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Panel

Advancing the Frontier: Innovations in Health

Milken InstituteJeremy Lim, Goh Boon Cher, Russell Gruen, Kabir Narang, Prashant Tandon
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Panel Composition and Introductions

  • Jeremy Lim (Moderator): Partner at Oliver Wyman's healthcare practice in Singapore.
    • Acknowledged the panel's gender imbalance (five men) and encouraged female audience participation.
  • Boon Chia Goh: Professor and medical oncologist at the National University of Singapore.
    • Directs the investigational medicine unit and leads clinical trial teams developing oncology drugs.
  • Russell Gruen: Professor of Surgery at Lee Kong Chian School of Medicine and Executive Director of NTU's Institute for Health Technologies.
    • Focuses on trauma surgery, global surgical access, and integrating engineering with clinical care.
  • Kabir Narang: Partner at B Capital, Singapore.
    • 15 years in consulting (BCG, Warburg Pincus, Fidelity) focusing on Series B/C investments in healthcare, finance, consumer, and transportation.
  • Prashant Tandon: Founder of 1MG, India's largest digital health app.
    • Platform boasts 25 million monthly visits for e-pharmacy, e-diagnostics, and telemedicine; previously founded HealthCart and worked at McKinsey.

The Core Challenge: Cost, Quality, and Access in Asia

  • Surgical Access Crisis:
    • An estimated 5 billion people (two-thirds of the global population) lack access to safe surgery and anesthesia.
    • Road traffic fatalities cause more global deaths than malaria, HIV, and tuberculosis combined.
    • Infrastructure Deficit: Facilities often lack basic safety; e.g., 350 frontline hospitals in Myanmar are in similar dilapidated conditions with mold and exposed wiring.
    • Solution Proposal: Russell Gruen advocates for "plug-and-play" prefabricated operating theatres that can be deployed globally in one week at a fraction of the cost of rebuilding.
  • Cancer Care Affordability:
    • Asia lacks the insurance models prevalent in the West, forcing 60-90% of patients to pay out-of-pocket.
    • Cost Escalation: Average monthly cancer drug costs rose from ~$3,325 in 2001 to ~$13,250 in 2014, outpacing salary growth.
    • Pricing Barriers: Therapies priced at $475,000 (e.g., Novartis) are unattainable for the growing middle class in Asia.
    • Proposed Mitigation: Boon Chia Goh's team is investigating drug metabolism inhibitors to reduce required dosages and lower monthly costs from ~$10,000 to ~$3,000.

The Role of Technology and Innovation

  • Efficiency Over Infrastructure: Kabir Narang argues that adding physical resources (doctors, beds) is insufficient due to existing deficits; technology is the only lever for systemic efficiency.
    • Triage: Investments like "Bright MD" help manage 250 million annual US primary care visits by triaging urgency, reducing unnecessary specialist visits.
  • Digital Leapfrogging:
    • Prashant Tandon posits that Asia will "leapfrog" legacy systems via digital highways, noting that 40% of Filipinos may never see a doctor physically.
    • AI Applications:
      • Retinal Imaging: Google's AI matches ophthalmologists in detecting diabetic eye disease, allowing non-experts to screen 80% of normal cases instantly, boosting productivity fivefold.
      • Radiology: AI is expected to handle 80-90% of triaging, allowing doctors to focus on the remaining 10% of complex cases.
  • Behavioral Tech:
    • Insurers like AIA use data and micropayments (e.g., step-count incentives) to drive preventative behavior.
    • Incentive models where patients pay for weight loss programs but get refunds upon success are being explored to align financial interests.

Regulatory and Market Dynamics

  • Regulatory Friction:
    • Healthcare regulation prioritizes "perfection," often stalling "good enough" innovations needed for mass access.
    • Shift: Regulators in India are becoming proactive due to a "point of desperation," recognizing legacy models are failing.
    • Government Role: Governments must establish interoperability protocols, data privacy frameworks, and "sandbox" environments to accelerate innovation approval.
  • The "Doctor Cartel" and Transparency:
    • Prashant Tandon reports that a transparency app in India revealing price variances for generic drugs triggered a shift.
    • Outcome: Over 40% of patients asked doctors to switch to cheaper brands; the majority of doctors agreed, demonstrating that consumer awareness can break traditional pricing moats.
  • Investment Barriers:
    • Kabir Narang notes that "low-cost hospitals" in rural areas fail due to a lack of willing medical professionals, not just capital.
    • Doctors prefer urban recognition over rural deployment, necessitating technology-enabled telemedicine to bridge the gap.

Future Trends and Specific Technologies

  • Genomics and Cancer Prevention:
    • Only 5-10% of cancers are linked to known germline genetic mutations; the remaining 90% are largely attributed to "bad luck" (random mutations).
    • Strategy: Focus shifts from germline screening to early detection to prevent genomic instability during treatment.
  • Surgical Robotics:
    • Russell Gruen states robots are currently unsuitable for complex surgery due to the need for nuanced, individualized decision-making.
    • Timeline: Fully autonomous robots are 10+ years away; remote surgery (human-in-the-loop) is a more immediate, realistic application.
    • Ecosystem: Drones for blood delivery (e.g., Rwanda) show success, but the surgical environment itself remains a high barrier.
  • Prevention vs. Treatment:
    • The panel consensus rejects an either/or choice between education/prevention and high-cost specialty care; a mix is required.
    • Education Gap: Primary prevention (e.g., diet, smoking) faces cultural and political hurdles similar to historical tobacco issues, requiring significant public will.
  • Demographics:
    • Asia has a unique dual challenge: a young population requiring education and a rapidly aging demographic requiring chronic disease management.

Audience Questions and Insights

  • Primary Prevention:
    • Victoria, Australia, reduced road fatalities from 1,034 (1969) to 250 (present) through systematic legislation and trauma care integration, proving prevention works best when paired with care infrastructure.
  • Cost Reduction:
    • Pharma companies are exploring business models where adherence to treatment (e.g., diabetes management) extends the asset's lifecycle, monetizing long-term health rather than transactional drug sales.
  • Data and Interoperability:
    • India's lack of legacy infrastructure is an advantage for building unified digital health platforms, whereas the US faces siloed data challenges.