IndiaMedToday Oct 2019

OCTOBER 2019, VOLUME 3 ISSUE 10 `200 INDIA MED TODAY

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INTERVIEW

CHRISTOPHER COLECCHI, MD, BROADVIEW VENTURES

DEVICE TRAIL

OSTEOCHONDRAL IMPLANTS

EVOLVING

PULSE

MRCS FOR INDIAN DOCTORS

EYECARE MOVEMENT OF INDIA

A close look at the private ophthalmology market to find out how the segment has disrupted in India OCTOBER 2019

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OCTOBER 2019 EDITORIAL

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Opening our eyes to ophthalmology THERE IS a huge unmet need for eye care market in India. India is home to a quarter of the total global blind population. With high incidence of cataract about 75 per cent of the blindness is preventable in this population.

Common conditions such as age-related macular degeneration (AMD), cataracts and glaucoma are driving the demand for quality eye care in India.

But the largest demand is for cataract surgery and it is a key revenue driver for both for profit institutions and non-profit institutions.

There couldn’t be a better bet in healthcare than eye care, for investors are flocking to pick-up stakes in the private eye care market. This market is one towatch. Although the segment provides a wide range of investmentopportunities; it is equally important to understand both macroand micro trends, to stay ahead of the game.

India, offers an eye care market that is ripe for disruption. It is a market with more variations than the variations in individual eye colour.

If you look at the macro trends they are very distinct, an increase in ageing population driving the disease burden; and an informed patient population seeking better quality care. This is the force behind much of the investments and consolidations. The opportunity is clearly in the heavy demand supply gap, pointing more towards new cities and townships tier 3 markets. Even though the eye care supply remains heavilyreliant upon hospital settings yet these are less capital intensive and easier to build considering the regulations and policy requirements.

India is home to a quarter of the total global blind population. With high incidence of cataract about 75 per cent of the blindness is preventable in this population Besides, this market is set fordisruption on many levels. For example, eye care relies on retinal imaging for diagnosis. This means that not only digital technology can use artificial intelligence to learn and diagnose disease but also send images from one place to another for specialist opinions. Something that radiology has established and is running with ease.

A number of smart eye care diagnostic devices are being piloted and some even proven to be efficient and time-saving in diagnosing disease early. A large number of companies are working on proprietaryalgorithms to help ophthalmologists diagnose disease faster. Software are being tested to further assist ophthalmologists deliver better eye care.

India is at the forefront of evolving technologies for better healthcare delivery. We must all open our eyes to the fact that next few years will see disruptive technologies and business models making eye care accessible and affordable for all.

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UPFRONT

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Navigating at Hospitals

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COVER STORY

Evolving Eyecare Movement of India

Advantages of implementing wayfinding technology in hospitals and medical centers. Simone Health Development Companies, USA

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FEATURE

Medical Value Travel in India

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October 2019

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Health Insurance and MVT 6

Osteochondral Implants

Christopher Colecchi, MD, Broadview Ventures

PULSE

How a Royal College of Physicians and Surgeons (UK) Membership is a game-changer for Indian doctors

DEVICE TRAIL

INTERVIEW

A close look at the private ophthalmology market to find out how the segment has disrupted in India

MRCS for Indian Doctors

04 Editorial 07 Letters 08 News roundup 42 Event Listings

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LETTERS WORLD HEART DAY

Dr Minnie Bodhanwala, CEO, Wadia Hospitals

I

t is always better to eat wisely, exercise regularly, keep away from any kind of tobacco and have regular checkups with our own doctors. Remember, the first pain is too late. It does not mean the beginning of problems

but rather signals the end of tolerance. So, the best cure is not to have problem at all.

Dr. Kunal Sarkar, Senior Vice-Chairman & Senior Consultant Cardiac Surgeon, MedicaSuperspecialty Hospital

On Mental Health

Cancer not only affects the body but also have a profound psychological impact like anxiety and depression throughout the cancer journey and beyond. Cancer care professionals need to address the emotional needs of their patients and refer them to qualified mental health professionals. Early detection of emotional difficulties of patients can lead to a better quality of life and treatment outcomes.

Dr. B. S. Ajaikumar, Chairman & CEO, HCG Ltd

The increasing burden of cardiac disease in India is worrisome and must be brought under control. Higher rates of indoor and outdoor pollution, combined with a shift towards a sedentary lifestyle and an increase in life threatening habits such as smoking, vaping and other drug abuse, particularly in the urban youth, poses a threat to the heart health of the nation. Unfortunately, incidences of heart attacks have been occurring in very young age groups, even between the ages of 20-30. India is home to the largest youth population, and we must ensure that we pass down healthy lifestyle habits to the next generations. It is also important to keep heart health in check with regular screenings, to catch early signs of a deteriorating heart so that the damage can be managed or reversed. No matter the age, a healthier diet and active lifestyle can bring incredible health benefits to the body, including the heart.

Dr. Ganeshakrishnan Iyer, lead consultant, CTVS surgery,

Over the last decade, we’ve continuously made efforts to simplify healthcare access for millions of consumers. Digital healthcare and technology have transformed mental healthcare in a way that makes it easy for patients to consult a psychiatrist or psychologist online and book an instant appointment if required. Also, people who suffer from mental health disorders are worried about confidentiality and privacy while discussing their mental condition. At Practo, we make sure that only the patient and the doctor has access to all records, thereby ensuring complete privacy.

Dr Alexander Kuruvilla, Chief Healthcare Strategy Officer, Practo

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Fortunately, many children with cardiomyopathy can lead a relatively normal life with lifestyle modifications. They also require special vaccinations to prevent seasonal infections and regular visits to the paediatric cardiologist for monitoring their condition. Other interventions involve diet, restriction from competitive, contact sports, minor school adjustments and some require palliative/ supportive care.

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NEWS ROUNDUP SIEMENS HEALTHINEERS OPENS FUTURE-READY MEDICAL IMAGING MANUFACTURING FACILITY IN INDIA As a part of its strategy for India, Siemens Healthineers will integrate manufacturing, technology and innovation functions at Bengaluru. Accordingly, 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.

The INR 200 million investment in the new manufacturing facility builds on the INR 25 billion invested in the R&D Center so far, exemplifies company’s enduring commitment to India. The manufacturing facility will produce mobile C-arm radiology system Cios Fit and computed tomography systems from

Siemens Healthineers

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October 2019

the Somatom go. platform for the Indian and other emerging markets. The facility will start with around 70 employees, workforce will be extended in three phases by fiscal year 2025.

Explaining the strategic significance of the manufacturing facility at the inauguration ceremony on September 19, 2019 in Bengaluru, André Hartung, Executive Vice President Computed Tomography and incoming President Diagnostic Imaging, Siemens Healthineers said, “Collocating a manufacturing facility with our R&D center in Bengaluru marks a significant step in strengthening our presence in India, which is one of our important markets. It also reflects our enduring commitment to India, where we have been enabling better healthcare outcomes for over 90 years, manufacturing medical devices for 60 years, and advancing software excellence for over 25 years.”

GerdHoefner, Managing Director and

President, Siemens Healthcare Pvt. Ltd. added, “As Siemens Healthineers is leading the digitalization of healthcare, the collocation of the manufacturing with R&D center is especially important as it will enable us to deliver value to customers faster. Over the years, the R&D center at Bengaluru, has grown into a digital hub for the company accounting for over half of all the software engineering talent within Siemens Healthineers. It is also the largest such center within the company globally.”

Talking about the products that will be made at the new facility, André Hartung said, “The facility will make computed tomography (CT) systems based on our trendsetting Somatom go. platform that we co-created with 500 customers in eleven countries. The new platform combines numerous softwareled innovations with our novel detector technologies for radically enhanced workflow

efficiency, expanded clinical applicability, improved patient experience, and meeting the financial requirements of healthcare providers.”

Talking about the Cios Fit,Peter Seitz, Executive Vice President Surgery, Siemens Healthineers stated, “Cios Fit, our latest C-arm was created to address the tough demands of India with high patient loads and the need to perform multiple procedures. It offers clear images on a touchscreen monitor, it is simple to use, and has fewer moving parts for higher reliability. We are very proud that the Cios Fit is designed, developed, and manufactured in India for the world.”

AGATSA RAISES $1 MILLION IN FUNDING LED BY IAN AND THE TECHNOLOGY DEVELOPMENT BOARD, GOVERNMENT OF INDIA Agatsa, India’s most agile health solutions innovator, has raised $1 million in funding from Indian Angel Network (IAN) and the Technology Development Board (TDB), Department of Science and Technology, Government of India. The start-up is working in the field of creating affordable and pocketsized healthcare devices that help in the early diagnosis and management of lifestyle diseases.With this funding, Agatsa will scale up its operations and marketing along with expanding its global outreach. Their flagship products under the name of SanketLife 2.0 and SanketLife Pro+ are the world’s first and only portable medical-grade 12-LEAD ECG devices that can be carried around in the pocket.

MEDDORAISES $3 MILLION IN PRE-SERIES A FUNDING LED BY SRI CAPITAL

Meddo, India’s first and largest 360 degree connected health platform has raised $3 million in their Pre- Series Afunding led by SRI Capital with participation from growX

Meddo Founders-Saurabh Kochhar and Dr. Naveen Nishchal

Ventures, LetsVenture, Jitendra Gupta (Cofounder Citrus Pay) and Venture Gurukool, among others.

The Gurugram based startup currently has over 400 doctors and 200 clinics and is currently operational in Delhi NCR. Meddo works closely with all dominant NABL accredited diagnostic lab partners across the city. They work with 250 trained peri clinical staff for in clinic and at home sample collection and have served more than 1,50,000 customers so far.

Meddo was founded in June 2018 by SaurabhKochhar (ex-Founder & CEO of Foodpanda and Printvenue; IIT & IIM alumnus) and Dr Naveen Nishchal (co-founder, Cygnus Hospitals and a Harvard graduate). The platform functions in offline and online space – through standalone doctor establishments with the central objective of bringing together all healthcare needs for the patients onto a single platform, bringing convenient and comprehensive care into healthcare.

ASTRAZENECA’S DIABETES DRUG SHOWS SIGNIFICANT BENEFITS IN PATIENTS WITH HEART FAILURE

AstraZeneca has announced its detailed results from the landmark Phase III DAPA-HF trial for Forxiga (dapagliflozin) that showed the medicine on top of standard of care reduced both the incidence of cardiovascular death and the worsening of heart failure.

DAPA-HF is the first outcomes trial with an SGLT2 inhibitor investigating the treatment of heart failure in patients with reduced ejection fraction (HFrEF), with and without type-2 diabetes (T2D). Forxiga is currently approved to treat patients with T2D.

