To begin with, I am not a disgruntled Facebook investor, several of whom are suing the company, Nasdaq and Morgan Stanley.

Ever since the historic opening on Nasdaq last Friday, the brutal analysis of  Facebook’s fall from grace is relentless and writers are tearing apart its management of (social) media strategy, with an opinion piece in Wall Street Journal even calling it The IPO From Hell. Reuters’ Felix Salmon in this piece writes an incisive account of why and how things went horribly wrong.

Quants and analysts aside, even academics have chipped in to say how the $100 billion valuation is hard to defend.

Amidst this high-voltage drama, Steve Blank, who teaches entrepreneurship at Stanford and Berkeley (and is now taking his course to other universities on government invitation), wrote Why Facebook is Killing Silicon Valley. He also found some quick rebuttals in articles like social networking has not supplanted real innovation.

Tomes have been written and more will be written about Facebook in the coming weeks and months. But I want to make a simple point here: Facebook has unleashed a social culture that cherishes the virtual world, but we live in the real world and have real issues to grapple with. What Facebook and other internet companies, e-commerce in particular, valuations have done is raise the expectation of investors and entrepreneurs to such unrealistic levels that most other advanced science and technology based ventures look pale in comparison as they don’t offer easy and quicker exit routes.

Make no mistake; there’s no denying the importance or game changing abilities of software that some of these internet companies are trying to develop. Mark Andreessen (founder of Netscape and now an investor in Facebook, Twitter, Zynga, Groupon, Foursquare, etc) wrote a provocative,  rather an over-optimistic, essay in WSJ last year, Why Software Is Eating the World.

Software will creatively destruct many industries — and the hard realities of hardware companies like HP, Dell, Cisco, Nokia, etc ain’t helping — but we still need products and devices other than software. A cursory look at the start-up ecosystem in India, and we are struck by similarities to Silicon Valley in business ideas, approach and investor behaviour. (A handful of start-ups that look beyond software, say in nanotechnology or life sciences, have an uphill task in finding money and mentorship; some have even fled to places like Singapore or Malaysia where the investment climate is more conducive.)

We need new medicines (which is the most regulated industry in the world as opposed to software which is the least regulated); advance materials; clean water; new sources of energy; better quality seeds; new ways of cleaning environment (from carbon capture to pollutants detection), sustainable fertilizers, pesticides; cost-effective, point-of-care diagnostic devices; better educational content and delivery mechanisms…the list is endless. Agreed, a lot of it is the responsibility of the state. To be fair, at least to some extent, governments everywhere are trying to address this. But without the industry, investors, markets partnership, and loads of entrepreneurial energy, the government effort to prop innovation in these areas is somewhat like a bunch of blind men trying to describe an elephant.

In the West, the quest for the Next Big Thing, or at least the debate for the next wave of innovation has begun. For a region like Silicon Valley that has innovated for over 100 years –  from vacuum tubes to integrated circuits to social media – a few decades of indulgence in the social networking or consumer-led businesses won’t do much harm. There are enough smart people with enough money in the Valley to bring  course correction.

The question is can India afford to parachute into the so-called tech-bubble wave without solving its real world problems in any meaningful way?

It was sort of a report-card day for Wido Menhardt, the chief executive of Philips Innovation Centre (PIC) in Bangalore on Friday. A little over two years into this role, he was showcasing some of the technologies and products that were developed “in India, for India�, a tagline that has, frankly speaking, begun to sound clichéd. Far too many MNCs have started using it, and far too often!

Along with managing director of Philips India Rajeev Chopra, Menhardt unveiled two new, portable ultrasound machines, a suite of Intelli-Hospital products and an e-ICU. The first two categories of products were a global launch for Philips. Now that’s some change in mindset. Exactly two years ago when I had met Menhardt, barely two months into his new role in India, he had said, “There is need for more value products in the Indian market. Until now, the lowest products in the US market were picked up for sale here.�

Wido Menhardt, CEO, Philips Innovation Centre

That was a refreshingly honest statement from the head of a large MNC centre. A year later in 2011 when I asked him how he was doing, he said, “I can say that I am making progress on some of the key objectives I had set out to achieve to bring PIC and the local [Indian] sales operations closer.� But he did hint that his report card would show results only next year, that is in 2012.

So watching some of the demo at PIC yesterday, it was clear that Menhardt and Philips have taken the “value� segment seriously. For the first time they have general managers, marketing teams and a full supply chain support to make these products work, here as well as in other markets. “Earlier there would be someone in the US or Europe telling teams here what to do,� said Menhardt.

Though competition, GE in particular, has been ahead in leveraging the insights and constraints that the Indian market offers for innovation, Philips’ technologies look promising. For instance, the ClearVue ultrasound, which is built ground-up, and besides claiming lower cost, higher energy efficiency, better image quality (that will handle about 50% cases earlier referred to CT), etc, has brought a new technology, Active Array, that moves intelligence from the system to the tiny transducer (the probe that does the scanning). Despite repeated questions, the team did not give away much, but it clearly points toward a healthcare era where the device is separated from the data; stored and  analysed on the cloud.

