HEALTH MATTERS. It’s the age of redefined PPPs

The discovery of penicillin by Alexander Fleming was a watershed moment in medicine. This near century-old breakthrough marked the beginning of modern curative medicine which has saved millions of lives, helped improve surgical outcomes, increased life expectancy and enhanced the ability of the human race to fight the perils that exist in nature. This singular discovery was significant since from that time onward, medicine has become interventional, curative and reliant on the use of mass-produced drugs to tackle diseases and conditions. While penicillin and other modern interventions have come to define the era of modern medicine, the 21st century is witnessing another such inflection point.

A new ‘PPP’ in healthcare is now finding a firm footing in planning treatment modalities for a significant portion of populations across the world. I believe the next era of medicine will be preventive, predictive and personalised. This new triad of medicine is both path-breaking and the need of the hour.

India today is critically short of infrastructure in healthcare. A report by Bain & Company estimates that India has a current bed shortfall of 2 million. They also report a 2 million shortfall of doctors and 4 million nurses. This would require ten times the current budgeted investments in the coming decades.

Additionally, disease patterns are showing significant changes in our country. The prevalence of communicable diseases, though still quite burdensome, is being slowly overtaken by non-communicable diseases (NCDs). These lifestyle diseases claim over 36 million lives a year globally — equivalent to the population of Canada succumbing to NCDs annually. The financial burden on economies the world over is estimated to be over $30 trillion of which India’s share would be $5 trillion. So, both on the infrastructure front and on managing the social and economic costs of 21st century diseases, a paradigm shift in disease management is imperative.

Preventive medicine is the single most important health intervention that can save lives. Researchers, clinicians and policy experts have hailed preventive medicine — which includes health checks, screenings, vaccinations and disease management — as having a direct impact on the productivity, morbidity and mortality of any population group. Preventive health checks were introduced at our hospitals over 20 years ago.

Then considered a novelty, today they are a significant tool in our battle against NCDs. Having conducted over 12 million health checks, we have been able to advise patients on impending health concerns and also better plan interventions based on the predisposing factors that result as an outcome of these checks. The government’s admirable step to provide tax benefits for health checks have contributed to their growing numbers in India. It is my firm belief that we need to further expand preventive health checks and mass screenings to bring an even larger section of our population within this fold. Doing so will have a lasting impact on the health of our people.

Further, mass screenings and appropriate vaccinations can help prevent cervical cancer in women in India. According to the Cervical Cancer Free Coalition and published literature in the Indian Journal of Medical and Pediatric Oncology , cervical cancer is ranked as the most frequent cancer in women in India and the second most common cancer in women worldwide. India has a population of approximately 365.71 million women above 15 years of age, who are at risk of developing cervical cancer. The current estimates indicate approximately 1,32,000 new cases diagnosed and 74,000 deaths annually in India, accounting for nearly one-third of the global cervical cancer deaths. Even if we were to start today, within five years, we could declare our victory over cervical cancer. Preventive medicine today holds that power of deliverance from cancer. It must be fully realised.

Preventive medicine has also opened modalities for personalised medicine over the past decade. Tailor-made disease management interventions help improve efficacy in treatment for NCDs. Personalised medicine helps regulate the type of treatment, drug type and dosage, frequency of consultation and help decide surgical and non-surgical interventions for the individual based on her disease pattern and genetic predisposition. This helps improve outcomes and, in many cases, reduces the cost of care. The introduction of specialty-specific clinical infrastructure such as diabetes clinics have helped usher in a new era of personalised medicine. These centres enable tailor-made medical interventions while also aiding disease management.

Another significant adjunct to personalised medicine is an area, which I believe, will significantly change our current approach to disease management. The advent of genetic medicine, which analyses the genetic make-up and predisposition of an individual, and helps create a suitable care plan, will become the mainstay of clinical management in the decades ahead. Some clinical applications already exist that help in creating an individual-specific disease management plan based on genetics. This area needs the focus of researchers, clinicians, health administrators and policymakers since it will change our method of management in the future.

Preventive and personalised medicine has helped create an environment for the dawn of the age of predictive medicine. For doctors, nothing would be a greater boon than to have early diagnostics and a genetic profile of their patient along with a tool that can predict the possible outcomes and progression of a medical condition. Predictive medicine, though nascent, will be a significant part of our disease management armamentarium in the years ahead. Predictive medicine is also important in India to help trace patterns of disease prevalence and create models of possible future outbreaks of diseases in specific regions of our country. This will help reduce mortality rates and better align resources to tackle outbreaks in our country.

This new triad in healthcare has many interdependencies. Preventive checks aid personalised medicine. Similarly, personalised medicine will guide predictive tools on future outcomes and disease progressions. Thus, it is essential to focus on all three as the sum part of the whole rather than individual compartments.

It is greatly encouraging to see new inventions and innovations being reported on this triad the world over. Health monitoring applications for smart phones and devices have ushered the power of personalised medicine literally into the hands of every individual. Similarly, genetics-based health checks and medications are today a reality and finding traction with clinicians and patients alike. Means of financing such as insurance products tailor-made for specific disease management, are today available in the market as are specialised clinics focusing on a particular disease or interventions. These innovations will become the defining standards of management for new-age diseases of the 21st century.

While the healthcare sector innovates, the government must help create an enabling and collaborative environment for innovators and providers to sandbox their ideas to become viable methods for clinical use. This will be our penicillin moment.

The writer is founder-chairman of the Apollo Hospitals Group

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