Sunday, May 14, 2017

US: National Women's Health Week is here

In the United States, May 14 - 20 is National Women's Health Week this year, at least I guess because the funding hasn't been pulled yet. HHS has a website specifically dedicated, with suggestions for women of various ages on what they can do to improve their health. A link is available below.

Introducing gyn.io

Recently, I started a project of my own, with no intention of coinciding with the commemoration. Nevertheless, I think the timing is opportune. I have always wanted to write about and expand on my interest and experience in Women's Health.

Gyn.io is a blog/resource site on which I have started blogging about Women's Health issues, and through this week, I hope to write a post a day, highlighting a unique area or problem in Women's Health.

Please visit, sign up for updates and do leave me feedback, areas for improvement and/or posts you'd like to see on the site.

Here is the link: http://gyn.io


Also, a link to the HHS Website: https://www.womenshealth.gov/nwhw

Saturday, May 06, 2017

Now, Nepal challenges India on Medical Tourism - what protectionism brings!



A few days ago, I wrote about India's Medical Device Market: http://chaaraka.blogspot.com/2017/04/indias-bizarre-medical-device-market.html

And then, today, I came across an article that makes things even more interesting. Turns out, Nepal is, as one should, taking advantage of the Indian Government's narrow minded attempts at making medical devices available to the market. While India's ominously named NPPA (National Pharmaceutical Pricing Authority - "Authority", puts a nice Democratic spin to things indeed) has decided to control stent prices (especially for drug eluting ones!) at ridiculous rates, at least two companies, Abbott and Medtronic proposed withdrawing from the market. And, it is possible, Boston Scientific wants/wanted to follow suit.

To further wrinkle matters, the NPPA apparently rejected requests by Abbott and Medtronic to pull out of the Indian market! Yes, and apparently so, because, there is no provision in the law to allow a company to withdraw its products from the Indian Market. Well, if companies did not hesitate about bringing their products to India, now they sure as hell will!

Getting back to Nepal, apparently, not only are Nepali Hospitals accommodating Indian patients, but also the Indian doctors that want to operate on them. In my last post, I had lamented about India losing out on medical tourism, and even I hadn't imagined the problem to be as deep as it is. Doctors from India already have lucrative opportunities to do small stints in the US and Europe, when local doctors, especially specialists, go away on vacation, or are unavailable otherwise. This, apparently extends to regions such as Dubai, Singapore, etc. and that is good for them. I am sure, exchanges happen the other way too, but when talent is displaced due to protectionism, it results in a loss of competitiveness. I assume Nepal is even cheaper than India. So, if you didn't have the price controls in place, even with the cost of the stents on market, and the travel expenses, Indian patients, and patients from around the world can only benefit from going to Nepal, not to say anything about the winning local economy.

Confounding Issues and the Ultimate Losers!

I know I keep saying bizarre, but what shocks me is, apparently the NPPA, egged on by a court decision, and at least one organization, All India Drug Action Network, believes that price control is the way to police, regulate and prevent abuse of stents by hospitals, in their search for profits. Before we jump into further arguments on this, it is puzzling enough that the NPPA also wants the Cardiological Society of India to regulate and police itself, to prevent over-use of stents.

So what does the NPPA believe then? Price control works, but is not enough? Or do they doubt that price control would work? The whole thing looks like a mess, and I can tell you one thing - the ultimate and severe losses appear to be that of India's patients.

We'll keep watching the Indian Government and the industry and see what shakes out. It looks like the road ahead is long and bumpy.

References:

1. The article (loading issues and spelling errors lie ahead): http://www.firstpost.com/india/nepal-cashes-on-as-indias-price-cap-send-stents-disappearing-from-country-3427822.html

2. Image, courtesy Pexels: https://www.pexels.com/photo/glacier-snow-mountains-sunny-199/

Monday, April 24, 2017

A Review of the 2nd Stanford Drug Discovery Conference, Part 1

I found about this exciting event on Friday, about to happen today, and the first thing I did was sign up, as it was free for the public. My alma mater always puts on the best shows (very objective I am), and the price was right (along with excellent Stanford Dining supplied lunch, coffee, dessert...). I did have some things to do this morning, so I arrived about two hours into the event, and still I ended up taking enough photos of slides and taking enough notes, I am going to split this into two posts.

