www.MedgateToday.com
Volume X | Issue II | Feb 2019
Special issue for
Your Gateway to Health & Medical World
Anupriya Patel
Gets Candid About Modi Govt. Healthcare Initiatives
GOVT. STRENGTHENS THE FOUNDATION FOR VISION 2030
An Advance Media Publication
Advance Media Group A Healthy Journalism
Interim Budget
Industry Speak
News Update | Doctor Speak | Expert Views | Product Line | Industry Watch | Healthcare Management
EDITOR SPEAK
Magazine
2019
Volume - X Issue - II Feb 2019
Medgate Today on Growth Path Completed a decade in healthcare Media
At the outset , as we are celebrating 10th anniversary of Medgate Today, I wish to thank all of Medgate Today's readers for their continued support and encouragement. We owe our success and existence to all of you. As annual feature we are gearing up for 9th MT India healthcare awards 2019 ceremony to be held on alongside of Medical Fair 2019 at Delhi. We humbly invite your gracious presence on 22nd February 2019. These are probably first healthcare awards Instituted to recognize and honour best healthcare minds across the nation. Indian medical fraternity deserves more than this for their immense contribution to nation's health security, ours is just a humble gesture. I also wish to inform all of you that your magazine participated in Arab Health 2019 held between 29th-31st January 2019 at Dubai. The international visitors flocked to our stall at Arab Health 2019 ,and we ended up distributing magazines to them. The international visitors took keen interest in India's growing prowess in healthcare. It's sheer delight to share that our continuous advocacy for last mile healthcare delivery and our regular interactions with health ministry & healthcare leaders reflected in more govt spend on public healthcare in recent interim budget 2019 . Your magazine has been at forefront of promoting govt. healthcare policies and programs for last 10 years. We humbly thank honourable union health minister and ministers of state for considering opinions of industry experts featured in your magazine time to time. As 2019 is in progress, we would bring more and more interesting issues to ensure best value of your precious time.
Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m
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Inside NEWS UPDATE
GOVT. STRENGTHENS THE FOUNDATION FOR VISION 2030 INDUSTRY SPEAK 24-34
About Precision Medicine...
08 130 Crore people of the country are
been looted everyday through India’s biggest medicine scandal... Health Fund will work together...
10 Among 50% Infertility Cases Primary Factor Is Male Infertility
12 Urgent need to remove myths and misconceptions about vaccination
12 52 year old got successfully treated
at Indraprastha Apollo Hospitals for acute breathlessness
14 Directorate of Health Services and Sanofi India join hands to reduce diabetes burden on the State’s health exchequer
16 Health Minister confers ‘Award of
Appreciation’ to Rajiv Nath of AIMED
18 Apollo Hospitals opens South East
Asia’s first Proton Therapy Centre for Cancer
20 Dubai Health Authority, inaugurates new 150 Bed Multi-Specialty Aster Hospital in Al Qusais
20 Anupriya Patel Gets Candid About Modi Govt. Healthcare Initiatives
20 Dubai Health Authority, inaugurates new 150 Bed Multi-Specialty Aster Hospital in Al Qusais
Industry Speak
MEDGATE TODAY LAUDS INTERIM BUGET 2019-20
06 Y oung Delhi strides against Cancer 06 Illumina, Executive Chairman Talks
10 The Stop TB Partnership and India
Interim Budget
36 Latest Angioplasty technique-
A boon for renal failure patients
38 New healthcare trends to hit the industry in 2019
40 Medgate Today steals the show at Arab Health
42 ERBA Group showcases its latest
technologies critical to Hematology
43 AVM can now be treated with zero
risk through cyberknife radiosurgery
44 Now natural cartilage of the joints can be regenerated and need
46 PHILIPS: committed towards
improving people’s lives with a steady flow of ground breaking innovations
48 Cancer A disease with increasing incidence and confusing trends
50 For Early to Mid-Stage Knee
Osteoarthritis Consider Robotic Partial Knee Replacement Surgery (PKR)
52 Setting Up Oncology Centre: A Spatiality Approach
56 The impact of technology on healthcare
58 Industry veterans, health experts and policymakers from 25 countries to participate at Medical Fair India
60 S edentary Behavior and Cancer 62 Nicotine Replacement Therapy:
Supporting the willpower of those who want to quit smoking
64 “Navya Care” Scales Access to Rare Pediatric Cancer Care Expertise To Empower Every Child With Cancer Across India
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2019
NEWS Update
Young Delhi strides against Cancer - Thousands join walk for Life CanSupport, a WHO awarded organization providing free palliative and supportive care services to cancer patients since 1996 organized its 12th annual walk-a-thon called Walk for Life: Stride against cancer supported by ONGC, CORE Diagnostics, Boeing International Corporation India Private Limited and Max India Foundation. The walk was organized to draw public attention to the growing and menacing presence of cancer in our country, to show support for cancer patients, honor those lost to cancer and raise funds for CanSupport’s free of charge home care services to people with cancer in Delhi/NCR and Amritsar. Ms Harmala Gupta, Founder-President, CanSupport gave the welcome address followed by a speech by Ms. Jeannie Mulford wife of Ex US Ambassador to India, a breast cancer survivor. Guest of honour Mrs. Gursharan Kaur flagged off the Walk. Dr. A.P Maheshwari, DG Bureau of Police Research & Development; Ms. Mary Carlson, Deputy Chief Of Mission, US Embassy; Mr Manoj Barthwal, GM-HR, ONGC; Ms. Mohini Daljeet Singh, CEO, Max India Foundation and Ms. Praveena Yagambhatt, Leader for Boeing Global
Engagement India were some of the distinguished guests at the Walk. This year, the Walk saw the youth taking the lead and individuals from more than 30 Corporates, Embassy, 50 Schools and Colleges Institutes came forward to show solidarity with those suffering from cancer and remove the stigma attached to cancer. The Walk also witnessed participation from the Harley Davidson Rider Group
who rode with cancer survivors to show their support. The Band from BSF, Drummers from Djembe Circle and Zumba performance by Fantezy group kept the walkers entertained as they walked down Rajpath, the route of the walk. Ms. Harmala Gupta, Founder-President CanSupport said “The huge turnout at CanSupport’s Walk for Life and the variety of participants are a reminder that
ILLUMINA, EXECUTIVE CHAIRMAN TALKS ABOUT PRECISION MEDICINE AT CORE DIAGNOSTICS MEET CORE Diagnostics, a healthcare startup and the go-to institution for highend clinical diagnostics organized a healthcare meet on “Precision medicine: Progress and Promise” at The Oberoi, New Delhi. Precision medicine (PM) is an advanced, data-driven approach that helps select the best treatment option, customized for each patient. The event was inaugurated by keynote speaker Mr. Jay Flatley who serves as the Executive Chairman of the Board of Directors, Illumina; a global leader in genomic sequencing and array-based technologies for application in the life sciences, oncology, reproductive health and other emerging segments. Mr. Flatley commented, “Precision medicine harnesses patient-specific data to create therapeutic options exclusively tailored to individual patients.” Among 6
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other diseases, various forms of cancer, when managed with this approach, improve the chance of survival with fewer adverse side effects, reduced exposure to harmful radiations, and increase the overall effectiveness of care. His keynote focused on the evolution of genomics over the past two decades, where the cost of sequencing the whole genome of a person went from over
cancer does not recognise boundaries of country, class, age or gender. What unites us all today is our determination to stand shoulder to shoulder and not allow cancer to crush our spirit” Ms. Zoya Brar, Founder & Managing Director, CORE Diagnostics said, “We are grateful and privileged to support CanSupport’s initiative to spread positivity and celebrate cancer survivorship. In order to give back to society, we believe that such first-hand partnerships can immensely transform the state of cancer awareness, care and support in our country. Being so closely entwined with cancer care, we are happy to associate with a cause at this scale to spread much-needed awareness about early detection and prevention to save more lives. We will continue to walk and work for the community this way several billion dollars, to less than $1000, with a hundred-dollar target well within the near term horizon. A largescale population study with an Indian cohort is the much needed next step in understanding disease patterns that are specific to people of Indian origin – such as propensity to diabetes, metabolic disorders, cardiovascular disease, several types of cancer. Flatley described several such largescale genomics studies across the globe - in the UK, US, China, and underscored the importance of such studies in India. Ms. Zoya Brar, Founder & MD, CORE Diagnostics, added, “India has made excellent progress in the past five years in creating awareness about molecular diagnostics and precision medicine. Our aim is to make genomic sequencing accessible to a much broader population base. We are excited about Illumina’s interest in India.”
NEWS Update
130 Crore people of the country are been looted everyday through India’s biggest medicine scandal, abnormal MRP printed on Medicines by the manufacturers’ upto 3000% more on their selling prices Today there is no drug price policy to control prices of medicines - P.R. Somani
P.R. Somani, Founder president of THE NIZAMABAD CHAMBER OF COMMERCE & INDUSTRY Expose biggest Medicine scandal regarding abnormal MRP printed on medicines by the manufacturers here at a press conference at Press club of India in Delhi. While addressing to Media, Somani said that MRP printed on Medicines by the manufacturers’ upto 3000% more on their selling prices and 130 crore people of the country are been looted everyday by them especially poor people are getting squeezed. Somani shared the proof, facts and figures regarding this with media persons. He said, As on today there is no drug price policy to control prices of medicines. Therefore, pharmaceutical companies are printing abnormally high MRPs even up to 3,000 per cent on their medicines including generic medicines and life saving drugs and even surgical equipment also. Thus, there is a huge difference between wholesale price and retail price of medicines. For example Manufacturers are selling medicine to wholesalers at Rs.95 and the wholesalers in turn are selling the same medicine to retailers at Rs.100. However, the retailers are selling the medicine at MRP Rs.2, 000/as manufacturers are printing the MRP Rs.2,000 on the labels. For your kind information, I am giving details of generic & life saving drugs. Cinwox 25T(Cinnarizine IP 25mg) manufactured by Wockhardt, price to distributor is Rs.8/- but MRP is printed at Rs.160.13 means 2001% more. Okacet-L (Levocentrizine Dihydrochloride 5mg) manufactured by Cipla, price to distributor is Rs.3.70/- but MRP is printed at Rs.57/means 1540% more. Erythropoietin injection IP 4000 IU (Dialysis injection) manufactured by 8
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Reliance, price to distributor is Rs.150/but MRP is printed at Rs.1400/- means 933% more. I have studied number of drugs of different companies & found that there is huge price difference between purchase price of retailers and MRP on the label. Why manufacturers are printing such an abnormally high price on labels? Because manufacturers want to sell more drugs and under the pressure of retailers and doctors who are colluded and prefer high MRP for their self interest. Due to this abnormal MRP, 130 crore Indian citizens are getting looted especially poor people are being squeezed. Being unable to purchase medicine at the highest prices they are facing financial problems in their whole life. Some are purchasing them selling away their meager assets, borrowing at higher interest rate, mortgaging “mangalsutras”, ornaments and so on. Literally, their condition are horrible and leading a wretched life due to their medical expenses which are several times to their food expenses. Following the high MRP with their self interest doctors tend to prescribe medicines unrelated to the real disease of patients. They also tend to prescribe more number of medicines which are not required for treatment. As a result, the patient health is getting eteriorated. Whether Government is getting GST in proportion of the abnormal MRP?
If Government puts a cap on printing MRP patients will have an opportunity to get medicines at lower rates and their medical expenses will be 10 to 15% and Government’s health budget, premiums of health insurance and reimbursement by insurance companies will drastically come down. India has more foreign tourists visiting India for medical treatment, with capping MRP India will become the more attractive destination for medical treatments. Therefore, I have suggested to the Government to put the cap on the trading margin of medicines at 35 per cent on manufacturers’ net selling price on all medicines by amending the National Drug Price Control Act. If there is a cap on margin of profits there will be competition among manufacturers to print lower MRPs on medicine resulting in further benefit to the poor patients. I have given representation by mail to Shri.Narendra Modiji, Prime Minister of India on 20.10.2018 along with all the facts with proof and PMO has immediately responded & forwarded the issue to concern department. I have also represented the matter to Hon.Shri.Venkaiah Naiduji V.P.of Inida on 26.12.2018 at Delhi and through his initiation I have represented the matter to Shri.D.V.Sadananda Gowda Minister of chemical fertilizer, Sri.J.P.Naddaji Union Minister of health & family welfare, Shri Mansukh Mandviyaji Minister of State for Chemical & Fertilizers, Shri. Jai.P.Prakash Secretary, Department of Pharmaceuticals, Shri Navadeep Rinwa, Joint Secretary, Department of Pharmaceuticals. Everybody is shocked, surprised & accepted the fact in toto. Conclusion: In principle Government of India has accepted to control trading margin on medicines at 35 percent on manufacturer’s net selling price and is thinking over a plan to amend the Act and get it approved in the Parliament.
NEWS Update
The Stop TB Partnership and India Health Fund will work together towards accelerating the roll-out of new people-centered TB innovations in India and other high-burden countries The Stop TB Partnership and the Confluence for Health Action and Transformation Foundation (“India Health Fund”) signed a Memorandum of Understanding (MOU) today in Geneva. This MOU represents a critical milestone for the tuberculosis (TB) community, as it contributes to accelerating the roll-out of new, people-centered TB innovations in the fight against TB in India and other high burden countries, in support of India’s ambitious commitment to end TB by 2025 and the targets committed to by global leaders at the United Nations High-Level Meeting (UN HLM) on TB. The MOU between the Stop TB Partnership and the India Health Fund will focus on joint advocacy and knowledge sharing to increase access to healthcare for people affected by TB in India and other high burden countries by modernizing how and where TB care services are provided, sourcing and supporting start-ups and smallmedium enterprises from India developing new, people-centered TB innovations, and identifying public and private sector donors and investors to support the Stop TB Partnership’s Accelerator for Impact (a4i) and the India Health Fund. “Signing this MOU with the India Health Fund is very promising step in the right direction. There is an unbelievable amount of gamechanging solutions coming from India, and the Stop TB Partnership strongly believes that we need to do whatever we can to get these innovations to the people who need them, not only in India but to the world. We also foresee this unique opportunity as a tangible way to strengthen our engagement with the private sector in India to jointly develop creative solutions in the vast TB space, which is in dire need of novel approaches to solve complex problems,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership. Mr. Manoj Kumar, Director, India Health Fund, said, “The vision of a TB-free world by 2030, and India by 2025, is as promising as it is challenging. To achieve this, we simply cannot rely on traditional approaches. We need to think bolder, take risks, and invest in disruptive innovations, that can accelerate TB elimination in a nonlinear manner. Solutions that are validated and scaled up in India, have the potential to catalyse elimination of the disease across the world. India Health Fund, which is seeded by the Tata Trusts, aims to aggregate philanthropic capital, and efficiently allocate the pooled funds to the most promising innovations, catalysing their lab-to-market journey. We, at India Health Fund, are delighted to formalise our collaboration with the Stop TB partnership and join hands in this endeavour to leverage the power of innovations in ending TB.” The India Health Fund is a collaborative initiative, seeded by the Tata Trusts, which endeavors to leverage the power of collective impact to eradicate TB in India by 2025. 10 Feb 2019 w w w. m e d g a t e to d a y.co m
Among 50% Infertility Cases Primary Factor Is Male Infertility
Of all infertility cases, approximately 50% is due to “male factor” infertility. As per the report of WHO on the status of infertility in India, nearly 50% of infertility is related to the reproductive anomalies in the male. Doctors of All India Institute of Medical Sciences have reported that over 12–18 million couples in India are diagnosed with infertility every year. They have reported that while the sperm count of a normal Indian adult male used to be 60 million/ml three decades ago, it now stands at around 20 million/ml. Dr Jyoti Bali, Infertility Specialist, Medical Director, Baby Soon Fertility & IVF Centre informs, in our practice we have observed that male infertility factor is the primary reason for inability to conceive specially between the age group of 29 to 35. They either have combination of low sperm concentration or poor sperm motility, or abnormal morphology. However due to social stigma, male fertility problems is considered secondary and most often go undiagnosed and untreated in some cases. 28 year old Saloni Singh was unable to conceive for 3 years after the marriage. There was constant pressure of family and friends on her. Everyone was blaming her for not getting pregnant. When she consulted the doctor, her reports were within normal limit almost fine but there was major problem in her husband’s semen analysis report. With right treatment and guidance she conceived and gave birth to a beautiful girl. There are number of factors responsible for dip in male infertility. Modern unhealthy lifestyle, lack of physical activity, high pressure job, pollution, poor diet, alcohol consumption and smoking are the culprit for increased rate of infertility in men. Tobacco use affects spermatogenesis and has been linked with low sperm count. Smoking, alcohol, unhealthy lifestyle have unfavourable effects on male semen parameters, Informs Dr Jyoti Bali, Infertility Specialist, Medical Director, Baby Soon Fertility & IVF Centre However with advancement of medical science there are assisted reproduction techniques, such as Intracytoplasmic Sperm Injection (ICSI) and IMSI (Intracytoplasmic morphologically-selected sperm injection) that can help men with poor sperm count to father a baby.
