TALKING PHARMA BIZ WITH AJAY D’SOUZA July 2012 l `100 $8
Meet the ‘Marco Polo of neuroscience’
Dr Vilayanur Subramanian Ramachandran
Kiran Mazumdar-Shaw EXPERT INTERVIEW
Dr B M Hegde
Scanning rural healthcare
Healthcare in rural heartlands is in a pathetic state. Learn how India’s NRHM leads by example, though it too has miles to go...
ADMISSIONS ARE OPEN LIMITED SEATS
Study in the Gulf Learn from the world.
College of medicine • MBBS - Bachelor of Medicine & Bachelor of Surgery Gulf Medical University has opened new avenues in the ﬁeld of medical education. It brings world class learning to you.
College of allied Health Sciences
With a unique pragmatic curriculum that matches global standards and a wonderfully crafted academic program which combines theory with hands on training experience. Students get to learn from various case studies from our experienced faculty drawn from around the world. With a student body that spans 79 countries, Gulf Medical University opens a new avenue for excellence for students at a global level.
• BPT - Bachelor of Physical Therapy
College of Pharmacy
Equipped with a state-of-the-art learning center, lecture halls and laboratories, the country’s only dedicated teaching hospital and a 10,000 sft fully equipped library, with thousands of books, medical journals, online libraries and journals, video conferencing and a lot more it’s time you entered the international league.
• Pharm D - Doctor of Pharmacy
Study at Gulf Medical University. Learn from the world.
College of dentistry
GULF MEDICAL UNIVERSITY P. O. Box: 4184, Ajman - U. A. E Tel: +9716- 7431333, Fax: +9716 -7431222. E-mail: email@example.com, firstname.lastname@example.org
• DMD - Doctor of Dental Medicine COLLEGE OF MEDICINE
COLLEGE OF DENTAL SCIENCE | COLLEGE OF PHARMACY | COLLEGE OF ALLIED HEALTH SCIENCE | COLLEGE OF GRADUATE STUDIES
College of GRADUATE STUDIES
Masters Program (2 years) • MS - Clinical Pathology • MS - Toxicology Post Graduate Diploma Programs (1 year) • Diploma in Toxicology
• MPH - Master of Public Health
center for continuing education and community outreach CERTIFICATE COURSE (10 MONTHS) • Dental Assistant • Medical Assistant - Laboratory • Medical Assistant - Administration • Nurse Assistant • Medical Assistant - Clinical • Physical Therapy Assistant • Pharmacy Assistant CERTIFICATE COURSE (SHORT TERM) • Introduction to Health Careers • Certificate In Medical Terminology • Clinical Nutrition • Medical Billing and Coding • Medical Insurance Billing • Phlebotomy • Dental office Management • Nutrition for Sports and Human Performance • Legal Fundamentals of Health Care and Public Health • ECG and Rhythm Interpretation • Infection Control for Non-clinical Healthcare Workers • Geriatrics Health Care • Pharmacy Review • Pharmaceutical Sales and Marketing • ECG Monitor Technician • Basic Surgical Skills • Basic Arabic for Health Professionals
Learn from the world.
Specialization and Residency Program P. O. Box: 4184, Ajman, United Arab Emirates TEL: +9716- 7431333, FAX: +9716 -7431222 E-mail: email@example.com www.gmu.ac.ae
EDITOR’S NOTE Bridging the gaps in healthcare
I Volume 1 Issue 1 | July 2012 Editor Ravi Deecee EDITORIAL Associate Editor T N Shaji Deputy Editor Sanjeev Neelakantan Assistant Editor Dipin Damodharan Senior Reporter & Editorial Coordinator Prashob K P Senior Reporter & Research Analyst Sreekanth Ravindran Senior Reporters Lakshmi Narayanan Shani K
BUSINESS Head - Business M Kumar ADVT SALES Senior Managers Kainakari Shibu Rajasree Varma Anu P M Biju P Alex K S Syam Kumar Managers Febin K Francis Bipin Kumar VS
MARKETING Sr Manager RESPONSE TEAM Sabu Varghese Coordinating Editor Mathew Sumithra Sathyan Assistant Managers Special Correspondent Priya P A Ziad Siddque Mobin E Mathew Reporter Rimshith Jaleel Tony William Circulation Design & Layout Athul P M Kailasnath Sone Varghese Anil P John www.futuremedicineonline.com Published from DC Books Pvt Ltd, D C Kizhakemuri Edam, Good Shepherd Street, Kottayam – 686001, Kerala, India and printed at DC Press Pvt. Ltd., Industrial Development Area, Poovanthuruth, Kottayam – 686012, Kerala, India. Printed, published & owned by Ravi Deecee
DC Media Publication
t’s our greatest pleasure to share with readers the joy of launching the first edition of Future Medicine. Published by DC Media, the media division DC Books, Future Medicine aims to provide a true and captivating account of healthcare in a world increasingly being driven by economies of scale. Our team will strive to provide the latest medical news developments from across the world, simple human interest stories reflecting the pain and misery of the common man due to yawning gaps in healthcare, awe-inspiring tales of success, an expert take on specific aspects of medicine and pharma business, an insider view of the comeback trail of traditional branches of medicine, and handy information for those still engaged in medical studies, or aspiring to pursue a career in medicine. Modern day medicine comes to the rescue of an ailing man with a premium. Quite often, more than the ailment, it’s the process of frequently coughing up huge amounts for what is called ‘holistic treatment’ that cripples patients these days. Medical innovations and technological wonders make ample sense for those who can dig deep into the pockets, while the rest either have to make do with primitive, cheaper modes of treatment, or simply give up the hope of healing in complete disdain. Affordability and access remain the primary concern across continents. Promotion of healthy lifestyles is another area of medicine where sufficient ground has to be covered. The pathetic state of sanitation and hygiene in urban slums and rural pockets continues to be a critical area in the Third World. Worse still, many countries in the Third World are yet to meet most of the millennium development goals, such as providing universal access to basic amenities like safe drinking water, sanitation facilities, and reducing the high infant, child and maternal mortality rates. On top of all these problems, a large number of medical professionals are increasingly becoming voluntary slaves of material prospects, agents of dubious drug companies, and violators of the code of ethics. The grim and darker side of medicine gives us a cogent reason to be vigilant and reflective while choosing serious medical issues and focussing on the contributions are being made by the agents of change. Happy reading and take care.
FUTURE MEDICINE I July 2012
21st â€“ 23rd November 2012
Dubai International Convention & Exhibition Centre Dubai, UAE
COVER STORY Scanning Rural Healthcare People living in the rural heartlands of the world are facing the twin healthcare problems of access and affordability. India’s National Rural Health Mission too has a long way to go, but it can certainly help other countries in emulating a sustainable model
ONCOLOGIST’S DIARY Dr Nalini Rao
BIOPRENEUR Kiran Mazumdar-Shaw
EXPERT INTERVIEW Dr B M Hegde
CAREERS & COURSES Speech Therapy
With more than 36 years of experience in biotechnology and industrial enzymes, this Padma Bhushan awardee is known for having taken up entrepreneurship against all odds. That too, long before others in the game
EYECARE Masters of Shalakya Tantra
A young eyecare centre in Kerala has an intellectual legacy of about 300 years in the traditional branches of medicine, especially the Shalakya Tantra, which can be practised only by those endowed with deep knowledge
FUTURE MEDICINE I July 2012
Cover Photo: African children from Masai tribe in Masai Mara, Kenya.
EXCLUSIVE INTERVIEW Dr Vilayanur Subramanian Ramachandran A world renowned neuroscientist and Padma Bhushan awardee, Dr Vilayanur Subramanian Ramachandran is the Director of the Center for Brain and Cognition, and Distinguished Professor with the Psychology Department and Neurosciences Program at University of California, San Diego. He speaks about the possible role of mirror neurons in understanding the condition of Autism
Allied Industry Focus
Medical Devices Industry
Ajay Dâ€™souza, Crisil
FUTURE MEDICINE I July 2012
India to use Thai warning against smoking NEW DELHI: Cigarette packets in India are all set to carry new anti-tobacco pictorial warning from Thailand. The new pictorial warning, which is faceless, will be notified by the Ministry of Health as a replacement for the controversial old one that bore the image of English footballer John Terry. The Government of Thailand, which owns the copyright for the said warning, has permitted India to use these on cigarette products being marketed in India.
Since Thailand had the copyright for the said warning, the Health Ministry formally wrote to the Government there to seek permission for its use. India had been hunting for replacements of the old warning following threat of legal action by managers of John Terry. The new pictorial warning will carry the same message regarding the adverse public health impact of tobacco use. For the first time, a faceless anti-tobacco warning will be approved for use in India, once notified by the Ministry.
New polio cases in Pakistan alarm WHO ISLAMABAD: The World Health Organisation (WHO) has expressed concern over the emergence of new polio cases in Pakistan`s northwest tribal region, where about 1,50,000 children have reportedly not been immunised against the deadly virus. At least eight cases have been detected in Khyber agency this year, one from Tirah, and seven from Bara town. Khyber agency is the only area in Asia having polio virus 1 and 3 types.
Vodafone launches mobile health NEW DELHI: Telecom major Vodafone India has launched its mobile health website â€˜Ask a Doctor Health@5â€™ across the country. With this service, a Vodafone subscriber can ask health-related queries for Rs 5 per day to an expert medical panel, which will get back to the subscriber with the answers
Zabia, the 23-month-old daughter of Noor Jan, a resident of Akhakhel area of Tirah, is one of the latest cases. Zabia did not receive any dose of the oral polio vaccine, as the area where she lives has not been visited by any medical team since September 2009 due to fear over terror attacks. WHO said spread of the virus will continue as long as anti-polio programmes miss children either due to insecurity or poor quality health campaign.
Life-long aid for HIV/AIDS victims
within the next 24 hours. The service will also allow users to browse through information on disease management, myths, trivia, general remedies, latest updates, diet and fitness information different segments like everyday health, trivia and facts, apart from home remedies. Stay fit, go mobile. NEW DELHI: In a first in the country, the National Capital Territory of Delhi has promised to provide a life-long, monthly financial assistance of Rs 1,000-2,500 to poor people infected with HIV/AIDS. People with HIV/AIDS on anti-retroviral treatment will get Rs 1,000 every month, while orphans, destitutes or abandoned children infected with HIV/AIDS will be given Rs 2,050.
Chief Minister Sheila Dikshit distributed cheques to 27 people at the inaugural ceremony of the scheme at the Maulana Azad Medical College recently. Of these, 17 were children, while the rest were women. Dikshit said that almost half of the people living with HIV/AIDS in Delhi were from poor socioeconomic background and hoped that the scheme will benefit these people.
FUTURE MEDICINE I July 2012
Shortage of 10 lakh MBBS doctors: Azad JAMMU: A shortage of 10 lakh MBBS doctors in the country is affecting the healthcare delivery system in rural areas, Union Health and Family Minister Ghulam Nabi Azad has said. “There are seven lakh doctors in the country against a requirement of 17 lakh, leaving a deficit of 10 lakh doctors. This is directly affecting the healthcare delivery system in rural areas,” he said, adding that though the Centre was providing adequate funds for construction of hospitals, there was shortage of MBBS doctors. Azad said that in order to provide better healthcare in rural areas, the
Union Health Ministry and the Indian Medical Association were amending the syllabus of MBBS doctors who are undergoing training. After the changes in the syllabus, trainee doctors would have to serve in villages for one year before getting the MBBS degree. He said the Union Health Ministry would launch a scheme under which 100 districts of the country would be covered in the first phase. As part of the scheme, free check-ups and diabetes tests will be conducted in males and females above the age of 30 years at the nearest PHC, while for pregnant women, there will be no age bar for conduct of the test.
Thailand to be medical metropolis BANGKOK: Thailand Center of Excellence for Life Sciences (TCELS) is pushing Thailand to become a medical metropolis or ‘Medicopolis’. TCELS Advisor, Honorary Professor Montri Chulavatnatol, said although the policy promoting Thailand as a medical hub is underway, it does not cover all medical institutions. He added many of the hospitals still lack technology, medicine and equipment, which have to be imported, resulting in higher medical bills. Professor Montri explained that if Thailand is able to provide a complete service in terms of locally
produced medicines, equipment, and technology, it will help lower its medical costs; The Medicopolis concept has been introduced with a focus on developing public health research and medical service covering health and beauty areas. According to the TCELS Advisor, the Medicopolis will provide effective medical service, strengthen the economy by the service, and integrate research in medical development, medicines, and equipment. He urged the government to support the move and allow the private sector to invest in the project for further improvement in the medical field.
New hearing screening test in China BEIJING: The University of Southampton has developed a new hearing screening test which could help an estimated 100 million people suffering from hearing loss in China. This new Chinese version is based on a hearing screening test developed by the University’s Institute of Sound and Vibration Research (ISVR). The test has already been taken by more than a million people across Europe. The tests aim to address the fact that hundreds of millions of people worldwide have hearing loss but only a fraction obtain hearing aids that would help them overcome hearing difficulties. The percentage of people with hearing loss using hearing aids has been estimated to be only 16 per cent in Europe, while the figure is as low as 1 per cent in China. FUTURE MEDICINE I July 2012
The test was developed by Professor Mark Lutman and Dr Guoping Li of ISVR. Dr Li says: “This project will have a massive social impact in China. There are at least 100 million adults who are hearing impaired and this is the first adult hearing screening test via telephone made available in China.” Lutman adds: “It is expected that widespread use of these tests in China will increase awareness of hearing problems and the availability of solutions, thereby reducing the social, health and economic burdens of hearing loss in the enormous population of China. These burdens will increase as the population distribution becomes older unless something is done to mitigate the effects of hearing loss.”
Summit on medical tourism in October WEST PALM BEACH (FLORIDA): The Third Ministerial Summit will take place during the Fifth World Medical Tourism and Global Healthcare Congress, from October 24th-26th at the Westin Diplomat Resort and Spa in Hollywood, Florida. This roundtable meeting will gather Ministers of Health, Tourism and Economy as well as Trade Commissioners, Consul Generals and VIP international officials who will share knowledge of the best practices in order to further promote medical tourism to their countries. Ministers from more than 50 countries will share information about existing programmes. They will have the opportunity to develop initiatives, gather ideas to improve existing programmes, create new programmes, and design strategic alliances that generate revenue for their respective countries. At the same time, they will explore newer ways to improve medical care and access for their own population. There will be deliberations on
innovation in management and reduction of healthcare costs, wellness and engagement programmes, public private partnerships, value-based healthcare design and insurance, healthcare investment and development, disease and catastrophic condition management, medical tourism and local healthcare infrastructure, legal healthcare issues, research on ROI and country brand development, and regional healthcare collaboration. The Fifth World Medical Tourism and Global Healthcare Congress is the largest medical tourism event in the world. Attendees can network with leading health insurance companies, employers, hospitals, medical tourism facilitators, tourism boards, governments and healthcare providers from around the world. Registration for this event will enable access to a networking software which allows attendees to schedule one-on-one meetings with other conference participants. Registration for this event is open.
SEMDA’s annual meet to be held in Atlanta ATLANTA: The Southeastern Medical Device Association (SEMDA)’s Seventh annual conference will take place on February 19-20, 2013. Recognised as the premier gathering for the Southeast medical device industry, the conference balances presentations by medical device companies to investors with educational programmes, partnering and networking opportunities. “The 2012 Conference was the most successful in the organisation’s history, and we are building on that success by incorporating lessons learned for the 2013 Conference,” said Charlie Harrison, SEMDA’s 2012-2013 president and Global COO of Medical Compression Systems, Inc. Art Spalding, Founder of TAMM
Net, Inc., has been named Chairman of the 2013 Conference. The Conference will be held at the Georgia Tech Global Learning Center, a midtown Atlanta conference facility that offers a professional learning environment with room for presentations and meetings, complemented by state-of-the-art technology capabilities. SEMDA is a non-profit trade association that supports and promotes medical device companies in the Southeast. Created in 2004, the association provides a unique resource and networking opportunity for medical device companies, inventors, physicians, and investors interested in accelerating the growth of the medical device industry in the Southeast.
FUTURE MEDICINE I July 2012
Coffee drinkers have lower risk of death MARYLAND (US): Findings of a new study revealed that older adults who drank coffee - caffeinated or decaffeinated - had a lower risk of death as compared to those who did not drink coffee. According to a study by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, and AARP, coffee drinkers were less likely to die from heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, although the association was not seen for cancer. These results from a large study of older adults were arrived at after taking into consideration the effects of other risk factors on mortality, such as smoking and alcohol consumption. Researchers caution, however, that they can’t be sure whether these associations mean that drinking coffee actually makes people live longer. The results of the study were published in the New England Journal of Medicine. Neal Freedman, PhD, Division of Cancer Epidemiology and Genetics, NCI, and his colleagues examined the
association between coffee drinking and risk of death in 400,000 US men and women (aged between 50 and 71) who participated in the NIH-AARP Diet and Health Study. Information about coffee intake was collected once by questionnaire in 1995-1996. The researchers found that the association between coffee and reduction in risk of death increased with the amount of coffee consumed. Relative to men and women who did not drink coffee, those who consumed three or more cups of coffee per day had approximately a 10 per cent lower risk of death. Coffee drinking was not associated with cancer mortality among women, but there was a slight and only marginally statistically significant association of heavier coffee intake with increased risk of cancer death among men. Freedman said, “Although we cannot infer a causal relationship between coffee drinking and lower risk of death, we believe these results do provide some reassurance that coffee drinking does not adversely affect health.”
Good and bad fats affect brain health WASHINGTON: “Good” fats like monounsaturated fats and “bad” fats like trans and saturated fats aren’t just factors in heart health - a new study shows they can affect brain health and memory, too. Researchers from Brigham and Women’s Hospital found that women who consumed the most “bad” fats during their study were the ones who had the worse memory and brain functioning over a four-year study period, as compared to women who consumed the fewest “bad” fats. Meanwhile, women who consumed the most “good” fats scored better on cognitive tests during the study. Saturated fats are commonly found in animal products, like butter and red meat, while monounsaturated fats are found in olive oil, among other foods. “While FUTURE MEDICINE I July 2012
looking at changes in cognitive function, what we found is that the total amount of fat intake did not really matter, but the type of fat did,” said study researcher Dr Olivia Okereke, MD, of the Brigham and Women’s Hospital Department of Psychiatry. The study, published in the journal Annals of Neurology, included data from 6,000 women who were part of the Women’s Health Study. These women, who were all aged 45 and above, participated in a cognitive functioning test every two years over a four-year period, and had answered questionnaires on the kind of food they consumed. Okereke said, “Substituting the good fat in place of the bad fat is a fairly simple dietary modification that could help prevent decline in memory.”
Teen finds anti-ageing solution
TORONTO: A Singapore-born teenager, who recently moved to Canada, has won a science award for her groundbreaking work on the anti-ageing properties of tree pulp, officials said. Janelle Tam, 16, showed that cellulose, the woody material found in trees that enables them to stand, also acts as a potent anti-oxidant. “Her super anti-oxidant compound could one day help improve health and anti-ageing products by neutralising more of the harmful free radicals found in the body,” Bioscience Education Canada said in a statement. Tam’s work involved tiny particles in the tree pulp known as nano-crystalline cellulose (NCC), which is flexible, durable, and also stronger than steel. Tam, a student at Waterloo Collegiate Institute, chemically bound NCC to a well-known nanoparticle called a buckminster fullerene, or buckyballs, which are already used in cosmetic and anti-ageing products. Since cellulose is already used as filler and stabiliser in many vitamin products, one day, Tam hopes NCC will make those products into super-charged free radical neutralisers.
Intel awards cancer detection prodigy PITTSBURGH: Jack Andraka, 15, of Crownsville, USA, has developed a new method to detect pancreatic cancer. He secured first place at this year’s Intel International Science and Engineering Fair. Jack created a simple dip-stick sensor to test blood or urine to determine whether or not a patient has early-stage pancreatic cancer. His study resulted in over 90 per cent accuracy and showed his patent-pending sensor to be 28 times faster, 28 times less expensive and over 100 times more sensitive than current tests. Jack received the Gordon E Moore Award, named in honour of Intel co-founder and retired chairman and CEO, of $75,000. From Pakistan, Shiza Gulab, Mahnoor Hassan and Bushra Shahed from the Institute of Computer and Management Sciences were winners of a fourth place grand award in the animal sciences category and awarded $500 for their project entitled ‘Energy Square for Cattle’. This year, more than 1,500 young scientists were chosen to compete in the Intel International Science and Engineering Fair.
Quantum level tiny super computer
SYDNEY: It is only a tiny device - a flat, pancake-like layer of 300 atoms hovering in space. Yet, it has the potential to provide insights into how materials behave at the quantum level, something none of today’s conventional computers would be capable of calculating. When fully operational, its performance could only be matched by an impossibly large machine, said Michael Biercuk, a Sydney physicist and member of the international team that built and tested it. “The system we have developed has the potential to perform calculations that would require a supercomputer larger than the size of the known universe. And it does it all in a diameter of less than a millimetre,” said Dr Biercuk of the University of Sydney. The device, known as a quantum simulator, is just one atom thick. Its 300 charged beryllium atoms are trapped in suspension by magnetic and electric fields, and their interactions can be controlled by lasers. He said the device’s role was like that of a scale model of an aircraft wing, which engineers might test in a wind tunnel to design a better plane.
