The Hindustan Summit 2023 brought some interesting conversations into the national contention. One that caught our attention in particular was the dialogue with Harvard Professor Keith Flaherty and Indian entrepreneur Vivek Wadhwa specializing in advancing technologies including Ai and quantum computing. Their endeavour to bring advanced cancer care to India and from India to the world would disrupt the entire eco-system by placing emphasis on early detection, breathalyser tests instead of blood tests making it more affordable to check disease. We produce a few extracts from this conversation.
The Start of the Indian Odyssey
Vivek Wadha: I lost my wife to cancer. We tried every possible means to save her, and I realized how screwed up the American medical system is. I call it corrupt, incompetent, I mean everything bad you would ever say about a third world country. I decided that I’m going to do what I teach. I was teaching advancing technologies, everything from AI to quantum computing. So I said, let’s figure out how to cure cancer.
It occurred to me that the best place in the world to do something transformative is India. Why India? Because India has no legacy to protect. So, it took a lot, but I got a meeting with Prime Minister in 2019, and I spent nearly an hour with him. I was amazed at the discussion we had. At the end of it, he told his people, do whatever it takes to help Professor Wadhwa. Another long story, but eventually connected with Venkat Ramachandran, who was the head of TATA Trust and Dr. Moni Abraham Kuriakose is one of the greatest oncologists in the world, and they were looking to transform India’s cancer care system by setting up a distributed cancer network. So, we teamed up with the idea to transform not only India’s cancer care system, but to make an impact on the whole world.
Keith Flaherty: Well, it’s really all about connecting capacities and technologies that is what’s already happening and really at a faster pace than I thought imaginable. So, playing that forward over the next two, three years. I think what Vivek is alluding to is that we’re at a point right now where we have methods for interrogating biospecimens at the DNA RNA protein level that allow us to really see all of the complexity that cancer represents.
Vivek Wadhwa: So Karkinos Healthcare has built already the most advanced cancer care system in the world, the IT infrastructure that they have. When we told the White House about it, the cancer moonshot about it, they were blown away with the head of the US cancer moonshot Daniel Carnival said was, oh my God, we were talking about this happening in the next five to 10 years. This is what has already been built in India. They’re implementing it at a scale that is unprecedented in the world. So, what’s happening in India is amazing. Move forward five years, India will have the best cancer care system in the world thanks to the work that the folks at Karkinos is doing. What my colleagues at Karkinos realised is that we’re catching cancer too late.
All of you have relatives, friends who you lost to cancer. I’ll bet you there’s not one person in this audience who has not been impacted by cancer personally. In India it’s almost always at stage four when it’s too late. You’re desperately trying to get drugs which are not available. It’s a hopeless cause. So what Venkat and Moni started doing was they started doing early screening because if you can catch cancer at the earliest stage, you can treat it. You can now go back to natural remedies. In India, Ayurveda for example and holistic health are very strong. Well, if you know that you’re going to die, if you don’t change your lifestyle and habits, you’re going to change your lifestyle and habits. What do Indians do normally? They fill themselves up with chemicals and processed foods and smoke and God knows what else. You’re killing yourselves rather than going back to your roots and eating healthy food. So this is what becomes possible if you can diagnose at the earlier stages.
Now in reviewing the progress Karkinos has made, they had screened about 1.5 million people over an eight-month period. The trouble is that they’re just doing superficial screenings. The poor can’t afford blood tests, let alone genetic sequencing. You have very few people in India can afford that.
There was a technology that I had access to in Chile that I had invested in; this converts water into plasma, back into water, the company’s Plasma Waters, and they are about to launch the next Green Revolution in India. But a byproduct of that technology is the ability to ionise any fluid. So, what I realized is that we have a chance to disrupt the entire medical diagnostics industry because the way blood testing is done right now, you take a sample of blood, you put it into micro containers and you run immunoassays on it. So, you’re testing specifically for certain things. What if you could now convert organic matter into light spectra and then use the advances in AI to analyse that spectra? Well, you need a lot of data for that. You need data at a scale which is not available by any means in the West.
Well, guess what there is AIIMS and Tata Memorial. This is how many patients they’ll see in a month. So, India has all the data, it has the need, it has a scientist. So I decided, I’m moving to India because I can do things at a scale which is unimaginable in Silicon Valley.
Indian Sense of Humility, No other Trust like Tata Trust!
Keith Flaherty: I have learned that entrepreneurs, scientists and doctors in India through the lens of interacting with Karkinos and now through those interactions now interacting with more and more of each of those constituents beyond Karkinos, if you will, at the publicly funded health institutions and research institutions and the like. They have a really disorienting sense of humility, disorienting for a westerner because humility is not a thing that is a cultural norm. The point being that what was happening then was quietly, somewhat out of our view because we couldn’t come to India until the beginning of 2023 when Covid cleared enough, was that this team rising out of the Tata Trust, which I want to emphasize that there is no Tata Trust anywhere else in the world.
