Health technology: India
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10 medical miracles
India Today December 29, 2008
Ambulance Service, 2004
The introduction of the well-equipped ambulance service in 2004 by the Emergency Management Research Institute, founded by B.Ramalinga Raju of Satyam Computers, is changing the paradigm in emergency care.
Access to the unique service is through the common number 108 in 12 states.The public-private partnership model of ownership and management makes it a sustainable system that is poised to outstrip similar services abroad. “The service has 652 ambulances taking victims to 3,300 registered hospitals” (India Today,November 2008).
Catheterisation Lab, 2002
The development of the indigenous cardiac catheterisation laboratory (Cath Lab) in 2002 to undertake a coronary angiogram and perform an angioplasty has cut back the cost of setting up such a facility as well as the fee that the patient pays for cardiac risk assessment and treatment.
With continuous technological advancements, the Cath Lab is becoming more flexible and offering a variety of features not just for imaging the heart but also for other areas of the human body.
First coronary artery graft, 1975
The first successful coronary artery graft was done in 1975 at the Southern Railway Hospital, Perambur, in Chennai by Dr K.M. Cherian. Twenty years later in 1995, aided by the most advanced technology, cardiac care and surgical skills, he performed the first heart transplant at his International Centre for Cardio-thoracic and Vascular Diseases, Chennai. This was made possible only after the legislation for brain death and the law permitting transplantation of human organs was passed in the country. With phenomenal experience and far-sightedness, he also conducted the first bilateral lung transplant, the first paediatric heart transplant as well as the first heart and lung transplant.
PRODUCT OF LABOUR
Coronary Bypass Surgery, 2002
A team of surgeons at the Wockhardt Hospital and Heart Institute, Bangalore, led by Vivek Jawali, performed the first minimal invasive coronary bypass surgery in 2002 without putting the patient under general anaesthesia or ventilator support. The 78-year-old patient, a smoker, had multiple complications including diabetes, renal problem and blockages in the carotid arteries supplying blood to the brain. His lungs were unable to tolerate general anaesthesia and the multiorgan dysfunction made him unfit for the heart lung machine.
DNA Finger Printing
A new kind of identification
The science of DNA 'fingerprinting'-that is, identifying people based on specific characteristics of their DNA-is a relatively new one. In India, the development of this technology owes a great deal to a single man, Dr Lalji Singh. In the 1970s, while studying the evolution of sex chromosomes in a particular species of snake-the banded Krait-Dr Singh and his colleagues observed and recorded a specific pattern in the DNA sequences, which they named the 'Bkm sequences'. Between 1978 and 1988, while working at the Centre for Cellular and Molecular Biology, Dr Singh established that these sequences, and the methods of studying them could be used to generate DNA 'fingerprints' even for human beings. In 1991, Dr Singh made use of this technology to provide evidence in a court case over disputed paternity. This techonogy was then used in a number of other cases as well, including the infamous murder of Naina Sahni in 1995-popularly known as the 'Tandoor murder'-as well as in the murder of Priyadarshini Mattoo. Cases such as these established the science as a robust and reliable one, and ensconced Dr Lalji Singh as the 'Father of DNA fingerprinting' in India.
Eye Transplant, 1998
Eye specialists Virendra Sangwan and Geeta Vemuganti at the L.V. Prasad Eye Institute, Hyderabad, grew corneas in a petridish in 1998 using adult stem cells extracted from the oral mucosa of a patient and transplanted it to restore sight.
The pathfinding work promises to save huge sums incurred on immunosuppressants that patients have to take after the transplant.
1997: pig heart transplant, controversial
Breakthrough In A Field That, 20 Years Ago, Caused A Scandal In India
Some days ago, researchers from Germany, Sweden and Switzerland reported in the journal Nature that “modifications to a cross-species transplantation approach … for the first time has enabled baboons that received genetically modified pig hearts to survive for more than six months”.
Researchers at the Ludwig Maximilian University of Munich, Germany, led by transplantation researcher Bruno Reichart, replaced the hearts of five baboons with those from genetically engineered pigs. With this, human trials for inter-species transplants could finally be on the horizon.
