN foot is an immensely practical, beautifully designed structure built to bear many times its weight thousands of times a day and bounce back and ready for more. Feet carry whole body weight in a way when we stand or walk whole body weight is distributed properly in forefoot and hind foot and no part of feet goes for uneven body weight bearing. There is an arch which distributes body weight in evenly manner. When there is uneven distribution of body weight, by flat feet, high arch feet, wrong foot wear, wrong kind of gait and any other deformity of foot, then certain areas of feet go for excessive wear and tear and deposition of dead skin which causes formation of corn and callosities. Sometimes these corns and callosities can be very painful and daily routine activities also become difficult. COMMON FOOT CONDITIONS Corn, Calluses and Plantar Warts Corn and calluses are common conditions that arise when there is excessive pressure on some part of the feet; these are common on bony prominences. Plantar warts are because of Verrucae Virus an infective condition that a person gets from a contaminated surface. The best way to treat a corn or calluses is to re-distribute pressure with help of an orthotic or an insole. Surgery should be

November 2019

avoided for corns, calluses and warts unless it is having pus, otherwise scrapping of corn and callosity by a Podiatrist is advisable. Corn caps available in market work in few people but at times it causes chemical burn of surrounding skin which gets infected and it unnecessarily requires a surgical intervention. Corn caps are strong no for a diabetic patient. In a plantar wart it should not be used. Dry & cracked Skin Some people have tendency for excessive dry and cracking of skin which at times leads to pus formation. Fungal infection of Feet or Athlete’s Foot Fungi are attracted to warm and moist areas of the body such as the feet – usually between sweaty toes. Unprotected feet can contact fungi from a lot of places, including swimming pools, shared changing areas. Nail problems Infected in growing toe nail condition is very common and recurring kind of problem which at times starts with wrong nail trimming. One should be very careful in trimming their nails if it is difficult to trim the nails one should go to a Podiatrist before the condition becomes bad and require any kind of surgery. At times nails are thick discolored and distorted which can be because of fungal infection of nails for which antifungal treatment can be taken from foot doctor. Other painful feet conditions Some of other common painful conditions of feet are heel pain, Metatarsalgia a condition in which the balls of Metatarsals are painful, bunion deformity, tendonitis, sprains, soft tissue injuries of the feet are other common painful conditions. Diabetes Patients Must Be Aware In India there are more than 60 million people having diabetes. There are about 60,000 amputations every year because of diabetes in India. As everybody knows wound healing is delayed in diabetics, so diabetic patients should protect their feet from any kind of

trauma, infection or any other insult. Half of the amputations are because of negligence or because of casual attitude of people about preventive diabetic foot care. After 10 years of diabetes, nearly up to 60% of diabetic have decreased or complete loss of sensation in feet called as numbness or neuropathy. Patient may complain of burning, tingling, numbness, crawling of insect like feeling in feet or walking in a mattress like feeling which are an indicator of weakness of nerves carrying sensation for pain, touch, temperature, position and vibration and irritability of nerves gives above mentioned symptoms to the patient For diabetic patients it becomes very important to take care of their feet, as rightly said “if you have diabetes, take care of your feet as you take care of your face”. Other Diseases which can cause foot problems Various diseases can impact the feet like gout is caused by increased levels of uric acid in the blood which causes inflammation of various joints including that of feet. Recent advances in the diabetic foot ulcer treatment DFUs represent a current and important challenge in the development of novel and efficient wound dressings. In general, an ideal wound dressing should remove wound exudate, offer protection from secondary infections, provide a moist wound environment and promote tissue regeneration. Currently, there are different types of commercially available wound dressings that can be used for DFU treatment which differ on their application modes, materials, shape and on the methods employed for production. Dressing materials can include natural, modified and synthetic polymers, as well as their mixtures or combinations, processed in the form of films, foams, hydrocolloids and hydrogels. A wide variety of advanced treatments for diabetic foot ulcers, such as Topical growth factors, Bioengineered skin grafts (BATs), VAC (Vacuum Assisted Closure) Therapy, and hyperbaric oxygen therapy (HBOT). Recently,