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NEWS Update
Urgent need to remove myths and misconceptions about vaccination This method is one of the most pertinent harm reduction strategies and can help prevent several diseases New Delhi, 10th February 2019: About 2 to 3 million deaths from diseases such as pneumonia, diarrhea, measles, and diphtheria are averted annually due to vaccinations. They are universally recognized as among the most cost-effective public health interventions. They are an established harm reduction strategy. Although the overall prevalence of complete vaccine refusal is <2%, the same may lead to preventable diseases in an individual. There is thus a need to create awareness about the importance of this method in the country. The first-ever conference on harm reduction organized on 30th January 2019 by the Heart Care Foundation of India (HCFI) and IJCP focused on vaccination. It discussed how the aim should be to eradicate a disease and if not, then reduce the burden in the society. Withholding vaccines from a child or an adult because of a hypothetical risk places them at risk for real infection that may have real sequelae. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Immunization is necessary for one and all. Often, people assume that it is not necessary because their children appear healthy or do not fall sick often. In other cases, health workers may not be able to reach out to some families due to non-availability of members at a certain point. There is a need to create awareness on the importance of immunization particularly for children and expectant mothers. Doing so will help us play a role in the larger good of the nation and achieve the government’s target also in a timely manner. Apart from this, there is also a need to scale up manpower, supplies, budget, and other resources to speed up the process.” Mission Indradhanush, depicting seven colors of the rainbow, targets to immunize all children against seven vaccine preventable diseases namely Diphtheria, Pertussis, Tetanus, Childhood Tuberculosis, Polio, Hepatitis B and Measles. In addition to this, vaccines for JE (Japanese Encephalitis) and Hib (Hemophilus influenzae type B) are also being provided in selected states. Apart from this, there are also vaccinations for adults. Adding further, Dr Arun Gupta Sr Paediatrician and President DMC said, “Apart from operational challenges, there is reluctance, opposition, and slow acceptance by some in the society. Vaccine hesitancy must be addressed on priority. Vaccinations are definitely one of the most imminent harm reduction strategies.” Some recommendations from the conference· • WHO has listed vaccine hesitancy as one of the 10 threats to global health in 2019. Vaccine hesitancy should be addressed on priority at every level. • Hepatitis B vaccine protects from hepatocellular carcinoma. • Human papillomavirus (HPV) vaccine protects from HPV infection, a major cause of cervical cancer. • Adult vaccination should also be addressed. 12 Feb 2019 w w w. m e d g a t e to d a y.co m
52 year old got successfully treated at Indraprastha Apollo Hospitals for acute breathlessness The patient was suffering from Swine Flu Pneumonia and had a history of hypertension and type II diabetes
“Breathlessness is a major symptom of Swine Flu, yet it gets ignored,” remarks Dr. Sudha Kansal, highlighting the unique case of Mr. Elbualy Mohamed Ali, a 52 year old Kenyan national who was suffering from Swine Flu Pneumonia and its associated complications. Ali is already a patient of hypertension and type II diabetes. He came to Apollo Hospitals with severe breathlessness and cough with mucoid sputum which progressed to multiple organ failure and lower Gastro- intestinal bleeding. His critical condition was successfully treated by Dr. Sudha Kansal, Respiratory Medicine, Critical Care & Sleep Medicine and Dr. Mukesh Goel, Senior Consultant, Cardio Thoracic & Vascular Surgeon, Indraprastha Apollo Hospitals. Explaining about the patient’s condition, Dr. Sudha Kansal said, “When the patient was brought to the hospital, he had very high fever, acute breathlessness and cough. He was required to be put on mechanical ventilation within 24 hours of his admission. Despite high ventilating support, his oxygen levels were not maintained. He had to be shifted to prone ventilation (mechanical ventilation that improves oxygenation in patients with acute respiratory distress syndrome). However, he still continued to be hypoxic (low oxygen level) and his condition was deteriorating day by day.” “Considering his critical condition we decided to put him on ECMO (Extracorporeal membrane oxygenation) support. Through this technique, prolonged cardiac and respiratory support can be provided to persons whose heart and lungs are not able to provide sufficient amount of gas exchange or perfusion to sustain life. He had a stormy course with multiple episodes of fits that required high dose medicines to control it. Later, he also developed bleeding in the lower part of large intestine requiring multiple blood transfusions. Due to this, we even had to reduce the dose of a blood thinner which is required during ECMO,” said Dr. Mukesh Goel. “With all these efforts, his condition improved gradually and he came off the ECMO support after about eight days. He was also found to have profuse muscle weakness (critical illness myoneuropathy). Hence, his tracheostomy was done. In this, an incision in the trachea is done opening a direct airway. Slowly, he came off the ventilator and the tracheostomy was closed. With intensive physiotherapy his muscle power also improved steadily and he was discharged from the hospital on a wheel chair,” further added Dr. Sudha Kansal. “The patient is doing all fine now and he came walking to the OPD one week after the discharge. We are delighted the see his progress,” Dr. Sudha concluded.
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NEWS Update
Directorate of Health Services (Government of Goa) and Sanofi India join hands to reduce diabetes burden on the State’s health exchequer Ink partnership for capacity building of healthcare personnel Launch the KiDS project to raise awareness amongst next generation adults Progressive in its approach to holistic healthcare, Directorate of Health Services today announced a 3-year partnership with Sanofi India Limited (SIL), to build awareness of diabetes and its management, for a better quality of life. Through this Corporate Social Responsibility (CSR) collaboration, Sanofi India’s team of medical experts and diabetologists will educate and upskill the State department’s healthcare personnel serving the Rashtriya Bal Swasthya Karyakram (RBSK) cell; and the Medical Officers of the Health and Wellness centers. Alongside, Directorate of Health services will also partner Sanofi India to run its international programme KiDS (Kids and Diabetes in School), to raise awareness of diabetes amongst school children. The public-private partnership between the State of Goa and Sanofi India Limited follows a two-pronged approach. One, where training on diabetes management will be conducted for the staff (doctors, counsellors and ANMs) at the RBSK cell and the Medical Officers of the Health and Wellness centres (as a part of Ayushman Bharat). The other, where education and engagement about diabetes amongst
school children (10-15 years old), teachers and parents, will help curtail the overall disease burden on the State. Commenting on the partnership, Shri Vishwajit Pratapsingh Rane, Hon’ble Minister of State for Health, Craftsmen Training, Women and Child Development, Goa said, “Goa’s population is facing diabetes-related issues that are growing at an alarming rate. Immediate action is required to curb this menace, so the State does not face repercussions in the foreseeable future. We look forward to partnering Sanofi in battling various noncommunicable diseases such as diabetes, cancer and heart disorders, which are collectively known to be responsible for over 70% of all deaths, worldwide*.” N. Rajaram, Managing Director, Sanofi India Limited said, “Diabetes must be addressed both in clinics and hospitals, as well as in classrooms and homes. Through programmes specially designed to achieve sustainable change, Sanofi is committed to working closely with States and policy-makers in their progressive efforts to fight Non- Communicable Diseases (NCD) such as diabetes, heart disorder and cancer. The impact of this
3-year CSR partnership will strengthen our fight against the diabetes epidemic.” RBSK doctors and Medical Officers of Health and Wellness Centres will participate in capacity building workshops which will help them manage NCDs better. They will also be equipped with educational tools for patients. Sanofi will also place awareness posters in the public areas of the Health and Wellness Centers. Since 2014, Sanofi has run the KiDS programme across States likes Maharashtra, Rajasthan, Gujarat and New Delhi, impacting 50,000 children and 6,600 teachers. The project supports children with Type 1 diabetes, helps manage their disease, aims to avoid discrimination in schools and raises awareness of healthy diets and physical activity among children. In Goa, Sanofi will execute the KiDS programme across 2000 schools.
Father of Indian Medical Device Industry: Mr. Narendranath is no more among us.
He’s no more but leaves behind a huge legacy of value systems to follow With his departure an era of Independence of medical device industry comes to an end. He was one of the great visionaries and dedicated Karmayogis of Indian medical industry who after Independence in 1947 , initiated another mission to reduce country's dependence on medical industry's imports and to achieve Independence in domestic production and distribution of medical devices. Absence of formal medical background did not deter his mission to commit to spirit of swadeshi, which he embraced till his last moments. He chose to lead by example and set up HMD which is now one of the largest manufacturers of medical devices in the world and first Indian healthcare MNC. He successfully demonstrated that value can be created out of strong value systems. This is a great learning for healthcare entrepreneurs of today who must reconsider their obsession for valuations over values. Sir Narendra Nath would continue to inspire many healthcare entrepreneurs to come. He always walked the talk and his foot prints would always be followed by any one who wishes to embark upon healthcare entrepreneurial journey in India. 14 Feb 2019 w w w. m e d g a t e to d a y.co m
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NEWS Update
Health Minister confers ‘Award of Appreciation’ to Rajiv Nath of AIMED for his contribution to Global Healthcare in India, Preferred Manufacturing Destination and the leading supplier of Medical Device worldwide. Mr. Rajiv Nath is also the Jt. Managing Director of Hindustan Syringes & Medical Devices Ltd. which is having a turnover of over 600 Crores, one of the largest manufacturers of Disposable Syringes in the World and the largest for Auto Disable syringes along with being the President of All India Syringes & Needles Mfg. Association (AISNMA).
Rajiv Nath
Forum Coordinator, AiMed
Mr. Rajiv Nath was conferred upon the prestigious ‘Award of Appreciation’ by Shri. Ashwini Kumar Choubey, Hon’ble Minister of State for Health & Family Welfare for his contribution to the Global Public Healthcare sector at The Award of Appreciation Ceremony held yesterday at Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, organized by Diaspora Foundation. The Award was collected by Pradeep Sarin & Manoj Tiwari from Shri Ashwini Choubey ji, Hon’ble Minister of State for Health & Family Welfare at Ministry of Health, Delhi in absence of Rajiv Nath on behalf the Indian Diaspora Foundation Mr Nath was honoured for his valuable, remarkable and outstanding achievements in the field of healthcare & community services for affordable Medtech access & patients safety initiatives. His eminence and dynamic leadership to drive innovations and contributions in medical devices for healthcare has helped India to carve out a niche for itself in the global map. He has demonstrated remarkable and exceptional performances in setting the agenda and road maps for the future healthcare by setting an exemplary entrepreneurial competency and leadership in the healthcare industry not only by his own manufacturing company Hindustan Syringes & Medical Devices Ltd but also for the entire MedTech industry segment to realize his vision to position India among the top 5 manufacturing global hubs of medical devices. As the Founder and Forum Coordinator of Association of Indian Medical Device Industry (AiMeD), with over 350 Members nationwide, Mr. Nath has taken many initiatives of establishing a collaborative framework with various Dept. of the Govt. and media to bring to their attention issues troubling the industry and attract investments into India in his quest to make India as the Global Manufacturing Hub of Medical Devices – Make 16 Feb 2019 w w w. m e d g a t e to d a y.co m
AiMeD is an Umbrella Association of Indian Manufacturers of Medical Devices covering all types of Medical Devices including consumables, disposables, equipment’s instruments, Implants, electronics and diagnostics. With a Primary Membership of over 350 Manufacturers and additionally of over 200 Associate Members representing the interest of over 700 Manufacturers of Medical Devices to address the manufacturer’s problems. (www.aimedindia.com ) Mr Nath expressing his gratitude to Shri. Ashwini Kumar Choubey and Diaspora Foundation said “I am pleasantly surprised and humbled to receive this award. It validates the contribution and efforts made by us at AIMED, HMD and AISNMA to better the healthcare sector in the country and internationally in areas of Injection Safety, Drug Delivery, Patients Safety & Affordable access. This recognition by the Indian NRI Diaspora is an appreciation of the hard work and dedication we have made towards transforming the healthcare sector in India. I thank the teams of all three organisations who were always behind me, supporting my vision and working relentlessly to meet our common goal.” Recently Mr. Rajiv Nath has also been appointed as the Member on Board of National Medical Devices Promotion Council by DIPP established to Boost & Strengthen the Indian Medical Devices Sector and lead India to an export driven market in the Medical Devices sector. We are glad MoH is serious about making PM Modi’s mission of making quality healthcare affordable and available to the masses at large” said Mr. Rajiv Nath. Mr. Rajiv Nath also applauded Union Minister of State for Health and Family Welfare Shri. Ashwini Kumar Choubey’s remarks for considering to increase custom duty on medical devices by 15-20% to promote indigenous manufacture of medical devices in order to reduce India’s 70% to 90% import dependence on Medical Devices and ensure affordable access in long run to homegrown Indian made devices.
NEWS Update
Apollo Hospitals opens South East Asia’s first Proton Therapy Centre for Cancer
Apollo Proton Cancer Centre (APPC) brings new hope to cancer patients in India and S.E.Asia Apollo Hospitals Enterprise Ltd. (BSE:508869; NSE: APOLLOHOSP), India’s first multi-speciality chain of hospitals today opened the Apollo Proton Cancer Centre (APCC), giving cancer patients access to a specialised form of radiotherapy that is extremely precise in destroying cancer cells. The Apollo Proton Cancer Centre was inaugurated in Chennai by the Hon’ble Vice President of India, Shri Venkaiah Naidu in the presence of the Hon’ble Chief Minister of Tamil Nadu, Shri Edappadi K. Palaniswami and Dr. Prathap C. Reddy, Chairman, Apollo Hospitals Group. Opening a new frontier in cancer care, the 150-bed APCC is an integrated cancer hospital in Chennai providing world-class 360o comprehensive cancer care. The APCC will offer patients advanced multiroom proton therapy with cutting-edge pencil-beam scanning technology that provides the highest degree of precision. The APCC strengthens Apollo Hospitals’ position at the frontline in the war on cancer. The clinical advantages of proton therapy as compared to conventional radiation therapy are many, with more than 200,000 patients successfully treated worldwide. Proton beam therapy takes the fight to cancer with increased precision and greater dose delivery at the precise site of the cancer, minimizing damage to healthy tissue, better quality of life and a higher cure rate. This ultimately results in better results with fewer short and longterm side effects. Speaking on the occasion, the Hon’ble Vice President of India, Shri Venkaiah Naidu said, “Cancer is a leading cause of death worldwide and is a major cause of mortality in India. My heartiest congratulations to Dr. Prathap C. Reddy and the Apollo Hospitals group on the launch of the first Proton Cancer therapy centre that will serve patients not just in India, but also our neighbours in South East Asia. This pioneering treatment also marks a new milestone in the medical journey of our country.” 18 Feb 2019 w w w. m e d g a t e to d a y.co m
The Chief Minister of Tamil Nadu, Hon’ble Shri Edappadi K. Palaniswami said, “The Proton Therapy Centre at Apollo Hospitals will make this advanced treatment for cancer care easily accessible to patients. Tamil Nadu has always been in the forefront when it comes to healthcare and with the opening of this centre, the State shall continue to offer the best to patients. We extend our best wishes to Dr. Reddy and his team for this groundbreaking effort to make the best-in-class healthcare facilities available to cancer patients in India and abroad.”
