In India, there are several difficulties in the identification, cure, and management of chronic illnesses: Academician (Dr.) D. Prabhakaran, CCDC Executive Director

Chronic lung disease, diabetes, cancer, heart disease, stroke, and other noncommunicable diseases (NCDs) remain a serious public health concern. In addition to being the cause of 63% of fatalities in India, chronic illnesses including cancer and heart disease are also predicted to cause the nation to lose $3.55 trillion in GDP between 2012 and 2030.

Since 2000, the Centers for Chronic Disease Control (CCDC) has spearheaded initiatives to modernize public health and provide public health experts with the tools they need to address the rising prevalence of chronic illnesses in low- and middle-income nations (LMIC) like India.

Prof. (Dr.) D. gave an interview to Financial Express.com. The Center for Chronic illness management’s (CDC) executive director, Prabhakaran, discussed obstacles, the importance of precision medicine and customized medicine, and current advancements in the field of chronic illness management. Take-outs:

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According to Apollo Hospitals Enterprise Ltd. President of Group Oncology Dinesh Madhavan, advances in CAR-T cell treatment and nanotherapy show great promise. The AI-Precision Oncology Centre (AI-PoC), recently opened by Apollo Cancer Centres, has the potential to completely transform cancer treatment in India. Dinesh Madhavan, President, Group Oncology & International, Apollo Hospitals Enterprises Limited, discussed the function of AI-Precision Oncology Centre (AI-PoC), obstacles, and other technical breakthroughs in cancer treatment in an interview with Financial Express.com. Excerpts: How is cancer doing in India? How has the nation’s care and treatment for cancer advanced? India’s cancer case count is predicted to climb to 15.7 lakh by 2025, indicating a considerable rise in the country’s cancer burden. The increased prevalence of cancer highlights the critical need for all-encompassing strategies in early identification, prevention, and treatment. Modern oncology facilities with state-of-the-art equipment have been established, and despite the obstacles, great progress has been made in the care and treatment of cancer. Improving patient outcomes has been greatly aided by the creation and use of cutting-edge therapeutic techniques including targeted medicines and precision medicine. Cancer care in India has advanced significantly as a result of foreign collaborations, public-private healthcare sector cooperation, and other factors. Strategic investments in research, development, and training programs are required due to the rising incidence of cancer. These expenditures will promote innovation and guarantee the provision of cutting-edge cancer treatment across the nation. India’s emphasis on tailored and interdisciplinary methods highlights the nation’s dedication to meeting the changing requirements of cancer patients and improving the quality of cancer treatment in the nation. How might medical technology help with cancer treatment and care in India? A revolutionary age in cancer via immunotherapy is being ushered in by significant breakthroughs centered on immune checkpoint inhibitors. This new strategy uses the immune system to fight cancer cells. Furthermore, advancements in CAR T cell therapy and nanotherapy show great promise for changing the face of cancer care by providing customized therapies. Within the next 12 to 16 months, India plans to rapidly expand the use of CAR T cell treatments, which are now licensed for B cell lymphomas. A more comprehensive picture is painted by ongoing clinical studies in Bangalore, Chennai, Kolkata, Mumbai, and Delhi. Given the size of India’s population, a cooperative strategy combining the public and commercial sectors of healthcare with charitable organizations would probably provide a variety of CAR T treatment choices. With expected CDSCO approvals, these medicines will be available nationally for complete treatment of a variety of blood malignancies, going beyond B cell lymphomas. Cutting-edge technology like liquid biopsies and AI-powered imaging have greatly improved early detection, increasing the precision of early cancer diagnosis. Advances in imaging technology have made it possible to implement more targeted and efficient treatment plans that maximize patient results while reducing treatment side effects. Additionally, we have international partnerships that, via promoting information sharing and technical developments, might act as a spark for the improvement of cancer research and treatment in India. Apollo’s affiliations, such as the Oncology Alliance and Apollo Practicum, demonstrate the importance of international collaboration by providing Indian practitioners with the opportunity to engage with specialists from other countries and apply cutting-edge therapies like Precision Oncology, Bone Marrow Transplants, and Proton Beam Therapy. By providing access to a range of medical experiences, technology advancements, and clinical trials, these collaborations successfully close the knowledge gap and strengthen India’s position as a leader in the fight against cancer. What is the AI-PoC (AI-Precision Oncology Center)? What potential impact may it have on India’s cancer situation? As part of the diagnostic and treatment planning process, the AI-Precision Oncology Centre (AI-PoC) at Apollo Cancer Centres offers tailored identification of suitable patients for targeted therapy and immunotherapy. The center is developed with the patient in mind. Accurate diagnosis, real-time insights, cancer risk assessment, treatment plan, and a continuity of care are guaranteed by the innovative center. The dynamics of cancer treatment in India are significantly shaped by these sophisticated skills. Apollo Cancer Centres bridges crucial policy and governance gaps in the Indian cancer scene by using AI technology to improve the precision and efficacy of cancer