Dermozone range containing+dalethyne compound has been launched in India. This product has promising role in treatment of non-healing chronic wounds including DFU. Though recent advances in the management of Diabetic Foot Ulcers have increased our abilities to salvage the lower limb, the best management still remains prevention. This can only follow with intense patient education about foot care and a proactive role in treating the factors which lead to these foot problems. FOOT FACTS

 25% of bones in the human body are located in the feet, each foot is made of 26 bones and both feet make it to 52 bones out of 206 of whole body bones.  The average person walks about 10,000 steps a day.  During a lifetime the average person will walk more than 250,000 miles.  Toenails and fingernails grow fastest in hot weather, in pregnancy and during the teen years.  The ancient Romans were the first to create distinct left and right shoes; previous to that all shoes could be worn on either foot.  Your average foot gets two sizes longer when you stand up.  A 2½-inch high heel can increase the load on the forefoot by 75%.  The average foot expands about five percent in volume as the day goes on.

References  ActaBiomater. 2013 Jul;9(7):7093-114. doi: 10.1016/j.actbio.2013.03.033. Epub 2013 Mar 27.

 JIMSA October - December 2011 Vol. 24 No. 4

 The most common foot injury is plantar fasciitis (Heel Pain) which is pain under and in front of the heel.  Runners hit the ground with a force of two and a half times their body weight.  Walking is the best exercise for your feet. It also contributes to your general health by improving circulation, contributing to weight control, and promoting all-around wellbeing.  Your feet mirror your general health. Conditions such as arthritis, diabetes, nerve and circulatory disorders can show their initial symptoms in the feet - so foot ailments can be your first sign of more serious medical problems.  The two feet may be different sizes. Buy shoes for the larger one.  Walking and running shoes are your most important accessories, when buying footwear one should give priority to comfort not to style.

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SPECIAL FEATURE

How are Robots changing Healthcare? Dr. Manohar B, Senior Consultant Urologist and Renal Transplant Surgeon, Columbia Asia Hospital, Sarjapur Road`

November 2019

FROM THE stone age of handmade tools to the 21stcentury technological age of gadgets, man has evolved leaps and bound. From the times of washing clothes with hands to now fully automatic machines doing this, from the times of handwriting the accounts to now have computersand calculators for it, from animal driven wheel carts to self-driven cars, from writing letters as a means of communication to making live video calls in any part of the world, from simple LAN phones to super-smart cell phones that literally contain everything, humans have come a long way in advancement of machines and technology and also the dependency on it. Like all other sectors that have been touched upon by technological advancement and gadgets, healthcare sector too is significantly changing not just in the form of new medicines and treatment options but also with digital technology aiding doctor in better diagnosis and more accurate treatment. Development of medical robots is one of such man machine innovations in the medical field The rapid advancement in the field of robotics is certain to facilitate effective outcomes in management of some diseases. This does not mean machines are replacing doctors. It is just that use of robots aid the medical profession to get accurate results with minimum interphase. Robotic surgery for instance, is eventually being deemed by many as a safer than open surgery, simply because it means lesser handling of tissues, precise reach to the operative site, lesser blood loss and lesser infections

Why robotic surgery is preferred?  It is considered by many as safer and more aprecise  The hospital stay is reduced  Lesser risk of infection  Decreased pain and discomfort  Faster recovery  Lessened blood loss and transfusions  Smaller scars as robot’s limit injury to the affected area Though the costof infrastructure is high andspecialized training requirement for those operating via robots, the novelties displayed by robotics in medicine is proving that they are not just useful but also critical in modern medicine. Artificial intelligence (AI) is swiftly making its way in our lives and is being used in medicine in many ways with several applicationsto analyze complicated medical data, compute information, and assist physicians in improving the outcomes of treatments for the patients, etc. and the potential only looks limitless. Importance of robotics in medicine are:  Robots act as medical assistants, entering patient vitals from monitors to electronic medical records  Remote controlled robots are also being by surgeons who operate them from a console  For telepresence, that allows physicians to examine patients in remote locations and provide them necessary treatment  Rehabilitation robots are playing a significant role in the recovery of people with disabilities by helping them improve mobility, strength, coordination etc.  Robots are also being used for medical transportation to deliver medicines, meals

