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Plus understand the health care industry in India and many soda better and figure out how we can partner together and the first question that I'm seeing repeatedly coming up in these questions is the costs are the medical device companies and many soda doing enough to understand the patient needs in the socio-economic context of India what are some ideas that you can provide and i think i'll have my conveyor and the fall address this question for us I think right now the company's probably or not they're not doing here okay going probably are not doing enough to address the magnitude of the need and India the fact is that most medical devices are developed for a global marketplace that's from early United States North America Western Europe those markets and then they're sold around the world and often they don't take into account the different cost pressures their present those worlds because those are you know in many cases very small markets right now I think personally one thing the awesome or medical device company is doing is taking advantage of again the engineering talent that's in India because there is I'm quite positive there's a very different engineering mentality and mindset in India which we haven't really tapped into very much about the frugal designs and really kind of maximizing the design performance characteristics where we often design for the 99.999% occurrence events so it's a it's a different way to design products which I think ultimately will give you more the margins that companies typically have are really pretty high sixty percent seven percent eighty percent I think what companies are going to need to do this is doing something they're going to have to look at getting into these marketplaces with lower prices possibly lower margins quiet when you look at the volume that you could have in countries such as India even just getting a small percentage of that place it's it's really worthwhile and that's kind of the message we're bringing to our partner companies we're working with again the margins might not be the same as you are in the US but truly these are these are massive markets to go after and I think that's what they're they're looking at you know at understanding a little bit more thank you about and sort of what would you say you know we have these different stance and different devices the medical devices that we have is there any more innovation that can be done so that they can be produced but at a lesser cost for different modules well I am an eternal optimist and being an eternal optimist eyes at the answer short answer will be yes of course we can't do that but just to put things in perspective I just want to put some numbers on the table here recently when I went to India of course I've been here in this country for way too long and being so in in my doctor's opinion I have been pasteurized for way too long so when I went to India for all my precaution that I had taken I came down with typhoid and yeah painful as it was but the recovery was pretty quick so about a month ago when I made a presentation to a team of executives it came to the University of Minnesota at the invitation of the president Kaler just put things in perspective I put out a challenge to the medical device industry is that for my entire diagnosis and treatment the amount of money that I spent was twenty dollars twenty dollars now any match that okay now of course I understand that's the pharma industry medical device industry works in a different way so so that's the cost perspective and and also when I was meeting with officials of the Indian government is very increased to hear that they started this program is called csr 800 what 800 means is targeting 800 million people addressing the needs of 800 million people and so these aren miniel people if you look at the their gross income that's a very sobering number so to cater to those needs we have to think differently the our mindset has to change old paradigm of coming up with very sophisticated devices and building our own sophistication about sophistication that doesn't hold any more I I pose as an example as a challenge is look at our cell phones the amount of technology as cellphone holes and I'm sure the medical device industry can can deliver upon those kind of promise and those kind of hopes sure and as we are seeing in in computer devices in the cell phone industry the things seem to be getting cheaper the technology gets cheaper as the time continues to as the technology continues to progress as they are more and more things coming in the market we can we can get the same cell phones that were pretty costly earlier now you can get for twenty bucks thirty bucks is there any possibility of devices going that way at any given year point in future well I just might put a couple things first of all you know devices actually are getting cheaper and all around the world the asp s sale and prices on all devices are going down every year five percent ten percent twenty percent dependable market you're in so prices continue to go down as volumes go up in technology matures that's that's not it this device industry is not immune from that at all the one point I want to make though is that you know there's a lot of consumer examples we have like cell phones where prices are dropping well they're just shifting the cost from the phone to your monthly bill right so there's the costs are moving its but you're still paying for it the medical device images doesn't have the luxury that if they went to cheap on the phone your phone breaks what do you do you go back to the store you get a new one you throw it away it's not a big deal Chum pacemakers are a little stickier