BW Healthcare April-May 2023

#BWMarketing40under40 JUNE 2023 NOMINATE NOW Mir Salika: +91 85270 48483, [email protected] Chetan Mehra: +91 98117 02464, [email protected] For Nominations: Aparna Sengupta: +91 99580 00128, [email protected] Ravi Khatri: +91 98913 15715, [email protected] Somyajit Sengupta: +91 98182 47444, [email protected] Kiran Dedia: +91 98333 99009, [email protected] CS Rajaraman: +91 93422 62859, [email protected] For Sponsorship: 1 3 6 2 4 7 8 5 ARVIND R.P Chief Marketing Ocer, McDonald's India SAI NARAYAN Chief Marketing Ocer, Policybazaar.com AJAY KAKAR Brand & Marketing Strategist ARVIND SAXENA Sr. GM & Head - Marketing & Corporate Communications, NEC Corporation India RAHUL SINGH VP & Head of Marketing SAP India GAURAV MEHTA Chief Marketing Ocer, Noise 1 2 AMIT DOSHI CMO, Britannia MANISH SINHA CMO, Sterlite Technologies 7 8 3 4 5 6 JURY MEMBERS

52 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM Biologics Manufacturing: An Opportunity That Needs To Be Tapped As per industry reports, the global biologics market is expected to be worth around US$ 719.84 billion by 2030 and will expand at a CAGR of 7.8 per cent from 2022 to 2030. By Dr Mahesh Bhalgat COLUMN One reason for the rising popularity of biologics is that they are highly effective at treating a wide range of conditions and are typically associated with fewer side effects. This includes autoimmune disorders (rheumatoid arthritis and multiple sclerosis), cancers (breast cancer, leukemia, and lymphoma), inflammatory diseases (Crohn’s disease or ulcerative colitis), infectious diseases (hepatitis), and even osteoporosis. Biologics,however,are expensive to produce, limiting the access to these novel therapeutics. Given the benefits of biologics drugs, pharma companies today are looking at alternative and effective approaches to makethem easily available and affordable for patients. Biologics drugs or biopharmaceuticals are pharmaceuticals produced from biological systems. They are designed to interact with specific parts of the cell surface or intracellular components, allowing them to provide targeted and more effective treatments than traditional small-molecule drugs. The majority of biopharmaceuticals being developed today and available in DR MAHESH BHALGAT Chief Operating Officer, Syngene

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 53 the market are monoclonal antibodies (mAbs), which are proteins made in living cells to help patients fight various diseases. The generic versions of these biologics drugs, referred to as biosimilars are biological products that are highly similar to an approved biopharmaceutical product (innovator biologic). As per a recent report from McKinsey, the biosimilars market is expected to grow to US$30 billion by 2025 and to more than US$60 billion by the end of the decade. Biosimilars offer the same therapeutic benefit and treatment advantages as the innovator biologic and are also made from living biological systems like the approved biopharmaceutical product. The specific cells (seed) used are different; however, in both cases, the innovator biologic or its biosimilar seed material makes (encodes) the same protein. In contrast, small molecules or conventional medications are most commonly made from chemicals and have the potential to possess higher level of undesired off-target effects. Although several small molecules have been launched to rave reviews, there has been a remarkable surge in the number of biopharmaceutical products in recent years. THE COMPLEXITY OF BIOLOGICS MANUFACTURING Unlike conventional medicines, biologics and biosimilars cannot be created by following a chemical ‘recipe’.The biological drugs are produced by growing live cells in bioreactors and it is these cells that produce the required drug. Their structures are also more complex coming from the large size associated with biological molecules. Thus, developing biologics is a more difficult process than producing conventional chemical drugs. Biologics manufacturing is very sensitive to the process used, starting material (seed), growth conditions and raw materials. Any change in one or more of these can impact product quality. This places a very high emphasis on not only the final product but also the in-process controls. Therefore, any change in the process or the manufacturing conditions and raw materials used could lead to a change in product quality and batch to batch variability that is unacceptable. It is for this reason that biosimilars manufacturing is a lot more challenging and biologics difficult to copy. Any change in the process or the inputs used to make them increases the possibility of dissimilarity from the innovator biologic. This is why the first step for biologics or biosimilar development is establishing the manufacturing process (including the starting materials – most importantly, a well-characterised cell bank or the seed used for cells to be grown). The success of commercial manufacturing of biopharmaceuticals depends on several steps being designed well, characterised and supported by robust analytical tools to assess product quality and impurity profiles along the way. Also, large molecules are complex and therefore necessitate a battery of tests to establish potency, purity, safety and efficacy, adding to the cost of these drugs. Many biologic molecules are also associated with post-translational modifications and glycosylation (adding sugar molecules to an otherwise long protein), to complete the process of generating the desired drug. This involves transformations that the cell performs on its own to modify the basic protein backbone structure. Small molecule drug synthesis does not involve any such transformations. For biologics therefore, a well-developed cell bank and the right nutrients for the cells, the micro and macro environment in which the cells grow, the downstream steps (where the protein is purified from all other impurities) all play a key role in obtaining a consistent product, which requires detailed studies (product characterisation) to establish the quality of the biologic. COLLABORATION WITH CRDMOs Following the development of a biologics product, launching it in the market, comes with its own set of challenges. There is a need to use a qualified and validated biologics

54 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM biologic to its launch on the market is also a very long cycle involving preparing a scalable process and conducting extensive clinical trials. The capital investment is particularly acute for biotech firms in the clinical stage that are virtual or have limited infrastructure. For large biopharmaceutical manufacturers, investing in capacity for new products has its own challenges, mostly stemming from uncertainty of demand. Relying on Contract Research Development and Manufacturing Organisations (CRDMOs) offers flexibility while delivering speed to market and Capex avoidance. CRDMOs allow the integration of drug discovery services with development and manufacturing services, all under one roof. The biopharmaceutical development team at a CRDMO works with several clients to optimise their productivity and help them reduce their eventual cost of goods, while maintaining high quality. CRDMOs such as Syngene are in a unique position to apply a wealth of experience at various stages of development and manufacturing. According to the 19th Annual Report and Survey of ‘Biopharmaceutical Manufacturing Capacity and Production,’ published in 2022 by BioPlan Associates, 86.9 per cent of respondents outsourced some biopharmaceutical manufacturing in 2022, compared to 82.6 per cent in 2021. Respondents also indicated higher spending on such activities over time. The most frequently outsourced activity reported was analytical testing/bioassays at 31.7 per cent, followed by toxicity testing at 31.6 per cent, fill/finish operations and testing of cell line stability at 26.7 per cent (refer to Figure). Presently, there are more than 132 approved biopharmaceutical products in the US and EU, of which 50 per cent are mAbs (monoclonal antibodies), and the remaining products are other biologics. There is also a higher demand for drugs, vaccines and supplements for animal health, fuelled by the growing number of companion animals present. To meet this market requirement, animal health companies are also increasingly collaborating with CRDMOs. For example, one of the world’s leading animal healthcare companies recently partnered with Syngene to manufacture drug substance for bedinvetmab, a first-in-class monoclonal antibody used for treating osteoarthritis in dogs. This agreement initially centered on creating the drug substance, paves the way for the development and manufacturing of other molecules in the coming years, and is expected to be worth up to US$ 500 mn over 10 years. While biologics products are effective, with a potential for fewer side effects, developing such products requires strong technical expertise and a well-equipped facility. Also, manufacturing such products or their generic versions, referred as biosimilars,requires high Capex investments with significant lag time before seeing a return on investment. Furthermore, seeking necessary regulatory approvals for the facility and producing biopharmaceuticals in a cost-effective manner is complex and challenging. To mitigate these stumbling blocks, partnering with a CRDMO with US-FDA (US Food and Drug Administration) or EMA (European Medicines Agency)approved facilities for biologics manufacturing, can help significantly. COLUMN Source:19th Annual Report and Survey of Biopharmaceutical Manufacturing Capacity and Production, BioPlan Associates, April 2022 Analytical testing: Other bioassays Testing: Toxicity testing Fill/Finish Operations Testing: Cell line stability API biologics manufacturing Validation services Selected Areas: Average Percentage of Activities Outsourced Today (2022) Estimated Average Percentage of Activity Outsourced by Facilities How much outsourcing of the following activities is done by your facility today? (2022) (Approx Percent of Activity Currently Outsourced) 31.7% 31.6% 26.7% 26.7% 24.8% 23.4%

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 55 CAHOCON 2023 In The City Of Pearls By Team BW The city of pearls in the state of Telangana recently hosted a mega festival for healthcare professionals, the seventh edition of CAHOCON which was held on April 15-16, 2023 at Novotel Hyderabad Convention Centre. The two-day conference for healthcare professionals was attended by over 1500 delegates from across 26 Indian states and 15 countries, and it was by far the highest-ever attended CAHOCON conference. The event was organised by CAHO (Consortium of Accredited Healthcare Organisations), a notfor-profit body that aims to enable quality and patient safety initiatives in Indian healthcare. The theme of CAHOCON 2023, “Leadership is the Key to Quality,” was chosen to emphasise the importance of leadership in promoting patient safety SPOTLIGHT The two-day conference for healthcare professionals was attended by over 1500 delegates from across 26 Indian states and 15 countries in the healthcare delivery systems. Speaking at the event , the guest of honour, Dr Annurag Batra, Founder, exchange4media and Editor-inChief, BW Businessworld said that after Covid anything is a bonus. No one ever thought they would survive, especially the way the virus devastated the world. In business sustainability is important. But, in health care patient outcomes are important, stated Dr Batra. He talked about the 3Cs to stay away from which were Complain, Criticise and Compare. And asked the audience to embrace the 3Hs— Hope, Hard-work and Humility for a better life. Dr B. Bhaskar Rao, Organising Chairman of CAHOCON 2023 said that India is now the healthcare hub. Hyderabad is a medical tourism hub. Earlier people used to go abroad for advanced treatment. But now patients come here from various countries. The city has done remarkably well. Hyderabad is the place which does 100 lung transplantations in a year, which is a record, not just in India but across Asia, stated Dr Rao. He appealed to the state government as well as all the governments across India to create green corridors for ambulances, the way Hyderabad police have done for organ transportation. CAHO must work along with the governments to devise ways and means to transport patients, especially in emergencies, Dr Rao said. Dr Ravi P.Singh, Secretary General, Quality Council of India (QCI), stated that in order to encourage and promote quality, QCI will rate and rank 1000 NABL accredited hospitals in India. This work may begin in July this year. The few topranked hospitals will be accorded status as centres of excellence, he said. During the valedictory function, three medical professionals were recognised for their outstanding contributions. Dr Narottam Puri, an ENT specialist, a veteran in the field of clinical practice and healthcare management was honoured with the Lifetime Achievement Award.

56 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM “OUR AIM IS TO SERVE THE SOCIETY” By Sneha Patro I ndia’s healthcare sector has undergone considerable transformation in the last couple of decades, thanks largely to the efforts of the private sector. They laid the foundations of a modern healthcare infrastructure in the country by setting up speciality and multi-specialty hospitals equipped with the most modern facilities and offering advanced treatments and services. Aditya Birla Health Services, the healthcare arm of the Aditya Birla Group set up Aditya Birla Memorial Hospital (ABMH) at PimpriChinchwad under the Pune metropolitan area in 2006. The hospital is the brainchild of the late Aditya Vikram Birla, the former chairman of the group, who had thought of setting up a world-class multispeciality hospital in India. INTERVIEW “Our core values come from the top, so we know that we are under the vision of Birla. We are too small to talk about their visionaries” Aditya Birla Memorial Hospital, located at Pimpri-Chinchwad, is by far the leading multispecialty hospital in the Pune metropolitan area, thanks to the leadership and efforts of its CEO, Rekha Dubey. In an interaction with BW Healthcare World, Dubey talks about her own journey as well as that of the hospital. Excerpts ABMH is today the leading multi-specialty hospital in the Pune metropolitan area, thanks to the leadership and hard work of its CEO, Rekha Dubey. She says matter-of-factly that although the sector has grown tremendously in the last two decades, it has yet to go a long way. In a recent chat with BW REKHA DUBEY CEO, Aditya Birla Memorial Hospital