At Sonapur, 20 km from Guwahati, Dr Dhani Ram Baruah sits in his office in the eponymous ‘Heart City’, a 50-acre campus he set up decades ago with his life’s savings. A Fellow of the Royal College of Surgeons and Physicians in the UK, Baruah is today mainly confined to the premises, two decades after being arrested for transplanting a pig heart to a human recipient in 1997.
Half a world away from Munich, Baruah is not surprised by the findings. “I was the pioneer,” he told TOI. “Whoever transplants a pig heart into a human now, I was the first to do it successfully with seven days’ survival. Xenotransplantation has a bright future if it goes in the right direction.”
Way back in 1997, Baruah had transplanted a pig’s heart into a 32-year-old man, Purno Saikia, who had a ventricular septal defect, or hole in the heart. With Baruah was an equally controversial Hong Kongbased cardiac surgeon, Dr Jonathan Ho Kei-Shing. Ho had his own run-in with the Chinese government in 1992, when he fit heart valves made from ox tissue — designed by Baruah — into human patients.
Saikia’s surgery, according to Baruah, lasted 15 hours. He died of multiple infections a week later. The survival period determined by the International Society for Heart and Lung Transplantation for a xenotransplantation — the transplantation or infusion of any organ from one species to another — to be considered safe for human trial is 90 days.
Before Baruah, few surgeons had managed to xenotransplant organs into humans. The survival rates had always been abysmal and each attempt had stirred a hornet’s nest.
It was no different in Assam.
Both Baruah and Ho were arrested and charged under section 304 (culpable homicide not amounting to murder) of the Indian Penal Code (IPC) and section 18 of the Transplantation of Human Organs Act, 1994 (removal of human organ without authority). Besides, the Dr Dhaniram Heart Institute and Research Centre was found to have “neither applied for nor obtained registration” as required under the transplant laws.
The government alleged that the heart may not have been that of a pig — a claim that was later dismissed by Central Forensic Science Research Laboratory in Kolkata in June 1999. Baruah, now 68 years old, was released on bail after 40 days in jail.
He returned to find his clinic and lab gutted, his animal farm destroyed, and his water and power supply cut off. He spent the next 18 months under virtual house arrest. He then survived on rainwater and little food, and depended on the charity of friends and his wife, also a doctor in Glasgow.
When the controversy had erupted, Baruah was a heart surgeon of international standing. In the early-1980s, he was asked by then-Prime Minister Indira Gandhi and Assam chief minister Hiteshwar Saikia to set up an openheart surgery clinic in his home state. In 1989, he set up a facility in Mumbai to manufacture the patented Baruah heart valve, which has since been used on patients the world over.
After the controversy, public opinion and the media turned against him. Over nearly two years of being confined to the gutted campus, Baruah was subjected to taunts and abuse by residents of the area, who called him insane to his face. But the doctor carried on with his research.
In the years since, Baruah has surfaced continually with claims considered bizarre or path-breaking — depending on which side of the debate one is on. In 2008, he claimed to have developed a “genetically engineered” vaccine that would “correct” congenital heart defects. In 2011, he claimed to have found the “cure” for HIV by “stopping the amplification of micro-RNA”. Four years later, he announced he had successfully isolated biological molecules from medicinal plants in the Himalayan region, the Baruah Biological Combat Genes, which he said would act as “biological missiles” to “kill HIV”.
So where is Baruah investing his efforts now? “I have gone further ahead. I am making strides in applied human genetic engineering, with which the need for xenotransplantation itself will be reduced,” he said, wading into what could be yet another contentious territory. Meanwhile, he says patients continue to come to him for his “expertise”.
Dr Dhani Ram Baruah illegally conducted a pig heart transplant with a human recipient in 1997. The recipient survived for a week before dying from multiple infections. For his illegal procedure, Baruah was arrested and charged with homicide. He was released on bail after 40 days in jail.
First transplant (liver)
The first successful liver transplant was performed on twoyear-old Sanjay Kandaswamy at the Indraprastha Apollo in Delhi in 1998.
The transplantation of solid human organs was undoubtedly one of the greatest medical breakthroughs of this century.