diagnosis and treatment. It provides specialist medical services that enable precise diagnosis, in-the-moment insights, and customized treatment plans, greatly enhancing the results of cancer care in India. The AI-PoC represents a major breakthrough in the field of cancer treatment in India by using AI technology to accurately diagnose cancer via its all-encompassing and specialized approach. It is committed to expanding the field of oncology in India by creating significant new prospects via its cutting-edge cancer treatment capabilities. Using AI to oncology helps identify new patient populations, which is in line with India’s goal of being a worldwide center for accessible oncology treatment. The AI-PoC seeks to close significant gaps in India’s cancer landscape by integrating AI into cancer research and treatment, resulting in better patient outcomes and overall advancements in the country’s cancer care system. What part does artificial intelligence play in the treatment of cancer? What more should be done to enhance the accessibility of these developments? In cancer treatment, artificial intelligence (AI) is essential because it improves early diagnosis by analyzing test data and medical histories of patients. AI systems, for instance, are capable of analyzing genetic data to find mutations linked to a higher risk of cancer. AI helps precision medicine by precisely identifying patients who may benefit from immunotherapy and targeted therapy, which enhances treatment results and minimizes needless side effects. In order to provide more precise and timely diagnoses, clinical decision support for cancer diagnosis and screening is one way that artificial intelligence is being used to cancer treatment. Meanwhile, AI improves patient participation, helps physicians make decisions, and maximizes treatment results to enhance healthcare. Based on worldwide data and experiences, AI-driven algorithms help with medication doses, surgical procedures, follow-ups, and patient reminders. In order to enhance the accessibility of these developments, healthcare practitioners must get training in AI technology and infrastructure. This would guarantee that AI solutions are widely adopted and used in various healthcare settings throughout India. Building trust and promoting broad deployment of AI in cancer treatment requires educating the public and healthcare professionals about the advantages and limitations of this technology. This will support the adoption of AI tools and technologies in the face of any opposition. In order to guarantee that the instruments and applications stay applicable, efficient, and flexible to the changing terrain of cancer treatment and research, ongoing research and development in AI technologies customized for cancer care is essential. What are the main obstacles that Indian cancer patients must overcome? Significant obstacles face India’s oncology research in the areas of cancer prevention, diagnosis, and therapy. The primary obstacle is the pervasive underinsurance, in which the majority of people have inadequate coverage for post-secondary illnesses. Furthermore, advancement is hampered by the lack of a clear national strategy for malignancies that may be prevented, such as HPV vaccination. Advances in oncology are further hindered by inadequate focus on clinical trials and a lack of a collaborative strategy between government and corporate organizations. This prevents the nation from achieving optimum cancer prevention, early detection, and effective therapies. Disparities in care and treatment results result from access to major cancer centers being hampered by infrastructural problems and the large rural population. The “Make in India” movement encourages domestic manufacturing, but it also has to be in line with expanding surgical and medical oncology seats, broadening program offerings, and building easily accessible community cancer centers. It is still difficult to address these issues in the absence of cancer becoming a reportable condition. Do you have anything further to add? The first AI-driven Precision cancer Centre (POC) in India was introduced in Bengaluru, and the AI-Precision Oncology Centre at Apollo Cancer Centres marks a substantial advancement in individualized cancer treatment. The center represents a significant breakthrough in tailored oncology treatment using artificial intelligence, guaranteeing a better future for cancer patients and the oncology care landscape in India as a whole. The AI-Precision Oncology Centre has made vital contributions to India’s efforts to become a worldwide medical powerhouse for reasonably priced cancer treatment. These contributions ensured new patient identification and enhanced care pathways in the battle against cancer. Apollo Hospitals’ dedication to using cutting-edge technologies to assist patients, medical professionals, and the community at large is shown by its investment in AI technology for precision oncology, which is a new direction in the battle against cancer.
According to Apollo Hospitals Enterprise Ltd. President of Group Oncology Dinesh Madhavan, advances in CAR-T cell treatment and nanotherapy show great promise.
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Which kinds of chronic illnesses are most common in India?
The most common chronic illnesses in India include diabetes, hypertension, angina, heart attacks, strokes, cancer, mental illnesses, and disorders of the kidneys, liver, and lungs. Non-communicable diseases (NCDs) are the term used for this. HIV and tuberculosis are two examples of communicable illnesses that are chronic. In India, chronic illnesses are the cause of two thirds of fatalities. Furthermore, diabetes and heart disease comprise more than half of India’s burden of chronic illness. The wealthy are no longer disproportionately affected by chronic illnesses. It is quite common in all socioeconomic groups, and when it strikes the impoverished, the results are disastrous because of limited access and crippling medical expenses.