The program details are linked below.


One of the first astounding things I heard this morning was that NO off-target effects have apparently been reported with CRISPR either in mouse or in human models! There appears to be some modicum of disagreement on this, but more later.

The Molecular Stethoscope

Another cool thing I learned of, is a company that proposes to use cell free RNA to monitor various health and disease conditions. They got a nice and well deserved plug. Link below.


CIRM

One more excellent presentation was that of Stephen Lin from CIRM, reminding us all of the wisdom of California voters in creating CIRM through Proposition 71 at a time when the Federal Government made several narrow-minded choices on restricting stem cell research. CIRM's creation has made power houses of Universities and Teaching Hospitals up and down the state, and CIRM is on a roll, with $700mn more to give away!


I had a standing lunch, off excellent Italian food, steamed potatoes and beans, chatting with a gentleman, when he pointed out this to me. If true, it saddens me, but kudos on some well timed marketing!

The plane was fast, and the phone didn't do a great job, but it says "Stanford unfair to disabled workers". I will try to find out more about this.


Industry Presentations

The Post-Lunch Industry Presentations were indeed quite exciting! The presentations were from Novartis, Amgen and Takeda, each offering a unique perspective, all praise to whoever picked the three choices. Here are some observations:


1. Novartis needs to be involved earlier rather than later in drug development.

2. Novartis – “We innovate in isolation, we prescribe in combination”. This was in reference to their attempt to prescribe a combination of therapies, and this appears to be a recurring theme, especially in oncology, something I have observed over the past decade.

3. "We need to innovate a new science of therapeutics”. The idea here is that there are many diseases to fight and more work needs to be done. The presenter also alluded to CRISPR's potential for helping create new therapies.

4. The presenter also left us with this really nice reminder that when companies and academy share capabilities through collaboration, success can be achieved.


5. The presenter from Amgen stressed how important it is to first identify the correct targets, and not simply try to fit modalities to targets, or pick the wrong targets and then ask biologists to come up with satisfactory animal models for test. With focus on modalities, you say, “I have a hammer and I am looking for nails”. I can definitely relate to this quite well. My first position, right off academia, was as a Front-End Research Scientist, and my manager wanted me to do both - identify diseases and try to extend our existing, patented technologies far and wide. This has always stood with me as great strategy and I don't see why it wont work well for drugs, as well as it does for devices.


6. "Be extremely disciplined in the scientific approach you take." He reiterated that even though this might sound cliched, that it is very important. Again, who can disagree?

7. Again, striving to remind us of the fundamentals, he said the following. You have to patent the interdiction that you inhibit/activate the target with to fight the disease. The interaction of the target with the disease is not patentable.

8. Perhaps the biggest takeaway of his presentation is of how nearly half of Iceland's population has had their genome sequenced! From this, various therapeutic and other knowledge can be gleaned.

9. From the Icelandic population, it was gleaned that people with very very low Cholesterol LDL levels had a PCSK9 protein mutation. Similarly, a French team found that a mutation caused others to have very very high LDL levels. More such discoveries are possible through genome sequencing.


10. The speaker from Takeda mentioned headwinds and tailwinds affecting the industry.


11. We are able to basically target any gene with small molecules. This can indeed lead to lot of therapies.

12. In today's world, the patient's voice is valuable. We will come back to this in the second part blog post.

13. "If you look at the top 10 pharmaceutical companies, there is not a single one saying, give me a “me-too” molecule and I can commercialize it." An interesting rebuttal follows in the next post.

14. An analysis of the top 15 R&D spends in the industry, showed Takeda is 15th at $3.2bn.

15. Intense focus on Japan for about 236 years in existence! In 236 years, there have been 9 CEOs. 7 had the same last name.