to patients and staff, in addition optimizing communication  Many healthcare facilities have started using robots to clean and disinfect surfaces, especially with the rise in antibiotic-resistant bacteria and outbreaks of deadly infections like Ebola  Comparatively safe and less invasive surgeries Following are a few medical robots that have marked their presence: I. daVinci Becoming standard for Robot Assisted Surgery, daVinci has been obscuring differences between ‘robots’ and ‘medical tools’ by being under the complete control of the surgeon and aiding the operations to be conducted with only a few tiny incisions very precisely allowing less bleeding, quicker healing and reduces infection risk. II. Orthoses (Exoskeletons) By providing an extra support to the weak muscles, exoskeletons are being used to assist paralyzed people in walking again,

correct malformations, for rehabilitation after spinal cord injuries, etc. III. Disinfectant bots Like it or not, hospitals can be among the most unhygienic places making rooms for treatments for various diseases but also housing infections and can sometimes become the breeding ground for some of the worst antibiotic-resistant bacteria. Hence it becomes crucial to ensure sanitation and cleanliness at all times in the hospitals and that is where the modern disinfecting robots are proving of great use as they autonomously move room to room of discharged patients and get rid of every tiny microorganism left alive through high-powered UV rays. IV. Clinical Training Bots These are a saving grace for many surgeons for whom practical learning happened either while on the job or on cadavers. But with these bots, they have a chance at first hand treatment with these life-sized trainees having realistic blood to make sure the surgeons know what they

are doing when they are put at it. Companion Bots For people who are exposed to chronic loneliness and lack stimulation like the elderly or disabled and also the ones who require regular check-ups with constant care, companion robots are a boon solving all these problems at a single shot. VI. Robotic nurses From filling digital paperwork to measure important symptoms and monitor patient’s condition, etc. some of these robotic nurses are actually easing the overburdened nurses who are the center of life at a hospital. Actuated and sensory prostheses, endoscopy bot, targeted therapy micro-robot, telepresence robot surrogates, pharma-botics, AI diagnostics, Robotic Assisted Biopsy, AI epidemiology, Antibacterial Nano robots, etc. are some of the other robotic advancements that medical industry has witnessed. As the human mind matures and technological exposure enhances, men will certainly strive for creating more intelligent and capable surgical bots soon. V.

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DEVICE TRAIL

Beyond Medication, Advances in Diabetes Therapy

Divya Ramaswamy

38 November 2019

INDIA IS currently in the midst of a diabetes epidemic. According to the International Diabetes Federationâ&#x20AC;&#x2122;s report (2017), about 72.9 million Indians are diabetic. And the worst part is that about one in every two diabetic Indians is unaware of the condition and only about a quarter of them have been trying to manage it effectively. A recent study conducted by the Public Health Foundation of India has reported that rural men with low income and educational qualifications were at a higher risk

of getting diabetes as compared to the other study groups. It is also predicted that by 2045, the nation might have 134.3 million individuals who might suffer from diabetes. So it is equally important for the country to find ways to navigate this huge health burden and invest in newer methods and technology to combat diabetes. Diabetes mellitus is a group of diseases that affect bodyâ&#x20AC;&#x2122;s blood sugar levels. Diabetes Type 1 is an autoimmune disorder and Type 2 is more

to do with insulin deficiency. Over the years, there has been more clarity on the etiology of diabetes and so various other forms of diabetes like pre-diabetes, gestational diabetes etc have been identified. Present treatment options for Diabetes Alongside lifestyle modifications like making healthy food choices and regular physical activity, taking insulin or other diabetes medications are the most common options for treating diabetes. Insulin There are several types of insulin including rapid-acting, long-acting, short-acting and intermediate-acting. Each kind begins to work at a different speed and its effects last for different duration. There are also several ways in which insulin is administered to patients. The widely used method is the needle and syringe way where you will give yourself insulin shot by injecting it into your upper arm, belly, thigh or buttocks. The dosage also differs from patient to patient depending upon the blood glucose targets. There are other tools such as the Insulin Pen, Insulin Pump, Inhaler, Injection port and the Jet injector which are all used to inject insulin into a diabetic patient’s body. Oral Medications Most cases of diabetes are treated with oral drugs for examplebiguanides like metformin which helps lower the amount of glucose your liver produces and helps your body to use insulin better. Other oral medications that act in a similar way include alpha-glucosidase inhibitors, bile acid sequestrants, DPP-4 inhibitors, meglitinides, sulfonylureas, GLP1-agonists, thiazolidinediones, and SGLT2 inhibitors. Doctors might sometimes prescribe a combination of these medications if they feel just one of them might not be sufficient to achieve the desired effect on a patient’s blood glucose.

