1 The
Best
PHYSICAL
REHABILITATION
CENTERS To Watch
Barbara Walczyk Joers
2020 / Vol.10/ Issue-03
President & CEO
Potential Realized More than a Vision at Gillette Children’s Specialty Healthcare
Note
Editor’s
Healing with Nature
T
hat our environment impacts the well-being of our body is a well-known fact. For those who still doubt, research has established that too. A natural or nature-like setting and environment reduces our stress, uplifts our mood and helps our nervous, immune and crucial body functions to work smoothly.
2003, to describe the benefit of exercising amidst nature has proven effective for not just general well-being but also physical rehabilitation. A recent study conducted in 2019, suggests that spending at least two hours a week in green spaces was enough to promote good health and psychological well-being.
Not only that but nature also helps us to deal with physical pain and even heal quickly after a medical procedure like surgery. In a classic test conducted on patients who underwent gall bladder surgery by Robert Ulrich, half were given a view that had trees while the other half could see a wall. Those with a view of nature healed better, quickly, handled pain better and had a low negative impact of surgery.
While medical science has surely progressed enough to help with rehabilitation in ways earlier unheard of, the role of nature in the healing process cannot be denied. In this edition of Insights Care, we bring The 10 Best Physical Rehabilitation Centers To Watch. Using advanced science, these institutes are helping patients deal with pain and disability, to live life at its fullest and as naturally as possible.
Even for general well-being, medical practitioners advise a brisk walk in a natural surrounding as the least rigorous form of exercise that can be done by one and all. ‘Green Exercise’, the term coined in
SNEHA SINHA
Cover Story
08
Potential Realized More than a Vision at Gillette Children’s Specialty Healthcare
CXO
CONTENTS
18
Modern Healthcare
In-depth Analysis
Physical Therapy in Pain Management: Evolving Roles of Extracorporeal Shockwave Therapy in Musculoskeletal Pain Management
Need to Strengthen healthcare research
28
Articles
16
Watch out
Hands-on
Trends in Physical Therapy that will rule 2021
Using Wearable Devices to Our Advantage in Everyday Life
26
Editor-in-Chief
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1 PHYSICAL The
Best
REHABILITATION Centers To Watch
Company Name
Management
Brief
Baton Rouge Rehab Hospital brrehab.com
Trisha Guidry Director
Offers comprehensive neurology-based inpatient and outpatient rehabilitation services.
Burke Rehabilitation Hospital burke.org
Jeffrey Menkes CEO
Burke, a member of the Montefiore Health System, has been a leader in rehabilitation medicine for over 100 years.
CHRISTUS Health christushealth.org
Susan Landreaux Executive Director
Delivers a complete healing experience that respects the individual
Craig Hospital craighospital.org
Jandel Allen-Davis CEO
A world-renowned rehabilitation hospital that exclusively specializes in the neurorehabilitation and research of patients with spinal cord injury (SCI) and brain injury (BI).
Gillette Children’s Specialty Healthcare gillettechildrens.org
Barbara Walczyk Joers President & CEO
Gillette provides comprehensive services, highlight trained specialists, integrated team approach, family-centered care and a lifetime of services.
Post Acute Medical postacutemedical.com
Anthony F. Misitano CEO
Post Acute Medical is committed to providing high quality patient care and outstanding customer service
Renown Rehabilitation Hospital renown.org
Anthony Slonim CEO
Renown is northern Nevada’s healthcare leader and Reno’s only locally owned, not-for-profit health system.
Roosevelt Warm Springs Rehabilitation Hospital augustahealth.org
David Mork CEO
A world-class health care network, offering the most comprehensive primary, specialty and subspecialty care in the region.
Spaulding Rehabilitation Hospital spauldingrehab.org
David Storto President
Spaulding Rehabilitation is a world leader in advanced rehabilitation treatment and research – serving the greater Boston region and beyond.
University of Michigan Hospitals-Michigan Medicine med.umich.edu
Marschall S. Runge CEO
Michigan Medicine is home to one of the largest health care complexes in Michigan.