Launch of ClearVue is also a big deal for  Philips, says Menhardt, because the company  is moving quickly to innovation in the emerging economies, be it India, Brazil, or China. “In particular if we’re able to set global benchmarks in speed to market, as we did with ClearVue.”

Two other demonstrations, of e-ICU for tier 2 and 3 towns, and IntelliHospital, for high-end healthcare centres, also gave a glimpse of where healthcare is headed. Intelli-Hosptial is a concept that a lot of medical and other technology companies have been experimenting with, but what gives companies like Philips (and perhaps Siemens and GE too) a big edge is the fact that they deal with disease management and hence the ‘clinical decision support’, or analytics, that they provide to the machines is far superior to what non-med-tech companies can offer.

A year ago Menhardt established a global Mobility Centre of Excellence for Philips at PIC, to extend the capabilities in healthcare, lighting and consumer lifestyle to mobile platforms. We got a whiff of what a smart phone can do in these spaces, nothing out of the world I must say, but it did show a more manageable way of doing things, be it hospital staff getting all alerts and streaming data on their phones, or a person getting control of all lighting in his workplace or home, or of music/photos/videos, done wirelessly through AirStudio using a phone/tablet/PC.

It’s not easy to make engineers, who’ve been hired in batches and bundled up with a manager to do the off-shoring job, to innovate. Now that Menhardt has begun attacking that problem, what should we expect in  near future?

He certainly expects “Jugaad 2.0″,  innovating in India for the world. “The ingenuity and innovativeness of India is all around us, and if we can channel that so it becomes repeatable, reliable, scalable, we may see India develop into a global innovation engine. But this will take time,” he says.

Sometime back Menhardt had said, Philips India, like other Indian arms of MNCs, was about sales, with super sharp focus on high quality and low cost. PIC on the other hand was less about cost reduction and more about innovation. He has been trying to bring the two closer. Watching Chopra and heads of healthcare and lighting, Krishna Kumar and Indranil Goswamy respectively, together talk about what’s new and in the pipeline, it seemed grades in Menhardt’s report card had improved from 2010.

Now, how much market share they’d clinch from the competition in some of these product categories, (especially in ultrasound, and excluding lighting), will reflect in the next report card. We’ll make sure we get you those grades next year!

A panel report, as reported in Mint today, shows the much suspected irregularities in the drug controller’s office. This specific committee report is about the drug approval process, but I want to raise a related issue here, of clinical trials.

I know, given the herd mentality, a fresh backlash against clinical trials will begin in the press and civil society and that can only cause more harm to healthcare at large. While this is a fresh blow, the health ministry said yesterday that the guilty in the poorly conducted clinical trials of human papilloma virus (or cervical cancer) vaccine in AP andGujarat, which were suspended in April 2010, would face punitive action if the investigation proves it. If and when that happens (the committee of experts ruled out direct linkage between the deaths and the trials when they put in their final report saying that “the cause of death in all cases could not be established with certainty�) it would not only bring justice to the affected families but absolve, at least to some extent, the field of clinical studies of the sins it has been heaped on. This case could set a precedent for punishing the guilty, medical and non-medical staff.

Just because the Indian regulatory regime is inadequate and incompetent (particularly in evaluating protocols), it doesn’t mean we paint the entire field in disrepute! As I was reporting for this story on cancer care and HCG in ForbesIndia, Dr R Badwe, director of Tata Memorial Centre in Mumbai earnestly requested more public understanding, especially from media, in dispelling misconceptions about clinical research.

It’s true most of the clinical trials that we hear of are conducted by pharma companies, either directly or through CROs but the impression one gets from outside is that everyone participating is a guinea pig. That’s not true, research is mistaken as experimentation. I’ll come to the missed (or soon to be missed opportunities) in a bit but just looking the industry numbers, it’s clear that the projection that McKinsey had made in 2006 about the industry being $1 billion by 2010 hasn’t come true. Assocham had predicted thatIndiawould garner 15% of the global trails, but the reality isIndiaaccounts for just about 1% of global trials today. The country did not gird up for the exploding market.

China,Braziland Eastern European countries are benefiting more from it. Recently, the Australian government announced tax credits particularly for preclinical and human clinical trials that will be brought into effect retroactively from mid September 2011. It means a company can get back between 15 cents and 45 cents of every dollar spent.

As far as the business is concerned,Indiais losing the plot.

Now, the academic progress and health benefits: clinical research in general and clinical trials in particular, is the way medical science progresses. While there may be stray incidents of medical research done unethically, the checks and regulations, some in place now and more to come, will ensure that good clinical research practices (GCP) are followed by all researchers. After all, there are a number of studies which conclusively prove that patients who are part of clinical trials end up with superior care than they would get otherwise, primarily because every small step and action in clinical trials follow a set protocol, says Dr CS Pramesh, associate professor and convenor of Thoracic Oncology Diseases Management group at TMC in Mumbai.

