KK's Blogs | Kapil Khandelwal KK

What’s Next? Operation Himalaya?

Operations Himalaya

Preamble

Operation Ganga was an evacuation operation by the Government of India to evacuate the Indian citizens amidst the 2022 Russian invasion of Ukraine, who had crossed over to neighboring countries. This involved transport assistance from the neighboring countries of Romania, Hungary, Poland, Moldova, Slovakia to reach India. Over 20,000 medical students were evacuated in Operation Ganga. I have been writing and talking about it over the last 10 years. Let me outline the magnitude of the situation at hand. India constitutes ~18% of world’s population. From here things become a bit trickier. We have world’s 21% disease burden. ie. One-sixth higher proportion of people falling sick. On the clinical manpower shortages, we just have around 8% of the total global labour force of doctors, nurses and healthcare workers to address the 20% of the global disease burden we carry with our people. We are short by 5 lakh doctors, 20 lakh nurses and 30 lakh short of other health workers. Fortunately, we are a net exporter of nurses to the world so we have to also back fill the gaps of nurses leaving out of India for those remaining in India. Coming to the capital to address these gaps, we require close to Rs 30 lakh crores or $430 billion to come to the global average of hospital beds. Another Rs 2 lakh crores or $29 billion is required to build capacity for healthcare manpower. Therefore the total investment is approx $460 billion. To give you the magnitude, 165 countries in the world had a GDP of less than $460 billion in 2018. Given the shortage of merit quota seats in Indian medical colleges, students have to migrate abroad for pursuing their medical education. We need an upstream Operations Himalaya in earnest.

Vision for Operations Himalaya

There is a saying “9 men cannot make a baby in 1 month”. Similarly, students enrolled into medicine today will add incrementally to the workforce in next 4 years. The silver lining is that this capacity building spend would lead to $1.45 trillion of additional incremental to the GDP after 5 years as 1 incremental bed capacity creates 28 jobs over its lifetime. In other words healthcare economy in India as a standalone would itself be #16 nation in terms of GDP. The table outlines the future of Medical Education.

What is the Future of Medical Education?
As per the Milbanks Report on the Future of Academic Medicine 2025, there are 3 key trends that are impacting medical education

Digitalization of Healthcare
new science and technology, particularly genetics and IT
speed of internet and digitalization
unimportance of distances
24/7 society
lack of agreement on where healthcare begins and ends

Personalization of Healthcare
rich and poor gap
seeking “wellness” and rise of self-care & sophistication
increasing anxiety about security and ethical issues
emergent diseases

Globalization of Healthcare
gap between what can be done and what can be afforded
increasing accountability of all institutions
loss of respect for experts (more so after the pandemic)
economic and political rise of India and China

Future of Medical Education

There needs to be a top-down vision for expanding the supply of clinical manpower in India which needs to be tied to the healthcare outcomes our healthcare system needs to achieve. The following framework which I presented earlier outlines the process for setting up the vision.

Our Health Markers – Linking Medical Education and Health

In the past I have defined these as the 3 A’s.

Affordability: The Cost and Benefits of Developing Careers in Healthcare in India
Accessibility: Providing trained staff in different parts of India
Assurance: Training to medical professionals meets global standards to perform in any healthcare system

Key Issues: Healthcare Manpower Economics:

It costs approximately Rs 2 crores per seat to set up a medical college for 100 seats in India. While this may be economical, investments in medical colleges and doctor training is a lengthy process; therefore, changes implemented to alter supply do not have immediate effects on the supply of trained healthcare professionals. A recent estimate reveals that as many as 40% of rural posting by trained medical graduates and post graduates in different states in India are not fulfilled. There is a huge shortage of gynaecologists, cardiologists and child specialists in rural hospitals in the government sectors. Hence the government announcement to increase the supply of medical graduates may still not address the accessibility issue. We may end up importing clinical manpower from lower cost destinations if we are not able to produce these cost effectively in India.

Medical education is supposed to be overseen by the different Councils of India, which is responsible for ensuring the quality of both the infrastructure and the professors at India’s medical institutes and also provide assurance that they meet the global standards. Since demand is high, it is difficult for schools to retain faculty over the long term, which creates a lack of continuity in both the school’s practices and its policy. The plethora of new and underequipped medical schools will create more doctors and healthcare professionals on paper, but will lower the quality of the doctors produced, further exacerbating the preexisting shortage. So, while attempting to alleviate a shortage of doctors, India has managed to create a completely new crisis on top of the preexisting one – the shortage of teaching professionals in these medical collages. Various estimates put this somewhere between 75,000 to 100,000 trained teachers and professions currently.

Finally,

Mere policy announcement for opening up more medical colleges in India is not the panacea for solving the shortages in the supply of healthcare professionals and the people to train healthcare professionals. It is time we look at the issues holistically and plan for the future by going upstream towards the Himalaya from the current emergency evacuation of Operation Ganga!

https://open.spotify.com/episode/5SwlhKl1MYBEMM95usMh2U?si=e51b6fa5d2974e6d

Also Listen Podcast on Russia-Ukraine Conflict

Also Read Article published in my Column – A Dose of IT published in Deccan Chronicle and Asian Age – 14 February 2011

Rs 1 Crore crores Human Capital Impact – A Generation Lost

My presentation at the 21^st World Quality Congress a fortnight ago just highlighted the human capital impact due to healthcare and education in India. A whopping Rs 92,28,230 crores to the Indian economy at net present value! This is like creating over 1500 TCS or Infosys or Wipro in today’s size overnight in our economy.