Barbara Walczyk Joers President & CEO
cOVER sTORY
Potential Realized More than a Vision at Gillette Children’s Specialty Healthcare
A
“
We have a long history of over 120 years in helping patients improve their health, achieve greater well-being, and enjoy life
n unwavering commitment to ensuring the best care for all children and a partnership between patients and providers is the deeply rooted legacy that drives the mission of Gillette Children’s Specialty Healthcare. 123 years ago Dr. Arthur Gillette and Jessie Haskins, a student who had grown up with a complex condition, successfully lobbied Minnesota lawmakers to establish the nation’s first hospital dedicated to the care and treatment of kids with disabilities. Today, this legacy and care model continues to guide more than 1,400 people who work at Gillette as they care for children with complex
“
c
onditions, rare disorders and traumatic injuries.
Defining a Unique Care Model Based on her own experiences with healthcare as a child, Gillette President and CEO, Barbara Walczyk Joers believes it’s important that everyone on the care team has a deep connection to the hospital’s mission and focus. “Most of our patients will require continued care and therapy throughout their life, so we built and organized our resources around a care model that treats the entire condition of a child and looks at their life goals, versus one episode of care. Such a plan helps patients and families think about what’s possible and how to reach their full potential now and throughout life.” Joers says.
“We are recognized worldwide for excellence in patient care, advocacy, employment, research and education”
This integrated practice model stands out in the current environment of consolidation in health care that can often leave patients and families feeling lost as they seek to navigate care. “Our care model is why patients choose Gillette” says Joers, “and why we feel that giving patients and families a choice in their care provider remains a priority for Gillette.” The Gillette Care Model is built on three pillars leading to the fulfillment of the vision—“Potential Realized.” These pillars are: Focused Expertise, Proactive Care Planning and Trusting Relationships. Barbara Joers explains: “At Gillette we are fortunate to be organized around a core of well-trained and
This amazing depth of expertise, combined with 120plus years of experience allows Gillette care teams to develop innovative and sophisticated care plans with families, says Joers. Proactive, individualized care planning, along with focused expertise, help establish and build trusting relationships with patients and families. “Parents come to us in a moment when their hopes and dreams for their child have been thrown into doubt,” Joers continues. “Maybe this parent just heard a diagnosis for their child or they witness their child endure a trauma due to an accident. Whatever brings a parent through our doors and to seek our help is often due to something life changing and unexpected.” Joers Inspiration Joers speaks from experience. Her dedication to patient care came at an early age. “When I was five I was found to have a middle ear condition that impacted my hearing, facial structure and speech. From there, several surgeries were done. During one of those surgeries I had a bad experience with a clinical staff member. While my surgeon was tending to the result of the incident, which was in the middle of the night, I asked how to make sure this doesn’t happen again. Instead of giving me orders or ideas for when I was hospitalized next – he leaned down to me and said - run a hospital and do it right. This experience drove Joers to pursue a career in hospital administration and ultimately to Gillette where she remains focused on the vison established by Dr. Gillette and the patients Gillette continues to serve. This clear focus on mission and vision can help clear the fog of anxiety and help everyone surrounding and
‘‘Gillette
is the right place for
‘‘
devoted pediatric specialists and sub-specialists in areas including Physical Medicine and Rehabilitation (PM &R), Orthopedics, Neurology, Neurosurgery and Complex Care Pediatrics. This depth and breadth of expertise forms the foundation for our care - many of our providers are truly the best of the best, leading research and filling conference sessions around the world when they speak.”
you and your family
supporting this child to find a path and plan. “Our first goal is to let the family know that we’ll help them discover and understand everything their child can do. As we work to help children reach their full potential strong bonds will develop.” The Gillette care model has a broad impact: the hospital sees patients from every Minnesota county each year, and over the last three years has seen children from all 50 US states and over 30 foreign countries.