But still, the shortage of donors and organs has impeded the necessary thrust that is required to save more lives.
“In the West there is a 20 per cent acceptance rate of those agreeing to donate organs”(India Today, March 1996).
LINE OF SIGHT
No multiple checks for speedy organ transplant: HC
The Times of India, Sep 7, 2011
Abhinav Garg TNN
In a crucial ruling that will fast-track the process of organ transplant for needy patients, the Delhi high court has cleared an ambiguity in the laws governing transplant.
Justice Rajiv Sahai Endlaw, in a judgment said the power to verify organ donors/receivers lies only with the authorities of the place where the intended transplant is to be performed. Till now, donors/ receivers are subjected to multiple scrutinies — a donor has to first convince his native state authorities, then present himself before the state from which the organ receiver hails, often leading to interminable delays that often prove fatal for the patient.
Asking the Delhi government to grant immediate NOC to a lady suffering from End Stage Renal Disease, Justice Endlaw lamented at “the long time taken by the authorities in dealing with applications” and cautioned “such delays can be fatal in cases of transplant”.
On its part, the Delhi government through standing counsel Najmi Waziri highlighted what it said was a disturbing trend. Residents of Delhi were flocking to Remedy Hospital, Kolkata, for transplants, prompting the authorities to minutely examine each application rather than leave the same to be dealt with by Kolkata authorities, who appear to be liberal in granting the permission.
Even as the court appreciated the Delhi government’s stand that multiple checks were put in place to reduce chances of trafficking in human organs, it emphasized how this should not result in delays. “Merely because the authorities entertain doubts of commercial trade in human organs, is no reason for them to exercise power which under the Acts and rules hasn’t been vested with them. There are other remedies available for curtailing trade in human organs…” Justice Endlaw noted, faulting the department of health and family welfare of the state government for rejecting the NOC. The court said as far as grant of NOC is concerned, the authorities are requiredto ensure that the receiver of the organ has a legal and residential status in Delhi and is in need of the transplant.
2018: in-human telerobotic coronary intervention
History was made from Akshardham, the Swaminarayan temple in Gandhinagar, when senior cardiologist Dr Tejas Patel took his seat behind a console at the temple complex on Wednesday. From the temple premises, Dr Patel performed an angioplasty on a middle-aged woman, who was in the operating theatre of his Apex Hospital, some 32km away, through the world’s first in-human telerobotic coronary intervention.
The procedure was carried out by an internet-enabled robotic arm at the cath lab in the operation theatre, which Dr Patel operated remotely. The woman had suffered a heart attack recently and a blockage in a blood vessel was removed through the robotic procedure.
Dr Patel said telerobotics has the potential to drastically change the way advance healthcare is delivered to patients in remote areas.“Today, the patient was 32km away, tomorrow, using the same technology, it will be possible for expert hands to operate on patients anywhere in the state, country and world,” said Dr Patel after the surgery.
Response Modifier Therapy, 2003
The therapy was introduced to boost or restore the ability of the immune system to fight cancer, infections and other diseases. It is also being used to lessen certain sideeffects that may be caused by some cancer treatments. Agents used in the therapy include monoclonal antibodies, growth factor and vaccines.
Stem cell banking
Stem cell banking came of age in 2004 with the launch of the first family cord blood bank in India to usher in the revolutionary breakthrough of umbilical cord stem cell banking.
LifeCell in Chennai was opened with a tie-up with Cryo-Cell International, USA, the world’s biggest cord blood bank. The cells are banked for 21 years for a fee. “It doesn’t present an ethical dilemma unlike the umbilical cord which has always been discarded as biomedical waste” (India Today, June 2005).