Let us understand, although India has 18% of world’s student population that is the largest in the world, its policy and direction on higher education, including medical and health sciences sector is not clearly articulated towards inclusive development. Regulation, size of funding to this sector, both public and private is one of the key determinants of India’s ability to generate wealth (GDP). Moreover sectorial priorities and directions in sectors such as health sciences, infrastructure if not clearly addressed could create future crisis in the economy and further impede economic growth.

On the demand side, we already know that India contributes to 18% of world’s population, however its share of world’s disease burden is 20%. Hence to treat the increased disease burden, India requires incremental human capital of doctors, nurses and other health workers. But the issues get very grave for India. We have around 8% of world’s doctors, nurses and health workers. Hence we may have to create more human capital in healthcare to treat India’s disease burden. What’s more, of the Rs 490,000 crores we currently require for skills repair to make the current human capital coming out of our colleges and universities, approximately 25% of this is to the medical and nursing schools make the graduate doctors, nurses and health workers job ready.

On the supply side, there are competing careers options and sectors that await the aspirants that are entering the colleges and universities to take up courses. Using the Lev and Schwartz model for human capital valuation, we evaluated the value of different careers in health sciences versus other sectors. What is interesting is that a nurse who decides to work in India human capital value would be Rs 19 lakhs while a surgeons with a master’s degree is around Rs 1 crore. Other non medical sectors are equally attractive in terms of their human capital value. Hence the issue for India is how do we make this attractive for aspirants to take up medicine as a career. While shortage in supply of doctors, nurses and health workers in the economy will obviously push up their human capital value, knowing the disease burden of India. However, we will lose a whole generation of boomers!

But all is not lost for India. Our enrolment ratio in higher education is 12% and is half of China’s at 24% of all students passing out of secondary schools. Hence even to match China’s enrollment, we would create a total human capital of Rs 1 Crore crores using the same valuation model at higher education level. To meet this potential, we need to be opening over 25 colleges everyday for the next 3 years in the brick and mortar world!

We will again fail to create such huge capacity in the real brick and mortar world as we have under supplied the infrastructure sector due to the boom in other sector in the last decade. Hence the only option left behind for the present generation to graduate through higher education is through ICT (online) world. Over the last 5 years there have been many ventures that have come forward looking at the wider opportunity in the ICT space for medical education. However the key barriers have been the regulatory and accreditation agencies that have slowed down the mass adoption.

It is time that we wake up to the huge human capital potential awaiting India. If we fail to deliver, we not only diminish this human capital over Rs 1 Crore crores, but the increased disease burden that I wrote about in my earlier column would cost us over Rs 25,00,000 crores of diminished human capital potential!

It’s all about the quality of human capital we produce and how we produce it that will matter for this generation that is passing us in India. This is the biggest scam that none of our future generations in India will forgive us as Indians.

Budget 2022: When is Healthcare’s Amrit Kaal Coming?

Budget 2022

Preamble

On 1 February 2022, our Hon. Finance Minister presented her fourth budget in the Parliament and introduced the “Amrit Kaal” in Point 4 of her speech, “we are marking Azadi ka Amrit Mahotsav, and have entered into Amrit Kaal, the 25-year-long leadup to India@100. Hon’ble Prime Minister in his Independence Day address had set-out the vision for India@100.”

Point 5 of the Budget Speech outlined the vision for Amrit Kaal, “By achieving certain goals during the Amrit Kaal, the government aims to attain the vision. They are:

Complementing the macro-economic level growth focus with a micro-economic level all-inclusive welfare focus,
Promoting digital economy & fintech, technology enabled development, energy transition, and climate action, and
Relying on virtuous cycle starting from private investment with public capital investment helping to crowd-in private investment.

The Finance Minister has envisioned to develop ‘sunrise opportunities’ such as artificial intelligence, genomics, and pharmaceuticals to assist sustainable development and modernise the country. However, this is more on the supply side industrial development. But the core issue of healthcare infrastructure is not addressed. Envisioning the Indian population which we would like to be a healthy one by 2047 when we enter India@100. I believe that Budget 2022 missed out a huge opportunity in envisioning Healthcare 2047! Here are my reasons.

Current Undergoing Transformation in Healthcare

The country has undergone a tough time during the pandemic. The Government has played its enabling role in ensuring the supply chain disruptions with China does not lead into a health crisis of sorts. On the other hand, the funding of Covid-Vaccine and immunization has ensured that the country emerges quickly into an endemic phase of Covid pandemic. While this was going on, there was strengthening and upgrade of the digital health infrastructure. The pandemic has also taught lessons to the private healthcare delivery ecosystem to restructure their business models and ensure that there is a push toward lower costs healthcare delivery models. These transformations have demonstrated India’s resilience in its healthcare systems to face emergency situations like the current pandemic.

India’s Amrit Kaal’s Population Demographics

As the chart below demonstrates that India’s population by 2047 will be shifting towards middle age bulge. Over 300 million (~19% of the total population) will be senior citizens by 2047. Our dependency ratio will be around 40%. These 40% will be in the tax paying bracket which will provide the then Finance Minister in 2047 the revenues to spend for different welfare programs including healthcare.

India's Population Pyramid Shifts to 2047 — India’s Population Pyramid Shifts to 2047

Lessons from Elsewhere in the World

In early 2000, I was involved in restructuring the healthcare systems of Saudi Aramco. Being the largest oil producer in the world, the company had been underfunding the pension and healthcare benefits of their employees who were going to be retiring in the future. The financing of these healthcare benefits created a financial crisis of sorts which have to be funded.