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 57 Healthcare World, Dubey opened up about her own journey as well as that of the organisation and the sector. Looking back at the journey, Dubey says that back in 2006, Pimpri-Chinchwad was hardly an ideal location for setting up a multi-specialty hospital, and only a visionary could have opted to build a hospital there. Today, of course, PimpriChinchwad has grown in a big way, uplifting the society, the surrounding, and the infrastructure. “I have seen different phases, the ups and downs. I have also seen how we have grown, and how others have grown. So it has been a very fantastic journey with ABMH,” she says. C H A L L E N G E S A N D VISION Talking about the vision with which the hospital was set up and the challenges it faced, Dubey says, “The vision is that we are here to serve society... A key challenge was that although the hospital’s infrastructure was superb, yet the people were not willing to enter the hospital assuming it to be very expensive.” Also, the people in the surrounding areas did not know how to use a sanitary toilet and had to be taught to do so over time. Then, there was a shortage of manpower to begin with, as the area did not have the concept of a full-time job. The challenges never became a deterrent for the organisation though. “The core values come from the top, so we know that we are under the vision of Birla. We are too small to talk about their visionaries,” she says. The organisation’s philosophy is that the people working there are its main investment, as they see through the needs of people and their families. M A K I N G O F T H E INFRASTRUCTURE As a part of its vision, ABMH aimed to be good in every segment. The hospital opted for at least the base to be the best in every area. Dubey informs that they looked at 28 international hospitals and picked up their best practices. “In 2006 we thought that technology should be our prime focus. But because this industry is human-driven, it would be beneficial if technology and humans were merged. At the time, we invested more than Rs 1 crore to establish computer and internet connection.” Also, the hospital’s focus was on providing something different that would attract people. They went for the best operation theatres, surgical and non-surgical equipment, ventilators, monitors, etc. “We were the first to have Hill-Rom beds in all the general wards, as well as Dräger ventilators. We were the first to have the pneumatic shoot in the country to have error-free processing of the samples with no human interventions. Also, we were the first to start with a paperless hospital,” Dubey informs. WORK-LIFE & WORKPLACE Speaking about her own journey, Dubey says that she was the first in the family to get into the healthcare sector. Though she came from an orthodox family, her father always wanted her to study law, but due to developments in her family, she chose the medical field and finally got placed in Apollo Hospitals. As to workplace disparities between men and women, Dubey says, “Expertise and skills should be measured in an organisation. Biases should not occur, everyone is equal. In our organisation, hiring is based on talent and leadership skills, not because someone is male or female.” She says that as a society, the hospital needs to create skilled manpower. The doctors in the hospital have the responsibility to train the personnel for tomorrow either for medical care, nursing, or technicians, etc. “Every six months, we train 100-200 students. The healthcare manpower for almost the whole of Pune area is trained at Aditya Birla Memorial Hospital.” The hospital also has a department for training the manpower for reception, wards, housekeeping, parking, etc., where they are given 15 days of basic training on their job aspect. The candidates then need to take an examination in which they must pass before they can be posted for the job. Dubey informs that every three months the workers are made to go through a refreshment process, and every six months their role changes. “Because those workers also deal with a lot of negative energy, we have a counselling session for their mental health.” C O V I D A N D I T S AFTERMATH Referring to the Covid pandemic and the hospital’s response to it, Dubey says the organisation could have done much better. But for that to happen, she says that budget allocation should be higher so that the segment could be worked out well in a cohesive manner. “There was havoc due to the pandemic, but the functionality didn’t stop. We had the largest ICU beds, PICU beds, and ventilation. So, if there is such a situation again in future, we are ready for it,” says Dubey. She informs that in the two years following Covid-19, there were lots of upgrading of technology at Aditya Birla Memorial Hospital. Some technologies that were not available in the country were also brought into the organisation, in addition to medical experts being added. “In 2023, we want that we should be known for our services,” she concludes.

58 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM In an interaction with BW Healthcare World, Dr Umang Mathur, Executive Director, Dr Shroff’s Charity Eye Hospital talks about how teleophthalmology can prove to be a vital tool for reaching out to the underprivileged, providing more routine eye examinations in rural areas, and detecting and treating various eye diseases. By Sneha Patro SPOTLIGHT Technological advancements in recent years have led to the development of a variety of techniques that enable medical professionals to remotely diagnose and treat a wide range of medical conditions in various medical fields, including ophthalmology. Teleophthalmology, a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology, garnered more prominence during the Covid-19 pandemic. Today, teleophthalmologyis being touted as the need of the hour in the eye care space. In an interview with BW Healthcare World, Dr Umang Mathur, Executive Director, Dr Shroff’s Charity Eye Hospital said, “As doctors, we have been slightly slow in adopting the TELEOPHTHALMOLOGY: NEED OF THE HOUR

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 59 DR UMANG MATHUR As doctors, we have been slightly slow in adopting the technology that was already available. To be able to deliver medicine remotely was something that we had never experienced, and Covid forced us to do that technology that was already available. To be able to deliver medicine remotely was something that we had never experienced, and Covid forced us to do that.” He said that during the pandemic, the government came out with a telemedicine policy, which allowed remote consultations. “We integrated our vision centres with cameras where a mobile phone could take pictures of the eye, and the electronic medical records that are available could be read remotely at the hospitals. Almost 3-4 per cent of the patients who are going to the vision centres are availing of tele consultations there.” ROLE OF AI IN TELEOPHTHALMOLOGY Artificial intelligence is also playing a role in developing the healthcare sector in every aspect. In ophthalmology too, there are microscopic lenses where vision can be made better through artificial intelligence. According to Mathur, “Ophthalmology probably offers the best scope for artificial intelligence as we are very image dependent, and we can look into the eye, blood vessels, and the back of the eye. We use an app through which we can access the vision on a mobile phone. It can calculate the distance and the light, vision assessment can be done at the doorstep. The lenses can take pictures of the back of the eye that can identify patients who have retinopathy due to diabetes.” “We have been training young women from rural areas and also from a lower socio-economic group in Delhi. In the last 6-7 years we have trained 1200 young women as eye care paramedics. At our hospitals in Uttar Pradesh almost 80 per cent of the workforce comprises paramedics,” he added. LACK OF AWARENESS Rural areas lack basic primary healthcare facilities, which affects the implementation of telehealth in these regions. The lack of awareness and acceptance of new technologies by both the public and professionals prevents them from going digital. “There is a need to increase awareness in society,” said Mathur. “The screening camps which have reduced post-pandemic help in increasing awareness.” Talking about Dr Shroff’s Charity Eye Hospital’s work on imparting teleophthalmology medical training to rural medical professionals, Mathur shared, “We have trained the technicians on several aspects. But it still hasn’t gone beyond our networks. There is a lot that needs to be done.” INFRASTRUCTURE India is one of the countries with a shortage of doctors. There are only about 12,000 ophthalmologists in India, most of whom are

60 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM concentrated in urban localities. In addition, poor road infrastructure, telecommunications, transportation, and the financial condition of patients make healthcare in rural areas even more difficult. Teleophthalmology offers solutions to this serious problem. According to Mathur, “The infrastructure for teleophthalmology in rural areas is improving. Even in remote areas, internet and smartphone penetration has improved.” “Documentation in healthcare in any case in India is very poor, but electronic healthcare records such as blockchain can help the movement,” he said. “The government is also working in this direction, but we need to do much more.” He added that in the West when a doctor is not available, some medical professionals who are trained and certified with the right of giving a prescription can help the system a lot. 2022, A GOOD YEAR The global teleophthalmology market has witnessed significant growth at a remarkable rate in recent years and is expected to continue to grow due to the increasing where the bottom of the pyramid today has access to healthcare and the hospitals are finding it to be a sustainable option as they get reasonable reimbursement for taking care of the poor. “Almost 15 per cent of our patients are accessing the Ayushman Bharat pathway and we are more than happy to treat them. So that’s a game-changer in the healthcare system,” he said. WHAT LIES AHEAD Teleophthalmology can prove to be a vital tool for reaching out to the underprivileged, providing more routine eye examinations in rural areas, and detecting and treating various eye diseases. Mathur stated, “In 2023, on one hand, there will be an increase in the number of eye care centres in Tier-1 and Tier-2 cities, and these centres are expected to address the needs of the top 5 per cent of the population. On the other hand, many corporates are looking at eye care as one of the areas they want to support because eye care is one of the best investments in terms of change and productivity.” He added that India is doing a good job, especially in the eye care space. Talking about the expectations from the policymakers in the teleophthalmology industry, he said, “Sometimes it is very daunting for a doctor or a small clinic to initiate a nice eye care practice because the infrastructure is so expensive. So it could be a much better option if the government and the civil society can work together to improve healthcare infrastructure.” “When it comes to eye care the government needs to encourage the Indian industry to make better medical equipment. Even in the case of more complex equipment, efforts must be made to ensure that such equipment comes under the ‘Make In India’ label,” he concluded. In 2023, there will be an increase in the number of eye care centres in Tier1 and Tier-2 cities, and these centres are expected to address the needs of the top 5 per cent of the population SPOTLIGHT usage of products. Mathur shared, “In India, the year 2022 has been very productive for teleophthalmology. We bounced back from the pandemic. I think we became more efficient because we learnt about teleophthalmology and how a vision centre can deliver because the bigger cities were badly affected, but the remote areas were less affected. So we learnt to create better access and primary care was important for that.” According to Mathur, another thing which made 2022 a productive year for teleophthalmology is the Government of India’s Ayushman Bharat initiative. The government has created a digital platform

Closing Date: May 02, 2023 Block your pages...    Summer of '23 A look at how an unpredictable summer is impacting summer categories Industry captains on their plans and targets to make the most of summer Exclusive insights from GfK on what summer sales look like, setting the pace for dierent consumer durable categories this year Insightful Features & Interviews Exclusive Columns from Industry Leaders Special Issue Highlights Ensure Your Brand’s Presence in this Special Issue!!! Ms. Aparna Sengupta, [email protected], +91 9958000128 Mr. Anjeet Trivedi, [email protected], +91 9818122217 Mr. Ravi Khatri, [email protected], +91 9891315715 Mr. CS Rajaraman, [email protected], +91 9342262859 Mr. Somyajit Sengupta, [email protected], +91 9818247444 Mr. Kiran Dedhia, [email protected], +91 9833399009 Mr. Sajjad Mohmmad, [email protected], +91 9911855935 For Editorial: Ms. Noor Fathima Warsia, [email protected]

62 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM In an exclusive conversation Dr Shashank Joshi, Chair, International Diabetic Federation IDF South-East Asia, speaks on diabetic remission, Covidinduced diabetes, economic strain of diabetes and right lifestyle to keep diabetes at bay By Bhupendra Paintola Q&A “THE COST OF DIABETES CARE IS DETERMINED BY COMPLICACIES” An estimated 77 million adults suffer from diabetes in India, making the country home to the second highest population of diabetics in the world, after China. Rapid urbanisation, bad eating patterns, sedentary lifestyles, and genetic predisposition are the reasons behind this disease. Additionally, some ethnic groups, such as South Asians, are more likely to develop type 2 diabetes and have a higher prevalence of the condition. Because of its numerous complications, such as cardiovascular disease, kidney disease, neuropathy and blindness, diabetes in India places a huge strain on the healthcare system. In India, diabetes is also a major contributor to premature mortility, accounting for an estimated 1.1 million deaths per year. Can diabetes be reversed, and if yes, what needs to be done? India is the second largest country worldwide with type 2 diabetes and the largest country in the world with type 1 diabetes. Both types of diabetes are different. Type 1 diabetes requires lifelong treatment, whereas type 2 diabetes is a lifestyle disease. People who are suffering from type 1 diabetes cannot reverse it. However, we can achieve type 2 diabetes remission through three

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 63 methods: eating fewer than 800 calories per day; curing diabetes with modern weight-loss medications; and losing weight after surgery using the endoscopic technique. People with type 1 diabetes who take the necessary precautions during the first 10 years of their disease can achieve remission. What reasons can be at- tributed to Covid induced diabetes? Just before Covid, in November 2019 the total count of people’s death due to diabetes stood at 4 million, whereas in November 2022, that number had gone up to 6.8 million. So Covid has definitely impacted life and death for people living with diabetes. The five primary mechanisms by which Covid aggravates diabetes are as follows: First, the Covid virus is an RNA virus and it went to the beta cells of the pancreas and damaged the pancreas to cause Covid diabetes. Second, people who are pre diabetic also develop the Corona virus, and that pre diabetes gets converted to diabetes. Third, many people with type 1 and type 2 diabetes developed Covid, which exacerbated their diabetes condition. Fourth, people who developed Covid were given steroids, particularly when their oxygen level dropped. And steroids raise glucose levels, which leads to diabetes. Fifth, pandemic-induced conditions such as excess or wrong eating, inadequate sleep, less physical activity, and stress also led to an increased number of people being diagnosed with type 2 diabetes. What would you comment on the economic burden of diabetes in India? The cost of diabetes care is determined more by complicacies rather than by treatment costs. There are direct and indirect costs associated with diabetes. Direct costs are related to the care of diabetes, which includes mindful lifestyle choices that include the food we consume. Moreover, the cost of medications and diagnostics is also part of the direct cost. The real cost of diabetes lies in its negative impact on people’s productive lives between 30 and 60 years of age, leading to work loss with serious complications like eye problems, nerve problems, foot problems, heart problems, kidney problems, or brain problems. Given that diabetes is a multifactorial disease, what approach should we take to treat it? Should it be a monopathy or integrated medicine approach? I think diabetes care is multidisciplinary. Hence, an integrated approach is always instrumental. It all comes down to lifestyle and supervised medication, as well as care for complications and prevention. So, we need to take the best of all possible treatments, but we also need to do the science around that. It is important to recognise that we need to integrate traditional practices with the modern medical system in an evidence-based manner. Tell us about the right lifestyle to keep diabetes at bay? We should modify our traditional diets to make them enjoyable and healthful and eat consciously— on time, slowly, and less, rather than opting for worldwide diet pyramids, food fads, and fast foods. A heavy breakfast, a moderate lunch, and a light dinner help us lose weight, whereas the opposite causes us to put on weight. Health is significantly impacted by stress. Adapting to stress or stressful situations with a smile and positive energy is an art. Our biological clock needs us to get at least seven hours of sleep every night between 10 p.m. and 5 a.m. Health is harmed by sleeping for fewer than five hours or for longer than ten hours. Please visit an expert and undergo a proper sleep study if you snore. Break your sitting posture every 30 minutes. According to experts, five minutes of brisk walking can extend your life by four years. The suggested number of steps is 10,000, but according to recent research, you should take at least 6,000 to 8,000. There is less muscle mass in Indians. Both sit-ups and the traditional Surya Namaskar can increase muscular mass. In conclusion, diabetes is a significant public health problem in India that needs immediate attention. Comprehensive strategies to prevent and control the condition are required given the high incidence of diabetes and its associated complications and mortality. Together, healthcare professionals, policy makers, and communities can lessen the impact of diabetes and improve the standard of living for diabetics in India.