FUTURE MEDICINE I July 2012
PERSONALITIES Dr Ram Kumar Menon
Into the mind of a neurosurgeon An apple a day keeps the doctor away, but in today’s world, there are not many good apples, so having doctors near you is becoming inevitable. Dr Ram Kumar Menon, a famous neurosurgeon, shares some anecdotes from his professional life By Lakshmi Narayanan
Dr Ram Kumar Menon MS, DNB, MCh, passed out from Calicut Medical College. He pursued neurosurgery training at King Edward Memorial Hospital, Mumbai. Subsequently, he pursued subspecialty training at the university hospital in Slovenia in central skull base surgery under world renowned neurosurgeon Prof Dolenc, and then at Barrow Neurological Institute at Phoenix, USA, under another eminent figure, Dr Spetzler. Now, he has settled down in Thrissur district of Kerala, where he works with Elite Mission Hospital and Care Well Clinical Centre as a consultant neurosurgeon.
he job of a doctor is divine. They witness births and deaths every day. Unmoved by pressure, they manage to pull out people from the jaws of death and other fearsome situations. They have the nerve to take on challenges. Talking of nerve, it’s a tough job to be a neurosurgeon. But Dr Ram Kumar Menon has the perfect mix of passion, obsession and interest to be a master of neurons. Dr Menon is used to dealing with clinical situations where the margin of error is so thin that it can make a huge difference between life and death. He has seen situations flipping over to the other side in a matter of seconds. His mantra is plain and simple: take stock of situations with a cool mind and live life to the fullest. “While at medical school, as soon as I entered my clinical side, I realised that surgery is a vital part of saving life. After my surgical specialisation, I wanted to choose between neurosurgery and paediatric surgery. I was deeply influenced by my teachers and their dedication, so I decided to opt for neurosurgery,” Dr Menon tells Future Medicine. A neurosurgeon’s life is a mix of tensions, prayers and curiosities. He has to update his knowledge regularly. Reading relaxes the mind. Dr Menon is actually addicted to books. He is in love with travelogues. He has penned many literary works as well. “It is my profession that has taken me to different parts of the world, to learn as well as teach… from America to Africa, from Helsinki to Colombo. Books help me in setting goals and inspire me to think differently,” says
Dr Menon vividly remembers the case of a six-month-old baby, who accidentally fell off the mother’s hand and stopped breathing. She was taken back home midway to the hospital as she was presumed dead. Fortunately, she was brought back to the hospital for the parents’ satisfaction. She was diagnosed with a subdural hematoma (bleeding in the brain) and operated upon immediately. She was on the ventilator. But she came out of it. She had developed vitreous haemorrhage (bleeding in the eye), for which she was operated upon at Chennai. Eventually, she recovered.
In 2006, Dr Menon and his crew had started a training programme for some surgical trainees in Africa. There were a lot of patients, but only a few treatment centres for neurosurgery. While there, he had the privilege to be the first neurosurgeon to successfully clip an aneurysm (posterior communicating artery), followed by a Swede and an American.
Challenges of Indian medical system
“India’s medical sector is not in a stable condition. Metros have better medical facilities, including super specialty hospitals. But in villages, it is very difficult to find even a good healthcare centre. This is because of lack of guided efforts to streamline the healthcare system. Only with effective use of manpower, money, and other recourses, we can bring about a gradual change in situation,” says Dr Menon.
FUTURE MEDICINE I July 2012
GUEST COLUMN Amar Jesani
Medical ethics? Why and for what?
n recent times, due to an increase in reporting of scams and debates on corruption, medical ethics are more talked about than ever. With commercial and corporate interests dominating the field - from medical education, hospitals, healthcare and insurance to drugs and medical devices - it is not surprising that doctors are being asked to follow medical ethics. Many doctors feel enraged when non-doctors talk about erosion of ethics in medical practice. They wonder why only they are being singled out to be ethical. They wonder if corruption is permeating the whole of society, how only doctors can remain immune to it. These are valid questions and so warrant better understanding of medical ethics. There are many reasons why ethics have a prominent place in medicine. Doctors often take pride in saying that the ethics in their profession are perhaps the oldest, having roots in the ancient codes of medical ethics. Naturally, people then would like doctors to follow them. Medicine is perhaps the most prominent field where the users (patients) of service are unable to decide what they should be consuming. Any amount of respect for autonomy, information provision and process of informed consent is not enough to overcome the information dissymmetry. Patients suffer from acute vulnerability not only because of their diseased state, but also from lack of technical knowledge. They are, at best, able to judge what to consume based on their social value system and not on the basis of science, where they rely on the doctorsâ€™ FUTURE MEDICINE I July 2012
judgment. No profession deals with the life and death issues as the medical profession does. In this situation, doctors will always be scrutinised for what they prescribe the patients to consume. There is no getting away from the question â€“ is the prescription for the good of patients or for some other entities like commercial needs of hospital, drug and insurance industries, or for the personal financial benefits of the prescriber? The only thing that tries to overcome this dichotomy is the patientsâ€™ trust that the first and chief loyalty of doctors is to the patients, and they will not have any other interest that can seriously conflict with this loyalty. Therefore, the trust deficit would invariably raise the issue of whether doctors are ethical or not. We do not live in ancient times. In the modern times, the health system creates many constraints on doctors, more so, if such a system is dominated by commercial interests and not built on the principle of universal access to healthcare for all, irrespective of their capacity to pay. Many such constraints explained by doctors in the present system are equally valid, but such explanation does not win the trust back unless doctors as a professional group are also seen to be working for a universal access system with cashless transactions. When the governments in the UK and Canada introduced the universal access system, the traditional medical associations had opposed it tooth and nail. But they failed to prevent establishment of such a system. Interestingly, in the last 30 years, when neoliberal policies of the
governments in the UK and Canada tried to dismantle such a system, doctors supported continuation of the system. One of the reasons was that doctors found it less constraining in doing ethical medical practice. Lastly, in a recent meeting I attended to discuss the code of medical ethics, a prominent doctor, very popular with his medico-legal expertise, opined that the ethics are an internal part of medicine and that doctors can decide what is ethical at a given point of time. This is, at best, only half truth. The role of ethics in medical practice, and for that matter, ethics in any situation, is to protect the welfare of the users of the services. If the internal code of ethics of a profession is not providing such protection to the users, it would have no credibility and would generate no trust. To win trust and credibility, the ethics of the medical profession should be rooted in the rights of patients. Amar Jesani is one of the founders of the Forum for Medical Ethics Society and its journal, IJME (Indian Journal of Medical Ethics, www.ijme.in) and is presently its editor. He is also a Trustee of Anusandhan Trust, which runs CEHAT (www. cejat.org) and CSER (www.cser.in) in Mumbai, and SATHI (www.sathicehat.org) in Pune.
VOICES “China’s medical instrument industry has become a “sunrise industry”, with a considerable market size of 400 billion yuan ($63.3 billion)” Fan Yubo, President of Chinese Society of Biomedical Engineering
“I will not support old age homes; we can’t send our seniors to old age homes, as in Western countries. We need to keep our seniors with us for their guidance and blessings”
“Adult humans normally breathe at the rate of one breath every six to eight seconds and inhale an average of 16,000 quarts of air each day. If nothing is done to restrict breathing, it will happen naturally and fully” John W Travis, Creator of the Wellness Inventory
Ashwini Kumar, Bihar Health Minister
“Surgery is the first and highest division of the healing art, pure in itself, perpetual in its applicability, a working product of heaven and sure of fame on earth”
“Mental illnesses such as anxiety and depression are extremely common, and they can be very disabling if they are neglected. However, unlike most long-term physical conditions, common mental health problems can be treated effectively with inexpensive psychological treatments” Sean Duggan, Chief Executive of the Centre for Mental Health, UK
Sushruta, the Father of Surgery
FUTURE MEDICINE I July 2012
Kiran Mazumdar-Shaw BIOPRENEUR
Snapshot of Biotech Queen’s grand success
Kiran Mazumdar-Shaw is the Chairman and Managing Director of Biocon. A first generation entrepreneur with more than 36 years of experience in biotechnology and industrial enzymes, she was awarded the Padma Bhushan for her pioneering efforts in biotechnology. In an exclusive interview with Future Medicine, she tells how her grit, determination and hard work guided her to start Biocon, at a time when not many had even heard of biotechnology. Excerpts: By Sreekanth Ravindran What made you take up entrepreneurship at an early age and how did you groom yourself for the role? My journey of building Biocon has been about exploration, experimentation and learning. Trying out new ideas and overcoming unforeseen challenges are part and parcel of developing a business. I also believe that one benefits from the learning and more importantly, the FUTURE MEDICINE I July 2012
improvement that follows. During my growing up years, I was inspired by my father, who was a well-known name in the brewing industry, and encouraged by him, I decided to take up brewing as a profession and went to Australia to pursue my Brew Master’s degree from Australia’s Ballarat University. However, when I came back to India, I realised there was no place for a woman brewer in India.
I started looking for alternates when I met my Irish collaborator who had founded a biotech company in Ireland. He invited me to be his business partner and start a biotechnology company in India. I was reluctant at first because I had no business experience nor did I have the investment capital but he persuaded me to give it a try. That is how the idea of Biocon in India germinated. I went to Ireland for six months to learn
BIOPRENEUR Kiran Mazumdar-Shaw
I started looking for alternates when I met my Irish collaborator who had founded a biotech company in Ireland. He invited me to be his business partner and start a biotechnology company in India. I was reluctant at first because I had no business experience nor did I have the investment capital but he persuaded me to give it a try. That is how the idea of Biocon in India germinated. I went to Ireland for six months to learn the business and came back to set up Biocon in Bangalore the business and came back to set up Biocon in Bangalore. The beginning of any entrepreneurial endeavour is always the most challenging, as we take the first steps on the journey, treading on unfamiliar territory. However, facing these challenges with ingenuity and determination to blaze a trail is an infinitely rewarding experience. When I started Biocon in 1978, I was a pioneer â€“ not many people in India had heard of biotechnology, leave alone envisaging it as a business. The obstacles I needed to navigate in the first two years of building Biocon were manifold â€“ ranging from infrastructural hurdles to issues related to my credibility as a businessperson. I refused to let them intimidate me and decided to chart my own path. I was trying to sow the seeds
of a biotechnology enterprise in India, which was, at that time, an underdeveloped economy, where business was bound by red tape, gagged by sub-optimal infrastructure, and held hostage by a precarious foreign debt situation. With no access to venture capital, money was scarce and high-cost debt-based capital was all I had. What I required to start my business was collateral security, a demonstrated business track record, and a well-understood business model. I had neither of these: I was a 25-year-old entrepreneur, a woman at that, with no business experience, and no collateral to offer. To make matters worse, I was promoting a high-risk, unknown business based on a relatively unknown science. It took me three months to obtain a Rs 5-lakh credit line in 1979, which saw me knock
on the doors of five banks before one brave banker decided to fund me. Beyond the financial challenges was the business of biotechnology itself. Enzyme extraction and production, the biotechnology with which I started, was a new concept and there was scepticism about the commercial viability of ecofriendly but expensive enzymes to replace cheap chemical processes. My challenge was to get the market to accept biotechnology and change old practices. Moreover, enzyme manufacturing for industrial application involved sophisticated fermentation, which demanded uninterrupted power supply and precision process control. This was not something I could manage to do in India, given the unreliable power supply situation and the limited resources I had. However, I went ahead with the
FUTURE MEDICINE I July 2012
Never giving up in the face of obstacles, thinking out-of-the-box and resourcefulness at making the best of what you have are qualities one should strive to develop. Today’s youth are at an enormous advantage than when I began my entrepreneurial journey. The economy has opened up and opportunities abound for those with the zeal to succeed idea and succeeded in building a green business model and provided a boost to environmental sustainability by doing away with chemical pollution in the process. I opted for specialty low-volume, high-value enzymes for the food and beverages industry as I felt that this was more doable for a small entrepreneur just starting out in business. Several factors have contributed to Biocon’s growth. One was my single-minded determination to see the venture succeed. I have never been one to give up easily; so, when I faced the initial hiccups that any start-up in India faced during the pre-liberalisation period, I simply became more determined to succeed. You did your masters from Australia. Did that help you in finding a firm footing in an industry that was still at a nascent stage back home? The Brewing & Malting program that I pursued at Ballarat University provided a strong foundation for my future. Not only did it equip me with the right international exposure, but it also helped develop my sense of confidence. I gained hands-on experience in brewing through a brief training internship at Carlton and United Breweries, Melbourne, which helped me pursue a brewing career on my return to India. All of this later proved invaluable in my own entrepreneurial endeavour, Biocon. Do you think the educational system in India is inadequate to produce desi versions of Mark Zuckerberg and Sergey Brin, despite availability of excellent avenues for higher education? Education is fundamentally intertwined with individual and national development and its inadequacy – and often its absence – has kept Indians and India from fulfilling its potential of realising comprehensive economic and social progress. Making primary education a fundamental right is a laudable effort, but mere legislation is of no use – implementation is crucial. A public-private co-operative venture towards this end can be initiated to make universal primary education a reality. It is also important that governments infuse funds into universities and encourage full-scale research. Freeze on full-time employment and poor salaries are leading to a lack of enthusiasm and accountability amongst the teaching staff, which is affecting the FUTURE MEDICINE I July 2012
quality of education. We must make concerted efforts to stop this rot and capitalise on our strengths if India wants to emerge as a knowledge leader in the near future. What changes do you recommend for the education system in India? The government must encourage educational institutions to move away from rote-based learning by investing in computer-aided education. The government must also invest in faculty at the primary as well as higher education levels – good teachers are likely to make the difference between the country’s success and failure. There is a need to increase budgetary outlay for higher education right up to the research level and encourage scientific research programmes in colleges. Tell us something about the most defining moments of your phenomenal success story. One of the biggest changes that happened was when Biocon went from being a producer of enzymes to a biopharmaceutical company. Manufacturing pharmaceuticals is completely different from manufacturing enzymes and there were numerous regulatory aspects we had to learn to bring pharma products into the market. However, we went about transforming ourselves with dogged determination and succeeded immensely. Our revenues moved from Rs 70 crore in 1998 to Rs 500 crore by 2004. What is your message to the youth? My message is simple: Learn to accept the challenges life throws at you and you will emerge wiser and stronger. The road that lies ahead of you can take twists and turns you never even dreamed of – but at each juncture, you will find opportunities to learn and grow. Take my own example. I aspired to become a medical doctor, but pursued biology and brewing technology only to become a successful entrepreneur. I have benefited more from this complex life trajectory than I would have if I had been rigid about my goals. Never giving up in the face of obstacles, thinking out-of-the-box and resourcefulness at making the best of what you have are qualities one should strive to develop. Today’s youth are at an enormous advantage than when I began my entrepreneurial journey. The economy has opened up and opportunities abound for those with the zeal to succeed. Make use of these opportunities as they present themselves.
COVER STORY Rural Healthcare
Where right to life is too hard to come by The bane of the modern day civilisation lies in the lack of collective consciousness to stand up for the basic rights of the man in distress. Today, care is a reckless emotion for a majority of people lost in the urban world of materialism, while life has become cheaper in the rural heartlands. Poor living conditions and lack of bare essentials due to the crippling influence of poverty have made the rural populations vulnerable to a host of lethal diseases and infections. Yet, the excuse of inaccessibility and lack of transportation to the rural world is often cited as a major hurdle in providing healthcare. In this edition, Future Medicine goes into the basics of rural healthcare through the Indian experience and makes workable suggestions that can improve the life of a humble villager Bureau
pen defecation is still a common sight in the rural parts of the world as well as urban slum settlements. More common is the sight of leakage from septic tanks finding its way into life-sustaining water resources. It’s not just a problem of non-awareness of healthy life systems. Rather, it’s the direct offshoot of a lack of social and political will to educate, shelter, empower and care for the life of a humble villager. It’s the same sob story in most rural pockets of the Third World. Since most resources and life support systems are concentrated in the urban settlements, access is often cited as a
roadblock in extending basic healthcare facilities to the rural poor. And while the debate of providing universal healthcare access goes on for days, months, and years, little ground has been covered in terms of improving the rural health infrastructure in most countries. That’s why there seems to be no escape from deadly diseases, infections and high infant/child/maternal mortality rates. Over the years, the rural healthcare problem has been worsening due to lack of knowledge on medication among villagers, unavailability of health centres, scarcity of doctors, nurses and paramedical staff, and non-recognition of
critical illness situations. As always, the West knows how to insulate itself from these kind of problems. Yet, emulation of Western healthcare models in the Third World is difficult because capital- and staff-intensive systems are unworkable in economically depressant pockets. It is in this light that Future Medicine attempts to showcase India’s National Rural Health Mission as a model that can be replicated by other countries where the rural healthcare system is in a bad shape. Though NRHM is considerably young and its achievements may not be of gigantic proportions, one can still learn a lot from this novel mission.
FUTURE MEDICINE I July 2012
NRHM leads by example, but concerns still remain The health of a nation can be better understood from the efficacy of the delivery system in meeting the problems at the grassroots. If the foundation is firm, there’s no reason why the structure can’t be sound. That’s why we at Future Medicine decided to take a look at India’s rural healthcare system. Knowing well that the social and economic disparities have a direct bearing on the health of the underprivileged class, the UPA government incorporated within its common minimum programme the ambitious National Rural Health Mission (NRHM) to make an architectural correction in the healthcare system. As NRHM has been given an extension of five more years in view of its achievements, we take a look at the progress made thus far Bureau
espite a poor monetary allocation of a little over one per cent of the GDP for the health sector, India has a reasonably sound medical system, given its success ratio in arresting the spread of new strains of dreadful diseases and epidemics. At the same time, the picture is not so comforting once we start measuring the immunity of the healthcare system in the rural pockets of the country, inhabited by three-fourths of India’s population. Stories of poor sanitation and hygiene, chronic malnutrition among children, maternal and infant mortality, lack of basic childcare facilities,
illiteracy, and dangers of the debtcum-death trap of poverty only reflect the failure of governance in providing the majority of the rural population an easy access to qualitative healthcare facilities and welfare alternatives. But today, the villager can breathe a sigh of relief, thanks to the UPA government’s commitment to making a much-needed course correction. Launched in 2005 in 18 states with an objective to improve the healthcare delivery system across the rural segments of the country, the National Rural Health Mission (NRHM) has made considerable progress in providing
universal, affordable, equitable, and qualitative access to healthcare. Taking a serious view of its achievements over the last seven years, the UPA government has decided to give NRHM an extension of five more years. So far, the NRHM action plan has been five-pronged: Communitisation: To ensure better community participation in health initiatives, various committees and organisations have been formed at the village, block and district levels of each state. The Village Health and Sanitation Committees, the Panchayati Raj institutions, the Rogi Kalyan
A special care newborn unit at the district hospital in Udhampur, J&K.
COVER STORY Rural Healthcare Minor success?
Samitis (Patient Welfare Committees) at the Primary Health Centres and the Community Health Centres, and the scheme of ASHA (accredited social health activist) are at the forefront of communitisation. Under the ASHA scheme, local women are educated to promote healthy lifestyles in rural communities. Flexible financing: All schemes of health and family welfare have been incorporated under the overarching umbrella of NRHM. Through the NRHM budget, funds are allocated to districts on the basis of their needs for judicious implementation of health programmes, and creation and upgradation of Sub Centres, Primary Health Centres and Community Health Centres. Untied funds are also available at various levels. Capacity building: Health workers at the block, district and state levels are trained through various programmes on skill development and capacity expansion. These programmes are conducted by various NGOs and development partners. Monitoring process: The progress of activities undertaken by NRHM agencies are monitored regularly to ensure that they comply with Indian Public Health Standards. Various health facility surveys are also carried out at regular intervals to monitor the functioning of facilities available at the Sub Centres, Primary Health Centres and
Community Health Centres. Independent monitoring committees are also being formed to take stock of the progress. Human resource development: To ensure availability of sufficient manpower at the Primary Health Centres and the Community Health Centres, additional staff, including nurses and medical officers, are being provided. Local residents in remote areas are being trained for providing basic health services. There is also stress on development of multiple skills of health functionaries, especially doctors and paramedics, so that they can singlehandedly carry out a number of tasks.