“Bad media coverage and uninformed, sensationalistic reporting will be the proverbial last straw on the camel’s back and combined with ill-advised policy making, could spell the death of clinical research and consequent medical progress in the country,â€� says Dr Pramesh.

Take for instance head and neck cancer: disease of the poor; it’s most prevalent inAsia. The pharma industry is not interested in developing new treatment for these patients. The onus therefore lies on the academic head and neck specialists to develop these trials. Thankfully a beginning has been made. But sustained opposition to clinical research and bad press would deter doctors from taking up these studies in academic institutions.

Then there’s the issue of finding cost-effective treatments which pharma industry is not very interested in as profits are low. Dr BS Ajaikumar of HCG says even trying low doses of very expensive cancer drugs like Avastin, — say a 1-2 mg-dose as opposed to the standard 10 mg dose that is sold by pharma companies at an astronomical price — have shown great improvements in patients. He says if hospitals, teaching or otherwise, keep trying such regimens, many innovative results can be obtained. “But inIndiawe are just followers. We only follow the Western clinical studies’ outcomes,â€� he says.

In cancer, doctors are not curing everybody, at least not in the non-toxic way. So, clinical research is an absolute must! Radical mastectomy (in breast cancer) was never challenged for over a century. “Now standard care is lumpectomy or breast conservation,� Alan Hatfield, executive vice president, Clinical Research, Piramal Healthcare, and a former longtime practicing physician from the National Cancer Institute, US.  “Hundreds and thousands of women across the world have participated in trials to bring the best of care in breast cancer.�

To cite another example, treatment of advanced lung cancer has been revolutionized by new targeted therapy (oral tablets as an alternative to conventional chemotherapy which has much higher side effects). The results from Asian countries with this treatment is far superior to that seen in the west because lung cancers in Asians harbor a genetic mutation much more frequently than in the west which makes these tumors more responsive to the targeted therapy. Isn’t this a clear benefit of clinical trial?

Furthermore, says Dr Pramesh, by blindly following the results of clinical research done in the west and extrapolating those results to our patients, we might actually be erring grossly as ethnic and genetic differences could make these results inapplicable in our setting. “Ultimately, it will be patients who suffer the most by a slowdown of clinical research in the country.�

Unarguably, some regulatory and local IRB Accreditation issues still need to be addressed. But the collective effort should be to fix the system, not abandon it.

 At one level, some would say, this is tautology. Aging and letting go have always been synonymous. At another, this would look defeatist, especially at a time when people are taking up professional challenges way past their prime and well into their 60s and 70s.

Perhaps it’s for this reason that there’s been a surge in scientific investigation and life-span theories in recent times. Adding to the tome is another study published in Science today where a German team reports that one of the keys to emotionally healthy aging is to let go of regrets about missed opportunities.

“Don’t’ Look Back in Anger� says the paper.

When we’re young, regret might help us make better decisions in the future. But, the likelihood of second chances decreases as we get older, and the benefit of ruminating upon them probably disappears, say researchers at the University Medical Centre Hamburg-Eppendorf inHamburg.

This work was inspired by very interesting findings from socio-emotional life-span research showing that emotionally healthy aging is associated with an increased focus on positive aspects, says Stefanie Brassen, the lead author of the study. “And this ‘positivity bias’ includes a reduced responsiveness to regret.�

Several behavioral studies have shown that older adults who disengage from regrets by using regulation strategies like external attribution — I had no personal influence on this situation when it happened/not happened — have a better “life-satisfactionâ€�. They also report fewer depressive symptoms. In this study the research group was interested in investigating whether there is a neurobiological mechanism underlying such a successful adaptation to age. They used functional magnetic resonance imaging (fMRI) to compare the brain activity of three groups of people – young adults, depressed older adults, and healthy older adults.

Without getting into the experimental set up, let me come to the conclusion: Brassen and colleagues propose that healthy older adults may use helpful mental strategies, like reminding themselves that the results were up to chance, whereas depressed older adults may blame themselves for the outcome.

The authors also speculate that training people to use these mental strategies might help preserve emotional health in old age.

“In our future studies we plan to address the question of whether such a frontal regulatory ability [of the brain] can be boosted by age-specific trainings of emotion regulation in late-life depression but also in healthy older adults,� she says. This has already been shown regarding the treatment of midlife depression and anxiety disorders

If are in the company of elderly people, they’d tell you that Indian philosophy has stressed upon this “let go� approach to life in its various texts and sub-texts. I don’t claim any knowledge on this; the only philosophic/religious text that I have read, in abridged form, is the Gita. One of the things that the Gita emphasizes is “emotional regulation.� (Researchers have shown that the concepts of wisdom in the Gita are relevant to modern psychiatry in developing psychotherapeutic interventions.)