Pediatric Rehabilitation Expertise and Much More While recognized nationally and internationally for their rehabilitation program, Gillette Children’s Specialty Healthcare is that and more. “We began as a surgical hospital, offering interventions to correct musculoskeletal deformities to improve function and mobility” states Joers. “From the beginning our patients needed rehabilitation and time to regain physical function. Over time our teams saw the importance of physical medicine and rehabilitation, physical, occupational and speech therapies, as well as custom orthotics, prosthetics and seating services in offering a full system of care for the children we treat.” Gillette’s Pediatric Rehabilitation Program is one of the most comprehensive in the nation and is just one of eight in the U. S. and only hospital in the Upper Midwest to earn the Commission on Accreditation of Rehabilitation Facilities (CARF) for pediatric specialty program and brain injury. Gillette has the highest concentration of pediatric rehabilitation medicine specialists in the nation who work with children, adolescent and select adult
patients with a wide variety of complex conditions. “Our rehabilitation services, both inpatient and outpatient, are among the best in the world and our outcomes show it” states Joers. A shining example of Gillette’s rehabilitation care model in action is the Cerebral Palsy program. “We are one of the top centers globally, really - for children with Cerebral Palsy” explains Joers. “We take a long-term, team focused approach to the proper diagnosis, management and selection of interventions in the treatment of Cerebral Palsy. The family will work with a team of providers including PM&R physicians, orthopedic surgeons, neurosurgeons, neurologists and physical therapists to understand the type and severity of Cerebral Palsy.” Gillette’s teams engage with physicians and clinicians from multiple countries to share protocols and to help advance care for children regardless of their location. Honored and Humbled to be Trusted
“We
are committed to providing the highest standards of care throughout our organization”
While Gillette remains focused on its core mission, Joers also recognizes that “change is constant in healthcare” and the hospital remains ready to adapt and move forward to ensure the best continues care for its patients. In 1890, Dr. Gillette addressed the Minnesota Academy of Medicine and said “Overcoming deformity is the first thing; the next and very important too, is to keep it so.” Barbara affirms this legacy of commitment saying, “Everyone who works at Gillette is driven by this responsibility and are inspired by our patients and our mission each day. At Gillette we want ALL children to be given the opportunity to realize their potential.”
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Trends in
PHYSICAL THE that will rule
16 | OCTOBER 2020 |
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Watch out
A
ERAPY
2021
s an important part of the healthcare system, physical therapists have provided quality care to the patients even during the current pandemic. Given the importance and magnitude of physical disability after accidents, many survivors, including those from Covid could benefit from physical therapy services. However, the lack of awareness leads to challenges to work. Physical therapy effectively helps treatments and improvements in a patient’s physical functioning. Switching to Telehealth For patients who cannot risk entering any healthcare facility, Physical Therapies will be provided by telehealth services. Because so many people are working from home, the situation will arise in the future for telehealth setups. It will help people who live in areas where access to physical therapy is lacking. During a private telehealth session, one can also involve the family members. Having this feature will prove valuable for the future. Aquatic Therapy It uses physical properties of water which is useful for a variety of medical conditions. Obesity is a big issue nowadays; this therapy is extremely useful for such people. It also strengthens muscles and decreases joint stress. Super-Suits and Robotics There is no cure for cerebral palsy. Moreover, many of the symptoms of cerebral palsy can be improved with physical therapy. Physical Therapy for cerebral palsy will take on a futuristic look with the introduction of exoskeletons or wearable robotic devices. It is a wearable device that combines robotics and electronics to help improve walking. It also strengthens wearer’s muscles and brain coordination. As healthcare continues to evolve rapidly, so will the physical therapy. The focus will be on physical therapy, with all these trends coming our way, it will certainly improve the way of living. Experts agree that the demand for physical therapy will continue to increase. It will be able to deliver the right care at the right time in the right place thanks to technologies of course. The employment as well is projected to grow 34 per cent, according to the Bureau of Labor Statistics. Physical therapy is the next big thing and a key to healthy living in many more ways.
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|OCTOBER 2020 | 17
Modern Healthcare
ABOUT THE AUTHOR As the Founder and Managing Director of V2U Healthcare, Dinesh Verma has established the company’s vision and mission and worked on crafting strategies to fulfil desired outcomes. He pursued parttime studies in Business Administration and later completed an MBA from Henley Management College in 1999. Dinesh has always wanted to create a difference by being a Solution Provider and not merely a distributor of physiotherapy products. Hence, he, along with his team, emphasized on careful technology selection, invested in employee learning, and educating the customer. To remain relevant, he established V2U’s clinical services in Physiotherapy in 2006 – Physio Asia Therapy Centre. This also provided as a test-bed for the company’s technologies and concepts.