16. Culture is everything. The science is important, but culture is very important.

17. Takeda used to be a platform company – small molecule synthetics company.

18. Takeda has established a partnership with Nobel Laureate Yamanata to make “models for human disease” and then find therapies.


Enjoy the images and the notes. More exciting stuff to follow in Part 2!

References:

1. The Program:

http://med.stanford.edu/content/dam/sm/cvi/documents/pdf/drug-discovery-program-2017.pdf

2. The Molecular Stethoscope

http://molecularstethoscope.com/

Sunday, April 23, 2017

India's bizarre medical device market


The Indian Government regulates the Indian Medical Device Industry, that are perplexing to say the least. I just came across this news that Abbott is pulling out a couple of their drug eluting stents from India, because of the price ceilings set by regulation (story linked below). Of course, the stents themselves might have issues, including a European Union safety warning.

That said, I still have a few observations here:

1. The drug eluting stent price limits set by the Indian Government appear to be quite low, for any drug eluting stent manufacturer to sell the devices in India. Safety Warning from the EU or not, Abbott appears to be pulling out the stents from the market.

2. Actually, Abbott has "applied" to pull the two stents off the Indian market claiming "commercial unsustainability". They don't say! Apparently, you have to go through a process, simply to stop selling devices in India! Because, of course, if the Indian Government decides that the stents are needed in India to treat patients, they can force you to sell them anyway!! Yeah, it is not just you. I am Indian, and I am a bit shocked myself. Mind you, all this craziness happening, while on the other end, the Prime Minister's Office (PMO) is claiming it wants to aid Foreign Direct Investment (FDI) and a Make in India initiative simultaneously. Honestly, I feel there are very few things out there that could be more conflicting.

If you force people to make their products in India, and then sell it at a price set by the Government's illogical vagaries, how do you expect enthusiasm from foreigners to invest in India. This is quite puzzling.

3. The other thing of interest here is, what of medical tourism. India's cheap medical care with well trained personnel fluent in English has seemed to make it possible for many people to travel from across the world to obtain cost-effective treatment in India. However, if medical devices and other therapies are simply unavailable, India loses leadership and significant revenue and employment in this arena.

4. I am all for Government intervention in healthcare, especially in developing nations. However, these price ceilings appear less to do with patient care. These are but two examples, the drug eluting stents. I am sure there are other devices that face the same sort of excision from the marketplace. Ultimately, Indian patients appear to lose the most here. The Indian Government should strive first to make most, if not all treatments available to Indians, first, before focusing on cost effectiveness. However, cost cutting is a low hanging fruit that politicians cannot resist, and therefore, this appears to be setting a rather dangerous precedent. For those who know the UK's NICE guidelines, know what a slippery slope government control over treatments can be.

5. In relation to all this, I have recently read several articles that lament about Indians' out of pocket costs outweighing subsidies, about the lack of momentum in spending increases by the Government, in comparison to, say defense spending, which is well above healthcare spending.

Conclusion

It is safe to say, India is still not taking a 360 approach to healthcare, and choppy, shortsighted decisions make healthcare investments, be it in medical devices or therapeutics/diagnostics quite challenging for the foreseeable future. We now await new regulatory announcements from the PMO, aimed at improving FDI. I eagerly await to see if any of the proposed changes make FDI, patient access and other aspects of healthcare in India exciting in the near term!

References:

1. Abbott proposes withdrawing drug eluting stents: http://health.economictimes.indiatimes.com/news/medical-devices/now-abbott-withdraws-2-stents-from-indian-market/58308578

2. Blog Image, courtesy, Pexels.com: https://www.pexels.com/photo/architecture-india-agra-delhi-62348/

Saturday, April 15, 2017

Quick Post: Digital Health Investments by Pharma

The CB Insights Blog has a great post about investments in Digital Health Companies, that go beyond the traditional VC Investors. They have prepared a nice infographic-like visual chart that serves as a map for companies that have been investing in Digital Health. Without much ado, I am leaving the link here for you to read:

Click Here

Thursday, February 04, 2016

Today is World Cancer Day

My plans for posting on this blog more frequently have not gone too well so far. But, I will keep trying till I get to that point. I ended up at my desk this morning to find out that today, February 4, is World Cancer Day, and this repeats each year.