So is this convergence of philosophy and neuroscience new?

Not exactly, says Rajesh Kasturirangan, associate professor at the National Institute of Advanced Studies inBangalore. His research interests are in cognitive science and philosophy of mind.

He doesn’t find this convergence surprising, though he wouldn’t put a huge emphasis on ancient Indian wisdom. “I think it is general common sense to not be too attached to one’s circumstances or to be too regretful of one’s past. ‘Let it go’ is pretty universal and I would predict that it is a successful strategy not just for older people but for all of us.�

More generally, he says, neuroscience has a lot to learn from philosophy, especially Indian philosophy, but it involves going well beyond the usual platitudes offered in the name of philosophy. The interface between the two is very exciting and just about beginning to bear fruit. “The biggest danger is an easy reduction of wisdom to neuroscience – there are no Rishi’s in the brain.â€�

Certainly, none of us is looking for Rishi-Muni’s in the brain. But a collective learning to develop right responses to missed chances in life would come in handy. I’d argue that such research findings have significance beyond themselves. Even a young nation likeIndia will have 12-13 percent of its population above 60 by 2025, according to the WHO. And the statistic about emotional health isn’t encouraging either. About 21 percent of the elderly population today suffers from old-age depression.

As more people age, “emotional� health would be integral to public health management. After all, don’t most of us also live with regrets? Oh okay, some regrets?

I do. Having lived through two dotcom booms (the first being followed by bust), the most current regret is: could I have opted for a career where money would chase my ideas, rather than I chase ideas (for stories, of course)?

What regrets do you live with?

Good things don’t last very long they say. Artemisinin, the plant-derived compound that has today become the best drug for malaria has started losing its effectiveness. Two new reports published today in Science and The Lancet show that the most deadly species of malaria parasite (Plasmodium falciparum) is becoming resistant to artemisinin-based drugs and the first evidence has come from the Thailand-Myanmar border.

The concern is rising that this could now spread to India and then to Africa, as has happened in the past with other malarial drugs. When the first-line treatment of a disease that kills close to 0.7 million people (655,000 in 2010, over one per minute, to be precise according to the World Malaria Report) shows cracks, then the full force of the global biomedical community is needed.

Artemisinin derivatives have the advantage over other anti-malarial drugs such as chloroquinine and mefloquine in acting more rapidly and having fewer side-effects. Until recently, no resistance was noticed anywhere. But a 10-year study, between 2001-2010, in the region by researchers at Shoklo Malaria Research Unit shows that the average time taken to reduce the number of parasites in the blood by half (known as parasite clearance half life) increased from 2.6 hours in 2001 to 3.7 hours in 2010. It’s a clear sign that the drug is becoming less effective.

These finings are backed by another report in Science by the same group of researchers and shows change in the genetic makeup of the parasites. This study narrows the search to a region of the parasite genome containing around 10 genes. Researchers say they haven’t found the precise changes involved, but they are “getting close.�

“This study emphasizes the importance of staying ahead of malaria,� says Prabhat Jha, Director, Centre for Global Health Research at the University of Toronto. He was  not involved in these two studies. Some of the resistance in East Asia is because of sub-standard drugs, or solo therapies (meaning artemisinin is used alone, without other anti-parasites) which are more likely to increase resistance, he says.

This is a strong argument for all governments supporting the Affordable Medicine Facility for malaria which uses novel economic subsidies to crowd out bad manufactures, and which should thus reduce the spread of resistance.  “The AmFM board is meeting this fall, and without question its funding should be renewed,� says Jha.

India needs to be extra cautious: One third of all the people who are at risk of malaria live here.

So how is the spread of the present resistance related to the past?

Professor Francois Nosten, director of the Shoklo  Unit says resistance to chloroquine and to sulfadoxine-pyrimethamine emerged in South East Asia (Cambodia) and spread westward through Thailand, Myanmar, Bangladesh, India, all the way to Africa. “Resistance to artemisinin may be different,� he tells Forbes India. “What we report is that it is present on the Thai Myanmar border but we do not know whether it has spread from Cambodia or emerged spontaneously. Either scenario is worrisome because ACTs [artemisinin combination therapies] are now used worldwide.�

As always, the case in India is complicated. Almost half of the malaria infection here is caused by another species, Palmodium vivax. In such  instance, what do we make of this resistance?

The relevance to vivax is indirect, says Nosten. This parasite is also developing resistance to chloroquine (now in Myanmar and Thailand) and there are calls to use ACTs to treat both falciparum and vivax, he adds.

Jha’s study in 2010, also published in The Lancet, found that there “could be about 200,000 malaria deaths in India in 2005, of which 120,000 were in adults�.  Similar findings have emerged from African death studies that malaria does not just kill kids but also adults.