COLUMBIA PACIFIC COMMUNITIES SIGNS MOU WITH COLUMBIA ASIA HOSPITALS

Columbia Pacific Communities, India’s largest senior living community operator, has tied up with Columbia Asia Hospitals, to enable its residents to have preferential access to world-class healthcare. As per the agreement, Columbia Asia Hospitals, as the healthcare partner of Columbia Pacific Communities, will provide their expertise in designing wellness centres at all future residential communities and provide training and protocol at Columbia Pacific communities.

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NEWS ROUNDUP NEUBERG BETS BIG ON SUPERIOR DIAGNOSTIC EXPERIENCE Neuberg Diagnostics Private Limited, the fastest growing healthcare start-up in India which ranks among the top 4 diagnostic service providers in the country, has announced the launch of Anywhere Anytime services – a first in the diagnostics lab chain space. The full-fledged sample collection and ECG services will be offered in Chennai, Bangalore, Cochin and Hyderabad.As part of the offering, samples can now be collected from any location that is convenient for an individual, subject to the place maintaining basic standards of hygiene and privacy.

PRUDENTIAL FINANCIAL TO ACQUIRE ASSURANCE IQ, FOR $2.35 BILLION Prudential Financial, Inc. has announced that it has signed a definitive agreement to acquire Assurance IQ, Inc., a profitable, fast-growing direct-to-consumer platform that transforms the buying experience for individuals seeking personalized health and financial wellness solutions.Terms of the acquisition include a total upfront consideration of $2.35 billion, plus an additional earnout of up to $1.15 billion in cash and equity, contingent upon Assurance achieving multi-year growth objectives. Using a combination of advanced data science and human expertise, Assurance matches buyers with customized solutions spanning life, health, Medicare and auto insurance, giving them options to purchase entirely online or with the help of a technology-assisted live agent.

CENTAUR PHARMA’S CLINICAL RESEARCH DIVISION, LIFESAN CLINICAL RESEARCH RECEIVES ZERO 483 OBSERVATIONS FROM BACK-TO-BACK US FDA INSPECTIONS

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LifeSan Clinical Research, the clinical research division of Centaur Pharmaceuticals was audited by the US FDA and was concluded with zero 483 observations which signify compliance and conformance to applicable GCP regulations. LifeSan has successfully faced 6 inspections from USFDA; 2 inspections from MHRA/ EMA and 1 inspection from MCC, South Africa, in its twelve years of existence.

It undertakes bioavailability/ bioequivalence studies, which are mandatory for generic drug approval process and phase II/III clinical trials.

Since inception, LifeSan has submitted many studies to regulatory agencies of USFDA, EMA, MCC South Africa and TGA, Australia as well as CDSCO, the Indian Drug Regulatory Authority, including successful conduct of phase II and III clinical trial of a new chemical entity [NCE].

prevention services to rural, semi-urban and urban population through its hubs and spokes clinic model. India faces a significant challenge with respect to accessibility, availability, and affordability of primary healthcare.

Government healthcare infrastructure is illequipped and understaffed with 70% of the Indian population being served by less than 10% of doctors. More than 30% of the rural population needs to travel over 30 Km to access healthcare services. PIC

INFLECTION POINT VENTURES INVESTS IN IKURE – A SOCIAL HEALTH ENTERPRISE

VBRI has released the long-awaited virtual hospitals platform- mHospitals, which is in the sixth phase of its field trials. This cardiac healthcare platform was launched in a grand manner across multiple offices of VBRI in three different countries and was met with a lot of enthusiasm and excitement. mHospitals is a revolutionary virtual cardiac hospitals platform that will serve the patients suffering from cardiovascular diseases. By utilizing advanced

Kolkata based iKureTechsoft Pvt. Ltd. has raised an undisclosed amount of funding from Inflection Point Ventures (IPV). iKure is a social health enterprise that is engaged in delivering primary healthcare, wellness and

Sujay Santra Founder & CEO, iKure

MHOSPITALS IS FINALLY HERE WITH THE FIRST TARGET OF 500 CARDIAC CONSULTANCY IN 90 DAYS!

technologies like cloud medicine, machine learning, and artificial intelligence, the platform will provide the best quality of cardiac care to the patients along with the ultimate level of convenience. By using mHospitals, patients will be able to access secure cardiac care right in their homes without having to travel an inch.

The product is all set to bring a new dawn in the world of healthcare.

GLOBALLY RENOWNED HEALTH RETREAT VIVAMAYR COMES TO BANGALORE

RESET Bangalore has invited VIVAMAYR, a globally acclaimed health center to conduct a Medical Talk presented by Dr. Christine Stossier on Metabolic Diseases and Biological Strategies. During this first time two day visit to Bangalore, VIVAMAYR will also be meeting with the press and presenting VIVAMAYR philosophy and Modern Mayr Medicine at private events.The visit is scheduled for September 20th& 21th at RESET Bangalore.

Its famed weight loss, skincare and chronic disease therapy programs is popular amongst royals, Hollywood and Bollywood & Sports Celebrities and International dignitaries.

ENT, Gastroenterology, Orthopedic, General Surgery, Internal Medicine, Nephrology & Urology, Neurosciences, Pulmonology and Woman & Childcare and Pharmacy.

TRICOG’S “INSTAECG” AIMS TO TURN AN 80% CHANCE OF A HEART ATTACK BECOMING FATAL TO AN 80% CHANCE OF PATIENT SURVIVAL InstaECG was launched by Tricog in 2015 and has so far analysed ECGs (electrocardiogram) for over 23.7 lakh people. It has identified 75000+ critical cardiac cases and 30,540 instances of heart attacks. Tricog’sInsta ECG is proven to be more accurate than a standard ECG machine and takes only 6 to 10 minutes to deliver results. This reduced time frame is crucial as every minute makes a difference in the ‘golden hour’ of emergency cardiac care.

InstaECG enables transmission of ECG data over standard mobile and WiFi networks to the Tricog ECG Cloud. The proprietary algorithms (in the cloud) and the in-house team of cardiac specialists interpret the ECG data and share an analysis report with medical professionals through SMS, Email and Mobile App notifications.

SAKRA WORLD HOSPITAL LAUNCHES SAKRA ACI CUMBALLA HILL PREMIUM CLINIC Sakra World Hospital, a leading hospital HOSPITAL OPENS DOOR in Bangalore promoted by Secom and FOR PATIENTS Toyota Tsusho, Japan has launched its first Sakra Premium Clinic. Spanning about 6,000 sq. feet in area, the clinic is located in the commercial hub of Kaikondrahalli, Sarjapur Road (close to Iblur junction) and will offer multispecialty healthcare services and facilities. The clinic was inaugurated by renowned Indian Film Actor Dr. Shiva Rajkumar and ShriMadhuBangarappa, Indian Politician, Producer and Actor in the presence of doctors, employees, staff members of Sakra World Hospital.Sakra Premium Clinic will have scheduled OPD services for Cardiac Sciences, Cancer Care & Blood Disorder, Dentistry,

After two years of interruption in service Cumballa Hill Hospital at the Kemps Corner has finally re-opened its door for the needs of patients. The 60-bedded multi-specialty hospital near Kemps Corner will be run by the management of the Asian Cancer Institute (ACI) and will be known as ACI- Cumballa Hill Hospital.

ACI Cumballa Hill Hospital which occupies about 22,000-square-foot area with 11 Intensive Care Unit (ICU) beds and four operation theatres offers services like the various tertiary cancer services coupled with general diagnostic radiology,

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NEWS ROUNDUP paediatric healthcare, urology, orthopaedics, rheumatology, and many more. Furthermore, the hospital will also offer laser surgery and complete endoscopy suite and minimally invasive surgery including robotics.

SAFEPOINT INDIA APPLAUDS BIHAR GOVT. FOR ADOPTION OF ‘AD SYRINGES FOR PATIENT SAFETY’ Dr. (Col) HS Ratti, Public Health expert, epidemiologist and Project Advisor to SafePoint India has applauded the Bihar Government for adoptingAuto-Disable Syringes in all Medical colleges & PSEs in all the districts of Bihar to contribute towards promotion of safe injection practices in the country. Govts of Punjab and Andhra Pradesh have already adopted this as a state

policy.Bihar now joins and takes the lead to encourage the use of Auto-Disable Syringes in state of Bihar.Dr. HS Ratti, said “I congratulate Bihar Govt. for implementing this important initiative and we are hopeful that Bihar Govt. will soon switch to auto disable syringes in all private sectors as well. If need be, as a value addition, SafePoint India isready to help Govt. of Bihar by offering to conduct training programs for all the healthcare workers of Bihar on correct and best Injection practices to avoid hospital borne infections.”

ASTER DM HEALTHCARE TO RUN AND OPERATE ITS 4TH HOSPITAL IN BENGALURU IN PARTNERSHIP WITH KARNATAKA LINGAYAT EDUCATION SOCIETY

Aster DM Healthcare, one of the largest integrated healthcare service networks in the GCC and the third largest healthcare company in India, is growing its presence in the Karnataka region with the introduction of two new hospitals. For its fourth hospital, to be named as Aster KLE Hospital, the company has entered into an agreement with KLE Society, which is recognized as a trusted healthcare provider, and runs over 270 institutions across Karnataka and Maharashtra and Delhi.

A 25-year lease deed agreement was signed with Karnataka Lingayat Education (KLE) Society.The 600 bedded hospital to be located next to KLE Dental College near Yeshwantpur on Tumkur NH Highway Road, would be Aster’s 15th hospital in India and part of its global network of existing 25 hospitals, 115 clinics and 231 pharmacies. The hospital is scheduled to begin operations in April 2024.

Dr. Azad Moopen, Founder Chairman and Managing director of Aster DM Healthcare

Dr Azad Moopen, Founder Chairman and Managing Director, Aster DM Healthcare and Dr PrabhakarKore, Chairman of KLE Society, Member of RajyaSabha from Karnataka exchanging MOUs

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said, “We are looking forward to the launch of the new hospitals. The establishment of the third and fourth hospitals in Bangalore cements our promise to offer path-breaking medical technology and treatment, making quality healthcare easily accessible to the people in the region. The expansion is also a part of our efforts to strengthen and diversify our operations in the State where we already have two operational hospitals.”

Dr PrabhakarKore, Chairman of KLE Society, Member of RajyaSabha from Karnataka said, “It has always been our effort to bridge the gap between modern facilities of diagnostics and treatment, including super specialty services, at affordable costs to people in remote areas and places where there is a dearth of these facilities. KLE Society has a long history of providing transformative healthcare, education and research and will continue to do so with this association with Aster DM Healthcare. The launch of the new hospital will be a vital blend of infrastructural, medical and technological excellence.”

LIVER TRANSPLANTATION TURNS LIFESAVING TREATMENT FOR A PATIENT WITH LIVER CANCER Victor, a 59 year old man from Bangalore recently underwent living donor liver transplantation at BGS Gleneagles Global Hospital, Bengaluru to treat liver cancer. The patient had been diagnosed with chronic liver disease which is believed to be a result of other conditions that he had been suffering from for a long period including fatty liver disease and diabetes.When he was initially brought to BGS Gleneagles Global Hospital, his condition was severe. Doctors here chose to first control the liver cancer by TACE, an imageguided, non-surgical procedure that is used to treat malignant lesions in the liver. Once he responded favourably, he was recommended a liver transplant as a definitive cure for his condition.