This monitors a patient’s blood sugar levels continuously and calculates the amount of insulin needed and automatically delivers insulin via a pump. It acts just as the way a pancreas in a non-diabetic person works. The FDA is collaborating with diabetic patients, care providers, researchers, academicians, and medical device manufacturers to foster the innovation by clarifying expectations for clinical studies as well as product approvals. Pancreatic Islet Transplantation It is an experimental treatment option for poorly controlled type 1 diabetes which is done by replacing destroyed islets with new ones that produce and release insulin. This method replaces islets from the pancreas of an organ donor and transfers it to a type-1- diabetic patient. Because this method is currently under study, the procedure is available only to those enrolled in such clinical trials. Implantable Insulin The artificial pancreas isn’t yet commercially available. The closest thing available currently is the Implantable insulin pumps example Medtronic MiniMed™ 670G. Implantable insulin pumps are surgically implanted under a diabetic patient’s skin and a catheter from the pump extends into the peritoneal cavity which is quickly routed to the liver (the normal

According to the International Diabetes Federation’s report (2017), about 72.9 million Indians are diabetic. And the worst part is that about one in every two diabetic Indians is unaware of the condition and only about a quarter of them have been trying to manage it effectively

Upcoming Trends in Diabetes Treatment Artificial Pancreas or Closed-loop Insulin Delivery System

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DEVICE TRAIL destination for insulin). Using this device, the liver gets a high concentration of insulin, keeps majority of it and lets only a small amount to pass to the other parts of the body. The concept of implantable insulin pump therapy began in 1980 when the first experimental insulin pump was implanted by the experts at University of Minnesota in Minneapolis. The current implantable pump is developed by innovative companies like MiniMed. Hydrogel Beads Orally administered insulin entrapped in amidated pectin hydrogel beads appears promising in mice models. They not only produced sustained release of insulin but also reduced plasma glucose concentration in diabetes mellitus. MIT offshoot Sigilon Therapeutics is working with Eli Lilly to develop implantable insulin-producing ‘living drug factories’, made of encapsulated, engineered cells. These ‘factories’ consist of hydrogel beads of 1mm in diameter which enters the patient’s body via minimally invasive procedures, and acts as an insulindelivery device. The hydrogel case also protects the insulin from the patient’s immune system in such a way that it doesn’t attack the implanted hormone. Removable implants A retrievable and scalable cell encapsulation

40 November 2019

device found promising to treat Type 1 Diabetes. It is an encapsulation system that is scalable to a clinically relevant capacity that can be retrieved or replaced whenever required. It is an ingenious method for implanting hundreds of thousands of islet cells into a type-1 diabetic patient. They are protected by a thin hydrogel coating and the coated cells are attached to a polymer thread that can be removed or replaced easily when they have outlived their usefulness. Ultrasound A recent study has found targeted ultrasound could be an effective, noninvasive and drug-free way to boost insulin levels in individuals suffering from type-2 diabetes. The research team at George Washing University is investigating this innovative method of diabetes treatment and they expect that their approach might provide a safe, controlled and targeted stimulation of insulin release from the pancreatic beta cells. Deep Brain Stimulation (DBS) It was serendipitously discovered when a person who underwent deep brain stimulation for OCD found improvement in his type 2 diabetes. DBS is a neurosurgical procedure where a neurostimulator is implanted under the patient’s skull. The device will be programmed in such a way that it delivers electrical pulses to specific parts of the brain which can treat OCD, depression and other neurological issues. Studies have reported that DBS increased diabetic patients’ insulin sensitivity and provides a way for diabetics to manage their condition in the future. Light-activated Gel This is a potentially less invasive method that uses an insulin-carrying gel which can be placed under the skin and activated by a flash of light to release insulin whenever required. The researchers from the University of Missouri linked human insulin molecules to a commercially available gel (a polystyrene & polyethylene glycol copolymer) using a linker molecule containing a lightsensitive chemical bond. During exposure of 365-nm-wavelength light, this bond breaks and releases the insulin.