If I had known earlier, I would have written up a post and tried to add some valuable information. Since I didn't, I have done a few things. I added this to my calendar, that I started creating last year. I will keep trying to add key events and dates to this calendar. I will embed it again in this post. Take a look, add yourself and/or send me dates, events, thoughts and suggestions.

Some Reading Material

I have been mulling about this informative write up on what it cost to provide President Jimmy Carter with the treatment that has helped recover recently. I might post something about it in due course, but here is some key reading for any stakeholder involved in cancer research:

http://www.newsweek.com/jimmy-carters-remission-took-expensive-drug-research-422699

Learn More About World Cancer Day

To learn more about World Cancer Day itself, go here: http://www.worldcancerday.org/about


A Nascent Effort

Cancer Research is one of my key passions. As with our modern, disorganized life, I find myself losing track of information, data and resources. So, I came up with the idea of a Wiki Site for me to store and share information, curated specifically on cancer research, treatment, politics and other related issues. It is very nascent and skeletal right now, but expect more changes as time progresses. You can take a look here:

http://onco.wiki/

The Medical Awareness Calendar Again

As with some of my other projects, this is work in progress and will become data rich over time. For now, I am reposting, for your perusal, comments and thoughts:

Saturday, January 31, 2015

February is the month for...

I was trying to find some generic topics to get back to blogging, at least once a month or a quarter, and I wanted to see what February has in store. A very quick search found a great resource, Healthline. The have a page with a listing of the significance of each month. I thought that was cool. You can find the page here:



I discovered that February is now National Condom Month in the US, as opposed to just a week. I took this and other key events and turned it into a calendar. I have only populated February, but I will go ahead and populate events for all months. If you wish, you can add this calendar linked below.



Suggestions for events and corrections are welcome. I hope to update this calendar about once a quarter or more.

Friday, February 28, 2014

MRSA & Super-bug Business Opportunities just begging for some attention!

Note: I have not posted here in nearly a year now. That is about to change. When I have been off something, I like to ease in, rather than rush in. So, I am going to post a few quick posts here. Please leave your thoughts and comments.

While tried and tired business opportunities for devices dry up, there are some that are being discovered, though one gets the feel that some of these were simply ignored. HealthDay is reporting a freshly minted publication in February's Mayo Clinic Proceedings. This study details how researchers tested physicians examining patients with stethoscopes, and found out that the diaphragms are second only to fingertips in terms of picking up bacteria! Now, is that eye catching or what?

The Opportunity? A simple solution for the Developing and Developed World, of course would be to sanitize the diaphragm between patients. However, how about a single-use, disposable, sterile sleeve that one quickly throws on the diaphragm and then discards after use?

Caveats? Before you get very excited though, remember it is just one brainstorm. And while you can undertake your own ensuing idea storming, I will just offer a few caveats to consider:

1. Why would this sleeve be more attractive than, say, just sanitizing the stethoscope diaphragm? Obviously you have to provide compelling solutions.

2. How would you ensure that the sleeve is removed after a single use? This can be designed in.

3. Who pays? Reimbursing preventive care can always be a bit tricky.

4. How will you stay competitive?

As you can see, any opportunity comes with its issues. MRSA and other drug-resistant antibiotics represent a grave danger for humans going forward, and there are huge market opportunities to be conquered.

Reference: HealthDay Article

Tags: #medical #devices #superbugs #MRSA #drugresistance #drug #resistance #business #opportunities #market #brainstorming #ideastorming #blog #weblog

Friday, April 12, 2013

Brief: Anthem Blue Cross is unbrazen as it's vindictive business practices lay exposed in California

Note: I don't have much time nowadays so I am switching to quick updates on key issues rather than wait till I have time to post in the long form I am used to.

I first came across this article on the erstwhile ducknetweb, and it makes for an incredible read. I generally do not like reproducing other peoples' hard work as a blog post, but I think Anthem Blue Cross's vindictive business could use all the bad publicity it can get, especially since they plan to appeal a decision against them, rather than apologize to the victims, including the Doctor they rejected from their network and the several patients on whose behalf he fought with Anthem Blue Cross.

