India faces foundational challenges when it comes to health, healthcare. The question is, how can technology in the many ways that we know it solve some of these problems. Whether it’s at R&D stage, development level or delivering healthcare to the millions of people who need it ?
And who better to put that question to Kiran Mazumdar Shaw, the founder of Biocon, one of the world’s largest biotechnology companies.
Ms Shaw, thank you very much for speaking with me. Let me get a broad sense from you first. We have a huge healthcare problem in this country. It’s as much research, delivery as it is, the number of doctors who are available, specialist doctors who are available. As a technology plus healthcare person, how do you define this problem?
Well, you know there’s no debate on this. The technology bridge is the only way you are going to solve this huge deficit problem. Whether it is healthcare delivery, research or just basically producing diagnostics and drugs and vaccines, everything today is about digital technologies.
Now let me just focus on Ayushman Bharat. Where we want to basically cover every Indian citizen in terms of providing them with access to healthcare. How are we going to do it ? I can tell you that you may still be able to reach semi urban areas but providing access to healthcare in rural India is today absolutely unthinkable and unimaginable in the very state it is in.
And no matter what the government does, it’s going to be very difficult. So you have to use technology and also if you want it to sustain, it has to be thought through much more. It is about preventive and predictive healthcare. This is what will build a sustainable healthcare model. I don’t think people have thought it through the way it should be. Otherwise, in its current format it is not sustainable. And it will not also produce or rather provide access to the rural population in our country.
Create digital primary health centres that basically start collecting data of our population, of our rural population. We have, through our Corporate Social Responsibility (CSR), created about 30 such e-health care centres, primary health care centres we call them eLAJ. And there we see that just being able to collect vital information, basic vitals of patients who are coming to those primary health centres is making a big difference in the way we can actually look at these populations.
Give us an example
So, for instance, these primary health centres are really centres we have adopted from government so obviously you have to upgrade them a bit and then you know, arm them with technology. We have a device that basically measures vitals, it gives us an electronic medical record it creates. You do need to basically use the power of Aadhar at some stage. So that you can actually make it truly a nationally connected healthcare system.
So what is this data telling you ?
First and foremost, its telling you simple stuff like how many hypertensive or diabetes patients are there. Then of course we are doing other things like mass screening the small populations for different types of cancer. Creating awareness of how to prevent certain types of cancer. Oral cancers are the biggest cancers in our country because of tobacco chewing. Both smokeless and you know, cigarettes and beedis.
But by actually focusing on the tobacco cessation program, we have seen a huge decline in oral cancers. But catching oral cancers early is almost curative. So, I personally believe when you talk about preventive healthcare you need to look at what is it that these rural population suffer from. Just providing clean drinking water reduces most of that diseases burden. Things like that, you know, you need to think about it as a public health problem and looking at different ways of down staging disease. That’s what it is all about.
And you cannot do this without technology, without diagnostics and without mass screening actually. And this is where MedTech plays a very very important role. You will be astounded to know the number of very innovative metrics that are coming up in our country. You can get a mammogram for a dollar a scan. Which is amazing. You can do any kind of cancer screening at that kind of level price point. You have heard about all the CT scans and MRIs being developed in a low cost way.
And then artificial intelligence rides over it..?
Today you can actually read scans in a much more intelligent and predictive way and in a much more accurate way. And in a faster way. You can eliminate a lot of human skills that are required to deliver good quality healthcare and so on. It is something that we need to think about very holistically. I don’t think this interview has enough time to talk about all the power of technology and IOT to actually do all of this !
But a big challenge as you are now putting it together is seems to me the challenge of capturing data and having those sensors physical or non-physical to actually get that data back and then form that response.
Absolutely. So that’s really the challenge we have today and unless we look at that approach, we will never be able to provide access to decent healthcare to every citizen in our country. And we will never be able to address the huge deficit we have of hospitals, beds or doctors or specialist doctors. And that’s where technology becomes very very powerful.
I recall a figure you quoted recently. India produces 55,000 MBBS doctors annually but only 12% are specialist. And there’s a huge gap obviously when it comes to specialists. Can technology bridge this ?