TRANSASIA AND PATUT UNVEIL VISION FOR ‘THALASSEMIA-FREE INDIA’ PadmashriPankajUdhas, Hon. President of Parent’s Association Thalassemic Unit Trust, Jackie Shroff, Brand Ambassador, Thalassmia India and Suresh Vazirani, Chairman & Managing Director, Transasia Bio-Medicals Ltd. shared their vision of a ‘Thalassemia-free India’ at a press conference held at HR College of Commerce & Economics in the presence of Dr. SuhasMohnalkar, Assistant Director Health Services, Blood Cell, Govt. of India and Mr. ParagThakkar, Principal, H.R. College and Mala Vazirani, Executive Director, Transasia Bio-Medicals Ltd.As a part of this initiative, over 200 students from HR College and other nearby colleges participated in a Thalassemia awareness and blood screening camp where they were briefed about Thalassemia and their blood samples tested for the condition.

BIOCON BIOLOGICS EXPANDS ITS R&D FOOTPRINT THROUGH ACQUISITION

Asia’s premier biopharmaceuticals company, has announced that its subsidiary, Biocon Biologics, has acquired R&D capital assets for a 60,000 sq. ftstate-of-the-art ‘bench to pilot scale’ Biologics research facility at TICEL Bio Park in Chennai, India.Biocon Biologics has acquired these assets from Pfizer Healthcare India Ltd. The facility will house an early stage research and innovation center including a pilot scale R&D Unit, well-equipped with cell line development, drug substance process development from bench scale to 400 litre scale bioreactors, drug product formulation laboratories and analytical R&D laboratories.

The facility is expected to be operational in a few months post qualification and will house over 250 scientists who will have access to state of the art R&D labs equipped with over 500 high- end process and analytical instrumentation.

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NEWS ROUNDUP US MNC LOBBY ONCE AGAIN PRESSURIZES GOI ON ROLLING BACK PRICE CAPS ON STENTS BEFORE PM MODI’S VISIT TO US In their constant bid to put extreme pressure on Govt. of India to roll back prices of stents, a delegation comprising of US Medical Device Multinationals along with US Ambassador Kenneth I Juster met the Commerce and Industry Minister, Shri. Piyush Goyal, pitching for MNC lobby’s interest, and seemingly attempting to influence internal Indian policies away from affordable patient care ahead of PM Modi’s visit to US.Once again US multinationals are putting extreme pressures on GoI through the US embassy to dilute price caps and replace it with soft trade margin caps so that they can enjoy the same 200% -300% profit markups from the patients in India.

DOCTORS AT VIKRAM HOSPITAL PERFORM SUCCESSFUL HEART TRANSPLANTATION

Vikram Hospital, Bengaluru’s trusted quaternary care multi-specialty hospital, has successfully carried out a heart transplant on a patient suffering from advanced Heart Failure, after supporting her failing heart using an artificial heart support machine called Bi – VAD for a record 155 days. This is the longest – ever duration that a patient in India has been supported on a Bi – VAD machine prior to a successful heart transplantation. This feat was performed by the ‘Heart Team’ at Vikram Hospital.

EDUCATIONAL PROGRAMME TO MARK WORLD ALZHEIMER’S DAY HELD AT BRAINS

In a bid to mark the World Alzheimer’s Day, Brains Neuro Spine Hospital had organized an interesting educational programme on Monday.The Neuro specialists team from BRAINS provided valuable educative

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information regarding Alzheimer’s and Dementia to all those gathered to witness the function.Addressing the gathering Dr. NK Venkataramana, Founder Chairman & Chief Neurosurgeon, BRAINS threw light on the social implications that comes along with Alzheimer’s and Dementia and the various ways to prevent dementia. Of all music plays an important role in the treatment of dementia, he said.

INITO GRANTED US PATENT FOR THEIR HOME DIAGNOSTICS TECHNOLOGY

Inito, a Bangalore based medical technology startup that is also India’s first Y-Combinator backed medtech startup has been granted patent rights for their Flat-lens technology by the United States Patent and Trademark Office (USPTO). This patent will further Inito’s mission of becoming a global health-tech company out

of India. The patented Flat-lens technology allows the Inito device to perform dozens of lab-grade diagnostic tests at home just using a smartphone and a low cost device. Inito comes with the Inito Reader, App and the Test strips. The sample is put on the test strip and the strip is inserted into the Inito device. The device is then attached to the phone whose camera captures images of the strip through the flat lens.The device also automatically calibrates the variations between different phones giving the same accuracy irrespective of the phone used. The Inito app displays the result and also tracks the values for analysis.

3M SIGNS MOU WITH INFUSION NURSES SOCIETY TO LAUNCH “INFUZE”- A QUALITY IMPROVEMENT PROGRAM IN INFUSION THERAPY 3M India, a subsidiary of leading global innovation company has signed a MoU with Infusion Nurses Society (INS-Ind) to launch “INFUZE”, a quality improvement program in Infusion therapy in India. The program is aimed at improving compliance to the best practices in Infusion therapy. As an extension to the partnership with INS-Ind since its inception, 3M India, now as the technical partner, will design workshop modules and conduct initial compliance assessment.While Infusion therapy is viewed as niche segment,

insertion and maintenance of peripheral intravascular catheters is expected of every registered nurse. The importance of this is missed in the absence of a dedicated curriculum. Addressing this, 3M India will create educational modules and checklists on the INS Policy and Procedures, and also conduct training workshops in the enrolled centers to help them comply with the Infusion Therapy Policy and Procedures and Guidance Manual. 3M India will also undertake an initial compliance assessment of the center within two months of completion of every workshop.

CARESTREAM HEALTH’S CEO DAVID WESTGATE VISITS INDIA Carestream Health’s CEO David Westgate made a brief but significant visit to India on 19th September. On his two-day trip, the US-based executive got straight down to business interacting with customers, business partners and employees. Describing him as a “customer-centric, goal-oriented, chief executive with diverse leadership experience,” the Carestream team in India is counting on Westgate’s well-rounded business experience to bring an innovation-centric perspective to the company.

TRANSASIA, THE FIRST IVD COMPANY IN INDIA TO BE AWARDED ZED DIAMOND QUALITY RATING Transasia Bio-Medicals Ltd., India’s Leading IVD Company has announced that it has received the Diamond rating in ZED Quality Certification from the Ministry of MSME, Government of India and the Quality Council of India for its manufacturing facility at Mumbai (Seepz). The plant was assessed on 30 stringent parameters including manufacturing infrastructure, Lean concepts, 5S, Kaizen, daily management practices, manufacturing process and FMEA, impact of manufacturing on the environment. The entire assessment process

is very elaborate and lasted a year.

DR. ANDREW PETERSON JOINS MEDGENOME AS CHIEF SCIENTIFIC OFFICER MedGenome, a genomics-driven research and diagnostics company, has announced the appointment of Dr. Andrew Peterson as its Chief Scientific Officer. Dr. Peterson will lead the company’s research programs to identify drug targets and biomarkers by leveraging its unparalleled access to south Asian cohorts and disease phenotypes.Its large network of collaborations with hospitals across India has enabled MedGenome to create a research platform to tap into thousands of patient records with oncology, auto-immune, metabolic and rare disease diagnoses. The platform capabilities are amplified by MedGenome’s high-throughput genomics sequencing and data analysis/ interpretation capabilities. Dr Peterson will also be instrumental in strengthening the organization’s capabilities and capacities to perform and execute large scale genomics research projects.

EISAI INDIA AND MYLAN ENTER INTO COEXCLUSIVE MARKETING AGREEMENT TO COMMERCILIZE TECERIS Eisai Pharmaceuticals India Pvt. Ltd (a subsidiary company of Eisai Co., Ltd., Headquarters: Tokyo, CEO: Haruo Naito, “Eisai India”) and Mylan Pharmaceuticals Pvt Ltd. (Mylan), has jointly announced that they have entered into a marketing license agreement to commercialize TECERIS®, the Innovator’s second brand of the anticancer agent Eribulinmesylate (eribulin) in India. TECERIS® will be manufactured and supplied by Eisai India and marketed by Mylan. This agreement is an important strategy for expanding the access of eribulin for the treatment of metastatic breast cancer (MBC) patients in India.

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DETAIL NEWS

Fertility Preservation A wish coming true for Cancer Patients DIVYA (NAME CHANGED) just like any other girl at the age of 28 had dreams of getting married and settle down with her family.

Life was picture perfect until her first year of marriage where she was diagnosed with breast cancer, all hell broke loose for her, and she was shattered on two counts, one the fear of fighting cancer and two, whether she will be able to bear a child in the state which she was in.

She realized soon that, life is not so unfair – when her oncologist specialist suggested her to meet Dr Durga G Rao – Medical Director and Co- Founder at Oasis Fertility. She was pleasantly surprised to know that, she was not alone in this kind of situation; there are hundreds of patients like her. She got a lot of Solace when she reached Oasis Fertility.

Fertility preservation is the process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have biological children in the future. It is the effort to help cancer patients retain their fertility, or ability to procreate.

How Does Cancer Therapy affect Fertility?

The effect of cancer therapy might be temporary or permanent and the degree of harm it does to your fertility depends on the type and stage of cancer treatment, age and various modes of treatment like: Chemothery: It is known that there are certain drugs like alkylating agents or cisplatin which affects the fertility of the patients more so in older women.

Radiation:can be more damaging to fertility than chemotherapy, depending on the location and size of the radiation field and the dose given. For example, high doses of radiation can destroy some or all of the eggs in the ovaries.

Surgery: Fertility can be harmed by the surgical removal of the testicles, uterus or ovaries.

Talking to the media Dr Durga G Rao – Medical Director and Founder of Oasis Fertility

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October 2019

stated that över a period of last few years we have seen a lot of patients secondary to cancer diagnosis being referred to us for fertility solutions, cancer and some autoimmune and idiopathic conditions are associated with a high risk of the male or female patient losing their fertility. We try and counsel them for fertility preservation and offer them solutions like embryo cryopreservation egg or oocyte cryopreservation or semen freezing, they can come back once they are fit both mentally and physically to start the journey of parenthood”.

Adding to this Dr Krishna Chaitanya –

Scientific Head and Clinical Embryologist – Oasis Fertility stated that “We are proud and glad to share that we have treated more than 100 such patients successfully and perhaps we are one of the only fertility care centres where we have been treating cancer patients and focusing on our cryo preservation technologies in highest numbers. We at Oasis have all the required competencies and dedicated teams like embryologist, reproductive technologists, psychologists, cryo preservation trained nurses and dietiatians who deal with the patient in a holistic manner.”