USA has also being facing such challenges when its baby boomers have now become unproductive senior citizens and their total healthcare bill is currently 18% of their GDP.

Vision for India’s Amrit Kaal Healthcare Delivery to Avoid Maha Kaal

As per current estimates, our country requires USD 400 billion of investments in healthcare infrastructure on our current demography to meet the global norms. There are no allocation in the current National Infrastructure Pipeline (NIP) funding for healthcare. Therefore much of the investment will be private sector driven in the future for healthcare infrastructure.

Such experiences elsewhere in the world remind me that our Amrit Kaal in 2047 does not end up as Maha Kaal of our Amrit Kaal where we would have to look up to Indian Gods who were invoked to end the situation. There have been several demands in the last few budget to accord infrastructure status to the healthcare industry. The current budgetary allocations to healthcare all though increasing has not been sufficient to build capital formation for healthcare infrastructure in the country. From the current 2.5% of GDP, there needs to broaden the spend on healthcare. We need the real picture of the input and outputs in healthcare. With the current GST regime of zero tax on healthcare services, we are not able to gather the real value of healthcare in the country and healthcare should be under minimum GST slab so that there is pass through benefits of the inputs that are set off. This will lead to a lot of transparency and provide real hard estimates of healthcare spend of the country.

Assuming by 2047 our dependency ratio will be lower than today. Which means that the total taxpaying population in 2047 may be same as today or even lower. There needs to be a plan to ensure that current taxes from the current population who will become senior citizens by 2047 will be underfunded like in the examples that I have mentioned below, leading into a budgetary crisis.

In all earnest, given the current constraints the current budget 2022 could do so much for healthcare. But now that the Amrit Kaal is out of the bag, there needs adequate focus to healthcare to avoid healthcare Maha Kaal in 2047 when we enter India@100.

2022: Healthcare and Life Sciences Investment Outlook

Since 2013 our algos have been accurately predicting the investment heatmap in the healthcare and life sciences in India which were predicting with 95% accuracy on the sectoral investment cycle in India till the end of 2019. Since the Covid Pandemic in 2020 we lowered levels of prediction accuracy like we started back in 2013. While we worked on the Heat Map for 2022, we realized that every new wave of Covid is like a black swan event and raises the uncertainty and reduces the accuracy of the predictions with a reset. For 2021, we released two sets of heat maps, one for the healthcare and life sciences sub sectors and another for the States. Since the Central Government took the mantle of immunization, the need for updating state-wise heat map for 2022 is not relevant and not much data is being updated except for the electioneering noise and promises by political parties and immunization achieved.

2022: A Year of Consolidation and Tempering Expectations

2021 was the record year since 2013 when we started tracking the healthcare and lifesciences investments. The investments across the board was the highest, with the maximum number of IPOs and M&A activity, with over USD 2.2 Bn in funding across all the sectors in 2021. Some of the investment activity we predicted for 2022 preponed to 2021 due to positive investor and market sentiments and uncertainty of the future waves of Covid. Therefore, 2022 is a year of consolidation and tempering the tempo of investments.

2022 Outlook — 2022 India Healthcare and Life Sciences Investment Heat Map

Let’s relook at the board trends for 2022 in terms investment activity and trends.

Healthcare Financing

2021 was an all time-high for healthcare financing sector. However, recent clamp down of Chinese funded consumer financing fintechs is going to temper down the healthcare financing sector. Health Tourism related funding is only going to take off in Q3. Consolidation activity to slow down.

2022 Outlook: Hot
What’s going wrong: regulation clamp down, right bite for the consumers, reach and penetration, higher debt financing costs, slower non-discretionary and elective healthcare spend, delaying of healthcare spend and health tourism, new wave restrictions, shortage of digital workforce
What’s going right: India stack digitisation, consumer borrowing to spend on non-electives, immediate gratification, reduced household savings supplemented by borrowings

Medical Education

Key shortages of healthcare frontline workers was very apparent during 2021 Covid Crisis. The need for regulatory regime to upskills is still being reworked. Healthcare could be the key job creator. Regulatory reforms are urgently required to push digitization and newer business models for upskilling existing workforce. Churn in ownership of assets due to consolidation activity will continue albeit at a slower pace.

2022 Outlook: Hot
What’s going wrong: regulation, corruption, no vision, skill shortages, alignment to new age care, increasing debt burden, new age skills certification, funding dry up
What’s going right: skill demand, digitisation

Med Tech Innovation and Life Sciences Discovery and Clinical Development

India has proven to be the vaccine supplier to the world in 2022. Capacity creation and new product development will continue. Dependence on Chinese supply chain will reduce further as alternatives are developed indigenously. Expect a few IPOs this year in this sector. Government grant funding will temper down.