Dinesh Verma Founder & MD 18 | OCTOBER 2020 |
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PHYSICAL THERAPY IN PAIN MANAGEMENT Evolving Roles of Extracorporeal Shockwave Therapy in Musculoskeletal Pain Management
P
hysical Therapy or Physiotherapy plays a particularly important role as the first line of treatment in pain management - for acute, subacute, or chronic pain. For decades, several modalities such as technologies in Electrical Currents, Ultrasonic, Lights and radiations (Lights & lasers) have been used. However, in the last decade, one modality that has really caught the attention of professionals in Pain Management is Shockwave Therapy Units. Shockwave can be defined as a strong pressure wave in any elastic medium such as solid, Liquid, or Gas. Such waves can be produced & felt when you stand close to a supersonic aircraft, explosions, lightning, or other phenomena that create violent changes in pressure. Characteristic Properties and Parameters of Shock Waves The energy of a shockwave is released as pressure on the environment. This pressure is remarkably high, builds up extremely fast and with a classical shock wave the pressure amplitude is mainly positive pressure. The negative part is much weaker and longer and corresponds to the tension wave, hence, the key characteristics of Shockwave are: Extremely fast rise of the curve, extremely high pressure, Low negative wave compared to very high peak pressure Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with ever-growing interest in musculoskeletal disorders. Modern musculoskeletal ESWT is divided into focused and radial technology and most musculoskeletal lesions to be treated are easy to reach with either of them. www.insightscare.com
In Late 70s & early 80s, Focused shockwaves were introduced as Lithotripter technology for damaging and destructive effects on Tissue (like Kidney Stones), while these effected were desired, it was also noticed that there were regenerative physiological effects as well in the areas that received lower energies. This led to development of a focused shockwave with positive lower energies delivered at non-destructive levels. These Focused shockwaves started to produce incredibly positive results of specific musculoskeletal conditions such as tendinopathies and in Bone healing. These devices focus the shockwaves to a point which is approximately 4–6 cm apart from the application to the skin. FOCUSED Shockwaves (f-ESWT) are generated extracorporeally (electrohydraulic, piezoelectric, or electromagnetic). Such energy is focused by concentrating reflectors and is transmitted inside the body to induce therapeutic effects at a target area via external applicators. In the early 2000s, there was a further development to offer lower cost and less energy devices hence devices with ballistic pressure waves were developed – they were able to produce RADIAL Pressure waves - mechanically by a compressed air driven projectile which hits the applicator. This technology is since named radial ESWT (rESWT). Such ballistic Radial shockwaves were generated either via Pressure generated Chamber Or electromagnetic Chamber that controlled the movement of Projectile in a tube that Hits the end Plate with a force – that ultimately transmits to the Subcutaneous tissue. As the Energy.
|OCTOBER 2020 | 19
Ÿ
Other key physiological effects include new functional proteins induced by ESWT promoting a chondro-protective effect, antiinflammation, anti-apoptosis, and tissue and nerve regeneration and as well as improves the treatment of ischemic muscle.
Clinical Applications for specific conditions Following are the list of approved clinical indications that are based on the strength of the supporting clinical evidence: Ÿ
In contrast to f-ESWT, the maximum rESWT energy in Radial Shockwave is delivered at the applicator Tip to skin interface. Focused shockwaves peak pressure is about 100 times higher while the pulse duration is 1000 times shorter. The clinical effect of rESWT are now growing with emerging research and now being demonstrated as a widely accepted method with comparable results specifically for superficial musculoskeletal disorders. Different tissues possess different acoustic impedance. At the interface between these tissues, acoustic energy is released and transformed into mechanical energy. In contrast – RADIAL shockwaves have different physical characteristics. They are pressure waves and not real shockwaves. Bio-physiological Effects of ESWT Ÿ
Ÿ
Ÿ Ÿ Ÿ Ÿ
Calcifying & Non-Calcifying tendinopathy of the shoulder Lateral epicondylopathy of the elbow Greater trochanter pain syndrome Patellar & Achilles tendinopathy Plantar fasciitis
Among recently emerging applications with available research evidence includes – Erectile Dysfunction & Bone Healing (Focused Shockwave); Knee Osteoarthritis / Myofascial dysfunction and Trigger Point therapy and back pain management (Radial Shockwave) Contraindications and adverse effects of ESWT While Shockwave therapy is providing great outcomes in pain management, care has to be taken to exclude certain conditions such as - Epiphyseal plate in focus Shockwave, Coagulopathy (high-energy ESWT is associated with a risk of bleeding ), Acute infection, Lung, Brain and nerve (in focus Shockwave), Pregnancy, Malignant tumor in focus.