SudhakerJadhav - Chief Operating Officer; Dr Durga G Rao - Medical Director and Co Founder; Dr Krishna Chaitanya - Scientific Head and Clinical Embryologist, Oasis Fertility

COVER STORY

Author: Arindam B. Strategy Consultant, Healthcare & LifeScience

EVOLVING

EYECARE MOVEMENT OF INDIA

A close look at the private ophthalmology market to find out how the segment has disrupted in India 17

October 2019

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COVER STORY

W

hy cataract surgery could not be performed with the same cost, speed and consistency with which McDonald’s makes hamburgers, wondered 58year old much accomplished Ophthalmogist Dr Govindappa Venkataswamy. The year was 1976 and Dr V was staring at the problem of avoidable blindness, ~4 million cataract related blindness in India. Dr V found a solution in the 11-bed Aravind Eye Hospital in Madurai, instituted the same year. Over time, the hospital grew to become the world’s largest eye hospital performing over 1,000 surgeries per day, half of these for little or no money. On the other hand, 11 years later in 1987, Dr Gullapalli Rao and his wife Pratibha Rao, both trained in Ophthalmology in USA returned to Hyderabad, India where they started the non-profit, LV Prasad Eye Institute.

These two institutes have been the beacon of light for the private ophthalmology market in India. Following these two institutes a number of ophthalmologists were inspired to take the plunge into ophthalmology market and find ways to disrupt the market.

The fact that 80 per cent of blindness is avoidable and further 90 per cent of blind people live in developing

countries formed the core of a revolutionary eye care movement in India. High quality eyecare should be available to all, regardless of their ability to pay; this belief made way for an overarching purpose and quality, affordability and access became the foundational pillars.

The sheer economics of the problem paved way for the solution ahead. The early entrants had to convert all the need for eyecare including the unmet into actual demand by targeting every patient, affording and the non-affording. These diverse segments had to seamlessly fit into the larger puzzle to drive synergies and margins which in turn had to drive the core purpose – thus setting a virtuous cycle!

Purpose driven Innovation Culture These early pioneers wanted to deliver quality and equitable eye care to all in a sustainable way, but they were also focussed on creating financially sound and self-propelling organizations. They knew very well that charity could not be scalable. They had to be more efficient and productive so that margins from the paying patients could subsidize for non-affording ones.

They had to aggressively cut costs and drive system efficiencies while retaining the highest levels of quality.

Led by a deep sense of purpose, the only way forward

THE FACT THAT 80 PER CENT OF BLINDNESS IS AVOIDABLE AND FURTHER 90 PER CENT OF BLIND PEOPLE LIVE IN DEVELOPING COUNTRIES FORMED THE CORE OF A REVOLUTIONARY EYE CARE MOVEMENT IN INDIA

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A HUB-ANDSPOKE MODEL MADE A PERFECT FIT TO CAPTURE HIGH PATIENT VOLUMES ACROSS SEGMENTS AND THEN LEVERAGE THESE VOLUMES TO CONTINUALLY LOWER COSTS AND IMPROVE EFFICIENCIES

was to drive unparalleled innovation.

A hub-and-spoke model made a perfect fit to capture high patient volumes across segments and then leverage these volumes to continually lower costs and improve efficiencies. This allowed the concentration of most expensive equipments and scarce human resource expertise at the hubs while leveraging the hubs and spokes for running focused production lines. LVPEI achieved this through its ‘five tiered pyramid’ model extending upwards from the village level through small towns and larger urban areas leading to its referral hospital in Hyderabad. Community eyecare practices serving the bottom of the pyramid formed the very foundation for both Aravind and LVPEI’s care delivery models.

Another brilliant move was to carefully shift the non-core expertise tasks from highly specialized doctors to nurses and other paramedic staff who were specifically trained and skilled to match the intermediate task requirements. This created and empowered new categories of low cost health care workers and technicians (Ophthalmic paramedics) to help run the primary centres at the BOP - village and town levels. While another set aided the highly focused specialists at the higher treatment centres. Further, Aravind’s smart process design allowed one surgeon to operate on two cataract cases parallelly with a centrally placed swivelling microscope and two pairs of nurses at each station by his side. Aravind’s doctors thus operate

on five-six cataract cases in an hour as compared to just one or two in a conventional set-up. Put together, task shifting and process design innovation led to a remarkable boost to surgeon productivity, operating suite utilization and overall system efficiency.

Clinical innovations to solve native challenges while driving down costs also played a key role in this journey.

LVPEI developed a novel corneal slicing method that allowed a single cornea to treat two patients thus addressing the shortage of cornea donors. Aravind perfected a manual small-incision cataract surgery early on which was quicker and could be done with less sophisticated equipment. Another legacy player focussing more on specialty eyecare, Dr Agarwal’s started its modern eye hospital in 1976 in Chennai and contributed procedure innovations like Glued IOL for complicated lens problems and the PDEK for eye transplant.

Encouraging continuous learning and skill development at all levels ensured high quality standards with a spread of protocols and best practices uniformly across the system. At an average cataract surgery price of $50, Aravind out performed UK’s NHS on several performance quality indicators. Over the years, both Aravind and LVPEI continued to train the largest number of optometrists and ophthalmologists in India. At the same time, they continued to produce a high number of peer-reviewed publications in reputed national and international research journals. They

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COVER STORY TODAY, AUROLAB PRODUCES A RANGE OF RIGID AND FOLDABLE IOLS ALONG WITH LOW-COST SUTURES, BLADES, OTHER OPHTHALMIC CONSUMABLES AND ALSO EYE SURGERY EQUIPMENT

further shared their innovations and best practices with multitude of hospitals in India and other developing countries through an evangelism outreach.

Interestingly, Aravind realized the need for low-cost equipment and in a first, set up its own manufacturing facility, Aurolab which made Intra-Ocular lenses (IOLs) for a meagre $ 5 apiece through a technology transfer pact with a Florida based firm in 1980s. Today, Aurolab produces a range of rigid and foldable IOLs along with low-cost sutures, blades, other ophthalmic consumables and also eye surgery equipment. These are currently being exported to over 120 countries.

Into the new millennium – A vibrant ecosystem Since the early pioneers, the new millennium has seen the entry of several new players that continue to innovate, impact and grow; tapping into conventional and newer opportunity spaces.

For Profit Systems Running the largest number of private eyecare centers (73) across India with another 12 in Africa, early pioneer and speciality eyecare focussed Dr. Agarwal’s Eye Hospital is on an aggressive growth mission. Having raised 270 crores in 2016 from ADV Partners, Hong

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Kong and INR 160 Crores debt from Edelweiss in 2017, the biggest boost has come this year through an INR 270 Crores fundraise from Singapore’s sovereign wealth fund, Temasek. Led by 4th generation Ophthalmologist and CEO, Dr Adil Agarwal, Dr. Agarwal’s chain is majorly boosting its technology capabilities leveraging on its American and German technology partnerships. It is poised to double its centers across India besides tapping into new international markets like the USA and Europe over the next three to four years. Dr. Agarwal’s targets to double its top lines from current INR 500 Crores to INR 1000 Crores over next three years while maintaining robust 25 per cent EBITDA margins.

Incorporated in 2002, Dr Mahipal Singh Sachdev’s Centre For Sight (CFS) received its first institutional funding of INR 30 Crores from Matrix Partners, India in 2013. It currently runs about 35 centers across 32 cities in India with a center of excellence in Dwarka, Delhi.

Dr Sachdev has pioneered the Phacoemulsification procedure for cataract in India and has co-authored a book on the same. CFS leverages cutting edge technology and operational excellence in providing high-end eyecare to its patients. The minimally invasive SMILE (blade free LASIK) procedure for refractive error correction and robotic cataract surgeries are few of its strengths. CFS has further raised INR 206

Crores from Mahindra Partners, India in May 2019 through a minority stake sale while offering a full exit to Matrix Partners. CFS wishes to deploy the fresh investments primarily to grow in the Indian market through greenfields and acquisitions besides boosting its technology positioning.

Another pathfinder in this category is ASG Eyecare. Founded in 2005 by AIIMS Ophthalmologists specialising in anterior segment, Dr Arun Singhvi and Dr Shashank Gang, ASG Eyecare started its flagship specialty eyecare center in Jodhpur, Rajasthan. With Sequoia Capital, India pumping in INR 50 Crores in 2013 and IDFC Alternatives, India another 75 crores in 2017, ASG has quickly grown to 33 centers panning India, Nepal and Africa. The UAE-based Foundation Holdings has just pledged INR 308 Crores in fresh fundraise announced in September 2019. ASG looks to deploy these funds to grow both organically and inorganically including entering new micro-markets besides continue to invest in cutting edge technology advancements. ASG has not seen any major investor exits yet.

Kiran Anandampillai and Dr Rajesh Babu founded social impact start-up Drishti by Disha Medical Services to target affordable quality eyecare in the underserved micro-markets of Karnataka State. Drishti received seed funding from Lok Capital in 2013 and further Series

A from Nandan Nilekani’s Entrust and other HNIs in 2016. Drishti currently operates six district level eye hospitals, several telemedicine supported vision centres along with its much awarded mobile eye-clinics to serve the BOP segments - villages draining into its district hospitals. Drishti has recently started two urban centers in Bengaluru adding another layer to its care delivery model. The recent INR 27 Crores Series C fund raise from Insitor Impact Asia Fund made way for a full exit for seed investors, Lok Capital. Drishti aspires to become a regional brand by scaling up the physical care model and through greater deployment of telemedicine services in near future. It is poised to strengthen its more distributed care model with a greater focus on easing last mile care delivery.

Another focussed teleophthalmology start-up, Welcare Health Systems took off in 2013 in Chennai. It was founded by Dr Tamilasaran Senthil. Having received seed funding from Unitus Seed Fund, Welcare works through setting up a tele-ophthalmology service center at existing HCOs tapping into their captive chronic disease patient base for tele-screening/ diagnosing.

Largely focussed on screening for diabetic retinopathy for the burgeoning Diabetes patient numbers, Welcare currently services ~275 partner centers connecting them to its Chennai command center. It has recently

WITH SEQUOIA CAPITAL, INDIA PUMPING IN INR 50 CRORES IN 2013 AND IDFC ALTERNATIVES, INDIA ANOTHER 75 CRORES IN 2017, ASG HAS QUICKLY GROWN TO 33 CENTERS PANNING INDIA, NEPAL AND AFRICA

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COVER STORY received fresh funding and offered an exit to Unitus Seed.

It looks to rapidly expand its footprint and add other value add services like tele-consultations through its platform. AI powered early flagging and a growing shift to preventive care models is driving not just Welcare but all major eyecare systems’ future capabilities.