What are the contributing causes to the rising prevalence of chronic illnesses in India?
There are several reasons for the rising burden of chronic illness. One of the main risk factors for chronic illness is smoking. Smoking has decreased with regard to cigarettes, although beedi smoking is still quite common. Furthermore, there are no regulations controlling the sale of cigarettes in India, so anybody, regardless of age, may get them with greater ease than they can life-saving medications! When an adolescent begins smoking, their life expectancy might be shortened by ten years, but their quality of life will also suffer. Cigarettes, pipes, cigars, beedies, and even vapes contain a variety of chemicals that may cause lung disorders including chronic obstructive pulmonary disease, lung cancer, and chronic bronchitis, as well as heart disease and stroke. A bronchitis episode that occurs often leads to a very low quality of life. It is not well known that this is a major contributing factor to impotence and infertility in men. Another risk that has surfaced as being comparable to smoking is air pollution. We now have strong evidence connecting hypertension, diabetes, coronary heart disease, and other chronic illnesses, and its prevalence has grown dramatically over the last several decades. The daily lifestyle we lead also contributes significantly to the increased risk of chronic illness.

Among them is a healthy diet. Every day, we are subjected to so many contradictory and confusing messages about nutrition and food that it seems like a crazy hatter party. The easiest is to eat a modest diet. This indicates that regardless of how much we love a certain dish, we should cut down on our intake of four white substances: sugar, flour, salt, and white rice, and stop eating when we are 80% satisfied. Furthermore, foods that are processed and deep-fried are high in trans fats and should be consumed in moderation. Chronic illness rates are also rising mostly due to feelings of sadness and inactivity. Ultimately, the growth in chronic illnesses may be attributed in large part to drug misuse and alcohol intake. Nonetheless, a lot of people think that hereditary risk, age, and gender play significant roles in chronic illness. Although this may be somewhat accurate, we don’t take action since they often result in fatalism. It is important to remember that genetic risk is like a loaded gun—it requires a trigger to fire. These are the lifestyle triggers. This proverb, found in several Indian languages, asserts that wisdom has the power to change one’s fate. Likewise, lifestyle may override genetics.

What are the obstacles that India faces when it comes to managing and treating chronic illnesses?
There are several difficulties in the diagnosis, treatment, and management of chronic illnesses in India. Some of the issues that are frequently encountered are a lack of knowledge about the causes and symptoms of disease, poor access to primary healthcare, the high cost of treatment, an inadequate patient-to-public healthcare facility ratio, a shortage of healthcare professionals, inadequate social support networks, and difficulties in making sure that patients follow their doctors’ instructions. In addition, a lot of individuals in rural regions are not used to the concept of early diagnosis, screening, and preventative health examinations for a number of reasons. Because of this, illnesses often go undiagnosed or untreated until it is too late.

India has made significant strides in the field of medicine recently. Do you believe that in order to meet changing health problems and enhance public health outcomes, advances in the management of chronic diseases are necessary?
Compared to other countries in the globe, India provides healthcare that meets international standards at a far lower cost. As shown by the COVID-19 immunization distribution process, our healthcare system is ready to grow and adapt to the demands of the moment. Consider the Ayushman Bharat Digital Mission (ABDHM) as one example of the many advancements in Indian healthcare that have occurred recently. With the ability to provide doctor consultations online and eliminate the inconvenience of lengthy wait times and travel distances to a clinic, telemedicine has the potential to completely transform the healthcare industry. For women, who sometimes find it difficult to prioritize their health due to their caregiving duties, this may be a blessing. A number of new ideas are being tested and launched for primary care, such as community clinics and health and wellness centers. Employees do the first examination and evaluation in many of these basic health care clinics, freeing up the doctor’s time for more specialized treatment needs. We now have skilled home health care providers for the elderly and sick. Numerous Indian applications are available that guarantee pharmaceutical delivery to homes.