Yes, if you look at diabetes, it’s a huge pandemic for India. We have over 50 million diabetics and counting. Any yet we have only so called “less than a thousand qualified diabetologists.” So that’s the huge deficit. So technology is a very powerful bridge for a country like India and we have to think things in a very different way. Even if we scale up the number of specialist doctors now, its not going to be enough. But we can actually make our MBBS doctors smart, with technology. And that’s what it’s all about.
Tell us about the work that you are doing in areas like cancer and diabetes. And where is technology helping you to, let’s say, come with better or more effective drugs to market. In addition to what you are doing already.
Today the most exciting field in cancer is immuno-oncology. And the immune system is a very complex system. And there is this dovetailing with cancer genomics. So you’re really dealing with big data in every sense of the word. I think the pharmaceutical industry globally has been very slow to adopt the power of technology. Today, every big pharmaceutical company is scrambling to see how they can catch up and, you know, suddenly start becoming technology savvy.
And I think again, India needs to take advantage of being amongst the front runners in adopting technology and digital technology for research and innovation. A company like ours, even though we are much smaller than Big Pharma, we have actually been looking at technology to mine a lot of the data that we already have. We have been looking at data to actually embed in our manufacturing process to make them more efficient and predictable. And I think a lot of this is helping us.
The pharma sector is actually looking at ways of quickly using technology and digitizing all their data, research and manufacturing data. Which up to now was sort of in dossiers and in print form and we had always hard copies. In fact, the mind of regulators is still not electronic.
We’re still supposed to provide hardbound dossiers, which I think tells you what the mindset of the industry and the regulators is. Slowly the regulators of course are beginning to understand that electronic formats are now going to replace the hard formats.
And I think that tells you why we’ve been so slow to adopt it. Because the industry is very risk-averse to using new technologies and new ways of doing things. But it is about being obsolete if you don’t do that. And I always say when we keep talking about failure, I keep saying the biggest failure is not taking the risk of getting into technology in a big way.
Right. So it appears that some of the answers to our biggest medical mysteries and questions lie in the data that’s already there. And I’m sure you are closer than maybe other people to finding some of those answers. Any further insights?
Today I think there’s a lot of post hoc analysis of all the clinical trials that have ever been conducted. And in fact, there are lots of very interesting tech companies that are basically giving second opinions to patients who are, you know, diagnosed with a certain condition. Saying, by the way, you will benefit from this drug or this, you know, sort of combination by just looking at historic data and these are new regimens which have never been tried.
So there’s a lot of that kind of data coming out. Then of course you do a lot of post hoc analysis as to why certain drugs didn’t work and why certain drugs worked. And there’s now a re-purposing of drugs that is becoming a very new way of innovating new drugs so there’s a lot of exciting things happening.
I think today the opportunity is to actually multiplex a lot of data. Because these are very complex diseases. So when you multiplex immunological pathway data with genomic data with biochemistry etc you are getting a lot of very interesting insight into how cancer actually progresses or how cancer is destroyed.
Looking ahead what are the top two or three things on your mind and focus areas.
As a company we focused a lot on biosimilars and biosimilars the way we developed in the past. We want to definitely accelerate the speed of development of biosimilars, using technology intelligently. But the other new areas are very exciting. One of course being very embedded in diabetes and cancer. We’re very excited by a pipeline of fusion antibodies that we are developing. These are bi-specific antibodies which basically target tumours and engage with the t-cells to kill the tumours, to put it in a very simplistic way.
So its just a metastatic cancer, breast metastatic cancer.
Well, it could work in any cancer. It could work in a localised cancer, it could can work in a metastatic situation. So, I think it’s a very exciting approach to cancer and as you know many cancers which previously could not be even treated are today being cured.
And I think that is the exciting progress we are making in cancer research and to me cancer research is the next frontier for Biocon, and we are really focusing on cancer in immune oncology in a big way. And there I think data mining and data intelligence itself is going to be the way forward for Biocon.
That’s a good note to end on and I wish you all the best because our lives depend on it !