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Why Clinical Research in India Outpaces U.S.

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“Opportunities to develop cutting edge [medical practices] are fast disappearing in…the United States,” says Dr. Kushagra Katariya, who was born in New Delhi, specialized in New York, and recently returned to India. He says that when it comes to developing a new, improved way to treat patients, he can do it “quicker, develop it better, and have the ingredients to really take it much further" than he could in the same amount of time in the U.S.

His decision to first go to the U.S. for advanced medical study was an easy one: “It was obvious that education of all forms was...the best there [in America]. If you had to be the best at what you did,” you “had to go” to America.

He spent almost two decades in the U.S., first in New York training to be a cardiothoracic surgeon and then as an associate professor at the University of Miami. While abroad, he dreamed up the Artemis Medical Institute and developed the contacts he needed to make it real. Here in Gurgaon, ten days from now, the clinic will move from soft-launch into full-scale operations.

Katariya tells me he held on to a “passion for coming back to India…I do belong here.” But when he did finally return, his reasons were far more than emotional. Here, he can combine his clinical practice with scientific research and technological development, all at a breakneck pace.

"Clinical research and translational research is down 70% in the U.S.," he tells me, laying out two primary explanations:

First, he blames “the lobbies, restrictions, confidentiality problems, insurance companies regulating what needs to be done, what can be done, what cannot be done…the usual ambulance chasing that occurs." In the U.S. there’s too much red tape.

Second, there’s an “inhibition of intellect coming together.” Because “provisions for funding are few and far between," there is a huge amount of “talent divided among 200 universities" that don't always collaborate.

This, in addition to "super-specialization," creates a "silo-mentality" between and within leading institutions. “Clinical applicators at the bedside” and the “researchers in the lab” are like “two parallel railway tracks that never meet” even though they’re working toward the same goal, improved patient care. In India, he says, ideas are fresh and different sectors are more amenable to being brought together to “beat the disease.”

Another draw for Katariya is that he’ll be providing medical care at a fifth the cost of parallel U.S. treatments. 400,000 Americans get coronary bypass surgery each year paying at least "$30,000 dollars each, with their hospitals paying more." At Artemis, the surgery costs $5,000.

So could there be some international health tourism? I ask. Certainly says Katariya, especially from some Scandinavian countries where the wait for care can be excessively long. There’s also talk of promoting international health tourism by working out deals with insurance companies that would offer lower premiums to those clients willing to travel to obtain the best medical care in the world, says Katariya.

skull.jpg
Using the hottest new technology, Artemis' 3D MRI.
The equipment is in place. Our interview occurs in an operating room without corners made of “modular stainless steal," with every device hanging off the ceilings so the floor can be easily swept clean through “hermetically sealed doors.”

However, over lunch with staff doctors, I’m told just how underpaid physicians in India are, with an average salary of around 13,000 rupees a month, or about US$300. Many migrate to Gulf states, England, Australia and America and not all return. Yet India is large, the middle class growing, and so the medical academies here are still fiercely competitive, attracting very bright minds. Artemis feels confident it will have the talent to match its technology for years to come. It can also afford to pay its doctors more than the local average, though MBA’s still make much more even though they study for two years instead of twelve.

But does Katariya stress keeping doctors in India? “No,” he says, “We want people to get experiences everywhere else that the world has to offer, but at the end of the day…we want to bring it back to India....because the local talent, the local ingredients exist to be able to create that stuff [new treatment methods] over here much faster than at a Hopkins, or Cleveland Clinic, or a Stanford or the big names you hear about in the U.S.”

Keep your eye on Gurgaon, the booming suburb of New Delhi with malls everywhere. This is where Artemis is. From afar the hospital looks like a mirage: situated down a long dirt road ridden with potholes. Encircling Artemis is an arid expanse of jagged rocks, untidy construction sites and rubble. It's from here that Artemis hopes to rise, and out-pace America’s medical giants.

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Comments (46)

NunoH:

Cool article. But I must say that medical tourism has always been a choice for the well informed traveler. Now its just a wider known subject. Even where I live, in Portugal there is such a company: http://www.fly2doc.com

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JRLR:

Concerning references I gave in my posts above (June 26, 2007 9:19 PM and June 28 and 2007 3:29 PM), for the record, and so as to avoid confusion.