64 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM In an interaction with BW Healthcare World, Dr Vikas Gupta, India Business R x Head, Cipla speaks on the causes of the increasing asthma burden of India, its solutions, stigmas, challenges and awareness and management of the disease. By Shivam Tyagi INTERVIEW “Asthma Plagued by Myths, Stigma, and Lack of Information” What do you think is the reason behind the increasing burden of asthma in India? The Global Burden of Disease study 2019 estimated that India accounts for 13 per cent of the global asthma burden with 34.3 million cases of asthma. Furthermore, India also accounts for over 42 per cent of all global asthma-related deaths and ranks number one in the world for disability-adjusted life years (DALYs) due to asthma. According to the Global Asthma Network (GAN) study, nearly 70 per cent of individuals with severe asthma symptoms aren’t clinically diagnosed as having asthma, with less than 9 per cent of those diagnosed receiving ICS (inhaled corticosteroids) treatment, which is the foundation of asthma management. Keeping all these statistics in mind, the startling disproportion between the prevalence of the disease and the level of morbidity due to the disease in India can be attributed to two key factors – under-diagnosis and unwillingness to accept the right treatment owing to associated myths. Therefore, in my opinion, to combat these two factors, there is an inherent need to create heightened awareness about the disease as well as a better understanding of inhalation therapy, which is vital in the effective management of the disease. As of now, fuelled by lack of awareness about the disease and the associated notions about its recommended treatment i.e., inhalers, asthma as a disease category is plagued by myths, stigma, and lack of information leading to the improper management of the disease. In fact, the taboo associated with asthma has led to patients not wanting to be termed as asthmatics with only about 23 per cent of asthmatics calling their condition by its actual name. Patients often overlook early symptoms, putting off early medical intervention which is critical to the effective management of any chronic respiratory disease. Additionally, misconceptions about inhalers being harmful or addictive leads to conditions either being left untreated, or patients just abruptly discontinuing doctor-prescribed treatment once symptoms are manageable. In fact, it could be said that the burden of social stigma associated with asthma in India is comparable to the disease burden itself. All these factors paired with the increased prevalence of risk factors on a socio-cultural and lifestyle level, further adds to the increased burden of asthma in the country.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 65 “The taboo associated with asthma has led to patients not wanting to be termed as asthmatics with only about 23 per cent of asthmatics calling their condition by its actual name. Patients often overlook early symptoms, putting off early medical intervention which is critical to the effective management of any chronic respiratory disease” of the disease and its management, access to healthcare and cost of medication, poor inhaler technique and inability to recognise the warning signs, further adds to the challenge.These factors not only contribute to inadequate treatment and management of the disease but also fundamentally hinder patients from getting diagnosed accurately. There are a lot of social stigmas attached to inhalers, what are the steps that need to be taken to address the challenge? Even though inhalation therapy is the recommended drug delivery method for managing asthma – the perception that inhalers can cause side effects, the aversion to inhalers is rampant amongst both asthmatics as well as caregivers. In fact, parental concerns about the use of inhalers range from growth suppression to addiction. Additionally, with most asthmatics viewing the use of inhalers or even carrying an inhaler as an embarrassment and an impediment to their social life, the social stigma associated with the therapy is yet another barrier to overcome. These widespread misconceptions can be attributed to multiple factors like lack of guidelines or guidance regarding device selection, poor inhaler technique, and limited information to help patients better understand the importance of inhalation therapy. With the latter posing a more profound effect on the diagnosis and management of the disease. Here patient education through dedicated patient educators can help address these challenges. As per you what can be a probable solution that can help combat the current scenario? Lack of patient education, stigmas associated with inhalers, and concerns about medication side-effects needs to be combated with a considerable shift in perception in the way India views asthma and inhalers. And to achieve this change, a three-fold approach of – awareness about the disease, acceptance, and adherence of its recommended treatment needs to be championed across the country and the sector. Awareness around asthma and its management is a preliminary step that lays the foundation for a better, more well-informed conversation around the disease and treatment efficacy. Serving as a gateway to the next crucial phase, which is acceptance of the condition itself as well as its treatment – tackling the social stigma around asthma, educating patients about inhalers, their benefits in asthma management, inhaler usage as well as correct device technique. These two phases ultimately aid in the final stage of treatment – adherence. While inhalation therapy is the cornerstone in asthma management, more than 40 per cent of asthmatics do not adhere to treatment and stop the use of inhalers once they feel better. Therefore, it’s the hope that with better awareness, comes heightened acceptance and increased adherence, thereby improving the patient’s quality of life. What are some key challenges around asthma management in India? The key barriers to asthma management in India are – the social stigma associated with the diagnosis of the disease, as well as acceptance of the recommended route of drug delivery i.e. inhalation and for those on inhalation therapy, adherence to the prescribed treatment. Furthermore, according to an article published on challenges faced in managing adult asthma in Asian countries– poor awareness Dr Vikas Gupta

66 BW HE ALTHCARE MARCH 2023 WWW.BWHEALTHCAREWORLD.COM In an exclusive interaction, Dr Samir Parikh, Consultant Psychiatrist,Director– Department of Mental Health and Behavioural Sciences, Fortis National Mental Health Programme, Fortis Healthcare, speaks to BW Healthcare World about employee mental well-being. By Team BW INTERVIEW Why do we need to talk about mental health at the workplace? Mental health related conditions are a lot more prevalent than we would like to believe. According to the World Health Organisation, 15 per cent working adults were estimated to have a mental disorder in 2019, and this number has only risen given the pandemic. Mental health at work is an elephant in the room that can no longer be ignored – it can impact any of us at any given time, and for an individual not keeping good mental health, it may impact their productivity, relationships at work and home, health and overall quality of life. In fact, it is estimated that depression and anxiety alone cost the global economy US$ 1 trillion every year. What are the challenges we are encountering in mental health care? The lack of awareness and lack of access are the two most significant barriers to treatment when it comes to mental health. There continues to be a lot of stigma associated with mental health due to lack of information and understanding. People hesitate reaching out to mental “Ensuring employee wellbeing is going to require a shift in attitude” health professionals for fear of how they would be judged. At the same time, access may be limited due to the shortage of mental health experts in the country, or the time and costs associated with mental health treatment. How do you see the role of digital tele-health moving forward? Given the deficit when it comes to experts, geographical distances and busy schedules of working professionals, I see digital tele-health as the only viable solution to bridge the treatment gap for mental health in India. Tele-health allows individuals from the remote corners of the country to access a doctor at the click of a button. Even in large urban cities, it reduces the time, effort, and even expense required to consult a mental health professional, therefore making it easier for individuals to access and continue treatment as required. What are some things that each of us can do to sup- port our team members who may be struggling? You know, while we often talk about the stressors associated with work,

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE MARCH 202 3 67 what we don’t often appreciate is that work is a protective factor when it comes to mental health. It allows individuals to work towards goals and feel a sense of accomplishment, provides a sense of structure, a means of livelihood and most of all, a sense of community. Any of us may experience mental health related problems at any point in our lives, and it’s important for us to look after not just ourselves but our colleagues and team members as well. Social support is probably the key factor when it comes to emotional well-being. It’s time we humanise our relationships at work – talk to each other not just about work but as people. If you find someone not as productive as they were, making more mistakes than usual, feeling under confident or unable to meet deadlines, before jumping to criticism or judgement, take a moment to understand if your colleague may be experiencing any psychological distress. Check with your team member in private and offer an empathetic listening ear. Guide them to seek help that you may be aware of and follow-up. Support team members – both with work as well as other aspects of their lives – at times when they may be struggling. What can organisations do to look after the mental health of their employees? If we have to address the well-being of our people, then it’s organisations that need to take the onus of providing mental health care to its employees. Mental health needs to be treated on par with physical health and be similarly included in health policies. It’s important for organisations to create an environment of acceptance and understanding, where individuals are able to talk openly about mental health challenges. Individuals need to be reassured of the organisation’s commitment towards them during difficult times when they might be struggling. Companies can work towards creating awareness by organising training initiatives, regular conversations and messaging on mental health, and inculcating an environment of empathy and sensitivity both in attitude and language. However, one-off talks, wellness weeks or seminars alone aren’t enough. Organisations must also step up to bridge the access-gap. They need to create mechanisms to provide access to resources, for individuals who don’t know whom to reach out for – this includes information about helplines as well as psychiatrists or psychologists that employees in the organisation may consult. At the same time, the nature of mental health treatment is such that individuals may be required to take regular therapy for a few weeks or months. As an organisation, we need to provide individuals the time and flexibility required to consult doctors or take therapy – this may mean stepping out of office for a couple of hours every week, or even a safe space within the organisation that may be conducive to a tele-consultation. And most of all, what will cement the organisation’s commitment towards their employees’ well-being is financially supporting the treatment of employees so that individuals need not let treatment costs deter them from getting the help that they need. As we move forward, let’s also ensure that the culture of the organisation promotes well-being. A good work-life balance, avenues for growth, healthy communication and redressal systems, and respect and dignity for each person goes a long way in creating psychological safety. Dr Samir Parikh “According to the World Health Organisation, 15 per cent working adults were estimated to have a mental disorder in 2019, and this number has only risen given the pandemic.”

68 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM In an exclusive conversation with BW Healthcare World, Narendra Varde, Managing Director, Roche Diagnostics India & Neighbouring Markets speaks on the 2023 trends for the diagnostics industry, the challenges faced by the sector, new products in the pipeline, the roadmap for future challenges and the power of data analytics By Shivam Tyagi INTERVIEW TIER-II & TIER-III CITIES WILL FIND QUALITY DIAGNOSTICS IN THEIR NEIGHBOURHOOD Narendra Varde How has the diagnostics indus- try evolved in the last couple of years? What new trends do you foresee in the Indian diagnostic space in 2023? Like all industries, the pandemic brought medical diagnostics to the limelight and at the same time accelerated the speed of innovation, especially those focused on data-driven technologies in the sector. The increased awareness about preventive health and the greater burden of NCDs is driving the growth of diagnostics. Individuals are realising the importance of preventive healthcare and are getting themselves tested in order to improve health outcomes, aid in early detection, and

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 69 Narendra Varde Managing Director Roche Diagnostics India & Neighbouring Markets thus leading to early disease management, while also decreasing medical costs. For 2023, what I feel will impact the industry most are, diagnostic accessibility, market consolidation and health data digitalisation. People living in tier-II and tierIII cities will find quality diagnostics in their neighbourhood, if not at their doorstep. We are currently present in 450 cities in India. In the year to come, we will see more and more organisations taking modern diagnostics and novel biomarkers into the interiors of the country so that people need not travel to large city laboratories. Additionally, the National Essential Diagnostics List (NEDL) has also helped policymakers in determining which tests are most crucial across the different healthcare facilities of the nation, thus positively impacting delivery of diagnostics. In India, standalone diagnostic centres account for 45 to 50 per cent of the market share while the organised chains own less than 35 per cent. Hospital-based diagnostic centres own the rest. A few reports predict that a number of small and independent labs will become franchisees for big players. In such a scenario, private diagnostics chains, empowered by their better quality services and wider test menus, are expected to capture a higher market share. Online aggregators will further add to this competition, which should result in lower prices for tests for the end customer. Over 2022, more than 4 crore citizens have linked their health records with the Ayushman Bharat Digital Mission. This digitalisation of data “In India, standalone diagnostic centres account for 45 to 50 per cent of the market share while the organised chains own less than 35 per cent. Hospital-based diagnostic centres own the rest” will enable citizens and caregivers to access their health data at their convenience. Digitalisation of health data will help in culling out insights into various facets of healthcare. It will be a space to watch how all this data will be leveraged to better healthcare in the country. Are there any new launches in the pipeline for 2023 for the Indian market? India is one of the important markets for us, and one that demands that we bring in our cutting-edge products. For 2023, this stance remains the same. During the pandemic, Roche Diagnostics was the first one to introduce an extended range of Covid tests in India. In the coming year, we will continue our work in making clinicians and the laboratory fraternity aware of the new and advanced biomarkers. In a country like ours, where there is a huge burden of cardiovascular diseases, Roche cardiac biomarkers can