Mechano-transduction
Conclusion -
Mechanical energy is transferred to the cell by altering the cytoskeleton and extracellular molecules connected to the cytoskeleton. It is probable that stimulus transmission occurs particularly in the cell nucleus, but also in other cellular structures (endoplasmic reticulum, mitochondria, etc.).
Both Focused and Radial Shockwave techniques are being used by the professionals for Pain Management.
Healing Neovascularisation plays a central role in the healing of ESWT-treated areas (formation of new blood vessels). This has been demonstrated with several clinical findings. In addition, changes in the nerve cells can also be detected, which would explain a change in pain perception after ESWT.
20 | OCTOBER 2020 |
A systematic review - confirms that “there is no scientific evidence in favour of either rESWT or fESWT with respect to treatment outcome” (ref - C. Schmitz, N. B. M. Csasz´ar, S. Milz et al., British Medical Bulletin, vol. 116, no. 1, 2015) However, due to the smaller sizes and lower costs of the devices, Radial ESWT has increasingly been used all over the world. Even if the applied energy diminishes by square relative to the penetration depth, this method has demonstrated its effectiveness for soft tissue injuries and applied to treat more complex musculoskeletal symptoms associated with trigger points. www.insightscare.com
USING WEARABLE DEVICES
TO OUR ADVANTAGE IN
EVERYDAY LIFE
24 | OCTOBER 2020 |
www.insightscare.com
Hands-on
L
ife is about uncertainty, and in most cases, the only reason one loses one’s life. Despite the best of health, there are aspects to life and health which ought never to be taken for granted. For example, a cardiac arrest, a brain hemorrhage or even certain forms of virulent cancers that take just days to spread. What is taken to be uncertainties, in reality, are conditions ignored for the longest periods of time in the absence of knowing them well in time. Our bodies do give signals when things start to go wrong. Some are subtle, others fairly obvious. Most get the latter but never the former, and in that become prone to the so-called “death by uncertainties”. With advances in medical sciences, uncertainty and subtle hints of bad health can be caught fairly early so that one can live a healthy life for a fairly long time. Some of these advances include the following wearable devices.
Embrace, the smartwatch! Yes, this indeed is the ultimate watch that manages to keep a watch over all your essential bodily activities like pulse, heart-rate, blood flows and the likes using sensors that are anything but mundane. Yes, the sensors they use on this piece of wearable device uses medical-grade equipment for output which people can believe without a doubt. Besides, it has other features including an accelerometer which senses movement or vibrations, and measures changes in velocity and speed of one’s movements, a gyroscope which identifies one’s bearings in relation to the earth’s surface to know if one is standing, sitting or lying prone on the ground, a companion app called Empatica Mate which ‘works with Alert to visualize Embrace data, enabling you to view your day at a glance. Quickly get a holistic view of your daily routine including how much you’re moving and resting, and any seizures that may have occurred’. The wearable device also has Bluetooth connectivity, USD accesses and decent battery life.
Google Smart Contact Lenses Google is omnipresent! It’s everywhere, sees everything, and these days even hear everything that everyone says. Short of being God, Google is now also into the field of eye-care with smart wearable contact lenses which besides being the best in eye-care also help those who progressively lose vision to diabetes and as a last resort, have to use normal spectacles. In partnership with Novartis of Switzerland, Google is bringing out these smart contacts which besides restoring sight, also informs its users of the status of their blood sugar which directly affects diabetes. How this takes place is by measuring glucose levels from the user’s tears which are the specialty of this nifty piece of technology. It is said 'to restore the eye’s natural autofocus’. In the coming days, this is one fine piece of technology that shall find increasing use for fairly obvious reasons.