Shri G. Nageswara Rao, Chairman, AERB said, “AERB appreciates the efforts of Apollo Hospital for establishing the state of art “Proton Therapy” facility, the first of a kind in South East Asia. AERB earnestly hopes this most advanced “Apollo Proton Cancer Centre” will conquer the dreaded Cancer disease at affordable cost in a safe manner to the needy people of India and others in the region.” Speaking at the launch, Dr. Prathap C. Reddy, Chairman, Apollo Hospitals Group said, “Today is a red letter day in the history of healthcare in India. The launch of the Apollo Proton Cancer Centre puts India on the global map for the best and latest in cancer treatment and will give new hope to cancer patients not just in India, but across South East Asia,
the Middle East and Africa, i.e., countries that comprise over 40% of the world's population! It is pertinent to note that even a first world country like the U.K. launched a Proton Beam centre just last month, in December 2018, making our achievement in bringing this best and latest medical technology to India truly praiseworthy. It is with a sense of pride that we dedicate the Apollo Proton Cancer Centre to the health of the nation!” Ms. Preetha Reddy, Vice Chairperson, Apollo Hospitals Group said, “The state of the art Proton Therapy at Apollo Proton Cancer Centre introduces a new frontier in cancer management. With a proven capability to treat a wide spectrum of cancers, Proton Therapy has gained tremendous momentum globally, due to its ability to greatly enhance treatment in challenging cancer sites with minimal side effects ensuring superior quality of life. The advanced precision of Proton Therapy will now provide new hope to millions of patients for whom treatment options are limited due to the type or site of the cancer and is testament to our commitment to bring the latest proven developments in medical technology for the benefit to our patients.” On the occasion Ms. Suneeta Reddy, Managing Director, Apollo Hospitals Group shared, “Apollo Hospitals has been at the forefront of the incredible progress made by healthcare and oncology in India in the last three decades, so much so that a cancer diagnosis is no longer a death sentence. We have replaced fear with hope and have given millions of patients the courage to fight the disease and emerge as survivors. With the Apollo Proton Therapy Centre, we will offer patients an answer beyond treatment and survival – we will offer them “survivorship” a full life with an enhanced quality of life for many decades after treatment. Our investment in Proton is a reiteration of our commitment to putting the patient at the centre of everything we do because India deserves the best!”
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NEWS Update
H.E. Humaid Al Qutami, Director-General of the Dubai Health Authority, inaugurates new 150 Bed Multi-Specialty Aster Hospital in Al Qusais With this new facility, Aster DM Healthcare strengthens presence in UAE, with 2 Aster Hospitals and 4 Medcare Hospitals. To match the changing requirements of Dubai’s population with mandatory insurance cover, the hospitals will provide tertiary treatments. Over the last three years, Aster DM Healthcare has invested AED 750 million in UAE and another AED 250 million is envisaged over the next two years. Total estimated investment of AED 1 billion in 5 years in UAE, with 2 new hospitals expected to come up in the next 3 years. H.E. Humaid Al Qutami, Director-General of the Dubai Health Authority (DHA) formally inaugurated the 150-bed multispecialty Aster Hospital located in Al Qusais, in presence of Dr. Azad Moopen, Founder Chairman & Managing Director of Aster DM Healthcare and H. E Abdulla Ahmed Al Habbai, Chairman of Dubai Holdings and Group Chairman of Meraas. H.E. Humaid Al Qutami, Director-General of DHA commented, “Increase in demand for quality health services due to Dubai’s rapid urban development, rise in demand for inpatient services and influx of medical tourists has necessitated the continued need to support and encourage the development of world-class healthcare delivery system. At DHA, we remain committed to support a conducive environment for investments and encourage the leading healthcare players like Aster to play an active role in shaping the sector. Through the launch of this new hospital today, we are glad that Aster DM Healthcare is adding more beds with advanced treatment facilities in UAE.” “The 150-bed Aster Hospital in Al Qusais, with 352 employees will have all the usual specialties with new specialties like neurology also being introduced. Apart from 38 doctors at Aster Mankhool, the new hospital would also tap into Aster DM Healthcare’s network of over 2500 doctors to bring-in acclaimed specialists in UAE. Some of these doctors have performed complex surgeries like organ transplants, brain and cardiac surgeries. With high-prevalence of chronic non-communicable diseases like cardiovascular disease and diabetes, an increased availability of tertiary care expertise locally, is the need of the hour. The new hospital is part of Aster DM Healthcare’s continued commitment as an integrated healthcare service organization to cater to the growing needs of the population while making quality healthcare easily available and more accessible for people. We are grateful to DHA for its continued patronage and for being an enabler in our mission. Our approach to care aligns with a universal principle of human beings treating each other 20 Feb 2019 w w w. m e d g a t e to d a y.co m
well to ensure social progress and betterment, supporting the values of tolerance and co-existence whilst also supporting the happiness agenda,” said Dr. Azad Moopen. A combined bed capacity of 275+ is now being offered by Aster Hospitals, spread across the two locations. In total, Aster DM Healthcare now offers a bed capacity of 600+ across its facilities in UAE. At Al Qusais, further to facilities including as many as six operation theatres, the hospital features a critical care unit, a neo-natal unit, 24-hour emergency care and a pharmacy, in addition to a range of recovery rooms at scalable price points. Obstetrics and gynecology, pediatrics and neonatology, gastroenterology, colorectal surgery, neurology, neurosurgery, ENT, endocrinology, orthopedics, urology, nephrology, ophthalmology, general & laparoscopic surgery, dermatology, internal medicine, dentistry, emergency medicine critical care, 24/7 emergency room and trauma care, radiology, pathology, rehabilitation, pulmonology, cardiology, family medicine, hepatology, anesthesiology, oncology are some of the specialisms on offer. Specialisms including rheumatology, hematology and bariatric, vascular and plastic surgery will be offered in the near term.
NEWS Anupriya Patel Gets Candid Update
About Modi Govt. Healthcare Initiatives
Government of India Ministry of Health and Family Welfare
H
ealth is an important cornerstone to the Govemment's vision of development, 'swasth Bhorat, Samriddhq Bharat '(Healthy India, Prosperous India). With this vision, the Govemment is implementing various schemes, programmes and initiatives to provide universal access to quality healthcare in the country. The National Health Mission of the Government envisages universal access to equitable, affordable and quality healthcare services that are accountable and responsive to people's needs. To fulfil the vision of 'Health for All' and 'Universal Health Coverage', enshrined in the National Health Policy 2017, the Govemment conceived Ayushman Bharat' (Healthy India), a pioneering initiative in the health sector. Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. It adopts a continuum of care approach, comprising of two interrelated components, namely Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojna (PMJAY). The first component envisages creation of 1,50,000
Anupriya Patel
Minister of State For Health & Family Welfare Government of India
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Health and Wellness Centres in the country by 2022 which will bring health care closer to the homes of the people. The second component is the Pradhan Mantri Jan Arorya Yojana (PMJAY) which provides health protection cover to poor and vulnerable families. Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana aims to cover over l0 crore poor and vulnerable families (approx. 50 crore beneficiaries) providing coverage of up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization. After a gap of 15 years, the Government approved the National Health Policy (NHP) 2017 which addresses the current and emerging challenges necessitated by the changing socioeconomic, technological and epidemiological landscape. Under NHP 2017, the Government is committed to raise public health expenditure progressively to 2.5o/o of the GDP by 2025. The Policy aims to attain the highest possible level of health and well-being for all at all ages through a preventive and promotive healthcare and universal access to quality health services ensuring that no one faces financial hardship as a consequence. NHP 2017 advocates allocating major proportion (two-thirds or more) of resources to primary care and aims to ensure availability of two beds per 1,000 population distributed in a manner to enable access within 'golden hour'. The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) is being implemented with the aim to correct regional imbalances in the availability of affordable/reliable tertiary healthcare services and also to augment facilities for quality medical education in the country. It envisages setting up of AIIMS-like institutes and upgradation of existing Govemment Medical Colleges/ Institutions in various parts of the country. India's Universal Immunization Programme (UIP) is one of the largest public health programmes in the world. It targets 3 crore pregnant women and2.7 crore new borns annually. More than 90 lakh immunization sessions are conducted annually. It is the most cost-effective public health intervention and largely responsible for reduction of vaccine preventable under- 5 mortality rate. Mission Indradhanush launched in December 2014, targets to immunize children who have either not received vaccines or are partially vaccinated. Four phases of Mission Indradhanush have been completed wherein 3.38 crores children have been vaccinated, of which 81.67 lakh children have been fully immunized. Intensified Mission Indradhanush (IMI) was launched for the areas where immunization coverage has been very low in spite of repeated phases of Mission Indradhanush with an aim to rapidly build up full immunization coverage. New vaccines namely, Inactivated Polio Vaccine (IPV), Adult Japanese Encephalitis (JE) Vaccine, Rotavirus Vaccine,
NEWS Update
Measles-Rubella (MR) Vaccine and Pneumococcal Vaccine (PCV) have also been introduced. National Vector Borne Disease Control Programme of the government tackles the challenges posed by the vector borne diseases like Malaria, Dengue, Chikungunya, Japanese Encephalitis (JE), Kala- Azarand Lymphatic Filariasis. The Ministry has developed the National Strategic Plan (NSP) for Tuberculosis (2017-25) which builds on the success and learning of the last NSP and encapsulates the bold and innovative steps required to achieve sustainable development goal on TB in India by 2025, five years ahead of the global timelines. Achievements made under Revised National TB Control Programme (RNTCP) can be gauged from the fact that more than 2 Crore patients are on treatment under it and it has saved more than 35 lakh lives in the country. Steps have also been taken to specifically strengthen maternal, child and adolescent health care services in the country. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aims to provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month. PMSMA has been rolled out in all States/ UTs. Labour Rom Quality Improvement Initiative (LaQshya) has been launched to improve the quality of care that is being provided to the pregnant mother in the Labour Room and Maternity Operation Theatres, thereby preventing the undesirable adverse outcomes associated with childbirth. Intensified Diarrhea Control Fortnight (IDCF) is being observed during July-August every year since 2014 with the ultimate aim of 'zero child deaths due to childhood diarrhea'. RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK) is implemented for child screening and free treatment for 4 Ds i.e .Defects at birth, Diseases, Deficiencies and Development delays including disability. It Provides for free management of 30 selected health conditions. RASHTRIYA KISHOR SWASTHYA KARYAKRAM (RKSK) is being implemented as a comprehensive programme focusing on Sexual Reproductive Health, Nutrition, Injuries and violence (including gender based violence), Non-Communicable Diseases, Mental Health and Substance Misuse with a promotive and preventive approach. National Nutrition Mission, a joint effort of MoHFW and the Ministry of Women and Child development (WCD) was launched towards a life cycle approach for intemrpting the intergenerational cycle of under nutrition. The impact of the mission is envisioned to reduce the level of stunting, undernuirition, anemia and low birth weight babies. In order to prevent and control major Non-Communicable Diseases, the Government is implementing National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in all States across the country with the focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral. Recently launched population-based initiative for Diabetes, Hypertension and Common Cancers (Oral, Breast and Cervical) is an important move towards control of these non-
communicable diseases. National Multi sectoral Action Plan to prevent and control NCDs has been developed in consultation with a range of stakeholders including 39 Departments of the Government of India. The plan and process of its development has led to scaling up of a number of interventions, having direct impact on NCDs, but outside the health sector. India's multisectoral efforts in prevention and control of NCDs have been recognized by United Nations. With the aim to reduce the expenditure incurred by common patients on treatment of Diabetes, CVDs, Cancer and other disease, AMRIT (Affordable Medicine and Reliable Implants for Treatment) pharmacies have been set up across 23 states for providing medicines for Diabetes, CVDs, Cancer and other disease at discounted prices to the patients. Various legislative measures have been undertaken to strengthen the health services in the country and to ensure life of dignity and respect for those suffering from certain diseases. The Government has approved the Allied and Healthcare Professions Bill,20l8 for regulation and standardisation of education and services by allied and healthcare professionals. Medical Devices Rules, 2017 have been notified for comprehensive regulation of Medical devices notified under the Drugs and Cosmetics Act. The new rules are harmonised with the intemational regulatory practices and provide comprehensive legislation for the regulation of Medical Devices to foster India specific innovation and provide a fillip to 'Make in India'. National Medical Commission Bill 2017 has been introduced which will replace the Medical Council Act, 1956 enabling a forward movement in the area of medical education reform. The Mental Health Care Act, 2017 adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in provision of mental healthcare services in order to protect the rights of people with mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect. HIV & AIDS (Prevention & Control) Act,2017 has been enacted with an aim to end the epidemic by 2030 in accordance with the Sustainable Development Goals set by the United Nations. The Act ensures that a person living with AIDS is not treated unfairly at employment, educational establishments, renting a property, standing for public or private office or providing healthcare and insurance services. Acknowledging the importance of ASHA workers in improving the delivery of health services in the country, the Government has taken a landmark decision to double the routine and recurring incentives given to ASHA workers from Rs. 1000 per month to Rs. 2000 per month. In addition, all ASHA workers and their helpers would be provided free insurance cover under Pradhan Mantri Jeevan Jyoti Bima Yojana and Prime Minister Suraksha Bima Yojana. Thus, the Govemment has adopted multipronged strategy to address health issues in the country and to ensure universal access to quality health services ď Ż w w w.medgatetoday.com â&#x20AC;&#x201A; Feb 2019
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Interim Budget
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Industry Speak
MEDGATE TODAY LAUDS INTERIM BUGET 2019-20
GOVT. STRENGTHENS THE FOUNDATION FOR VISION 2030 DISTRESS FREE AND COMPREHENSIVE WELLNESS SYSTEM FOR ALL
P
ast five years have seen massive scale up of health care. Earlier, a poor man used to be in dilemma whether to fulfil daily needs of the family or save the life of an ailing member. This situation has deeply pained our Hon'ble Prime Minister. We launched the world's largest healthcare programme, Ayushman Bharat, to provide medical treatment to nearly 50 crore people. Already close to 10 lakh patients have benefited for medical treatment which would have cost them Rs 3,000 crore through free treatment made available under the scheme. Lakhs of poor and middle class people are also benefiting from reduction in the prices of essential medicines, cardiac stents and knee implants, and availability of medicines at affordable prices through Pradhan Mantri Jan Aushadhi Kendras”, said Piyush Goyal during his Interim Budget Speech in Lok Sabha. Waiting for the budget with enthusiasm and anxiety, the healthcare sector welcomed Modi Government’s interim budget promising vision 2030: a distress free and comprehensive wellness system for all. The budget having something for everyone in its kitty greeted the health sector with higher budget allocations.
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Some of the Highlights of the Budget in Healthcare Section are:
R s. 61,398 crore for the healthcare segment, 16% higher than last year’s Rs. 52,800 crore. R s. 6,400 crore for Ayushman Bharat PM Jan Arogya Yojana (AB-PMJAY) which provides Rs. 5 Lakh per annum family for treatment of diseases. S o far, 10 lakh patients are believed to have benefitted from the scheme. R s. 4000 crore for Pradhan Mantri Swasthya Suraksha Yojana R s. 250 crore for establishing Ayushman Bharat Health and Wellness Centres under National Urban Health Mission R s. 1,350.01 crore for Ayushman Bharat Health and Wellness Centers under National Rural Health Mission. R s.700 Crore for Family Welfare Schemes R s. 25,789 crore for National Rural Health Mission. R s. 950 crore for National Urban Health Mission 2019-2020 R s. 4,250 crore for Human Resources for Health & Medical Education R s. 2,500 crore for National AIDS and STD control Programme R s.550 Crore for Tertiary Care Programmes R s.1,500 Crore for Medical Treatment of CGHS Pensioners. R s.1361 crore to strengthen Government Medical Colleges (undergraduate seats) and central government health institutions R s. 800 crore for upgradation of State Government Medical Colleges (Post Gradaute seats) R s.20 crore for establishment of State Institutions of Para Medical Sciences and colleges of Para-Medical Education. R s. 2000 crore for upgrading district hospitals. R s. 3599.65 crores for setting up New AIIMS 2 1 AIIMS known to be either already established or being established. 2 2nd AIIMS announced to be established in Haryana. The Healthcare segment of the budget not only pleased the
COVER
Interim Budget
STORY
Industry Speak
industry experts but also strengthened its promise to improve the condition of lakhs of poor and middle class families. The launch of Ayushman Bharat Scheme which aims to benefit 10 crore families with free treatment of patients upto the cost of Rs.5 Lakh per annum per family is a step towards providing affordable healthcare to the people. Making available to lakhs of patients the benefit of reduction in the prices of medicines, cardiac stents and knee implants through Pradhan Mantri Jan Aushadhi kendras is another such initiative.