I mean, I just want to be very clear, having travelled the world, doing the work that I do, trying to advance science to medicine in oncology, there’s nothing like it. And that foundation and that culture and those people being the very ones who then were responsible for creating this now for-profit company, but one that behaves in a way that’s not at all like a for-profit company that I’ve ever interacted with. Basically, what they’ve enabled to do is put together infrastructure, five laboratories that are absolutely cutting edge molecular diagnostic laboratories. They’ve launched these population-based screening campaigns. The numbers are astonishing and exponentially rising. Of course, the Indian population is astonishingly large, though the numbers need to exponentially rise. And as I witnessed their ability to create this capacity, bring together the technology in these laboratories to bring technology and here, I mean not biomedical research technology, but what India is so wealthy in which is tech knowledge, knowhow and tools.
And to bring that for the purpose of screening rural populations who’ve never been approached ever before for cancer screening. We saw this witnessed for the first time in January in a three city, three state week-long tour ending here in Delhi. And it just became clear to me that we’re in the West, and again, US, Europe put it all together. We face headwind. We are up against impediment after impediment in terms of doing these things that are obvious that need to be done where you need numbers to be able to actually really unpack the complexity of cancer biology, develop new diagnostic tools for early detection. And here there’s tailwind. I mean there’s just something fundamentally culturally different. And the alignment from government to publicly funded research institutions to physicians, to companies, it’s astonishing.
Vivek Wadhwa: I want to add one more thing about Indian culture and values. Venkat and Moni, I just mentioned them, they’re donating the majority of their stock to a trust for cancer patients. They’re taking nothing about it. The humility. The White House, when Modi came to the US a few months ago, they announced that the US and India are going to be working together on cancer. And Karkinos was actually mentioned in the White House press announcement, Venkat and Moni won’t even talk about it. Humility. I said, Venkat, what’s wrong with you? He says, no, our actions have to speak for themselves. I said, Venkat you need to promote what you’re doing because otherwise no one’s going to know who you are or what you are. I mean the value system that you have here of people who are doing good for the world, you don’t see anywhere else in the world. The fact is that this is the beauty of Indian culture and values. It’s all about giving back.
PM Modi and his Magic Wand!
Vivek Wadhwa: So when I met Prime Minister Modi in 2019, I walked him through what was happening. I was amazed. I was told, here’s what you can do with the PM. Don’t talk too fast. Don’t say this. Don’t say that. Modi and I were like friends talking to each other by the time we were done and his people were panicked. That the way I was talking to Modi, I was talking, literally talking to him as a friend. And then I came back and I said, dear prime minister, I want to thank you for what you enabled. I said, it’s only because of you that I put the grand plan together. It’s only because of you that I got this advisory group together. It’s only because of you that we are helping Karakinos and you have made all of this possible. He was just amazing.
Keith Flaherty: I mean, it was astonishing. We don’t have public figures like that in the United States, so it was hard to be prepared for that meeting. We’d been told, if you’re lucky, 15 minutes, the Prime Minister is a busy man. We had 50 minutes, where he was directing the conversation, probing the areas, and really looking around the corner, if you will, where this is all headed. Now, basically we have the opportunity to actually have India be the hub, and ultimately coming from Boston and Cambridge, Massachusetts, which are right immediately next to each other, which is the world’s biomedical research capital. There’s nothing even close to it. The next biotech hub, at least for cancer research, is going to be here. PM Modi saw it as clearly as we did and that type of vision and the conversations that we had the day before with the heads of each relevant ministry across.
Accessibility to the global south?
Vivek Wadhwa: Well, you talking about bionics. I mean, my ambition is to be able to detect every disease. Just like when genetic sequencing first happened with DNA was sequenced. We turned biology into letters. I’m turning biology into light, and the magic happens here. When you train your AI. India we have all the data we need.
Literally, my goal is a hundred rupees to do a test and not only a blood test. I’m going to start with breath test because like TB and others, there are a lot of diseases you can detect in the breath itself. Certain cancers you can detect in the breath.
Some cancers may not show up in the breath for that. You may have to do blood tests.
But my goal is to detect every disease because it’s become an AI problem. Actually, that’s the magic of AI. And I also learned Hardik Shah told me yesterday that the Prime Minister is planning to spend $800 million, nearly a billion dollars on setting up an AI infrastructure in India. So, if India does that, it has the data, it has the people. India could become, well, not only lead the world in curing cancer, it could become the world’s AI hub in the next three or four years. If everything goes the way expected, it’s going to be. Because solving the grand challenges of humanity now is a data problem. And AI enables you to understand data and if you have the skills and everything necessary, magic can happen. So, this is India’s opportunity.