Bengaluru based cell therapy start-up Eyestem has raised an undisclosed amount in funding from Zurich based Jacesa investments and South Africa based Church Street Trustees. Founded by Dr Jogin Desai, Eyestem has created a platform for allogeneic, scalable cell therapy – Eyecyte-RPE holds the promise of finding a treatment for dry AMD (age related macular degeneration) – the largest cause of blindness that affects nearly 170 million people worldwide – mostly above the age of 50 years. With excellent pre-clinical animal results from partners, Oregon Health and Science University, USA, Eyestem looks to deploy the new funds to accelerate the start of human clinical trials by the end of 2020. Eyestem is at the forefront of global disruption for hitherto incurable blindness causes like Retinitis Pigmentosa (peripheral vision loss leading to tunnel vision) and Macular Degeneration (central vision loss).

It had earlier received funding from India based Impres Health.

Non –Profit Systems LVPEI has long partnered with Massachusetts Institute of Technology (MIT), USA to develop next generation of optometric technologies. Taking design innovation to the next level, this partnership has been holding Humanistic Co-Design Workshops for the visually impaired at Hyderabad. These hackathons provide a unique opportunity for design and engineering students to directly collaborate with people with visual disabilities to ideate and rapid prototype design solutions. Another strategic partnership with Ocutech, a North Carolina, USA firm offers high-tech eyeglasses, Field Expanders to Retinitis Pigmentosa (RP) patients. The incidence of RP is ten times higher in India than in the West and progressively causes tunnel vision severely affecting quality of life in the young – one in every 350 Indians. Internally, LVPEI continues to structurally commit a remarkably high level of resources – both human and capital to its research and innovation core to consistently deliver high social returns on investments. The Senior Alexander Von Humboldt Fellowship Award (Germany) winner, Dr Mohammad Javed Ali has just won the coveted CSIR, India’s Bhatnagar Award for Medical Sciences, 2019. This marks LVPEI’s fourth Bhatnagar Award since its inception, the highest multidisciplinary Science award in India.

THE NATIONAL PROGRAM FOR CONTROL OF BLINDNESS (NPCB) ESTIMATES THE CURRENT BLINDNESS PREVALENCE AT ABOUT 0.8 PER CENT OF THE OVER 1.35 BILLION INDIAN POPULATION AND 80 -90PER CENT OF THESE ARE CURABLE OR PREVENTABLE

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THESE HACKATHONS PROVIDE A UNIQUE OPPORTUNITY FOR DESIGN AND ENGINEERING STUDENTS TO DIRECTLY COLLABORATE WITH PEOPLE WITH VISUAL DISABILITIES TO IDEATE AND RAPID PROTOTYPE DESIGN SOLUTIONS

LVPEI is currently adding to its 20 secondary centers spread across the states of Telangana, Andhra, Odisha and Karnataka to grow its regional reach. It is parallelly allocating, honing and upgrading resources at these secondary centers to offer more complex eyecare procedures including eye transplants. This impacts the scale and the depth of eyecare services offered through its pyramid model with the Hyderabad Center of Excellence followed by three tertiary centers making the top care delivery layers. LVPEI continues to offer over 50 per cent of its services across the board free of cost, regardless of case complexity. Besides, it is now playing a lead advocacy and policy planning role working with multiple State and Central Governments to transform the reach and outcomes of India’s public eyecare programs.

Growth ahead The National Program for Control of Blindness (NPCB) estimates the current blindness prevalence at about 0.8 per cent of the over 1.35 billion Indian population and 80 -90per cent of these are curable or preventable.

Until recently, NPCB was primarily a cataract-centered programme. Cataract is by far the commonest cause of blindness (63per cent) followed by uncorrected refractive errors (20per cent), corneal blindness (1per cent); glaucoma (6per cent) and posterior segment disorders (5per cent). However the focus is now strongly shifting towards management of Diabetic Retinopathy, Glaucoma, Ocular Trauma, and Childhood blindness, Squint, Low

Vision and Retinopathy of Prematurity (ROP). The disease burden (absolute numbers) of these would be steadily on the rise due to continuing rise in population and longevity. With innovative models for eyecare delivery and better last mile care delivery, increasing disposable income and rising insurance penetration including the potential impact of India’s Universal Healthcare Plan – Ayushman Bharat , CRISIL estimates the Indian eyecare delivery market to reach $4.4 billion by 2020. Having witnessed a double digit growth over last few years of this decade and armed with fresh funds infusion, the top private eyecare systems are eyeing a CAGR of ~25per cent upto 2022-23 ahead.

Cataract remains the number one surgery by volumes in the larger Indian healthcare market. However, frontier technology acceleration through AI, AR and robotics would enable increasingly lesser invasive anterior segment interventions for cataracts, refractive errors, cornea and glaucoma through autonomous systems. These currently constitute ~85per cent of all eye interventions by volumes.

Data-driven connected technologies and systems would cause the future growth drivers to shift to early flagging and prevention. New interventions and cures for a large number of posterior-segment blindness causes involving the retina and the optic nerve present with the other future growth engine.

With the greater purpose of ‘doing good’ at its very foundation and a thriving innovation ecosystem catering to diverse target populations and segments, the future of the Indian Eyecare Movement remains rock solid!

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PULSE

MRCS for Indian Doctors How a Royal College of Physicians and Surgeons (UK) Membership is a game-changer for Indian doctors

Dr. Ranjan Venkatesan Dean, Post-graduate Medicine at Texila American University; Fellow of the Royal College of Obstetricians and Gynaecologists, London

24 October 2019

AS LAUDABLE as it is to be a doctor, the aspiration to serve the community and make it into a lucrative career poses numerous challenges while opting for a post-graduation in India.

To many of the MBBS graduates who have long wanted a viable PG option to achieve better standards and global recognition, Royal College of Physicians and Surgeons (UK) Membership is a blessing in plain sight.

With increased possibilities to attain post MBBS, doctors in India have increasingly begun to opt for PG through Royal College of Physicians and Surgeons (UK) Programs.

With a population of over 1.25 billion people, India produces less than 50,000 medical specialists each year. A meager 315 seats to do PG in cardiology against a need of 3,375 and

120 PG seats in nephrology against a need of 2,000 kidney specialists a year, shows the dismal figures that paint India’s healthcare crisis and how far the government initiatives have fallen short. India also has a dismal doctor-patient ratio of less than one doctor for 1,000 people, the country lags far behind in the number of seats made available for postgraduate studies in medicine. Presently, after completing MBBS, students start their practice as junior doctors in public and private hospitals undertaking a strenuous job. There are 479 medical colleges in India, in the hands of government and private domains. The average admission capacity for post-graduate seats clocks at 31,415 across the country. In addition, there are 6,848 DNB seats – considered MD/MS equivalent.

Bridging supply and demand The necessity to bridge this gap in available seats against growing need for more specialists opens new avenues, such as an international degree in post-graduation – one that is recognized by international professional bodies, most notably

by Royal College of Physicians and Surgeons in the United Kingdom.

Among Commonwealth countries, a Royal College of Physicians and Surgeons is technically a college with Royal patronage and permission to use the prefix Royal. The educational institute is usually granted permission through a Royal Charter. Although incorporation is obtainable more easily, the distinction of a Royal Charter makes it still the most sought by and granted to educational institutions, those specifically considered to professional societies in the public interest.

As its recognized by the Medical Council of India (MCI), a certification from the Royal College of Physicians and Surgeons (UK) is considered as an equivalent to a post-graduate medical degree in India.

Localizing international recognition Gone are the days when one had to travel overseas to take these examinations, anyone wanting to appear for a PG diploma from Royal College of Physicians and Surgeons (UK) can attend at any of the metropolitan cities such as New Delhi, Mumbai, Bangalore, Chennai, Hyderabad and Kolkata. To ease the number of candidates appearing in each schedule, dates are allotted 2 -3 times a year in these centres, often falling on February, May and November each year. Details on enrollment and examination schedule are rolled out 3 months in advance before the exams are held.

The following are the various Royal College (UK) Memberships awarded for Physicians and Surgeons: MRCP – Member of the Royal College of Physicians MRCS – Member of the Royal College of Surgeons MRCOG – Member of the Royal College of Obstetricians and Gynaecologists MRCPCH – Member of the Royal College of

Paediatrics and Child Health MRC Path – Member of the Royal College of Pathologists FRCR – Fellow of the Royal College of Radiologists MRC Psych – Member of the Royal College of Psychiatrists Indian doctors who wish to get the abovementioned certifications need to enroll as soon as the dates are announced to ensure they are not pushed to the next intake.

Each of the aforementioned qualifications has two or three theoretical papers which a doctor has to pass before appearing for a final oral and clinical exam. Fee to take these tests are ranging from 500 to 1000 British pounds per exam. Doctors with one year of experience at a clinic, preferably associated with a teaching hospital such as DNB approved or affiliated to a medical college, can attempt the first part of each of these exams individually. However, a total of 3 to 4 years clinical experience is necessary in the same specialty to appear for the final examination and subsequently qualify for the degree.

Those who ponder on the various advantages of gaining certification from Royal College of Physicians and Surgeons (UK) often need to direct to the simple facts, where NEET PG is yet to build a reputation of fierce competition in quality, rather in the number of

With a population of over 1.25 billion people, India produces less than 50,000 medical specialists each year

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PULSE There are 479 medical colleges in India, in the hands of government and private domains.

The average admission capacity for postgraduate seats clocks at 31,415 across the country

26 October 2019

people competing in its pool. A NEET PG exam has multiple choice questions (MCQs), single best answers (SBAs) and extended matching questions (EMQs), giving ample opportunity for any candidate to ace the exam.

In stark contrast, the Royal College of Physicians and Surgeons (UK) does not shy away from criticism of being competitive in quality, which is amplified in the increased awareness among doctors wanting a PG qualification outside NEET PG. This is strongly supported by the astounding career path and job opportunities in multispecialty hospitals catering to their rich and elite patients coming from different parts of India and overseas. This further validates the global recognition and reputation these qualifications garner in other countries.

An Indian doctor with certification from Royal College of Physicians and Surgeons (UK) has the unique opportunity and ability to practice across South East Asia, Africa, Australia, New Zealand, Europe and Middle East.

With a striking alternative to NEET PG, preparing for PG certification from Royal College of Physicians and Surgeons (UK)

becomes paramount of importance. Coaching and training for this particular field of PG equivalent takes more than a cursory online research.

Global recognition for Indian doctors Texila American University, located in Guyana and overseas presence in India and Zambia, is renowned for its record of accomplishment in prepping Indian doctors appearing for these qualifications.

The university has bespoke programmes based on Royal College of Physicians and Surgeons (UK) modules to suit Indian doctors, along with attractive stipend while studying, exclusive training and assessment

by Royal College consultants and a plethora of opportunities to have hands-on practical knowledge.

In partnership with the Central University of Nicaragua (UCN), their tried and tested method in training as well as in its wellresearched literature are testament to its insightful success among the Indian diaspora qualifying for Master of Medicine/Master of Surgery - upon completion of Thesis.

