December 2013

Quality Diagnosis A Must for Rural Healthcare

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Dr Nidhi Bhatnagar, Specialist Consultant, MSK USG, Max Medcare, Panchsheel, talks to Ankush Kumar, ENN, about how companies in the West are targeting lucrative markets like India with technologies that are obsolete in their own country.

How do you see the Indian Diagnostic Market? What kind of Imaging & Diagnostic setup you have at Max Hospital?
Market depends upon a triangle-like association between the producer, provider and the consumer. A balance has to be struck between the three viz a viz need based productivity, cost efficacy and reasonable degree of flexibility to accommodate the changes as and when they are encountered. In India due to continued inflation the prices of latest diagnostic modalities are steadily on the rise , hence market remains restricted only to the bigger cities. In general, masses remain deprived of the usefulness of technological advancements. Max Panchsheel has Colour Doppler scan and routine / HF Ultrasound facility, conventional Radiography, Mammography and Dexa scanning. Apart from this it has state of the art Laboratory facilities for all routine and specialised investigations. The range of cross-sectional investigative modalities at Max Saket are extensive and offers services related to every specialised unit that can be , at a leading Institution.

There are lots of cases of Clinical trial, where we call them guinea pigs. What you think about such practices, are they worth doing on human or it is a kind of malpractice?
Clinical trials form the basis of the ultimate technically safe treatment , to reduce morbidity and mortality pertaining to diseases which challenge the Medical fraternity. To transform a killer disese into a treatable one takes years of perseverance and cannot be interpreted only by the results of studies conducted on animal models. Human trials are imperative to the growth of medicine but, should have strict codes of conduct. They have to be properly monitored, controlled and have a monitoring committee to regulate such trials . The most challenging issue is to be able to manage and provide appropriate treatment in the event of complications. Very close quality monitoring by Specialists should be available round the clock. The patients should be under close observation, preferably as in-patients. Informed consent should be mandatory from the patients undergoing such trials and should be in detail appraised of the consequences.

Long back, R&D is mainly done abroad but today India is emerging as new hub for the researches. What is your viewpoint on this?
This change is so very welcome. We have the man-power and intellect both, for such ventures. It will keep the resources within the country and strengthen the economy. Our dependency on foreign companies would reduce. We certainly need to strengthen in-house R&D. We need to convince the Government and strong Financial houses of this concept so that Gross under-funding towards this field can be eliminated. Mis-appropriation of funds in bane plaguing research projects strips the country of credibility and results. Pseudo-researches flood medical conferences and clinical trials, there – by mitigating the efforts by honest scientists. Plagiarism has to be kept in check by strong committees from Premier Institutes with heavy penalties. The bottom line is that one cannot keep re-discovering the wheel in the name of originality and claiming it to be in-house R&D.

With emergence of new technologies and equipments, people have started doing test in homes only. How much do you think it is reliable and acceptable?
Every in-house investigation kit should be backed by proper information leaflet and perhaps a small word of caution / counseling by the Pharmacist dispensing them. An in-depth training of the Pharmacists, preferably through the companies manufacturing such kits, would lessen the hazards through rampant use of such investigations and patients getting entrapped with the results they are not equipped to deal with. The up side of this is strengthening a common man’s power to enable him to monitor his illness more closely than offered through the Hospitals. Of course the down side is false negative or positive results which if left unaddressed for too long can result in increased morbidity. Also, the Pharmaceutical companies that are providing such facilities should manufacture these kits for diseases which seriously warrant close patient monitoring eg blood sugar levels, Pregnancy tests, occult blood in stools or urine.

With technologies at its peak, where do you see Medical Diagnostic in India in near future?
Companies in the West are looking for lucrative fertile markets and I believe India stands out as the most receptive ground. However, their reality check on India’s payment parity to their expectant pricing of the product is not in complete sync with the current market trends governing medical practice in India. To gain foot hold, International companies are pushing in outdated technology which may have lost their purpose back in the West but may still hold a purpose in technologically parched peripheral regions of India. Outdated technology gets touted as the latest “new” concept and floods the market, further weakening the economy through financial drain. This is the price we are paying for not addressing our own R&D more vigorously. In fact a forum needs to be created on the lines of FDA, to approve / disprove Bgrade technology infiltrating our markets. Each such equipment should be routed through a panel of experts and be assigned a rating on its functionality, applicability to the current medical practice, price structure and comparative analysis with other existing equipment. B-grade technology should not find its way into Indian market. Consumer awareness has also to be addressed on lines of “Date of expiry.”

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