2022 Outlook: Hot
What’s going wrong: innovation pipeline, IP regulation, regulatory bottlenecks on clinical development, newer skill sets for research and acceleration, Government grants and funding slow down
What’s going right: Human capital, cost advantage, emerging social innovation models, lower dependence on Chinese supply chain

Pharma and Therapeutic Solutions

M&A and consolidation activity was at a record high since 2016. Shortage of digital workers will slow down the digital transformation activity. As China substitution and supply chain threats mitigate, the Government will temper down their PLI support as well

2022 Outlook: Hot
What’s going wrong: price controls, policy log jam, wrong product portfolio, innovation and scale up, global or China-level cost competitiveness, exit of PLI incentives, shortage of skilled digital workforce
What’s going right: cost advantage, distribution infrastructure, digital business models, Government incentive programs

Healthcare Providers

Funding costs will zoom up and will make access to long-term capital dearer. Huge churn in asset ownership and consolidation activity will continue. Digital transformation activity will slow down due to skill shortages

2022 Outlook: Moderate
What’s going wrong: margin pressures, price controls, GST slabs rationalization on inputs, execution of programs on the ground, PPP in healthcare, supply and demand mismatch in micromarkets, debt financing costs, gun powder churn, operating cash runway, liquidity and working capital crunch
What’s going right: Digital business models augmentation, asset-lite models

Healthcare Insurance

The IPOs in 2021 in the sector have created uncertainty in valuation and investor sentiment. The sector will continue to grow as it did in 2021. Digital push and intermediation will be the key to growth.

2022 Outlook: Hot
What’s going wrong: product fit to consumer needs, product approvals, loss ratios, operating cash runway, human capital reduction, consumer offtake and demand, IPOs pricing and valuation
What’s going right: Consumer demand, digitisation

Health Retail

The major consolidation of the health retail after hectic M&A activity of 2021 will slow down the decibel levels of consumer discounts and offers to focus on generating healthy bottom lines. Only one major IPO expected in 2022.

2022 Outlook: Moderate
What’s going wrong: regulation, consolidation, slower consumer spending, excess funding for GMV and operating cash runway
What’s going right: Consolidation, newer cross-vertical innovative business models, profitability focus

Wellness

2021 was the highest growth year in the last 10 years on the back of discretionary consumer spending on wellness. Digital business model innovation is still lagging behind. Medical wellness tourism will be recover in Q3 of 2022. M&A activity and consolidation to continue in 2022 but at a slower pace. Corporate Wellness spends to continue to fuel growth in 2022

2022 Outlook: Very hot
What’s going wrong: regulation, maturity to scale, new mass market business models
What’s going right: newer cross-vertical innovative business models, corporate wellness spending

Alternative Therapies

Newer products and therapies that have accessed funding in 2021 will continue to fuel growth and investments. Adoption of alternative therapies into mainstream allopathic as complementary treatment is going to accelerate. Newer product development and business models is the key to sustained growth and success in 2022

2022 Outlook: Hot
What’s going wrong: maturity to scale, consumer education and confidence, clinical research, new product development, inflated valuation, over capitalization and cash burn to gain market share
What’s going right: discretionary consumer spending, newer cross-vertical innovative business models, mainstream complementary treatment.

Let’s wish that there are no further variants and waves in 2022 for any black swarm events for affecting investor sentiments.

Happy investing and stay safe!

Kapil Khandelwal is Managing Partner of Toro Finserve LLP, India’s First Healthcare Infrastructure Fund and Director EquNev Capital Pvt Ltd.

Who is Twitter to Adjudicate Life Sciences Opinion?

Preamble

I had written in my blog Ban Twitter | Kapil Khandelwal (KK) last year as Twitter refused to follow Indian regulations and also muzzle certain sections of religious and political voices and opinion from India by banning or suspending their twitter handle. Under the leadership of the New CEO, Twitter seems to be adjudicating opinion on Life Sciences and that too experts. The latest controversial account suspension is of Dr. Robert Malone.

Who Is Dr Robert Malone? Robert W Malone MD (rwmalonemd.com)

Malone is the father of mRNA vaccines. mRNA is the same technology used in COVID vaccines by Pfizer, J&J, etc in the US. He has served as an adjunct associate professor of biotechnology at Kennesaw State University, and he co-founded Atheric Pharmaceutical, a company that was contracted by the U.S. Army Medical Research Institute of Infectious Diseases in 2016. Malone has long been an outspoken critic of the global COVID vaccine rollout, warning of the risks of a rushed release and saying normal procedures have not been followed throughout the process. He has been crusading to stop vaccines from being mandated for children, and to stop corruption in the government and the medical-industrial complex and pharmaceutical industries.

He had over half a million followers on his Twitter account. On 27 December 2021, his account was permanently suspended for not adhering to Twitter’s Covid 19 misinformation policy.

He can still be followed via his substack page.

Muzzling Divergent Scientific Opinion on Social Media

As this pandemic is playing out, the so called official expert spokesperson of the US Government have been proven time and again how wrong they have been in guiding the public. In fact on of the experts and advisor to the US President, had gone on to rubbish the work of our scientist at IIT Delhi who published that they discovered four insertions in the spike glycoprotein of the Covid-19 virus which they say are not present in other coronaviruses. These experts have been using social media to guide or misguide the masses. As a result, the public opinion on the official experts is now suspect and individuals now want to assess both sides of the scientific views before excessing their personal judgement.

Twitter does not possess scientific material peer reviewers to state whether a certain scientific opinion is valid or not. It can at most highlight as not peer reviewed by a wider scientific community. This sort of baning scientific expert opinion is a dangerous trend. In future, the big-pharma can short change the scientific community’s opinion by muzzling their voices and views on social media. For the individuals who are interested in knowing the scientific voices will have to now put pressure for a much open, unbiased social media to allow for alternative scientific views to emerge.

The Oracle Returns

oracle-and-cerner

Background

On December 20, 2021, Oracle Corporation and Cerner Corporation jointly announced an agreement for Oracle to acquire Cerner through an all-cash tender offer for $95.00 per share, or approximately $28.3 billion in equity value. Cerner is a leading provider of digital information systems used within hospitals and health systems to enable medical professionals to deliver better healthcare to individual patients and communities.

