This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.
Rajiv Doshi, MD, is the executive director (U.S.) of the Stanford-India Biodesign Program and was part of the Stanford team that initially flew to India in 2007 to propose the program to the Government of India. He has commercialized devices to treat sleep apnea and snoring and later served on boards of multiple medical device companies. In 2012 he was named by Forbes India as one of the top 18 Indian scientists who are changing the world.
Doshi answered questions about the early days of the Stanford-India Biodesign program and the hurdles entrepreneurs face in India.
Why did you want to start the Stanford-India Biodesign program?
Starting the program was both an opportunity and an obligation. My belief was that this was going to be a difficult challenge spanning perhaps a decade. We were working with a partner [the Indian government] where we didn't know the people very well and we didn’t know many of their systems. We had never assembled such an international collaboration of this scale. If we failed then at least we tried and did our best. If we were successful then we would have helped a lot of people. I felt that this was a once in a lifetime opportunity to have an impact of this scale.
What were some of the hurdles the early fellows faced when they tried to develop technologies in India?
Probably the number one problem they face in India is that there is really little mentorship as we know it here. Few people in India have successfully developed a medical device from scratch so it is really hard to find mentors who are already domain experts in medical technology. The next issue is raising capital. There is very little early stage venture capital focused on medical technology in India.
Then there are challenges with research and development. Imagine you're creating a difficult-to-make medical device that has small, complicated parts. Odds are the suppliers aren't available for all these parts in India. Then there's manufacturing and supply chain issues. Let's say the entrepreneurs are able to develop a product, then they may struggle to find an in-country manufacturer to make this product. In many cases, in-country manufacturing capabilities just aren't at the same level as you would see here or in Singapore, Germany or other locations. So you start stacking these challenges together and you realize that they are pretty serious.
Does it get easier once they’ve developed the device?
No, I think the greatest challenges are related to commercialization - after development has been completed. Let’s imagine you created a great product, you've figured out all these issues. Your next challenge is then to market your product and convince healthcare providers in India to start using your product. This takes time and money to support your marketing and sales efforts. Additionally, many of the providers may not be as trained as their US or UK counterparts and may be less likely to adopt your product if it requires a certain level of training. Finally, there is the issue of who is going to pay for the product. In India, only about 25 percent of people have basic health insurance so any device in India needs to be quite low cost to be broadly used.
How do you overcome all this and help the fellows be successful?
We looked at the problems first and asked how we could stack the deck in our favor. Our first few years we focused on emergency medicine, in the hope that these issues would be fewer. There are a series of large ambulance companies in India that represent large purchasers. They could do both distribution of the product and training of the end users. Then you could also say when you are fundraising, “Well, we talked to three of the major ambulance companies and they are interested,” so maybe the funding is more likely as well. That's why taking an inventory of the problem at the start really helps.
Another thing we focused on was helping to build out the ecosystem. I have to give credit to my wife for this: We started holding a yearly medical device summit that brings together the entire medical technology community in India. In order for us to succeed with our Stanford-India Biodesign program, we knew that the entire ecosystem had to develop. When a young entrepreneur starts a company, he or she will now benefit from having vendors who can supply them with components for their R&D, and they will be able to hire people who are knowledgeable about medical technology or find legal advisors and other experts who can help them.
Do you feel like the program has had an impact in India?
One of the questions we were asked when we started this, by a pretty senior academic in India, was, “Okay, you guys are training four people a year. We have 1.3 billion people in this country. How do you expect to make an impact?” My response then was the same as it is now. It's about creating a precedent. When you create a precedent you empower the masses to believe that they can do the same. Several of our entrepreneurs will fail but when you start getting successes you will inspire others and create a ripple effect.
I think one of the things our fellows take away from their time at Stanford is not just our Biodesign process; it’s also a renewed belief in what they think is possible in their careers. Our fellows have now started successful companies in India and other Indian universities are beginning to teach our Biodesign curriculum, funded by the Government of India.
One thing that has been enormously satisfying is that invariably when the fellows go back to India they focus on devices to help the bottom of the pyramid. They could focus on things that could generate more money but there seems to be a strong belief that we need to do something for the lower classes of India.
Previously: Writing a “very specific sentence” is critical for good biodesign and Good medical technology starts with patients’ needs
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