APPROACH

Designing Ophthalmic Setup Dr Aniruddha Chimote Director, Hosconnn Consulting Services

A FREE-STANDING ophthalmic setup is an Ambulatory Surgery Centre (ASC). In fact, designing and building an ASC can increase your practice’s profitability, or it can become an attractive but underutilised money pit.

Additionally, careful research, planning and financial analysis can pave the way for success.

When we start designing a facility, whether new or renovate an existing one, we need to focus on:  Outpatient Departments  Surgical spaces for cataract and other eye surgeries  Diagnostic and treatment spaces for Outpatient care  Indoor bed facilities for inpatient care Moreover, we also need to plan for other spaces such as entrance and reception areas, administrative offices, conference halls, medical records, lounges, canteen, library, pharmacies and outlets for lenses and other optical devices and so on.

One of the most important things, to be remembered is that patients using these facilities are visually impaired. So, the facility should be designed in such a way that these visually impaired patients find it easy to navigate through the facility. The design should pay special attention to reducing and/or eliminating obstacles that may hinder smooth mobility of these patients.

There are several design principles that need to be kept in mind when we begin designing a facility. The order of these may vary, but hygiene must always be a priority in any healthcare facility.

Hygiene Hygiene is a concept which has never been

28 October 2019

alien to the medical fraternity. We are probably more obsessed with cleanliness than anyone else, close to the point of being an obsessive compulsive disorder.

Yet we have probably never thought about incorporating the concept of hygiene in the design of a healthcare facility. The major thrust areas are: Limit Dust and Mould Countries with tropical climate like ours, cannot eliminate dust completely. Airconditioning helps to a great extent. But we need both extra filters to keep out dust and humidity control to prevent moulds.

Handwashing The importance of handwashing in any healthcare set-up cannot be overemphasized.

In fact, design of hospitals have to make provisions for handwashing at all necessary points. These is overwhelming evidence that frequent hand hygiene has reduced SSI and VAPs. There cannot be a bigger proof than this.

Asepsis Surgical spaces are our top priority when we design an ophthalmic set up. Asepsis in the OTs and designing a unidirectional flow in the CSSD are an important and integral part of the design process.

CSSD The space allotted should be adequate and there should be no segmentation. The design must include designated spaces for each of the activity involved in CSSD while maintaining a unidirectional flow.

Appropriate and Sustainable Technology Technology is an ensemble of mechanical and scientific methods, products or systems

invented for achieving human goals.

Appropriate and sustainable technology reminds us to be aware of the consequences of our choices.

Flexibility and Change Use building systems that are simply built and can be altered or augmented. Provide modest component of excess capacity.

Medical technology and technical support Facility design should support up-to-date technology with the needed space, structural support, electrical services, communication lines, piped medical gasses and other services.

Sustainability The hospital building should meet good building standards for structure, ventilation, HVAC, maintenance, ease of cleaning and energy conservation. A reliable level of human comfort and air quality should be provided.

Incorporating natural lighting into the design is perhaps the most important thing to do.

Function The hospital building must be designed to help staff work effectively and efficiently.

Form follows Function The building should support good medical practices. It should not stand in the way of staff efficiency. The building should allow easy repairs and renovation.

Make clear functional layout It can either be doctors hopping from one area to another or patients going from one point to another. One of these concepts should be followed in the design of the workplaces.

Functional requirements and design criteria Waiting Areas Combined waiting or de-centralised waiting? Both have their positives. But locating waiting area near the professional staff rather than searching for patients in a general waiting area makes better sense as it improves efficiency and reduces wastage of time in searching for the patient.

In fact, designing and building an ASC can increase your practice’s profitability, or it can become an attractive but underutilised money pit

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APPROACH Hygiene is a concept which has never been alien to the medical fraternity.

We are probably more obsessed with cleanliness than anyone else

30 October 2019

Response to Social Context and Community Design An important aspect of planning a new or redesigned eye care facility is to understand the beliefs and behaviour of the society. It must respect and support local social, cultural and spiritual practices and patterns. The design must be arranged to appropriately support the dignity and effective participation of everyone involved in large volume, high quality and sustainable eye care delivery.

Support local patterns of life Respect for and response to the local customs and the overall way of life goes a long way in building patient loyalty. A hospital design should incorporate all of this.

Community and privacy There are many intricate community practices on how they sleep, how they prefer ventilation etc. All of these small choices built into the design helps to develop that extra bond with the community.

Care-by-kin A very controversial point. However, if the community prefers that way the facility needs to be designed to educate the kin on personal hygiene, eating habits, and wound care etc. the facility needs to have a dedicated area for such training activities.

Beauty Celebrate Eyesight The eye should have something to celebrate in an eyecare facility. Local artists and craftsmen can be used to showcase local talent.

Consider using textured surfaces, colours and shapes that can be appreciated in different ways by people with different visual acuity – they appreciate more vibrant colours with higher contrast.

Site Repair Builders often tend to select the most beautiful spot on the site and replace them with a building there. The aim should be to conserve that spot and build the new building around it on probably the worst area on that plot.

Economic Issues Hotel Care and Medical Care Very often we see lavish interiors in hospitals that compete with lobbies and rooms of a 5-star or 7-star hotel. What hospitals need are functional interiors that are high on their utility quotient, pleasing to the eye, yet, are easily amenable to HIC policies of the organisation. The LEAN concept of eschewing ornamentation is more important here than anywhere else.

Outpatient Care Ophthalmology is one branch that has embraced outpatient care, positively. However, facilities located in remote areas need to factor in whether effective post-op care is possible at home after discharging patients immediately after surgery as is routinely done. Patients coming from remote areas may not be able to go and come back for routine post-op visits; some may have co-morbidities that may need to be monitored. Inpatient facilities may have to be created for such patients.

Finances Finances is a separate topic by itself and can be discussed ad nauseum. But to sum up in short, in planning a budget for a hospital it is critical to remember that the construction is not the whole project cost. It is equally important to consider the life cycle cost implications of building decisions.

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N on C ard i a c C T Insitum 338 comes with 19.20 mm detector width delivering 32Ă—1.2 mm, 32Ă—0.6 mm True Slice Acquisition.

1024x1024 reconstruction matrix Comprehensive clinical imaging applications.

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INTERVIEW

How Venture Philanthropy is Fighting CVD Burden Broadview evaluates its success based on whether its investments improve patient health rather than on financial return

BOSTON-BASED Broadview Ventures, created by the Leducq Family Trust, promotes the development of technology for the diagnosis and treatment of cardiovascular disease and stroke through direct equity-based investments.

It targets early stage companies seeking to fund proof-of-concept for technologies that hold promise as future breakthroughs for patient care. With 40 such investments over the last few years, Broadview has considerable experience in the seed and early-stage space, and its investment model is demonstrating early signs of success. Christopher Colecchi, Managing Director, Broadview Ventures talks to M Neelam Kachhap about broadview’s work and opportunities in India.

Broadview is a for profit VC firm but is mission driven. What does this mean and how does this guide your investment decisions?

Broadview’s mission is to invest in technologies for the treatment of cardiovascular and neurovascular disease—which establishes our therapeutic area mission. We focus specifically on investing intechnologies that are at a very early stage of development (preclinical to first in human)--a critical juncture when scientific and technical risksare high and available capital is relatively low.

Broadview is for-profit in that the fund makes equity and debt investments into early-stage companies under standard venture capture deal terms. We understand that our investment

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October 2019

is not sufficient on its own to bring a technology through to commercialization, so we participate within the venture ecosystem as a seed stage investor, creating value and de-risking our portfolio companies. We work closely with companies to help them raise additional capital tobring them closer to market.

Broadview is supported by a single limited partner, the LeducqCharitable Trust, which has the same shared missionand operates under an evergreen fund model, which means that itis not subject to a 10-year return horizon, and returns from Broadview’s portfolio are made available to invest in new opportunities. This

enables Broadview to take a long-term view, aligning our incentives with those of our portfolio companies.

As a mission-driven fund, Broadview evaluates its success based on whether its investments improve patient health rather than on financial return.

Kindly tell us about your earlier investments? Are there any success stories you would like to share?

Of the 40 investments made to date, numerous companies in our portfolio have reached suc(courtesy Edwards Lifesciences)

CardiAQ Valve

cessful financial and development milestones.

One example is CardiAQ Valve Technologies, a transcatheter mitral valve replacement implant company that Broadview funded in 2009, and which was subsequently acquired by Edwards in 2015 for $400M. In 2014, Broadview invested in Remedy Pharmaceuticals, a company developing CIRARA, or intravenous glyburide, for large hemispheric infarction. CIRARA was acquired by Biogen for $120M upfront in 2017 following the completion of the GAMES-RP Phase II study. Biogen is now conducting pivotal clinical trials of CIRARA. Broadview also invested in Apama Medical, a company developing a pulmonary-vein isolation ablation catheter for atrial fibrillation, which was acquired by Boston Scientific in 2017 for $300M. As our portfolio continues to mature, many companies are actively completing clinical trials, achieving regulatory milestones, and raising additional funds to further progress.

Up till now, which areas of CVD have you invested in?

As a part of our mission, we define cardiovascular disease broadly. We invest in technologies for the treatment of heart failure, cardiac rhythm disorders such as atrial fibrillation and heart block, and peripheral vascular disease.

We also consider underlying pathophysiological processes of heart disease such as chronic inflammation, insulin resistance, and atherogenesis. We investigate predisposing factors such as hypertension, diabetes mellitus, and obesity, as well as co-morbidities including cardio-pulmonary and cardio-renal syndromes. In addition, we have made investments in rare congenital heart indications as well as adjacent indications such as pre-eclampsia and lymphedema.

What are the areas of investment in neurovascular space?

Target indications of interest include ischemic and hemorrhagic stroke, cerebral aneurysm, and vasospasm.To date, Broadview has made four investments in companies focusedon the neurovascular arena.

Christopher Colecchi, MD, Broadview Ventures

What percent of Broadview’s investments are related to diagnostics, therapeutic and medical devices categories?

Today, wehaveinvested into 40 portfolio companies—17 (42.5%) are medical devices, 14 (35%) are therapeutics, 5 (12.5%) are gene and cell therapy companies, and 4 (10%) are diagnostics.

Have you looked at the work being done in India in the CVD space?

Admittedly, we haven’t seen many opportunities come from India to-date, but as an investor with a global footprint, we welcome the opportunity to start discussions with India-based entrepreneurs.

Please tell us about your collaboration with VCs and Funds in other parts of the world? How do you work together?

Broadview has a global investment remit and therefore collaborates with investors in many different countries. Our co-investors are based in the US, Canada, Europe, Israel, and China.

We actively focus on expanding our network of potential co-investors for innovative opportunities that we source and diligence.

As a philanthropic investor what is your outlook of the burden of disease and need to intervene for these two disease segments?