Breathalyzer for cancer?
Keith Flaherty: So basically the method that Vivek is describing is distinct from our other ways of trying to analyse biological specimens in that we go hunting for specific types of analytes, if you will. So, the early detection methods that have been really, I would say exploding in terms of the evidence that they can find cancers that we could never find early before, but not as reliably as we’d like these tests to work. They try to pick up. So-called circulating tumour, DNA. So, from a relatively early point in cancer formation, DNA is shed from tumour cells. DNA is also shed from other non-tumour cells of course. And those are rare events, if you will, in a small early cancer. And if you put your blinders on and you’re only looking for that type of analyte, you’re giving up a lot of the potential detection power. This method is essentially agnostic to what the analyte is. So regardless of the nature of a complex macromolecule or a specific small molecule or even a simple analyte like sodium, this method basically can detect all of those species in a way that current methods that manipulate a specimen before analyzing spectra don’t allow. So basically, this sort of unmanipulated approach allows you to basically take a specimen, vary the temperature, vary the pressure, and vary the power supply.
Across those three dimensions, basically understand through the photo spectra, the surface features of all of these molecules again in three dimensions. So, there’s a depth that this method can probe that no other method that we have currently can.
Cancer is complex. I mean it’s an inflammatory disease. It’s a disease where there’s a lot of communication going on between the tumour cells and non-tumor cells in the body. That leaks out, if you will, into the bloodstream why we think the blood is such ultimately an important compartment to be able to characterize. And again, this method can potentially wrestle down that complexity. So, we’re all very excited. But these approaches, including the blood-based early detection methods I mentioned in the West, they are going to take a decade to advance in the West based on our inability to pull together diagnostic technology screening, broad-based population screening, patient’s data and their outcomes. These things can’t come together. And when we talk to the companies that are developing these blood-based methods that I referred to about this enterprise since this visit in January, their jaws drop and every one of them is lining up to basically partner with this platform that is itself a company.
Seeking Partnerships to Make it Work!
Vivek Wadhwa: My goal is within a year to prove the technology and I’m going to have several devices available to different universities. This is why I met the AIIMS researchers, brilliant faculty. I’m going to make it available to them, let them do the discoveries. I think within a year I’ll be able to prove the technology. It’s going to happen from India, made in India, research in India, papers published in India. That’s what my goal is.
Keith Flaherty: India can drive a diagnostic revolution on its own effectively based on all, everything we’ve talked about so far. Where we need partnership is in the therapeutics. Access to therapeutics in India is a major problem. Very impactful cancer therapies that when applied, particularly early here, I mean specifically drugs, they are out of the reach of the vast, vast majority of Indians. And that’s unacceptable. To make this whole research engine that we’ve talked about work in the population of patients once they’re diagnosed with cancer, we need access to therapies and for that we need partnership. And so, I’m campaigning, I am petitioning, imploring my colleagues in pharma and biotech to rise to this opportunity. And again, I need all the help I can get.
Vision for the future?
Vivek Wadhwa: I want to cure every disease. I want to first of all, prevent it from happening, catch it early because yes, therapeutics, but I also believe in Ayurveda. I believe there’s a health wealth of knowledge here, which by which we can start treating ourselves in holistic ways. So, I’m a big fan of holistic. So yes, I’m working with the scientists and I believe in western medicine, but I also believe in Indian/eastern medicine. So, I want to see us living healthier lifestyles, being able to diagnose disease and then to cure all disease. This is what I want to see happen in the next decade. That’s my vision for medicine.
Keith Flaherty: This hyper collaborative model that we’ve tried to describe it is going to set the example for the world, the model that’s being created here, and literally the digital platforms that tie it all together. They are going to be portable to even more challenging environments to navigate Africa. They’re also going to be ported to the United States and Europe. This concept, this hyper collaborative concept, it could not have been started in the United States, but it can certainly be borrowed by the United States. So, I am here to try to do the work that I’ve been trying to do in the United States because it’s going to happen here first, and that’s going to have global benefit, as I say, sort of upstream and downstream, if you will. India, of course, itself has everything, which is to say everything from poverty to wealth, has every dimension, if you will, all packed into one very large populated country. So, I really think this sort of what we’re describing is an end to end solution that is going to have global relevance.
ABOUT
Dr. Keith Flaherty is Director of Clinical Research at the Massachusetts General Hospital Cancer Center, and Professor of Medicine at Harvard Medical School.
Vivek Wadhwa is a Distinguished Fellow at Harvard Law School’s Labor and Work life Program. In 2018, he was a recipient of Silicon Valley Forum’s Visionary Award for his contributions to Silicon Valley’s technology ecosystem.