(In Jha’s study, death figures are 13 times of what the WHO had estimated and 200 times of what India’s own National Vector Borne Disease Control Programme has recorded. The big leap in Jha’s study is the sampling of the rural areas; WHO estimates rely on just hospital settings. In the true Indian tradition, a committee was formed soon after Jha’s study was published. It intended to resolve the issue – How many people actually die of malaria in India? More than a year later, the committee is yet to give its report.)

The strategy, according to Jha, particularly for Orissa (where his group estimated about 50,000 malaria deaths) is to expand artemisinin combination therapies, including for adults.  “This would have the benefit of treating early, before more resistance forms take place (such as happened with chloroquine resistance in India).�

The international community is rattled by these findings. “This new study suggests that containing the spread of resistance is going to be even more challenging and difficult than we had first feared,’ says Nick White, chair of the Worldwide Antimalarial Resistance Network.

UPDATE at 1.30 pm: 

Prof G Padmanabhan, DBT’s Distinguished Professor and former director of IISc in Bangalore has been experimenting with a combination of artemisinin and curcumin. He thinks that “ART-Curcumin combination will make a difference in considerably delaying spread of resistance,� but ultimately we need a new pharmacophore to replace ART and that is only at the research stage. “I do not expect a new effective molecule as a drug to replace ACT within the next three to five years, even if the international leads fructify.�

“Falciparum malaria is the main issue in India and I am not sure decisions based on appropriate treatment are taken in time. The country has to ensure effective use of ART-based combination and make it affordable.�

The problem in Thai-Cambodia border ( and developing countries in general) is the use of spurious and sub-optimal doses of the drug, a sure prescription for resistance development. He is not sure if any body has studied this in India.

It’s a provocative question, I admit. And those who swear by examples of frugal engineering that India has championed would scoff at it. And if you know that JC Bose was the first in the Indian sub-continent to be granted a US patent in 1904, and that the first Indian scientist to start a company and use the proceeds to start a research institute was none other than Sir CV Raman, you’d scoff even more. You could argue that India has always innovated.

Let me give the context: the two-day annual technology conference of MIT and its magazine Technology Review, EmTech India 2012, kicked off in Bangalore yesterday. While some speakers are permanent fixtures in this event*, it is a good beginning in a country that hardly has any conference where a wide variety of technologies, from energy systems to diagnostic devices to network coding are discussed over two days.

So when Vijaya Kumar Ivaturi, former CTO, Wipro Technologies, and co-founder and board member at India Innovation Labs asked his group of panelists if India is innovating (read IP-driven innovation), he got rather mixed responses. A visibly confident and upbeat YV Prakash, former government official and founder of GAV incubator spoke of his start-up that being in stealth mode has sold its product to 100 brands in the country, whereas P Balamuralidhar, head of the innovation lab at TCS, Bangalore, came laden with the confessions of an innovator, so to say.

His answer to Vijaya Kumar’s question epitomized the dilemma of many a company—need-driven innovation versus dream-driven innovation. How do you position the two?  How do you overcome the fear of failure? In a way, how do you move away from thinking small and expecting it to grow big?

That wasn’t music to ears as you often hear Indian companies discuss this in their moments of candor. The fact that this discussion was happening after a morning talk of GE’s 100+ years of innovation, I wondered why is it that Indian companies, even those which make good money, are not able to find a balance between quarter-on-quarter numbers and long-term vision? And then, I saw Murali Sastry, former chief scientific officer of Tata Chemicals who drove innovation at the company for seven years, sporting another designation – Director, India Innovation Centre, DSM, the Dutch chemicals and nutrition company. Since I wrote a detailed story of Tata Chemcials’ green makeover last July I couldn’t help asking him why he left the Tatas. He wouldn’t say much except that he “wanted to learn how MNCs innovate�.

To be fair, it’s not just the Indian companies that are grappling (or need to grapple) with this issue. George Westerman of MIT Center for Digital Business yesterday quoted from his study of 50 companies (each with at least $1 billion in revenue) across several countries where he found that four out of seven employees felt the innovation culture was not what it should be. All 50 companies faced common pressures but having engaged in broadly common activities they had widely different results.

Well, culture does eat strategy for lunch!

Vijay Kumar believes the overall environment has improved in the last four-five years, and hopes this decade will fix the remaining gaps that exist in financing, precision manufacturing, tech adoption, etc. Unlike the developed markets where companies go for differentiation, in growing markets it is scale that drives people and real innovation takes a backseat. But he thinks India today offers an “unusual sandbox, a mix of developing and developed markets features� which will drive more serious innovation in the next few years. Till then, SoCoMo will prevail – solutions in Social Media, Cloud, and Mobility.

In the meantime, ingenious start-ups like Achira Labs will continue to do frugal engineering. Achira is developing a lab-on-a-chip platform for protein tests. Since low-cost, or even high-end, manufacturing in microfluidics is impossible in India today, Achira is testing the innate nature of wicking in silk fabrics to develop their platform.