than that so we have different standards and so there will always be a different trajectory for this industry you're never going to adopt things as quickly shouldn't see those kind of dramatic drops but I think they are going down in price it goes down all around the world constantly just a matter of how fast it's going and as the love will hit a point where most patients can get access to it great thank you thank you Mike and I think moving away from the cost the next question that we had is how much is the medical device / defibrillator market in terms of dollar numbers in India anybody really have a guess on that it's probably 20 to 30 million dollars that most at the most at most out of you know then the whole end of the cardiac rhythm industry is probably about six billion so it's very very small right and the next question was again on the costs are defibrillators / peacemakers affordable in India but I guess there may not be too much of cost difference what we have from here to there any ideas on that the question is are defibrillators / paste pacemakers affordable in India and how much does Medtronic defibrillator cost in India as compared to us so I don't know the ASP is in India specifically they are less expensive in the US I think the big difference is on the question of affordability as most Americans have access to insurance whether its private insurance whether it's Medicare so if you have a cardiac condition and you go to a hospital you need a defibrillator either Medicare or blue cross and blue shield America pays for your defibrillator and you pay a small copay since Indians largely don't have access to insurance they have the same bill but they how to pay for it themselves and so suddenly an annual salaries worth a defibrillator is a very dramatic expense so I think the healthcare infrastructure and the system is part of the question of is it affordable or not even the prices were lower without that support network here the u.s. people couldn't buy them are there to pay for themselves thank you let's change the pace a little bit and this is a physician's question so by 2020 India is going to be the diabetic capital of the world what are the medical devices company doing to reduce the prevalence of diabetes globally I wonder if that would be the medical devices or the physicians doing something about that so the question is about obesity and that's a lifestyle alteration for Indian people Indians are genetically and racially not their job their risk factors are totally different when we compared to Caucasian or European population and I don't think medical devices has anything to do with prevention of diabetes but i want what i feel is they need more of education and probably it should be physician in a mediated and also probably you know well integrated into college and educational systems robinson and yes i'm going to stay on my eternal optimism path and i can say that because my program is now actively engaged in coming up with medical device solution for our diabetes believe it or not and we are on the threshold of making some very path-breaking innovation so we are waiting for just a few amount of some feasible results and if they pan out the way our info hypothesis is working i think we just might have a solution for that okay but once again okay I have to put a word of caution here now this is early in the game and we all know some of the promises don't always hold up sure but neither does it make there are ways to come at it and it comes from a very basic understanding of what the mechanisms are of diabetes and yes when we engage India that's one of the area common grounds that will be working on together that's really good i think that's a positive note and that we need here and again a question on the cost but i think it may be better put are there any challenges for the high tech high cost items in the Indian market that you guys are seeing in today's introduce today's world when you go there with your high tech high cost items what can I challenges you face I think again it's going to be in select markets where they can afford it some of the areas where they're doing a lot of medical tourism they are you know touting the fact that their hospitals have all the latest technology all the latest devices so people coming into India will be getting those I also think it's certainly what I saw and talking to a lot of people you know there's there is a lot of wealth in India now and I think those people will be demanding you know the latest devices they they can go online and see what's going on in the medical community but for the masses know it's going to be hard pressed to do that so thank you and the next question is from the assistance from the state and federal government now what kind of assistance would you ideally seek of state and federal government to foster the India Minnesota relationship and the medical industry well and again this was my first trade mission with the Department of Commerce and I know there's a number of service folks the commercial service folks that are in India they were very very instrumental to us and setting up meetings with hospitals physicians distributors getting an understanding of the marketplace I think that's very very beneficial for hospitals or for device companies I don't think most people know that they also vet these people the distributor's so we know they're reputable they will pay their bills etc and that's such a huge issue for device companies as they seek partners in other countries I think those are very good I do think there is an issue pending though with with high cost devices we heard when we were over there that the Ministry of Health and India has lowered the price of stents I believe