Many economists believe that governments all over the world must invest in Healthcare Sector which can be seen as a push towards economic development. If the nation’s work force is healthy it can contribute better towards economic development. Higher budgetary allocations and Hon’ble Prime Minister’s initiatives indicate that the budget will go a long way in laying the foundation of New India as a Healthy India is necessary for India’s success story.
Ashish Gupta CEO, Docprime.com
The interim budget presents some encouraging possibilities for the social and healthcare sector. While the details are still to be studied, it is reassuring to see the official recognition of Artificial Intelligence with the announcement of the National Artificial Intelligence Centre and National AI Portal. AI is critical for the Healthcare sector to mitigate the unfavorable doctor-patient ratio in INDIA, which is further compounded by the rich-poor and urban-rural divide. This combined with 2030 vision of 1 lakh digital villages could help transform the way healthcare is delivered in the country. We do hope these initiatives will be rolled out effectively and fuel a spurt of healthcare innovation in the country.
Ms. Suneeta Reddy
Managing Director, Apollo Hospitals Group Ayushman Bharat for the financially weaker section took centre stage in healthcare last year. However, the middle class is still at risk! A first step to universal health coverage would be to increase deduction for medical insurance premium u/s 80D for self, family and dependant parents. An enhancement in the medical allowance for salaried employees in line with inflation and a separate deduction in respect of preventive health checks would be desirable. Declaration of a National Priority Status for Healthcare to support investment like subsidized infrastructure, tax holidays, monetary and fiscal incentives is hoped for. We look forward to zero-rating of GST for the sector, or for normalization of the GST rates for services consumed by the health care service providers at 5%. Reinstatement of weighted deduction under section 35AD of Income Tax Act, 1961, which would promote setting up greenfield healthcare projects. Given the tremendous potential of Medical Value Tourism, we hope that the budget will show far-sightedness in exempting this income, thereby making “Heal in India” the new mantra. A Healthcare Infrastructure Technology Upgradation Fund that would provide subsidies for capital investment in upgradation of healthcare infrastructure is the need of the hour. A healthy India will have a significant impact on the health of the economy, with the potential to spur GDP. We look ahead to a budget which builds a healthy foundation for this
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Interim Budget
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Industry Speak
Mr. Arindam Haldar CEO, SRL Diagnostics
The interim budget presented by the honourable finance minister is on expected lines given that the country is going to polls in another few months. However, we would have expected more for the healthcare and diagnostics sector given that that seems to be the stated focus of the government since the beginning. The last year has been a challenging one for India’s private healthcare providers. Increasing costs of doing business as well as an overall slowdown in consumers business due to increased competition and most of the sector being in expansion mode. The overall sector has become less attractive for investments without which growth gets hindered significantly. We welcome the proposals for the middle class and we expect it will encourage people to increase expenditure on consumer healthcare and preventive care. Further, the intent expressed in the budget, especially regarding the goals and increased fund allocation for Ayushman Bharat, are commendable. But what remains to be seen is the execution part of it. The government must look at better partnerships and incentives for the private healthcare and diagnostic providers if it expects to successfully achieve its target of universal healthcare for all in the country in the next few years. The cost reduction of secondary and tertiary care hospitalization facilities and medication has already benefitted lakhs of people across the nation. The proposal to strengthen the healthcare infrastructures of the economy by inaugurating multi-speciality hospitals such as AIIMS or primary healthcare centres is also to be appreciated.
Dr Partap Chauhan Director Jiva Ayurveda
We welcome the Central Government’s announcement to open the 22nd All India Institute of Medical Sciences (AIIMS) in Haryana. A world-class medical facility like AIIMS in Haryana will further the cause of providing comprehensive healthcare to all in the state. In November 2018, it was announced that Ayurveda departments will be opened in all the new 19 AIIMS, such initiative will further the government’s mission of ‘Ayurveda for Public Health’. A few months ago, the Ministry of AYUSH took the pioneering step of publishing the guidelines for insurance coverage to Ayurvedic treatment and settlement of claims on the basis of benchmark rates for various interventions. Following this the Insurance Regulatory Development Authority (IRDA) issued clarifications to general and health insurance companies and Third Party Administrators (TPAs) to provide coverage to Ayurveda and other systems of medicines under AYUSH. We hope in coming years Ayurvedic treatment will also be covered under Ayushman Bharat, the world’s largest healthcare programme.
Ragunathan Kannan
Director, Sathguru Management Consultants Private Limited This budget is a good cocktail of prudence and populism, being the last one before upcoming election. The boost to middle class and MSME is in the right direction. The tax section contains quite bit of rational announcements, which will go to improve overall savings and growth rate. Overall, well balanced in the interim.
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COVER
Interim Budget
STORY
Industry Speak
Ms. Sangita Reddy
Joint Managing Director, Apollo Hospitals Group The interim budget threw light on the Government’s dedication to a healthy India with a distress-free healthcare system. The budget mentioned the Government’s aim to bridge the urban rural divide and provide benefits that people in a city have to those staying in villages. Healthcare should be a critical component of these efforts. We must not lose this opportunity to address the urban-rural imbalance in health infrastructure and ensure specific policies to encourage private sector to invest in the same. The announcement of a National Centre on Artificial Intelligence is also a big positive. AI today has great potential in transforming and designing new tools which will equip doctors in the fight against non-communicable diseases. At Apollo, we have already taken the first step with an Intelligent Platform designed to predict cardiovascular disease risk score for Indians.”
Mr. Siraj Dhanani & Mr. A. Vijayarajan Founders, InnAccel Technologies
Creating a healthy India with distress-free and comprehensive wellness system for all is a laudable aim, which can be achieved by the widespread adoption of indigenously developed medical technologies that solve problems faced by Bharat and India both. Artificial intelligence has the potential to disrupt Healthcare Delivery in the country. With the focus on Digital India in the last few years and integrated with this New AI initiative will help us to meet some of the challenges in the Healthcare Industry.
Mr. Manish Sacheti CFO, Ziqitza Healthcare Ltd
We applaud the Government on the announcement of a budget directed towards the lesser privileged and middle class population. The budget this year has indeed addressed a lot of issues that will help the economy to prosper. The allocation of INR 19,000 crores for the development of the roads in the rural areas is a great initiative. Being an emergency medical provider, this will help us reach out to the remotest corners of the country which has connectivity constraints. The success of the Ayushman Bharat Scheme is commendable and we are glad that the healthcare sector of the country is undergoing a significant transformation. We hope that the Skill India program will include training of youths to become dedicated paramedics to help efficient and quality ambulance services. One avenue that should have been looked at is making Healthcare services "zero-rated" under GST provisions, instead of being exempted, as the cost of inputs throughout the industry could further be reduced by claiming refunds of taxes paid on these inputs. This would help to enable these specialized services to reach out to the masses.
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COVER STORY
Interim Budget
Industry Speak
Dr. Alok Roy
Chairman Medica Group of Hospitals A populistic Budget with an eye on election. Hopefully, this will be good to both sides. We can see significant measures to help poor and marginal population of our country. We wish best to both-policy makers and people of our country, said Dr. Alok Roy, Chairman Medica Group of Hospitals. “Now that the Interim Budget is announced, people of the country will look forward to how best the policies are implemented. In terms of healthcare, the citizens of India, will look forward to even better facilities and more infrastructural developments in deeper pockets and hinterlands. Upgrading the national health mechanism should always be a primary agenda for any government to come. We can see significant measures to help poor and marginal population of our country in this interim budget,” added Dr Roy.
Mr. Antony Jacob
CEO Apollo Munich Health Insurance Today’s budget has maintained a pragmatic balance between the country’s economic development and holistic growth. While the Vision 2030 is a commendable move taken towards building a distress-free and comprehensive wellness system for all, it will act as an impetus in making India health confident. Also, the full rebate on income up to Rs 5 lakh will leave more money with people to buy health insurance and other investment avenues, which will ensure their financial security against unforeseen situations. said Mr. Antony Jacob, Apollo Munich Health Insurance
Mr. Anurag Yadav
Chief Financial Officer, Parkway Pantai - India Operations Division Interim Budget 2019 has continued commitment on the free health coverage to being continued for about 50 crore Indians under the Ayushman Bharat scheme. It was also mentioned in the budget that the prices of medicines have come down with the control of drugs, stents, and knee implant prices. The government reiterated its vision of creating a healthy India, with distress-free and comprehensive wellness system for all” “Under the government’s India 2030 vision, the ninth and tenth dimensions focus will be on healthy India and a comprehensive wellness system, respectively. It remains to be seen how this will help the healthcare industry to grow and the overall development of health eco system” says Mr. Anurag Yadav, Chief Financial Officer, Parkway Pantai - India Operations Division 28 Feb 2019 w w w. m e d g a t e to d a y.co m
COVER
Interim Budget
STORY
Industry Speak
Dr. BS Ajaikumar
Chairman and Chief Executive Officer, HealthCare Global Enterprises Ltd (HCG) Dr. BS Ajaikumar is the Chairman and CEO of HCG. Dr. BS Ajaikumar founded HCG to realize his vision of making advanced cancer care accessible to all. He has been the driving force behind HCG’s growth since 1989. Dr. BS Ajaikumar’s contribution to the field of cancer care in India as well as his achievements as a first-generation physician entrepreneur has been widely recognized. He has been awarded the Ernst and Young Entrepreneur of the Year Award, the CII Regional Emerging Entrepreneurs Award, and the BC Roy Award by the Indian Science Monitor. Dr. Ajaikumar’s model for cancer care in India is now a case study at the Harvard Business School. Through his vision for accessible and affordable cancer care, Dr. Ajai through HCG’s hub & spoke model has been encouraging and mentoring fellow doctors to emerge as health entrepreneurs. Today, under his leadership, cancer care in India has seen a paradigm shift and cancer care has been redefined as a chronic disease. Dr. BS Ajaikumar has been a practicing Oncologist in the US and India for over three decades. He completed his residency training in Radiotherapy from the MD Anderson Hospital and Tumor Institute of the University of Texas, and his residency training in Oncology from the University of Virginia Hospital, Charlottesville. He received his MBBS from the St. Johns Medical College, Bangalore.
Shanthini Arunthavanathan
Chief Financial Officer (CFO), Westminster Healthcare The 2019-20 union budget comes as a cheer to many due to the government’s attempt of creating a mass -budget this year with special focus on rural health. Ayushman Bharat Scheme that was launched last year for providing medical treatment to around 50 crore people have so far treated 10 lakh people who could save nearly Rs 3,000 crore. This is a great achievement by the country’s healthcare and roping in private hospitals to the scheme as proposed by the government last year will certainly provide more teeth to it. However, more allocation of fund for appropriate execution of the scheme was a necessity and was expected. Apart from announcing about 14 new AIIMS since 2014, the announcement regarding setting up of 22nd All India Institute of Medical Sciences (AIIMS) in Haryana is a welcome move towards enhancing advanced medical research in India, producing a greater number of qualified medical professionals and expanding opportunities for the aspiring medical students of the country. The government’s vision towards having a distress free healthcare and a functional, comprehensive healthcare system by 2030 are praiseworthy. Availability of drugs at a subsidised price at Jan Aushadhi Kendras and implementation of a price cap on drugs have made medicine affordable for all. With five lakh villages being declared open-defecation free along with achievement of over 98% rural sanitation coverage, there will be a certain improvement in both rural and urban health condition.
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COVER
Interim Budget
STORY
Industry Speak
Mrs. Neerja Birla
Founder and Chairperson, Mpower "With the new budget comes an indication that we will be taking on a more comprehensive approach to healthcare and wellness, and I think that it is definitely aimed in the right direction. However, I hope that this holistic vision will mean a more focused approach to mental health as well, especially in terms of creating the required infrastructure and encouraging more mental healthcare professionals. According to the plans outlined, there should be around 1.5 lakh Health and Wellness Centres by 2022, and I do hope that the promise of affordable treatment extends to mental health as well. While we are taking positive steps to provide health insurance and reduce the burden of medical expenses on lower income families, I think it would not be as effective in the long run if it does not offer the same for mental health concerns as well. 1 in 5 Indians suffer from a mental health concern, and if left unaddressed, we could be seeing its negative impact on our economy to the tune of trillions by 2030."
Tejbir Singh CEO, AffordPlan
“Interim Finance Minister Piyush Goyal has essayed the role of healthcare in Budget 2019. The combined outlay is a massive 16.65 percent more than the amount budgeted for 2018-19. He has also highlighted the role played by the largest public health insurance program — Ayushman Bharat, which was launched last year. While the government is working on a comprehensive wellness system, more clarity is needed on the Budget allocation for this health insurance program, which aims to provide insurance to the common man of up to INR 5 lakh per family per year for hospitalization expenses. The increasing medical inflation is a worry today. Fin-tech startups in healthcare like us will have a role to play by designing relevant healthcare focused financial products for better access and affordability to high quality medical care for a common man. I also feel the government should initiate a dialogue with platforms like us in policy making.”
Vijayaraghavan Kannan
Chairman, Sathguru Management Consultants Private Limited he budget focuses extensively in addressing the rural sector pain and will provide bottom up propelled change in rural economic livelihood. The focus on fishery sector is commendable and the digitization of villages for networked connectivity. However, the agriculture transformation would require game changing technologies to be deployed for farm productivity and a focus on bringing that change would have complimented the contemplated reforms in rural agriculture.
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COVER
Interim Budget
STORY
Industry Speak
Pushpa Vijayaraghavan
Director & Healthcare Practice Lead, Sathguru Management Consultants Private Limited The budget has extensive focus on the rural dwellers and middle class. Farmers stand to gain with the direct income transfer and the salaried class finally gets its due with the Rs. 5 lakhs tax exemption. The attention to animal husbandry and especially fisheries is a positive step as this significant potential to result in tangible enhancement of farmer incomes. However, there is negligible visibility on roadmap for growth targets being actualized. The healthcare and education sectors are still crying for attention – while we continue to be excited about the transformative potential of the Ayushman Bharat scheme, without a significant allocation or incentives for creation of healthcare delivery capacity, the scheme will remain a goal and will not translate to tangible reality. The healthcare sector across pharmaceuticals, medical devices and healthcare delivery need urgent attention but haven’t received any focus. The API problem in pharmaceuticals is a national security threat and remains unaddressed. Overall, my biggest disappointment is that the manufacturing sector and industry have been ignored and no tangible measures have been rolled out for industrial growth and resultant job creation.
Dr Shravan Subramanyam
Managing Director, India and Neighbouring Markets, Roche Diagnostics India "The Union Budget 2019 speech this morning clearly spelled out the Central Government's scale-up in healthcare initiatives over the past few years. This is encouraging as this focus helps augment and strengthen health access across India. While establishing access through healthcare infrastructures like hospitals and medical colleges is great, focused and planned expenditure on improving participation from the public in preventive healthcare at these hospitals through awareness programmes is important. With the announcement of ambitious projects like Ayushman Bharat last year, expectations were high for the 2019 Budgetary recommendations on healthcare. Some inclusions on outpatient care and diagnostics would have been great. We would have liked to see in this Budget a roadmap for healthcare development programmes announced last year to be implemented seamlessly across the country
Mr. Parag Agarwal
Founder & CMD, Janajal - Water Sector As expected, this is a positive Budget with several announcements for the social and economic welfare of the country in the long term, much in line with the Government’s intention of a “New India” by 2022. It is heartening to see safe drinking water to all Indians as part of the Government’s plan by 2030. Water ATMs have a big role to play and can help achieve this vision much sooner. Safe water made accessible to people in a decentralised format such as water ATMs can have a force multiplier effect on the Government’s intentions through good health and wellness besides job creation and social entrepreneurship
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COVER
Interim Budget
STORY
Industry Speak
Dr. Manoj Luthra CEO- Jaypee Hospital
The honourable finance minister’s proposals laid out in today’s budget are commendable. The focus on assuring access to quality healthcare services has the potential to change the way Indians live and work. National Health Protection Scheme-Ayushman Bharat has taken long strides to ensure the achievement of the Prime Minister’s vision of providing quality and affordable healthcare facilities to all. Already around 10 lakh poor and vulnerable people have benefited through the free medical treatment made available under the scheme. Significant number of poor and middle class people are also benefitting from the reduction in prices of essential medicines, cardiac stents and knee implants at affordable prices. Government’s approach to advance the healthcare infrastructures of the economy by inaugurating multi-speciality hospitals such as AIIMS or primary healthcare centres is also significant. Healthcare is a backbone of any economy and a healthy India is essential to keep up the growth momentum of our nation and contribute towards becoming a $5 trillion economy in the next five years. I congratulate government on their visionary approach to building a distress-free and comprehensive healthcare system for all.”