Recently, drone deliveries of medical supplies and life-saving equipment have been tested. Apps that provide customized nutrition monitoring services and exercise regimens for both fit and unfit people have been created by Indian start-ups. India is now a manufacturer of wearables that use AI and Big Data to gather data, assess patient health, provide patient interaction features, and enable remote healthcare monitoring. The Internet of Medical Things (IoMT) enables connected devices and sensors to monitor patients with chronic diseases in real-time, remotely; biofortification of plants results in the production of staple crops rich in micronutrients that provide people with diabetes an option of diabetes-friendly food; these are all cutting edge technologies that are revolutionizing healthcare and improving health outcomes. Portable radiography devices diagnose and monitor patients with chronic diseases; bioimpedance devices measure body composition and fluid shifts and aid in early detection of heart failure. Nevertheless, given the scope of the issue, I think much more work has to be done promptly. More funding for healthcare and medical research, improved R&D facilities, more health centers, and more qualified personnel to care for very sick people are all necessary. Solutions that deal with the problems of awareness, cost, and access must also be taken into consideration.

A personalized healthcare system bases a patient’s course of treatment or recommendations on their own health profile. For instance, a patient’s inclination to a certain ailment may be disclosed by their family medical history. There’s a strong likelihood that diabetes or early-life heart attacks run in the family if one parent has either condition. With this information, the doctor may prescribe and suggest essential examinations beginning at age 35.
a heart-healthy way of living. With the use of smartphone applications, smart devices can simply track food intake, compute calories, measure physical activity, and take blood pressure in real-time. Users get timely warnings to help them be aware of any health problems. As individual reactions to medications differ, pharmacogenomics helps physicians prescribe the most effective medication and dose depending on a patient’s gene profile. This method guarantees a safer and more customized course of therapy.

What function has the Center for Chronic Disease Control (CCDC) performed in India in regard to chronic diseases? What are the main areas you are focusing on as the instances keep rising?
Leading the charge in initiatives to lessen the prevalence of chronic illnesses in low- and middle-income nations (LMICs) like India is the Center for Chronic Disease Control (CCDC). By constructing lengthy longitudinal investigations, we have carried out a number of research initiatives and studies to better understand the processes and causes of these chronic illnesses. These are now widely acknowledged instances of comprehending the intricate mechanics behind these illnesses. In order to tackle these illnesses, the CCDC has built a huge body of research to examine and discover low-cost solutions. These creative strategies include job shifting and coupling digital technologies, such as telemedicine solutions, decision support systems, and electronic health records. Our area of expertise is clinical research with an emphasis on long-term non-communicable diseases (NCDs), such as diabetes, cancer, cardiovascular disease, and mental health issues. In addition, CCDC is stepping up its initiatives in other intersecting fields including digital health, nutrition, reproductive, and environmental health. Our study has shed important light on the biomarkers, developmental causes, and epidemiology of diabetes and cardiovascular disease in India. We support creative, economical scientific solutions, such as combining contemporary medicine and ancient therapies like yoga.

Young people are experiencing heart attacks at a rising rate. What are the potential explanations, in your opinion?
The main causes of heart attacks in children include unhealthy lifestyle choices such poor eating habits, smoking, drinking alcohol and abusing other drugs, being sedentary, stress from low physical activity, and low physical exercise. Low levels of physical activity are the consequence of the replacement of active and contact sports by video and smartphone-based hobbies. Extended durations of sitting are a significant but underappreciated risk factor. On the other hand, intense physical activity in those who are not acclimated might cause a heart attack. Many people also believe that stress is the main factor that causes heart attacks. Although it is difficult to quantify stress, it is believed that emotional stress may lead to tiny wounds and inflammation in the blood vessels, which can eventually culminate in the buildup of plaque and cholesterol deposits in the arteries and cardiac arrest. Certain types of “stress,” however, play a significant role in raising the risk of a heart attack. These include clinical depression masquerading as stress, lack of control over one’s life (a secretary may have less control over their time than their bosses), and suppressed hostility—the feeling that you hate someone but are powerless to stop it. Regularly getting 7-9 hours of sleep each night is crucial for preventing heart attacks.

Prior to discussing management and therapy, it is important to raise public knowledge of the signs and symptoms of diabetes and cardiovascular disease. It is critical that vulnerable populations maintain continuous contact. We will be able to grasp the scope of the issue by conducting screenings at many touchpoints in both rural and urban India. After this is finished, in order to control the disease and stop additional deterioration, we will need to develop affordable, readily available therapies and technology. In particular, air pollution and climate change have garnered a lot of attention. While broad policy measures like phase-out of fossil fuels, regulation of polluting industries and construction activities, improvement of public transportation, and behavior modification to reduce stubble burning as an individual are necessary for mitigating these issues, we as individuals can still incorporate environmentally friendly activities into our daily lives.