70 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM healthy India. Some challenges we face are fragmented markets, lack of accreditation, and concentration of good quality healthcare services in metro cities. All these challenges give us an opportunity to add value to the future of healthcare delivery and the development of the Indian diagnostics industry. Out of pocket expense for diagnostics is one of the most pressing detriments for people in low-income groups. We need to create ways and find alternatives to make sure that all sections of society have equal access to diagnostics. One solution that we could look at are Public-Private Partnerships (PPP), which I believe will pave the way for a healthy India. Government alone cannot face a problem as mammoth as high-burden diseases such as CVD, diabetes, and the like. We started our partnership with the National Aids Control Organisation (NACO) in 2018 for AIDS elimination and we continue to work with various state governments in other population screening programmes. The PPP model was successful in Covid diagnosis and vaccine development and could potentially help solve problems such as scaling up diagnostics infrastructure for infectious disease or NCD management in tier-II & III cities. In India, especially in smaller cities, there are many labs that are being run by underqualified technicians within poor quality environments, which can impact the overall delivery and accuracy of the results. To tackle this, standardised regulations for the accreditation of labs are an urgent need of the hour. How are we harnessing the power of data analytics and workflow integration to gain insights for better patient and operational decision-making? Roche understands the value of clinical laboratories in the broader healthcare ecosystem and through digitalisation, we are committed to developing innovative solutions to help labs and clinicians meet the needs of today and tomorrow. We have a healthcare digital centre of excellence (CoE) that focuses on leveraging technologies for delivering actionable insights in the healthcare space. We also provide personalised consultancy from the first assessment through implementation and beyond. With our solutions, labs can help improve patient care with more efficient management of data, both operational and clinical and turn that data into actionable insights for fact-based decision-making for clinicians and patients. Our digital and workflow integration solutions reduce laboratory workloads as well as provide for efficient data review and enhanced clinical documentation. help in the early detection of heart failure and related ailments. Additionally, we launched a cerebrospinal fluid (CSF) assay that will facilitate early diagnosis of Alzheimer’s, leading to better management of the disease. We are also focusing on digital pathology that will help us offer personalised healthcare in India. What do you think the future roadmap should be to meet the health challenges of tomorrow? Healthcare and diagnostics have come a long way in India, but there is a long road ahead to create a truly INTERVIEW “Some challenges we face are fragmented markets, lack of accreditation, and concentration of good quality healthcare services in metro cities. All these challenges give us an opportunity to add value to the future of healthcare delivery and the development of the Indian diagnostics industry”

RSVP: Smridhi Sharma [email protected] +91 98715 98343 Sponsorship Opportunities: NORTH AND EAST Somyajit Sengupta [email protected] +91 98182 47444 Sajjad Mohammad [email protected] +91 99118 55935 WEST Kiran Dedhia [email protected] +91 9833399009 SOUTH CS Rajaraman [email protected] +91 9342262859 DR. VAIBHAV KAPOOR Co-Founder Pristyn Care SATISH KANNAN Co-Founder & CEO Medibuddy SHASHANK ND Founder & CEO Practo Technologies PREETHA REDDY Executive Vice Chairperson Apollo Hospitals DR. AMIT VERMA Managing Partner Quadria Capital DR. RANDEEP GULLERIA Chairman- Institute of Internal Medicine Respiratory & Sleep Medicine Director - Medical Education Medanta – The Medicity, Gurugram SANJIV NAVANGUL MD & CEO Bharat Serums & Vaccines DR. R.S. SHARMA Ex-NHA CEO ADAR POONAWALA CEO Serum Institute of India MAHESH PRATAPNENI Group CEO and Co-founder MedGenome Register Now And the Nominees are...

72 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM Specialist doctors as well as healthcare honchos and officials shared insights and awareness about the dreaded disease at the Oncology Summit 2023 organised by BW Healthcare World By Bhupendra Paintola ONCOLOGY SUMMIT 2023 I n India, the prevalence of cancer and the number of cancer-related deaths are both on the rise. Breast cancer, lung cancer, cervical cancer, and oral cancer are the most common kinds of cancer in India. Breast cancer is the most frequent cancer in women, whereas oral cancer is the most common in men. Prostate cancer, liver cancer, and stomach cancer are also prevalent in India. Cancer is a major public health issue worldwide. Cancer is the second biggest cause of mortality globally, accounting for an estimated 9.6 million deaths in 2018, according to the World Health Organisation. The most frequent cancer in the world are breast, lung, colon and rectum and prostate cancers. REINING IN C NCER Surgery, chemotherapy, and radiation therapy are the most commonly used therapies. Targeted treatment and immunotherapy have also grown in popularity in recent years. Cancer is a serious public health problem in India, with stress, lifestyle, and environmental factors all playing a part in its development. The Oncology Summit 2023 organised by BW Healthcare World on February 10 brought up some interesting insights to marshal the awareness about the fatal disorder, cancer. Specialist doctors, Padma Awardees and authorities from apex government bodies across the healthcare sector came together for the knowledge sharing over following niche topics:

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 73 LINK BETWEEN RESPIRATORY DISEASE & CANCER The knowledge flow on cancer kickstarted with Dr Randeep Guleria, Chairman, Institute of Internal Medicine, Medanta, The Medicity, Gurugram, delineating the domino effect of pulmonary disorders. The doctor stated that there are several data points establishing a link between respiratory disease and cancer. “Practices such as smoking and exposure to indoor and outdoor air pollution lead not only to chronic heart diseases but also increase the odds of getting cancer,” he added. CANCER IN MEN Next, the discussion threw light on cancer in men as the data have shown that men are more likely to suffer from cancer, and the mortality rate is also higher in them. Decoding the prevalence of cancer cases in men, Dr Indu Bansal Aggarwal, Director and Senior Consultant, Dept. of Radiation Oncology, Narayana Super-specialty Hospital, Gurugram, said, “Causative agents like smoking, alcohol is more prevaAbout 70 to 80 per cent breast cancer cases in India are detected in the third or fourth stage

74 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM We are picking it up late.” Along the same lines, Dr Anil Kumar Anand, senior director and HOD of radiation oncology at the Fortis Memorial Research Institute in Gurugram, mentioned that early detection of cancer is something that can change the entire procedure of treatment. “While treating patients with stage I head and neck cancer, rendition therapy can cure the disease. The earliest detection simply means a good cure and a good quality of life. In several ways, technology has also helped doctors make treatment easier for patients,” he added. Emphasising on the importance of preventive healthcare in cancer, Jyotsna Govil, Chairperson of Indian Cancer Society, New Delhi, said that we need a complete change of mindset. “We want people to come to us before there are any symptoms at all. Come to us on a regular basis, come in without having any symptoms,” she added. Bringing in the vitality of screening alongside vaccination in cancer, Rita Bhalla from the Indian Cancer Society, explained that the reason most women are left untreated is ignorance as they do not pay attention to the signs and symptoms of the cancer and also have no idea about pap smear tests. Speaking about the global strategy, Bhalla said that a single dose of the HPV vaccine effectively prevents cervical cancer in women. Visual Inspection with Acetic Acid (VIA) test of the cervix is currently the most common cervical cancer screening method in underresourced settings. Furthermore, cervical cancer morbidity and mortality has been significantly reduced thanks to successful screening in many countries. GOVERNMENT INTERVENTION Dr Urvashi Prasad, Director, Office of Vice Chairman, NITI Aayog, lent in men. Moreover, men are more exposed to occupational hazards like working in the paint industry or the asbestos industry,” she added. Conveying the reason for this, the doctor explained that women are seen to be genetically predisposed to a lower risk of cancer due to some protective genes. TIMELINES MATTER The first and foremost step one can take towards dealing with breast cancer is going for a screening. Highlighting the importance of timely detection of breast cancer, Dr Kanchan Kaur, Senior Director, Breast Surgery at Medanta said, “About 70 to 80 per cent breast cancer cases in India are detected in the third or fourth stage, while nearly 6 per cent of breast cancers in the West are detected in women below the age of 40, in India, the number is as high as 16 per cent. We need to have a proper network between the government and medical practitioners. Ayushman Bharat, as everyone says, is a game-changer. But the real gamechanger would be going from a primary health centre to a wellness centre ONCOLOGY SUMMIT 2023

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 75 talking about the vitality of screening and government intervention, stated, “Under the Ayushman Bharat scheme, the government has set up healthcare and wellness centres that are supposed to provide comprehensive primary health care. This is a departure from our past approach, where our primary health was mostly focused on reproductive health and maternal child health issues and of course we also need to focus on those. But, now that we have realised that we have a massive and growing burden of cancer and other sorts of lifestyle disorders, there is opportunity for us to use these health care and wellness centres to train our health workforce for cancer resilience.” Further, expounding the role of primary health care, Govil mentioned, “We need to have a proper network between the government and medical practitioners. Ayushman Bharat, as everyone says, is a game-changer. But the real gamechanger would be going from a primary health centre to a wellness centre. The word ‘wellness’ should be emphasised everywhere. It will shift the perspective from illness to wellness.” T EC H N O LO GY AS A GAME- CHANGER Technology is making a big change in every sector and it’s a helpful tool for doctors. Tech has given doctors a broader area to think about solutions to problems related to health. Describing the role of technology in oncology, Dr Vishal Rao, Group Director, Head and Neck Surgical Oncology and Robotic Surgery and Dean, Research and Academics, HCG, Bengaluru, conveyed, “Technology has entered operating rooms, and the volume of tech machines has been increasing, we have one dedicated machine for head and neck related problems. We are using technology to cure cancer patients.” Cancer is curable, and medical science and technology have gone to some extent to cure some cancers, and sooner or later they will find solutions for every cancer, the doctor stated. IMMUNOTHERAPY On the shores of newer therapies to treat cancer efficiently, speakers discussed Immunotherapy, which won the Nobel prize in 2018 and has changed the entire landscape of cancer. On this, Dr Nitin Yashas Murthy, Consultant, Medical Oncologist and Hemato, Manipal Hospital, conveyed, “Earlier, at stage 4 cancer we used to talk of survival in terms of weeks to months. But, after immunotherapy, the survival rate has upgraded in terms of years.” Oral tablets, Gene sequencing, and Targeted therapies are the methods being used to identify what the cancer cells are expressing. However, chemotherapy remains the treatment’s backbone, according to Dr Murthy. INTEGRATED NUTRITION & ONCOLOGY Expounding the vitality of a healthy gut, Luke Coutinho, Holistic Nutritionist and Lifestyle Medicine Mentor, said, “The microbiome, i.e., the gut, plays a huge role in your immune system, along with inflammation, neurotransmission and basically everything that is connected with the disease.” He defined integrated nutrition and oncology as knowing which drug is depleting what and putting that back into your diet to meet the deficit. Coutinho delineated the relationship between sleep deprivation and inflammation as well as cancer. He also underlined the linkage of traumatic suppressed stress with prostate cancer and breast cancer.