Mr. Gaurav Gupta Co-founder, Navia Life Care
Government's focus on improving tertiary healthcare in the country is evident from this budget and earlier announcement of National Health Protection Mission. This should help in improving the access to high-quality care for Indian in rural areas. Healthcare is one of the key priority areas in the National Artificial Intelligence Program, which will help in evolving the ecosystem and create a larger talent pool of AI professionals and improved innovation in the industry. With villages becoming digital villages, we expect an increased penetration of technology products in general, healthcare providers and insurance providers would also be able to help the population far and wide in the country
Vivek Srivastava
CEO and Co-founder, HealthCare atHome The interim budget is a dream budget for the middle-income group. The government has successfully pleased the farmers and service class by introducing pensions, increasing gratuity, and tax rebates. Although Mr. Goyal counted the government's achievements in the healthcare sector, I was hopeful of some new developments in the Ayushman Bharat Healthcare scheme. The ambitious nature of PM-JAY requires continued analysis and upgradation to ensure its success. New features like introducing home healthcare solutions in the ambit of Ayushman Bharat to further increase accessibility and availability of healthcare to the masses, can make the scheme more comprehensive. Overall, I believe it is a people's budget but I was hopeful of seeing more policies or announcements around health.
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COVER
Interim Budget
STORY
Industry Speak
Mr. Vikrant Gugnani
Founder and Managing Director, UCare. The Finance minister has announced a "people's budget"! Even though this was an interim budget, the focus on delivering benefits to farmers and unorganised workers, tax cuts for the middle class and a kicker on real estate investments while aiming to keep the fiscal deficit more or less the same is a great achievement. These sops are the result of a smart uptick in tax collections, both direct and indirect, over the last 2 years - giving the government the ability to balance the books.
Nikunj Turakhia
President, Steel Users Federation of India The Union Budget-2019 is growth oriented and populist. It has taken into consideration in grieved farmers, lower and middle class. This is the first time that any government has worked with such a broad vision. The speech of Finance Minister Mr. Piyush Goyal highlighted achievements of the present government and the journey it has set forth in the last four and a half years. The vision of this government, no doubt is superlative and it will be interesting to know how this will be implemented. The interim budget was rhetoric in nature and sounded as the manifesto to the upcoming election. The ten dimensions it has conceived are laudable. This budget has many positive provisions such as PM Kisan Samman Nidhi Yojana a project worth 75 thousand crore that guarantees direct income support to poor farmers of upto Rs 6,000/year. Also, PM Shram Yogi Mandhan Yojana provides pension to unorganised sector workers after the retirement age of 60 years. The defence of the country is very important and the budget increased the allocation to three lakh crores. A relief to three crore middle class individuals is that tax rebate is increased to five lakh rupees. Also, no income tax will be levied on notional rent for people having second self-occupied home. This Budget is definitely a welcome note for every citizen of the country. For the first time it feels that management of economy is solid and all macro-economic parameters are in order. With this the nation will gain further impetus and grow in the right direction by increasing expenditure and giving more buying power to middle class. However, the government should have proposed this budget last year or earlier. Yet, I hope it is still not too late and in order to continue India’s growth, we cannot afford to be complacent.
Pankaj Aswani
Founder & CEO of Coolberg Beverages Private Limited Today’s budget to be consumer friendly “By giving more spending power to the middle class, the budget has proved to be an impetus to the consumer goods market. The government’s focus on rural reforms will also help uplift the retail industry. Initiatives like MGNREGA, PMGSY will play a crucial role in development of infrastructure and raise the standard of living for lower and middle class population of India.
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COVER STORY
Latest Angioplasty techniqueA boon for renal failure patients
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oronary Angioplasty is a wellestablished treatment for blockages in the coronary arteries. When performed by an experienced operator in a center where it is routinely done, it is safe and has good long-term results. An iodine contrast dye is used during coronary angioplasty. This dye is removed from the body by the kidneys. In patients with renal insufficiency or dysfunction, the dye can further damage the kidneys, hence caution should be excised in these patients. In patients with acute renal failure or Acute Kidney Injury (AKI), the use of this dye is contraindicated. In patients with chronic renal insufficiency or Chronic Kidney Disease (CKD) it can be used with caution, safely upto a creatinine value of 2mg/dl.
In patients with a creatinine above 3 mg/ dl it is better avoided. There is a chance of landing up with acute renal failure needing dialysis. With newer technological advancements in the field of angioplasty and intracoronary imaging, it is possible to do angioplasty safely in these patients with no or minimal dye. Intravascular Ultrasound (IVUS) is a device which can image the coronary artery lumen and tell the operator about the extent of the blockages, length of the lesions and diameter of the coronary artery to be stented, without using contrast.
One such patient with Chronic Renal Failure who had multiple blockages in the coronary arteries, was presented by cardiologists Dr. Karthik Vasudevan, Senior, Consultant â&#x20AC;&#x201C; Cardiology& Dr. PrabhakarShetty, Consultant Cardiologyfrom Columbia Asia Referral Hospital Yeshwanthpurperformed a Zero Contrast /minimal contrast complex two vessel angioplasty using 3 stents without causing further damage to the kidneys. The extent of the blockages within the coronary artery, the length of the artery where the stent had to be deployed, the diameter of the artery to choose the right diameter of the stent was measured by IVUS without giving contrast. The proximal & distal extent of the stent was marked by placing a wire in the branches of the artery above & below the lesion. Using these as anatomical landmarks, the stent was deployed after predilating the lesion with a balloon. IVUS was performed to confirm the position of the stent and to see whether the stent had expanded well and was opposed to the vessel wall well. Post dilatation with a balloon was done in areas where it was not opposed well, as shown by the IVUS to optimize the result. No dye was used throughout other than the initial angiogram pictures.
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After confirming the result with the IVUS, minimal contrast (6 ml) was used to document the final result. Patient had a creatinine of 3.2 mg/dl at the beginning of the procedure, which became 3.1mg/dl, the next day after the procedure, in view of good hydration given during and after the procedure (close to 3 litres of Normal Saline) and the minimal amount of contrast used. It came back to 3.2 mg/dl at the end of 5 days and remained at the same level at one-month follow-up says Dr Karthik Vasudevan who is a senior interventional cardiologist at ColumbiaAsia Referral Hospital Yeshwanthpur. Contrast induced nephropathy (CIN) or Kidney damage due to dye usage during coronary procedures usually happens during 3rd to 5th day of the procedure and if the creatinine is normal at the end of 5th day, it means that we have avoided this complication. Image guided angioplasty with minimal dye usage is a promising option for renal failure patients who need to undergo angioplasty. Earlier these patients were managed medically or would land up on dialysis after the procedure. This procedure brings a new option for thissubgroup of patients.
COVER STORY
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EXPERT VIEWS
New healthcare trends to hit the industry in 2019
Mr. Kunal Kishore Dhawan CEO - Navia Life Care
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ndian Healthcare sector is evolving rapidly after the introduction of new age technologies. The time has gone when the healthcare industry was just based on doctor and patient interaction and has now reached at the real time engagement without any geographical limitation. With advances in technology, the healthcare industry is becoming more aware and smart to lead a healthy life. The consciousness of people especially for their health is resulting in the acceptance of more efficient and innovative systems among hospitals and other healthcare providers. With the continuous adoption of new age technologies, the healthcare industry is going to get through major transformation and claims to accelerate towards “value based care” outcomes. In the upcoming year, there will be a huge impact on healthcare sector with two of the most hyped technologies – Artificial Intelligence (AI) and Blockchain.
AI to drive the sector’s growth AI works to create a personalized environment for both patients and providers. Today, several companies use AI to streamline their administrative work for increasing efficiency and 38 Feb 2019 w w w. m e d g a t e to d a y.co m
decreasing bureaucracy. Therefore, many healthcare experts anticipate that operationalising AI across healthcare work management would result in 1015% increase in productivity in the next 2 years. In addition, within the AI framework, machine learning will further strengthen human and machine interaction. This would create an impacton, but not limited todiagnostic, risk analytics and drug discovery verticals. According to the estimates of a Frost & Sullivan Survey in 2018, AI for healthcare (IT application) market is expected to cross 1.7 billion by the end of 2019 and projected to achieve CAGR of 68.5% by 2022.
Big Data to result in preventive care Healthcare industry is getting comfortable with data management. Thus, it is expected to see analytics solutions which will strive to investigate treatment viability, drug utilization, and self-care programs specific to chronic conditions. Moreover, success of healthcare providers will depend upon leveraging analytics capabilities. It is expected that almost 50% of healthcare companies would have resources to access, share and analyze real world data for individual conditions. In addition, several researchers have found that the adoption of big data is projected to touch USD 34.27 billion by 2022.
Blockchain to bring healthcare efficiencies After several years of hype, Blockchain is finally going to come into deployment to help solve data exchange security problems. Blockchain has the tendency to provide faster access to vast amount of data that provides improved patient experience in just no time. Blockchain has gained a lot of popularity in the past several years and now the blocks of the technology are going to come together into real commercial
implementations. The other ways in which the technology is going to make an impact on healthcare payers and providers are by streamlining and providing transparency in process, eliminating intermediaries wherever possible, providing a guard against counterfeit drugs and reducing unnecessary healthcare costs.
Cloud technology to change the healthcare scenario Cloud computing has already become one necessity in healthcare sector. Last few years marked the beginning of cloud computing in healthcare industry. The upcoming year clearly focuses upon adopting cloud based computing for more convenient and cost effective healthcare services. Many hospitals are changing their everyday processes by including electronic health records and digital paper filling work. Cloud computing is set to evolve the way healthcare industry works. It is going to provide the quickest and easiest access to business applications and customer relationship management. Moreover, it offers large storage facility for clinical and non- clinical records with an enhanced security environment.
Innovative Insurance models for preventive healthcare Insurance models play a crucial role in healthcare payer industry. Undoubtedly, the healthcare insurance policies that are available today do not meet the personalized needs of an individual. To ensure better growth prospects of the industry, companies are focusing on providing personalized healthcare policies that are driven by data and IoT to reduce potential claims. As per the research estimates of Frost & Sullivan Survey, such innovative policies will enable insurance companies to come up with personalized premium plans by leveraging individual data. The upcoming year in healthcare sector points towards preventive healthcare due to innovative insurance models based on information from healthcare systems and data from sensors, wearables and trackers.
Hair Transplant Fight against Receding Hairline
DOCTOR SPEAK
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ave you noticed your hairline beginning to recede? Most men and women notice the first signs of hair loss at some point in their late 20's, 30's or 40's. Nothing is quite as terrifying to an individual as losing his/her hair. Each year thousands of individuals go abroad and go under the knife to get back their hair. Receding hairline is a type of progressive hair loss that is characterized by the thinning of hair – typically on the sides of the forehead – before developing into full baldness. It is, therefore, an early warning sign of baldness or balding. A receding hairline is something that most individual – if not all – will have to deal with at some point during their lives. It’s easy to panic when you see your hairline creeping backward every year but there are some measures you can take to help keep your luscious locks in-tact and ready to fight another day. Take a look at your lifestyle; if you’re particularly stressed, have had a change in diet or have male pattern baldness in your family then the likelihood of you losing your hair is higher. A receding hairline is most often linked to aging and hereditary factors. Other factors like smoking cigarettes can contribute to a receding hairline and aggravate hair loss. There are more natural, herbal remedies widely available for you to try. While these might not grow your hairline back, they can certainly offer a slight relief when it comes to hair loss, especially when it comes to thinning hair for men. The social stigma surrounding hair transplants is steadily decreasing. This is thanks in no small part to a number of highprofile public figures opting to have the treatment and be open about it.
Dr. Niranjana Raj
MBBS. MD Skin,VD & Leprosy, FRGUHS – Dermatologist, Dermatosurgeon Joint Managing Director – YCDCMBBS
Put simply, the procedure involves extracting hair follicles – either individually or in strips – from an area of the scalp where hair doesn’t get lost (usually the back and sides). Then it’s a case of rehoming them in places affected by hair loss. The finished results can be very impressive, with many men enjoying full heads of hair again within a year. However, the surgery’s continued success hinges on the use of the medications mentioned above. If a patient has the treatment and is not taking a hair loss preventing drug, hair loss could continue to get worse and make the transplant look unnatural. Apart from this, your diet plays a massive part in knowing how to stop a receding hairline as a diet rich in protein and iron will help fight against the balding. Now, this isn’t a cure for a receding hairline, but it will certainly help tackle it. If you have, or have ever had, an eating disorder, then this may be a reason for your shedding scalp; also crash dieting as well, as you’re denying your body of the nutrients it needs to help regrow your hair. At the end of the day, most of us would rather keep the hair we have – if only because it’s fun to have a hairstyle and reassuring to have something to keep your bonce warm in the winter. w w w.medgatetoday.com Feb 2019
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POST EVENT
Medgate Today steals the show at
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very year the healthcare fraternity all over the world meets for the festival of healthcare conferences and trade shows called the Arab Health. The Arab Health is organized by Informa Exhibitions. The Arab Health acts as a forum to showcase state of the art imaging equipments, cost effective disposables, latest developments in surgery and advances in prosthetics. It organizes exhibitions, business, leadership and continuing medical education conferences and workshops. It also provides healthcare solutions and serves procurement needs of costumers from all over the world. This year Arab Health was organized between 28 and 31 Jan 2019 at the Dubai World Trade Centre in Dubai, UAE. More than 4000 companies took part in Arab Health with total 160+ countries represented. Informa Exhibitions and its team are worthy of praise for conceiving the idea of Arab Health and developing it into a world class event. This year, the Arab Health welcomed more than 84,000 dignitaries from across various countries to its forum. Medgate Today, a leading international healthcare monthly magazine also took part in Arab Health. Head-quartered in India, and having a pan India presence on a larger scale, Medgate Today caters the Doctors and Hospitals in Asia. It is a unique platform catering to diverse health and lifestyle sectors. It is a subsidiary of Advance Media Group having various publications across many domains. An adept promoter of the Indian healthcare industry, Medgate Today grabbed the attention of the who’s who of India’s healthcare Industry at the show. Guided by the vision of Editor-in-chief Mr. Afzal Kamal, Medgate Today, the premiere healthcare magazine has brought pride for the Indian Healthcare Industry over the last 10 years of its existence.
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For Medgate Today, it was an amazing experience as its team made the most of the opportunity provided by the event. The number of international subscriptions of the magazine saw an unprecedented shoot up and the global advertisers acknowledged the potential of branding implications of advertising with Medgate Today. The advertisers showed positive response by striking on the spot deals and making potential business inquiries with Medgate Today. Although many healthcare events take place all over the world, Arab Health stands unique as it emphasizes on planning and spacing and providing excellent business environment for the exhibitors attending it. The organizers facilitated the exhibitors with spacious lounges, food and beverage points and signages to give them a quality experience. “Medgate Today strives for promoting the Indian Healthcare Industry and aims to stay relevant in promoting the same in changing healthcare scenario through exchange in the global healthcare ecosystem”, said Man of the moment Mr. Afzal Kamal, the globally recognized face of Indian Healthcare Media.
POST EVENT
ERBA Group showcases its latest technologies critical to Hematology, Urine Analysis and Immunoassays at MEDLAB 2019
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t the recently concluded MEDLAB expo, the ERBA Group, a leading global In-vitro Diagnostic Company, launched their latest hematology analyzers, H 360 and H 560. Designed for improving lab efficiency, these systems are paving the way for better healthcare outcomes in over 100 emerging market countries. These latest additions are targeted at small to medium laboratories and complement the larger automatic Elite 580 hematology analyzer launched at MEDLAB 2018. The newly launched, H 360 3-part differential analyzer can run up to 60 samples/hr and requires only 9 microlitres of blood. The H 560 5-part differential analyzer also runs 60 samples/ hr and requires only 15 microlitres, which is highly beneficial in pediatric cases. In both systems, interpretation of results is aided using an advanced 3D scattergram. ERBA also displayed the latest version of its powerful Laura XL platform, which is a fully automated urine chemistry and sediment analyzer. Using digital microscopy and AI technology, it autorecognizes 16 urine sediment elements. Moreover, the photometric urine strip reader aids in precise determination of 10 analytes using ERBA’s standardized test strips DekaPHAN®. The ERBA group also hosted an education session by Dr. Mir Majid Mossalaeie, Vice President of Iranian Association of Clinical Laboratory Doctors on the effectiveness of AMH ELISA test kits, which helps childless couples conceive though better estimation of ovarian age. Dr. Mossalaeie commented on the high quality of ERBA’s AMH kit which is made by its US subsidiary, Calbiotech Inc., along with 200 other immunoassay products.