I just referred to the WIKIPEDIA site.

PLEASE NOTE THAT WIKIPEDIA NOW ADVISES: "This page was last modified 18:38, 30 June 2007.

My quick observations are:

1. The site is now at:

http://en.wikipedia.org/wiki/Medical_tourism

2. The text has been modified substantially.

3. I can no longer find there the entire quote I presented above. What follows now seems to be missing: "India is one of the most touted destinations in the world for medical tourists. ... The government and private hospital groups are committed to the goal of making India a world leader in the industry. ... In 2003, Indian finance minister Jaswant Singh called for India to become a “global health destination"."

4. The reference to the UDaily (university of Delaware) is now given in note number 2.

I believe the site on medical tourism is still well worth referring to, in Wikipedia's spirit:

"Wikipedia articles should be used for background information, as a reference for correct terminology and search terms, and as a starting point for further research. As with any community-built reference, there is a possibility for error in Wikipedia's content — please check your facts against multiple sources and read our disclaimers for more information."

Dr. Vivek Vaid, Artemis Clinic:

India is being promoted as a destination for low cost medical treatments and this might look attractive particularly to the insurance companies in the west, particularly Europe, middle East and South East Asia. Apart from the cost, I believe, the acclaimed skills of Indian doctors is also likely to contribute. However, our hospitals need to be approved by international accreditation bodies ( who have very stringent parameters) before a mass scale activity could happen in this field. I am not in the knowledge of exact number of patients coming to India as medical tourists .

Ted L.:

Great post, Amar. I'm not surprised you wrote about this topic. Keep up the good work!

JRLR:

Guy writes: "re: the quote from the always questionable Wikipedia -- "India performs nearly 15,000 heart operations every year, and the post-surgery mortality rate is only 0.8 percent, which is less than half of most major hospitals in the United States."... In any event, I don't see where this number comes from or how they got it & I just wanted to point it out as another example of having to be careful about what you read on wikipedia."

Guy, congratulations for being "careful about what you read on Wikipedia". It is most unfortunate, however, that you "don't see"! That is, of course, assuming that you did read the article I referred to.

As it says explicitly in what you arrogantly call "the always questionable Wikipedia" article on "Medical Tourism", note 1, the number comes from "Medical tourism growing worldwide" by Becca Hutchinson, UDaily (UNIVERSITY OF DELAWARE), July 25, 2005, retrieved September 5, 2006. The fact that you did not see the sources given as reference would seem to suggest that your own credibility is highly questionable.

In the UDaily, one can further read:

"Ten years ago, medical tourism was hardly large enough to be noticed. Today, more than 250,000 patients per year visit Singapore alone--nearly half of them from the Middle East. This year, approximately half a million foreign patients will travel to India for medical care, whereas in 2002, the number was only 150,000.

... Argentina, Costa Rica, Cuba, Jamaica, South Africa, Jordan, Malaysia, Hungary, Latvia and Estonia all have broken into this lucrative market as well, or are trying to do so, and more countries join the list every year.

Some important trends guarantee that the market for medical tourism will continue to expand in the years ahead. By 2015, the health of the vast Baby Boom generation will have begun its slow, final decline, and, with more than 220 million Boomers in the United States, Canada, Europe, Australia and New Zealand, this represents a significant market for inexpensive, high-quality medical care.

Medical tourism will be particularly attractive in the United States, where an estimated 43 million people are without health insurance and 120 million without dental coverage--numbers that are both likely to grow. Patients in Britain, Canada and other countries with long waiting lists for major surgery will be just as eager to take advantage of foreign health-care options.

...

India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India’s clinics are equipped with the latest electronic and medical diagnostic equipment.

Unlike many of its competitors in medical tourism, India also has the technological sophistication and infrastructure to maintain its market niche, and Indian pharmaceuticals meet the stringent requirements of the U.S. Food and Drug Administration. Additionally, India’s quality of care is up to American standards, and some Indian medical centers even provide services that are uncommon elsewhere. For example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy--an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the U.S."