Jeffrey Nordella, a doctor who doubled as a patient advocate stood up against Anthem Blue Cross when they rejected patient claims. He put up a brave fight, and in return Anthem Blue Cross barred him from participating in their network. The Supreme Court of California had clearly stated in a 2000 case that when insurance companies kick doctors out of their network, they must give them due process.

Such minor details or a clear verdict from a jury are of no consequence to Anthem Blue Cross apparently. Read for yourself.

I am going to post the links here, and I hope that you will go through them, read and understand what happened here, and, if you happen to be in a similar situation, you will be ready for a long fight!

Links:

1. http://ducknetweb.blogspot.com/2013/04/doctor-wins-38-million-dollar-law-suit.html

2. http://www.latimes.com/business/la-fi-anthem-doctor-verdict-20130410,0,2796259.story

Monday, April 01, 2013

Brief Reminder: Autism Awareness Month

Hello there! It has become nearly impossible to write because of a couple of key projects I have been involved in. Therefore I am trying to write very very briefly to try and keep blogging and hopefully increase the frequency as time passes.

April is Autism Awareness Month. It is a great time to learn about Autism, identify new research and talk to people about expelling common myths. Here is a good place to start:

http://www.cdc.gov/ncbddd/autism/index.html

Wednesday, August 22, 2012

The Myriad Decision: When commonsense took leave of American Jurisprudence

If you thought America's problems were the first-to-invent vs. first-to-file, or the Apple-Samsung trial or the medical device tax as various golf-playing company executives and clueless Republican Congressmen from Indiana would have you believe...you are wrong. The American legal system's problem is...what appears to be a disastrous lack of baseline commonsense! Why would I go ahead and say that?

If like me, you have been reading the real news instead of Taylor Swift and the Kennedy she is dating or why Shia Labeouf and his girlfriend threw a lachrymal part on the streets, you have already heard about the Myriad decision.

Irresponsibility - A systemic problem

From Antonin Scalia to Tom Head, an otherwise inconsequential Judge in Texas who predicts a civil war if Obama is re-elected, the American Judiciary system is full of some very irresponsible individuals. The fact that the country and her future rests in the hands of such people can best be described as appalling. And now the Myriad decision comes as sound proof of what a mix of lack of scientific education, ethical responsibility combined with partisan judges can do for the future of science, technology and ultimately business in this country.

Nature is not an excuse

In the Myriad case, allowing the company to patent BRCA1 and BRCA2 the judge writing the majority opinion wrote - “Everything and everyone comes from nature, following its laws, but the compositions here are not natural products. They are the products of man, albeit following, as all materials do, laws of nature.”

If you read that as if he was interpreting that breast cancer is man-made. The statement also seems to open the doors for people to patent minor variations on naturally occurring substances. However, the problem is a bit deeper. Somehow a collective majority of judges at an appeals court don't even seem to have the level of scientific background that a 6th grader would be expected to have. 


Dangerous Precedent

This ruling sets a very dangerous precedent! If uninformed judges are allowed to get carried away and make such poor decisions, then the life sciences industry will truly be in shambles. And this is not some conspiratorial warning for the future - it is already here. Unless a full appeals board or the Supreme Court strikes it down, you will have a whole bunch of patented genes. What will this lead to? The answer is blindingly obvious:

1. Research will be stifled. If something as basic as BRCA1 or BRCA2 is patented, then who would want to continue research and drug development that influences either gene? 
2. If someone did want to conduct research, what would they have to do? License the very act of handling, using or talking about the genes from Myriad? How stupid is that?
3. It is not a stretch to conceive that people will start patenting SNPs (Single Nucleotide Polymorphisms) and make even simple diagnoses fall out of the reach of the masses. 

There are several other small and large disturbing possibilities. 

Protecting ourselves from the judges...