My Tryst with Cerner and Oracle Along with My Journey

Cerner has been a leader in the health information systems since it was founded as PGI & Associates (after its three founders Patterson, Gorup and Illig) who quit their jobs from Accenture (then Arthur Andersen) in 1980s. I had the chance to work closely with Neil Patterson when Cerner expanded outside of US in Gulf region with the implementation at Saudi Aramco (now Saudi Aramco-John Hopkins) in early 2000s.

During the same time, I had worked with Oracle leadership in the Gulf region on several roll outs in the Government sector.

In early 2000s, Saudi Aramco, world’s largest producer of crude oil was migrating from mainframe environment and had embarked on world’s largest big bang implementation of SAP and corporate performance improvement program in the world. To migrate and manage its in-house healthcare delivery to its employees, contractors and their dependents in Kingdom of Saudi Arabia (KSA) and overseas, the choice was between SAP Healthcare and Cerner. Neil Patterson, the co-founder of Cerner made multiple visits to Dharan, the headquarters of Saudi Aramco to pitch and win the first major implementation overseas. That’s was the beginning of my personal friendship with Neil. As Neil would visit Dharan on quarterly steering body meetings, we would share a quiet dinner and discuss his vision about Cerner and his international growth initiatives before he boarded his private jet to Kansas City. Over the years, Cerner witnessed major growth outside of the US, including some inorganic growth acquisitions like Siemens HMIS and starting their offshore development centers in Bangalore, the largest base after Kansas City. Unfortunately, Neil succumbed to cancer in 2017. I lost a fantastic friend and mentor forever who had guided me in my career at different points in time.

While at KPMG Consulting in the Gulf, I made several bids with Oracle to the various governments in the Gulf. Oracle was great with their database and their product architecture; their major issue was that they lack clinical prowess to manage healthcare either in hospitals or with state healthcare. It was around this time that I was associated with Sam Rao who was Head of Business Development and Large Deals at Oracle. Although, he understood healthcare, but the product deficiencies of Oracle was just not a great fit for running eHealthcare initiatives for the population of GCC countries. Later Sam and I collaborated to start out XY Clinics (an innovative nutri-genomics and diagnostics venture) in GCC and India and had a great run and exit

Flash forward: Many of Cerner and Oracle leadership in the US and Rest of the world either worked with me or had been a partner with me on some of the healthcare initiatives. One of them being Dr John Glassier who I also invited on my podcast QuoteUnQuote With KK.

https://open.spotify.com/episode/5np4XQN473NTia8xeHcvyF?si=WpSetp-xT-6OQ6abID-LZg

How Cerner Acquisition Helps Oracle and Vice-versa

Oracle has always had a weak presence in the clinical healthcare information management system. Although it has a great rooster of clients not only in the us but around the world. A mega-29 billion dollar deal will signal that Larry Ellison, Oracle’s founder is serious about getting a big leap into the healthcare sector once again. Its earlier acquisitions in healthcare were small and somewhere did not change Oracle in its ways of doing business with healthcare clients. Therefore Oracle Returns. In the post-pandemic era, as healthcare providers and Government healthcare systems, step up to spend more on their digital and clinical transformation, Oracle-Cerner would definitely be a very strong option. I am informed from my ex-colleagues and industry insiders that Cerner will be kept as a dedicated business unit within Oracle. This would be a very positive development both for Cerner and Oracle as independence of Cerner in the larger Oracle would be a critical success factor for this acquisition. As for Cerner, Neil vision and dream of taking Cerner globally as a leading healthcare information systems player will come true posthumously.

Wishing Oracle and Cerner All the Very Best in their combined journey!

Rx: Dr House MD : Bad Madicine?

Hurray! I finally completed watching all the Eight Season, 177 Episode Series of Dr. House MD last night. This was one of my wish list for 2021. In the past, I had watched some of the episodes but could not watch the full series. Over the last 350 days of 2021, as I watched through all the episodes of Dr House, I realized and learnt a lot about myself not that I am interested in medicine and healthcare, but as a person. Here are some of my learnings from Dr. House MD.

Statutory Warning

This blog may contain references to sex and nudity, substance abuse, or realistic/non cartoon violence and frequent strong language. Read ahead with extreme caution

Co Dependency

Everybody has co dependencies whether to substances, situations, surreal events, sapiens of human origin, society at large, etc. Not many are able to break this in their life to emerge stronger

True Love is not OTC Medicine

Not everyone has been able to find true love of their life as they has treated their love mate as an episodic medical event. Managing true love is like managing a life-long chronic condition

Hookers Polyescort is not a Relationship Transition Gap Binder

Loneliness and emptiness cannot be filled by hookers. They may relieve pain and the weight of your wallet in the short term but leave behind big hole in your wallet and your heart.

Pain in the Ass does not come only from Butt-Plugs and Suppositories

Some people can be a pain in the ass. But like Dr. House, look at their true intent in ragging you. They want you to succeed and improve. Don’t switch them off completely because you are pissed off with them.

Paternity Tests Still Do not Tell You Who You Are

Finding your genetic father still does not answer why you are who you are!