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Further, the ERBA team of experts provided first-hand experience to the delegates on the new systems with more than 10 demonstrations being conducted each day! The Director-General of Dubai Health Authority, His Excellency Humaid Al Quatami, visited the booth and was highly impressed by the wide range of technologies being offered by the group. During the exhibition, customer interactions were complemented by a series of informational presentations conducted by industry experts and ERBA team members. Insightful discussions on the benefits of fast reporting for better treatment outcomes, validation methods for clinical chemistry systems, and the advantages of AMH ELISA testing were held in addition to presentations on Laura XL, H 360 and 560 and Calbiotech’s high quality ELISA test range. Speaking about ERBA’s participation, Nikhil Vazirani, CEO, ERBA Group, said, “We are glad to be associated with MEDLAB as it offers an opportunity to interact with customers from across the world. ERBA operates in a dynamic global economy and MEDLAB gives us a great opportunity to help understand changing customer needs and how we should adapt our technologies to offer seamless services. We are committed to focusing our products and solutions on the emerging markets and impacting a billion lives globally.” An annual event, MEDLAB has been successfully operating in the MENA
Erba conducted scientific session on AMH ELISA test kits
The Director-General of Dubai Health Authority, His Excellency Humaid Al Quatami, at the Erba booth
region for over 17 years. Home to hundreds of medical laboratory manufacturers from across 46 countries worldwide, it attracts decision makers at all levels of development, manufacture or marketing of medical devices. Held between 4-7 February 2019 at Dubai World Trade Centre, the event attracted more than 25,000 visitors from 130 countries!
DOCTOR SPEAK
AVM can now be treated with zero risk through cyberknife radiosurgery How it is treated? Dr. Aditya Gupta
Director-Neurosurgery & Head Cyberknife, Artemis Hospital, Gurgaon
AVM happens when there is a wrong connection between the arteries and veins and leads to swelling of blood vessels and there is always a danger of bleeding in these blood vessels.
What is Spinal AVM? Spinal Cord arteriovenous malformation (SCAVM) is a relatively rare disease. Normally the oxygen rich blood enters the spinal cord through arteries which further branch into smaller blood capillaries and the oxygen is utilized. Veins carry the oxygen depleted blood away from spinal cord to other parts of the body. When the blood directly passes from the arteries to the veins, bypassing the capillaries, the condition is known as spinal AVM. This disturbance of flow in blood deprives the surrounding cells of vital oxygen and causes cells in your spinal tissue to rapture, deteriorate, bleeding in spinal cord or die. Timely diagnosis and treatment can prevent the spinal cord from permanent damage.
Spinal AVM â&#x20AC;&#x201C; though rare, more common in children Spinal AVMs can occur at any age, but more than 80% present between age 20 and 60 years. More rarely younger persons may present due to this rare lesions.
What are the symptoms? If left unnoticed the condition only worsens over time with elevated back pain, sensory loss and weakening of leg muscles. The patient may feel numbness, weakness, loss of bowel control. Depending on the severity and location the symptoms may vary person to person. Random pain throughout the body and burning sensations are usually the marked symptoms of Spinal AVM. It is thus advised to immediately consult a neurosurgeon in case the symptoms persist, as delay in diagnosis may lead to worsen the complications even not treatable ones.
High-resolution MRI is very useful in diagnosis of presence of spinal AVM. Thereafter the lesion is study in detail by spinal angiography. In this procedure, a small tube (catheter) is sent through leg blood vessel and injection is done in spinal arteries to detect the location of abnormal connection between artery and vein Embolization is a preferred and minimally invasive technique for treating AVM with surgery. But sometimes due to its complex location and size, the surgery may require high expertise and skills, where a new and advanced procedure is useful. Cyberknife radiation surgery reduces the long term risks of AVM hemorrhage by delivering high doses of radiation to shrink it completely. With the use of latest image guidance and computer assisted robotic system, the procedure delivers multiple beams of high frequency radiation to the actual site from all the directions. Another advantage is that the missile guided technology can also automatically track and detect any movement in patient to correct the delivery of radiation beams to the exact treatment location. During the procedure, the robotic arm slowly moves around the patient and they will not feel anything. The patients can be as relax as always in their own dresses comfortably listening to music. The process being completely pain free and 100% safe (with no side effects), also eliminates the use of anesthesia or other invasive head frames for stabilizing (as in case of other traditional techniques like gamma knife). Almost in 99% of the cases patients recover within single treatment and get back to normal activity immediately after the procedure.. Any unfavorable signs or symptoms that indicate a problem with the nervous system, for example headaches that wonâ&#x20AC;&#x2122;t go away easily with rest and medicines, and difficulty controlling your muscles and their movement, that should be consulted with your doctor. w w w.medgatetoday.com â&#x20AC;&#x201A; Feb 2019
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DOCTOR SPEAK
Now natural cartilage of the joints can be regenerated and need not be replaced At the 5th International Congress of Indian Cartilage Society, discussions will be held on techniques for regeneration of cartilage may not be required to get replaced. Instead, natural joints may get repaired and rejuvenated through these new medical techniques.
Dr. (Prof). Raju Vaishya President of Indian Cartilage Society (ICS)
I
n the time to come, defective knee, hip, ankle and shoulder joints will be repaired, rather than being necessarily replaced, which will be made possible through cartilage regeneration and restoration technologies. Dr. (Prof). Raju Vaishya, President of Indian Cartilage Society (ICS) said that the new techniques of cartilage regeneration and restoration had kindled hope that knee and other joints which become defective and worn out because of osteoarthritis (OA) and other causes
Dr. Raju Vaishya said that cartilage specialists from India and abroad will be deliberating on these path-breaking technologies at a congress, which gets underway at Jaipur this week under the auspices of Indian Cartilage Society (ICS). The 5th international congress of ICS is going to be held on December 7 and 8 in Jaipur, where around 200 cartilage specialists will deliberate on cartilage regeneration and restoration techniques. He told that his Presidential theme of the year 2018 is "Regeneration is better than Replacement" emphasizes the fact that it is vital to preserve the natural joint by regenerating one's tissue rather than replacing it with the artificial joint. It becomes much more relevant in the younger people, who have joint pains due to cartilage damage or arthritis. Cartilage regeneration techniques have developed in the recent past, which can help to develop the natural cartilage and thus avoid or postpone the need for joint replacement. Dr. Saurabh Mathur, Organising Secretary of this Congress, said experts
from the country and abroad, including US, Britain, Poland, Hungary, Iraq, Iran, Bangladesh, Nepal and Afghanistan, are participating in this Congress. Worldrenowned specialists like Drs. Bruce Reider, Jacek Walwaski and Raji will be the key speakers at the conference where specialists will be deliberating on techniques like articular cartilage implantation, stem cells therapy and scaffold. According to Dr. Nishith Shah, Past President of ICS, the Cartilage is an important structural component of the body, which is a firm tissue but is softer and much more flexible than the bone. Cartilage is made up of specialized cells called chondrocytes, and these cells produce large amounts of extracellular matrix composed of collagen fibers, proteoglycan, and elastin fibers. Dr. Deepak Goyal said that cartilage tissueâ&#x20AC;&#x2122;s ability to repair itself is severely limited because it does not contain blood vessels, and bleeding is necessary for healing. Several techniques have been used for cartilage regeneration. While some of these are being used today, researchers continue to look into newer ways to regrow cartilage in an attempt to give people relief from the pain of osteoarthritis (OA) and to live with their natural joints, as far as possible.
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INTERVIEW
PHILIPS: committed towards
improving people’s lives with a steady flow of ground breaking innovations and patient care by integrating architecture, design, dynamic lighting and sound. Recent innovations include the development of the Philips Smart Air Purifier and Philips Azurion, the next-generation image-guided therapy platform that enables clinicians to perform a wide range of routine and complex procedures, helping them to optimize interventional lab performance and provide superior care. Over the years since Philips’ inception, we are committed towards improving people’s lives with a steady flow of ground breaking innovations.
Mr. Rohit Sathe
President, Philips India Healthcare Tell us about your journey into Medical device Industry since inception? Philips has a legacy of more than a century of innovation and entrepreneurship. Starting from light innovation 1891 to 27 years later in 1918, introducing medical X-ray tube, marking the point when the company diversified its product range and systematically protected its innovations with patents in areas stretching from X-ray radiation to radio reception. In November 2018, we launched the world’s first helium free MR- Ingenia Ambition X 1.5T, enabling helium free operations, thus reducing the chance of potentially lengthy and costly disruptions and virtually eliminating dependency on a commodity with unpredictable supply. In view of Philips’ focus to make the world healthier and more sustainable through innovation, our solutions are ready to improve hospitals’ workflow 46 Feb 2019 w w w. m e d g a t e to d a y.co m
Tell us about your role into Philips as a global health leader & achievements? At Philips, we are striving to make the world healthier and more sustainable through innovation, with the goal of improving the lives of 3 billion people a year by 2025. We are focused to catering all our customers’ needs and driving a shift to value-based healthcare- a system that aims to increase access to care and improve patient outcomes while also raising cost productivity. This robust growth strategy has helped us in transforming Philips from being a productdriven company into a focused leader in health
technology, delivering innovation to help people manage their own health and support care providers in providing care effectively and efficiently. With our understanding of many global long-term healthcare challenges, we see major opportunities to apply our innovative competencies in the areas of personal health, diagnosis, treatment, connected care and health informatics. Philips has the depth of perspective across hospital and home needed to break the boundaries standing in the way of organizing healthcare around the patient. We collaborate on designing innovations to seamlessly bring together people, data and technology to help you achieve first-time-right diagnosis for increased patient and staff satisfaction, better patient outcomes and lower costs. Taking our customer’s strategy and needs as our starting point, we are increasingly shifting towards developing integrated solutions that really make
INTERVIEW intelligent solutions to meet the challenges they face in improving outcomes, lowering cost of healthcare delivery and enhancing patient and staff experience. At recently concluded RSNA 2018, Philips highlighted its new portfolio of innovative imaging systems, intelligent software applications and associated services. These solutions connect people, data and technology and have been designed to meet the requirements of the quadruple aim: improved outcomes, enhanced patient experience, increased staff satisfaction and lowered cost of care delivery. Recently, Philips also showcased portfolio of innovative solutions in radiology to enable precision diagnosis and enhance productivity. These solutions connect people, data and technology and have been designed to meet the requirements of the quadruple aim: improved outcomes, enhanced patient experience, increased staff satisfaction and lowered cost of care delivery. In the artificial intelligence segment, Philips announced the launch of IntelliSpace Discovery which is a comprehensive, open platform to enable the development and deployment of Artificial Intelligence assets in radiology with the aim to support radiologists in their clinical and translational research. In the Ingenia MRI portfolio, Philips’ Ingenia Ambition 1.5T MR is the latest advance. The portfolio comprises fully-digital MRI systems, healthcare informatics and a range of maintenance and life cycle services for integrated solutions that break down diagnostic boundaries by delivering speed, comfort and confidence, all with the aim to help improve patient care. Apart from this, key mentions would be Pinnacle Evolution, Big Bore RT (CT system designed to provide precise treatment planning through enhanced accuracy in lesion identification, tissue density calculation and segmentation), Philips Digital Diagnost C90, Ingenia Elition 3.0T MR-RT and Ambition X 1.5T MR-RT systems. The overall purpose is to improve staff satisfaction, patient experience and What are the latest advancement in enhance cost effectiveness the difference across health ecosystem. In the clinical space, we are focusing on delivering integrated solutions – packaged suites of systems, smart devices, software and services that we put together with our partners and customers to solve a particular problem. In this way we actively address the challenges that healthcare providers are facing, helping to improve patient outcomes and productivity. This might involve one department or service, an entire care pathway or even an entire hospital. In simple terms there are two types of solution, of increasing complexity and value. The first type is configured solutions –packaged/ bundled propositions that integrate products, software and services to deliver greater value, in terms of outcomes, than the sum of the individual parts. This may involve the introduction of new business models. Our Diagnosis & Treatment businesses enable efficient, first-time-right diagnosis and precision therapies through digital imaging and clinical informatics solutions. Our Connected Care & Health Informatics businesses empower consumers and care professionals with predictive patient analytics and clinical informatics solutions. Our Personal Health businesses enable people to take care of their health by delivering connected products and services We have strong positions across the health continuum to build a leading company in health technology. Our health technology businesses have leading positions in diagnostic imaging, image-guided therapy, patient monitoring and health informatics, as well as in consumer health and home care. Our professional healthcare and consumer portfolios are increasingly connected and data-driven through Philips’ cloudbased HealthSuite digital platform. This positions us to serve consumers, clinicians and caregivers in an increasingly connected world, in a much better way. We are extremely proud of the progress and we continue to make a difference.
radiology & Imaging devices sector?
As health organizations continue to move toward value-based care, they need w w w.medgatetoday.com Feb 2019
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DOCTOR SPEAK
Cancer
A disease with increasing incidence and confusing trends
A
recent report highlighted that cancer is the second leading cause of death after heart disease in India. Although incidence has continuously shown up going trends for the past few years, it still remains lowest in comparison to the Western world. A report stated that cancer incidence in India is about 94 per 1 lac population. Dr. Kanika Sharma, senior consultant, radiation oncology at Dharamshila Narayana Superspeciality Hospital says, “India is the second largest country by population and there are fair chances of underreporting and deficiencies in screening. Also, majority of Indian population live in the rural area where healthcare facilities are not as developed as urban areas. Insufficient medical facilities can be a reason for underreporting. A report also pointed out that actual cancer incidence can be between 150 and 200 per 1 lac population, which still is quite low in comparison to the West.” Men are 25% more commonly affected by cancer throughout the world. However, India shows completely opposite trends, where women are more commonly affected. No clear explanation has been presented by anyone for these opposite trends. The picture becomes more confusing with the fact that despite lower incidence men has a higher death rate due to cancer. Lifestyle changes in the past decade have reflected as the increased incidence of cancer. In India, Lip and oral cavity cancers top the chart for men whereas breast and cervical cancers top the chart for women. Lip and oral cancer are mostly seen in men with smoking or tobacco chewing habits. Delayed diagnosis with poor prognosis contributes to higher mortality. However, increased awareness of breast and cervical cancer
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have helped in early diagnosis, which is often followed by better treatment options and prognosis. Dr Gaurav Thukral, COO & Critical Care Specialist, HealthCare atHOME says, “Cancer management has improved drastically in past few years. Latest technologies have made it possible to screen breast and cervical cancers at home. Also, most part of the treatment, which includes chemotherapy, post-surgical care, hydration therapy, and paliative care can also be availed at home. Cancer care at home has directly benefited the patients from tier-2 and tier-3 cities who were completely dependent on the tier-1 hospitals for care. Advanced technology, improved awareness, healthcare facilities at home have played a leading role in bringing down the mortality especially in breast and cervical cancer patients.” Indian cancer trends may be opposite to the world and we may still have the lowest incidence, however, we need to realise that incidence is creeping up steadily and cancer is the second most common cause of death. There is no absolute prevention against cancer but following a healthy lifestyle can help in the long run. Cancer is treatable if diagnosed early and we have quite a few celebrities who overcame the challenge of cancer to live a healthy life. On this cancer day, let’s pledge to contribute in cancer prevention and treatment. Follow a healthy life style and encourage others too.