Other features • • • •
Promotion of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy) in the mainstream Janani Suraksha Yojana aims to reduce maternal mortality and infant mortality rates Converging health, nutrition, water, sanitation and hygiene activities through District Health Plans Integration of vertical health and family welfare programmes at national, state, district and block levels Fostering public-private partnerships, regulating the private sector Instituting Indian Public Health Standards
Over the last seven years, NRHM has shown improvements in increasing the quantum of investment in health programmes, upgrading the health infrastructure, setting institutional standards, training a number of local healthcare staff and providing technical support to various schemes. However, it has achieved only “minor success”, according to a report by the National Institute of Health and Family Welfare (NIHFW). Yet, the report has something to rejoice. It points out that no other state programme in the health sector has achieved such radical and significant outcomes, although the achievements fall short of what had been originally envisaged. Prime Minister Manmohan Singh recently admitted that unavailability of health professionals is emerging as one of the serious impediments to providing universal health coverage for all. There are other factors as well, impeding full maturity of the health initiatives. They have to be identified for step-by-step resolution of problems in a time-bound manner. According to various appraisals of NRHM, given below are some key areas where the government needs to accord priority to problem resolution: • The subject of health figures in the State list. Had it been in the concurrent list, considerable headway could have been made in terms of extensive coverage. As of now, one of the major factors hampering proper channelisation of the NRHM programmes is the fact that while funding is from the Centre, implementation is being taken care of by the state governments. This is causing duplication of efforts, sluggishness in implementation and confusion over accountability. If healthcare services are to be provided in a seamless manner, this dual mechanism (of the Central and state involvement) has to be made more effective, uniform and expeditious. • With NRHM getting a five-year extension, there’s more scope for translating short-term health targets into permanent solutions for the rural population. • NRHM should not merely be identified as a pet project of the Centre. It should be integrated with
FUTURE MEDICINE I July 2012
the healthcare systems of the states in such a way that there is optimum utilisation of both human resource and infrastructure. States should compare its data with NRHM’s growth indicators for an informed assessment of the health status of various regions and social groups. There should be a greater concentration of schemes in regions with poor health indices. NRHM functionaries can also help the states in improving their governance by giving them constant feedback on the efficacy of their social and economic programmes. The Manmohan Singh government plans to double the expenditure in the healthcare sector from a little over 1 per cent to 2.5 per cent of the GDP during the 12th Five Year Plan. Even such a desperate move may not help us stand in the company of countries with far better health indices. For instance, the healthcare expenditure in the US is 16% of the GDP, while France and Belgium spend 11% of the GDP, followed by Switzerland, Canada, Germany and Austria with a health budget of 10 to 11% of the GDP. Is our government listening? The public healthcare system should have the capacity to provide treatment for all kinds of health problems, including rare/serious disorders and complicated cases that are hard to be diagnosed. Besides, the national health insurance scheme should be amended, taking into consideration the lack of affordability of the poor to undertake specialised and expensive treatments. The entitlements should give the rural poor enough insurance coverage as compared to the competitive private insurance schemes. The migrant labourers of India are living in deplorable conditions in urban shanties and they do not have access to proper healthcare facilities, making them highly vulnerable to the ills of poor
FUTURE MEDICINE I July 2012
sanitation and hygiene. This is an area where both NRHM and the National Urban Health Mission can be integrated with a common agenda. NRHM should look into all aspects of health. A grand vision plan should be conceived for the containment of health problems that are not only common in nature but also neglected in the remotest parts of the country. Instead of keeping track of the money being invested in health schemes and its utilisation, there should be result-oriented evaluation of a certain scheme for follow-up action. This will help us improve health indices. Health professionals working in the remotest parts of the country must be given incentives and rewards. This will help in stopping absenteeism. There is a need for proper region-wise collation of information/data on the health status of the rural population. At the same time, the monitoring mechanism must identify the gaps in the healthcare system. In this connection, NRHM’s community monitoring and social audit programmes should be strengthened to ensure diligent use of funds and empowerment of local communities. Efforts should be made to provide the rural population basic requirements to lead a healthy life, such as clean water, sanitation, nutrition, housing, education and employment. NRHM’s schemes should also be linked to various government programmes to ensure synergy. The Central and state governments should bring in more transparency to curb malpractices and corruption. The multi-crore NRHM scam in Uttar Pradesh gives a glimpse of how corruption can weaken the delivery mechanism. There should be concentrated efforts towards covering the entire population of urban poor under the National Urban Health Mission.
COVER STORY Interview
Large–scale maternal, child under nutrition a hurdle for MDG The United Nations International Children’s Emergency Fund (UNICEF) has been working in India since 1949, with a commitment to help children in realising their basic right to life. In an exclusive interview with Future Medicine, Dr Satish Kumar, the Chief of UNICEF Office, Tamil Nadu and Kerala, talks about India’s rural health emergencies, initiatives, outcomes and needs
By Our Correspondent Where does UNICEF stand today in respect of the goals it has set out for itself? UNICEF has been working with the Government of India and also with many development partners in the NGO set-up to improve the situation of children and women in the country. The objective has been to create an enabling environment to realise the rights of children, that is, their rights for survival, development, protection and participation. Impressive progress has been made in the areas of child health, maternal health, primary education and provision of safe drinking water. Infant Mortality Rate came down from 80 (1990) to 50 in 2009-10, Child Mortality Rate from 116 to 60, and Maternal Mortality Rate from more than 300 in 1990 to 230 in 2009. The number of polio cases fell from more than 1 lakh in 1990 to just one case in 2011. The achievements of the government’s education-for-
all programme, called Sarva Shiksha Abhiyan, are evident in improved gross completion rate at the primary level, which now stands at 98%. Besides, more than 80% of rural habitations have access to improved drinking water source. However, progress has not been very satisfactory in the areas of child nutrition and rural sanitation. Large-scale maternal and child under nutrition poses a challenge for us in reaching the Millennium Development Goals on child nutrition, survival and development. We have about 40% children below three years of age in India who are under weight, while 23% suffer from acute malnutrition or stunting. Only 35% of rural households use toilets. We also have to deal with serious problems of child violence, child abuse and adverse child-sex ratio. What kind of health problems are plaguing the rural population? Do we need a change in policies? Common health problems faced
by the rural population in our country include child malnutrition, infectious diseases in children like diarrhoea, pneumonia, vector-borne diseases like malaria and encephalitis. Besides, children also die of preventable accidents and causes like drowning and burn injuries. Tribal population and those inhabiting difficult-to-reach areas are the worst sufferers. We need changes at the policy and programme implementation levels to address the problems of child malnutrition, anemia and service coverage for tribal and difficult-to-reach population. What kind of solutions are possible in the given scenario? Firstly, to effectively deal with the problem of child malnutrition, the Integrated Child Development Services - the largest national programme tackling malnutrition and health problems among children aged below six years and their mothers - should change its focus. It
FUTURE MEDICINE I July 2012
must focus on children below three years of age. Secondly, we need to have alternative approaches to cover all difficult-to-reach rural pockets through mobile health systems and periodical campaigns, which will bring about an improvement in delivery of services. Thirdly, we must energise the local governance systems, such as the Panchayats, empowering them to monitor and manage health services. Fourthly, on one hand, we must enhance community awareness about the entitlements one can get from the government, and on the other hand, improve their capacity to look after the health of children and mother in home settings. This can be done by disseminating simple messages for action like exclusive breast feeding, feeding during pregnancy, use of ORS and continued feeding of children during diarrhoea etc. Lastly, we must improve the capacity of our health systems to provide better referral support and timely treatment facilities for both the mother and the child being brought to hospitals from far-flung areas. Which state has an impressive health record? States in South India like Kerala, Tamil Nadu and Karnataka. Maharashtra, Goa, Sikkim and Himachal Pradesh also have good health indicators like child mortality, child immunisation and health infrastructure, including primary health centres and community health centres. How is the UNICEF aiding the National Rural Health Mission? Launched in 2005, NRHM aims to improve and restructure the healthcare delivery system, enhance quality and coverage, and broaden the role of local self-governance to improve utilisation of healthcare facilities. UNICEF, under NRHM, helps the state and district health officials prepare project implementation plans. Besides, it supports capacity development training programmes for medical officers, Accredited Social Health Activists and Panchayati Raj institutions, helping them carry out their responsibilities under NRHM. Has India conquered Polio? Or are there any gaps in the fight against Polio? Yes, India has made tremendous progress in its fight against Polio. It is evident from the fact that the number FUTURE MEDICINE I July 2012
of Polio cases has dropped from 1 lakh in the 1990s to one case in 2011. But we should not be complacent. The momentum of the social awareness campaign has to be maintained. The success can be attributed to the active involvement of people. Public awareness and public participation are essential for complete elimination of Polio. Do you think enough is being done to counter health emergencies in rural pockets where even the basic facilities are not available? Healthcare is a fundamental right. Both the Central and state governments have been making sincere efforts to deal with public health emergencies. For instance, there was a time when there used to be frequent outbreaks of waterborne diseases and other epidemics. Today, such health concerns have been adequately addressed through timely upgradation of the health infrastructure and facilities across the country. Apart from this, we have social security schemes such as Janani Suraksha Yojana and Rashtriya Swasthya Bima Yojana, which help people in dealing with unpredictable health emergencies. What measures do you propose to reduce the rural-urban divide in matters of health? We need to take adequate steps in both urban and rural areas. Because of rapid urbanisation, the situation in urban slums is really bad. The migrant population is really disadvantaged when it comes to accessing proper healthcare facilities. We must plug the gaps in town planning and guard against multiplication of urban slums and unplanned cities. Similarly, we have to increase allocations for health to ensure that everyone is cared for. The National Urban Health Mission should take off under the 12th Five Year Plan. We should effectively deal with problems of slum-dwellers such as water pollution, epidemics like H1N1 and malaria. In rural areas, vacancies in the public health system, particularly in far-flung areas, should be filled up. The problem of absenteeism of health workers in community health centres and public dispensaries also needs to be addressed on a priority basis. We should undertake data analysis to identify under-developed areas where provision of basic facilities has to be ensured. These steps would help us in reducing the rural-urban divide on the health front.
Dr Satish Kumar, Chief of UNICEF Office, Tamil Nadu and Kerala
Unicef has been conducting many field studies and publishing its reports to sensitise people and policymakers. Have the authorities shown an immediacy and resolve to tackle today’s health emergencies in an equal measure? UNICEF’s efforts to carry out evidence-based advocacy with political leaders, top administrators and key development partners have been largely successful in influencing health policies of the country in the larger interest of children and mothers. For example, under the Universal Immunisation Programme, we supported the Government of India in formulation of policies on National Immunisation Days, fixed day outreach immunisation sessions, Vaccine Logistics and Cold Chain Maintenance System etc. The concept of first referral units and comprehensive Emergency Obstetric Care Centers were promoted to reduce maternal mortality under the Child Survival and Safe Motherhood programme in mid-1990. UNICEF has also worked with the Government of India to promote “Short-term Obstetric Anesthesia” courses for general duty medical officers. This course is being followed in many states. UNICEF has also contributed in planning and designing of a training programme on “Integrated Maternal and Newborn Care Illness” in the country. The scope of Janani Suraksha Yojana on maternity benefits has now been extended to cover all mothers who deliver in private hospitals as well. The concept of “community-based preparedness” for disaster management, initiated by UNICEF, is now widely followed by the government and NGOs in disaster prevention, management and disaster risk reduction.
COVER STORY Appraisal
NRHM falls short of equipment, manpower In an interview with Future Medicine, Dr Zakir Husain, Associate Professor, Population Research Centre, Institute of Economic Growth, Delhi, gives an expert opinion on the operational aspects of the National Rural Health Mission (NRHM). A PhD holder in Economics from Calcutta University, Dr Husain works in the field of Development Econometrics and Public Health By Our Correspondent How successful has been the National Rural Health Mission (NRHM) in streamlining and improving the health system? Targets have not been fulfilled in most cases. States need to focus more effectively. But given the complexity and magnitude of the task, NRHM has been a success in terms of keeping health to the forefront of policy-making. The government intends to convert NRHM into the National Health Mission (NHM). What are the specific problem areas that the government should attend to before such upgradation?
The Health Management Information System needs to be more effective. It is crucial for monitoring and evaluation and has tremendous potential. The Statistics Division, Ministry of Health and Family Welfare, is working on this along with Population Research Centres. Finding manpower requirement in rural areas remains an important challenge. Given the economic crisis, frustration with corruption and red tapism, and shift of attention of donors to Africa, funds may become a major issue as scale of NRHM is enhanced to NHM. Planning needs to be more responsive to the
Equipment remains a worry. Manpower shortage is an even greater constraint
FUTURE MEDICINE I July 2012
Address two concerns of rural doctors: the education of their children, and the need to lobby for transfer back to urban area Dr Zakir Husain, Associate Professor, Population Research Centre, Institute of Economic Growth
local needs and concerns. Unrealistic targets are leading to falsifying of figures. Do you have any recommendations for strengthening the network of sub centres/primary health centres/ community health centres? Physical location of health centres is fine. Equipment remains a worry. Manpower shortage is an even greater constraint. Allocating existing manpower in keeping with the incidence of morbidity and epidemiological profile and existence of equipment/ other staff is another challenge. Is there an alarming level of shortage of medical equipment and medicines in the rural health establishments? How can we overcome this, considering India’s huge population? Yes, there is a shortage. But we also have to focus on leakages. Repeat economist and social activist Reetika Khera’s study, which had showed that 50% of PDS subsidy leaked away, to find out the true deficit. In addition to the problem of absenteeism, the rural health system is in acute need of more qualified doctors and paramedical staff. How do we attract more professionals, especially in the light of opposition from a section of the medical community to the proposal of compulsory rural service? “Barefoot doctors” may be a step forward. Address two concerns of rural doctors: the education of their
children, and the need to lobby for transfer back to urban area. We should adopt a mixed policy in which a doctor spends four days in a rural posting and two days at the nearest urban centre. How effectively has NRHM empowered the backward states? Look at Uttar Pradesh! The state has been forced to invest in health. Some improvements have occurred. How can the ASHA scheme be enhanced further since it is one of the areas where NRHM has been successful? Re-training can augment their medical knowledge, and their functions should be increased in accordance with experience. Is there a way to give better insurance entitlements to the rural population? The Rashtriya Swasthya Bima Yojana has been a failure. Local community-based insurance schemes may be an option. Let us learn from experience of other countries.
Icon of hope for poorest of poor Motivating oneself to dedicate life for a humanitarian mission isn’t as easy as it sounds. It requires a steely mental resolve, deep compassion and respect for the underprivileged, and a fervent commitment to stay the course. Here’s how a Zoology professor turned into an icon of hope for the lesser mortals By Shani K
n these days of abject materialism, our evolutionary cycle is badly hit by the misadventures of the misguided man. Yet, thankfully, we get to hear some soul-lifting stories that guide us into a safe and promising future. Here’s such a story of an ordinary person who has dedicated herself to the self-exhilarating cause of serving the lesser mortals. Seven years ago, Dr M S Sunil, a Zoology professor at Catholicate College in Pathanamthitta district of Kerala, had visited Chalakkayam to take part in a meeting. While there, her gaze fell upon a group of tribes, called Malapandaram, giving her a first-hand, heart-rending impression of their pathetic living conditions and primitive lifestyles. Her interaction with the tribes proved to be the turning point of her life as she decided, then and there, to spare enough time for their welfare. “When I saw the tribes, I had realised that they were keeping a safe distance from the public fearing the repercussions of a close encounter. They were simple-minded, never feeling the need to cover their partially naked bodies. I spoke to them and gave them some essential food items and clothes. I met them two weeks later, only to find them partially naked yet again. Upon enquiry as to why they were averse to cover their bodies, they simply said that they did not know how to wash clothes.
That called for my intervention, and I, along with my students, taught them how to wash clothes and made them realise the importance of maintaining cleanliness of body by bathing daily. It only made their lives better,” says the beaming Professor Sunil. Today, she is an icon of hope for the lesser mortals, building houses for the tribes and the homeless, donating books to libraries and wheelchairs to the physically handicapped, providing books and uniforms for school students and blood for patients. Professor Sunil’s entry into the lives of the tribes has also brought them the hope of social and economic empowerment. Following her advice, some of them have started sending their wards to schools. They have also learnt to use modern communication devices like the mobile phone. Apart from the tribes, 24 homeless families have been provided new homes, constructed by Professor Sunil and a team of volunteers, including her students. Professor Sunil, who is also the Programme Officer of the National Service Scheme of Catholicate College, says: “Each house is sponsored by different persons from various walks of life. In each case, I have strictly followed the documents submitted by them to make sure they are eligible for the house. Construction work on the 25th house is underway.” Once, she says, a foreigner heard about my activities and offered me 100 hearing aids. “This gesture from an unexpected source shows that where there’s a will, there’s a way. Fame or money doesn’t matter to me. I just felt the need to serve society, and I am doing it in whichever way I can,” she says. She has earned recognition for her contribution to society. She has bagged the Best NSS Programme Officer Award of the Mahatma Gandhi University, a state award and the Vanitha Seva Samaj Puraskar.
FUTURE MEDICINE I July 2012
Wellness is the state all of us aim to be in
Dr Wasim Mohideen
Wellness is the jump from discomfort to comfort, where nagging issues like weight, energy levels, mental well-being, sleep, bowel habits, stamina and sexual life are all in harmony
ellness has become a cult these days. Some of us have experienced it, some of us have been given an idea about what it is and most of us have been given all the wrong ideas about what wellness is. Suddenly, everything that everyone offers is being branded as wellness and credibility is at stake for a genuinely wonderful area of medicine. Being an allopathic physician who went on to practice wellness after quite a few years
of training, I will attempt to introduce wellness into your life. To put it in simple words, wellness is the state that we should all aim to be in. Discomfort is the state in which most of us are. We fall ill and go to the doctor who cures our illness and puts us back
into a state of comfort, and we move on. Wellness is the jump from discomfort to comfort, where nagging issues like weight, energy levels, mental well-being, sleep, bowel habits, stamina and sexual life are all in harmony. When all of this is in harmony, you experience wellness. One of the key therapies in wellness is a detox. If someone tells you that a detox is a myth and that your body detoxes itself and people suggesting a detox are all quacks, just ask them why do people fall sick if the body is detoxing perfectly. Your body has a defence system that needs help with medicines. Similarly, your bodyâ€™s detox system needs help from time to time. Smoking, pollution, stress, lack of sleep and other not so healthy stuff, overwork your bodyâ€™s detox mechanism and stall or slow it down, thus leading to accumulation of toxins. But the question on most peopleâ€™s mind is what can wellness do for me? It can do wonders. Imagine wellness as an extended spa. Just the way the spa makes you feel rejuvenated on a given day, wellness therapies will stay that much longer and make you feel lighter and rejuvenated. It will make you feel as if you have the vigour to conquer the world. Of course, all that will happen only when it is done by qualified people after a thorough diagnosis of your present condition. Wellness is not a one size fits all, but one where your doctor
will be able to customise the programme just for you. Wellness is also not specific to any stream of medicine. Ancient doctors were able to deliver wellness to all their patients, but today, medicine is more of a treatment-oriented field. In fact, in ancient China, doctors were paid a retainer to keep the population healthy. If someone fell ill, the doctor lost some of the retainer. Wellness plays a large role in prevention. When you are really well, you will not be obese, will have a great sexual life, will not need smoking or alcohol to keep you going and you will not feel tired all the time. When all of this happens, you will manage stress better, you will eat better and feel better and reduce your risk of diabetes, heart attacks and strokes. This will also help you and your insurance companies save money. If you already have diabetes or blood pressure or have recovered from a major illness, wellness still applies to you. You can prevent complications and make the best out of life. Therefore, there is something for everyone in wellness. What you should be careful about in wellness though is finding the right person to guide you through. There are a lot of people using the term wellness to sell services that might just not be bad, but also have nothing to do with wellness. I hope and pray that all of you have a wonderful life. (Dr Wasim Mohideen is the Director of Basil Wellness Studio, a centre for preventive and wellness medicine. He is a doctor who has been trained extensively in wellness in the US, the UK and Sri Lanka and he writes for various newspapers and magazines. His clients include celebrities and CEOs.)
