Why Clinical Research in India Outpaces U.S.

For one year from 2007-2008, Amar traveled around the world reporting on how people from all walks of life view the United States through text and video.  The following is one of a number of posts from India. For more, click here.

Gurgaon - “Opportunities to develop cutting edge [medical practices] are fast disappearing in…the United States,” says Dr. Kushagra Katariya, who was born in New Delhi, specialized in New York, and recently returned to India. He says that when it comes to developing a new, improved way to treat patients, he can do it “quicker, develop it better, and have the ingredients to really take it much further" than he could in the same amount of time in the U.S.

His decision to first go to the U.S. for advanced medical study was an easy one: “It was obvious that education of all forms was...the best there [in America]. If you had to be the best at what you did,” you “had to go” to America.

He spent almost two decades in the U.S., first in New York training to be a cardiothoracic surgeon and then as an associate professor at the University of Miami. While abroad, he dreamed up the Artemis Medical Institute and developed the contacts he needed to make it real. Here in Gurgaon, ten days from now, the clinic will move from soft-launch into full-scale operations.

Katariya tells me he held on to a “passion for coming back to India…I do belong here.” But when he did finally return, his reasons were far more than emotional. Here, he can combine his clinical practice with scientific research and technological development, all at a breakneck pace.

"Clinical research and translational research is down 70% in the U.S.," he tells me, laying out two primary explanations:

First, he blames “the lobbies, restrictions, confidentiality problems, insurance companies regulating what needs to be done, what can be done, what cannot be done…the usual ambulance chasing that occurs." In the U.S. there’s too much red tape.

Second, there’s an “inhibition of intellect coming together.” Because “provisions for funding are few and far between," there is a huge amount of “talent divided among 200 universities" that don't always collaborate.

This, in addition to "super-specialization," creates a "silo-mentality" between and within leading institutions. “Clinical applicators at the bedside” and the “researchers in the lab” are like “two parallel railway tracks that never meet” even though they’re working toward the same goal, improved patient care. In India, he says, ideas are fresh and different sectors are more amenable to being brought together to “beat the disease.”

Another draw for Katariya is that he’ll be providing medical care at a fifth the cost of parallel U.S. treatments. 400,000 Americans get coronary bypass surgery each year paying at least "$30,000 dollars each, with their hospitals paying more." At Artemis, the surgery costs $5,000.

So could there be some international health tourism? I ask. Certainly says Katariya, especially from some Scandinavian countries where the wait for care can be excessively long. There’s also talk of promoting international health tourism by working out deals with insurance companies that would offer lower premiums to those clients willing to travel to obtain the best medical care in the world, says Katariya.

Using the hottest new technology, Artemis' 3D MRI.

The equipment is in place. Our interview occurs in an operating room without corners made of “modular stainless steal," with every device hanging off the ceilings so the floor can be easily swept clean through “hermetically sealed doors.”

However, over lunch with staff doctors, I’m told just how underpaid physicians in India are, with an average salary of around 13,000 rupees a month, or about US$300. Many migrate to Gulf states, England, Australia and America and not all return. Yet India is large, the middle class growing, and so the medical academies here are still fiercely competitive, attracting very bright minds. Artemis feels confident it will have the talent to match its technology for years to come. It can also afford to pay its doctors more than the local average, though MBA’s still make much more even though they study for two years instead of twelve.

But does Katariya stress keeping doctors in India? “No,” he says, “We want people to get experiences everywhere else that the world has to offer, but at the end of the day…we want to bring it back to India....because the local talent, the local ingredients exist to be able to create that stuff [new treatment methods] over here much faster than at a Hopkins, or Cleveland Clinic, or a Stanford or the big names you hear about in the U.S.”

Keep your eye on Gurgaon, the booming suburb of New Delhi with malls everywhere. This is where Artemis is. From afar the hospital looks like a mirage: situated down a long dirt road ridden with potholes. Encircling Artemis is an arid expanse of jagged rocks, untidy construction sites and rubble. It's from here that Artemis hopes to rise, and out-pace America’s medical giants.