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For Early to Mid-Stage Knee Osteoarthritis Consider Robotic Partial Knee Replacement Surgery (PKR) If your knee pain affects your ability to lead a normal life, you may be a suitable candidate for PKR, a Robotic Partial Knee Replacement surgery
T
here was a time when patients with an early onset of knee osteoarthritis had not many choices. Since a total knee replacement was too severe for early to mid-stage knee osteoarthritis, patients generally preferred leading an inactive lifestyle or delayed the treatment until the pain really got worse. But, with the new-age technological advancements and treatment options such as Robotic PKR. Patients whose arthritis is confined to one compartment only too can get rid of knee damage, pain, and disability and lead a normal life. The knee joint consists of three compartments or areas; the medial or inner side, lateral or outer side and patello-femoral or the area that’s between the kneecap and thigh bone. So when a candidate has two or more compartments of the knee affected, he or she is usually advised to go ahead with the total knee replacement. But, cases where only one compartment of the knee gets damaged and there’s no relief from other non-surgical treatment options, the patient is advised to get a partial knee replacement surgery done. Earlier, in a conventional setup, surgeons used to perform the partial knee replacement manually and therefore, making a precise implant placement was a bit of a challenge. However, with the aid of a robotic arm, or with the latest minimalinvasive procedures such as Robotic PKR, the success of a partial knee replacement procedure has greatly increased.
What is Robotic PKR?
Robotic PKR is basically a robot-assisted minimally invasive knee replacement surgery where the surgeon uses a speciallydesigned computer console to control surgical instruments on thin robotic arms. Robotic partial knee procedure aids in replacement of the damaged surface of knee joints with the artificial implants which are made of high-grade plastic, metal alloys, and polymers. It is more of a naturalfeeling knee because in this all ligaments ACL and PCL and meniscus preserved and is designed to relieve the patient of severe pain in the knee area that's largely caused due to a condition known as osteoarthritis.
Who is the Ideal Candidate for Robotic PKR?
The partial knee surgery is highly suitable for the patients if arthritis in the knee is confined to a limited area (one compartment). Because of better implant availability and advance technique indications are expanding. But, if the arthritis is more widespread, then the patient may be advised to get the total knee replacement surgery. Your surgeon will evaluate for suitability for PKR.
More natural feeling knee post surgery: The preservation of the natural healthy bone and ligaments along with precise positioning of the implant results in a more natural feeling knee. Such knee is more athletic and you can play more sports with it. Long implant life: New age implants usually last a lifetime. These have a life that ranges between 15 to 30 years. Reduced recovery time: As it is a minimally invasive procedure with less blood loss, the recovery time is greatly reduced which means a quicker return to work. Infact, after approximately 6 weeks, patients are able to resume their daily activities such as running, moving around, etc. Less expensive: In comparison to the total knee replacement surgery, partial knee replacement is little less expensive. Besides, it requires less hospital stay(12 days/Daycare) which again reduces the overall cost of the surgery. So if your knee pain is giving you discomfort and causing hindrance in leading a normal everyday life, it’s time you seek an appointment with your orthopaedic surgeon and explore your options about Robotic PKR, the minimally invasive partial knee replacement surgery, and lead a quality life.
Advantages of Robotic PKR
Preservation of healthy bone and tissue: By treating only the damaged part of the knee, the surgeon removes the diseased bone while preserving the healthy bone and tissue (ACL,PCL and meniscus) surrounding it. This minimises trauma and reduces the recovery time. Minimal scarring: Robotic PKR is often performed through a small incision of about 4 to 6 inches over the knee, thereby, resulting in minimal scarring. 50 Feb 2019 w w w. m e d g a t e to d a y.co m
Dr Ishwar Bohra Sr. Consultant, BLK Hospital Delhi
EXPERT VIEWS
SETTING UP ONCOLOGY CENTRE: A SPATIALITY APPROACH
INTRODUCTION
Healthcare has been a service used by every human being throughout one’s life. And every person plays an important role in sustaining or improving the facility. One such role is played by a healthcare Architect who plans the facility for all user types. The facility has to be sustainable, disabled friendly, affordable with low running cost yet efficient, functional and infection free, inspite of being technical in it’s nature. The planning starts immediately when the idea of setting up a hospital has been conceived. The design can influence the user psychology to a great extent by either making it dull & dead or lively & interactive to enhance the healing process. The major cognitive stimulus such as spaces, forms, shapes, as well as as minor stimulus like colour, illumination, scale impacts the patients’ overall response towards recovery. For instance, colours and lighting helps to change perception of space, alter a patient’s emotional state and enhance staff productivity. Generally, people feel more secure in spaces with warm colours. Cooler colours give the perception of a more open space and are recommended in areas with limited access to natural light or in small spaces with low ceilings. Cancer is one of the leading causes of dead worldwide, that is primely due to lifestyle disorders. It has been declared by WHO, in 2014 report that cancer cases will double by 2030. When it comes to the planning of a Cancer facility, shielding of radioactive zones demands shielding from undue radiation exposure to both the staff and patients. As per Onco-specialities, the hospital is divided into three types of zones: Medical, Surgical & Radiation Oncology. These spaces require ideal segregation of critical spaces yet integration for smooth man and material flow. The planning has to be structurally safe with following considerations: The design should be flexible and expandable. It should allow adequate amount of natural light and ventilation for faster healing. It should be sustainable and energy efficient. The design should have access to advancing technology along with user-centric comfort, safety and efficiency. The accessibility to the facilities by both patient and staff should be minimum with maximum visibility of patients by nurses yet privacy of both. The flow of sterile supply to various departments and the waste from these departments to the disposal/re-sterilisation should not cross each other. The spatial planning should be as per the equipment sizes and the clearances required around them.
Ar. Shruti Gupta
Health Facility Planner Assistant Professor Faculty of Architecture & Ekistics, Jamia Millia Islamia
ambulance or wheelchair. The number of consultant chambers is generally tenth in number to the total bed strength for 200 bedded hospitals and above. Although, it varies due to number of reasons such the catchment, the targeted socio-economic profile of patients, number of OPD working hours, disease profile of that zone/district, etc. The reception and registration area should be adequate enough for unbarred wheelchair movement followed by a Nurse station to measure patient vitals, consultant chambers of both Oncology and allied specialities, procedure room, recovery room, toilets for patients & staff, Clean Utility, Dirty Utility, xerox space, etc.
OPD Consultation Chamber with examination bed The specialised Onco-Consultation rooms should be accompanied by centralised Tumour Board room for case discussions. The optimum area for a consultant room is 17.5 sqm while that of a procedure room is 21-24 sqm.
Day Care Centre:
The Daycare Centre is different from the OPD. Here, a patient is required to be admitted for a short span of time whereas in OPD, only consultation is provided to the patient. Spaces such as chemotherapy, haemo/ peritoneal dialysis, eye surgeries, many ENT procedures, and endoscopic & laparoscopic procedures, are generally categorised as day procedures
ZONES IN A CANCER HOSPITAL: Out Patient Department:
This department should generally be located on the ground floor where it can also be accessed by patients on stretcher via 52 Feb 2019 w w w. m e d g a t e to d a y.co m
Dialysis Centre and RO plant for Dialysis, Dharamshila Narayana SS Hospital (DNSH)
EXPERT VIEWS
The operational time of Chemotherapy depends on the level of service being provided. Units operate on a 5-7 days/week, with 8 – 12 hour working days. Chemotherapy infusions require around 15 minutes to 12 hours. Intensive and complex chemotherapy infusions that may take 1-4 days, often involving the sequential infusion of a variety of drugs, that requires a short stay in an inpatient facility. Allied services that are associated with the chemotherapy service include: Physical Medical Rehabilitation Therapeutic Nutrition C linical Psychology Social work services Palliative Care P lastics & prosthesis services. T he functional areas in a Chemo unit comprises of: E ntrance/Reception lobby with adequate waiting are, patient & staff toilets, public amenities, patient interview & counselling room, social worker room, and trolley bay. Consultant room/s for Medical Oncologist N ursing Station C hemo Treatment Recliners with Patient toilets Isolation Rooms Cytotoxic Room Support Areas comprise of Clean Utility, Dirty Utility, Linen Rom, Med Store and portable equipment room. The ideal location of chemotherapy unit is where it has easy access to diagnostic services.
Diagnostics & Radiology:
For a Cancer facility, the following are further sub-divisions of zones: Non-Radio Imaging: ECG, ECHO, TMT, PFT, Holter, EMG, EEG, Ultrasound, Doppler. Radio-frequency Imaging: MRI Radio-Diagnostics: X-ray, Fluoroscopy, Mammography, BMD, Computerised Tomography, SPECT, Gamma Camera, PET scans. Nuclear Medicine: LINAC (IGRT, IMRT) and Proton Therapy. Ideal location is either ground floor or basement Radio-Surgery: Often a part of Nuclear Medicine, it requires radio-therapeutic services. It includes Brachy Therapy (LDR or HDR) with Brachy Operation Theatre, IORT, SRS like Gamma Knife Pathology & Microbiology The radio-active zones are planned as per AERB guidelines in India. The most common material used for construction is concrete of 2.35gm/cc density. However, the concrete thickness of walls and ceilings vary as per the Radio-isotope used and its intensity. For LINACs, the wall goes from thickness goes from 1800 to 2400 mm as per AERB guidelines, with Lead shielding. All radiation therapy equipments should be located within the hospital at a place where occupancy is the minimum to avoid unwanted exposure to radiation.
Inpatient Department:
It comprises of hotel like setup, where patients are required to get admitted and stay until discharged. It comprises of general/ speciality ward units, High Dependency Units, critical care units, specialty intensive care units, isolation wards and private/ semi-private wards. The spatial requirement varies for all types. Medical and Nursing support services such as Doctor’s duty room, nurses’s lounges, procedure rooms, ward pantry, ward lab, ward pharmacy/medical store, CU, DU, sluice room, equipment room, UPS room, etc should be planned as per the requirement. For an Oncology centre, 10-20% beds should be allocated under Intensive/Critical Care category excluding the beds under Chronic, Bone Marrow Transplant specialisation or isolations. ICUs need segregation and restricted flow of visitors with best possible allocation of space near Operation Theatre department.
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Therapeutics:
This includes the surgical suite, Bone Marrow Transplant Unit and physical therapy unit. Surgical suite is core of all health facilities. The location and flow of the patients, staff and material supply progresses from the outermost zone with maximum footfall to inner most zone with least footfall. It is supposed to be the most sterile and infection free zone with 100% air changes and comprises of four major zones: Protective zone, Clean Zone, sterile zone and Disposal Zone. The Protective zone comprises mainly of: The Pre-post operation rooms. Change rooms separately for doctors, nurses, technicians and class IV staff. Post Anaesthetic Care Unit (PACU): preferably adjacent to the recovery room with an area of 10.5 sqm/ bed. Counselling Room Trolley change and patient transfer bays The Clean Zone generally acts as the link between the protective zone and Sterile Zone comprising of: OT control Theatre Sterile Supply Unit (TSSU) directly connectedly via service lifts or dumb waiters with the CSSD. It temperature should be maintained between 18-22 degree Celsius. OT pharmacy Equipment Stores M aintenance workshops Flash Autoclaves Staff Lounges C old Storage (if necessary). P antry for staff. Induction Room The anaesthesia Gas or cylinder storage area O T laboratory
The Aseptic or Sterile Zone has all the operation theatre units with scrub stations and sterile stores. Optimum corridor widths must be 3.0 m. The Disposal Zone collects all the waste generated in sterile zone, further segregated and transferred to CSSD, Laundry or Bio-medical Waste Disposal zone. This zone must have an independent access to the outside corridor, with only one-way traffic, viz. from inside the operating room to the outside and never vice versa.
Clinical Support Services:
These include the following services that support the day to day patient care and clinical services: Admission & Discharge Medical Records Department Central Sterile Supply Department Hospital Pharmacy Materials Management Food & Dietary Department Laundry & Linen Department Housekeeping Bio-Medical Waste Management Medical Gas Plant Mortuary Bio Medical Engineering department that is responsible for procure, maintenance and repair of hospital equipments.
Administrative & Support Services:
Executive Suite generally headed by Chief Executive Officer. Finance Department generally headed by Chief Finance Officer Professional Suite Nursing Department Human Resource Marketing Team
Hospital Engineering Services:
Operation Theatre, DNSH 54 Feb 2019 w w w. m e d g a t e to d a y.co m
These constitutes of all the building integrated services that helps in smooth functioning of man and material within the hospital such as: HVAC plant Electrical Supply. distribution & backup Lighting and illumination Plumbing and water supply Sewage treatment Plant Safety and security Communication & Networking Transportation such as Ambulance Vans or Hearse Vans Environmental Control and Bio-Hazard management teams Hospital Workshops Fire Prevention, Control and Protection Services.
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The impact of technology on healthcare
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key driver of technological innovation in the IVD space include solutions that are critical for early identification of the disease and the further treatment process which enable manufacturers to offer value beyond just devices and connect with customers and their patients. In the future, drone technology may make it easier and safer to provide this home-based care. When a provider rounds on a home patient, blood can be drawn and immediately sent by drone to the lab to be tested. In a similar manner, medications and organs for transplant may be delivered to a healthcare provider by drone. Technological innovation is critical to expanding the reach of medical services, lowering costs of deployment and improving patient outcomes. The government has already witnessed the possibilities of these and therefore rolled out its ambitious projects such as Ayushman Bharat Yojna. This shift hopefully will lead to more people benefitting from the treatment they require without having to spend much. The government too will get the highest value for every rupee spent.
The powerplay of Technology!
With the current access to technology and Internet, it is possible now to find fault in a machine even before the fault has happened or as the fault is progressing. Whether it’s a software bug or hardware related error, early access to data can help resolve all operational glitch remotely. This will improve the speed of service and TAT of machines. Further, with Internet of Things (IoT), the service team can monitor the performance of 100s of machines online. Therefore, the investment in medical devices is better utilized and can be used to treat a larger number of patients. Transasia has already started offering our customers the convenience of IoT. Our fully automated clinical chemistry analyzers are integrated with remote diagnosis technology, Transconnect. This cloud-based system, is designed to increase the lab efficiency through predictive maintenance and remote monitoring for faster response time and 56 Feb 2019 w w w. m e d g a t e to d a y.co m
ease of service support. This besides, our latest urine analyzer, comes embedded with digital microscopy and artificial intelligence that aids in autorecognition of the sediment elements, thereby minimizing manual errors.
The need of the hour
Most Indian manufacturers of medical devices have been investing in R and D, have a global reach and produce worldclass products that are also exported. However, for Ayushman Bharat scheme to get an impetus, it needs to be fully supported by policies that support costeffective local manufacturing. Though India has been showing promising growth in the healthcare field, a hardhitting fact, staring right into our faces, is that even today, 70% of the medical devices of the USD 7 bn Indian medical device industry, are imported. And this is where, as an industry, we are expecting the government to step in. If we look closer home and take the example of China, favorable government reforms have incentivized the growth of their domestic manufacturers, who now account for 70% market share. While Make in India continues to remain the central focus for the government, as an Indian manufacturer, we wish there would have been some more efforts on reducing the dependency on imports through concerted efforts such as: Providing tax holiday to the medical device R and D centres to boost investment in setting up in-house R and D capabilities Inclusion of healthcare services in the GST regime, to lower cost of treatment for patients. Creating and strengthening our own supportive regulatory system Hiking the import duty on finished products Recognizing medical technology as a separate entity Introducing financial incentives such as those for exports, to further encourage the growth engine of the economy
The balancing act
As an established player in the global market, Transasia is broadening its presence from offering instruments alone to offering value-enhanced innovations especially in emerging markets. Infectious diseases are a growing concern in these countries and offering affordable diagnostics for the same, the biggest challenge. Transasia has recognized this need, and is pooling in clinical and technological expertise from its different USA and European R and D facilities to manufacture locally and adapt to the local distribution models. Transasia’s large outlay of investment in acquiring R and D companies has resulted in a pipeline of products to make high quality immunology tests including Molecular test affordable to the public at large. In this way Transasia is successfully able to combine innovation to offer quality, affordable products to these regions. That’s the value, we are adding! Furthermore, as a country we should be able to accelerate further reforms to promote Health for All.
PRE
EVENT
Industry veterans, health experts and policymakers from 25 countries to participate at Medical Fair India
Dedicated to the fast-growing rehabilitation sector in India, rehaindia will be featured alongside Medical Fair India for the first time.