But if we are looking at the next generation of innovations that will need to go beyond price, functionality, and design – triad that occupies innovators today — to include sustainability, we need to be agile innovators as a country. We are not even close to it but the signs are encouraging. For example, the electric car maker RevaMahinda has developed a new technology (advanced telematics-based system called REVive) to provide remote emergency charge to its customers in case of breakdowns. Meant to address range anxiety among drivers, the technology is completely driven by consumer insight, says Chetan Maini.

The hunger for efficient innovation was apparent at the conference. After his talk, Vishwanath Poosala, head of Bell Labs India, was surrounded by dozens of aspiring young innovators. “All of them want to set aside some time on weekends where they can brainstorm potential ideas. You don’t find this kind of energy elsewhere,� says Poosala.

Can we, collectively, harness this energy notwithstanding the economic slowdown, policy paralysis, political drama, and what have you?

*Note to organizers: Please get speakers from other towns and cities; don’t reduce EmTech to a Bangalore event.

UPDATE: I stand corrected. Organizers say of the 75 speakers at EmTech, 55% came from Ahmedabad, Chandigarh, Chennai, Delhi, Hyderabad, Kasaragod, Mumbai and Pune.

We live in times when healthcare is challenged in most geographies: In the developed world for obscenely high costs; in the developing world for pitiably inadequate coverage. So when a global executive of one of the largest conglomerates in the world says eight years from now, she wouldn’t be surprised if the world said India’s healthcare model circa 2000s foreshadowed the direction of the global healthcare, you pay good attention.

Terri Bresenham, President and CEO, GE Healthcare South Asia

Terri Bresenham, new President and CEO of GE Healthcare India and South Asia, is passionate about healthcare. She finds the Indian market unique. But haven’t we heard that before? Yes, but according to her the uniqueness lies in the fact that Indian healthcare model brings out the best in people.

“India is the only country where consumers shop around for healthcare, where physicians and providers know their respective cost structures. This helps bring the right behaviour,â€� she says. (Though it’s another matter that as health insurance penetration increases, shopping around will decrease and costs will escalate.)

Perhaps that’s the reason GE Healthcare is reassessing its “purpose� in India. Healthcare is not just about business, she says. “We are asking who are we solving the problems for— physicians, nurses, patients, government institutions or private care providers?� Challenging its own paradigm in India, the company has put forth a new platform called “Network for Healthier India� and is girding up to run a slew of challenging programs around it.

You will see more national ad campaigns about healthy lifestyles, early detection of cancer, etc. As much as the company wants to be seen as connecting to the end consumer, (so far left to its partners), it has even undertaken a re-jig of its product development philosophy. In the next 12 months, the company will launch 20 new products that are designed and developed in India. In two to three years, 25 percent of its revenue will come from new products, designed, developed and manufactured in India, up from about 12 percent today. “That’s a big statement from a multinational,� says Bresenham.

Indeed it is, but seeing the staccato healthcare reforms in the West, it won’t be far fetched to say the “reverse innovation� that GE’s CEO Jeff Immelt so famously popularized (in a Harvard Business Review paper), will come as a saviour for all. It’s not there yet. Exports from GE Healthcare India are growing by leaps and bounds but they have to overcome a perception hurdle. Earlier there was an inherent bias in developed markets where prices were associated with technology, says Bresenham. “I think that paradigm is shifting.�

And companies like GE Healthcare are possibly hastening that shift by sending experienced global executives to India so that the two-way learning process is swift.

Bresenham has an endless list of ideas for the Indian market: from innovating new business models (to connect with customers), to new training modules; from starting a research network for clinical research to even working with the universities to train industry-ready professionals. The research network is already off the ground with molecular imaging for breast cancer in collaboration with Thyrocare that’s going out to 150 towns in the country. She says clinical research on the latest molecular diagnostics platform for cancer would have taken 18 months to just recruit the patient in the developed world but in India it got started in three months, with the same calibre of clinicians and institutional support as anywhere. She intends to do more of such work in India, though one hopes it also leads to faster roll out of newer technologies in India.

Healthcare has been dear to Bresenham; she even worked in hospitals as a teenager. But professionally she entered this business, first as an engineer, and later as a product development executive. Twenty five years on, the passion remains undiminished. Her staff in Bangalore, who find their own pace of work enhanced manifold since she took over in December 2011, say she hardly sleeps or eats.

I verify with her at a “meet and greet� session last week.  “They are not right about food, but yes there’s less time for sleep. There’s just so much to do in healthcare…�

A few weeks ago Wall Street Journal carried a story on how the new GE way for its top executives is “Go deep, not wide�. A little over an hour with Bresenham and I thought, “She goes both deep and wide.�

In a very surprising move, Pfizer and Biocon announced today that they have called off their 17-month old commercialization alliance for generic insulin. “The companies have agreed that due to the individual priorities for their respective biosimilars businesses, it is in their best interest to move forward independently,� said the press release. This was followed by many tweets from Biocon CMD Kiran Mazumdar-Shaw saying the parting has been “amicable�, clinical development of biosimilars is on track, Glargine global Phase I nearing completion, etc.