FUTURE MEDICINE I July 2012
Dr Vilayanur Subramanian Ramachandran EXCLUSIVE INTERVIEW
Meet the ‘Marco Polo of neuroscience’ Padma Bhushan Dr Vilayanur Subramanian Ramachandran, a world renowned neuroscientist, is the Director of the Center for Brain and Cognition, and Distinguished Professor with the Psychology Department and Neurosciences Program at University of California, San Diego. In 2005, Dr Ramachandran received the Henry Dale Medal and was elected to an honorary life membership at the Royal Institution of Great Britain (joining the ranks of Michael Faraday, Thomas Huxley, Humphry Davy, and dozens of other Nobel Laureates). His other honours and awards include fellowships from All Souls College, Oxford, and from Stanford University (Hilgard Visiting Professor); the Presidential Lecture Award from the American Academy of Neurology, two honorary doctorates, the annual Ramon Y Cajal Award from the International Neuropsychiatry Society, and the Ariens-Kappers Medal from the Royal Netherlands Academy of Sciences. In an exclusive interview with Future Medicine, he speaks about the possible role of mirror neurons in understanding the condition of Autism, the usability of his invention, called the mirror box, and his theories. Excerpts: By Sanjeev Neelakantan & Sreekanth Ravindran Is Autism mainly related to the dysfunctionality of mirror neurons? Possibly, yes. There are two reasons for thinking so theoretical plausibility (and absence of competing neural theories) on the one hand, and empirical evidence on the other. In 2000, we listened to a lecture by Giacomo Rizzolatti, who discovered mirror neurons in monkeys. Most “motor command neurons” in front of the brain fire when, say, monkey A reaches out and grabs a peanut or pushes a stone. Some of them will also fire when A merely watches monkey B perform the same action. The neuron was in effect adopting B’s “perspective”; so A���s higher brain centres were saying “The same neuron is firing in my brain as WOULD fire if I were FUTURE MEDICINE I July 2012
Photo: Beatrice Ring
EXCLUSIVE INTERVIEW Dr Vilayanur Subramanian Ramachandran to grab a peanut; so THAT’S what B is up to. “The neurons allow you to adopt another person’s view of the world for empathy and for constructing a model of that person’s behaviour. Which, in turn, is required for imitation and pretend play (“I’ll pretend that action figure of superman is me”) We were struck by the fact that these are precisely the abilities that are dysfunctional in Autism Spectrum Disorders (ASD); adopting another’s point of view, empathy, imitation, pretend play etc. The empirical evidence comes from brain imaging studies, especially EEG and fMR. A recent meta-analysis by Lindsay Oberman showed that five studies found evidence for mirror neuron dysfunction, whereas one did not. We must bear in mind that in some ASD individuals, the mirror neurons may be normal,
but their target zones might be abnormal. It’s important to note that even if the empirical evidence is inconclusive at this point, the THEORETICAL reasons outlined above would still stand. Science is about generating testable ideas; and the mirror neuron system (MNS) theory is better at explaining the symptoms of ASD than any other candidate theory. At this point, however, I would say that the evidence is suggestive and not conclusive. Is there a way to repair or rehabilitate the mirror neurons and bring about a change in treatment of people suffering from Autism? There’s a group in Australia that’s using transcranial magnets to directly stimulate dormant mirror neurons. There are hints that the procedure works. Why has your theory of mirror neurons on Autism come under attack? “Attack” is a layperson’s word. Einstein didn’t “attack” Newton or Bohr. We presented the MNS theory only as a possibility for testing; it may fall or it may stand. It wouldn’t bother me if it falls because it would have anyhow served its purpose of stimulating discussion. As Charles Darwin said, “It’s fine if a clever theory is disproved because in the process of doing that, you will often have simultaneously opened another path to the truth.” Also, some philosophers have argued that there’s no direct evidence that mirror neurons exist in humans, which is a bit like saying there’s no DIRECT evidence that the Sun is hot unless you take a thermometer up there. There’s fmR evidence that the “simulating other minds” module in the brain is distinct - although adjacent - to the area with mirror neurons (MN). In evolution, an area such as the conventional MN area for MOTOR simulation might have split into two with the second area subsequently evolving to perform novel but A mirror neuron is a neuron that fires when an animal acts analogous functions (“mental” and observes the same action performed by another. The simulation). The latter “second neuron “mirrors” the behaviour of the other, as though the order” mirror neuron system observer were itself acting. Such neurons have been directly might be dysfunctional in some observed in primates. Many researchers argue that mirror types of Autism. neuron systems in the human brain help us understand the But as I said before, the actions and intentions of other people. shattered mirror theory of Autism is at this point merely suggestive
What’s a mirror neuron?
FUTURE MEDICINE I July 2012
What’s a mirror box?
A mirror box is a box with two mirrors in the centre (one facing each way) to help alleviate phantom limb pain, wherein patients feel they still have a limb after having it amputated. To retrain the brain and eliminate the learned paralysis, the patient places the good limb into one side, and the stump into the other. The patient then looks into the mirror on the side with the good limb and makes “mirror symmetric” movements. When the subject sees the reflected image of the good hand moving, it makes him feel as if the phantom limb is also moving. Through the use of this artificial visual feedback, it becomes possible for the patient to “move” his phantom limb and overcome the pain. and not conclusive. Apart from Autism, how has the discovery of mirror neurons benefitted the scientific community? It is a new way of looking at many seemingly unrelated aspects of brain function. How does your invention, the mirror box, help people with amputations overcome the phantom limb pain? How successful is the mirror box in rehabilitating patients suffering from trauma? The mirror box has been used for four conditions: phantom pain, pain in an intact hand that persists with a vengeance after trivial injury (Complex Regional Pain Syndrome CRPS), stroke paralysis and rehab after hand injury. There are dozens of case studies and brain imaging studies confirming its efficacy and a few double-blind placebo controlled trials. A “gold standard” Cochrane data base study reported by Dohle demonstrates efficacy FUTURE MEDICINE I July 2012
for stroke. A paper by Chan, Tsao and others reports effectiveness for phantom limb. And Cacchio et al showed striking recovery in 48 CRPS patients. I would add two remarks. There is a great deal of variability in response as is true for any procedure (cornonary bypass, knee surgery, spine surgery, prozac treatment etc.) and the reasons need to be determined. Second, given the cost (five dollars), non-invasive nature, and ease of use, I would encourage patients to try the procedure for a few weeks first, subject to approval from their primary care physician and under medical supervision, before resorting to costly, risky, surgery or drugs. You have been quoted by the media as saying that science has become too professionalised? What’s the import of this statement? This is well described in my new book, “The Tell-Tale Brain”, in the preface. (An
EXCLUSIVE INTERVIEW Dr Vilayanur Subramanian Ramachandran
Neurons are cells that send and receive electro-chemical signals to and from the brain and nervous system. There are about 100 billion neurons in the human brain. excerpt from the book – “Homogeneity breeds weakness: theoretical blindspots, stale paradigms, an echo-chamber mentality, and cults of personality... Science should be question-driven, not methodologydriven.”) What’s your message for the youth who want to pursue a career in science and technology? Read widely - not just books in your discipline. Read about the history of science and biographies of scientists. Hang around senior scientists who are passionate and excited about what they do; there’s nothing more contagious than passion. Avoid bores, curmudgeons and nay-sayers who haven’t themselves done original work; they can stifle your imagination. At the same time, learn to be genuinely sceptical; although some, usually non-creative people, cultivate scepticism for its own sake, avoid that. What’s your current area of engagement? For the last three decades, brain research has been based on the AI (artificial intelligence) model. The brain was thought to consist of specialised, hierarchically organised modules which
autonomously computed and made explicit some aspects of the information before passing it on to the next module for further processing. They are hardwired by genes at birth and don’t interact much. I argue in my book that this picture is false, except in some specific cases such as area V4 for colour or hippocampus for memory acquisition. Modules are highly malleable and may be said to be in a constant state of dynamic equilibrium with other modules, with the external environment, with the skin and bones (as in RSD), even with other brains (through Giacomo Rizzolatti’s mirror neurons)! Even as basic a distinction as between sensory and motor gets blurred in my scheme. We have even found that even an injury to a finger bone (followed by excruciating pain and paralysis of the hand - CRPS) can act “backward” on the brain’s inferior parietal lobule and cause you problems in identifying other people’s fingers and in doing mental arithmetic which you originally learned using fingers! It’s a new world in neurology.
Dr Ramachandran, who earned the moniker “the Marco Polo of neuroscience” from Oxford University Professor Richard Dawkins, has several books to his credit. His acclaimed work “Phantom in the Brain” has not only been translated into nine languages, but was also featured by top US and British TV channels. His book “The Tell-Tale Brain” was on New York Times’ bestseller list. Newsweek magazine has named him a member of “The Century Club”, one of the hundred most prominent people to be watched in the next century. He is also the grandson of Sir Alladi Krishnaswamy Iyer, former Advocate General of Madras province (British India) and the co-architect of the Constitution of India.
FUTURE MEDICINE I July 2012
TECH TRENDS IN MEDICINE
Moving robotic arm using thoughts
ew research shows that people who are paralysed have the ability to move robotic arms with their thoughts through an implanted chip on the brain. The report, published by the journal Nature, is the first to show that humans with brain injuries can send neural signals to a computer in order to move a prosthetic arm. It’s a new way to imagine the connection between brain and body, and as robotic technology in medicine continues to grow. Chet Moritz, Assistant Professor of Rehabilitation Medicine and Physiology and Biology at the University of Washington, said: “I think that certainly the ability for electronic devices to improve functions in paralysed individuals is only beginning to develop... as we enhance our ability to replace function and restore natural function to individuals.”
Mobile X-ray technology innovation
himadzu, a worldwide manufacturer of diagnostic imaging equipment, has introduced the first wireless flat-panel detector (FPD) for its mobile, fully digital X-ray system MobileDaRt Evolution. This new CXDI-70C detector generation is the next evolutionary step for mobile X-ray applications. It enables X-ray personnel to act even more independently when taking X-ray images on site – for instance, in radiology, on the ward, in emergency rooms, traumatology, orthopaedics, or paediatrics. In addition, it simplifies sterilising the detector due to the lack of any attached cables. The FPD weighs only 3.4 kg and can be easily positioned. Its field of view of 35 x 43 cm
also covers larger examination areas. The caesium iodide (CsI) scintillator combines high sensitivity with the lowest possible radiation dose and thus reduces patient exposure. The resolution of 2,800 x 3,408 pixels provides sharp images in excellent quality. The wireless flat-panel detector is suitable for general radiography. Hospitals already using a MobileDaRt Evolution can have it refit to wireless detectors. Apart from its application with the MobileDaRt Evolution system for mobile X-rays, CXDI-70C can also be connected to a RADspeed DR. The RADspeed series from Shimadzu includes floor- and ceilingmounted systems for general radiography applications.
Tattoo ink for diabetics
cientists are developing a unique tattoo ink for diabetics that changes colour depending on glucose concentrations in the body and would allow continuous monitoring of blood sugar levels. Researchers at Charles Stark Draper Laboratories in Boston, USA, said that the ink could ultimately save lives and would mean that diabetics no longer need to painfully prick their fingers to draw blood and manually measure glucose levels.
FUTURE MEDICINE I July 2012
Dr B M Hegde EXPERT INTERVIEW
‘Promotion of alternative medicines is essential’ Dr B M Hegde is an Indian medical scientist, educationist and well-known author. He is the former Vice-Chancellor of the Manipal University and the Head of the Mangalore chapter of Bharatiya Vidya Bhavan. He has authored several books on medical practice and ethics. He is also the Editor-in-Chief of the medical journal Journal of the Science of Healing Outcomes. He was awarded the Dr B C Roy Award in 1999. In 2010, he was honoured with a Padma Bhushan, one of India’s highest civilian awards. In an interview with Future Medicine, he shares his concerns on the dangerous and wrong concepts in modern medicine. Excerpts:
By T N Shaji What are India’s prospects of becoming a medical treatment hub in the near future? It is a very dangerous thing to happen. Medicine is not a commodity to be marketed. Medicine is a very personal thing between two human beings. A person who is ill or imagines being ill comes to seek the advice of another person in whom she/he has confidence. This coming together of two human beings is medical consultation from where all else should flow. You can’t make India a medical hub. Medical enterprise is not a commodity to be marketed. You would be making a huge profit by selling things, where a patient becomes a commodity. It means total commercialisation. Just like selling mangoes. The price is varied from place to place. At some places, it is cheap, and at other places, it is expensive. That doesn’t mean you are improving the quality of mangoes. A recent study, conducted in 14 countries, showed that despite FUTURE MEDICINE I July 2012
the existence of many hospitals, doctors and specialists, they are witnessing more deaths. In contrast, Japan has the least number of doctors per capita and fewer specialists as compared to the US. Yet, Japan has the best health status. People there enjoy longevity in life and have the least number of morbidity and mortality, while the US has the worst scenario, in spite of having a large number of doctors per capita (almost all of them are specialists). Do you think man lives mainly because of the efforts of the medical fraternity and the pharmaceutical industry? It is, in fact, the other way round. The medical fraternity, especially the pharmaceutical business, is responsible for a majority of deaths in the world. That is why when the doctors go on strike, patients rarely die. Health/medicine is a big industry now. What do you think? Health is not an industry, but medicine is. We need proper healthcare. India needs clean drinking water, sanitary facilities, economic empowerment, women’s education etc. Most of the medical concerns are being funded by vested interests. What are the possible implications? The implications are terrible. Medical professionals are funded by vested interests. It can open up a Pandora’s Box. Everything concerned with medicine is a sponsored affair, and it is a universal phenomenon now. I feel it is a dangerous situation indeed. Why are environmental changes and diseases not being taken seriously by the medical fraternity? We are polluting the environment. That is very alarming. I am not against any developmental activities, but it should be done with some morality. We have to keep the equilibrium of the eco system. The environmental pollution will definitely affect the living things. Naturally, the medical fraternity would not be interested. It would want more diseases. After all, disease mongering is a big business in the world these days.
EXPERT INTERVIEW Dr B M Hegde
medicines by vested interests? There is a collective effort. I believe a strong mafia is behind it. Ayurveda is the Vedic system of healthcare developed in India over 5,000 years ago. This ancient ‘science of life’ is health- and not disease-specific. It takes into account the patients’ entire being - body, mind soul and spirit. Though it originated thousands of years ago, Ayurveda is more appropriate for present day society, where so many people suffer from stress-related conditions, which conventional medicine has been unable to cure. Ayurveda’s logical and common sense approach to health and living is combined with philosophy, psychology and spiritual “We have to keep the equilibrium of the eco system,” says Dr B M Hegde. guidance. Do you agree with the allegation that medical education Despite all-out efforts, alternative medicines in India are is mostly under the influence of drug companies? not gaining momentum. Why? I completely agree. Now, studies in Western countries There are many reasons. The pivotal thing is that the are also pointing out this alarming fact. The influence of government doesn’t support such activities for various medical companies’ money in medical education is horrible. reasons. There are so many wonderful treatment methods What is meant by medical humanism? and good physicians in Ayurveda, Yoga, Homoeopathy, This is a word I coined in 1997. Humanism simply Unani, Siddha etc. But they are not getting enough backing means that every human activity should aim at betterment from the authorities concerned. We have to really support of humanity. There should be humanism in all sectors. So, these systems to provide better healthcare to our people. why can’t we think of medical humanism also? We must have more money in alternative systems and more research facilities. Presently, we are doing researches by What’s the impact of globalisation on the poor in terms blindly following the Western methods, which are very of treatment? unscientific in nature when applied to Indian systems! Globalisation has made the price of drugs expensive in different countries. The same drug varies in prices in What are the implications of overused antibiotic different parts of the world. The NPVr (net present valuemedicines? risk adjusted) shows horrible things. If you invest one We are already experiencing the implications. These rupee in cancer drugs, your NPVr will be Rs 2,980 today! medicines are destroying the immunity or the diseaseCompanies are making a killing by selling cancer drugs. resisting power in human beings. For example, the elderly But all these drugs are not of much use to save patients from dying! The story is the same in other areas also. Life-saving drugs have become too expensive for the middle class as well. What is the remedy? First of all, there is no drug called life-saving drug. Every drug has become expensive. Most of the population in the world is not able to access modern medicine, according to a study by UNIDO. Only one per cent of the population in the world can access them. I feel this is a blessing in disguise for the poor because they are not falling prey to the dangers of these unwanted drugs. Do you think there is a collective Japan has the least number of doctors per capita and fewer specialists as effort to trivialise the importance compared to the US. Yet, Japan has the best health status. People there enjoy of Ayurveda and other alternative longevity in life and have the least number of morbidity and mortality.
FUTURE MEDICINE I July 2012
people who are admitted to hospitals rarely come back home alive because of the infections they get from there. This is a very serious matter. Our former Prime Minister Morarji Desai was admitted to a hospital at the age of 98 and did not survive. He was perfectly alright but for an ordinary flu. You are known as a people’s doctor. What is your suggestion for an ideal health programme for a country like India? We must promote wellness by providing basic necessities like food, water, shelter etc. Most of the diseases are the by-products of unhygienic Ayurveda is more appropriate for present day society environments. We require doctors only for corrective surgeries, emergency surgeries and emergency treatments. in Western countries? We seem to have forgotten values, the most vital part Asian medical care is, in fact, better. Most of what of education of a doctor. Do you think this is the main we hear about Western medical care is just claptrap. reason behind the decline of ethics among doctors? There is a book named Overdo$ed America: The Broken We don’t educate doctors at all. We must instruct Promise of American Medicine, by Dr John Abramson. them and make them good human beings. We have to The book narrates that Americans pay extraordinary educate doctors and inculcate in them good human values. amounts for healthcare that is not measurably better than Then only we will have committed medical practitioners. other less expensive care elsewhere, and as a result, Dr Science doesn’t know anything beyond the five human Abramson believes that Americans are over diagnosed senses. There is some power beyond us, which science and overmedicated. Dr Abramson investigates the is not able to fathom. It’s called the divine power, or commercialisation of medicine at every stage, from spirituality, or whatever you call it. deceptive clinical trials to aggressive pharmaceutical advertising. Could you compare Asian medical care with the model Dr Belle Monappa Hegde is a physician par excellence, an astute clinician and a teacher in the true Guru tradition. His encyclopaedic knowledge, brilliant oratorical skills and natural instinct to teach have endeared him to generations of students and teachers across the globe. Throughout his tenure as a medical student at Stanley Medical College, Madras, Dr Hegde was a brilliant student. He had received a gold medal and a special prize in surgery from Madras University. He did his MD (Medicine) from Lucknow University with scholarship from the Government of India. Subsequently, he went to England on Commonwealth Fellowship and had passed the Membership of Royal College of Physicians of UK examination. He then underwent advanced training in Cardiology at Harvard Medical School, Boston, under Nobel Laureate Bernard Lown; and at the National Heart and The Middlesex Hospitals in London, under Late Walter Somerville and Late Richard Emanuel. He is now the Fellow of all Royal Colleges and the American College of Cardiology. Dr Hegde started his teaching career as a tutor in 1962 in Manipal. He then served the Kasturba Medical College in Mangalore and Manipal for 45 years, occupying the posts of Professor of Medicine, Director (PG studies),
FUTURE MEDICINE I July 2012
Principal, Dean, Pro Vice-Chancellor and the ViceChancellor of Manipal University. He is Affiliate Professor of Human Health (University of Northern Colorado) and former Professor of Cardiology (The Middlesex Hospital Medical School, University of London). He is also the Chairman of the State Health Society’s Expert Committee, Govt. of Bihar. He has been a visiting Professor to a number of universities in India and many countries abroad. Dr Hegde has been the recipient of numerous national and international Awards, including Dr B C Roy National Award for being an Eminent Medical Teacher, Dr JC Bose Award for Life Science Research, Pride of India Award from the US, Distinguished Physician of India Award from API, Healer of Mankind Award (Symbiosis University, Pune), Vaidya Ratnakara Award (Shankaracharya of Swarnvalli Mutt and Karnataka Rajyothsava Award. He has been examiner for the MRCP (UK) and MRCPI (Dublin) examinations. Dr Hegde is a prolific writer. His articles are frequently published in various magazines and newspapers. His talk shows are a big hit. He has penned nearly 35 books and over 3,000 articles in lay press. During the last decade, Prof Hegde, along with 15 world renowned scientists (some of them Nobel Laureates), has been publishing a journal titled Journal of the Science of Healing Outcomes, of which he is the Founder and Editor-in-Chief. In 2010, he was conferred the prestigious Padma Bhushan Award by the President of India.
CAREERS AND COURSES Speech Therapy
Listen, assess and treat special people Communication disorders are quite common these days. Accepted as a major public health concern, difficulties in speech, language or hearing can derail the normal course of a personâ€™s life. Abnormalities could compromise early childhood development, restrict vocational pursuits and attenuate the economic well-being of an individual
n recent times, speech and hearing therapy has become one of the most opted paramedical careers for students across the globe. The role of a Speech and Language Therapist (SLT) is to assess and treat speech, language and communication problems in people of all ages and to enable them to communicate according to their abilities. SLTs work closely with infants, children and adults who suffer from various levels of speech, language and communication problems. They also work with people who have swallowing difficulties. Therapists assess the
clientsâ€™ needs before developing individual treatment programmes to enable each client to improve as much as possible. Treatment plans often involve those with whom the client has a close relationship. They could be family members, friends or teachers. Speech and language therapists usually work as part of a multi-disciplinary team comprising health professionals such as doctors, nurses, psychologists, physiotherapists and occupational therapists. They may also liaise with professionals in the education sector and those who engage themselves in social services.