it's drug-eluting stents into about a hundred dollars which is pre low for you those of you who are physicians you know what these costs on Anna you know here in the US so I think there is you know we need to have a good dialogue with with the Ministry of Health and India to make sure they understand what these technologies are and why the costs are what why they are etc because that will preclude people from coming into this marketplace that they cannot you know get paid for their technology Thank you Thank You bar and another question on the medical side with the doctor Roberts presentation the status of women in India what interventions can a person in us do to meet the gap for the women in India and improve the quality of life of those unfortunates women in rural community in India that's a very good question and that's the biggest problem given the population of India and the fact that more than seventy percent of India is rural most of as we know most of the the new technology and and high high tech devices and and hospitals and everything is kind of concentrated in urban in cities and they cater to a fluent and educated people whereas the rural in rural communities people tend to not even be able to get primary care so even a small intervention like having these women get a pap smear get a mammogram will go a long way in preventing cancer related mortality which is very high in India a small intervention like having them take prenatal vitamins when they are pregnant this driven development of birth defects so these are small interventions they are not expensive they are in no way related to medical devices it'll they are not high budgeted but they will have they have a they will have a very deep profound impact on these women thank you dr. Roberts and I think what I'm getting on and what my understanding turn out from your thoughts and discussion that we had is that probably there is a different segment there is a segment of population that may benefit from the devices and there's a different segment of population that is probably still going to need a lot of development in the public health care education sanitation and the basic medical needs that we are looking at and moving on to the next question are you aware of reprocessing of used medical devices invasive and so-called single-use medical devices is it a viable and safe way of cost savings for hospitals and locations I don't think anybody would mind let's see what the penalty is we've actually worked with one of the reprocessing groups there was one here stare amid was a Minnesota company there is another company called ascent healthcare again what we'd like to see is if a device is going to be reprocessed or reused certainly cleaning and sterilization is critical but making sure that device does indeed work the same way it did on the initial try and I'm not an engineer here but I do know that we had to there is a in Australia we had to get devices approved to be reprocessed and we had a look a lot of clinical data that was published on the use of reprocessed devices so I think it's an opportunity for India but again not all devices can be reused they should be tested before that's done and widespread use and certainly the sterilization is critical to to keep infection rates under control all right thank you and our next question is for you too it's how well defined is the device approval process in India how long does it take on a typical device and how is the process has compared to us well first of all there's there's really not a device division in india yet they're still working on kind of drug regulations there's ten categories of devices that are regulated so that means there's a lot of devices that are not regulated that is going to change in the next few years there's pending legislation and india to do that we did meet with the head of the device division of their equivalent of the fda and right now there's a lot of products you can get in in the country with no regulation i'd say a typical device again something what we would consider a 510 K or a class 2 device here you could probably get those through in india in three to six months in the US that can take 9 to 12 months sometimes longer depending upon the fda so i think it's about half the time again it has to do with the quality of how good the submission is to the agency if it's a class three device you would have to do clinical studies in India to have that device come in and then it's going to take longer depending upon how long you have to run the clinical studies so but right now there's kind of this window of opportunity to bring products in because they're not regulated that's edges I'm just saying ok so the follow-up question and that is whether that biggest three challenges of selling medical devices in India that you have faith ar
anybody else's well i'm not sure i'll hit the top three for sure but certainly awareness of the therapies is a big barrier a lot of patients simply are not aware that there's treatments for the kind of diseases that they have or they are in a rural setting where they don't have access to specialists that would know that which is the second one you lost earlier about some of the the challenges for high technology products as a comparison the type of doctor that implants a pacemaker defibrillator is called electrophysiologist we have about 2,000 or so in the united states in india we have maybe 34 a country several you know three times maybe the United States we have one tenth the number of the specialist and so other physicians do is kind of work so there is a issue and that's where as the hospital infrastructure and healthcare systems built out more specialists will come in and we'll have easier access for the