It’s still a million dollar question what went sour in the relationship – between the world’s biggest drug maker and India’s largest biotech firm.

Biocon says the priorities changed on both sides and in the absence of any plausible reason, sources are raising the issue of “quality� and “missing systems and processes� at Biocon’s end and of “confused� strategy at Pfizer’s.

Analysts are busy calculating the costs on both sides. For one, Biocon will certainly not get all of $350 million of the deal amount, let alone the several hundreds of millions it could have made in royalty. It will have to search afresh for new regional partnership in marketing its insulin biosimilars; it is already scouting for a new partner for its oral insulin (that was not part of the Pfizer deal) that failed to meet the final endpoints in its Phase III trial last year.

For Pfizer, which has said clearly that it is not abandoning diabetes portfolio and will continue to be active in their “own research and business development efforts for diabetes, which represents a huge unmet medical need�, getting a solid foothold in India remains as unresolved as it was 17 months ago.

Hopefully, we’ll eventually know what didn’t work in this partnership but for now I can’t help but think why diabetes partnerships for Indian pharma run into trouble?

The first kid off the block was Dr Reddy’s Laboratories which out-licensed two diabetes molecules to Novo Nordisk and Novartis in 1998 and 2001 respectively. That class of molecules – insulin sensitizers – was initially promising but later the big pharma dropped it and that brought an end to DRL’s innovation in diabetes drugs. In 2008, Glenmark faced a similar situation when Eli Lilly suspended work on a diabetes drug that was out-licensed by Glenmark.

Smarting from these setbacks, and also the raised bar that the US FDA has placed on approval for metabolic drugs (diabetes and cardio vascular disorders), both Glenmark and Dr Reddy’s have exited this therapeutic area. Though it’s another issue altogether that as diabetes and cardiac disorder patient populations grow, esp in India, even the biggest drug companies are shying away from developing new drugs for these diseases. The new rules slapped by the FDA just don’t make the proposition attractive.

So do such broken deals!

The cost of genome sequencing has been falling dramatically, nearly a million-fold in the last six-seven years. Earlier this year yet another milestone was reached when Life Technologies announced that its latest gene sequencing machine, Ion Proton, could decode a human genome for as little as $1000, and in just a few hours. That’s a game changing development. So when I met its Chairman and CEO Gregory T Lucier recently, my first question was: Are we going to get our genome sequenced for $1000 in India?

“Yes, in a year from now you can get your genome sequenced for Rs 50000,� he said.

Well, that’s really good news (not because I intend to get my genome sequenced) because availability of such portable (akin to a desktop printer) and affordable technology would mean the associated procedures and the missing innovation ecosystem would begin to fall in place. Initially, it’ll be government labs and high-end medical centers where we could expect more gene sequencing to happen. Soon, it should spread to routine medical centres, after all it’s widely believed that genetic testing is going to explode. Virtually all the gene tests that we have today, be it KRAS (for colon cancer) or BRAF (for lung cancer) are single gene tests. That’s going to extend to large regions of the gene, let alone the whole genome.

“I don’t think India is going to be two steps behind the developed world,â€� says Lucier. A valuable use of this technology — and that’s what he is convincing the Indian policy makers about – is to includiegenetic testing in crime control and terror fighting, just as countries like US, Brazil, Japan, China, Western Europe and others use it to stop repeat offenders.

But to my mind, it’s in the healthcare space that the falling sequencing cost, booming bio-medical data and entrepreneurial talent are making a difference. We’ve had many false starts but this time around technology and science are converging. In the last four years we’ve come to know more about cancer genetics than we knew in the last 30 years.

Imagine all primary or secondary healthcare centers having this routine test – a chip that can screen all new born babies for a set of inherited diseases so that nobody goes on some unknown medical odyssey.  Take another instance. What if in a routine practice, a cancer patient can get the tumor sequenced and have the doctors tailor-make the treatment for him, choosing from both established and experimental drugs?

A study in Nature Medicine recently showed that more than half of lung and colon cancer patients can benefit from high-end DNA tests that detect flawed mutations. A Cambridge, Mass, start-up Medicine Foundation is doing precisely that – enabling personalized cancer medicine.

Lucier says he wants to work with the Indian government and private institutions to develop tools that lead to “therapies that would otherwise take a billion dollar to develop in the West�. The company has invested $10 million in India operations in the last two years and is ready to start a venture capital fund now to support start-ups that work in this area. (We don’t even have half a dozen home-grown start-ups to count in this field.) He sounds pretty convincing in all of these but what about the hype around the wellness concept – sequence the genome of healthy people to prevent diseases? Is that a Western fad?

