This one needs not X, but Double XPrize

 

The 68th session of the World Health Assembly is currently under way in Geneva. Among other things, all the health experts and policy makers will deliberate and announce a global strategy to fight anti-microbial resistance. But before we get to that, let’s look at this case.

 

At one of the most trusted public hospitals in Bangalore, a patient comes with high fever. In a matter of hours his respiratory complications get him into the Intensive Care Unit; he is put on ventilator. Four days later his condition shows no sign of improvement. His soaring hospital and other medical bills exceed Rs 150,000. Finally the doctors order a molecular diagnostic test, a platform technology developed by a local company. Within eight hours, the lab detects a bug called leptospirosis, bacteria that are transmitted by domestic and wild animals. The patient is treated with crystalline penicillin, which comes at an unbelievable price of 65 paise a pop. In five days the patient walks out of the hospital. While the diagnostics cost him Rs 12,000 and the hospital stay several times more but he paid merely Rs 9 for his medicines post diagnosis.

 

Such is the power of first-rate diagnostics.

 

In this story in Mint and German daily Der Tagesspiegel, I argue why India shouldn’t overlook diagnostics as a tool for containing anti-microbial resistance. Whether it is diagnosing pneumonia (which millions of newborns and adults get), tuberculosis (which kills one person every two minutes in India), cancer (which kills 500,000 to 700,000 in India every year) or simple cold and fever, an affordable device in the hands of a general physician can work like a magic wand.

 

Even in ICUs, which are well-provided for and equally well-charged by the hospitals, diagnosing diseases is proving difficult because the mix of bugs is getting more complicated as is the mix of antibiotics doled out as the first line of treatment.

 

But the business model for developing and scaling multiplex technologies is broken. The companies mentioned in the story – Bigtec and Xcyton—have spent more than 15 years developing their platforms. For existing molecular tests to be automated and packaged as a pathlab-in-a-box requires enormous engineering, time, and funds. Agrees Mark Perkins of FIND, the Geneva-based non-profit which champions diagnostics in public health. These assays, if automated and simplified, can be used in remote locations without any technical assistance.

 

So I asked Xcyton founder, BV Ravikumar, who is struggling to raise funds to scale his technology, what will it take to make the currently centralised and lab-confined solution to reach a broader set of hospitals. To begin with, Rs 10 crore (about $2 million) over 24 months to automate it so that the time to diagnose reduces from 7 hours to 2.5 hours and the cost by nearly 50 percent.

 

Apart from these start-ups (can’t help but call them so even after 15-20 years of founding because they continue to have starting issues) trying to do their thing and find a balance between high-end ICU tests and low-cost public health technologies, what we need is a few champions. Champions – less bean-counter more dreamer-firiendly — who can set up a few trophies for some of these engineering challenges.

 

Much has been done to take guesswork out of medicine in the past few decades but for all practical reasons, and impractical public health spending particularly in India; it’s still very much a stab in the dark. Can someone sponsor an X Prize for a point-of-care diagnostics for common classes of bugs? Or at least for common cold, cough and fever?

 

The XPrize site says:

 

IF YOU HAD THE POWER TO CREATE A LEGACY THAT WOULD TRANSFORM THE WORLD,
WHAT WOULD YOU DO?

To that I’d say:

Well, I don’t have the skills to create such a legacy but I can help spread the word so that someone creates simple-to-use, inexpensive diagnostics that prevents doctors from using cruise missiles to shoot quail

 

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