FUTURE MEDICINE I July 2012
Given below are some of the major tasks of SLTs that were identified by the Association of Speech and Hearing Therapists of UK (ASHT):
Tasks at junior levels • •
To identify children’s developmental speech and communication difficulties/disorders Assess and treat swallowing and communication difficulties, which arise from a variety of causes such as congenital problems (like cleft palate) or acquired disorders after a stroke or injury Devising, implementing and revising relevant treatment programmes after assessing the progress in a patient Advising carers on implementing treatment programmes and training them in delivering therapy
Tasks at senior levels •
Conducting personal development reviews with colleagues • Supporting/supervising newly-qualified speech and language therapists and speech and language therapy assistants • Setting organisational and personal objectives • Planning and delivering training sessions • Contributing to the implementation and evaluation of projects and developments • Undertaking clinical audit through the collation of statistical, financial and other data relating to service delivery • Participating in research projects ASHT has also mentioned the prerequisites a student must have before pursuing speech and hearing therapy as a career option. • Excellent communication skills - to relate to people of all ages and backgrounds and to motivate clients and gain trust. Clients may be uncooperative because they are frightened, frustrated or disorientated by their situation. • Patience - progress may be slow, involving repetitive exercises to aid clients who have problems memorising, processing and retaining information. • Creativity - to design programmes appropriate to different learning styles and communication issues. • Performing in a team - for interacting with other professionals. • Organisational skills and flexibility - to deal with a range of clients in varied settings. • The ability to be at ease in a clinical environment. A well-trained speech and hearing professional could work in a variety of settings such as hospitals (both inpatients and outpatients), community health centres, mainstream and special schools, assessment units, day centres and client homes. They can also engage in private practice. According to global estimates, FUTURE MEDICINE I July 2012
between two and three per cent of the total population experience speech or language difficulties. Five per cent of children enter school with problems in speech and language and about 30 per cent of stroke sufferers have a persisting speech and language disorder. There are only a few institutes in India which offer speech and hearing therapy courses. These institutes impart special training programmes for speech therapists and audiologists. The courses available are BSc (Speech & Hearing), BSc (Audiology, Speech and Language) and MSc (Speech, Pathology and Audiology). Apart from this, diploma programmes in speech and hearing therapy are available for students who have completed plus two. For three-year graduation programmes, 10+2 with English, Physics, Chemistry and Biology is essential. Given below is a list of major institutes in the country where speech therapy courses are offered: • All India Institute of Medical Sciences (AIIMS), New Delhi • J M Institute of Speech & Hearing, Inderpuri, Keshrinagar, Patna • Institute of Speech & Hearing, Hennur Road, Bengaluru • Ali Yavar Jung National Institute for the Hearing Handicapped, Mumbai • All India Institute of Speech and Hearing, Mysore • National Institute of Speech and Hearing, Thiruvananthapuram After completing courses in speech and hearing, one should register with the Indian Speech and Hearing Association. Only then a person is entitled to practice as an SLT or an audiologist. The demand for SLTs is growing day-by-day. There is ample scope for these professionals in India as well as abroad. As of now, SLTs are the only group of professionals which receives Green Card immediately on arrival in the US. While the salary of an SLT with proper experience could vary between Rs 15,000 and Rs 30,000 in India, he/ she can earn at least $30 an hour in US or Europe.
PHARMA EXPERT INTERVIEW Divyesh Shah
‘Pharma industry is in need of friendly policies’ CARE Research & Information Services is an independent division of CARE Ratings, a credit rating agency in India. It caters to a variety of business research needs with credible, high quality research and analysis on various facets of the Indian economy and industries. Besides assisting its ratings division, it provides high quality sectoral research to financial intermediaries, corporate, analysts, policy-makers etc, to help them in their decision-making process. In an interview with Future Medicine, Divyesh Shah, Assistant General Manager at CARE Research, shares his perspective on the pharma industry’s growth dynamics. FM Bureau What are the main challenges the pharma industry is facing today? The Indian pharma industry’s growth in future would be mainly driven by the impending patent cliff in the regulated market, thereby opening up opportunity for the global generic market. Indian players are front-runners to tap this generic market opportunity, but higher price erosions (90-95%, following loss of patent) due to competition and increasing marketing costs are impacting companies’ profitability. Also, stringent norms of the regulatory bodies the world over would pose challenge for companies to deal in export markets. In case of bulk drugs, intermediaries, and generic market, the domestic players are facing stiff competition from China. Also, the MNCs are in a better position than the domestic players in case of spending on drugs, R&D, and marketing, which is impacting the growth and profitability of domestic players.
Indian companies spend 5-5.5% of net sales on R&D activities, which constitutes a minuscule portion of overall global R&D activities. In order to have a product portfolio of their own, Indian companies would have to spend more on R&D activities. Pharma companies are now expanding reach in tier-II and tier-III cities in order to penetrate to a larger extent, which leads to higher marketing and distribution costs and lower profitability. There is a lack of encouragement and friendly government policies for the Indian pharma industry. The government should also increase its healthcare expenditure (currently, 1.4% of the GDP) and provide necessary infrastructure to companies and consumers. Do you think the Indian pharma sector is overregulated? Indian regulations with regard to product quality, manufacturing facilities, product approvals etc. are in place, but are relatively less stringent as compared to, say, the US. However,
Divyesh Shah, Assistant General Manager, CARE Research
FUTURE MEDICINE I July 2012
PHARMA EXPERT INTERVIEW Divyesh Shah
now the regulatory bodies have become more stringent due to mounting pressure from the consumers, concern of patients’ safety and improving healthcare standards. The Indian Patent Law is now in line with the TRIPS (Trade Related Intellectual Property Rights) and recognises product patents; However, enforcement of the patent law has not found any favour with the global innovator companies, who have tried to launch their patented drugs in India, only to be thwarted by litigations from Indian companies, with court rulings going against the global companies in a few cases. This is one of the factors for lower penetrations of patented drugs in the Indian market, the other being the affordability of such drugs. The drug price control regulation and the pharma policy assume national importance given the sensitive nature of healthcare in any country. The manufacturing and exporting pharmaceutical companies have to comply with the rules of the state FDA, Indian FDA, the Drug Controller General of India and also the norms of the FDA of exporting countries. The more stringent process is of standard Good Laboratory Practices, Good Manufacturing Processes and Good
Clinical Processes, to be followed by the companies; Such processes are timeconsuming, which delays the launch of the drug. Is there a need for rationalisation of pharma policies in the backdrop of the National Pharmaceuticals Policy and Patents Amendments Act? It would be fair to say that the National Pharmaceutical Policy should be governed by many factors, some of which could include providing access to affordable healthcare to all, strengthening norms related to product quality, manufacturing practices, marketing and distribution etc., strengthening the product registration and approval process, IPR protection, and encouraging investment in R&D. Providing affordable medicine to all strata of India’s population and improving the long-term competitiveness of the Indian pharma companies should be the two broad objectives on which the policy can be formed. As of today, multinational pharma giants are in full swing to acquire domestic pharma companies. Do you think it will lead to their monopoly, which, in turn, could result in unprecedented hikes in the prices of medicines?
MNCs are eyeing the domestic market participants to tap the potential of the growing pharmaceutical industry. The Ranbaxy-Daiichi deal and the Piramal-Abbott deal are examples showing the global players’ interest to enter Indian markets. Currently, MNCs are enjoying more than 20% share in the Indian drug market. Also, out of the top 25 medicines in India, 13 are from MNCs’ portfolio. The trend could continue in the future too; However, whether it would lead to a monopolistic situation and may cause unprecedented rise in drug prices is unlikely as regulators and policy-makers would step in to ensure affordable healthcare to all. Do you think India will emerge as a prime destination for research and development in the pharma sector? India has competitive strength and capabilities to perform world class R&D activities. Also, Indian contract research companies are giving tough competition globally on the back of chemical synthesis, availability of skilled manpower and better understanding of global IPR norms. In future too, India would remain a preferred partner of choice for global companies to perform their outsourcing research activities. However, Indian companies should also concentrate on in-house R&D activities for drug discoveries. How well are Indian pharma companies placed to make overseas buys and steal the march over their Western counterparts? The high cost of operating drug manufacturing facilities and conducting R&D in the developed markets has prompted global companies to turn to outsourcing to destinations like India. Acquisition of overseas assets by Indian companies should always be looked at with scepticism from what we have seen in case of some of the past acquisitions (Dr. Reddy’s acquisition of Germanybased Betapharm has yielded return on investment below expectations). The acquisition route would be handier for Indian companies in case they want to acquire a portfolio of established products, a marketing channel partner, or R&D assets, which have high potential for success. Other than that, acquisition of global assets comes with its own risks (Biocon bought stake in Germany’s Axicorp, but later sold its stake due to its declining profitability and unfriendly German policies).
FUTURE MEDICINE I July 2012
Clever diversifications and diligent investments In recent years, Piramal Healthcare has made some clever moves aimed at diversifications and diligent investments. Here’s why and how the Piramal model continues to inspire others FM Bureau
ergers, takeovers and acquisitions have always hit the headlines the world over. But the art of aligning offshore expansion plans with domestic growth is becoming a tightrope walk of sorts for many corporate companies in the backdrop of economic downturns. Still, there are many turnaround stories that have set newer models of comparative advantage, prudent diversification and diligent investments. In this issue, we take a look at the growth trajectory of Piramal Healthcare, one of India’s largest pharmaceutical and healthcare companies. Two years ago, Piramal had sold its domestic formulations business (healthcare solutions) to US giant Abbot Pharma for a whopping $3.7 billion. Industry experts viewed the sale of Piramal’s most attractive portfolio as a reduction in the value of the company. But, flush with funds, Piramal Healthcare started making some wise investments, turning criticism on its head. The key focus was on consolidation in the healthcare segment as well as diversification. At the time of going to press, Piramal Healthcare was engaged in talks to buy US-based healthcare company Cambridge Major Labs for $200 million. This development comes close on the heels of Piramal Healthcare’s acquisition of the US-based healthcare analytics firm Decision Resources Group (DRG) for Rs 3,400 crore. The acquisition was made as part of its quest to foray into a new business area. DRG, which provided web-enabled research, predictive analytics via proprietary databases and consulting services to the global healthcare industry, was into three market segments: biopharma business, market access business and medical technology business. The three-decade-old DRG, with a turnover of $160 million, has been one of the largest players in the global healthcare information industry. Shortly after the acquisition, Piramal Healthcare Chairman Ajay Piramal was quoted in the media as saying, “The acquisition is a perfect fit for Piramal Healthcare, now operating in businesses such as drug discovery, contract manufacturing and critical care, financial services and defence. Not only is DRG’s business highly profitable, it is also a low investment business with significant growth potential.” Piramal’s tie-ups with leading global pharma companies and its domain knowledge and network across India and other emerging markets will help DRG in expanding its business. Another key focus area for Piramal Healthcare is the discovery of blockbuster drugs. But discovering a new drug means going FUTURE MEDICINE I July 2012
A key focus area for Piramal Healthcare is the discovery of blockbuster drugs.
through several stages of rigorous trials. These trials are very expensive and also run the high risk of failure. Hence acquisition and tie-ups are the new mantras in the global pharma industry, say industry experts. Piramal Healthcare also intends to focus on niche segments that may not be big enough or fit into the portfolios of global majors. The company is attending to the four therapeutic areas of oncology, inflammation, anti-infective, diabetic and metabolic disorders. The company has invested in Canada-based Biosyntech, a manufacturer of knee replacement surgery implant that had filed for bankruptcy. According to sources, the Canadian company was brought for Rs 35 crore. Piramal has already obtained the license to sell these implants in the European Union markets. Earlier, Piramal Imaging, a 100% subsidiary of Piramal Healthcare, had acquired the research and development portfolio of molecular imaging from Germany’s Bayer Pharma, asserting its seriousness in the intellectual property side of the pharma sector.
Of late, Piramal Group has become serious about diversifying its business interests. The company has agreed to acquire an additional 5.5 per cent stake in Vodafone India from ETHL Communications Holdings (Essar) for approximately Rs 3,007 crore ($606.2 million). This deal marks Essar Group’s complete exit from its joint venture with Vodafone Group. After the
transaction, Piramal’s holding in Vodafone India will increase to approximately 11 per cent and it will get a seat on the company’s board. The company considers the acquisition a shortterm investment (one to two years) and expects returns in the range of 17-20 per cent. Piramal expects to exit either through an IPO by Vodafone or by selling its stake back to Vodafone, which has the first right to buy it. Indiareit, the real estate equity funding arm of Piramal Healthcare, has about Rs 3,800 crore under its management. It has domestic and offshore funds, and has recently raised funds from the UK, Singapore and Dubai. PHL Finance Pvt Ltd, another subsidiary of Piramal Healthcare, is a non-banking financial company that was recently formed to look into funding of real estate and infrastructure projects. With assets across North America, Europe and Asia, Piramal Healthcare is one of the largest healthcare companies. Set up in 1947 as Indian Schering Limited, the company has come a long way before affirming its position in the global pharmaceutical industry. Once, when asked by a journalist whether Piramal Healthcare is increasingly becoming a holding company for diverse businesses, Ajay Piramal had said that Piramal Healthcare is much like the Warren Buffet-controlled Berkshire Hathaway, the eighth largest public company in the world as per the Forbes Global 2000 list. That just reflects his vision, ambition, competence and confidence in delivery.
FUTURE MEDICINE I July 2012
Easy steps to stay fit Your body is the temple and mind the inner sanctum. Together, they provide you the energy, intelligence, dexterity and power of reason to take on the myriad challenges of life. Here’s a list of dos and don’ts for you to maintain a healthy body and mind
f you take good care of your body and mind, it will only help you strengthen your spirit and undertake a longer, happier ride through the varied seasons of life. Therefore, it is essential for everyone to follow a lifestyle that enables a happy union of body, mind, and spirit. Given below are a few mantras that can help you maintain a healthy, happy body:
Our body is like a machine, which requires proper upkeep and high maintenance. Healthcare professionals say that you need to provide high quality fuel to energise your physical body and build its capacity for execution of various tasks. Maintain a chemical-free diet that is rich in vital nutrients, and do not forget to take herbal/vitamin supplements.
Reserve time for rest
Ensure that you get the right amount of uninterrupted sleep to engage your REM patterns. REM sleep is the nervous system’s way of healing and refuelling the body. There are times when you may feel you are too slow or inactive. That’s when you should, without fail, take a short nap or rest. If you are faced with chronic sleep disorder or sluggishness, you should approach your doctor at the earliest.
Live in the moment
Don’t burden your mind or heart with feelings of regret or worries about a past or future event. They will only waste your precious time and give undue stress to muscles and nerves, making you more susceptible to disease. Live in the present and cultivate a positive attitude, which will help you look at the brighter side of life.
of life. And the only ones who can comfort, support and guide us during such low moments are our family and friends. So, always surround yourself with a good support system, that is, a group of people which supports, loves, respects, and cares for you.
Tone up your body
We use 72 muscles to frown and only 14 to smile. So, why apply so much of strain on our body? Be easy on yourself and smile as much as possible even during tough times. There are a number of studies highlighting the significance of laughter, fun, and mirth in healing sick people. So, there’s no need to say what it does to those who stay healthy. Look at the lighter side of life and keep smiling.
Exercise helps you stay fit and positive. It will not only bless you with a longer and healthier life, but also make you a quick finisher of daily tasks. So, you better move it (body), or lose it!
Mental workout key to success
A healthy physical body also denotes a sound and sharp mind. Keep challenging your mind to expand, grow, learn, experience, decipher, and explore. So, learn how to look within with a sense of purpose and meaning.
Peace and tranquility
Meditation can help you maintain the rhythmic beating of your heart and reduce your stress. It is a simple yet powerful medium helping you connect with your higher self. Once you learn to be in peace with yourself, serenity, joy, and spiritual liberation will flow into your life automatically.
Good support system
There are times when we find ourselves at the lowest ebb
FUTURE MEDICINE I July 2012
Laughter is the best medicine
Life has its ups and downs, and the mastery of life lies in the power of positive thinking.
Express yourself clearly
Give your emotions an outlet, or else, it may suffocate you and land you in negative situations. So, never store negative emotional energy. You should have the courage to face your innermost fears and feelings. Express them clearly and in a healthy way. Otherwise, they may drain you completely.
DIARY OF AN ONCOLOGIST
Dr Nalini Rao
Cancer cases rising due to high-risk behaviour C ancer is a very challenging and unpredictable disease – no two patients are similar. I really love to confront the intellectual challenges that arise frequently while dealing with cancer patients. It is also essential for an oncologist to maintain an emotional equilibrium during interaction with patients and their families. The process begins with convincing patients on accepting the diagnoses of cancer. This has to be followed up with selection of the right treatment method, appraisal at regular intervals, and final rehabilitation. All through the process, an oncologist has to repeatedly make sure that a patient’s confidence does not erode. In my career, spanning more than two decades, a few patients have left an indelible impression on me. These
patients have been inspiring me to strive harder for better results. I had a 33-yearold female patient who had a tumor in her salivary gland. Let’s call her Rema. The tumor had been diagnosed about three years ago during Rema’s first pregnancy. After her daughter’s birth, she had undergone surgery and radiation therapy. By the time she approached me with multiple metastases in her brain, Rema’s daughter was two-and-a-half years old and her elderly father had Parkinson’s disease. What struck me was her poise and courage to take on severe adversities in life. When I saw her for the first time, Rema was very weak. During the first consultation, we had a lengthy discussion on her health status. She had requested me for a week’s time before appearing for the treatment. I was dumbstruck when I met her a week later. In that one week, The government should she had spoken to her provide subsidies on daughter’s teachers (the expensive drugs. Cancer child was in pre-nursery then) and informed her drugs are quite expensive. in-laws and parents We also have a shortage of about her illness. It was oncologists really hard for me to comprehend her courage and optimism as she had
already planned her future, starting from her daughter’s education to her funeral. In spite of being a trained oncologist, I experienced great difficulty while talking to Rema about her disease progression and the final judgment (death). On the contrary, this young lady had planned everything, including how to deal with the future of her beloved ones after her death. I wish more and more patients approached their life and this disease in a similar fashion. Dealing with cancers in children can be extremely stressful for young parents who are themselves financially unstable and emotionally evolving. There were two child patients, whom I vividly recall – one was a five-year-old girl who was suffering from leukaemia. Her parents were young and she was their only child. She underwent treatment for almost two years with many ups and downs, and subsequently, became cancer-free. Today, she is an accomplished teenager. The second patient was a fourteenyear-old boy with a bone tumour – needless to say that he and his family epitomised courage and grace. Unfortunately, he lost the war after fighting several battles for four years. The number of cancer patients are increasing in India at an unprecedented rate. As an oncologist, I feel a
FUTURE MEDICINE I July 2012
combination of factors, including our ageing population and changes in lifestyles with more high-risk behaviours such as smoking, drinking alcohol and eating junk food, is contributing to this catastrophe. Fortunately, major advances are taking place in the field of oncology. We are in a better position to tackle this disease. There has been a technological boom in the field of radiation oncology. We have access to state-of-theart treatment machines like linear accelerators, computerised treatment planning systems and excellent image guidance to deliver precise treatment and advanced robotic radiosurgery systems. Simultaneously, there have been major advances in the field of pathology, radiology, surgical oncology and medical oncology. These ensure that we diagnose the tumour with more accuracy, are able to ‘see’ it much better with radiology and treat it effectively by combining medical methods including surgery, chemotherapy and radiotherapy.
The current practice is to integrate all these treatment modalities in such a way that we are able to cure the patient, apart from conserving and preserving the cancer-affected organ. For example, earlier, every woman suffering from breast cancer had to undergo a mastectomy, removal of breasts. Nowadays, we do breast conservation surgery, which has the same cure rates. This treatment doesn’t distort the patient’s body image. Though our treatment modalities have improved, we need to go a long way before conquering and defeating this dreadful disease. In a country with a billion plus population, it will be a difficult task and almost impossible for the government unless the public, along with NGOs and the private sector, actively join their hands. I am listing a few detrimental factors in our fight against cancer: • There is a huge rural-urban disparity when it comes to delivering cancer treatment. Currently, villagers
have to relocate themselves to cities, making an already expensive treatment totally unaffordable. • The government should provide subsidies on expensive drugs. Cancer drugs are quite expensive. • We have a shortage of oncologists. Both the government and the Medical Council of India need to look into this matter urgently. We need a lot of enthusiastic youngsters to specialise in all branches of oncology. • There is only a little awareness about prevention and early detection of cancer among the masses. We have to educate the public as detecting cancers during the initial stages is the only way to cure them. • Each and every one of us should follow a healthy diet, healthy habits and regular exercises. Also, one should undergo regular screening tests and strive to remain stress-free. To be an oncologist, one has to be really tough-minded. When I see a young child with cancer, I’m struck by the injustice; I am frustrated and dejected when a cancer refuses to go away in spite of all our best efforts; I’m more disappointed than the patient when a cancer, which was cured, relapses. I agonise when a patient suffers pain and a helpless family grieves. However, all this is momentary. They only strengthen my resolve to read more, research more and work harder with my next patient. These ‘failures’ also serve as a reminder that there is a force beyond us. My lasting thought on this disease is that CANCER IS CURABLE, more so, if it is detected early. Even if it is in the chronic stage, a patient should go for repeated treatment. It is not the end of the world. God is kind, and of course, there are dedicated doctors to help you. Dr Nalini Rao is a Radiation Oncologist at HCG Institute of Oncology, Bengaluru. She has extensive experience in advanced techniques like 3D-CRT, IMRT, IGRT and Whole body Stereotactic Radiotherapy. She also has adequate experience with Gynaecological Brachytherapy and Interstitial Bracytherapy for Head and Neck, Breast and Soft Tissue Sarcomas. She received Fellowship at the Christie Hospital & Holt Radium Institute, Manchester, UK, in 2000.