Now that we know a bunch of geniuses are stalking the halls of American Justice, we need to find ways to make sure that research and industry make progress despite them and not because of them: 

1. Get Congress to pass specific laws barring naturally occurring genes from being patented.

2. Carefully examine how judges get elected to the various echelons of the judiciary.

3. Establish procedures and guidelines that will quicken the process of censuring runaway judges and if possible, impeach them, or nudge them to retirement.

4. Be vigilant about for-profit companies that would constantly want to find loopholes and exploit them. This one seems so obvious, and yet, it cannot be emphasized too much. 

References:

1. http://www.nytimes.com/2012/08/17/business/court-reaffirms-right-of-myriad-genetics-to-patent-genes.html?_r=2







Thursday, August 09, 2012

India's Pharma FDI Mess...



A note: "Apothecurry" - a blog with a very creative and meaningful name is my favorite blog to get some nifty scoops  on the status of the Indian pharma industry, and I suppose what the Indian Government is doing to it...

You can find the blog linked at the end of  the post.


The question everyone wants to ask: Why is the Indian Government f*ing up the pharma industry?

Among other things they have done:

1. They forced Bayer to license a Cancer drug in a very ambiguous manner. Bayer is no saint, the proposed drug cost and their stance is a direct evidence of either greed or self-loathing inanity - hard to say.

2. They have made a pledge to provide free drugs to India's teeming millions without a proper plan or even the semblance of one...

3. Now, they have threatened Foreign Direct Investments, and, according to Apothecurry, in quite a disparate manner.

Bringing the License Raj back:

Well, not the TBBT Raj, but the much maligned "License Raj", the practice of requiring companies to obtain licenses and burying them in reams of paperwork, promoting corruption, stifling even a whiff of innovation and essentially choking an industry.

Apparently, various arms of the Indian Government have their own plans to stuff their hand in the cookie jar. First apparently the Commerce Ministry wants every foreign investor to go through an intermediary agency called the Foreign Investment Promotion Board (FIPB).

A group of folks from various ministries, on the other hand have suggested that this hell befall only those foreign investors that dare seek more than 49% of a local pharma company. Either way, this is not good news for the Indian pharma industry.

Pharmaceutical Xenophobia

As with everything else, independent India simply misunderstood and maligned Gandhi's "Swadesi" exhortation. Untimely as his death would have ever been, were he to live today, he would pooh-pooh the anti-foreigner sentiment being used to gain popularity and votes while burying real issues.

You would think in a failing economy, the Indian Government, led by none other than Manmohan Singh, famous for bailing India out of the License Raj would not even think of suggesting protectionism.

However, like any other Government, they would like to blame their failings on someone else and thus would have you believe that India's impoverished healthcare system is a consequence of unscrupulous FDI. They may be unscrupulous, yes, but the bulk of the problem, all the way from apathy to lack of vision and corruption rests solely with India.

Whither India?

Someone should tell Sonia Gandhi, Manmohan Singh and their bandwagon of daylight dreamers that the Indian economy is not on a bed of roses. Rather than ease restrictions and make it easy for investor money to flow, the Indian Government is looking to take the country back and plunge it into the same darkness as the energy grids.

If they worry foreign investors would get carried away, they should put forth legal barriers, not imbue some Russian-Venezuelan axis of Xenophobic Hell on Earth.

If this continues, we will see that India's healthcare reach suffers worse than ever, drugs get pulled off the market, or never get into the market and the industry will whither away with stiff external competition.

Reference:

http://apothecurry.wordpress.com/2012/08/08/fdi-in-pharma-another-punch/http://apothecurry.wordpress.com/2012/08/08/fdi-in-pharma-another-punch/

Thursday, July 12, 2012

The more obvious ACA - India connection: The windfall to Indian IT

If you are unaware of the Supreme Court decision last month, you are either completely disconnected from the US or are a very successful cave-dweller.

There are several groups benefiting from this decision, all the way from insurance-starved Americans to stir-crazy Tea Party loonies, otherwise known as the GOP. And yes, no matter the amount of fake tears that AdvaMed sheds and its senseless parrots mimic, medical device makers and the pharmaceutical industry are also going to benefit immensely. Sensing huge windfalls, the health insurance industry has also reacted with hidden glee.