76 BW HE ALTHCARE APRIL -MAY 2023 WWW.BWHEALTHCAREWORLD.COM ONCOLOGY SUMMIT 2023 ‘An Overall Holistic Approach is Needed to Prevent Access to Tobacco’ In an exclusive interview with Bhupendra Paintola of BW Healthcare World,Dr Dipanjan Panda, Senior Consultant - Medical Oncology, Indraprastha Apollo Hospitals, New Delhi, talks of the importance of a healthy lifestyle in controlling cancer What kind of lifestyle and eating habits would you recommend as a preventive to cancer? There are modifiable as well as unmodifiable factors for cancer. The unmodified factors are your age, your gender – you cannot change that. Breast cancer, for instance, will happen obviously, in females more than in males, whereas testicular cancer is an exclusively male form of cancer. You also cannot change the genetic profile. What you can change is the way you eat, your addictions like smoking or alcohol, the water you are drinking, the air you are inhaling. Moreover, there are certain viruses that can cause cancer. So, you get vaccinated on time, especially against the Hepatitis B virus, which, thankfully, is now included in our universal immunisation programme. And more than that, living a healthy lifestyle is important. In case you find something abnormal, go and see your doctor. Can taxation on tobacco bedeterrent to cancer? The thing is that I am not a policymaker, but simply by raising taxes, you cannot change people’s habits. Maybe when it becomes too expensive, people will smoke less. However, they may switch to another form, from cigarettes to bidi, for instance. So, I think access to tobacco products is also an important issue. Most people’s experience shows that people usually start smoking when they’re in high school. It has been observed that if you do not begin smoking by the age of 25, you will most likely never smoke in your life. Secondly, oral tobacco has become very cheap. And you must understand that tobacco is a drug. We used to believe that tobacco only had a psychological dependence. But now we know nicotine has a physical dependence – you can actually have withdrawal symptoms. And the actual effect of nicotine is very high. Taxing tobacco cigarettes is one way (to stop people from consuming tobacco). But people will always find another way, they will go for a cheaper option. So, I think an overall holistic approach is needed to prevent access to tobacco. The government can make money out of it (the tax on tobacco), but I think healthcare costs will ultimately outrun the revenue they get from tobacco. Does the Indian healthcare system ensure the best treatment for cancer? How can problems in the system be rectified? Well, the government has started to realise that noncommunicable diseases like diabetes, hypertension, and cancer are important things, and there is a National Cancer Mission as well. However, to effectively implement that, we need funds. So, I believe the government’s healthcare budget needs to increase significantly. Right now, it is less than 2.5 per cent of the GDP. I think it should be higher; it should be at least five to six per cent of the GDP, if not overnight, maybe in the next five years. Investing in healthcare, especially primary healthcare and primary education, has a long-term positive impact, that has benefits beyond the immediate visible effect. Also, primary healthcare is something in which private entrepreneurs will not be interested because it doesn’t have an immediate return on investment. Now that many medical colleges are appearing overnight, with district hospitals being converted to medical colleges, many of them are woefully inadequate in infrastructure. So, just converting their name will not work. You have to give them adequate, educated, and trained manpower, which is unfortunately missing in every case. DR DIPANJAN PANDA

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 77 “DIET HAS TO BE BASED ON PRECISION NUTRITION” In an exclusive interview with Bhupendra Paintola of BW Healthcare World, lifestyle coach Luke Coutinho, who runs the Holistic Nutrition and Lifestyle Medicine programme, talks about the connection between food, nutrition, lifestyle and cancer ONCOLOGY SUMMIT 2023 Can food cause cancer? Cancer is multifactorial. No one food can cause cancer. Otherwise, everyone eating that food would have cancer. But food can impact inflammation, it can impact immunity, it can impact your microbiome, which is related to immunity and can cause inflammation. So, it’s a circular argument; you can never say that food will cause cancer. However, ultra-processed food is, of course, bad. It can create inflammation in the body, and inflammation can trick the immune system into working the wrong way. And certain microscopic cancer cells can slip past the guard of the immune system. How are food and lifest y l e c o r re l a t e d i n cancer? Certain foods don’t allow us to sleep well. So now you’re sleep deprived and you’ve eaten the wrong food. Sleep deprivation has a direct correlation with inflammatory diseases, not just cancer but all inflammatory diseases. However, there are potential carcinogens found in grilled foods because of coal and certain toxins. So, there are foods that contain certain carcinogens, but a carcinogen is a possible element that can cause cancer. It doesn’t necessarily mean it will. Even the air we breathe has many carcinogens, but that doesn’t mean everyone’s going to get cancer. It’s the basis of the immune system, how your DNA works, and your overall lifestyle. When you eat food, it either nourishes you or creates a disease or a problem in the body because every cell in the human body requires oxygen and nutrients to function and survive. So, if it gets the wrong nutrients, or less oxygen, you have possible problems in the body. Can there be a specific diet for cancer patients? The diet is dependent on bio-individuality. Knowing which drug is going into your body and what it’s depleting so that you can add that nutrition back into your body is important. And of course, supporting the body to prevent collateral damage is what goes into a diet plan. It’s not just the list of great foods. There are certain foods that support angiogenesis and certain foods that support DNA repair, so they’re complementary to the treatment. It has to work together. And during every phase of the treatment, the diet will be different. So, there are certain foods that you cannot use when a patient is going through chemotherapy and there are certain foods that you can use in the building phase. So, it’s a very scientific approach, and you can never have the same diet for the same patient because of the nature of the disease. It has to be based on precision nutrition. LUKE COUTINHO

78 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM Dr Indu Bansal Aggarwal, Director & Senior Consultant, Department of Radiation Oncology, Narayana Superspeciality Hospital, Gurugram, believes in the importance of a positive attitude in the treatment of cancer. In an exclusive interview with Bhupendra Paintola of BW Healthcare World, she also talked about the importance of tobacco taxation in preventing cancer and the hurdles in treating the disease. Excerpts: ONCOLOGY SUMMIT 2023 What are the hurdles that you see around cancer treatment and diagnosis and how can they be rectified? We have civil hospitals, district hospitals, and primary healthcare facilities. But actually, are we offering quality services? When a person goes to a government setup, the appointment time that they get for cancer treatment is sometimes five to six months. And in that time, a patient with stage one cancer may develop stage four cancer. So, we have to make these services available promptly. If a patient is diagnosed with a curable cancer in its early stages, we should prioritise curing them. And, of course, we cannot let people in stages three and four suffer. So, we should make palliative care services available for these patients. So many patients lose their jobs, and the caregivers lose their jobs because they have to take time off to take the patient to the healthcare facility. So, there should be some laws that permit cancer patients and their caregivers to work from home, or they should have some flexible workers who can make their lives much easier. There should be more vaccines, and HPV vaccination should be a part of the immunisation programme. “We Need Laws That Permit Cancer Patients And Their Caregivers To Work From Home” How important do you think tobacco taxation will be in curbing cancer cases? Everyone knows that tobacco causes cancer in 17 body sites. Tobacco smoke destroys everything from the nose to the mouth, the food pipe to the stomach, the pancreas, the gall bladder, the urinary bladder, the kidneys, and even leads to penile cancer. And the majority of people who use tobacco also use alcohol. If you take either, your cancer risk increases eight times. And if you take both, the risk increases by 28 times. Of course, taxation will definitely help because if it is more expensive, consumption will be lower.But at the same time, we should not forget that these companies are very smart. That is why there is a shift from smoked tobacco to smokeless tobacco, which is even marketed as paan masala. What kind of an attitude transforms a cancer victim to a cancer survivor? What I want to convey to the audience is that it’s not the diagnosis that matters. But what matters is: What do you do with that diagnosis? How do you handle it? Do you stop living with that diagnosis? Or do you still live and make a difference in the lives of others? So I tell all of my patients that, even if they have cancer, they should make a bucket list and keep checking off the items on it. Instead, if you have a reason to live, the patients will stick to their treatments and be more compliant with them. And they do well because they want to live. So, they have that desire to live in spite of the cancer diagnosis. This is what I would like to convey. “I tell all of my patients that, even if they have cancer, they should make a bucket list and keep checking off the items on it”

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 79 Biopsy never causes the spread of cancer, rather it detects the disease early, makes a proper diagnosis, and enables personalised treatment In an exclusive interaction with Sneha Patro of BW Healthcare World, Dr J. B. Sharma, Senior Consultant, HOD - Medical Oncology, Action Cancer Hospital, talked about how awareness, early detection, and prevention could minimise the risk of contracting cancer ONCOLOGY SUMMIT 2023 The goal of preventive healthcare is to protect people from contracting diseases and enable early detection of ailments to ensure good health. It includes identifying and minimising risks of contracting diseases, improving the course of existing diseases, and detecting diseases early through screening. In an exclusive intearction with BW Healthcare World, Dr J. B. Sharma, Senior Consultant, HOD - Medical Oncology, Action Cancer Hospital, said, “To know about the preventive measures for cancer, first we need to know its risk factors. Inadequate sleep, mental stress, satu- “Awareness Can Prevent Cancer” rated food, etc. can be the risk factors. Meditation, avoiding excess stress, having a good diet, avoiding drinking and smoking can minimise the risk of contracting cancer.” Cancer has suddenly assumed the proportions of a serious health hazard in India. In 2020, the projected incidence of cancer among men was 6,79,421 (94.1 per 100,000) and 7,12,758 (103.6 per 100,000) among women. Being diagnosed with cancer in itself can cause considerable mental agony. According to Dr Sharma, a patient should adopt a positive attitude despite the diagnosis. “When someone is diagnosed with cancer, they believe they are going to die one day, but this is not right. The family members should take care to ensure that the person diagnosed with cancer does not harbour any negative thoughts,” he stated. There is also a belief that cancer cannot be cured, Dr Sharma pointed out, emphasising that if detected in the initial stages, it can be treated and cured. As a matter of fact, cancer can be cured even when detected in advanced stages. There is also a myth about the disease spreading after a biopsy. “Biopsy never causes the spread of cancer, rather it detects the disease early, makes a proper diagnosis, and enables personalised treatment,” Dr Sharma said. Another myth about cancer is that a lump that is painful is indicative of the disease. Dr Sharma pointed out that a lump that is painless could also indicate a cancerous growth, so an early diagnosis is necessary. Lack of awareness, he pointed out, fuels many myths and misconceptions about cancer. Preventive healthcare for cancer, he stressed, entails awareness, early detection, and prevention. “First, it is very important to make the public aware of cancer, types of cancer, reasons for the disease. Second, early detection is when we make people understand the early signs of cancer and get early treatment. Third is prevention, in which one can be careful and adopt preventive measures should there be a risk to get cancer genetically,” Dr Sharma said.

80 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM The afflicted often shy away from seeking treatment for head and neck cancer, which usually begins in the mouth, throat or voice box, worried that the surgery would leave them disfigured or create problems in eating or swallowing. Speaking to this correspondent on the sidelines of BW Healthcare World’s Oncology Summit 2023, Dr Anil Kumar Anand, Senior Director and HOD, Radiation Oncology, Fortis Memorial Research, Gurugram, pointed out however, that the treatment for head and neck cancer had evolved tremendously over the years. Dr Anand said technological improvements had enabled advancements in treatments. “For radiation, we have technologies called the IMRT (Intensity-Modulated Radiation Therapy) and IGRT (Image-Guided Radiation Therapy), which can kill the tumour with very little side effects and similarly surgical techniques have also improved,” he said. The modern treatments, he pointed out, do not mar the social life of patients, as they are able to eat, swallow and speak without any difficulty. Talking of the challenges of fighting cancer, he said the general caveat in cancer treatment was late detection. “We have failed in screening and have also partially failed in early detection. I still feel we are seeing very advanced cases, we are seeing only 15 per cent to 20 per cent of early stage oral cancer whereas we see advanced lung cancer at a rate of 80-90 per cent,” he said. Owing to detection in the stage three and stage four phases, survival rates in India are almost half the survival rates in North America and Europe, DrAnand said. He feels that lack of availability of expertise, specialised Technological advancements have now wiped away some of the unseemly impacts of treating head and neck cancer, according to Dr Anil Kumar Anand, Senior Director and HOD, Radiation Oncology, Fortis Memorial Research, Gurugram. However, he laments the poor rates of screening and detection in India ONCOLOGY SUMMIT 2023 Head & Neck Cancer Treatment Breakthroughs By Shivam Tyagi “We have failed in screening and have also partially failed in early detection. I still feel we are seeing very advanced cases, we are seeing only 15-20 per cent of early stage oral cancer whereas we see advanced lung cancer at a rate of 80-90 per cent” DR ANIL KUMAR ANAND surgeons, radiation oncologists and medical oncology in tier-2 two and tier -3 cities was also a major hindrance. Dr Anand’s advice to patients is that should they experience symptoms like mouth ulcers, pain in the tongue or jaw, cough and hoarseness of the voice persistently for a period of two to three weeks, they should immediately consult an ENT specialist or visit the cancer department of a hospital.

