Can you tell us more about the first product you build and how did you come up with its idea?

We used to go to rural camps while I was at St. John’s Medical College at the ENTdepartment doing my postgraduate training. We would take a mirror and put around a headlight to see patients voice box while looking at its reflection in the mirror. It is an age-old technique for diagnosis and inexperienced doctors, like I was at that time, would struggle to see the vocal cord. I felt a need for more magnified images to be able to pick early cancer lesions. At St. John’s Medical College, we had a very nice endoscopy system that produced magnified images. For me, the question was why can’t we have a camera-based system in the rural area and not rely so much on these mirrors that fog up, are very small and difficult to use. That is what first spurned the idea of having a low cost camera and creating a mechanical coupler which can attach to any endoscope. I bought an off the shelf camera for about Rs. 10000 and got a mechanical engineer to make a small attachment device for the camera that could hold any endoscope. 

What was the cost difference between the clinically available system in the market and the device that you had built?

The entire endoscopy system at the hospital cost about Rs. 2 lakhs, then. With the same quality of image, the manufacturing cost of my device with the camera and the coupler was below Rs. 15000.

What was your experience in taking this product to the market?

There was a lot of struggle in the beginning, especially since I was a part time doctor. You can come up with an idea and can make a proof of concept, but you don’t really have the background and expertise to raise or spend the kind of money which is needed to take the product to the market. I could not take my initial company called Yukti Medical Innovations beyond a point. So, we hired a design firm and an electronics engineering team and spent one year trying to raise money, which did not work out too. Then, using our own savings, we made a refined prototype of my device that could be used on patients and licensed out the product to the design firm itself. After Yukti, I got selected for a fellowship program called Stanford India BioDesign (SIB) where I learned how to invent and understand the market well. My mistake was that the prototype was built from a doctor’s point of view whereas I needed to design it for rural usage where there are no ENT doctors.The device got redesigned one more time to meet the needs of health workers in the rural market.This time in collaboration with a design firm called Icarus. Eventually, a larger company called Medtronic bought the license. Marketing it as ENTraview, they have screened over 300,000 patients for ear infections till now. 

As a SIB fellow, what did you learn about the process of innovation?

I learnt to have realistic expectations in any scenario. Normally when you are inventing, you don’t know what to expect. You are just taking one step after the other and you deal with situations on a case to case basis. At SIB I learnt to see the entire roadmap in advance – to have a sense of the kind of resources you will need, the time, money and the commitment it would take to make a product into reality. The second thing SIB taught me was the importance of working in teams. That was my million dollar lesson from the program. I understood I cannot be a designer, an engineer, a business person and a lawyer, all at the same time. As a doctor, I initially thought I could be (everything). Once I understood the amount of effort required to take the product to an industrial level, in terms of design, quality &standard, manufacturing, human factor, safety analysis and regulatory requirements, I realised I am better off sticking to the doctor domain. I learnt to work with teams that are cross-disciplinary, rather than trying to own that entire knowledge and do it myself. Now, I limit myself to giving clinical inputs and validation. This has also helped me work with multiple teams and develop multiple products. 

You belong to a small tribe of medical practitioners who’ve transitioned from being a doctor to an innovator. Tell us about the challenges you faced in this transition.

One was communicating with members in a cross-disciplinary team. Though I understood the clinical part well, articulating and explaining it to non-clinical team members like engineers and design team wasn’t easy. I would only come to know about the problems once the product was ready and realise belatedly that the engineers didn’t get the full requirements right, like in terms of dimensions etc. The second thing was to raise money. There are a lot of things that are considered by the investors and governments when you want to raise money for product development. So, even though money is available, the process is not easy if you don’t know how to go about it. This takes a bit of hit and trial which is very time-consuming. The third challenge was multitasking between spending clinical duties as well as trying to invent at the same time. It takes time to understand the right balance. 

You’ve been involved with 18 innovations, so far. Which of them is closest to your heart?

Yes, I have been involved with 18 innovations, but 7 have also failed or got stalled for various reasons. They taught me that I need to stick to my clinical domain. The current product, Sinucare, officially launched into the market in October 2016 is closest to my heart. It is a device that treats sinus without any tissue removal in a safe manner through the use of an inflatable balloon that clears up the sinuses. As a surgeon, it allows me to deliver a safer and faster method of recovery while being protective of the patient’s environment, all at a low cost. This is the kind of portfolio of products I want to develop. 

As a doctor, why do you think there is a dearth of low-cost innovations in India? Why are people in the rural areas still using age-old methods?

The primary person to treat patients is a doctor. So, an integral involvement of doctors is absolutely necessary to create new technology that aids in treatment. In real life, however, this doesn’t happen for reasons like our education as a doctor, the kind of burdens that we face and lack of formal ways for us to contribute to new technology that can improve treatment. Most doctors do not even know how to formally engage in being an inventor and there is the added stigma of losing credibility if they spend time inventing devices. The understanding that a doctor can treat patients by not just physically examining them, but also by working on a technology that will eventually reach the patients, is still lacking in India. At present, inventions mainly come from engineers who look at things from an outsider’s perspective and don’t truly understand the ground realities. As a result, there is a gap between products and requirements. Once you bridge that gap, like in the west, you will have more inventions coming out from India.

How is InnAccel-the MedTech innovation platform that you started, aiding in bridging this gap?

Our whole philosophy is to bridge this gap. Whenever we work on any product, there is a doctor, an engineer and a designer working together as a team and none of the doctors leave their practice. There is still a way to do work together in an integral way without losing clinical practice and we have figured out a way to do that. Our main message is that you don’t have to be just an inventor or a doctor; you can be both provided you know how to balance them together.

What does the mentor in you wish to say to the budding med-tech innovators?

My main advice is that doctors and engineers need to spend more time on the ground together to understand requirements of clinical space.The team is most important and doctor-engineer engagements have to be lot more concrete.