The Intuition Injectable

Talking of the pain in the butt, there are some who inject great intuition into the situation to solve the issue or guide the direction. Sometime they can be painful and overbearing and may not respect the hours of dedicated work and effort you may have put in with no results

Pediatric Morphism is not a Medical Condition

Being a child is not a medical condition. It’s perfectly fine to be a kid or behave childishly. You will not be diagnosed for a mental medical condition. Many problems are better solved when a kid. Play the pranks, its healthy

Hiring, Firing and ReHiring is not a HR Disorder

Word like talent, hire, fire do not exist for a genuine inspirational people leader. Talent will still flock to them inspite of their unstable and inconsistent people behaviour

Jerking is not always Masturbation

Relationship ejaculation does not always happen by jerking of people due to right reasons. Over mental masturbation will definitely lead to ED of true and sensible solutions and ideas

Dopamine High is not Always Hallucination

Day dreams or nightmares are not medically treatable if controlled on to a problem solving situation. Sometimes you need the dopamine high to break away from the situation to analyse it dispassionately to arrive at a solution

Game People Play is not a Medical Pharmacopeia

There is not prescribed drug list to treat games people play. Either face and challenge it or become depressed to consume anti-depressants to cope with it

A Surgery of Lies does not Cover the Wounds of Truth

People always lie. Sometime for the good. But they always. No drastic surgeries can cover up those lies to truth

Music is a Therapy

Like Dr House who played several musical instruments and also solved many medical cases and saved the lives of many patients, music was therapeutic for him and me. You can also see music when you are on drugs

True Friendship is like Intensive Care

True friendship can only be nurtured when you take intensive care and measure and watch all the parameters like in the ICU

Walk through Life not using Carrot and Stick

All of us use stick to force our authority to walk ahead in life. Our fear and dependency on the walking stick makes us powerless and sidekick. How can you live a life without the crutches of a carrot and a stick?

New Mental Strings in Life! Keep Playing

New Strings in Life! Keep Playing

The Destiny is in Your Fingertips!

Many don’t know the miracles and health benefits of keeping your fingers in good shape. Here are seven key facts that you need on your fingertip about your fingertips.

Direct Connect to your brain

Like your feet, the fingers have millions of nerve endings that connect to the brain providing it with six different type of sensations as heat, tactile pressure, vibrations, texture, pain, and the position of the body in relation to its surroundings. This direct connection to brain of the fingers leads to stimulating and improving the neural functions of the brain.

Detect Minutest of Objects

The touch receptors in the finger tips are so concentrated that even a thinnest of a pin of 0.2 mm can be felt. The fingertips are even more sensitive to dynamic (or in-motion) touch that you’ll find you have a whole new level of intuitive, precise control.

Feel Vibrations

Our fingertips can decipher tiny vibrations that are created when any surface meets them. Different structures create different vibrations based on the amount of friction and wrinkle width (which is how scientists gauge non-smooth textures) present on its surface. Fingertips interpret motion vibrations in order to assist touch.

Move Without Muscles

Our fingers have tiny arrector pili muscles, which can make the hair on the fingers stand up straight. The brain communicates directly to the fingers for movement

Move In Harmony With One Another

Because of this complex network of muscle, tendon, and bone, it is incredibly difficult, if not impossible, to move one finger by itself. There are 29 major and minor bones, 29 major joints, at least 123 named ligaments, 34 muscles, and 48 named nerves in the hand—and they all work in conjunction with one another to make the fingers functional.

Communicate with Others

The fingers’ dexterity also supplies a vast well with possibilities for non-spoken language. Gestures and hand motions can also increase understanding among non-signing people

Our Aadhar (Identity)

It’s common knowledge at this point that no two fingerprints are alike, and because of this they’ve been used as personal identifiers for millennia—even our unique identification number (UID) uses our fingerprints.

Why the need now?

As I am getting older, I am seeing some of my friends and acquaintances parents suffer from Alzheimer’s, A type of brain disorder that causes problems with memory, thinking and behaviour. This is a gradually progressive condition. Some other mental degradation conditions include:

Dementia: A group of symptoms that affects memory, thinking and interferes with daily life.
Parkinson’s Disease: A chronic and progressive movement disorder.
Huntington’s Disease: A condition that leads to progressive degeneration of nerve cells in the brain.
Early-onset Alzheimer’s disease: Early-onset Alzheimer’s disease, also called early-onset Alzheimer’s, or early-onset AD, is Alzheimer’s disease hits people between the ages of 30 to 65 years
Vascular Dementia: A condition caused by the lack of blood that carries oxygen and nutrient to a part of the brain.
Lewy Body Dementia: A progressive dementia that results from protein deposits in nerve cells of brain.
Multiple Sclerosis: A disease that affects central nervous system.

Over 1 million new cases of Alzheimer’s in India are appearing every year. This is a huge issue not only for the person suffering but also for the family members and care takers. I was wondering if the onset can be delayed or avoided. During the pandemic, I was witnessing many people falling prey to mental illnesses and that could further degenerate to Alzheimer’s if not properly diagnosed and treated. I wondered on the need for some solution to combat this during the lockdown and pandemic. I looked towards music.

My Experience with Music

From my childhood I have been musically inclined. Apart from singing I was exposed to various musical instruments. As I grew up I started playing the guitar and learnt strumming and composing as a hobby. Somewhere in between my busy work life I gave up. However, I encouraged my kids to take up playing a musical instrument. As they grew up, I realised that playing a musical instrument was therapeutic and help them focus better. During pandemic I took up to walking to remain fit and during my walks I would listen to rock music. This did help me in reducing my weight and remain calm and sharp while working alone in my office during the lockdown.