Test tube baby: Durga: India’s first
Test tube baby
The birth of Durga
The first test tube baby in India-and the second one in the world-was born in Calcutta on October 3, 1978. At that time, Dr Subhash Mukhopadhyay claimed that Durga, the test-tube baby born under his care to Ms Bela Agrawal, at Belle View Nursing Home at 11:14 am was the first baby conceived via in-vitro fertilisation. This was just 67 days after the world's first test-tube baby, Marie Louise Brown, was born in the UK. Unfortunately, Dr Mukhopadhyay's claims were not believed by the scientific community, and he was subjected to both ridicule and institutional setbacks. After repeated failed attempts to convince his colleagues of his achievement, Dr Mukhopadhyay hanged himself on June 19, 1981. His story was later immortalised, in the 1991 film Ek Doctor Ki Maut. It was only in 2005 that his acheivement and contributions to science were recognised. Then, Durga-now known as Kanupriya Agarwal-exclaimed: "I am not a trophy but proud to be the living example of the work of a genius. Justice has been done to my scientific dad."
In 1997, Shantha Biotechnics, Hyderabad, founded by electronics engineer K.I. Varaprasad Reddy, launched India’s first genetically engineered vaccine for Hepatitis-B, at half the price charged by the MNCs in India.
Rotavac: first indigenously developed Rotavirus vaccine
Manufacturing capacity in India
Hyderabad in 2020
As international vaccine companies and academic institutions race the clock to deliver a safe Covid-19 vaccine, all eyes are on India that makes 60% of the world’s vaccines. And within India, if there is one destination that all of them are making a beeline for it is Hyderabad. The city has the capacity to churn out well over a third of the global vaccine supply.
Be it India’s first indigenous Covid-19 vaccine candidate Covaxin or Russia’s Sputnik V, Johnson & Johnson’s Ad26.Cov2.S, FluGen’s Coro-Flu or even Sanofi’s under development vaccine candidates, all have a Hyderabad connect.
Whether a successful Covid-19 vaccine is developed in Hyderabad or not, a vaccine developed anywhere in the world will be churned out of Hyderabad, feels Dr Varaprasad Reddy, founder & chairman, Shantha Biotechnics Ltd.
“All Hyderabad vaccine companies are robust in manufacturing technology and have the capacity to manufacture millions of doses with good standards,” says Reddy, who is awaiting Sanofi’s own vaccine candidate in the first half of 2021, a chunk of which is expected to be manufactured in Hyderabad. Sanofi had acquired Shantha Biotechnics in 2009.
Hyderabad will be an integral part of the Covid-19 solution just by the dint of the sheer vaccine manufacturing capacity it houses, feels Mahima Datla, managing director, Biological E Limited, which has a tie-up with Baylor College of Medicine, Texas, to develop its own vaccine candidate and a tech collaboration to manufacture Johnson & Johnson’s vaccine.
Datla, who is also president of the Developing Countries Vaccine Manufacturers Network (DCVMN), points out that most of the Covid-19 vaccine candidates are being developed by academic laboratories or non-vaccine companies, who don’t have the requisite infrastructure and will have no choice but to partner with companies in India or China.
In fact, most of Hyderabad’s vaccine manufacturers are in informal discussions for a manufacturing collaboration so that whenever a successful candidate is developed they can offer their manufacturing capabilities.
For instance, Indian Immunologicals Ltd, a human and animal vaccines maker that was set up by NDDB, has a new 20 million single dose (200 million multi-dose) fill finish capacity coming up at Genome Valley on Hyderabad outskirts that it is ready to deploy for third party Covid-19 vaccine manufacturing. The company is learnt to be in talks with Russians for making Sputnik V.
Datla points out that as no one knows whose vaccine candidate will be successful or by when, most manufacturers are open to offering their capacities to a successful candidate. Even Aurobindo Pharma has jumped onto the Covid-19 vaccine development bandwagon with the acquisition of a US-based R&D company earlier this year and hopes to have vaccine manufacturing capacities ready by March 2021. IIL deputy MD Prasanna Deshpande feels that as affordability will be the key in battling Covid-19 given its global spread, no one is better poised to offer this than Hyderabad given its scale of operations.
The Telangana government too is gung-ho about Hyderabad’s role in the Covid-19 battle given. “Being the vaccine capital of the world, we are fully committed to playing an enabling role in global vaccination efforts against Covid-19 and proactively support our companies to quickly ramp up production to serve the world,” said Jayesh Ranjan, principal secretary, industries & ITE&C, Telangana.