I had the great pleasure of interviewing Professor Mahesh Misra, keynote at FAMx Paris, thanks to the cooperation between the French Foundation of the Academy of Medicine and Doctors 2.0 & You. Unesco headquarters will be the site of FAMx Paris on May 31st-June 1st, 2018, organized by the Foundation of the Academy of Medicine. This international forum will bring together 400 participants from all continents. The program focuses on “reverse innovations” in healthcare, coming from key emerging economies whose healthcare institutions have partnered with the Foundation. Registration is free. I hope you will take advantage of this opportunity.
“With these low cost or frugal innovations in healthcare, we can do the same or better work as what is currently done in Europe. And if the technologies that we develop in partnership are good for human beings in India, they are good for developed countries as well.” Pr Misra
Professor Misra is currently President of the Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India, where he is also the Director of Surgical Disciplines and Professor of General and Minimally Invasive Surgery. Professor Misra advises the Ministry of Health on the future All India Institute of Medical Sciences*, Nagpur. Professor Misra was previously Director of All India Institute of Medical Sciences, New Delhi. He did his medical degree at Kanpur University, India and his Master in Surgery at the University of Allahabad, India.
* The All India Institutes of Medical Sciences (AIIMS) are a group of public medical schools in India.
DS Professor Misra, would you describe your main messages for FAMx Paris participants?
MM As world health becomes a global village, it is our responsibility to innovate in both diagnosis and therapy, and thereby help large populations of the world, particularly in Asia. When we speak of universal health in 21st century, we refer to the provision of health for all. So, we need to rationalize the cost of healthcare, and this requires partnerships.
We also need to develop a strategy for the prevention of various preventable diseases and focus on “low cost innovations” which can be applied to large populations in under-served geographic areas of the world. These include India, southeast Asia Bangladesh, Sri Lanka, Pakistan, Afghanistan and other Asian countries.
With these low cost or frugal innovations in healthcare, we can do the same or better work as what is currently done in Europe. And if the technologies that we develop in partnership are good for human beings in India, they are good for developed countries as well. Healthcare cost is an issue for countries like India, but also in Western Europe and the USA. How can we have accessible and affordable healthcare for everyone?
DS In Europe and the US, we are increasingly speaking about personalized medicine. What do you think of this concept?
MM Well, can we rationalize and personalize? These are two divergent issues; personalization involves costs. I think we need a reasonable healthcare, which is acceptable and affordable to the majority of the population. In India, we will personalize for a smaller segment of the population than in Europe. Who is paying? The taxpayer, the individual, the insurance company? Someone has to bear the cost.
DS You are a strong proponent of public health. Can you elaborate?
MM We study WHO projections for the diseases which are responsible for major healthcare costs in coming decades. They are: cardiovascular disease, mental health, injury and trauma in terms of DALYs (Disability Adjusted Life Years Lost). Injury is a disease of the young population. Injury in males aged 15-24 is more prevalent than cancer and heart disease. In developing countries, the number of patients who die due to injury is greater than for cancer and heart disease. We need prevention strategies to reduce mortality from injury and injury itself.
We have a paradox in India. Tuberculosis and malaria are still taking a huge toll on our lives; w e see many bacterial and viral diseases; new infections, such as dengue fever, have emerged. Plus, we have an epidemic of non-communicable diseases, such as high blood pressure, respiratory diseases (Pollution linked), diabetes. The problem of morbid obesity is on increase significantly but we have not yet won against malnutrition. We cannot ignore these major public health problems.So, we need frugal innovations in order to be able to attack all these challenges simultaneously.
DS How did you get interested in “injury”?
MM In 1988, I was awarded a commonwealth medical fellowship at the University of Manchester, UK.I chose to study trauma care services when nobody was talking about trauma as a problem. Many colleagues were laughing at my choice. They didn’t realize that it was a serious issue. Sixty thousand young lives were lost on roads in India. The only difference is that this number has grown exponentially. Look at road deaths alone. There are more than 150 000 every year (5 – 8 % increase each year). As to accidental deaths, there are more than 400, 000 in India
Injury incidence is about 30/100,000, double that of breast cancer ( incidence ranges between 14 – 29/100,000 in different cancer registries).
DS You also have an interesting experience to share regarding students. Please tell us about it.
MM Yes, I will share the experience of the i-fellowship in information technology.We have young engineers as Fellows with interest in medicine. They join and get immersed themselves in the hospital environment and shadow some of the physicians and surgeons to see the issues/problems and the potential solutions. We do this at the All India Institute’s School of International Biodesign, (Erstwhile Stanford India Biodesign). We started this fulltime two-year International fellowship around ten years ago. Our students also work with Stanford in Japan, and we would like to work with France.”