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Essentially what the smart device does is that it sends data to the Empatica Mate app on one’s mobile phone which depending upon the status of the readings, processes it further as also alerts all those who need to know of the wearer’s condition in real-time. Elders with health issues, those with epilepsy and abnormal heart conditions are the kinds who would find this app of most use. HealthPatch MD from Vital Connect! This is one patch of health everyone everywhere ought to have, to give accesses to the best of healthcare professionals anywhere on the planet! Vital Connect’s HealthPatch MD has re-usable biosensors embedded onto wearable patches that stick to the skin of the wearer. While the patch itself can be disposed of, the embedded
|OCTOBER 2020 | 25
sensors within which can be removed contain ECG sensors that help read pulse rate, heartbeat rate, breathing and even body temperatures. Besides, the bunch of sensors also have accelerometers that detect body position and speed of movement. With its Bluetooth connection, the HealthPatch MD can connect to any mobile phone and pass on information received from the biosensors in real-time. It is one vital piece of a wearable device that everyone, everywhere on the planet ought to have on their shelves all the time. Problems never arrive with prior warnings and it thus makes sense to have something which gives signals at just the right time. Quell Relief They call themselves 'Advanced, personalized pain relief technology' which surprisingly is available without a prescription! It's one nifty piece of wearable that lives with you day and night. With zero drugs and no surgery, it involves stimulating sensory nerves with safe and precise electrical pulses from attached electrodes that trigger a natural pain relief response which works 24 x 7 even during sleep and which in addition self-compensates for weather changes. A single charge lasts for as long as 40 hours. While providing for chronic knee pains, it notifies the wearer about changes in the ambient weather that may affect pains, tracks one's activity, movements and gait, and also coaches on how one can achieve optimal results – all this with extreme personalization to one's body type and levels of activity while remaining discreet enough to be worn throughout the day! Intelligent Asthma Monitoring with ADAMM An asthmatic knows the worth of each breath what with the body itself creating problems in ingesting it. With labored breathing, life becomes tough to say the least. But like always, when a problem refuses to be cured, one ought to look for solutions that raise the red flag even before the symptoms of the problem starts to arise. For Asthama, this comes in the form of a complete solution for monitoring asthma with Intelligent Asthma Monitoring with ADAMM. A three-part solution, the first part consists of wearable and a flexible patch-type device that can be worn anywhere on the upper torso, front or back and can be moved around as one may choose. The device has very sensitive monitors that detect every aspect of breathing including cough counting, respiration, wheezing and heart rate and provides notifications, inhaler detection and voice journaling. The 2nd part consists of a smartphone app that gathers all the information and manages all the medication and remedial issues, including sending reminders, displaying on the mobile phone likely symptoms and giving out a treatment plan. In the 3rd part, a web-portal constantly monitors and reports the treatment's efficacy to both the user and any attached medical authority. As per the product's website, 'over 3,000 devices already committed for clinical trials thus making ADAMM-RSM a leading digital health revolution for respiratory monitoring in clinical trials which remains a complete package featuring a unique searchable database that allows very flexible query’
26 | OCTOBER 2020 |
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In-depth Analysis
Need to Strengthen Healthcare Research T
he world today is confronted with a dangerous virus that has brought economies, travel and life to a complete standstill. Healthcare systems are trying their level best to keep afloat and discover a cure as soon as possible. This urgency to save lives has once again highlighted the need and importance of high quality scientific evidence and knowledge, stable research infrastructure as well as funds available for medical research, to ensure better response and resilience. Healthcare research also known as medical research is the driving force for improving the performance of healthcare systems and the quality of life of individuals by finding better preventive and proactive treatments and drugs. This can involve testing new medicines, vaccines, medical devices, new medical procedures as well as examining the whole genome sequence to find out the cause and treatments for various diseases. While India today is well known for its excellent medical facilities and clinical expertise, it really lacks behind in the field of medical research. A study published by Ray et al (2016) revealed that between 2005-14 out of the 579 medical institutes and hospitals, that 28 | OCTOBER 2020 |
were evaluated, only 25 produced more than 100 papers in a year and alarmingly 57.3% of the medical colleges did not have a single publication in a decade as compared to the research output of Mayo clinic, which was approximately 3700 studies in a year. The reason for such a disappointing output can be insufficient funds, poor research infrastructure, the notion that research is done only for the benefit of the pharmaceutical industry as well as overburdened physicians having little time and energy left to think about any serious research. Apart from this the government and authorities have also failed to integrate medical education and research with basic sciences as well as technology as prevalent in the United States and most European countries. This proves to be a major roadblock to “Make in India” based innovations. In addition to this there is also a strong presence of an authoritative and hierarchal set up that discourages capable startups and faculty to go beyond the routine healthcare practices particularly in the field of genetics. Genomic research defined as the study of the whole genome to identify genetic mutations, the impact of these mutations on gene functions as well as the interaction of the genes with each www.insightscare.com
ABOUT THE AUTHOR
Chandni Luthra
Co-founder & Director
www.insightscare.com
Chandni Luthra is the Co-founder and Director of FutureMed a molecular genetic company that specializes in genetic testing for wellness, precision medicine as well as clinical genomics. FICCI Ladies Organization (FLO) in association with Ministry of Micro, Small & Medium Enterprises Government of India recently selected her amongst 100 successful women entrepreneurs in MSME.