patients to find these specialist and technology okay they elect to a second what Micah said okay it's about first of all awareness and of course there's the resource barrier to because anytime you and when you're delivering delivering healthcare the question that always becomes who is paying and who has a capacity to pay and some of the hospitals that I visited in India some of them have different cost structures addressing different needs for instance when I went to the money pal hospital in bangalore they have teared payment structure for people who can pay for a specific in our health care needs okay they can even charge them up two hundred thirty dollars for people who are not able to pay that much okay they can give it for thirty dollars and people who really cannot afford to pay they give it for free so so there are those hierarchies and within those hierarchies of course okay when you are using a medical device and were to touch upon or some of the previous questions 2.a and it was a very telling comment that i do remember from ideas from st. Jude Medical we've been doing some trials at Harvard so one of the physicians was doing this trial who is he was looking at all the facilities that we had to do some of those trials and so look at all this equipment that we have but if you go to a developing country like India he won't even have that basic facility the basics of the basics okay so so facilities also become a challenge so how can we bridge that gap and I'm going to go back one more question that you posed so how can the institutions here both the government and independence tutions how can they help okay so two to answer that question the way I would approach it is to first assess what is needed what is the gap what is what is lacking what is lacking in India is the basic infrastructure the basic infrastructure for innovation for medical devices they have gotten some kind of a handle over the pharma industry but medical device innovation and infrastructure is completely missing had the good fortune to go visit know some of the national laboratories in India and yes innovation happening in pockets silos but there is no concerted effort how to bring it together so the reason why university Minnesota program got chosen to be a partner in all of this is it all begins with like Mike said awareness and awareness leads to education so University of Minnesota this program as its training some bright fellows and bright minds to come up with is okay with with innovation we can translate the similar kind of knowledge to India already institutions like Stanford have taken the lead our to start that kind of a collaboration and that collaboration has has borne some fruits but they want to make it even bigger so they are looking for consortium of universities consortium of educational institutions consortium for medical device industries who can partner together because at the end of the day everybody wants a win-win solution not a competition a win-win solution so so the task that has been put on my plate and this is where and I've been talking to Mike about that and thank you for your support mike on this is that we are trying to come up with a proposal together that we can present with indian government how we can take this thing further and of course we can we can we can request health from from the government entities here because whenever you start something together now funds become a challenge and the indian government has made it very clear that they are willing to put up funds so now the request now is with us here how to solace it those matching funds because for a win-win solution to happen collaboration to happen both parties have to come together so thanks thank you sir that's there's a lot of information and very interesting information that we need for developing the future and the next question is on the same lines how do you balance the trend or if there is a trend to innovate devices in countries like India which you are just talking about and selling two countries like us versus selling devices developed in the u.s. to the countries like India and is there any maturity in the market of the local Indian manufacturers and making devices yeah obviously the the indian medical device market is very immature there's very few companies and they are they're basically providing some very basic devices I think that the you asked about the trend I think you have to put the engineering teams actually in India working with indian customers and in that ecosystem to see how things should be designed to build products that are suitable i think as we've seen in other industries those products may come back to the US or other developed markets and they find a niche there as well or even more than an ishit may find a broad following but i think there's a lot a lot of maturity yet to occur in that industry in india and i think that will see more multinational companies establishing themselves there to get access to wear those customers need and build better solutions for them yeah as a step to that okay it's very clear that the Indian market has a need but but there has not been in concerted effort there's no infrastructure how to promote that so it all begins like Mike said with awareness and to generate that awareness even a as of as a this month we were planning to make a trip to India to do what is called the clinical immersion to first see what is needed by the Indian hospitals by there in the healthcare system because our awareness begins there because whatever healthcare system we are exposed to doesn't really hold in back home the system is totally different so once you go there you get a feel for what's needed then only you can come up with solutions to address those