Robot can beat cancer, but not red tape

— Dr. Ajit Singh, Partner, Artiman Ventures, comments to The Hindu on the challenges faced by MedTech innovators in India —

By Peerzada Abrar – The Hindu Updated: June 10, 2015 07:51 IST — A 54-year-old finance professional with stomach cancer used to take tablets to get over the pain. But they became less effective over time, with his body developing resistance. The father of two used to endure unbearable pain. His family took him to a hospital in Chennai where Dr. Madhan Kumar used Maxio, a robot, to deliver the medicine precisely to the nerve root where the pain originated.

The treatment was done in five minutes, faster than the conventional method that uses continuous X-ray imaging. The old method, the doctor said, carries a risk of damage to motor and sensory nerves that could lead to paralysis. The patient can now carry on with his routine, which was not possible when he was on painkillers, as they used to cause drowsiness, constipation and blurred vision.

“We are bang on target. Robotics is a big boon,” said Dr. Kumar, a 36-year-old senior consultant at Chennai’s Global Hospitals Group. The robot that helped him perform complex procedures has been developed by Chennai-based start-up Perfint Healthcare. In the past year, Perfint’s robots have helped treat over 1,500 patients around the world.

The eight-year-old firm, founded by three former employees of GE Healthcare, has done something very few start-ups can aspire to do — innovate in the field of medical technology. Its product managed to enter developed markets such as Germany and Australia. Last year, the U.S. health regulator Food and Drug Administration gave Perfint its approval to sell Maxio there. What Perfint is concerned about right now is its biggest market, its home market.

In India, said S. Nandakumar, its 46-year-old co-founder and CEO, “the challenge is the delay in the government process, as we focus on government-run teaching hospitals.” One million new cancer cases are diagnosed in India each year, and this number is projected to jump to 1.7 million by 2035, according to the British medical journal The Lancet. Nearly 700,000 people die of cancer in India each year, which is projected to rise to about 1.2 million in 2035.

Funding structure hits robot-maker

“The government has to become the biggest buyer of medical technology,” says S. Nandakumar, 46-year-old co-founder and CEO of Chennai-based start-up Perfint Healthcare, who started the firm along with K. Guruswamy and K. Puhazhendi. Perfint’s cancer-treating robots have entered developed markets.

The three launched Perfint as a design services firm for the health-care industry, but soon changed direction when they realised the opportunity in the image-guided navigation space.

One of the stumbling blocks Mr. Nandakumar refers to is the funding structure under the government’s National Cancer Control Programme. Under this, three-fourths of the money is designed to come from the Centre and one-fourths from the State government. “Many times, based on their priority, the State government may not approve the funding.”

This means, the whole funding could get stuck. He says 100 per cent Central support is the answer. India’s medical technology industry, about $6.3 billion (Rs. 40,000 crore) in size at present, is capable of growing to $50 billion (Rs 3.1 lakh crore) by 2025 if it receives appropriate support from the government, according to a report by the Confederation of Indian Industry.

Mr. Nandakumar’s concerns go beyond just sops. He says, “Doling out the routine tax breaks only benefits the larger, profitable companies.”

Perfint also faces a problem during tendering processes, when it has to necessarily mention the names of competitors. It doesn’t have any in the country, Mr. Nandakumar says.

The other issue is that there is not a single administrative ministry in India that deals with ‘med-tech.’ “Is it the Department of Science & Technology? Is it the Ministry of Health? Department of Pharma? Or the Department of Biotechnology?” he asked.

Ajit Singh, a consulting professor at the School of Medicine in Stanford University and partner at venture capital firm Artiman Ventures, said, “For medical innovation in India to find market in India, the regulatory and peer-review publication framework in India must gain trust of the clinicians.” Otherwise, “We will stymie the adoption of Indian innovation in India,” said Mr. Singh, who is also a part of the board of Max Healthcare.

Perfint is counting on hospitals that have adopted its product to spread the word. It is also talking to bureaucrats at government forums. There are clients beyond the Indian government, though.

It has until now set up robots in institutions such as Alfred Hospital, Australia; University of Frankfurt and University of Regensburg in Germany; and the Tata Memorial Hospital and Jaslok Hospital in India.

At the University of Regensburg, Philipp Wiggermann, who is on Perfint’s advisory board, recently treated a 41-year-old women patient for liver cancer. “This procedure could not have been completed so easily without Maxio,” said Dr. Wiggermann.

The company sells two robot products — Maxio and Robio — in India, Europe, Asia-Pacific, China and West Asia. It is now eyeing the U.S. market, the largest medical devices market in the world with sales of about $110 billion and growing.

“Given the expertise of the team and the disruptive nature of the products, Perfint is well-placed to be a leader in this domain,” said Sudhir Sethi, chairman of IDG Ventures India, an investor in Perfint. IDG, Norwest Venture Partners and Accel Partners have together invested about $30 million (Rs. 192 crore) in the firm.

Perfint is in the process of raising a further $20 million (Rs. 128 crore) for scaling up sales and distribution in India.

Dr.Riccardo Lencioni, founder of the International Liver Cancer Association, who is also on Perfint’s advisory board, said, “The ablation treatment plan was mostly based on an educated guess of the physician. At some time point in the near future, the manual approach will be abandoned. Isn’t this a revolution?”

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