Another issue that I realised is that I am typing more and writing less. This is another reason that my finger tips were not being adequately used. To balance all this, I acquired a Yamaha acoustic guitar to connect back to music. How does this help?

There are several research papers on internet that tells how using the fingertips while strumming the guitar helps. Here are a few that I have felt:

Playing guitar helped to lower blood pressure and reduce heart rate as it is mentally calming. A recent BMJ study suggests the same heart health benefits.
Relieves stress and anxiety and reduces cortisol levels in me
My brain was sharper and memory clear. A recent study states, playing a guitar or any string musical instrument is helping to stave off degenerative diseases that are common in older people, including Alzheimer’s and dementia. In fact, seniors who engage in the kind of engaging mental activities like playing an instrument can reduce their risk of developing these conditions by up to 75%.
My creativity increased. Enough studies state that
Mathematical and numerical dexterity increased. It’s not that I am now going to sit for some competitive exams like CAT. But I could focus back on numbers
My vibrational energy significantly improved
Lastly, my interpersonal communications and relationships took a huge 360 degrees turn for the better

So it’s upto you. What strings you would like to pick up? Towards mental degradation or mental upgradation?

The destiny is in your fingertips.

That’s Lazer Sharp Vision, Literally!

Background

Perfect human sight is the greatest gift that a man can get. Years ago, I remember on one of my Rotary Eye Camps in a village near Bangalore, an old lady came to the Eye Camp with the help of her assistant holding her and guiding her to take the steps due to poor vision. The doctors checked her eyes and gave her a pair of spectacles. On wearing the spectacles the lady was overjoyed and filled with tears. She could see perfectly which she had not for years. Her dependency on others and quality of life improved immediately. This incident bought emotional tears to all the people around her. Like the old lady, there are millions of Indians who have poor quality of life due to lack of proper sight as they cannot afford proper spectacles to correct their sight. I seem to be amongst the more fortunate ones who can afford the luxury of sight correction.

My Issues with Hypermetropia, Myopia and Presbyopia

As far as I am concerned, I have always tried to maintain my eyes inspite of long-distance sight (hypermetropia) correction from my teenage years. As I aged (presbyopia), the complexity of near-distance (myopia) reading and long-distance sight have emerged. My lenses that Essilor fitted to combine both of these into one lens in a spectacle resulted in near catastrophe while driving on the highway. As a result I preferred to maintain two sets of spectacle for hypermetropia and myopia. With presbyopia, I have to fit new lenses as the vision for hypermetropia and myopia keep changing. This means a new set of spectacles every year or so to maintain proper vision.

My Experience This Time Getting Vision Correction on Digital

Every year, I visit the optometrist around the festive season to get my vision tested and procure new set of spectacles and lenses as per the advise of the optometrist. Given the lock down situation, I thought of procuring the spectacles through the digital online platforms like Myntra, LensKart, Titan Eye and Amazon, etc rather than shopping for at the physical optician stores. I wanted to try out Lenskart as my daughter had bought two pairs of spectacle recently and was a very loyal customer of them. While all the catalogues of Myntra, Titan Eye and Amazon offered just the spectacles, Lenskart offer the spectacles and a zero-powered bluecut and anti-glare computer lenses fitted along with it. Similar spectacle designs on platforms other than Lenskart turned out to be cheaper as Lenskart was loading the price to the lenses additional. I needed powered lenses to be fitted at an additional cost and throw away the lenses already fitted with Lenskart spectacles.

My WhatsApp Interaction and Talk with Amit Chaudhary of Lenskart

Pissed off with the experience, I WhatsApp Amit Chaudhary, Founder of Lenskart. That’s when I realized the business model of Lenskart versus other digital and brick and mortar opticians out there. Here are some of the excerpts of my telephonic conversation with him

Lenskart is the largest AR eyewear venture in the world
Over USD 150 mil of eyewear is sold by them through their platform and lenses are manufactured and fitted through their fully-automated robotic facility
AR technology and fully-integrated robotic manufacturing facility makes them the cheapest provider of eye wear in the world due to the scale
They are targeting a total addressable market of around 1.5 billion eyes in India
They are therefore integrated to provide the full solution of spectacles and lenses as operationally there are challenges of product warranty when customers buy spectacles from them and fit the lenses outside at a local opticians.

There is a stand out quotes that while talking with Amit that summarized their business model

“We are the Maruti of the eye wear business. Customers like you form the top 10% who are the Ferrari’s who would like spectacles not only for functional, but for esteem value”

I like the lazer sharp vision of Amit. As entrepreneurs like him who raise lot of VC and PE capital at some time want to dominate and move away from their core business model and value proposition in the pressure for growth, profitability and valuations.

Although Amit offered to service me as an exception, but that is not core to their way of working. Consumers sometimes miss out on this and crib and bad mouth the start ups on social media, missing out how these start ups are making the world better by offering sight to millions by being cheaper, better and faster. Remined me of the old lady in tears who could see properly and so did I on Amit’s perspective.

Kudos to such start ups which are bringing in technology and production techniques to reach scale!

QuoteUnquote with KK (Kapil Khandelwal) Season 2 premiers as the first podcast on Dailyhunt

India’s leading business podcast QuoteUnquote With KK (https://kapilkhandelwal.com/podcasts/) produced by healthcare and investment industry veteran, Kapil Khandelwal of Toro Finserve LLP was launched on Dailyhunt, India’s #1 local language content platform, this month. This podcast organises a virtual fireside chat with thought leaders around the world on various current issues and topics across business, economics, investments and socio-politics. The show successfully completed its first season comprising ten episodes with global thought leaders Mark Mobius, Parag Khanna, Rajeev Peshwaria and Mark Kahn, to name a few.