He doesn’t deny that whole genome sequencing of healthy people will increase but that’s “not the big market, though that certainly gets more media.� The big market is in therapies as every disease at some level starts out genotypically, he says. “We’ll start with cancer then move to digestive tract, nervous system and other diseases. But cancer is certainly one disease where this technology can have the most impact in the very immediate term.�

When I insisted that whole genome sequencing, for an average person like me at least, still looks somewhat faddish, (let alone the scope for unnecessary anxiety that is now seen to be associated with PSA tests in prostrate cancer in the US) he threw a scenario at me:

“You are successful, you make good bucks. Suppose you get cancer. Would you spend Rs 50,000 to get your genome sequenced?�

As we live longer, one in four humans will get cancer in their lifetime (a statistics validated in the West). So I don’t think what Lucier threw at me is hypothetical.But until I come to that cross-road, I’d rather not see what secret the three billion base pairs hold for me. Life is good without it!

What a question, many would say. Particularly in a blog post that is close on the heels of a special report on innovation that we did in Forbes India March 2 issue. Actually, this question emanates from the feedback to that report.

So, does Indian science suck? Yes and no.

Yes, because like so many other enterprises in this country, scientific enterprise is not without flaws, major flaws some would say, and I fully agree. Choking bureaucracy, hierarchy, orthodoxy, mediocrity, follow-the-supervisor (or Godfather) culture, fear of asking bold questions, doing-confirmatory-tests-and-saving-the-skin, science-lodged-in-ivory-tower-syndrome …the list goes on. All the reader comments I got in this story, are true and justified. I even got a few calls asking why didn’t I flag the major issues plaguing the system.

But don’t we know that already? The reason we did this story was to talk about the change that is unfolding. And as my editor says, “Our story isn’t about the state of Indian science.�

So let me take a few criticisms, one by one.

People say the ills of the system are self-perpetuating. Prof Jayant Murthy of Indian Institute of Astrophysics has commented: “The institutions that are being set up have the same old people in charge. These people, by and large with exceptions, are hidebound and hierarchical. In many cases, they are self-perpetuating because they pick their successors in their own mold.�

True, but let me give a few examples of change: When IISER Pune was set up and K Ganesh made it’s director, one of the criticisms floating around was that Prof CNR Rao, chairman of the scientific advisory committee to the PM who promoted setting up of five IISERs, chose his son-in-law as the first director. It was a valid point. I don’t know if there were more suitable candidates, but today IISER is certainly considered to be shaping very well.

If you’ve read the NCBS story in the package, you’d know how S Ramaswamy was brought back from the US to lead a few new centres at NCBS.

While it’s good to have change agents from outside, sometimes even insiders can do the magic if they want to. Prof Pankaj Jalote, an IIT-system product, is running a new institute Indraprastha Institute of Information Technology in Delhi. And visiting faculty there sing praises of his professionalism and the speed with which ideas get executed.

Another reader comments: “This initiative has the capability to change India’s fortune obviously if properly executed which does not happen most of the times. Nothing less than a revolution is required.â€�

It’s bang on. Some of the architects of these initiatives understand that and question the limitations publicly. DBT secretary MK Bhan says there is substantial legacy problem in the institutions which are not thinking about younger people who don’t feel part of the system. So, does he only lament or is he doing something?

He is working with the older IITs on this as he is helping them establish research infrastructure in lifesciences. He is setting up network called Bio-Connect in Bangalore that would look after young researchers in life sciences across the country. RA Mashelkar in the last issue of Science proposes a new Academy for the younger generation so their voices could be heard.

Bhan even wonders if “our ambition is larger than what we have in the government� as he seriously wishes the government would do systemic and institutional studies to pinpoint and eliminate the bureaucratic and ideological limitations and do public-private partnerships in the right manner. But does that stop him from innovating in his own department? No.

When I asked DST secretary T Ramasami how can the industry be made part of the innovation process so that both public-funded research and industry work to each other’s strengths, he gave a fitting example: At Central Leather Research Institute in Chennai, a CSIR center with the then budget of Rs 15.8 crore, he raised Rs 13.8 crore from the industry. So the basic question is not whether industry is willing to participate but whether both can work to each other’s time scales. Industry needs to innovate and execute faster, but Indian institutions want to file patents just to be able to publish papers. (Once the patent is filed, they can publish and get their academic credit as our system is more geared towards rewarding publication than innovation). Is there a common ground?

Yes, but covering that sufficiently requires a significant cultural change. It may not happen soon. “Not in my tenure, or even in my lifetimeâ€�, says Ramasami. “But if I have to play the role of Rahul Dravid for this country in science, I don’t’ care how long I need to bat, whether I get runs or whether I’m sweating hard or not, I bat.â€�

I am tempted to tell him (in retrospect, of course) that given the present need, he and other batsmen in Team India Science need to swing for the fences, not just settle for singles and doubles.

This special report is not only about how Ramasami, Bhan, and others are batting, but how they can inspire and facilitate many more, both test players and T-20 enthusiasts, to score quick tons.