#RFGT23 2ND EDITION PRESENTS MAY 2023 NOMINATE NOW Last date to nominate: April 30, 2023 EMINENT JURY DR. ANNURAG BATRA Chairman & Editor-in-Chief, BW Businessworld & Founder- exchange4media DR. AMIYA SAHU President, National Solid Waste Association of India MR. SUDHIR MISHRA Founder & Managing Partner, Trust Legal DR. SUNEEL PANDEY Director, Environment & Waste Management, TERI MS. SANCHITA JINDAL Former Adviser (Scientist G), Government of India, Ministry of Environment, Forest and Climate Change MS. GAURI SARIN Founder, Making Model Gurugram, Bhumijaa- platform for organic agripreneurs, Living without Medicine DR. SAMEER JOSHI Vice Chairman, Indian Plastics Institute, Acclaimed Polymer Technologist & Expert on Plastic Recycling MR. ASHUTOSH JOSHI CEO, Glasspower Recycling & Glasspower Group MR. ANSHU GUPTA Founder, Goonj & Indian Social Entrepreneur For Nomination & Partnership Opportunities: Talees Rizvi; +91 93106 34007; [email protected] Priyanshi Khandelwal; +91 84508 44111; [email protected] Somyajit Sengupta; +91 98182 47444; [email protected]

82 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM By Shivam Tyagi INTERVIEW The Indian pharmaceuticals industry is dominated by the power of generics and vaccines business so much that they are often called as the country’s soft power. India is the biggest supplier of generic medicines and vaccines, holding 20 per cent of the generics supply globally and delivering over 60 per cent of the world’s vaccines. But lately the generics industry is reeling under headwinds due to oversupply in some prominent markets like the US. In an interaction with BW Healthcare World, R.K. Baheti, Chief Financial Officer, Alembic Pharmaceuticals spoke about the headwinds impacting the generic pharma industry and much more. Excerpts: Why do you think price erosion has occurred and which products are affected the most by this development? As far as the generics business in the US is concerned, everyone knows that it has been facing headwinds almost for the entire industry except for companies who are in specialty branded business. So except for companies like Sun Pharma, Dr Reddy’s, which are riding on a couple of branded products, I think the entire generic industry is suffering. And the industry is not suffering due to volumes but due to price erosion. The US is a very open market and it always depends on the demand and supply curve. As of now, the suppliers are probably too many for the demand. So they have been pushing the prices down and I think this has happened because for three years there was Covid-19 and the United States Food and Drug Administration (US FDA) was not inspecting plants. And less inspection means fewer instances of issuance of FDA Form 483 (this form notifies the company’s management of objectionable conditions) and fewer import warnings which might have resulted in oversupply. However, in the last six months or so the US FDA resumed their visits. R.K.Baheti “PRICE EROSION IN US HURTING GENERIC PHARMA INDUSTRY” These visits invariably keep the plants occupied for meeting the demands or for giving responses. So that will again probably push down the supply a bit and will create better pricing. Are there any updates on the recent US FDA inspections at Alembic Pharmaceuticals? All three facilities which were inspected in the last six months, the general injectable facility, F2 which is an oncology facility, and F4 which is the Jarod facility got few observations from the US FDA. I believe none of them were serious enough In an exclusive interaction with BW Healthcare World, R.K. Baheti, Chief Financial Officer, Alembic Pharmaceuticals, speaks on price erosion in the generic pharma industry, updates on the US FDA inspections, PLI schemes in pharma, takeaways from the budget, and future outlook in FY 2023-24

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 83 and we have submitted our responses. We are yet to receive the Establishment Inspection Report (EIR) and we are expecting it to come any moment. Also, we have started getting approvals for the products. We have received a communication from the US FDA, which says that we can commence commercial production and start supplying to the market, which is a positive sign. It is not a substitute for an EIR and we still need to get it but receiving product approvals at all the three facilities gives me an indication that the US FDA has found my responses to be complete, and hence acceptable. How would you rate the progress of Production Linked Incentive (PLI) schemes in making the Indian pharma sector independent in Active Pharma Ingredients? We are also enrolled in the PLI scheme and I think it’s a good scheme, though probably too late for the day. Because I think from 2002 onwards we have been voicing our woes to the government, however unfortunately it did not reach their ears. Once India had a very strong fermentation industry. We had penicillin facilities, we had large erythromycin thiocyanate facilities which were all fermentation-based. But between 2003 to 2010, China dominated the market, dumping products in India. Due to this most of the Indian facilities were shut down. Our products could no longer compete with China’s prices. Now, to re-establish fermentation-based production is not easy. I mean, the government has been supportive but we have not got into the fermentation base and we do not wish to get into this market. But the PLI scheme is working for many sectors like medical devices. Currently our objective is to produce all export-oriented APIs. So we are not looking at even our captive consumption for the domestic market which we are outsourcing but largely it is for either our captive international generic business or for exports. This year a boost was giv- en to the pharma industry in terms of allocation in the budget among other announcements. What are your key takeaways from this year’s budget? We are not so enthused by the pharma push. I mean, the government is doing some lip service. They are talking about allocation for creating some dedicated research centres, but that will be largely either government-owned or public-private kind of relationship.We are not partners in that. There are two things which the industry was expecting. One was the revival of exemptions for R&D, which has not happened and the second was giving the pharma companies some kind of export incentives, which were also discontinued some time back. And though export incentives have been re-initiated, the amount is miniscule. I do not see an increase in that. So as far as pharma is concerned I think the government seems to be of the view that we are now selfdependent and we have to fend for ourselves and compete with the world, but other than that I think the budget has been pretty positive as taxes have been reduced. I think it will spur investment in many areas including healthcare. How do you see the financial year 2023-24 for AlembicPharmaceuticals? Going forward, I think we will continue to do new launches. We will continue to try and get more market share. But at the same time we will not sell recklessly at any price just to gain market share. I think one major plus for the company will be that all the three new plants, which were lying idle in a way, will commence operations and start supplying products to the market. From a financial point of view there will be a setback because some of the expenses which were getting capitalised as pre-operation expenses will start affecting the P&L but cash flow wise it will not make a difference. Going forward, we will con- tinue to do new launches. We will continue to try and get more market share. But at the same time we will not sell recklessly at any price just to gain market share.

84 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM In an exclusive conversation with BW Healthcare World, Dr Vinoth Kumar, Group Head– Supply Chain Management, Jehangir Hospitals, Pune speaks on the supply chain management challenges faced by hospitals, circular economy in healthcare and future of supply chain management in healthcare in India. By Shivam Tyagi INTERVIEW The Covid-19 pandemic shook the foundations of the healthcare industry, leaving policy makers and industry leaders looking for various answers in a short span of time. One of the prominent challenges that the industry faced was effective management of the healthcare supply chain. The country at one time faced shortages of PPE kits, oxygen concentrators, and ventilators among other important medical devices and equipment, leading medical experts to ponder on the resiliency of the supply chain of the Indian healthcare industry to sudden shock waves such as the pandemic. The pandemic has put supply chain “‘Cut Costs’ Echoing in Every Nook & Corner of the HEALTHCARE INDUSTRY”

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 2 3 85 management (SCM) at the centre of the healthcare sector’s map, implying that healthcare systems will be unable to overlook its importance in their future plans. We caught up with Dr Vinoth Kumar, Group Head – Supply Chain Management, Jehangir Hospitals, Pune, to know about the supply chain management scenario in the healthcare industry. From a SCM perspective, what are the key challenges faced by hospitals? How do you think the sector can overcome them? The recent pandemic has exposed a structural weakness in healthcare systems, especially in the supply chain, viz. most notably a lack of resilient systems resulting in inability to obtain critical supplies on time like PPE kits, ventilators, oxygen, critical medications etc. in hospitals. Prior to the pandemic, healthcare organisations focused merely on cost negotiations and the supply chains were not built to be efficient and resilient. Covid brought to light the previously unseen vulnerabilities. The pandemic has had substantial negative impacts on supply chains, and it has highlighted the significance and need for greater supply chain efficiency and resiliency. The healthcare industry is under mounting pressure to drive down costs because the revenues are declining, while the cost of materials as well as manpower costs are increasing with each passing day. Moreover, the recent price fixing by the National Pharmaceutical Pricing Authority (NPPA) on products such as drugs, stents, implants etc. has reduced our profit margins. If we look at our operating margins, it confirms the problem. Unfortunately, we find it difficult to revise the tariff in this competitive world. The only solution is to cut costs and the hospitals must develop effective procurement plans and supply chain strategies to maintain profitability. Ideally the cost of materials in hospitals should not be more than 25-26 per cent of the revenue earned. But if we look at the P&L statement of many hospitals, the cost is more than the ideal figure. ‘Cut Costs’ is the slogan echoing in every nook and corner of the healthcare industry and we need to develop effective supply chain strategies to reduce costs and maximise margins. In healthcare, five per cent of cost savings in supply chain might result in up to 25 per cent increase in turnover. One of the biggest factors in supply chain costs can be the physicians’ preferences for specific brands and products which might be mainly due to unawareness of the cost impact of the materials that they use or prefer. Value analysis meetings can be conducted periodically and that will be beneficial for clinicians to understand the costs associated with care. We need to bridge the gap between the supply chain and clinical stakeholders. It’s essential to bring all hospital stakeholders together to understand available options for improving supply chain processes and to quantify the tangible benefits of these options. How do you foresee healthcare supply chain management in the days to come? I foresee a paradigm shift in healthcare supply chain managementfrom a demand-supply aggregator approach to a Cost-Quality-Outcome (CQO) approach, a fragmentDr Vinoth Kumar In healthcare, five per cent of cost savings in supply chain might result in up to 25 per cent increase in turnover

86 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM ed system to an integrated system, technology-driven to patient-centricity driven, efficiency-focused to resilience-focused and profit-driven to sustainability-driven model. A holistic, end-to-end approach not only improves efficiency and reduces costs but also results in better healthcare at lower costs to the patient. The data-driven systematic approach towards intelligent consumption planning and smart intelligent processes like digitalisation, supply chain automation and analytics; integration with new disruptive technologies like artificial intelligence, Internet of Things (IoT), application of lean management and six sigma concepts; Health Technology Assessment (HTA) by conducting cost-benefit analysis, clinical effectiveness and utility analysis will be the future of supply chain in healthcare. What is the significance of supply chain in hospitals in this competitive market? In healthcare, supply chain is the only area where one can think about cost reduction, and we may find less scope in cutting down other expenditures like manpower costs and administrative costs etc. Hence, it is clearly evident that the future competition might be between the supply chains and not among the hospitals. Unless we think outside the box and embrace best practices in supply chains, we face the possibility of being beaten by the competition or incurring huge losses. What is a circular economy and how do you think the healthcare sector in India can benefit from this? The circular economy is a model of production and consumption that strives to maintain the usability of existing materials as long as possible and at their highest value through sharing, leasing, rethinking, reducing, reusing, repairing, refurbishing, remanufacturing, repurposing, and recovery. In a circular economy, products are used to the maximum extent possible and thereby waste is reduced to a great extent and disposal is the last resort. The healthcare sector can benefit tremendously because it revolves around three fundamental principles – sustainability, resilience, and inclusiveness. The circular economy is the future of healthcare, and this approach not only reduces waste, carbon emissions and pollution, it also makes hospitals more regenerative, resilient, and sustainable for the future. Thus, the circular economy can help hospitals to save resources and money which will enable them to invest in other patient care facilities. This also helps patients because it incentivizes hospitals to use medical devices and natural resources more efficiently thereby mitigating climate crisis and making healthcare more affordable for everyone. You have won the BW Healthcare Excellence Award in the ‘Best Innovator’ category. Please tell us about your innovation and how is it beneficial to achieve sustainability. INTERVIEW The two major challenges faced in healthcare are the high cost of treatment due to highly expensive medical devices and the impact of huge medical waste generated daily that causes greenhouse gas emissions. Healthcare services are responsible for 4.4 per cent of greenhouse gas emissions. Most medical devices are very expensive which in turn makes complex procedures unaffordable for the majority of the population, particularly in developing countries like India. This has prompted us to innovate a solution i.e., 4D MUSIC methodology to achieve sustainable healthcare. The approach addresses all three elements of sustainability that constitute the triple bottom line of any organisation – Social Sustainability (People), Economical Sustainability (Profit or Prosperity) and Environmental Sustainability (Planet). The application of the innovative, novel 4D MUSIC methodology results in huge cost savings and a significant reduction in the generation of medical waste in healthcare facilities. There is a significant reduction in material handling costs by 50 per cent and reduction in medical waste materials due to effective management of the reuse of medical devices. The cost of procedures can be reduced by almost 60 per cent if this method is followed by ensuring strict control of hygiene and safety. The benefits arrived out of economic, environmental, and clinical outcomes can be shared with the community to make healthcare more affordable and accessible. In a circular economy, products are used to the maximum extent possible and thereby waste is reduced to a great extent and disposal is the last resort The pandemic has highlighted the significance and need for greater supply chain efficiency and resiliency

88 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM BW Healthcare World recently organised a round table conference on the issue of procurement of medical equipment and devices, where industry leaders contended that the Indian medical technology industry is moving in the right direction with exciting times ahead although the sector needs improvements in many aspects. By Shivam Tyagi IN FOCUS I ndustry leaders from across the healthcare space took part at the recently held BW Healthcare World round table conference on the issue of procurement of medical equipment and devices. Leaders from the medical technology sector, diagnostics sector, the hospital sector and a dignitary from NITI Aayog engaged in an active dialogue about the need to put forth an effective and efficient procurement strategy that will benefit the healthcare landscape to evolve into its next phase of growth. Industry leaders at the conference contended that the InRethinking Procurement Strategy of Healthcare Institutions