FUTURE MEDICINE I July 2012
INDIAN HOSPITAL FOCUS Sreedhareeyam
The masters of Shalakya Tantra Modern medicine has its own limitations in prescribing satisfactory remedies for certain complicated eye ailments. But before you conclude that it’s the end of the road, do have the confidence, courage and patience to look for alternate remedies in Shalakya Tantra. This branch of Ayurveda not only promises rejuvenation of damaged optic nerves, but also has the reputation of restoring 60-70% vision of people who had been warned of complete blindness. Here’s the profile of a young eyecare hospital specialising in Shalakya Tantra By Sanjeev Neelakantan
cientific and technological breakthroughs in the medical world always hold out a fresh hope for patients staring at a dead-end in treatment. At the same time, how honest and earnest are we when it comes to digging deep into the treasure trove of the traditional branches of medicine for alternative modes of healing? It’s a rarity, evident from the wide and blind acceptance of modern day medical techniques by the general public and the sheer neglect of traditional sciences in the mainstream. But then, some visionaries are championing the cause of neglected modes of therapy, and
their mastery in the traditional ways of healing is once again elevating the status of ancient systems of medicine. Here’s the story of a young Indian healthcare enterprise (specialising in eyecare) that is steadily making fresh inroads into the mainstream medical system with an intellectual legacy of about 300 years and expertise in a specialised branch of Ayurveda, Shalakya Tantra, which at once evokes both inspiration and apprehension. After all, it is a specialised field which demands utmost diligence and deep knowledge of various delicate techniques of treatment, as outlined in ancient
treatises of Ayurveda. Tucked away from the cacophony of traffic and a bustling market in Koothattukulam town in Ernakulam district of Kerala, the peaceful atmosphere and radiant landscape of Sreedhareeyam Ayurvedic Eye Hospital and Research Centre motivates an inquisitive first-time visitor. Under the spirited and dynamic leadership of its Chairman, N P Narayanan Namboothiri, and Managing Director and Chief Physician Dr N P P Namboothiri, the hospital has managed to take giant strides in disease mitigation, treatment and rehabilitation of patients
with serious disorders, and development of new medical solutions through sustained research efforts in a short span of 12 years. So, what’s the mantra of its success? Dr N P P Namboothiri says, “Today, an increasing number of people are suffering from lifestyle ailments. Losing vision is equal to losing life. To counter this, Sreedhareeyam is bringing together the ancient knowledge of Ayurveda and modern diagnostic techniques and facilities for the well-being of man.”
Genesis of Sreedhareeyam
The seeds of Sreedhareeyam were sown about 300 years ago by Nelliakattu Mana, a household of Vaidyas (physicians). Both the Chairman and the Chief Physician belong to this Mana, whose ancestors were famous for their vast knowledge and skills in Ayurvedic eye care. People from far-flung and nearby areas used to visit the Mana, seeking cures for various eye ailments. It was during his 35-year stint in government service as an eye specialist that several medical professionals, well-wishers, members of the Mana, and people from all walks of life had advised Dr N P P Namboothiri to keep the tradition of the Mana alive by setting up a hospital serving the needy. That dream came to fruition in 1999. Today, the Ayurvedic physicians of the Mana are professionally qualified doctors with many years of intense clinical experience and expertise.
diagnosis, prevention and treatment of diseases that affect organs above the neck, i.e. head, ears, nose, eyes, throat etc. The Ayurveda classic ‘Susrutha Samhita’ provides the most profound knowledge in Shalakya Tantra. Acharya Susrutha was the greatest proponent of this science. The prognosis made by him on Uveitis and Glaucoma is regarded exceptional. The treatise also contains description on 76 eye diseases, 28 ear diseases and 31 nose diseases that can be treated with Shalakya Tantra. Many illnesses like Retinitis Pigmentosa, which affects the eyes, have no proper remedies in modern medicine, while certain remedial measures have been mentioned in Ayurvedic treatises, which are still being studied. To preserve ancient parchments (Thaliyolas) and treatises, Sreedhareeyam is in the process of digitising them so that they can be referred by any physician at any given point of time.
Shalakya Tantra and Ayurvedic treatises
Sreedhareeyam Ayurvedic Group
A specialised branch of Ayurveda, Shalakya Tantra deals with the detailed study of etiology,
The group comprises Sreedhareeyam Ayurvedic Eye Hospital and Research Centre,
Today, an increasing number of people are suffering from lifestyle ailments. Losing vision is equal to losing life... Sreedhareeyam is bringing together the ancient knowledge of Ayurveda and modern diagnostic techniques and facilities for the well-being of man Dr N P P Namboothiri, Managing Director and Chief Physician, Sreedhareeyam Ayurvedic Eye Hospital and Research Centre
FUTURE MEDICINE I July 2012
INDIAN HOSPITAL FOCUS Sreedhareeyam
Sreedhareeyam Ayurvedic Medicines (P) Ltd, Sreedhareeyam Ayurvedic Gaveshana Kendram, Sreedhareeyam Research and Development Centre and Sreedhareeyam Herbal Farm.
Facilities • • • • •
Modern diagnostic equipment Ayurvedic treatment facilities Diet regulated Ayurvedic kitchen and canteen Accommodation in single, double, airconditioned rooms and cottages State-of-the-art aseptic production lines and packaging/bottling facilities
Special procedures are prescribed in Shalakya Tantra for treatment of diseased organs in the head and neck region. They include Nasyam, Dhoomapanam, Gandoosham, Kabalam, Shirodhara, Shirovasthi, Anjanam, Tharpanam, Pratisaranam etc. Traditional Ayurvedic treatments like Pizhichil, Dhara, Njavarakizhi, Steam Kizhi etc. are administered scientifically by qualified doctors and trained personnel.
Sreedhareeyam Ayurvedic Medicines
Sreedhareeyam group’s GMP-certified medicine manufacturing unit follows aseptic development processes and stringent quality control measures. Medical ingredients and formulations meant for various ailments, from poor eye conditions to diabetes, are prepared
and packed with the use of state-of-the-art equipment. Products have been developed after years of research and a series of tests ensuring safety and efficacy. The proprietary products include Sunetra eyedrop.
Centre of Excellence
The Department of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy) under the Union Ministry of Health and Family Welfare has honoured Sreedhareeyam Ayurvedic Research and Development Institute by sponsoring a Centre of Excellence unit in Ayurvedic Ophthalmology. The objective of this Centre is to make Sreedhareeyam’s medicines and treatment more efficient and standardised and help it emerge as an acceptable alternative in the field of Ophthalmology across the globe.
Sreedhareeyam College of Ayurveda Medical Science offers a one-year certificate course in Ayurvedic Nursing, Ayurvedic Pharmacy and Ayurvedic Therapy. The courses have been recognised by the Directorate of Ayurvedic Medical Education. As of today, Sreedhareeyam group has expanded its reach by opening new centres/ facilities outside Kerala. Within Kerala, it has 12 consulting centres. There’s a saying, “Sarvendreeyanam Nayanam Pradhanam (Of all senses, eye is the most vital).” Sreedhareeyam is a ray of hope indeed.
FUTURE MEDICINE I July 2012
Exploring new frontiers with Dept of AYUSH Sreedhareeyam Ayurvedic Eye Hospital and Research Centre does not depend on advertisements or campaigns to gain publicity. Feeling a deep sense of gratitude towards the physicians for helping them regain vision, benign patients are using their social networking skills to spread a good word about the eyecare centre among people. In an exclusive interaction with Future Medicine, Sreedhareeyam’s Director and CEO K S Biju Prasad talks about the eyecare centre’s core strengths and the medical sector’s need for a systemic change What’s your vision for a progressive medical system? Today, patients come to us only after exhausting all available avenues in modern medicinal systems. A better understanding of the traditional branches of medicine and deep co-operation from practitioners in the mainstream medical sector will only help us evolve a value-based system that can provide the best cure in both traditional and modern medicine at the same time. There should be a healthy collaboration between practitioners of the traditional modes of healing and modern medicine, which can work wonders in the health sector. How is the government helping in popularisation of the traditional medicinal systems? The Department of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy) under the Union Ministry of Health and Family Welfare, New Delhi, is popularising the efficacy of the traditional systems of medicine. It has honoured Sreedhareeyam Ayurvedic K S Biju Prasad, Director & CEO, Sreedhareeyam Ayurvedic Eye Hospital and Research Centre Eye Hospital and Research Centre by elevating it as a Centre of Excellence with the government. Under the scheme, we in Ophthalmology. A team of AYUSH train 20 practising doctors from the government and Sreedhareeyam is conducting studies as well as the private sector for six days. and research on specific diseases. Besides, During the training, they are familiarised with the Department of AYUSH has entrusted our treatment modalities and manufacturing Sreedhareeyam with the task of standardisation practices. We hold 10-15 such courses in a of 25 Ayurvedic medicines, for which work is year. Our Reorientation Training Programme is underway. The objective of the government is to ensure high quality and efficacy of Ayurvedic designed for teachers of Ayurveda colleges. medicines. What kind of complicated cases do you On the other hand, we have Continuing attend to other than eye ailments? Medical Education programmes under a tie-up We specialise in ENT treatment. Sensory
FUTURE MEDICINE I July 2012
INDIAN HOSPITAL FOCUS Sreedhareeyam
Sreedhareeyamâ€™s consulting centre in Bhopal. It has 12 other consulting centres outside Kerala. They are in Raipur, Erode, Chennai, Puthussery, Udaipur, Bengaluru, Mumbai, Bhopal, Hassan (Karnataka), Visakhapatnam, Hyderabad, Delhi and Jaipur.
For the poor, we have a free OPD every Friday. We also provide free consultation and free medicines to the poor. We receive about 2,000 poor patients in a month. Under our charity initiative, we provide free inpatient treatment to about 20 poor patients in a month. We also provide free medicines for life to genuine BPL patients
Neural Hearing Loss, Conductive Hearing Loss, Otitis Media, Deviation of Nasal Septum, Nasal Polyps, Migraine, neurological diseases such as Cerebral Palsy, Down Syndrome, Autism etc. are some of the complicated cases we attend to. What are the most common cases in Ophthalmology? Retinitis Pigmentosa, Macular Degeneration, Diabetic Retinopathy, Hypertension Retinopathy, Glaucoma, Progressive Myopia, and neurological eye diseases affecting people who have a history of consanguinity marriage (mostly from Tamil Nadu, Andhra Pradesh, northern parts of India, and Gujarat). Whatâ€™s the general profile of your patients? Do you have any scheme for the poor? We receive patients from all backgrounds. For the poor, we have a free OPD every Friday. We also provide free consultation and free medicines to the poor. We receive about 2,000 poor patients in a month. Under our charity initiative, we provide free inpatient treatment to about 20 poor patients in a month. We also provide free medicines for life to genuine BPL patients. Do you have any plans to open a facility abroad since you receive patients from foreign countries?
Twenty per cent of our patients are from foreign countries. We have been asked by people from the UAE, Germany, Russia and the US to open a facility in their countries. We are still studying foreign rules and regulations and are exploring the possibility of opening facilities abroad. How many hospitals/branches do you have outside Kerala? We have 13 consulting centres outside Kerala. They are in Raipur, Erode, Chennai, Puthussery, Udaipur, Bengaluru, Mumbai, Bhopal, Hassan (Karnataka), Visakhapatnam, Hyderabad, Delhi and Jaipur. While some of these are our own centres, others have been set up in collaboration with the respective state governments. Apart from the normal training programmes, are you doing anything else on the education front? Rashtriya Ayurveda Vidyapeeth, an educational body under the Department of AYUSH, has a course called Guru-Shishya Parampara. Under the guidance of our MD and Chief Physician Dr N P P Namboothiri (the Guru), about 10 shishyas (Ayurvedic doctors) from across the country are given in-house training for a year. The objective of this course is to build confidence, mould them into eye specialists and spread this SOP in all parts of the country.
FUTURE MEDICINE I July 2012
AIMED ALLIED INDUSTRY FOCUS
‘We should aim for import substitution’ Representing 700 manufacturers, the Association of Indian Medical Device Industry (AIMED) is working towards creating India as the most preferred manufacturing destination and global supply source of medical devices. In this segment of the healthcare industry, India is 70% import dependent. Hence there is a growing need for import substitution. In an interview with Future Medicine, AIMED Forum Coordinator Rajiv Nath touches upon this crucial aspect and also gives a wholesome picture of India’s medical device industry. Excerpts: By Prashob K P
What are your expectations from the Bill on medical devices scheduled to be introduced in Parliament? The medical device Industry wishes to be regulated (to establish its credibility and enable growth), but the regulation should be in an appropriate manner. We are looking forward to the possibility of the government passing an Ordinance to remove medical devices from the definition of drugs in the Drugs and Cosmetics Act. This may pave the way for introducing the Patient Safety & Regulating Medical Devices Bill and the FUTURE MEDICINE I July 2012
creation of a national regulatory authority under the Ministry of Health as a division of the Food and Drug Administration, or the Central Drugs Standard Control Organisation. The proposed Bill needs to be vetted by all stakeholders before being tabled in Parliament. Like the Telecom Regulatory Authority, which helped the telecom industry grow, we expect similarly from medical device regulations. The Drugs and Cosmetics Act have failed to stop counterfeits and spurious medicines.
ALLIED INDUSTRY FOCUS AIMED
Is India excessively dependent on import of medical devices? Yes, India is 70% import dependent. Earlier, only high-end medical devices, such as imaging equipment, pacemakers, orthopaedic and prosthetic implants, breathing and respiration apparatus, and dental equipment, were being imported. Now, some medical devices, whose local availability made India self-reliant, are being imported. These are devices like thermometers, hot water bottles, auto disable syringes, and stainless steel surgical instruments. It is interesting to note that while Indiaâ€™s medical technology industry is primarily import dependent, nearly 60% of whatâ€™s being manufactured is being exported. In fact, some companies derive as much as 75% of their revenue from exports. However, the export of high quality Indian products are very low as compared to countries like Malaysia, Taiwan and China. There is a vast opportunity for import substitution through local manufacturing. There is no limitation of access to capital. Indian entrepreneurs can borrow from commercial banks, get financing from
private equity funds or access public funds through an IPO. The anomalous duty structure does not make most of the medical device projects in India commercially viable. Can self-sufficiency in the production of medical devices bring about a drastic reduction in healthcare costs? In order to encourage the existing medical devices manufacturing companies to diversify the product range and enable import substitution, the cost of a product needs to be viable in comparison with imported products. The high cost of inputs/consumables due to peak duty rates, and high fixed and capital costs are discouraging investment in these products. This makes India not only increasingly import dependent but also exposes the common man to volatile price variations as a result of exchange rate fluctuations. The medical technology industry in India needs to innovate in order to address the challenge of low penetration and meet the healthcare needs of all income segments. In a country like India, where resources are scarce but needs are great, solutions have to be affordable,
reliable, easy to distribute, and easy to use. Consequently, frugal innovation is the way to go. What are the core strengths of the Indian medical devices industry and how satisfactory is the growth curve? The medical technology market in India is estimated to be worth US$5 billion currently with an annual growth rate of over 15%. This industry has not been well-documented in the Indian context, and estimates of the domestic industry size and growth vary significantly across different sources. While a wide range of medical products are covered under the medical technology industry, classification of key segments differs widely across the industry. The core strengths of the Indian medical device industry had been in surgical instruments and hollow ware. Now, India is losing out on products like disposable syringe, needles, IV cannulas, gloves, and contracaptives. India is losing its edge as manufacturers have turned to trading /outsourcing. In the case of intra ocular lens, stents, and lowend orthopaedic implants, India is stifling growth with inappropriate regulatory
FUTURE MEDICINE I July 2012
controls, as is the case with medicines. Demand in India is predominantly driven by major cities, while penetration in smaller cities/towns/rural areas has remained low due to lack of the four As (affordability, accessibility, awareness and availability). What are the activities of the Association of Indian Medical Device Industry? AIMED is working towards creating India as the most preferred manufacturing destination and global supply source of medical devices. AIMED is an umbrella association of Indian manufacturers of medical devices, covering all types of medical devices including consumables, disposables, equipment, instruments and diagnostics. With a primary membership of over 300 manufacturers and additionally, of over 100 associate members, it represents the interests of more than 700 manufacturers. AIMED provides various services to the manufacturers, such as advocacy on policy issues, information services, regulations for medical devices, education and training, testing assistance and guidance for quality certification (ISO, CE, GMP). It is also lobbying for funding for R&D from the government, promoting innovations, and improving clinician and patient access to modern, innovative and reliable medical device technologies. AIMED also has established the Indian Medical Device Regulatory Review Group, comprising regulators, industry players, quality
FUTURE MEDICINE I July 2012
The medical technology industry in India needs to innovate in order to address the challenge of low penetration Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry
assessment auditing bodies, and other stakeholders. Does the Association fund/sponsor/ support research and innovation activities? Yes, we do support research and innovation activities by promoting awareness and access to various government institutions and schemes through exhibitions and technology shows. We are closely working with the Office of the Principal Scientific Advisor to the Government of India to bring about a paradigm shift in the eco system and create an enabling environment for R&D activities. Do you provide a platform for Indian companies to foster partnerships with their foreign counterparts? We do provide a platform for Indian companies for joint ventures and collaborations with foreign counterparts. AIMED holds interactions with international organizations like JETRO, KOTRA and associations of medical
device manufacturers in Korea, Japan, Australia, Canada, Ireland and the US. The rural parts of India have been deprived of the benefits of high-end technologies. How can we bridge this deficit? Indian Manufacturers need to concentrate on frugal innovation and introduce appropriate technologies to make medical devices affordable and accessible as well as create awareness of their availability. Secondly, the PPP (Public Private Partnership) route to innovation needs to be exploited. Government support/ subsidies alone are not enough to cater to the healthcare needs of the rural population. There is a need to use medical technology effectively to address the yawning gap between demand and supply of healthcare services in India. Innovative products and business models are needed to make healthcare affordable and accessible to a larger percentage of the population.
Omron launches new pedometers
WASHINGTON: Omron Healthcare, a developer of healthcare and wellness products, has launched two new pedometers. The devices employ tri-accelerometer (TriAxis) technology that provides an accurate measurement of steps taken irrespective of the step being positioned horizontally, vertically or flat. The devices are convenient to handle and can be kept in the pocket or worn at the waist and can even be carried in a bag. Oprah Winfrey’s personal trainer, Bob Greene, advocates walking 10,000 steps a day to stay fit and healthy. Greene believes that keeping track of the number of steps we take every day would aid in working towards our fitness goals. He recommends Omron’s latest pedometers for this purpose. Research also claims that pedometer usage can be motivational for physical activity. Of the two pedometers launched by Omron, one is a no-frills, easy-to-use device labelled as HJ-320. The tracking modes offered in this device are steps taken and distance. There is also an automatic reset feature that enables walkers to commence each day with a fresh record. The second pedometer is labelled HJ321 and caters to power walkers. It features four tracking modes, namely, basic steps, brisk steps, distance and calories. The device is equipped with a seven-day data storage facility. This model also incorporates an automatic reset feature.
A bath gel instead of a bath
WASHINGTON: A new shower gel does not require one to take a bath. It could prove to be a boon for people who don’t have much access to clean water. Developed by Ludwick Marishane, a South African graduate student, the “Drybath” gel kills germs, moisturises the skin and exudes a pleasant, light smell, unlike hand sanitisers. Marishane drew inspiration for developing the gel from one of his friends, but his invention could be of greater use for those who live in areas where clean water is in short supply, experts said.
A scent for new moms LONDON: NEOM, leading providers of luxury organic beauty products and relaxation treatment, have launched a ‘Cocooning scent’. The latest scent collection, created by specialists at NEOM, has been produced with relaxation and pampering in mind. It combines a comforting blend of Ylang Ylang, Chamomile and Mandarin to offer stress relief to new and soon-to-be moms.