I am not sure it is wise to dismiss medical tourism offhand. No harm in hearing patients bear witness. Readers are therefore encouraged to watch Radio Canada's four parts series on medical tourism at:

http://www.radio-canada.ca/actualite/v2/enjeux/niveau2_6618.shtml#

Guy:

re: the quote from the always questionable Wikipedia
"India performs nearly 15,000 heart operations every year, and the post-surgery mortality rate is only 0.8 percent, which is less than half of most major hospitals in the United States."

In typical "lies, lies, & statistics" style propaganda, here we have a comparison of post-surgery mortality rates of "most major hospitals in the United States" with the very few highly specialized 'showcase' hospitals in India.

For a population of over 1 billion people, 15,000 heart operations is a figure that tells me there's only a few such hospitals in India.
It's a comparison of apples & oranges. A "few highly specialized hospitals" of a small sample vs. "most major hospitals" of a large. In any event, I don't see where this number comes from or how they got it & I just wanted to point it out as another example of having to be careful about what you read on wikipedia.

The Dr. in this article is right about the red tape though. Many things can't be tried on humans for many various reasons, whereas in India those reasons don't exist, for good or ill.

Anonymous:

Ayse, good point. and to keep costs low there's pressure to kick em out

Ayse:

The problem is after care, dirty hospital rooms etc. after wonderfully performed operations. Most emerging market countries have the US educated skilled surgeons and doctors but after care especially in case of major surgery is often a big question mark.

Ayse:

The problem is after care, dirty hospital rooms etc. after wonderfully performed operations. Most emerging market countries have the US educated skilled surgeons and doctors but after care especially in case of major surgery is often a big question mark.

Anonymous:

It sounds like you must know Katariya well Nujg to write a post like that with a screenname like that!

Jhimbala Nujg:

Katariya wanted to get back to India so that he wouldn't be ugly and have a funny name

Amar:

Hi, I've read these comments with interest. I think the interesting point to me from what was said at Artemis was that they feel they can develop clinical practices faster than they can in the U.S. because of less restrictions -- which is a mixed bag for sure. As far as better medical practices in India, I don't think anyone believes that's the case. America has tremendous resources, talent, finances and infrastructure that as one commenter said, it'll take decades to compete with. But where India can compete now is in the speed of clinical, translational research and development. That's where the doctors I met hope to charge to the forefront.

As far as the huge income inequalities as applied to health, there is no doubt, and each post on this blog can't address every issue. I'm dealing with local government run clinics and All India in the coming weeks. Even among the best gov-run clinics lines are enormous and seeking care is a "fight for yourself venture" as one recipient was telling me. More on that will come, and I expect the critiques of posters here might well invert...

Vijay:

I agree with MAHENDRA DEV. If you have lived or visited India, you would wonder why all the news about 8% GDP growth.
There are numerous electricity blackout when the temp. is 119 degreed Fahr. Corruption is rampant from a clerk to the Prime Minister. There are religious, caste, race tensions. And no need to mention the living conditions. It is a very bad 3rd world country.

Vijay:

When will the "medical advances" reach India's 800 million living in wretched poverty? Or for that matter, clean water, air, access to toilets, drivable roads....?

mahendra dev:

treating corrupt and few super rich people is not what india needs.over 90%of its people donot get safe drinking water.even in cities like bombay roads get flooded with first monsoon rains.
go to india to get some churn and agarbatties.of course ladies get best bargain as they buy all the sarees and salwar kameez. author is there to get some of the black money the corrupt politicians and bureucrats have.i belong to gurgoan, i know the reality.stay put in usa and get the best.

Steven Marshall:

To be sure, go to India and have surgery performed by an unschooled 15 year old; cutting edge with a vengance!!

j:

I am not sure I agree with Ramesh. I do not believe that the author tried to sell going to India for medical procedures as the next huge wave. I do believe that it is an interesting concept and rumors have been ongoing for some years now. A dialoge like this one is what one would expect from this report and you response is equally informative

Ramesh:

I lived in the US for 15 years. I moved back to India 3 years ago. Conditions in private hospitals in India are acceptable. They are appalling in Govt. hospitals. Research in India is scant in any field let alone healthcare. The system is simply not set up.

For routine medical procedures, India could be a cheaper option. However, one has to realize that ordinarily no one is held accountable if something goes wrong. So do it at your own risk.