Cardiovascular and neurovascular disease represent two of the largest causes of mortality and

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INTERVIEW morbidity worldwide. One contributing factor is the rapid increase in the rate of obesity and type 2 diabetes in ever younger patients, which in turn increases risk and burden of cardiovascular disease significantly each year despite generally broad access to safe and efficacious medicines in many areas of the world. Reimbursement and regulatory challenges are especially acute in cardiovascular disease due to the very large patient populations and existing therapies which are largely off-patent--further complicatingthe development of venturebacked businesses to tackle these indications.

In addition, many “low-hanging” biological hypotheses have already been attempted, either resulting in failure or great success—both of which set the threshold for the creativity of a given approach to manage the patient, provider, and payer ecosystems at a very high level.

These challenges impact the venture ecosystem

DECEMBER 2018, VOLUME 2 ISSUE 12 `200 INDIA MED TODAY

www.indiamedtoday.com

INTERVIEW IAN YOUNGMAN, UK

ARTIFICIAL INTELLIGENCE IN RADIOLOGY SYMPOSIUM SPECIAL FEATURE DEEPAK PAWAR, FICCI DALIP KUMAR CHOPRA

India’s Next Crown Jewel

DECEMBER 2018

MEDICAL TOURISM

accordingly: in the US in 2017, cardiovascular disease, cerebrovascular disease, and diabetes accounted for almost 900,000 deaths annually, more than any other therapeutic area, including cancer (600,000). However, while cardiovascular and metabolic disease venture funding from 2013-2017 amounted to $2.0B, oncology companies raised $8.8B over the same time period. As evidenced by this disparity, cardiovascular and metabolic disease represents a tough but important area for therapeutic and medical device development, one that Broadview’s philanthropic venture model is uniquely suited to address.

Tell us about your future plans.

Based on prior successes in our portfolio and to accelerate the advancement of our mission, we have established a new (2019) investment vehicle called Longview Ventures to make later stage follow-on investments in Broadview port-

folio companies. Longview isa $100M financial return-focused venture investment vehicle that will allocate between $6M and $8M per company.Longview makes investment decisions under a separate diligence process with an independent advisory board, and seeks to follow or co-lead in fundraising rounds that are priced by an independent institutional lead investor.

We believe a significant contributing factor to Broadview’s success has been the involvement and dedication of its Strategic Advisory Board – made up of world class advisors from the cardiovascular, investment, and corporate worlds.

In addition, our access to the now world-wide network of cardiovascular thought leaders funded over the last 20 years by our sister organization, the Leducq Foundation allows for a unique level expertise during our investment diligence process and then in support of our portfolio companies.

Subscribe to IndiaMedToday and get 20% discount + Extra FREE issues Indiamedtoday magazine reports on the issues and trends that are shaping the business of healthcare in India and abroad today. Each month, the print magazine discusses long-term strategies to meet the challenges posed by an evolving healthcare marketplace. In every issue, our readers discover the practical advice, analysis, and receive and insight on management trends, innovative 12 + 3 FREE issue. concepts, market strategies and real-world solutions they need to navigate the changing landscape of the business of healthcare.

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October 2019

FEATURE

Medical Value Travel in India Deepak Pawar, FICCI

MEDICAL TOURISM Market is projected to grow from US$56.333 billion in 2018 to US$136.591 billion in 2023, growing at a CAGR of 19.38% over the forecast period. Continuous rising medical costs in the U.S. and Europe with improved standards of healthcare technology in developing nations like India and China are driving the growth of medical tourism industry.

Other factors such as rising aging population worldwide, availability of affordable worldclass medical facilities in emerging economies, and, high medical insurance costs in developed regions are also boosting the demand for medical tourism globally.

APAC region has become the new hub for the medical tourism industry as countries in this region comprise high standards of hospitality with wide exposure to latest technology in the medical sector. Availability of low priced medical treatment options coupled with improved infrastructure in terms of healthcare facilities is making Asia Pacific an attractive location for medical tourism.

While countries such as Thailand, India, and Malaysia have already become key regions for medical tourists, several new countries like UAE and Taiwan are becoming new players in the global medical tourism industry. Growing demand for specialized surgeries such as breast augmentation, dermabrasion, and rhinoplasty and better pricing of such cosmetic surgeries in these countries will further fuel the growth of medical tourism market during the forecast period.

Medical Tourism in India is on a faster pace of growth compared to the previous years. The growth percentage is almost 25 per cent in Medical Tourism. The specialising hospitals in India also are gearing up their Patients Relations Protocols to make the patient experience comfortable. The official figure of the Ministry of Tourism suggests that there was an increase of 1,27,142 foreign patients during 2016 compared to the figures of 2015. In 2016, Medical Tourism arrivals was 3,61,060. The Indian Medical Tourism Industry is expected to grow to US$8 billion by 2020 from the US$3.9 billion of 2016.�

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FEATURE Opportunitiesfor forIndia India Opportunities Thus in inorder ordertotoemerge emergeasaspreferred preferredglobal globaldestination destinationforforMVT, MVT, India needs diversify Thus India needs to to diversify its its sources of medical tourism and offerings to create a strong value proposition sources of medical tourism and offerings to create a strong value proposition

In the short term, India can focus on Streamline the visa issuance process In the short term, in India focus on  Streamline visaforissuance process increasing penetration its can established Introduction the of E-visa medical tourists increasing in India its established  Introduction medical tourists markets withpenetration offerings where enjoys a  separate categoryofofE-visa visa hasforbeen launched i.e. markets separate visa” category of visa been treatment launched i.e. clear edge.with offerings where India enjoys a  “e-Medical for short termhas medical clear “e-Medicalfrom visa”for short term treatment Inedge. the medium term, India should focus on  Applicants nearly 161 medical countries are In the medium term, which India should focustoon  Applicants from nearly developing other regions contribute eligible for e-tourist visas 161 countries are developing otherpatients regionslike which eligiblefor forapplication e-tourist visas majority of MVT US bycontribute leveragingto  Window under e-visa scheme majority MVT patients like US by leveraging  Window for application scheme its existingof treatment capabilities.

Within new has been increased from 30under days toe-visa 120 days its existing treatment new  Provision has been increased 30 days 120 days offerings, India can startcapabilities. building its Within credibility has beenfrom given for tomultiple offerings, Indialike canweight start building its credibility  Provision in treatments loss surgery, spine entries (up tohas three)been given for multiple in treatments like weight surgery, spine  Visa entries to three) coming from Oman surgery and infertility etc. toloss further penetrate fees (up for travellers surgery and infertility etc.sources. to further penetrate  Visa fees for travellers coming from Oman into its traditional patient has been reduced intoInitsthe traditioVnal patient has been reduced long term, Indiasources. needs to target remaining like Canada, Europe In theregions long term, India Eastern needs to target Build on ‘Brand India’ as medical etc.; it also needs to expand footprint in value remaining regions like Canada, Eastern Europe Builddestination on ‘Brand India’ as medical offerings such as cosmetic surgery to effectively  Ministry of Commerce and Industry along etc.; it also needs to expand footprint in value destination tap into these regions with Service export promotion council offerings such as cosmetic surgery to effectively  Ministry of Commerce and Industry along (SEPC) has launched a healthcare tap into these regions with Service export promotionportal, council Summarising FICCI Activities Indiahealthcaretourism.com (SEPC) has launched a healthcare portal, We at FICCI closely work with the  Portal provides comprehensive information Summarising FICCI Activities Indiahealthcaretourism.com Government of India for the Promotion of to medical travelers We at FICCI closely work with the  Portal provides comprehensive information MVT in India.  Prehensive Government of India for the Promotion of to medicalinformation travelers to medical travelers Some of the Key Recommendations of  Portal highlights capabilities / advantages MVT in India.  Prehensive information to medical travelers FICCI to Govt. of India of India as MVT destination as Some of the Key Recommendations of  Portal highlights capabilities / such advantages availability of more than 20 JCI accredited FICCI to Govt. of India of India as MVT destination such as availability of more than 20 JCI accredited

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Medical MedicalTourism Tourism Market is Market is projected projectedtotogrow grow from US$56.333 from US$56.333 billion in 2018 to billion in 2018 to US$136.591 billion billion inUS$136.591 2023, growing at 2023,ofgrowing a in CAGR 19.38% at a CAGR of 19.38% over the forecast over the forecast period period

October 2019

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39

hospitals, zero waiting time, availability of qualified medical staff etc.  Government has set up separate immigration counters and facilitation desks at key Indian airports namely, Delhi, Mumbai, Kolkata, Chennai, Bengaluru and Hyderabad to assist medical tourists  The Ministry of Home Affairs has done away with the FRRO clause for medical patients with only exceptions being Pakistani and Afghanistan nationals that still need to register at FRRO / police stations Registration of medical facilitators  NABH has started accreditation programmefor empanelment of facilitators.  As of now 6 Medical Facilitators has been certified by NABH and are listed on their website. Another 4 have applied  A sub-committee was set up by FICCI MVT committee, to address the various issues faced by medical facilitators and hospitals in managing international patients  Committee has outlined a series of recommendations to facilitate the engagement between healthcare facilitators and healthcare services providers in India.

Self-regulation by providers  FICCI has created a task force that is working on creating a framework for grading of hospitals  The framework will leverage experience of from other international accreditation programs for MVT  Approximate range of medical treatment expense and duration is now being mentioned on the portal managed by SEPC i.e. Indiahealthcaretourism.com  Select hospitals catering to MVT travelers have published tariffs of 10 most common procedures, on their website We need to resolve following issues for the growth of MVT Industry in India  Visa Regulations  Registration & Guidelines for Facilitators  Price Regulation & Capping  Wages  Patient Rights  Streamlining Health Insurance  Self Regulation by Providers  Grading of Hospitals

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FEATURE

Health Insurance and MVT How it impacts the overall treatment transactions

Dalip Kumar Chopra, President, Foundation of Healthcare and Wellness Promotion, India and Director, Gurdasmal Hospitality and Consultancy Services Pvt Ltd, Noida, Delhi NCR

A GROWING number of international insurance companies and self – funded employers are exploring the idea of offering medical travel for treatment abroad as an option for their clients and employees. As healthcare costs in the U.S and Canada continue to rise, some people are seeking medical care abroad – as Medical Tourists. This type of travel insurance protects medical tourists from unexpected financial losses on a covered trip.

What makes medical tourism insurance unique?

A growing number of people are seeking medical care outside the borders in countries such as (india is mentioned twice). In most cases, the traveller has already paid for their medical treatment in advance for their medical treatment, but if they experience medical complications, or have to cancel their trip, this coverage will help them to recover their costs and avoid unexpected high medical expenses.

What Coverage is included in medical tourism travel insurance?  Coverage for medical expenses due to complications that result from your treatment.  Coverage for trip cancellations if the treatment is cancelled for a covered reason.  Coverage for evacuations if you need evacuation to another medical facility.  Coverage for unexpected medical costs not related to the treatment.  Coverage for flight accidents while on a covered trip.  Travel delays, missed connections, and lost luggage coverage are also included.