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 89 L to R (First Row): Urvashi Prasad, Director, Office of Vice Chairman, NITI Aayog; and Upasana Arora, MD, Yashoda Super Speciality Hospital; L to R (Second Row): Sojwal Vora, Chief Supply Chain Officer, Manipal Hospital; Dr Harsh Mahajan, Founder & Chief Radiologist, Mahajan Imaging; Sunil Khurana, CEO & MD, BPL Medical Technologies;Harbinder Narula, CEO, BW Healthcare World & BW Wellbeing World; Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute; and Madan Sampath, Chief Supply Chain Officer, HCG Hospitals. Upasana Arora, MD, Yashoda Super Speciality Hospitals stated that she recently upgraded a GE’s X-Ray machine with a Fuji’s X-Ray machine due to better and early detection of tuberculosis in the latter’s product. “We purchase our equipment keeping in mind the patients and then we also involve all our clinicians who are the end users as they ought to be satisfied with what we buy,” she said. From a doctor’s perspective of choosing the best technology, Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, stated that clinical governance is the modus operandi at his hospital and it’s an integral part of the decision-making process. Heading the Fortis Healthcare Medical Council, Dr Seth says his hospital has divided the procurement into two parts -- one is the consumables and the other is the high-end electronic medical devices and implants. “For consumables, the procurement officer can assess the quality and certifications and go for the cheapest option and then we can have internal audits around them as we are never sure of the quality control and assurances of these products, many of which are made in our own country,” Dr Seth said. He further stated that on the other hand, there are implants which make a serious impact on clinical outcomes, and products like these he says should be bought on the advice of clinicians. “In Fortis Healthcare the standardisation for stents, for instance, comes through a speciality council, which has 51 cardiologists from across the Fortis hospitals deciding on the cost-effective value-based product for the patients”. He said that these standardisation measures are necessary as the country has not really established a good quality matrix and the focus till now has been on increasing manufacturing, availability and affordability of these products. He added that now is the right time to have robust quality control metrics, which the healthcare providers should follow. “Today the manufacturers know how much the equipment is being utilised and the preventive maintenance that can reduce the cost for the hospitals, so it’s no more about increasing the Capex but about increasing the perfordian medical technology industry is moving in the right direction with exciting times ahead although the sector needs improvements in many aspects and still has a long way to go to reduce the 80 to 85 per cent import dependency of the Indian healthcare system when it comes to using medical devices in hospitals and diagnostic labs. P R O C U R E M E N T BY HOSPITALS On building a good procurement strategy, Sojwal Vora, Chief Supply Chain Officer, Manipal Hospital, said that his hospital gives preference to what the clinicians actually need, adding to that he said, organisations cannot only look at the purchase price but give the clinicians what they can use for best clinical outcomes. According to him, the clinical experts can also provide the purchase managers with a set of product options to choose from and then the managers can leverage choices from the multiple players suggested by the clinicians. Patient centricity is also high on the scale for healthcare providers,

90 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM mance of the equipment, or the training given to the clinicians or simply identifying the parts which can give it a longer life. The cost optimisation typically comes from what value-addition manufacturers can bring in for a particular institution,” stated Madan Sampath, Chief Supply Chain Officer, HCG Hospitals. PROCUREMENT IN THE DIAGNOSTICS INDUSTRY Dr Harsh Mahajan, Founder and Chief Radiologist, Mahajan Imaging said that procurement in the diagnostics industry depends on the applications that most of the clinicians require out of certain equipment be it an MRI, or a Cath Lab. “In the metros, especially since there is drainage from the surrounding geographies, one needs to have high-end equipment in the hospital even if it is a small specialty hospital. Similar is the case for diagnostic centres in the metros,” he added. He shared that the technology keeps getting upgraded in the case of highend devices and manufacturers should provide an upgradation path. Some manufacturers do provide a modular upgrade path and with this the old models can sustain for up to 15 years or more. “The next thing is getting assistance in repairing these costly machines, so the service backup and stability of the company are very important and after that one has to look at the cost aspect holistically by subsuming the service contract, the lifetime cost of the equipment, rather than just looking at the price,” stated Dr Mahajan. THE MAKE IN INDIA PUSH Speaking on the policy front, Urvashi Prasad, Director, Office of Vice Chairman, NITI Aayog stated that given the indigenous push by the government not only in the lower-end products like consumables but also in the high-end products which is where import dependency is perhaps the highest, that is where we need to encourage indigenous innovation. And yes at the lower end, we need to address issues of quality and standardisation without a doubt but we must continuously focus on the higher-end innovation and innovation at scale. Referring to the PPO (Public Procurement Order), she said the government in the order clearly said that preference will be given to indigenously manufactured devices. “The government’s policy in the Medtech space has made several strides over the last few years but more is definitely needed going forward, at the central and state levels,” she added. T H E M E D T E C H INDUSTRY The country’s DNA was never in the R&D space, stated Sunil Khurana, CEO & MD, BPL Medical Technologies adding that only in the last 7-8 years the shift towards R&D has taken place. “This change is now happening at large and we are seeing a great response as far as the reactive approach is concerned. India being 16-17 per cent of the global population contributes only two per cent of medical devices. We are talking about a US$ 10-11 billion industry against a US$ 600 billion market globally,” Khurana said. “In this scenario without incentivising it was not attractive for the players to make products and only in the last few years private players have sincerely started making products, he explained. Consumables and low-tech products are easy to make but when it comes to electronic products, it’s a long lifecycle, with R&D, development, trials, and approvals, and in this, if you have ten projects, only six may succeed.” Speaking for BPL Technologies, he said, ‘We have not gone for highend products but we are producing the mid-range ones and we are very successful in that with hospitals like Fortis, Manipal and HCG accepting our products, so now the acceptance I believe is very high.” He added that today India is exporting around US$ 1.5-2 billion worth of products, and if we have to become really successful in times to come then each company has to develop products which are of global standards. IN FOCUS Industry leaders deliberate on best procurement strategies for Indian healthcare sector

ustainable The in association with World Conclave 2023 Presents India's Big Leap with G20 Presidency  SUSTAINABLE 2022-23 COMPANIES India’s Most       #BWMostSustainableCompanies

92 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM At its core, corporate mindfulness is about being present and aware of the impact of our decisions, and of being mindful of the consequences of our actions. It is a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s thoughts, and emotions. Mindfulness is a commitment to always strive to make the best decisions possible, based on the most accurate information available and with the fullest consideration of the potential impacts of those decisions. Prioritising corporate mindfulness can have a profound impact on a company’s bottom line, as it can cultivate a culture of innovation and collaboration. Studies have found that businesses that actively practice mindfulness have higher levels of employee engagement, creativity and productivity. Mindfulness can also help create a more positive work environment, leading to greater job satisfaction and retention as well as helping employees to better manage stress and improve their overall well-being. Over the last decade, corporate mindfulness has become a popular and increasingly necessary practice for many organisations around the world. Corporate mindfulness can be broadly defined as the intentional development of awareness and self-reflection, which allows an individual or organisation to achieve their greatest potential. Mindfulness is more than just a buzzword; it is an essential tool that can help organisations succeed in the ever-changing world of business. The benefits of corporate mindfulness are numerous. Organisations that embrace this concept are able to create a more engaged Why Modern Organisations Are Now Embracing Corporate Mindfulness In today’s increasingly complex business landscape, the concept of corporate mindfulness has become a vital part of corporate success. By Deepti Pathak COLUMN DEEPTI PATHAK Executive Coach, Founder & CEO of Deepti Pathak Company

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 93 workforce, while also gaining a competitive edge in the global market. As a leader, do you focus on what you want from your people or what you want for your people? Ironically if you will focus on the latter only then will you get the results you want from people. Modern leadership focuses on the development and well-being of their employees. It is not to say that profits are secondary, but it is necessary today for leaders to understand that great profits are a result of a great culture. And great cultures are built by ‘good management practices’. Your employees are your most valuable asset. Don’t take your employees for granted or treat them poorly. They use your internal tools and they interact with customers. They are your strongest brand ambassadors. Loyalty is a two-way street. You can’t buy loyalty, but you can certainly nurture it. Leaders with a high degree of mindfulness ensure the general well-being of an organisation. They understand that if they want to successfully run the show, the key lies in nurturing their people well and not managing them. They understand the consequences of their words and actions, and how they can have a direct impact on morale for better or for worse. Modern leaders understand and acknowledge the need for being a more empathetic role model rather than an authoritative figure. The practice of mindfulness facilitates an enhanced sense of clarity; allowing us to develop an appreciation for the present moment and the opportunities it brings. Moreover, mindfulness can serve to foster a deeper sense of connection between team members, creating a strong sense of unity and purpose. It is a powerful tool that can be used to increase the effectiveness of our workforce, bolster morale and promote a positive work environment. As the thought leader of the industry, I am delighted to see the increasing embrace of corporate mindfulness within the workplace. Today, as we strive to create a more mindful workplace, we must remember that mindfulness is not a one-size-fits-all solution. We must ensure that our employees are properly supported in their pursuit of mindfulness, while also providing them with the necessary resources to ensure that they can successfully practice mindfulness in the workplace. Mindfulness helps us to identify opportunities and potential risks, empowering us to make informed decisions that will bring us greater success on both personal as well as the organisational level. Prioritising corporate mindfulness can have a profound impact on a company’s bottom line, as it can cultivate a culture of innovation and collaboration. Studies have found that businesses that actively practice mindfulness have higher levels of employee engagement, creativity and productivity.

94 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM I n a world with constantly evolving global and local situations that impact us all, one event of massive significance for human health and well-being is climate change. This global phenomenon has been building up, while governments and organisations across the world have been busy in the race for economic dominance and industrial superiority, with scant regard for the environment. But the environment is hitting back. NEW HEALTH RISKS The rise in global temperatures, sea levels, and changes in rainfall patterns are disrupting centuries-old ecosystems and exposing humans to new health risks while making the existing ones worse. Air pollution, the by-product of burning fossil fuels and deforestation, is one of the primary contributors to climate change. Research has shown that over 90 per cent of the world’s population is breathing polluted air. In India, air pollution during the winter months in some northern states is common. What is not common is the deterioration of air quality in cities that are in no way geographically contiguous. This winter, Mumbai witnessed its worst air quality ever with the Air Quality Index (AQI) surpassing New Delhi, leading to a massive spike in respiratory illnesses like asthma in children and high blood pressure among the elderly.Suspended particulate matter, especially PM2.5 has the ability to impact all the major organ systems of the body – and India’s PM2.5 cut-offs are eight times higher than those recommended by the World Health Organisation. In 2019 when the National Clean Air Programme was launched, 102 cities were part of CLIMATE CHANGE AND Last year, India witnessed a HEALTH prolonged heatwave, the hottest in 122 years. According to a report by Lancet, India’s vulnerability to extreme heat has increased by 15 per cent from 1990 to 2019 and heatrelated diseases are on the rise. By Dr Vikram Vora COLUMN it. Now there are 131 – indicating a worsening of pollution in more cities (despite the prolonged pandemic lockdowns that reduced industrial activity and people movement). According to the data from NOAA Climate.gov, the earth’s temperature that was rising at an average rate of 0.08°C every 10 years, has shot up exponentially to 0.18°C since 1981. As a consequence, like several countries, last year, India witnessed a prolonged heatwave, the hottest in 122 years. According to a report by Lancet, India’s vulnerability to extreme heat has increased by 15 per cent from 1990 to 2019 and heat-related diseases are on the rise. Last year, deaths linked to heat increased by 68 per cent in those over 65 years of age. The 2022 heatwave also reduced rainfall in the subcontinent to almost a third of the normal expected, setting the tone for further challenges to come.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 95 EXTREME WEATHER EVENTS Droughts, floods, hurricanes, tropical storms and landslides are extreme weather events that are becoming more common and intense due to climate change. The Centre for Science and Environment (CSE) reported that India witnessed 314 days of extreme weather events in 2022 across 34 states and UTs. Over 3,026 human lives were lost. This devastation is likely to continue and have major impacts on human health, potentially increasing waterborne and vectorborne diseases, like cholera, malaria and dengue. Perhaps the least visible but most damaging impact is being felt in the oceans, where rising temperatures are melting icecaps and acidification as a result of increasing pollution is threatening the health of marine ecosystems and coastal communities that depend on them for food and livelihoods. Health systems across the world are reporting an increased level of utilisation. Regions where tropical diseases were unheard of are now regularly reporting their occurrence. Micro-organisms have learned to evolve and survive in hitherto hostile environments. Non-communicable diseases like metabolic disorders, cardiac conditions, respiratory illnesses and cancers are on the rise across the world as a result of changing environments and lifestyles. P S Y C H O L O G I C A L IMPACT OF CLIMATE CHANGE What is becoming obvious is the massive psychological impact of climate change. Climate anxiety is real. People are struggling to adapt to the rapidly changing world around them, and the displacement of communities, illnesses, loss of homes and loved ones, and economic disruption associated with extreme weather events can lead to stress, anxiety, and depression. In some cases, the impacts of climate change are exacerbating existing mental health problems, such as post-traumatic stress disorder (PTSD). IMMEDIATE ACTION NEEDED Climate change is an immediate crisis that directly threatens human health and well-being as much as it affects the environment we live in. Unfortunately, even though this is a global problem, the health impacts are not evenly distributed. They are disproportionately severe for vulnerable populations, such as the elderly, children, and those with pre-existing medical conditions. Companies and organisations have a crucial role to play. They must work to reduce their carbon footprint, promote sustainable practices, and invest in renewable energy. International SOS’ ESG experts are advising several of them to help them draft policies, protocols, increase awareness and preparedness for a quick and efficient response to climate events and to maintain sustainable business operations. Time is running out. Immediate action is needed by each and every citizen, working together with communities, organisations, authorities and governments around the world. We can save the earth and create a healthier world for ourselves and the generations to come. We just need to do it NOW. Suspended particulate matter, especially PM2.5 has the ability to impact all the major organ systems of the body – and India’s PM2.5 cutoffs are eight times higher than those recommended by the World Health Organisation. DR VIKRAM VORA Medical Director, Indian Subcontinent, International SOS