needs and and also in talk to Mike and and and other executives from other local industries here we also get this get this correct me on this mike is that there is not just the issue of trying to export products over there there's also there's this new mindset of trying to create a human resources in India create some expertise so when multinational companies like Medtronic Austin sighs saying dude and others who go to India and they they create their own centers of excellence and their own satellite offices over there or satellite corporations over there they have a pool of talent that they can bank upon and bring it in bring them in under their roof create some innovative products and then compete worldwide Mike if you like to add to that all right well thank you thank you very much my panelists here I think we are coming to the close of this discussion and I think we pretty much touched on most of the questions that audience had asked there are some variations on the same topics that we have touched and I'm really glad that I could be here to listen to you guys and understand about this medical device industry and the future that we have in india and the partnership that we can bring to us and india now i will have you guys give us some closing remarks and we'll start with mike and then moved up well thanks again i think there's a lot of opportunity here for continued partnership there is a large there is a large unmet need in india there's a large market there's all the trends of the economy going and everyone demanding higher quality health care and better access to healthcare and there's a lot of very talented people in this industry that want to deliver those solutions whatever those right solutions are so we're going to see I think more and more engagement with the medical device industry globally in India locally what those market needs are and then what what solution should be built and dr. Roberts said it's not always going to be medical I mean we're not in a really prevention of disease is not usually a medical device focus it's usually interventional procedure or medication but when there is a treatment that's required that is a implantable or lifetime treatment that's where the devices need to be designed appropriately and then deliver to that system well again I wanted to thank you all for sitting and listening to this it is an exciting topic you know our company is is really focused on you know I it doesn't have to be even major devices I think some of the things we saw over there were things like ace bandages just not of good quality and and you know things that they could help like lymphedema and things like that so I at any of you in the audience certainly that's that's interested in this area would would love to have a conversation afterwards because I think there is such a great need for a lot of lot of things it doesn't have to be the most expensive things it's just basic basic things and and if you know people over there that need product we'd certainly love to hear from you thank you very much I would again thank the India Association of Minnesota for giving me this opportunity to be a part of this very interesting panel discussion I'm kind of out of league with the medical devices but still I I hope I was able to bring in throw in some light about the current situation especially in the men's health care and I hope there are some volunteer organizations in the in Minnesota which probably could do some good work there and help us to take care of our patients back home thank you thank you thank you all for being so patient and inviting me over here and Brisbane has been a great privilege to be a part of this panel and it's as I'm engaging in this kind of discussions now I chanced upon a presentation that was made by the surgeon general of india in 1913 at that time india was under british rule the population of us india was almost that of what the United States today and and the first opening line of his of his address was the health care system and issues of India are very complex now that was 1913 so imagine or what it is like today so I don't want to trivialize know the task at hand and I cannot even be so presumptuous as to say that medical device has all the answers yes it begins with awareness and in daily life styles at dr. Robert said and but these discussions know do take our journey one step ahead and and so thank you very much for hosting a discussion like this is certainly generous awareness and thanks for welcoming thank you and thank you for being such a great audience and let's give a big hand to our panelists and snows so thank you dr. Agarwal for your career moderation on that a great panel discussion now I would like to invite Kusum gosain and now Bulma ready to the stage for the presentation of the plaques to our panelist and our moderator so first we have dr. sorry Paul next we have dr. suture Roberts next we have barb Peterson next we have mr. mike hess and last but not least our moderator dr. Raja go so can we give one more round of applause to the panelists enter moderator so thank you again to the panelists the moderator Consul General for joining us this evening and making this night a true success without you you know none of this is possible but actually as Kusum said you know the I am fun does not stop here so we have you know festival of nations coming up in May and then we have the large india fest in august so i hope you can all enjoy us there so this concludes the evening the bar i think is now open or it has been open for a while as i can see some drinks out there so please stick around and mingle and i hope you i want to thank you all again hope you all have a safe drive home and thank you very much good night you