Travellers Medical Insurance differs from a normal in–land health plan or health insurance; as it is focused and designed for the medical tourist with the primary purpose of meeting the needs of the emerging industry of medical travel.

Many companies and organizations in the medical tourism industry provide benefits for the people who want or need to travel in order to receive medical treatment outside their countries. If you are currently considering a medical procedure abroad, it is important for you to review the policy of your travellers insurance and coverage plans.

Why do I need Medical Travel Insurance?

As mentioned before, if you are travelling abroad with the intention of receiving medical treatment, standard travel insurance does not work. Its coverage is limited and you will be classified as high–risk category client.

If you need cardiac surgery, dentistry, or-

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October 2019

thopaedic or cosmetic surgery, among many other categories, medical tourism to Singapore, Thailand, Colombia, Mexico, India, Cuba and Costa Rica might be of your consideration. Despite being Third World countries, they offer a surprisingly high quality medical environment, but still, the risk to take is yours. It is about your health, safety and comfort.

That’s why you need special travel insurance when you travel for medical care. Some of the organizations offer or provide coverage for:  Medical complications that result in extra expenses.  Enhanced benefits in relation with complications that appear up to 6 or so months after the procedure, once you are back at home.  Complication covered for disability.  Complication covered for death.  Additional costs of travel.  Family coordination.  Residence modification and others.

Basic Structure of Health Insurance for Travellers

Medical insurance companies offer these basic packages:  Before travel: if the patient has to cancel or delay the trip.  During travel: complications/accidents during the planned treatment, if the recovery period is longer or for post-operative complications. It includes accommodation, flights, daily allowance, consultation fees, and medication.  After travel: correction of unsuccessful surgery, including flights.

The Medical Travel Insurance will not only boost the Medical Travel from Developed Countries like USA and Canada to countries like India, Thailand, Singapore, Malaysia etc but also from developing regions ( Africa, Middle East, CIS and SAARC ) to countries like India, Thailand, Singapore, Malaysia with a reason that the claim cost of Medical Insurances Companies shall be reduced considerably when they are sending patients abroad to these mentioned countries without compromising the quality of medical treatment.

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DEVICE TRAIL

Osteochondral Implants Image courtesy: CartiHeal

Divya Ramaswamy

40 October 2019

THE PREVALENCE of osteoarthritis increases with the aging population and there is also an increase in various factors related to it such as obesity and sedentary lifestyle. Being the second most common rheumatologic problem, osteoarthritis has a prevalence rate of 22-39% in India. More women than men have been diagnosed with osteoarthritis (approximately 45% of women >65 years of age).

Despite several achievements in the knowledge of osteoarthritis disease pathogenesis, finding the best treatment option still remains a challenge. There isn’t any specific disease-modifying drug available yet for osteoarthritis patients. The standard pharmacological treatment comprises of several agents for pain management and controlling inflammation such as NSAIDs, analgesics, opioids and, intraarticular corticosteroids.

Recent research approaches TNF-alpha blockers in the pathogenesis of osteoarthritis.

Also, intraarticular administration of plateletrich plasma is also currently being evaluated as a potential future therapy.

Recently, CartiHeal Performs First Agili-C Cartilage Repair Implantation Procedure as part of Investigational Device Exemption

(IDE) clinical study by Joseph M. Berman, MD at Arlington Orthopedics Associates (AOA), Arlington, Texas. Arlington Orthopedics Associates is one of 15 U.S. clinical sites participating in this randomized and controlled IDE clinical study. The primary study objective is to demonstrate the superiority of the Agili-C implant over the current surgical standards of care: microfracture and debridement in the treatment of large spectrum cartilage defects.

What is Agili-C? The treatment of symptomatic osteochondral defects now involves the use of osteochondral implants. Agili-C is one such new implant which is designed to aid patients suffering from knee-cartilage defects to regenerate their own healthy cartilage alongside the subchondral bone that lies beneath it. It is a porous, biocompatible and resorbable scaffold that consists of interconnected natural inorganic calcium carbonate. It has been implanted in more than 400 patients with ankle, knee and great toe cartilage lesions and a broad range of various osteoarthritis patients.

CartiHeal, a privately-held medical device company headquartered in Israel and New

Jersey, develops proprietary implants for the treatment of cartilage and osteochondral defects in traumatic and osteoarthritic joints.

The company has developed Agili-C a cell-free, off-the-shelf implant which is CE marked for use in cartilage and osteochondral defects.

How does Agili-C work?

To implant the device, the surgeon will need to prepare a hole in the patient’s knee so that the implant will fit in seamlessly. Bone graft substitutes and bone fillers have been used to treat bone defects and during orthopedic surgeries. And Agili-C uses the same technique and performs as bone repair scaffolds exhibiting osteoconductive properties and regenerate healthy cartilage and its underlying subchondral bone.

Recent research Matta C et al who sought to evaluate the in vitro potential of the bone phase reported that the novel coral-based scaffold could promote the rapid formation of high-quality bone.

And another study conducted by Chubinskaya S et al who sought to investigate the ex vivo mechanisms of action of the Agili-C implant during the repair of full-thickness cartilage defects found that the scaffold can be used in clinical practice as a single-step procedure to treat full-thickness chondral defects. The study used fresh human cadaveric articular cartilage to demonstrate that chondrocytes were able to migrate into the Agili-C scaffold and aid the deposition of the extracellular matric rich in collagen (type II) and aggrecan. It also showed the formation of a layer populated by progenitor-like cells on the articular surface of the implant device.

Similar products: Chondrofix Osteochondral Allograft- It is the first off-the-shelf osteochondral allograft which transforms the regeneration of full-thickness osteochondral lesions in diarthroidal joints. The allograft is composed of human decellularized hyaline cartilage and cancellous bone along with mechanical properties.  Hyalofast- A Hyaluronic acid-based matrix that supports the regeneration of hyalinelike cartilages. The scaffold is composed of a single 3D layer of a benzyl ester of hyaluronic acid which can be cut and fit into irregular lesions and be implanted in mini arthroscopic surgeries.  Azellon Cell Therapeutics’ Cell bandage technology takes adult mesenchymal or skeletal stem cells from a patient’s bone marrow and grows the cells to form a collagen scaffold membrane. The stem cells would then be seeded onto the membrane and surgically implanted over the knee cartilage for repair. An enhanced version of the cell bandage is still under development. 

Being the second most common rheumatologic problem, osteoarthritis has a prevalence rate of 22-39% in India.

More women than men have been diagnosed with osteoarthritis (approximately 45% of women >65 years of age)

Ongoing clinical research An interventional clinical trial is estimated to be completed by the end of this year, in order to evaluate the performance evaluation in the repair of cartilage and osteochondral defects.

The candidates enrolled for the study have been screened for inclusion. Agili-C implant will be implanted using the respective surgical toolset designed specifically for implantation.

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EVENTS ADVANTAGE HEALTHCARE-INDIA Date: Nov 13-15, 2019 Venue: India Expo Centre and Mart,

Greater Noida(NCR) India

T

he medical value travel industry has emerged as one of the fastest growing segment of tourism industry despite the global economic downturn. According to the FICCI – IMS Report, India is one of the key MVT destinations in Asia with over 500,000 foreign patients seeking treatment.

MVT can be a 9 billion USD opportunity by 2020 through adequate focus and effective execution. The objective of this summit is to promote India as a Premier Global

HEALTHMS Date: Oct 18, 2019 Organiser: Medversity City: Hydrabad Contact: Assimilate - Revolutionizing

Healthcare Destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration of the ‘5 – Ts’ - talent, tradition, technology, tourism and trade.

The event will host three days exhibition with B2B meetings and hospital inspection. Along with Proposed Health Minister’s round table meeting followed

by Networking Dinner hosted by Hon’ble Health Minister. There will also a proposed Tourism Minister’s round table meeting followed by Networking Dinner hosted

by Hon’ble Tourism Minister along with networking dinner on last day hosted by FICCI.

SEPTEMBER 2019,

VOLUME 3 ISSUE

Click: indiaheals.sepc@gmail.com SEPC supported by Ministry of Commerce and Industry organizes IndiaHeals. India Heals will enable B2B meetings with over 100 foreign buyers from Afghanistan, Bangladesh, Bhutan, China, Indonesia, Kenya, Malawi, Mauritius, Myanmar, Nigeria, Oman, Rwanda, Tanzania, Sri Lanka, Uganda, Uzbekistan - our main export markets. They will meet with reliable NABH/JCI accredited hospitals, dental clinics, wellness centers and AYUSH centers. Foreign Buyers will also visit these establishments to experience first-hand the prowess of the Indian healthcare sector. Mainstreaming traditional medicine in healthcare is the vision of IndiaHeals. Ethical healthcare practices the world yearns for, will be strengthened through IndiaHeals.

9 `200

y.com

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TACKLE

HEART FAILURE

H HEAD-ON WIT LATION NEUROMODU THERAPY

is driving in Effectiveness ing Medical 3D Print

NAVIGATING HOSPITALS

INTERVIEW

S CAPITAL SOMERSET INDU STS IN PARTNERS INVE RE FIRMS, TWO HEALTHCA DEPLOYS II FUND

IMPACT

2019

October 2019

Council City: Kochi, Kerala Contact: MdIlias, 91-9940553791

Click: info@worldcongressonnursing.com Nursing conference brings together individuals who have an interest in different fields of nursing like psychiatric, cancer, cardiac, critical care, adult & women health, legal, pediatric and emergency nursing, midwifery, public health, healthcare and medicine from practice, research, administration, policy and education.

It is a forum to explore issues of mutual concern as well as exchange knowledge, share evidence

SEPTEMBER

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Date: Jan 31- Feb 1, 2020 Organiser: Services Export Promotion

Date: Nov 21-22, 2019 Organiser: BioGenesis Health Cluster Venue: J. N. Tata Auditorium, IIS City: Bangalore Contact: 80 2333 0446 / +91 80 2333 0019

APPROACH

WORLD CONGRESS ON NURSING AND HEALTHCARE SUMMIT 2019

INDIA HEALS, KERELA (AHCI)

INDIA MED TODAY

Healthcare Education HealthMS is a conference designed to address each of the aspects of building a strong brand which could include you as an individual, a new set up or an organization. HealthMS will also focus on a mix of topics around creating dynamic marketing strategies, understanding marketing channels like digital which have become central to most marketing strategies, insights from the healthcare universe.

This first-of-its-kind event, HealthMS will bring top global leaders, influencers and strategists to discuss, share and co-create strategies with you pertaining to the field of healthcare.You will get to learn, apply and create actionable strategies that will give you an edge in the healthcare sector. So if you’re looking to build a strong brand that’ll differentiate you from the rest, this event is for you.

and ideas, and generate solutions.

World Congress on Nursing and Healthcare Summit -2019 will provides you a platform for global networking and exchanging latest innovations in nursing and healthcare It also offer the opportunity to attend the presentations delivered by Eminent Experts from all over the world.

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