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Q&A

ASK THE EXPERT

Running a private medical practice in India comes with the risk of lawsuits and property damage. As a medical professional, you are probably well aware of the devastating effects of legal cases and security threats that await doctors who face the blunt of an angry patient. We encourage you to share your queries and concerns regarding legalities of practicing medicine in India to learn more about legal framework, legal cases and the experience of fellow doctors

d Q:

As you know, we get many trauma and assault injury cases in such hospitals.

s y

Many a times we have to attend court as a witness or expert. My question is can we

. ,

s l

Name withheld Ans: Any person with HbsAg cannot be denied job as most of the persons with HbsAg are healthy and can do a job. Your friend should complain regarding this to health Ministry / inform press and seek other remedial methods.

as a hospital appoints a MLC officer, who

I am a practicingorthopedic surgeon.

Weare starting a multispecialty hospital.

Prof ( Dr ) R K Sharma, President, Indian Association of Medico-Legal Experts , New Delhi will answer questions from our readers. Please send in your queries to editor@indiamedtoday.com

will be a MD in forensic medicine who can

Q: According

take care of court matters?

Court, can an internist, MD Medicine treat

Dr Paresh Pandya, Rajkot Ans: It is a nice idea to put a separate doctor for MLC work especially if he is MD Forensic Medicine. But I really doubt that you would get one as there is severe shortage of MD Forensic Medicine. I suggest that you put a plain MBBS doctor for it. Even getting MBBS doctor purely for MLC work is difficult.

acute MI or stroke or diabetes or UTI or

to MCI and Hon’bleSupreme

hepatitis or cirrhosis or hypertension or pneumonia or COPD or asthma or any other disease of any organ in the body. Why I’m asking is because, if one does attempt to do so, and fails, and is sued by the patient, he can be punished because he is not a MCI recognised ‘super-specialist’ in the field of cardiology, gastroenterology,

Q: I have come across a very sad incidence.

hepatology, or pulmonology?Is this really

One of my old college friend who is a

true? What is the logic behind this?

pediatrician and Intensivist applied for

And what of the millions of patients

a job- post of specialist at a corporate

in government hospitals who are being

hospital. He was denied job on basis that

treated and cured, of the very diseases

his HbsAg was positive. On probing his

alluded

history I found that his mother also had

generalists.Is it all illegal?

above,

the

hands

HBsAg positive indicating a perinatal

What did the Supreme Court say exactly

transmission.As far as I know this does

in this regard? Please elaborate because

not seem to be a valid reason for rejection

I’m sure many like me would like to know

as a pediatrician will not be involved in

can MD Medicine internist treat patients’

invasive procedures. I would like to know,

without risking jail or litigation or hefty

what are the medicolegal aspects involved

fines or MCI de-recognition.

in healthcare worker being HBsAg positive

Dr Sumeet Singla

and can he be denied job on the basis that

MD, DNB, MNAMS, FIACM, FICP Associate Professor of Medicine

he’s HBsAg positive?

www.indiamedtoday.com

Maulana Azad Medical College New Delhi Associate Editor, Journal, Indian Academy of Clinical Medicine Ans: Please understand that Supreme Court and MCI has never stated that internist, MD Medicine cannot treat acute MI or stroke or diabetes or UTI or hepatitis or cirrhosis or hypertension or pneumonia or COPD or asthma or any other disease of any organ in the body. The only question here is calling oneself a super specialist. With just an MD medicine one cannot call themself cardiologist, nephrologists, or endocrinologist. Please understand that in most instances MCI creates problems for us, and not courts. Specific guidelines are missing in this regard as MCI has never elaborated on it. On the other hand, 90 percent of government healthcare is provided by MBBS doctors; who are treating all typescases.

November 2019

I am an orthopedic surgeon working

at private hospital.I had an RTA patient ,15yr old school going boy,MLC filed.He had suspected knee ligamentous injury for which MRI was advised.

His parents refused to take MRI and got discharged 2 days later (againstMedical advice). My query is can wound certificate be given for this patient? Since I donâ&#x20AC;&#x2122;t know the exact nature of injury should I mention it as grievous or non-grievous? Ans: Do not give any wound certificate stating whether the injury is grievous or non-grievous. Just mention that it would be given after report of MRI which has been advised. Going out of way to help patient may be risky.

Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.