FUTURE MEDICINE I July 2012
Dr Haridas Verkot SPECIAL STORY
His serum tricks snakes and words melt medicos These days, young medicos are fighting an inner battle to overcome the natural urge to make money and serve the larger interests of the community. For those caught in a cleft stick, Dr Haridas Verkot, a doctor based in Kasargode district of Kerala, who has been treating people suffering from snakebites, offers some sane advice
By Sreekanth Ravindran
n a country where at least 50,000 people die every year from snake bites, Dr Haridas Verkot is a godsend. This 68-year-old doctor, who neither owns a hospital nor has any assistants to support, has helped thousands to return to their normal life after being bitten by poisonous crawlers. It was his deep-rooted social commitment which prompted him to resign from the Kerala State Health Services and work as a general practitioner treating snakebites in an obscure village of Kasargode district in Kerala. Born in Kongad, Palakkad district, Dr Verkot completed his elementary education at Kozhikode Samoothiri High School. He then moved to UC College, Aluva, where he was influenced by Kuttipuzha Krishnapillai, a wellknown rationalist and literary figure in Kerala. “After completing my premedicine course, I joined Kozhikode Medical College for MBBS. Gradually, I developed interest in Toxicology and Hepatology. At that time, there was no modern practical medical treatment available for snakebites,” reminisces Dr Verkot. Five decades ago, Vishaharis (traditional medical practitioners who were treating snakebites) thrived throughout the state. Dr Verkot laments, “These Vishaharis
FUTURE MEDICINE I June 2012
were prescribing totally unscientific methods for treating snakebites. Of course, there were a few experts, but the majority of them were misleading the patients.” Subscribing to the views of late Dr KG Adiyodi, a noted biologist, Dr Verkot refutes the claims by Ayurvedic physicians that Ayurveda is superior to modern medicine when it comes to treating snakebites. “To be very frank, there are no specific and systematic treatments in Ayurveda for snakebites. Generally, Ayurvedic physicians experiment with several medicines on patients. Sometimes they escape, sometimes they succumb.” However, modern medicine approaches the treatment in a scientific manner. Anti-venoms are made by injecting small quantities of venoms into animals, mainly horses. The
Dr Haridas Verkot
antibodies thus produced are powerful and hence it can easily neutralise the poisonous effect on patients. It’s just pure science and it can’t be wrong, the doctor explains. According to the doctor, most of the victims come from impoverished families and hence the huge expenses incurred during the treatment make them debt-ridden until death. The government has not done much in this regard, observes the doctor, adding that almost all government hospitals, except medical colleges, lack adequate facilities
SPECIAL STORY Dr Haridas Verkot
to treat patients who suffer from snakebites. “It is uncommon for a person bitten by a venomous snake to have medical bills in lakhs of rupees. At this pace, antivenom treatments and repairing of damaged tissues could turn out to be more expensive in years to come.” Recalling the old times, he says, “When I began my career about four-and-a-half decades ago, anti-venoms were not really expensive. But now, the snakes are an endangered species, and obtaining anti-venoms has become much expensive.” Dr Verkot is unhappy with the Medical Council of India’s rigid stand against approving Toxicology as a specialisation. “The situation is deplorable, especially in a country where thousands die of snakebites every year,” he asserts. In his utmost urge to contribute to society in a big way, Dr Verkot has also performed the role of a journalist. He was the first doctor in the state to run a medical column for any newspaper or magazine. During the late sixties, he started writing weekly medical
columns in Janayugam, a Malayalam weekly, and it was very well received across the state. Dr Verkot has written extensively on rabies, its prevention and cure. He also was a regular contributor to Deshabhimani, a Malayalam daily, and several medical journals. According to him, journalists have an important role in society. “Journalism has been one of my favourite inclinations. One should never use journalism for selfish ends, but it can be used to improve the life of many people,” opines Dr Verkot, who has also been a regular contributor to a medical magazine published by Kottakkal Arya Vaidya Sala, an Ayurvedic company having health centres in and outside Kerala. Recollecting his early days, Dr Verkot says that there were many challenging moments in his career. “The value of human life is beyond any reckoning and hence pressure situations are unavoidable in the medical profession,” he remarks. Once, a seven-year-old girl, who was declared dead at a hospital, was brought back to life by Dr Verkot. “While the girl was declared dead, one of her relative suggested my name. Initially, that suggestion did not get much support, and you might find it hard to believe that many taxi drivers declined to carry the poor little girl as she appeared to be a dead body. “Somehow she reached my hands. I tried my best and the rest was god’s invisible hands,” says the doctor, whose humility is a source of inspiration. He recollects another instance, when a pregnant lady suffering from snakebites was brought to him. “She was already having labour pain. It was one of the difficult cases in my career. Despite all efforts, I could only save
As of today, everything is market-driven. So is the medical profession. During our times, it was our passion and social commitment that guided our career... But now things have changed. The other day, a friend of mine told me that these days, young medical professionals actively engage in their own research and find out the co-relation between the different departments and number of patients. By the end of their course, they are very clear on their specialisation, knowing which will fetch them maximum patients and tonnes of money 60
FUTURE MEDICINE I July 2012
the lady’s life,” bewails the doctor. Taking heart from his edgy, yet positive, experiences in the medical profession, Dr Verkot feels that doctors should have the courage to take moderate risks when critical cases approach them. According to Dr Verkot, doctors should always give their 100 per cent. Even when they are not sure whether the patient will escape or not, especially in snakebite cases, he adds. Though Dr Verkot is not part of any establishment, he maintains interactions with medical experts, particularly Toxicologists and Hepatologists. “Last year, world renowned Hepatologist Dr Romilus Bitarker visited me and we had a fruitful interaction. Still, it remains unclear for me as to how and from where he came to know about me and got my contact address, telephone number etc.” Being a medical student for half-a-century, Dr Verkot bemoans on the attitude of new generation medical professionals. “As of today, everything is market-driven. So is the medical profession. During our times, it was our passion and social commitment that guided our career. An eye specialist was born out of his interest for Ophthalmology; an orthopaedic doctor would have opted for that specialisation due to his unstoppable quest to learn more and more about bones and its structure and formations. “But now things have changed. The other day, a friend of mine told me that these days, young medical professionals actively engage in their own research and find out the co-relation between the
FUTURE MEDICINE I July 2012
different departments and number of patients. By the end of their course, they are very clear on their specialisation, knowing which will fetch them maximum patients and tonnes of money.” Deeply condemning such trends in the medical profession, Dr Verkot articulates, “The situation is really bad. Nowadays, the majority of the PG entrance toppers are opting for Radiology because they know very well that two scannings can easily earn them a normal doctor’s annual income.” However, he is hopeful that a few committed medical professionals among youngsters would take society forward. Despite leading a simple life and keeping a low profile, international recognition has come searching for Dr Verkot. The British Broadcasting Corporation (BBC) has done an exclusive documentary titled “Bite of the living dead” on this great humanist. Dr Verkot was quite surprised to see the BBC team in his remote village. Concealing his astonishment, the doctor asked Bernie, its team leader and documentary director, “How did you find me?” Adding to his curiosity, Bernie replied, “We have a secret technique to find out anyone in this world who deserves international attention.” According to Dr Verkot, community service is a dawning realisation or greater understanding of our humanity. He affirms that no one can succeed in any profession without cultivating a sense of human compassion. He quotes Swami Vivekananda, “They only live who live for others, the rest are more dead than alive.”
Dyslexia has nothing to do with kids’ IQ Dyslexia, a learning disability, is not related to the intelligence quotient (IQ) of kids. But, in most cases, without recognising the disabling effects of Dyslexia among their wards, parents scold them for low IQ levels, which, in turn, affects children’s attitude towards learning
Hollywood actor Tom Cruise had suffered Dyslexia while he was young. About his condition, he has said, “When I was about seven years old, I had been labelled Dyslexic. I would go blank, feel anxious, nervous, bored, frustrated, dumb. All through school and well into my career, I felt like I had a secret.”
By Dipin Damodharan
o you remember how Ishaan ran into trouble with his father for securing poor grades? You might be wondering which Ishaan I am talking about. Well, he was the little brat of the 2008 Aamir Khan flick Taare Zameen Par who played the role of a Dyslexic child. This article is in no way related to the child star, but it deals with the problem of Dyslexia. Is your tiny tot always lagging behind in school grades? Does s/he have a school phobia? Or do you have a complaint
that s/he is using the study time mainly for cat naps? If you are going through such baffling situations, it is time for you realise that there’s nothing abnormal about your child. “Lagging behind in grades or showing study/school phobia should not be viewed as a serious problem at all. Parents can correct such problems with a little effort. But if you are unable to develop better schooling and reading habits in your child even after making some serious interventions, then it is time to take up the matter with a doctor,” Dr V J Sreedevi, a
FUTURE MEDICINE I July 2012
Bengaluru-based clinical psychologist, who has a doctorate on Dyslexia, tells Future Medicine. So, how do we recognise that a child is grappling with the problem of Dyslexia? Take the case of Anjitha, who belongs to a well-disposed family. There was a time when she had gone through a tough phase while studying in fourth standard. If she were given a book, she could recognise the letters and words familiar to her. She could even read them aloud. But she displayed a lazy attitude when a teacher asked her to jot down the letters and words. Her face used to display the rasas and bhavas of fear, denial, disinterest and rejection once she was forced to write. When Anjitha’s tuition teachers had complained about her indifferent attitude, her busy doctorparents were left confounded. Her mother, Dr Sheena, somehow managed to find time to help her daughter in studies. Today, things have taken a ‘U’ turn. Anjitha, now a plus two student, is preparing for the medical entrance with much hope. So, what brought about this change? Three years of regular counselling under a specialised clinical psychologist gave her enough confidence to overcome her disabilities. There are various types of disability among children because of Dyslexia. If one child faces a difficulty in reading one complete sentence, a second child might have a problem while writing, and the third child may not have the ability to comprehend. Sanal, another Dyslexic child, found it difficult to recognise letters even after making it to the fifth standard. When he was asked to write ‘M’, he used to scribble down ‘W’ or ‘N’. And when he was shown the letter ‘M’ and asked to read it, he used to identify the letter as ‘N’. In this case, the problem is neither connected with a disability to read nor with a disability to write, but with comprehension.
Problem not related to IQ
Problems like these can be corrected only if both teachers and parents show patience and pay attention. But in 99 per cent of the cases, Dyslexic children are found to be sidelined and dubbed as “not intelligent”. Experts clarify that this disability is not linked to the intellectual capacity of a child in any way. “Dyslexia or learning disability is not related to the IQ of children. But, in most cases, without recognising the disabling effects of Dyslexia among their wards, parents scold them for low IQ levels, which, in turn, affects children’s attitude towards learning,” points out Dr Sreedevi. “Right guidance during the initial days of their studies will help these children get into a normal path. Parents have to show patience to help them overcome the starting trouble. And at times, it may take one or two years,” she adds. FUTURE MEDICINE I July 2012
In most cases of Dyslexia, the root cause of the disability may be traced to some incident (often neglected) involving the mother during pregnancy. Minor accidents, including a fall during the early stages of childhood, might lead to Dyslexic conditions. There are many institutions treating Dyslexia and providing counselling to Dyslexic kids. If your child suffers from some learning disability, it’s time for you to rush to a doctor without thinking twice.
Dyslexia Not linked to the intellectual capacity of a child Root cause may be traced to some incident relating to the mother during pregnancy Right guidance can help your child overcome the disability Spend some time with your child to understand his/her difficulties in learning
TRADITIONAL MEDICINE Leech Therapy
Dr Leech can benefit us in very many ways Leeches may be one of the ugliest creatures in the world, but they help humans in a number of medical treatments. Nowadays, they are being used for various therapies by Ayurvedic as well as allopathic practitioners By Lakshmi Narayanan
eech therapy is not a new concept. It dates back to many centuries. It has been a vital part of the traditional methods of healing in many countries across the world since ancient times. Its origin may be traced to the early days of civilisation when man roamed about in the jungles, leading a nomadic life. Today, Leech therapy has found acceptance in the modern society as an economical, quick and effective way to cure blood circulation disturbances and related diseases. However, there are diverse views over the classification of Leech therapy. While some medical experts think Leech therapy is a part of Ayurvedic science, others deem it to be a treatment under naturopathy. \
Genesis of Leech therapy
There is enough evidence to point out that Leech therapy originated in India. The first use of leeches for a medical purpose is thought to have taken place in ancient India in 1000 BC. The ancient people of India used Leeches for a wide range of diseases, including headaches, ear infections and hemorrhoids. According to Hippocrates, an ancient Greek physician, in pre-scientific medicine, the medicinal Leech was used to remove blood from a patient as part of a process to “balance the humours” (bodily fluids), that must be kept in balance for the human
body to function properly. The four humours of ancient medical philosophy were blood, phlegm, black bile, and yellow bile. By the mid-1800s, the demand for Leeches in Europe was so huge that Germany witnessed shipments of more than 30 million leeches a year. People who have undergone Leech therapy should be thankful to American Researcher Dr Roy Sawyer, a well-known advocate for medicinal Leeches. He had noted the potential benefits of Leech therapy and established the world’s first large-scale Leech farm, Bio Pharm, in Wales, UK, in 1984. Today, the company provides lakhs of Leeches every year to hospitals in dozens of countries.
About Leech therapy
Leeches are placed on a body part having blood clots. Leeches have two “suckers”, one at each end of its body. The back end suction cup allows the Leech to ambulate on the dry surface of the human body, where as the front end suction cup contains the mouth with three sharp jaws that helps the leech for a Y-shaped bite. Leech therapy is recommended for patients suffering from blood circulation diseases or disturbances such as Thromboses, cramp veins, Haemorrhoiden, cardiac problems, impact accumulations, and Tinnitus. It is also used for treating rheumatism, arthritis, disk disorders,
FUTURE MEDICINE I July 2012
“Leeches suck only impure blood and smoothen the flow of blood in tissues. Now, research has proved that Leech therapy can be effectively applied on diabetic foot ulcers because it increases collateralisation, micro vascularisation, and tissue oxidation level and enables quick healing of diseases” Dr Anil, Ayurvedic practitioner, Government Ayurveda College, Tripunithura
bruises, muscular pains and muscle injuries. The blood-diluting and container-extending effect of the Leech makes it an ideal therapist. Generally, each Leech sucks between 5 and 15 ml of blood – four to six times their body weight in a single feeding. And Leech therapists use up to 10 Leeches so that the patient can lose up to 150 ml of blood during the treatment.
It’s not painful
Most people have a misconception that the Leech therapy is painful. The bite of a Leech can be likened to two to three mosquito bites. It is never painful as the bite of other insects. Besides, the Leech’s saliva is filled with a chemical that contains a painkiller. The saliva also contains a chemical which prevents blood clotting. The medicinal Leech lives in clean water and it is free from poison. The only thing that needs to be done before the treatment is the right choice of Leeches, given its varied size. That part is completely taken care of by experts in the research wing of treatment centres.
A part of Ayurveda
The founder of Ayurveda and father of surgery, Susrutha, had propagated Leech therapy during the ancient times. In his work ‘Susrutha Samhitha’, he had mentioned about Leech therapy and its benefits, various types of
leeches, and their uses and medicinal application. According to him, ‘Jalouka’ (a type of Leech) is mainly used to practice ‘Rakthamoksha’ (blood purification). And it is the best treatment for Thridoshas: Vatha, Pitha, and Kapha (catabolism, metabolism, anabolism). Dr Anil, an Ayurvedic practitioner at Tripunithura’s Government Ayurveda College in Ernakulam district of Kerala specialises in Leech therapy. He says, “Leeches suck only impure blood and smoothen the flow of blood in tissues. Now, research has proved that Leech therapy can be effectively applied on diabetic foot ulcers because it increases collateralisation, micro vascularisation, and tissue oxidation level and enables quick healing of diseases. A research to prove Leech therapy’s use in curing cardiac blocks is in progress. That will enhance the credibility of Leech therapy.” Normally, three-five courses of Leech therapy can cure skin diseases and other blood disturbances. Leech therapy is not practiced in Ayurveda alone. For better results after plastic surgery and re-fixing of skin, Leech therapy is resorted to. Allopathic doctors also recommend Leech therapy for those suffering from varicose veins and arthritis. It can be used to maintain the blood flow in muscle, skin and fat tissues that have been surgically moved from one part of your body and implanted in another part. This treatment has no side effects. That’s why it attracts a high number of patients. Irrespective of age, anyone can undergo Leech therapy under the supervision of a specialist in this field, says Dr Anil. Hirudo Medicinalis and Macrobdella Decora are two types of medicinal Leeches used in treatments. Macrobdella Decora is more widely used because it consumes 10 times less blood than Hirudo Medicinalis.
Dr Roy Sawyer, Founder of the world’s first large-scale Leech farm, Bio Pharm. FUTURE MEDICINE I July 2012
Leeches can help normalise the blood pressure of hypertensive individuals and lessen the risk of suffering from stroke and heart attacks. As the therapy increases blood circulation, it helps in quick healing of wounds and makes the body more active than ever before. It also reduces the lesions caused by diabetes.
MEDICAL TOURISM Singapore
A double dose of care for body, mind and soul With an estimated earning of S$940 million from medical tourism in 2011, the world class hospitals of Singapore continue to attract a large number of patients from across the world. The country offers a wide range of specialised healthcare services in oncology, ophthalmology, cardiology, stem cell transplant and several other sensitive areas at affordable costs. A well-networked and well-equipped medical infrastructure and exotic tourism destinations make this country an ideal place for healing the body, mind and soul By Prashob K P
ingapore, a nation made up of 63 islands, is at the forefront of medical tourism. The country has a robust healthcare system. More importantly, as compared to other countries, the low-cost treatment at world class hospitals in Singapore attracts a large number of people from across the world. At the recently-concluded ‘Healthcare in Asia 2012’ conference, Singapore’s Minister for Health Gan Kim Yong said that the country has shown a robust performance in the healthcare sector. “Health needs change; financing framework will also need to evolve to help Singaporeans meet the new realities,” he said,
speaking of future challenges. In 2011, medical travellers spent around S$940 million in Singapore hospitals. The country offers a wide range of specialised healthcare services in oncology, ophthalmology, cardiology, stem cell transplant and several other sensitive areas. Recently, Singapore was ranked third in terms of health infrastructure by the International Institute for Management Development. The country has a number of exotic tourism destinations as well, making it an ideal place for healing the body, mind and soul.
Singapore: a progressive health destination PlacidWay is a healthcare service provider based in Denver, Colorado, US. Singapore is one of the destinations covered under its medical tourism services. Pramod Goel, CEO and founder of PlacidWay, talks about the role of a healthcare service provider and tells why Singapore is a prime medical tourism hotspot How progressive is Singapore’s healthcare industry? PlacidWay recognises that Singapore continues to remain an attractive market due to its accessibility within the region and affordability, its skilled and certified physicians and facilities, and its exotic travel destinations. Singapore continues to lead the way with a strong health and wellness industry, entrepreneurial spirit to compete and standout in the growing crowded global market of medical tourism. Singapore healthcare industry is quite progressive. With high quality, affordable healthcare, it is becoming increasingly popular among Asians and Middle Easterners. How did Placidway get into the specialised field of
medical tourism? There was a need for accessible and affordable medical care and services to people not only in the US, but also abroad. Health tourism is growing by leaps and bounds. Personal healthcare is all about choices, and PlacidWay is dedicated to offering choices to all people. PlacidWay has designed a way to offer well-researched data regarding healthcare facilities, physicians and surgeons from Asia to Latin America to Europe and beyond. How does Placidway operate and what are its medical initiatives? PlacidWay facilitates international surgery,
FUTURE MEDICINE I July 2012
treatments and procedures, focussing on the needs of various demographics from around the globe. Through PlacidWay, people have easy and immediate access to some of the world’s renowned doctors, physicians and healthcare facilities, including clinics and hospitals that are accredited and certified by international governing boards such as JCI, ISO, TRENT, CCHSA and ASCHI. PlacidWay provides access to the best in cosmetic surgery, dentistry, orthopaedics, cardiac care, obesity and weight-loss surgeries and procedures around the world. PlacidWay meets the needs of international patients who demand technologically advanced healthcare infrastructures, unique treatments not available locally, or a combination of holiday and medical treatment. Medical tourism packages are PlacidWay’s speciality. Do you have a global presence? From where all do you receive patients and for what kind of treatments? PlacidWay has presence in about 60 countries. We have clients travelling to locations throughout Southeast Asia (India, Thailand, Korea, Singapore), Central Europe and Latin America for critical and non-critical services. Cardiac and orthopaedic care are two of the most popular ‘critical’ care treatments and procedures, followed by dental and eyecare services. North Americans and Canadians increasingly visit countries like Mexico, Turkey, India and South Korea for affordable surgical procedures in FUTURE MEDICINE I July 2012
dentistry, cosmetic surgery (elective and reconstructive), cancer care, orthopaedic procedures, and stem cell therapy. People from North America, South Africa, the CIS region and Pacific Rim regions are increasingly taking interest in medical care services and specialty practices around the world. Do treatments come with a premium or is there an intent to promote affordable treatments through medical tourism? PlacidWay always strives to provide customers qualitative, affordable treatments, procedures and surgeries abroad. We carefully research each clinic, doctor and facility to ensure safe, effective, and affordable choices. PlacidWay takes advantage of the expertise and experience of a multitude of professionals that come from diverse backgrounds, including healthcare, technology, and travel and hospitality industries, to offer the best options and choices for travel and healthcare needs. Tell us something about the expertise of your doctors? We at PlacidWay know how important training, skill and experience is to patients, whether they’re interested in a minor dental treatment or heart surgery. The doctors and surgeons from the facilities we partner with are well-educated, trained and experienced in their fields. We provide access to doctors and surgeons certified in their fields by their country of origin, and by international medical or surgical associations and organisations. A great
number of clinics, facilities and hospitals are JCI accredited and adhere to international standards of care. Do you have a tie-up with any international hospital chain? PlacidWay enjoys partners and affiliates in over 60 countries. We do not endorse one facility/doctor/procedure over another, but supply customers with the research and access to providers who may best meet the needs of individual cases. What are the challenges in the medical tourism industry today and how do you propose to overcome them? Medical tourism industry has numerous challenges: • Rapid rise in local, regional, and global competition among medical providers has made this industry very competitive and aggressive, benefitting consumers. • As more and more medical and service providers are coming to this industry without full knowledge of international trades, it is affecting the overall quality and service delivery • Supply exceeds demand at this point of time. • The world economic crisis has prevented this industry from growing at the projected rate. • Unstructured marketing approaches as well as unsustainable business models are in practice today. • Lack of transparency is impacting the growth potential of this industry.
