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Pathology has the power to be able to strengthen the core elements of global health

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As the field of pathology in India continues to evolve and bring answers to some complex medical conditions, there are certain issues that need to be resolved in order to propel growth. Dr Sushil Shah, Founder and Chairman of Metropolis Healthcare shares insights on the same in an interaction with Raelene Kambli

What according to you are the most fascinating aspects of pathology that you see today? And how would you describe its relevance in the coming years?

Pathology has greatly evolved over the past few decades. What has remained unchanged though is the dependence on pathology reports to make an accurate medical decision. This means greater accountability on pathology labs to deliver the utmost quality and care in performing a test as well as a report that practitioners can rely on.

A report recently by a journal suggested that medical information is set to boom in the coming years; at the current rate medical information is expected to double every two months. Newer and sophisticated diagnostic tools, molecular and genetic tests are leading to newer discoveries on diseases, more than ever before. It is therefore important that pathologists remain updated on newer evidence-based knowledge that they will have to process and apply while making diagnosis each day. In coming years, all this knowledge will have to be put together with the help of technology which will save time, costs and get even complex diagnoses right at a singular attempt.

There will be a greater deal of communication between pathologists/labs and the patient care teams in the future. Artificial Intelligence is something that everyone is talking about in healthcare, but it will always play an assistive role and help companies perform better and faster.

What is the biggest issue about pathology in India that you think needs to be addressed?

Pathology in India as all of us know is fragmented. Today, not everyone has access to accurate pathology services as public at large are not aware of good laboratory practices. There is no regulation that is governing this industry. Accreditations are voluntary. It is therefore important to enforce good laboratory practices so that medical decisions are accurate and treatment outcomes are better for patients .
Setting up a diagnostic centre in India is as simple as investing capital and obtaining a ‘Shops and Establishments’ license. No relevant qualification or certification required. There is no official checklist of basic requisites to set up a laboratory and standardisation to be followed. A change in the regulatory scenario can transform the landscape of the pathology industry. These improvements ought to begin with the emergence of a set of practice standards along with making accreditations by NABL (National Accreditation Board for Laboratory) mandatory for any operator in the industry. This will ensure labs maintain basic protocol, at the very least.

With the EDL coming into play what kind of changes do you foresee?

India has become the first country in the world to compile an Essential Diagnostic List that will help the government to facilitate diagnostic needs in the remotest part of the country. A lot of inputs has come from the first edition of essential diagnostics list released by WHO last year. However the list released by ICMR is customised to the needs of the country and its population. With Essential Diagnostics List coming into play, it is set to be beneficial to large established players like Metropolis as we have the strength to deliver in any corner of the country. With effective public private partnerships and with government taking the role of a facilitator, it is possible for the highest healthcare quality services to be delivered to every single citizen of this country.

What is the best model for the provision of molecular pathology in the future in India?

Modern medicine is dictated by developments in molecular medicine and technical advances. Molecular pathology aims to achieve the integration of a research and diagnostic activities. Academic molecular pathology, at the interface between diagnostics and research, drives such integration. The future of molecular pathology in India is already here. Add digital pathology into the mix and we are not only personalising medicine but also taking everything global. Tissue diagnostics, sub-speciality onco-pathology and digital pathology has already been adopted at Metropolis; all three are the central areas of molecular pathology and is driving the transformative phase. We are proud to have been the first movers in this phase; adopting to change and bringing about the best that technology has to offer. In my view, molecular tissue pathology will be the future and a lot of academics and training will go behind before this becomes the norm like how molecular haematology is a norm today.

Do you think ‘global health’ is something that pathology as a field needs to prioritise? And how does this help to unlock diagnosis for complex medical conditions?

Pathology has the power to be able to strengthen the core elements of global health and hence efforts on a global level should be made to ensure sustainability. Every country has their own set of unique health issues, requirements and access to healthcare. At present, the technologies and solutions we utilise are adopted. But in order to be able to secure the lives of people in developing countries, we need to be able to create technology at our end for which pathology has a critical role to play.

What changes would you like to see in funding for diagnostics and life science research in India?

In India, medical research receives proportionately much less funding compared to other fields of science. What we need to understand is that medical research leads to much advanced solutions to healthcare issues and no nation can advance without sufficient investment in science and technology. If we want to retain truly outstanding talent in India, we need to be able to provide them the environment where there is enough value for scientific talent. In medical research, our academic structures are set up almost to dis-incentivise research, with much stronger focus on clinical service and teaching than on research, even in our premier institutes. It is important for us to realise that the developments in the field of research and technology is huge and without proper investment, our country might remain way behind developed nations. We should realise that research is not solitarily for academic promotion but also for a wholesome development. A good quality research will always make way to ideas, innovations and progress.

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