Gone are the days when Indians would look towards the West for new technology with baited breath and anticipation for the same products to become available here, often at a steep premium. Or in the healthcare context, waiting for medical devices or getting treatment abroad (affordable obviously only for the super rich) or sending diagnostic samples abroad for a lack of the required services at home. However, serious investment over the last couple of decades by individuals, corporates, and the government have turned a nation of importers and let’s face it ‘copy-cats’ into a nation of innovators with the potential to change the world. Yes, you read correctly: “Change the World”.

With a focus on quality as well as affordability, independence from electrical supply and suitability for various climates, Indian scientists, engineers, and entrepreneurs have taken the bull of rising healthcare costs across the globe by its horns. Now, home-grown Indian companies are able to offer the same or even superior technological advances as in Europe or the US and at a cheaper cost too, delivering first class medical care to patients in India, and believe it or not, foreigners travelling to India for cheaper treatment. How the tables have turned! These days, many western countries, as well as other emerging economies, even look towards India and Indian medical innovations to reduce runaway healthcare costs, especially in hospitals.

One particular medical innovation that is transforming cancer care across the globe is ‘precision medicine’, also known as ‘personalized medicine’. In an age, where pharmaceutical companies have moved on from small molecule drugs to so-called biologicals in search of better cures, this branch of medicine has become even more important. What sets biologicals and other new generation medicines apart from your acetaminophen or ibuprofen is that they interact very closely with the genes and proteins that make our bodies tick. Needless to say, biologicals are also more expensive. Now, one thing pharmaceutical companies and scientists had not factored in was the variability of human genes and how this variability impacts the effectiveness of biological drugs. The cat was out of the bag quickly though, with some people benefiting tremendously from a new drug while the same drug would fail miserably in other patients or in some cases even endanger their lives (a story that is repeating itself in the even more recent development of immunotherapies). The race was on to find out what turned a promising drug into a failure or danger for some. The answer, it turns out, lay in part in people’s genes and the minute differences between all of us: Precision Medicine was born. And with it a new conundrum: How do we ensure the right person gets the right drug at the right time?

The discovery that genetic mutations lay at the heart of some drug responses has led to a shift in pharmaceutical development, especially in the field of oncology, that has seen the emergence of so-called ‘targeted therapies’. Targeted therapies work by interfering with the biological processes happening in our bodies or tumor tissue in a specific way. Choosing which drug works best for a particular patient now relies on genetic testing of tumor tissue and sometimes even the presence of hereditary mutations. Hereditary mutations are present in all cells of our body (not just in a tumor), like some mutations in the BRCA1/BRCA2 genes, and are passed down in families and significantly increase the likelihood of a woman developing breast or ovarian cancer in her lifetime. We’ve looked at this process in previous issues of myStrand and one patient’s story we shared in Issue 3, where the presence of a hereditary mutation in BRCA2 meant that a PARP inhibitor drug could be prescribed to an ovarian cancer patient where all other treatments had failed after her cancer had returned.

So what is India’s contribution to precision medicine in India and abroad? The answer lies in its abundant intelligent and highly-skilled science, engineering, and bioinformatics workforce. In a recent article, Raymond McCauley, chair Digital Biology at Singularity University—a Silicon Valley think tank devoted to training leaders in exponential technologies said: “India has more trained bioinformaticians than any other country on earth. These people, who are trained to use computers in the life sciences, and systems biologists, and biostatisticians, are the heroes of the coming biotech revolution. They keep it moving forward.” And he knows what he is talking about! He is part of the team that developed next generation DNA sequencing at Illumina, where he worked in bioinformatics, cancer sequencing, and personal genomics.