POWER OF MIND
Understand your brainwave states
P P Vijayan
The mind operates at four predominant Brainwave States or Frequencies
he different states of mind are classified according to the speed of the predominant Brainwave signals from one neurological point to another at any one point in time. This speed and frequency is measured in ‘Hertz’ and the figures are obtained using an Electrocardiogram (EEG) machine. Beta: This is where our mind usually operates in daily life. In such a state, we have full conscious awareness and attention of everything around us and usually, only one side of the brain is operating. Beta is usually typified by brainwave cycles of 15 to 40 Hz (cycle per second). Higher cycles of beta frequency usually equate to stress, anxiety and ‘over thinking’ as the conscious mind becomes misguided or reacts negatively to a given situation. High brainwave beta frequency also equates to hypertension, increased heart rate, increased blood flow,
around you. Meditation is usually aimed at achieving Alpha and the brain operates in cycles between 9Hz and 14 Hz. Alpha is typified by partial conscious awareness and partial subconscious predominance at the same time. It is useful to absorb information when in Alpha. It is considered to be highly desirable for more effective studying. Alpha promotes more of the left side of the brain for processing. Theta: Deep relaxation where the conscious mind is, for the most part, ‘switched off’, and the subconscious mind is left to flourish. This is usually typified by sleep, dreaming, and very deep relaxation. Theta shows brainwave cycle operating at 5Hz to 8Hz. Theta is where ideas, visualisation and suggestion are more likely to enter the subconscious mind consciously. We become less aware of what is going around us. Delta: Extremely deep relaxation/sleep with complete
cortisone production, and glucose consumption. Generally speaking, you would not want to experience the high beta state too often if you are concerned about your health (some techniques are included below to ensure this does not happen). Alpha: This is a mild daydream or light relaxation state. Operating in Alpha can be exemplified to when you are driving a car or just cruising around when you get captivated by a good book and sort of lose track as to what is happening
subconscious operation. Delta is experienced in the deepest of sleeps and is interesting because it is proven that the physical body begins to recuperate and recover at the heightened level. You can be in walking Delta if you are in an advanced state of meditation. This state is associated with kundalini experiences. Delta is typified by slow brainwave at 1Hz to 4 Hz. (The author is a mind power trainer)
FUTURE MEDICINE I July 2012
LIFE & SEX
Learning about sex from video games
he China Youth Internet Association and Communication University of China have released findings of a study indicating that more than half of young people aged 13-18 are learning about sex from video games and related material. Over 40% of young Chinese Internet users have encountered sexually suggestive or explicit content through message boards or websites that use sex as part of promotion. However, the study also shows that China’s ban on “vulgar marketing in online games” is ineffective. According to the report, 71.6 per cent of all people surveyed said that ongoing contact with visual sexual advertising had little to no effect on them. Of those surveyed, 38.7 per cent said they’ve come across sexually charged material in game advertisements or promos. In addition, 34 per cent of young Chinese males admitted they actively seek out adult content, compared with 9.1 per cent of female youth.
Rather than condemning video games, the researchers behind the study recommended that the government improve sex education courses to educate young people. China’s Ministry of Culture has issued a notice that allows local officials to force game companies to delete content in online game promotions that is deemed inappropriate. The stipulation not only bans the use of sex, but also gambling and violence in game promotion. Several homemade sex videos of a Chinese model leaked online earlier this year. The videos were made in 2007 and were apparently uploaded by a spurned lover. As with American celebrities who have sex tapes, the model suddenly became the focus of attention. An online game company then offered the model a chance to represent its game “Xi You Ji” (Journey to the West). The phenomena isn’t limited to this model. Last month, a Shanghai-based game developer hired Japanese porn star Aoi Sola to represent the game “Warrior OL”.
Women enjoy sex the most at the age of 28?
new survey has found that women have the best sex of their lives when they are aged 28, but men don’t reach their peak until they are 33. The study also found that women have the most sex at 25 and lose their virginity at 17. Men, who on average lose their virginity at 18, are most active when they are 29, the Sun reported. Asked when they had their best sex, 40 per cent of 1,281 people aged 28 said, “Now.” And those in their 50s and 60s said that they had their best sex at the age of 46. The results contradict a research finding, which says men reach their
FUTURE MEDICINE I July 2012
sexual peak at 18 and women at 30. The survey by online sex toy retailer lovehoney.co.uk also highlighted a shift towards losing virginity earlier. It found the average age of virginity loss was 17 for those in their 20s, 30s, 40s and 50s, but those in their 60s had waited until they were 18. Relationships expert Tracey Cox, 51, who has her own range of sex toys with Lovehoney, said that this finding destroys the myth that it takes women longer to master their sexual responses. Despite the female sexual system being far more complex than a man, women are discovering what works and doesn’t faster than men.
YOGA & MEDITATION
Triangle pose: a cure for joint problems, back ache Are you feeling disabled by some kind of joint problems or a back ache? Are you unable to carry on with your daily routine because of these problems? Don’t worry. Learn a simple asana and overcome your problems
o you have some kind of joint problems or a back ache? There’s no need to worry. Here is a perfect solution for your problems. Practice Trikonasana (Triangle Pose) regularly, and you will be free from all kind of joint problems within a few months. It is also good for regulating the menstrual cycle. Trikonasana is excellent for stretching the body. Normally, this can be done in the beginning of yoga practice. Here’s what you have to do to practice this asana: first of all, you have to stand on the floor. Your legs have to be spaced 2-3 feet apart. Place your hands loosely on either side. Legs should be firm and tight. Keep the back and neck straight, and look in front. While inhaling, raise the right hand and arm up towards the sky, palm facing inwards. The right arm should touch the right ear. Then, stretch it upwards. Keep the left arm close to the body and stretch it downwards. You have to keep the legs and arms straight. Then, start to exhale. While exhaling, bend towards your left so that the right arm becomes parallel to the ground. Simultaneously, slide your left arm along the left leg and try to touch the ground. Stay in this position for 10 seconds to one minute. Now, inhale and gradually come back to the starting position.
You have to repeat this procedure by reversing the position of the arms and bend to your right. But never do it with pain. It is ideal to repeat this asana two to three times a day. Trikonasana is good for the liver, kidneys, pancreas, and large intestine.
The compiler of yoga Yoga is a buzzword nowadays. But do you know the visionary who compiled concise aphorisms on yoga in today’s format? Patanjali is regarded as the compiler of ‘Yoga Sutra’, the guidebook of classical or Raja Yoga. The book was written by this great saint about 1,700 years ago. (The column is written by Aditi Iyer, a Bengaluru-based Yoga trainer)
FUTURE MEDICINE I July 2012
Russia WHERE TO STUDY
MBBS at affordable fees, low living costs Faced with the problem of unavailability of seats in top medical colleges, an increasing number of students have been opting for higher studies in foreign countries. And the advances in the field of science and technology in the West and other parts of the world only encourage our students to make an informed and equally sound choice. Pursuing MBBS in some countries may be prohibitively expensive, but before you wind up your plans, look at countries where it is affordable. In this issue, Future Medicine presents Russia as one of the possible destinations for a career in medicine By Shani K
ussia is known for having a high standard in the field of medical education. Russian medical courses have been recognised by international organisations like the World Health Organisation, UNESCO and so on. This has inspired a large number of aspiring medical students from across the world to opt for Russia as a study destination. Each medical institution in Russia is wellequipped, and their teaching methods are regulated and streamlined, providing students the right atmosphere for excellence in their chosen area of specialisation. Most Russian medical institutes offer MD degree, which is equivalent to the MBBS degree
FUTURE MEDICINE I July 2012
course offered in countries like India, Pakistan, Sri Lanka and Bangladesh. The duration of the course is six years, and each academic year is divided into two semesters. An MD degree is provided in both Russian and English medium. Most international students have been choosing English medium. If students prefer to pursue MD in Russian medium, students would have to undergo the one-year Russian Language Programme. What makes Russia a centre of excellence in medical education? While pursuing a medical course in Russia, students get ample exposure to clinical practices at highly equipped multi-profile hospitals. Thereâ€™s good news for those who fear they canâ€™t
WHERE TO STUDY Russia
Ashtrakhan State Medical Academy afford the course fee. Russian medical institutions have provisions for fee subsidisation. Besides, students do not require huge amounts of money for pursuing MBBS in Russia, as compared to the Western countries. The living expense of a student may go up to Rs 6000 per month. Students are advised to take medical insurance, which may cost about $100 per year.
1. H/she should not be more than 27 years old as on 1st of September in a given academic year. 2. H/she should have obtained an aggregate of 50% marks in Physics/Chemistry/Biology in the 12th standard. As per the requirement of the Medical Council of India, all reserved category students having an aggregate of 40% marks can also apply. 3. H/she should obtain an eligibility certificate from the Medical Council of India.
List of documents required • • • • • • • •
Notarised copies of 10th standard marksheet Notarised copies of 10th standard passing certificate Notarised copies of 12th standard marksheet Notarised copies of 12th standard passing certificate Notarised copies of college leaving certificate Copy of the passport 20 recent coloured photographs HIV-free certificate from registered medical practitioners
Institutions for MBBS:
There are many Russian institutions where you can pursue
Kazan State Medical University MBBS. Names of a few are given below: • Ashtrakhan State Medical Academy • Kazan State Medical University • Stavropol State Medical Academy, Stavropol • Rostov State Medical University • Volgograd State Medical University, Volgograd • IP Pavlov St. Petersburg State Medical University, St Petersburg • I I Mechnikov St. Petersburg State Medical Academy, St. Petersburg • St. Petersburg State Paediatrics Medical Academy, St Petersburg
Given below are some conditions set by the Russian Ministry of General and Professional Education: • The students should have proper clothes for all seasons, including warm clothes for autumn and winter • They should have at least $100 (or other hard currency of the same amount) for transportation from the airport to the place of study • They should have at least $100 per month for personal needs • They should have enough money to get back home upon completion of studies in Russia. In the event of a serious illness or some other unforeseen problem, there should be guarantees from the student’s next of kin that they will bear his travel expenses
FUTURE MEDICINE I July 2012
Dr Satish Bhat SURGEON SPEAK
‘Improve facilities at Govt hospitals’ Dr Satish Bhat is an Associate Professor in Plastic Surgery at Yenepoya Medical College and Consultant Plastic Surgeon at Arogya Specialty Clinic, Falnir, Mangalore. Over the past 10 years, he has conducted about 3,000 reconstructive and plastic surgery procedures. In an interaction with Future Medicine, Dr Satish Bhat shares his experiences Inspiration to become a plastic surgeon: From childhood itself, I was interested in handling delicate jobs. Surgery itself demands delicateness from the part of surgeons. I come from a humble family. So, I had the opportunity to interact with ordinary people. When I went to pursue MBBS, it revealed to me the miraculous side of plastic and cosmetic surgery. I understood that plastic surgery could bring about a drastic change in the life of ordinary people. For example, if a person’s fingertips is damaged in an accident, it may affect his entire life. That’s where plastic surgery comes as a blessing. It can help him overcome the handicap and deformity and bring back him to a normal life. Plastic surgery can restore his confidence and ability to work. All such attributes of plastic surgery inspired me to become a plastic surgeon. Memorable surgical experience: Santosh, a young man, was unloading postal parcels from a train at the Mangalore Central Railway Station, when the Parasuram Express knocked him down. He lost both legs in the accident. Thankfully, his dismembered legs were immediately collected from the site and brought to my hospital in a plastic cover at the time of his admission. After eight hours of surgery, I could reattach one leg. But the cells in the dismembered, second leg could not regenerate, so it could not be reattached. In the mean time, the reattached leg developed an infection. That stage was very critical. He underwent seven surgeries. When I approached him for the eighth surgery, he broke down and requested me to amputate his reattached leg. Upon counselling, he made up his mind for the eighth surgery. Now, he is a fine man. I am happy now because our efforts helped him get back to a normal life.
FUTURE MEDICINE I July 2012
Essential traits of a surgeon: Surgeons should be tolerant and hardworking since certain surgeries may take more than ten hours. Surgeons must not give more importance to the monetary returns than the service they are ought to provide. Suggestions for improvement in the healthcare system: Facilities at government hospitals should be improved. The government should provide sufficient number of staff and a good support system at its hospitals. Or else, doctors cannot function effectively. The government should also provide good pay packages to doctors to ensure that they do not leave in search of better alternatives. Prepared by Shani K
SECTORAL GROWTH Pharma
Pharma sector to post stable growth in 2012–13 The domestic pharmaceutical industry can hope for a stable period ahead. According to Crisil Research, the overall market size of the industry is projected to touch $33-35 billion in 2012-13 By Dipin Damodharan
cloud of economic stagnation is hovering over India. The grim development comes at a time when headlines in financial newspapers across the world are screaming about yet another impending global economic crisis. The cascading effect of Eurozone crisis and disappointing global manufacturing data, coupled with India’s low GDP growth and decline in industrial production, are fuelling fears of an economic slowdown. Despite all these negative factors, the domestic pharmaceutical industry can hope for a stable period ahead. India holds a considerable position in the global pharma sector. Statistics show that the Indian pharmaceutical industry is the world’s third largest in terms of volume, and in terms of value, it stands 14th in the world. The industry has a lot more to cheer about. According to a report published by Fitch, a global rating agency, the Indian pharmaceutical industry will remain stable throughout the financial year 2012-2013. Ajay D’souza, Director, CRISIL Research, a division of Crisil rating agency, says: “Over the past five years, the Indian pharmaceutical industry has shown healthy
double-digit growth driven by robust exports of both formulations and bulk drugs, coupled with steady growth in the domestic market. We expect the growth momentum to continue in 2012-13.” The depreciation in Indian rupee has also turned out to be good for the pharma sector’s growth. Since September 2011, the Indian rupee has depreciated significantly by 25-27 per cent. As 40-50 per cent of the earnings of the Indian pharma sector come from exports, the fall in the value of rupee has resulted in higher sales. This would definitely help pharma companies in the form of higher export realisations. Union Minister for Commerce and Industry Anand Sharma too is all praise for the Indian pharmaceutical products. He has said that Indian pharma products are of international standards and cheaper than other markets on an average by 30-40 per cent. The Fitch report pointed out that the sector’s 2012 earnings will primarily depend on the increasing demand for generics. According to various statistics, the spending towards generics will be 39 per cent of the total pharma spending in 2015. In 2005, it was 20 per
FUTURE MEDICINE I July 2012
cent and in 2010, 27 per cent. The US is the largest market for generics. The Indian companies have a vast scope ahead in this market. A report says that during 2011, out of the total 431 Abbreviated New Drug Application (ANDA) approved by the US Food and Drug Administration, Indian pharma companies received 144 approvals for ANDAs and 49 tentative approvals, amounting to over 33 per cent of the FDA approvals in 2011. The Indian companies constituted more than a third of ANDA approvals. This also resulted in the steady growth of exports of generic drugs from India. Between 2005 and 2011, the export has marked a growth rate of 21 per cent. Along with the US, other generics markets are emerging in countries such as Russia, Brazil, China, Mexico, South Africa, Turkey and Indonesia. A report published by Crisil Research says that the exports will grow continually in the next five years at 14-16 per cent compounded annual growth rate.
‘Growth story continues to be
buoyant’ Ajay D’souza, Director, Crisil Research, has more than 10 years of experience in the areas of industry research and financial analysis. In an exclusive interview with Future Medicine, he tells that the growth momentum of Indian pharma industry can be sustained in 2012-13. Excerpts: Tell us about Indian pharma sector’s growth potential in 2012? Manufacturing opportunities for Indian pharmaceutical players can broadly be classified into formulations and bulk drugs. Over the past five years, the Indian pharmaceutical industry has shown healthy doubledigit growth driven by robust exports of both formulations and bulk drugs, coupled with steady growth in the domestic market. We expect the growth
FUTURE MEDICINE I July 2012
momentum to continue in 2012-13. Formulation and bulk drugs exports are expected to grow at 14-16 per cent (y-o-y) while domestic formulations are expected to grow at 13-15 per cent. Overall market size is projected to touch $33-35 billion in 2012-13. What are the factors that can contribute to the growth? The Indian pharmaceutical sector’s growth story continues to be buoyant. Drugs worth $130-150 billion will
from these opportunities due to inherent benefits such as low cost manufacturing, high process chemistry skills, and availability of strong research talent pool at a low cost. The Indian bulk drugs industry, which primarily focusses on exports will also benefit significantly from well-developed process chemistry skills, lower manufacturing costs and easy availability of chemicals, placing it favourably, as compared to global peers. Additionally, over the last few years, innovator pharmaceutical companies are increasingly looking to tie up with Indian players for supply of bulk drugs. The healthy double-digit growth in the domestic formulations market is expected to continue over the next five years. The increasing incidence of lifestyle diseases, coupled with macro-factors such as rising healthcare awareness and disposable income, will be key drivers of this growth. What about our contribution to the global market? The process chemistry skills developed after the Patent Act of 1970 enabled a competitive advantage for the Indian pharmaceutical industry in the â€™90s, when the rising healthcare costs in many developed countries forced them to seek the cheaper generic drug option. These capabilities, coupled with the cost-competitiveness are evident in the growing share in the US generic market (globally, the largest generic regulated market).
Net Sales (in crore)
Net Profit (in crore)
Net Sales (in crore)
Net Profit (in crore)
Net Sales (in crore)
Net Profit (in crore)
Net Sales (in crore)
be going off-patent over the next five years, and there is increasing emphasis on generics in major markets. The global generics market is poised for healthy growth of around 9-11 per cent annually. Indian players will benefit
Net Profit (in crore)
Indiaâ€™s major pharma companies 76
FUTURE MEDICINE I July 2012
INSPIRATION Sreeja Suresh
TV professional turns good samaritan Sreeja Suresh, a Kerala-based television professional and actress, has had the opportunity to deal with burning issues of public concern through various programmes on the small screen. Responsible stints in various television channels have only given a direction to her social commitments. Despite her busy schedule, she finds enough time to do some praiseworthy charitable work through her not-for-profit SSREE Foundation Bureau
reeja is a Kerala-based television anchor who shot into the limelight through popular programmes that dealt with burning issues of public concern. She has anchored ‘MediTalk’ on Jai Hind channel, ‘Frames of Kerala’ on Doordarshan, and ‘Jeeva Thalam’ on Kairali channel. Apart from anchoring, Sreeja has several other accomplishments to her credit as the producer of some television programmes, coordinator of various stage shows, and Managing Director of an advertising-cum-marketing firm. Homemakers also remember her lovely characters in Malayalam serials like ‘Swami Ayyappan’ and ‘Omanathinkal Pakshi’. While at the peak of her career as a serial artist, she had decided to call it quits, only to able to give full attention to her social commitments. So, how did it all begin? Sreeja says, “I have anchored a variety of health programmes at various Malayalam channels for more than 10 years. So, whenever I came in touch with patients, they hoped that they would get some medical assistance from me. Their faith inspired me to establish a charitable trust called Social Support, Rehabilitation, Education & Empowerment (SSREE) Foundation.” Who are the beneficiaries of her charitable work? “Thanks to my job as an anchor of health programmes, I developed contacts with a number of doctors and hospitals all over Kerala. Over a period of time, I started to
realise that hospitals demand hefty fee from poor patients even for something as serious as dialysis. Their expenditure ranged between Rs 700 and Rs 2,500. Critical patients are required to undergo dialysis at least 12 times a month. How can poor patients bear such a hefty fee for dialysis? That very thought provoked me into action. Since December 1, 2010, SSREE Foundation, in association with NIMS Medicity in Thiruvananthapuram, has been providing free dialysis for poor patients,” says Sreeja. “Every month, SSREE Foundation has been bearing the expenses of 80 dialysis for registered patients under the Trust. NIMS Medicity has been providing its dialysis service to SSREE Foundation at a fixed rate of Rs 700 per dialysis,” adds Sreeja. How does SSREE Foundation raise money for poor patients? “Through sponsorships. We have a project named ‘SPONSOR A DIALYSIS@700’,” says Sreeja. Veteran Malayalam actor Madhu, founder-director of Soorya Stage and Film Society Soorya Krishna Moorthy, clinical psychologist Dr P M Mathew Vellore and founder and chief architect of Habitat Technology group Padmashree G Shankar are patrons of SSREE Foundation. A modest Sreeja says she has been lucky for having been blessed with such a responsible role. “My family has been supporting me all the while. We all have limitations. But if we join our hands, we can do a lot,” says Sreeja.
FUTURE MEDICINE I July 2012