So many medical colleges have spawned in India. Very few have the teaching staff, equipment, setup to impart quality education. The author is completely out of touch with the reality in India.

Such reports appearing on the front page of Washingtonpost is counter productive

RGK:

"Medical tourism vs basic care to everyone"

Indian medical system lags way behind. I understand a few medical facilities in India
excel and is able to provide life saving surgeries
and joint procedures at an affordable cost to a westener but not to an average Indian. Basic medical care in India still has a long way to go.

hi:

Im a radiology tech and the piece about everything hanging up in the operating room is brilliant. In american OR's you have everything on the floor of the OR. And that makes it tough cleaning and maneuvering also!

James B. Cole:

I am a physicist living in Japan. In the US funding for research in the physical sciences has been cut, and what is left is far too goal-directed. Here I combine theoretical and industrial research much more effectively than I could in the US.

Judge C. Crater :

..."basic research is a vital foundation for all advancement" in pretty much any subject you choose. Should we invest endlessly in basic biological research while people die from diseases that are entirely treatable with an emphasis on translation instead of study? Should we just completely divorce research from reality in the hope that 'someday' they will translate into benefits for the taxpayer?

JRLR:

Amar, according to Wikipedia:

"India is one of the most touted destinations in the world for medical tourists. It is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine. The government and private hospital groups are committed to the goal of making India a world leader in the industry. The industry's main appeal is low-cost treatment. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain....

Escorts Heart Institute and Research Center in Delhi and Faridabad, India performs nearly 15,000 heart operations every year, and the post-surgery mortality rate is only 0.8 percent, which is less than half of most major hospitals in the United States.

Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012. In 2003, Indian finance minister Jaswant Singh called for India to become a “global health destination"."

Source:http://en.wikipedia.org/wiki/Medical_tourism#India

Do you have more telling statistics on that phenomenon? Do you know how many Americans went to India for medical treatment, in the last five years, and how much they spent there on medical services?

Allen Smith:

In terms of "Judge C. Crater"'s claims about
NIH funding, I suggest an examination of that
basic research is a vital foundation for
all advancement in medicine; antibiotics came
about largely through prior research into soil
bacteria, for instance. I suggest that the problem
is more the separation between researchers and
clinicians - it is unfortunately difficult to
work on human subjects unless one has an MD,
even though a Ph.D. in a given area may well
know more than almost any "pure" M.D. M.D./Ph.D.s
exist - but require the same level of inane,
useless memorization as an M.D., and take almost
as long as both of them put together in many
cases (at least for programs in which one is
both a "real" M.D. and a "real" Ph.D., not some
lesser version of one or the other (or both)).

ram:

I do agree with some points in the article. But, it will take a couple of generations for Indian institutions to atleast try to compete at the international level. I doubt if private hospitals in India will ever concentrate on research as profits come before research.

International health tourism is good for the economy. But, when will Indians think about healthcare of a poor Indian citizen who form more than 70% of the population?

Judge C. Crater :

As far as the " 'silo-mentality' between and within leading institutions" he's certainly got that right. Funding is scarce and becoming scarcer. Academic faculty got to where they are by competing with Bobby at the next desk so, naturally, they are already the most hyper-competitive people on the planet.

Added to this is the fact that NIH funds increasingly biological goals disconnected from actual patient-based applications and you have a funding system that actively avoids treating disease in favor of chasing down tiny technical details. Of course, the possibility of "revolutionary changes in disease treatment" is always trotted out as the overall justification. In practice, however, at the end of the research 'interesting,' 'innovative' yet totally arcane biological goals assume precedence over clinical translation.

On the plantation:

Credible assertions. If the comparative advantages are tending to swing to India, then good forture to the medical professionals there. Time will tell.

Anonymous:

An interesting perspective. But he should not underestimate the power of America's educational institutions, which do compete with one another, sure, but have unparalleled resources (in part because of signficnat US gov support!) It's tough for the private sector anywhere to match that!

And I wonder what is lost in all the shortcuts (fair to say?) one can take in India. Are pateint confidentiality kept? Is after-care of high quality? One thing to operate, another thing to deal with fallout etc....just my two bits.Always wanted to be a doctor, figured Id make more banking.

a:

finding your reports of the most remarkable interest, like a novel i'm hooked daily.

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