Dr B S Ajaikumar is chairman and CEO of Health Care Global. He founded HCG to realize his vision of making advanced cancer care accessible to all. His contribution to the field of cancer care in India as well as his success as a first-generation physician-entrepreneur has been widely recognised. Dr Ajaikumar, who was presented with the BC Roy Award by Indian Science Monitor, has been a practicing oncologist in the US and India for over four decades. He completed his residency training in radiotherapy from the MD Anderson Hospital and Tumor Institute of the University of Texas. Exerpts from an interview with C H Unnikrishnan
How updated is the medical community as far as the latest technologies and their applications are concerned?
It’s like the use of smartphones, which have so many features. But people often do not use even 20 per cent of the features. The vast majority of the doctors in India are either not aware of many of the advanced medical technologies or do not use them for providing better treatment outcome. The second major issue is the limited time that they spend with the patients. I think, more than 90 per cent of the doctors in India spend less than five minutes with each of their patients, as they do not have time or they are not willing to spend more time. An improper understanding of the disease, a reluctance to go deep in to the treatment protocols and a lack of effort to improve the outcome using latest tests, drugs and procedures ultimately keep most patients deprived of the advancements that the world has achieved in medical science.
For example, we have PET scans, which have tremendous use in diagnosing diseases by revealing how your tissues and organs are functioning. But, what is the percentage of its usage in the country? I can say without doubt, that it’s very low. So, the real issue is not only lack of awareness, but also the reluctance to try out something which needs extra effort.
Genomics is emerging big now as it’s the era of precision medicine……
There are several path-breaking and revolutionary applications using genetic analysis. For example, when a cancer patient comes with a recurrence, how can a doctor give out a prescription by just spending five to ten minutes with the patient? Advanced genetic science offers a lot of capabilities to analyse why the patient failed to respond to the protocol which was decided earlier and what needs to be done to avoid further recurrence. But, in order to use these capabilities, the doctor should invest time and effort to find out why the recurrence has happened and what is the genomics of the patient and many other factors. The doctor should also be in a position to do a predictive analysis and also figure out how he can overcome the issues that caused the failure of the earlier protocol and how to proceed with more targeted treatment. For instance, in case of oligometastases, the normal practice today is to change the drugs each time the patient fails to respond. But, currently there are ways to kill it at one go with more precise diagnosis. But, how many would try such options, including innovative procedures such as radio surgery, cyber-knife, robotic surgery, awake surgery, tomotherapy among others? That’s why I always say that in order to handle such special cases, you have to take a deep dive.
At the same time, is there a tendency among many in the fraternity to not admit the ignorance and keep the patient deprived of better treatment options?
I am sorry to say that the practice of referring patients with complex cases to more informed doctors or better equipped hospitals is still not very common in India compared to the west. I am not sure whether it’s the result of certain ego working within us or to ensure that the patients remain with us. But, the danger that it creates is that the patient ultimately loses time and money with no effective management of the disease. More importantly, it often leads to deterioration of the patient’s condition, risking the chances of saving his life. It is strange that many doctors here believe that they can do everything, which is not possible in the normal case. I have seen in India that a single oncologist is practicing every type of cancer, such as breast cancer, head and neck, colon and brain tumour and others despite the fact that each speciality needs a different kind of expertise and experience.
What do you think about doctors discarding patients saying that they are in the terminal stage despite availability of such advanced options as you referred?
This is an evil in the system, where doctors are not updated with current developments and the knowledge dissemination is unequal. When the doctors are not aware of the advanced medical options, or are reluctant to practice them as it needs extraordinary effort, they often resort to words like “terminal stage” or “palliative care”. It is unfortunate that many in the profession of care do not really care about the chances of survival of the patient just because they don’t want to take the trouble of learning and to walk an extra mile to save a life. I have several case studies, with long survival of patients who have been discarded by doctors as terminal stage cases.