96 BW HE ALTHCARE MARCH 2023 WWW.B WHE ALTHCARE WORLD.C OM Vastu allows us to harness our energy, affect our stars, and enjoy more monetary and spiritual bliss By Acharya Vinod Kumar COLUMN You will spend most of your time at your place of work or where you live. It is therefore important to take into account how the placement of things in our homes and offices can influence our way of life in many ways. In this case, Vastu Shastra plays a key role. Health, wealth and the energy of the house are all influenced by Vastu. People are increasingly appreciating this concept and following it to create a happier and more peaceful home. While moving to a new house, those who follow Vastubased tips live a happier, more successful life than those who do not follow Vastu-based tips. While it is not feasible to follow every step of Vastu, the more you can, the more fortunate you will get. People who practice Vastu have a better mental state, are more optimistic and thus more likely to attain their aspirations. The following 15 Vastu Shastra-based ideas can help resolve conflicts and allow you to live a better and more tranquil life: 1. Lighting Guggul once a week in your home may stimulate good energy and help to eradicate all toxicity. 2. It will be advantageous to grind wheat with two grains of Nageshkar and eleven leaves of Tulsi. 3. Never let dry flowers be in the house. Transform your life with Vastu 4. Another fantastic Vastu tip for bringing prosperity and tranquillity into our homes is to light diyas with mustard and cloves. 5. Every Thursday, serving milk to Tulsi can put a stop to unnecessary arguments and promote tranquillity and mental harmony. 6. When some milk is poured over the tawa after cooking chapatis, it is considered sacred. 7. Take out the first chapati for the cow, which is revered as a sacred animal by Hindus. 8. The house’s three doorways should never be in an exact line. 9. Put portraits of saints and mahatmas in your living room that depict them bestowing blessings on you. 10. Things that are damaged, become garbage, or are no longer useful should not be kept. 11. Get a picture of anything loaded with a green hue in the southeast corner. 12. There ought to be no dripping faucets in the residence. 13. According to Vastu Shastra, furnishings with round rims should be present in the home. 14. The Tulsi plant should be maintained in an East-facing gallery or where Puja is frequently performed. 15. According to Vastu, drainage in the north or east is beneficial from an economic perspective. With people following these 15 very beneficial Vastu Shastra ideas, there seems to be a shift in their consciousness, for the better. A higher consciousness (knowledge and energy) basically solves many problems in a very simple manner. Once a person has elevated his or her knowledge and energy, then problems and conflicts can be dealt with very easily.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE A P R I L- M AY 202 3 97 Blueprint of the Authentic You takes you through many life-changing perspectives, making it easy to navigate the quest of finding your authentic self. Book Review by SIDDHI PALANDE Book blogger, former PR & Media professional BOOK REVIEW Each of us carries the element of supreme reality. We all are unique yet born out of the same source, same energy. There are those of us who have already realised our innate potential; and some of us are still grappling to come to terms with ONE ultimate fact – What is my true potential? These are the ones searching for that switch in the darkness. Therapies, yoga, mindfulness workshops will work only if you know what you are tackling; and 9 out of 10 times we do not know what we are after. The penultimate for us is to reach that innate reality at some point in time during our journey, the bend in the road that changes everything. But to get to that you need sage understanding of yourself. Who are you? What do you want? Why are you here? And, a book that helps you arrive at the right destination is Blueprint of the Authentic You by Jasrin Singh. I am an overtly spiritual person so I was instantly attracted to the book like a moth to the flame. Needless to say, this book provided me with a clear picture and paved a path to help me reach my goal, one step at a time. Realising Your True Potential The book is divided into two parts – discovering your authentic self; and aligning with your authentic self. While, who am I? Why am I here?, form the generic questions, what this book does is to go beyond the basics and help you evaluate and re-evaluate reality. It is only when you accept yourself as is,can you utilise your true potential. And the concepts presented in these two parts help you get closer to understanding of the true blue you. The book touches upon facets of our personality that determine how we act and react in varied circumstances, and with society, at large. The book is penned in a lucid conversational style and may seem like an affable soliloquy from a therapist. Blueprint of the Authentic You presents some doable and practical tools that will help you understand the inner mechanisms. If one religiously follows these tools then they are sure to get deeper insight that will help them upscale themselves. These tools are applicable in personal as well as professional life. The chapters are short and crisp which helps the reader zap through the book in no time. Add to that, the concepts are explained with appropriate real-life examples. The book begins with author Jasrin Singh talking about the lows she faced in her personal life, and the changes she brought about. Nothing happened overnight. From stepping out of an unhealthy lifestyle to creating a happy world for herself it took her a lot of strength and faith. Healthy mind leads to a healthy life. But to shift from a negative to positive outlook one needs great amount of perseverance, dedication, a strong resolve and discipline. How does one achieve all of this? Well, Blueprint of the Authentic You teaches just how. The book is after all a road map for self-esteem, well-being and success. It is a guidebook that gives you many life-changing perspectives. The reflection points given at the end of each chapter make it easy to navigate the quest of finding your authentic self. ABOUT THE BOOK Title: BLUEPRINT OF THE AUTHENTIC YOU: A Road Map for Self-Esteem, Well-Being, and Success Author: Jasrin Singh Publisher:Hay House Publishers India Number of pages: 240 Price: Rs 399

98 BW HE ALTHCARE A P R I L- M AY 2023 WWW.BWHEALTHCAREWORLD.COM The burden of diseases in India has undergone a huge shift, says Dr Randeep Guleria, Chairman, Institute of Internal Medicine, Respiratory and Sleep Medicine, and Director, Medical Education, Medanta. According to him, from communicable diseases and diseases of the childhood the burden has now transitioned towards non-communicable diseases (NCDs), and the healthcare system has to evolve accordingly to manage them. “If one talks about infectious diseases like malaria or dengue, after treatment the problem is solved however if one has non-communicable disease such as the respiratory diseases, diabetes, hypertension, or cancers, one needs treatment on a long-term basis, and sometimes throughout one’s life, and therefore the healthcare system needs to see how we can pick up patients early and monitor them on a regular basis. So, they do not develop complications,” Dr Guleria said. He further said that preventive health and early screening will prove instrumental and crucial in tackling the NCD stack. POLLUTION & LUNG CANCERS On being asked about the role of rising pollution in lung cancers, he stated “There’s now data emerging that in many diseases such as the chronic respiratory diseases, and even the heart diseases, pollution is coming out to be one of the major risk factors, both indoor and outdoor.” He further enumerated that one sees a lot of pollution in the Indo Gangetic belt as it’s a landlocked area and sometimes there is very little wind velocity to push the pollutants out, especially during the winter months. “But even if one looks at data throughout the year, let’s say if one looks at data from Delhi for the last five years, we find that more than 70 per cent of the days throughout the year were of bad air quality. It has only been good for a few days during the rainy season or the monsoon months. That means that we are all breathing that quality of air, both indoor and outdoor,” Dr Guleria said. He believes if we are breathing this air for a long time, it causes a higher chance of respiratory problems, but it also leads to a higher chance of developing cancers in later life. And the long-term effect of air pollution, both indoor and outdoor is something that medical experts are realising with various associations including cardiology associations that say that this exposure is as much a risk factor for heart disease as high cholesterol or smoking. POLICY PUSH NEEDED Dr Guleria said that the country needs to make pollution an important issue to bring any policy change, as the country is not only looking at the problem it can cause to the present generations, but to the future generations as well. “I think we should all become part of a movement to influence policymakers to get some changes in the policies so that the Indian cities are environmentally friendly,” he delineated. He gave an example of the industrial pollution in London in the 1950s which was effectively controlled and now being efficiently managed by the UK government despite large motor traffic is something which needs to be replicated in India, Dr Guleria explained. Dr Randeep Guleria on the emerging challenges for the healthcare sector in the form of NCDs, pollution and pulmonary diseases LAST WORD Make Pollution An Important Issue By Shivam Tyagi DR RANDEEP GULERIA

OPEN YOURSELF TO A NEW ERA OF SUBSCRIBE NOW & GET BUSINESS INTELLIGENCE! Returns... All-time high consumer sentiment pushes festive spending back on course Special Double Issue www.businessworld.in RNI NO. 39847/81 I 22 OCTOBER 2022 Splurge Season www.businessworld.in RNI NO. 39847/81 I 03 DECEMBER 2022 The National Logistics Policy (NLP) seeks to transform India’s logistics sector into an `ek\^iXk\[#Zfjk$\øZ`\ekXe[ sustainable ecosystem ON A FASTER TRAJECTORY Apoorva Ranjan Sharma Co-founder, Venture Catalysts Group (See Interview) RS 150 LOGISTICS: HAL TEJAS www.businessworld.in RNI NO. 39847/81 I 05 NOVEMBER 2022 RS 150 MAKE IN INDIA THE EARLY TRAILBLAZERS CUTTING-EDGE STARTUPS ARE THE BRIGHT SPARKS IN INDIA’S EMERGING DEFENCE INDUSTRIAL COMPLEX STARTUPS@DEFENCE M.K. STALIN, CM, Tamil Nadu RISHAD DADACHANJI, MD, Dadachanji INSIDE Group KAIRUS DADACHANJI, Chairman, Dadachanji Group www.businessworld.in INDIA’S TOP BSCHOOLS The Most Denitive Ranking of the top business management institutions RS 150 HR heads on what B-schools must factor in Illustrious B-school alumni share takeaways & lessons learned Been There, Done That Industry Expectations BUILDING BLOCKS OF THE FUTURE SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 19 NOVEMBER 2022 Special Double Issue www.businessworld.in RS 150 Festive Sparkle Returns RNI NO. 39847/81 I 22 OCTOBER 2022 LUXURY Thoughtful Spotlight: Beauty entrepreneur Katrina Kaif on the growth of her brand Kay Beauty and sectoral trends RECOVERY THE YEAR OF As India’s advances towards it’s $5 trillion mark, a look at what 2023 will mean for various sectors www.businessworld.in SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 31 DECEMBER 2022 INSIDE: IBLF Delhi Chapter Economy Education Agriculture Aviation Manufacturing Finance RS 150 BW Disrupt 40 under 40 Winner VINEETA SINGH Co-founder and CEO, SUGAR Cosmetics www.businessworld.in SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 17 DECEMBER 2022 RS 150 Young entrepreneurs like SUGAR Cosmetics’ Vineeta Singh are breaking barriers to create new-age brands that also have the potential to shine on the global stage THE ENTREPRENEURSHIP ISSUE POWER OF PM Modi sets a target to make India a developed nation by 2047 as he unveils his ‘Panch Pran’ blueprint. BW Businessworld comes up with ‘Five Pledges’ that will add momentum to the drive SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 24 SEPTEMBER 2022 RS 150 Leader India Inc. Will Miss Cyrus Mistry 1968-2022 www.businessworld.in 1 YEAR SUBSCRIPTION @ Rs. 3,900 Rs. 2,899 2 YEARS SUBSCRIPTION @ Rs. 7,800 Rs. 5,599 3 YEARS SUBSCRIPTION @ Rs. 11,700 Rs. 8,199 THINK BUSINESS. THINK BW BUSINESSWORLD. To subscribe, please visit subscribe.businessworld.in or scan the QR Code

C M Y CM MY CY CMY K BW BusinessWorld 33 million.pdf 1 12-11-2022 15:16:34