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From India, seeking simpler health-care products

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BANGALORE, India — It is a simple idea that could revolutionize the science of health care and turn accepted norms about innovation on their head.

Instead of designing health-care products in the West and then trying to adapt and simplify those products for sale in fast-growing emerging markets, Indian and American companies are increasingly realizing that products designed and built in India will naturally be better suited for market conditions here.

Scientists based in India, drawing on global technologies, are creating what proponents say are simple, robust and cost-effective diagnostic products that will make profits in India and can ultimately find markets — and help to contain health-care costs — from Africa to Europe, from China to the United States.

At the forefront are small companies such as ReaMetrix in the Indian city of Bangalore. It is rolling out a “lab in a box” that promises to bring diagnostic testing for a variety of ailments — HIV, malaria, diabetes, arthritis — cheaply and quickly, right to the patient. Its founders hope the product can one day transform health care in the United States.

There are others, too, such as Perfint in Chennai, which is using a robotic arm to help perform quick, cost-effective biopsies, to diagnose and then treat lung, liver and other soft-tissue cancers.

“You don’t really need to look to the West for innovation,” said Bala Manian, an Indian-born American and Silicon Valley entrepreneur who set up ReaMetrix. “If you frame the problem differently, in a local context, that is an innovation opportunity.”

Ultimately, though, ReaMetrix aims to use India as the research center and proving ground but find a market — and reshape the health-care industry — in the United States.

“Fundamentally, although I am born and raised in India, I am an American,” Manian said. “I really see this as an opportunity to transform the paradigm in how health care is managed in the developed economies, particularly the United States.”

Indian approach

Products designed in India start with a common set of assumptions. Power supplies in India are notoriously unreliable, so products are designed to run on voltages from 80 to 230, or even off a car battery. It isn’t enough for them to work in an air-conditioned hospital; they need to function in dusty conditions and summer temperatures that can reach 12o degrees.

Many Western-made products depend on costly disposable items thrown away after each test, but that business model is too expensive in India. Instead, cheap labor means that sterilizing and reusing components is more cost-effective here.

Indeed, it is the intense pressure on health-care costs in India that drives the innovative process in a different direction than in the United States.

“It is a very different market here,” said S. Nandakumar, Perfint’s chief executive. “It is not supported by insurance companies. Here everybody pays from their own pocket or the government’s pocket.” That, he said, makes it tough to survive in the Indian market. “So we are leveraging Indian market requirements, saying if something succeeds here, it should succeed elsewhere.”

Manian, of ReaMetrix, began his career in the world of digital optics, work spanning supermarket bar codes to the defense industry, from medical scans to movie special effects, winning him an Oscar in 1999 for his contribution to films such as “Indiana Jones and the Last Crusade” and “Return of the Jedi.”

At ReaMetrix, he saw an opportunity in the world of medical reagents — compounds that react with chemicals in blood, urine or sputum to help diagnose medical conditions.

Liquid reagents that often require refrigeration are not always suitable for the Indian market, so the company designed cheap, dried reagents that could be easily shipped across the country.

The next step was to design a multipurpose diagnostic machine, a neat box the size of a small PC’s hard drive that can be carried by hand, run on a car battery and situated in a doctor’s surgery clinic or a small-town medical clinic anywhere in the country.

Using state-of-the-art optics, it can perform CD4 blood tests to detect and monitor HIV in a fraction of the time and at a fraction of the cost of its competitors. Tests for diabetes and arthritis are being developed, along with others able to differentiate quickly among malaria, dengue fever and chikungunya, or between infectious and viral diseases.

Each test comes as a “panel” — in computer terms, an app — so the product can be effectively custom-built by the user. In poor states such as Bihar, where the parasitic disease leishmaniasis is a problem, doctors and medical centers could buy that panel. In richer cities, diabetes might be a more commonly needed test.

The box “leverages” global technologies — hardware from Germany, electronics from California, software from India and the United States, optics designed in India and made in Germany. Test results, instead of being sent to a lab and coming back days later, are available from 15 minutes to two hours later.

In a huge country such as India, the cost of a test is often dwarfed by the cost to the patient to travel to the point of care. ReaMetrix says its product “changes the paradigm” by bringing the test to the patient.

Manian said affordable diagnostic testing can shift the focus “from treating illness to maintaining wellness,” to make prevention and early detection much easier, even allowing people to monitor the effects of lifestyle changes on their metabolic parameters.

“It is no different when you have an expensive car,” he said. “You are willing to pay for regular and routine service calls, rather than wait for it to fail and have a pretty expensive repair bill.”

The cancer fight

In Chennai, Perfint is setting its sights principally on emerging markets rather than the United States. With the World Health Organization reporting that cancer was set to become the world’s deadliest disease, and with 40 percent of the world’s smokers in India and China, the company set out looking for a cost-effective method of diagnosis and treatment.

Existing methods of biopsies involve surgery, exposure to high-powered X-rays, significant costs for disposable items or difficult-to-acquire surgical skills. Under Perfint’s system, a robotic arm is positioned above the patient, with a CT scan and three-dimensional computer modeling system helping a doctor guide a needle to exactly where the biopsy needs to be taken.

The same procedure can help administer anesthetic to exactly the right spot and even burn a tumor with electromagnetic waves in a process known as ablation — a significantly more precise method than many other cancer treatments available.

There are a number of factors that could handicap India’s development as a global health-care research hub, including a lack of venture capital, the absence of a supportive policy framework and a shortage of clinical partners willing to test and help develop products.

Attracting good talent is a problem, too. The hierarchical culture makes young people not as adventurous here as they are in Silicon Valley, Manian said, while scientific accomplishment is valued less than material wealth in modern India.

Nevertheless, significantly lower costs help to compensate, as does the discipline that India imposes on the research scientist.

“The Indian market really pushes you to the edge,” Nandakumar said. “The procedures you look at are very different, very cost-effective, but when we do this, we find it is actually what the Western world wants.”

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