Kapil Khandelwal, as quoted in his podcast, shared “we have been listening to our listeners and in next year’s season, we’re going to run QuoteUnquote with KK on 2 tracks – Healthy and Wealthy. Healthy because of what we have gone through last year, and Wealthy because without a healthy world we cannot become a wealthy world. So, these are two very intermingled issues. We have lined up star speakers from different areas in healthcare and investments and current events and developments. On popular demand, we are going to run this podcast on a fortnightly basis. Our team is very excited to give more to the audience demands and feedback. QuoteUnquote with KK is available on global platforms like Spotify, iheart radio, Amazon. The strategic idea of our partnership with Dailyhunt is to provide access to Indian audiences looking for premium, short-format content. Additionally, Dailyhunt users will also be able to access all my blogs published on various subjects.”

Umang Bedi, Co-founder, Dailyhunt says, “Our 285+ million users challenge and inspire us to introduce formats that improve their experience on the platform. Communities socialized over content last year like never before, and Indian audiences are absolutely entitled to premium and intelligent content, regardless of their location or their network. I had the privilege of hosting a talk show with business leaders on Dailyhunt last year, and taking from its success, I’m quite confident that KK will enjoy an engaging and stimulating relationship with our users.”

On the launch occasion, Kapil Khandelwal, Father of offshore Quant Fund Investing in India and Managing Partner, Toro Finserve LLP, said, “I am glad to announce that India’s largest discovery platform, Dailyhunt is now hosting QuoteUnquote with KK. This will take the virtual fireside chat to over 285+ million monthly users on the Dailyhunt platform. I welcome the audience of Dailyhunt and am looking forward to interacting with them, on the platform”

Season one of QuoteUnquote with KK, with all ten episodes, is now available on Dailyhunt.

In Preparation for QuoteUnquote with KK (Kapil Khandelwal) Season 3 (2022), partners with Hubhopper for India cross-platform strategy push

QuoteUnQuote with KK on Hubhopper

India’s leading business podcast QuoteUnquote With KK (https://kapilkhandelwal.com/podcasts/) produced by healthcare and investment industry veteran, Kapil Khandelwal of Toro Finserve LLP has partnered with Hubhopper, India’s largest podcast hosting and distribution platform. The podcast reaches over 200 million listeners world-wide and organises a virtual fireside chat with thought leaders around the world on various current issues and topics across covid pandemic, self-growth, business, economics, investments and socio-politics. The show successfully completed its silver jubilee episode recently.

On partnering with Hubhopper, Kapil Khandelwal, commented “during 2021, with Pandora (not available in India) and some other platforms distributing our Podcast to English, Spanish and other foreign language listeners globally, our split of Indian and foreign listeners skewed from 90:10 in 2020 to 55:45 currently.QuoteUnquote with KK started with the intent to bring ‘outside-in’ perspective to our Indian during the lockdown on what the future holds, given the tremendous uncertainty amongst people, corporate executives and listeners. During 2021, India has demonstrated exemplary leadership in not only managing Covid situation and inoculating over one billion vaccine doses in the quickest possible time. Therefore over the last few months, we had been witnessing a steep rise in our foreign listeners whose interest in India has peaked. Our Season 3, will focus on the India success stories and continue the ‘outside-in’ perspective of the global thought-leaders focussed on India. We also need to address our core co-hort of Indian listeners who have been motivating us all along to produce such content. Moreover, our pilots with Zee5 and Dailyhunt as the first podcast on their platform to deepen our reach to the core Indian listeners has been very positive and successful and validates our cross-platform strategy we implemented for podcasts for the first time in India. Hubhopper partnership builds onto our experience to reach deeper to the heartlands of India and further execute our cross-platform strategy to introduce QuoteUnquote with KK on their platforms”

Gautam Anand Raj, Co-founder, Hubhopper says, “We are on the verge of a new dawn for podcasting in India with both creators and listeners adopting the medium as a staple within their daily routine. We are extremely proud to partner with QuoteUnquote in bringing their content to new ears across the country.”

On the launch occasion, Vani Garg, Associate Executive Producer QuoteUnquote with KK and Founder, Consoul said, “in the mobile first era, OTT transformed the video content distribution on demand with hyper personalisation shifting consumers from Cable/Satellite TV to their mobile phones. We are witnessing the same shifts with the consumers for authentic audio content which was predominantly on our FM Radio to cross platforms and podcasts on apps. Our strategy of distributing the original thought leadership audio content of QuoteUnQuote with KK is paying off. Consumers in India are not still mature for a Subscription Audio on Demand (SAOD) like Subscription Video on Demand (SVOD) on OTT and we will continue to monetise our content through Advertising Audio on Demand (AAOD) like Advertising Video on Demand (AVOD) on OTT. We are witnessing a dire shortage of content for AAOD in India. QuoteUnquote with KK has an early mover advantage and a large following of listeners globally. Our partnership with Hubhopper further deepens on our cross platform strategy to reach out maximum Indian listeners on Jio Saavn, Hungama, Gaana, Wynk Music, mobile phone platforms such as Xiaomi Music, Jio Phones – KiaOS wallet platforms such as Paytm, PhonePe and in cab entertainment systems such as Ola Play, to name a few ”

Season One (2020) and Two (2021) of QuoteUnquote with KK, with all 25 episodes, is now available on Hubhopper platforms.