|OCTOBER 2020 | 29
other and with the environment in general has gained popularity over the last two decades. Researchers world over have analyzed enormous amounts of DNA sequenced data to assess genetic predisposition to diseases, to improve diagnostics and therapeutic treatments for cancer, diabetes, neurological and cardiovascular issues and for the development of tests to improve efficacy of drugs to prevent adverse drug reactions. Even though genetic research and testing has the power to transform healthcare it is still grossly under utilized for disease management in India. Being home to different cultures and genetic diversity in addition to endogamous practices rare diseases such as blood disorders, primary immunodeficiency, neurodegenerative and musculoskeletal diseases amongst many others contribute significantly to the medical and economic burden of the country. According to the Council of Scientific and Industrial Research (CSIR) nearly 7 crore Indian’s suffer from rare disorders of which at least 40% are genetic in nature. Unfortunately quite a few of these genetic disorders are either undiagnosed or misdiagnosed due to insufficient clinical and diagnostic resources and even if these are known the treatment is not always available resulting in huge physical and monetary costs to patients who very often have to suffer all their lives. Rare diseases are also more common in children and are responsible for 30% of the deaths during infancy. There is a need to address these challenging issues by investing more funds into biomedical and genetic research to
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identify the main causes of diseases and discover novel therapeutic targets and strategies to improve healthcare in the country. It has also been observed that the genetic data of the Indian population is grossly under represented in worldwide genomic studies and thus clinicians need to rely on the gene data banks from UK, USA or the Caucasian population. This does not serve us well as this data is not reliable. Given the unique diversity in the Indian population, which is absent elsewhere, genomic research only seems to be the way forward to reduce the impact of diseases. Practicing precision medicine utilizing this indigenous data will also help to reduce inequities in how healthcare is financed. It is estimated that the government expenditure was about 1.4% of the GDP in 2017-18 while the private expenditure was three times this number. Given this pattern correct and early diagnosis and removal of trial and error through pharamacogenomics will greatly help to reduce this cost. The department of Biotechnology has made a considerable breakthrough to solve the struggle for genetic data in the last one year by mapping the genomes of 1008 people across different ethnicities. While this is a step in the right direction it is still a drop in the ocean given the sheer diversity and sub population of people in India. In China and the US almost a million people are included in research studies therefore it is essential for the government to scale up the sample size and include more people as well as reduce the cost of collecting such data.
Attention also needs to be given to carry out newborn screening pilot projects on a national scale to lower the burden of rare diseases and also train more clinicians, researchers and councilors to correctly interpret the results for the benefit of the common people. The government also needs to initiate researches on gut micro biomes and gene editing – a group of technologies that give the scientists the ability to change a person’s DNA by adding, removing or altering genetic material at particular locations in the genome- to help treat cancer, metabolic and cardiovascular disease as well as neurodegenerative conditions like Huntington disease, Alzheimer and Parkinson that have no specific diagnostic approaches or treatments. Our country is definitely active in the field of medical research but it is still not doing as much as it can. The discoveries that are being made are only a fraction as there is so much that can be learnt from our diverse population. India can truly become one of the models to study genetic variations and how these relate to disease and drug responses. It is now time for the government to increase funding and formulate polices to create a national genomic platform, which will improve the healthcare system so that our future generations can lead healthier lives without having to suffer tremendous financial burdens.
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