The Indian healthcare sector is diversifying rapidly and new opportunities are emerging in every segment. This has made India very critical in the current global healthcare scenario. Foreign investments have made the medical devices market a fast moving sector contributing significantly to the GDP. In its endeavor to fuel this growth and present a plethora of opportunities for Indian healthcare space to connect with the medical world, exchange ideas, invest and explore new growth avenues, Medical Fair India is back with it’s 25th edition. Medical Fair India (MFI) 2019 is slated to be held from 21st - 23rd February at Pragati Maidan in New Delhi. MFI is organized by Messe Dusseldorf India, a fully owned subsidiary of Messe Düsseldorf GmbH, world’s leading trade fair organizer and exhibitions service provider. For the last 25 years, Medical Fair India has been successfully addressing the various needs of Hospitals, Health Centre’s & Clinics. Together with MEDICAlliance and in association with Association of Healthcare Providers India (AHPI), Association of Indian Manufacturers of Medical Devices (AIMED), Association of Diagnostic Manufacturers of India (ADMI), Quality & Accreditation Institute (QAI),Quality Council of India (QCI), National Accreditation Board for Testing and Calibration Laboratories (NABL), National Accreditation Board for Certification Bodies (NABCB) and The Association of Practicing Pathologists (APP), the next edition promises to bring together 600+ exhibitors and is expected to surpass 15000+ visitors this time. “Medical Fair India is well known for its ability to detect trends and respond to new innovations. Therefore, each edition is unique as it explores new sub-segments and opportunities for diversification. Keeping pace with the global developments in 58 Feb 2019 w w w. m e d g a t e to d a y.co m
medical and healthcare space, MFI 2019 will successfully demonstrate the potential of Indian Healthcare sector on the world map.” said Thomas Schlitt, Managing Director, Messe Düsseldorf India. In 25 years, Medical Fair India has earned its position as a leading platform to provide an opportunity to find diverse solutions to the diverse healthcare needs and explore how the latest digital technologies and new approaches are shaping healthcare. MFI 2019 will host a variety of attractions including CLIN LAB India, Future for Health (FTR4H), REHAINDIA and the Make in India Pavilion. In addition to the exhibition, CLIN LAB India will be hosting knowledge sessions and conference to promote the recent developments and market trends in the IVD sector. The conference is jointly organized by Scherago International and Messe Düsseldorf India and covers topics on InVitro Diagnostic, Laboratory medicine, Point of Care Testing, Molecular Medical Diagnostics and Clinical Chemistry. Big Data, Artificial Intelligence, Mobile, Information technology are going to shape up the future of healthcare industry. FTR4H aims at bringing a platform for Start-ups, Multinational Companies to demonstrate what the networked future would look like, and how new approaches might turn the healthcare for tomorrow. Organized by Voice of Healthcare (VOH), a parallel two-day International Conference will bring together key stakeholders of Ayushman Bharat, Future of Healthcare, and Consumerization of Health on one platform. Rehabilitation, inclusion and empowerment of people with disabilities is one of the major social and economic goals, pursued in India and is paving way for a dynamic Indian rehabilitation
industry. Dedicated to the rehabilitation sector in India, REHAINDIA, powered by REHACARE will be featured for the first time in India, alongside Medical Fair India. The three-day event will attract all the categories of stakeholders in this segment. Addressing the special attractions at MFI 2019, Horst Giesen, Global Portfolio Director of Health & Medical Technologies at the Messe Düsseldorf Group said, “Indian rehabilitation industry has been growing steadily with the increase in the disposable incomes adding to the demand of high quality products. This is why we are bringing our knowledge and experience in this space along with REHACARE, the leading international trade fair for care and rehabilitation, to mark the anniversary of Medical Fair India. This special initiative will allow our exhibitors to access industry’s one of the fastest emerging segment.“ In association with Medgate today, MFI 2019 will also host a gala award platform to felicitate the medical industry stalwarts on the 22nd of February 2019. The Make in India pavilion at MFI 2019 will showcase the immense potential of India as a design, innovation, manufacturing and export hub.
EXPERT VIEWS
Sedentary Behaviour and Cancer
Sitting and cancer Sedentary behaviour is anything you do while sitting or lying down, excluding sleeping. Examples of sedentary behaviours include sitting and watching TV, lying on the sofa reading a book, driving to work, and sitting at a desk or computer. Recent research shows that long periods of sedentary behaviour can increase your risk of a variety of cancers including bowel, endometrial, ovarian and prostate cancers regardless of meeting physical activity guidelines. More time spent sitting also increases risk of developing heart disease and diabetes. You can meet the physical activity guidelines of 30-60 minutes of moderate intensity activity most days but still lead a sedentary lifestyle if a big part of your day involves sitting or lying down. Living a physically inactive lifestyle contributes to weight gain. Being overweight or obese is also a risk factor for several major cancers including stomach, bowel, oesophageal, pancreatic, gallbladder, postmenopausal breast, endometrial, kidney, liver and prostate (advanced) cancers. It’s very easy to sit too much. A typical day might involve eating breakfast, driving to work, sitting at your desk all day, driving home, sitting at the table for dinner, and then watching TV in the evening. But to reduce your risk of cancer it is important to reduce sedentary behaviours and move more. 60 Feb 2019 w w w. m e d g a t e to d a y.co m
How can I reduce the time I spend sitting? In addition to meeting the physical activity guidelines, it is important to decrease and break up long periods of sitting or lying in your day. Tips to reduce sedentary behaviour: Stand up and move about during ad breaks when watching TV When talking on your mobile phone, walk around instead of sitting Set a reminder on your phone or computer to get up and move once an hour Don’t eat your lunch at your desk, move to another location or outside Go for a walk with colleagues after eating your lunch Instead of emailing your work colleague, walk over to them and tell them in person Stand on public transport and get off one stop early or park your car a 5-10 min walk from your destination Have walking or standing meetings rather than seated meetings If possible, adjust the height of your desk/computer so you can sometimes stand while working Set screen time limits for you and your children, participate in active play with the family by going to the park or walking the dog
EXPERT VIEWS
Many cancer patients keep asking for any universal vaccination to prevent cancer, I would say it is practically impossible as cancer is multi-factorial and in many cases causes are unknown. Vaccines are medicines that help protect the body from disease. They help train the immune system to recognize and destroy harmful substances. There are 2 types of cancer vaccines: P revention vaccines T reatment vaccines There are 2 types of cancer prevention vaccines approved by the U.S. Food and Drug Administration (FDA):
HPV vaccine The vaccine protects against the human papilloma virus (HPV). If the virus is long-lasting, it can cause some types of cancer. The U.S. Food and Drug Administration (FDA) has approved HPV vaccines to prevent: C ervical, vaginal, and vulvar cancer A nal cancer G enital warts HPV can also cause other cancers the FDA hasn’t approved the vaccine for, such as oral cancer.
Hepatitis B vaccine The vaccine prevents hepatitis B virus (HBV) infection. Long-lasting infection with HBV can cause liver cancer. Talk with your doctor about whether you should be vaccinated against HPV and/or HBV.
Cancer treatment vaccines Cancer treatment vaccines, also called therapeutic vaccines, are a type of immunotherapy. The vaccines work to boost the body's natural defenses to fight a cancer. Doctors give treatment vaccines to people already diagnosed with cancer. The vaccines may: P revent the cancer from coming back D estroy any cancer cells still in the body after the treatment S top a tumor from growing or spreading Most cancer treatment vaccines are only available through clinical trials, which are research studies involving volunteers. However, in 2010, the FDA approved sipuleucel-T (Provenge) for men with metastatic prostate cancer. Sipuleucel-T is customized for each patient through a series of steps. F irst, white blood cells are removed from the patient’s blood. White blood cells help the body fight infections and diseases. T hen the researcher modifies the white blood cells in a laboratory to recognize and target prostate cancer cells. N ext the modified cells are put back into the patient through a vein. This is similar to a blood transfusion. The modified cells teach the immune system to find and destroy prostate cancer cells. U nfortunately this vaccine is only available in USA.
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Nicotine Replacement Therapy
EXPERT VIEWS
Supporting the willpower of those who want to quit smoking
I
Quit smoking by following these quick steps
n the recent years, cigarette smoking has observed a downward trend, worldwide. Despite these optimistic trends around smoking cessation, India has witnessed 1 million deaths due to diseases caused by tobacco use in India. Cigarette smoking is the greatest cause of illness and premature deaths in India. As per GATS report 2016-17, in India, more than 35% of the adults use tobacco in some form or the other. The deaths caused by tobacco are much more than those caused by Malaria, TB and HIV/AIDS combined, reads a training manual for doctors by the Government of India. While the Indian government has been committed to reduction of tobacco consumption, with 58% Indians wanting to quit the habit, only 17% have managed to do so in the past few years. Cigarettes contain 4000 harmful chemicals, most of these chemicals are cancerous and can cause irreversible damage to our body. Though most of us are aware about the ill-effects of this vice, it is still very difficult to completely quit this habit. The fundamental reason for this is the dependency caused due to nicotine, a vital constituent of cigarettes. Nicotine by itself is non-cancerous but is responsible for releasing an array of chemicals in the brain that induces a heightened sense of pleasure, fills a person with highlevel of optimism and calms anxiety levels. This experience is short-lived and leaves an individual wanting to experience the feeling again. Bouts of cravings occur repeatedly and then a vicious cycle that perpetuates addiction, kicks in According to a Global Adult Tobacco Report, 2016-17, 38.5% of smokers in India have made an attempt to quit, in the last 12 months. More often than not, quitting tobacco is considered psychological dependency but we must not forget that it is as much a physical ailment as it is a psychological dependency. The chemicals that a cigarette contains makes it difficult for the smokers to quit. Quitting smoking suddenly without aid may be associated with withdrawal symptoms, like headaches, irritability, restlessness, and difficulty in concentrating etc. which makes quitting all the more tough. One could follow these simple steps to quitting smoking:
Nicotine Replacement Therapy (NRT) One of the medically-approved aids to quit smoking is through Nicotine Replacement therapy. This therapy has been approved by World Health Organization (WHO), US FDA and is also a part of the essential medicines list for WHO. NRT supports a quitter’s willpower and helps reduce tobacco dependency. NRT provides small quantities of nicotine to the brain, which one normally gets from a cigarette, but in a lower quantity than cigarettes, and 62 Feb 2019 w w w. m e d g a t e to d a y.co m
without exposing the body to other harmful & cancerous chemicals associated with smoking. These small quantities of nicotine can help a smoker overcome the urge to smoke, and also prevent the withdrawal symptoms associated with quitting, which in turn can help them quit the habit. The research published in 2018 by Hartmann-Boyce et al, confirms that of NRT can help people to quit the habit successfully with a recorded increase in the rate of quitters by 50%-. In fact, when the WHO announced Nicotine Replacement Therapy (NRT) as a front line aid to the cessation of smoking, in the year 2008, it went on to become a successful means to quell the urge among smokers worldwide. In India, Nicotine gums is the most popular format available in NRT.
Behavioural therapy In addition to NRT, it would be good to speak to a counsellor or seek help of support groups to make one’s resolve stronger.
Keeping a track of your de-addiction program: Now that you have planned out your de-addiction program it is imperative to follow it meticulously.
The most crucial days - the initial days. The most important part of the de-addiction process is to understand that the first few days are going to be extremely difficult. Irritability, weariness and depression are inevitable in during the first few days, they could be considerably well controlled by using the Nicotine Replacement Therapy.
Trying a new sport or a hobby This is the good way to keep all the cravings at bay. Taking up a sport or some creative hobby keeps the stress levels down and infuses a great level of optimism within a person. The hobby or the sport makes you want to keep going further in the de-addiction journey by constantly motivating you and disregarding any thought of giving up. We must bear all these things in mind and try to take a step towards de-addiction. A complete dependence on our willpower is not enough to quit this vice. We need much more than that, something more comprehensive which will most certainly help individuals to quit on smoking eventually. We must respond to all our health needs as it is the crux and essence of our living. Health is not option, it is an integral part of our being – We must make a conscious effort to live a healthier life and to eliminate these preventable ailments.
EXPERT VIEWS
“Navya Care” Scales Access to Rare Pediatric Cancer Care Expertise To Empower Every Child With Cancer Across India
Gitika Srivastava Founder of Navya
Navya has scaled access to rare pediatric cancer care expertise, enabling every child with cancer to be treated with an evidence based treatment plan recommended by pediatric cancer experts. On the occasion of International Childhood Cancer Day, Bangalore based Navya emphasizes the importance of multidisciplinary expertise in treating children with cancers. Childhood cancers should be treated by a panel of experts ranging from surgical oncologist, medical oncologist, and radiation oncologist who specialize primarily in treating pediatric cancers, not adult cancers. There are a limited number of cancer experts who specialize in pediatric cancers especially when narrowed by cancer of organ, such as experts focused on pediatric blood cancers or pediatric brain tumors or pediatric bone and soft tissue tumors. Furthermore, pediatric cancer experts are located only in tertiary referral centers in metropolitan cities. They have limited time and availability to treat every child with cancer. However, in collaboration with parents and treating oncologists located in any cancer center in the country, pediatric cancer specialists can share their experience in guiding the treatment plan of children with cancer. Children can receive the appropriate treatment close to home without traveling to far away cities and waiting in queues at crowded referral centers to know what a pediatric cancer expert would recommend. Dr. Hari Menon, senior expert in Haemato Oncology at Cytecare, Bangalore states: “Navya allows treating oncologists, 64 Feb 2019 w w w. m e d g a t e to d a y.co m
patients, and specialists in tertiary centers to work together online and jointly determine a treatment plan that is evidence based and will maximize outcomes for patients. Cancer requires organ specific multidisciplinary treatment planning and Navya enables an online multidisciplinary tumor board collaboration between oncologists and organ specific cancer specialists.” Navya is a clinical informatics system and online expert opinion service that provides evidence based multidisciplinary expert opinions, within 24 hours, to thousands of pediatric cancer patients in India. Navya has created an ecosystem of collaboration between parents, treating oncologists, pediatric cancer specialists, and social workers who support the care of children with cancer. This enables improved outcomes of cure and quality of life for children. One can register and upload the case documents on www.navya.care. The expert opinion helps parents gain confidence in their care for their child, and provides an opportunity for parents to discuss evidence based treatments with their treating oncologist. This increases compliance in the treatment and together the treating oncologists and the parents proceed on the best path of cure, longevity and quality of life, for the child. Navya collaborates with social workers on the ground who handhold parents of pediatric patients and liaise with the treating oncologists to enable an online expert opinion. Navya is partnered with ImPaCCT Foundation and CanKids, two of the large childhood cancer NGOs, situated at Tata Memorial Centre and in over 50 cancer centers in India to empower children. The parents of a 17-year-old-boy in India registered online on Navya. Since the cancerous tumor was on the leg, the parents believed that amputation was the only way ahead. On reviewing the case with pediatric medical oncologist and pediatric surgical oncologist specializing in osteosarcomas (bone cancer), the Navya recommendation was for chemotherapy
followed by limb salvage surgery, not amputation. The social worker, treating oncologist, and parents collaborated online with Navya and rallied for the teenager to receive the recommended therapies. The boy is doing well and the parents are grateful and proud to have maintained their child’s quality of life. Navya has clinically validated its impact on pediatric cancer patients. “For pediatric cancers, the first chance of cure is the most important,” says Dr. TusharVora, Professor of Pediatric Oncology at Tata Memorial Centre. He has presented impact study results at globally reputable international conferences such as the 2nd Global Adolescent & Young Adult (AYA) Cancer Congress in Atlanta, USA and 50th International Society of Paediatric Oncology (SIOP) at Kyoto, Japan in 2018. These results showed doubling of pediatric patients receiving an online expert opinion, a growth rate faster than that of adult patients, demonstrating the Increased need and impact of pediatric cancer expertise in India. Of the 6804 pediatric patients analyzed in the study, 95.8% received the therapy recommended by Navya online expert opinion service. This shows seamless adoption by treating oncologists of an online collaboration with pediatric specialists. Further, the majority of patients required solid tumor expertise versus the more established treatment protocols of liquid tumors, demonstrating that complex pediatric cancers seek and receive the necessary multidisciplinary expertise. In the adolescent and young adult cohort, Navya provides complex therapeutic opinions on fertility and organ preservation, which is critical for quality of life. Gastrointestinal, gynecology, and head and neck cancers with metastasis formed the majority of cases in this cohort. Finally, in the key result presented at the national Pediatric Hematology Oncology Conference (PHOCON) in 2018, Navya reported a significantly higher proportion of pediatric brain cancer patients seeking online expertise and a high number of non-metastatic cases being referred for an online expert opinion, indicating the increased prevalent practice of seeking evidence-based expertise for all pediatric and adolescent and young adult cancers.
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