However, one important connection has not been made very obvious. Of course, in an election year, who would want to tout the fact that a whole host of Indian IT companies would be making money from a successful US bill? I always knew that EHR/EMR start-ups and Indian companies would benefit from the Affordable Care Act (ACA) -  the numbers seem to be surprisingly low, at least if you were to believe Economic Times.

A luke-warm $5.4bn!


In the truly egregious manner in which most Indian newspaper articles espouse information, analysts who are elevated to "experts" (although the article, linked below does dole out some borderline-pertinent comments) mention that the Indian outsourced software and IT industry would see about  1.2 lakh crores (frustrated by the strange units? Well, that is how the rest of the World feels about FPS) or $5.4bn from the ACA. The analysts from Everest Group, apparently also believe that the true "potential" for this market could be $22bn, which still appears low.


If you look at how big the EHR/EMR and other Medical IT market is going to be over the next decade in the US, one wonders if they mean annually? Understandably, NASSCOM, the Indian IT equivalent of AdvaMed (though not so self-involved) predicts that health based BPO only accounts for 4% of the overall industry, and that it can go up to 11-14% of the total outsourcing business. 


Higher Possibilities or Poor Vision?


While a single article does not a trend make, it would appear that the Indian IT industry is still stuck on "serving" rather than "leading". This is probably why the numbers appear too low to me. The companies are still probably stuck in the "Y2K" mode - calculating how many L1 and H1 visas they can snag and how they can benefit from innovation that comes out of the US. It would appear to me that the Indian IT industry and India in general has much farther to go before they can develop leadership in the true sense. 


It is not that Indians lack creativity, innovation, or simply the power to invent. Leadership has a little more to it by way of ingredients, and I believe this is where the Indian industry with its mob mentality, focused on 90-day cycles is giving in. 


An opportunity for the US that the GOP will take away?


Technically, the lack of Indian leadership in IT is an opportunity for entrepreneurs in the US to look past election-year rhetoric. 


34th time is a charm, no the 35th is, or the 36th...


33 times - that is the number of times the GOP in Congress has tried to repeal the healthcare law. Obviously, this creates unnecessary pall over the healthcare industry, ranging from traditional pharma and medical companies to new and innovative Health 2.0 companies. Over the long term, this could only get worse. Surprisingly, having sided with the GOP on the immensely disastrous attempt to repeal the law, now, on the verge of benefiting from all the effects that ACA will have, I am sure, the industry is tearing its hairs apart over all the uncertainties this constant invective on "Obamacare" is causing to future profits and the very fundamentals of growth in the healthcare industry.


Who will win? India, the US or someone else?


India should take a real close look and see how they have managed to water down a major business bonanza into $22bn or worse $5.4bn. True leadership would mean India turning herself into a leader and direct rather than follow world IT by simply serving as the Global IT bellhop. This might mean fostering indigenous entrepreneurship, doing away with the listless Congress Government, giving the BJP a stern warning that they will go the same route if they don't liberalize; importing Indian talent that has left shores, creating an environment where others would like to come and play - look at Start-Up Chile! There is much work to be done, none of which should involve a lengthy, strategic plan to grovel to others.

As for the US, the democrats need to tout their successes over the past four years, get over the election hoopla and look for true action - reforming legal immigration, realizing that low cost outsourcing is here to stay and fostering innovation. The ACA is only the first step. They should work to put a lid on all the nonsensical lobbyists, stop pussyfooting on efforts to strengthen the FDA and enact other laws key to creating a truly lasting, healthcare solution. Otherwise, if it is not India, it will be someone else!


Look out for more posts on the US and India...


Reference:


http://articles.economictimes.indiatimes.com/2012-07-03/news/32523799_1_healthcare-sector-healthcare-insurance-captive-bpo-unit?utm_source=Digital+Medicine+India&utm_campaign=516ff60956-RSS_EMAIL_CAMPAIGN&utm_medium=email