Tuesday Special: Ameera Shah On India’s Preventative Testing Boom

In The Signal Brief’s Tuesday special, I sit down with an expert from across industries.

Our focus remains the same: helping you understand the trends shaping India. We’re simply bringing you more of the conversations behind those stories.

Today’s guest is Ameera Shah. She’s the executive chairperson at Metropolis Healthcare, a leading diagnostic chain with presence in India and Africa.

We spoke about the massive rise in preventative testing that India is currently seeing.

The Core produces The Signal Brief. Follow us wherever you get your favourite podcasts.

NOTE: A machine transcribed this episode. A human has looked at this text but there might still be errors. Please refer to the audio above, if you need to clarify something. If you want to give us feedback, please write to us at feedback@thecore.in.

TRANSCRIPT:

Kudrat (Host): Hi, I’m Kudrat Wadhwa, and you’re listening to the Tuesday special interview on The Signal Brief.

Today’s guest is Ameera Shah. She’s the executive chairperson director at Metropolis Healthcare, a leading diagnostics chain with presence across India as well as the continent of Africa.

I began by asking Ameera what kind of a rise Metropolis has seen and especially, what specific tests Indian consumers are asking for.

Ameera: I mean, if you look at it, obviously, COVID was a sort of a big sort of point where, from there, we saw healthcare getting a little bit more focused. Basically, before that, you know, 95% of healthcare was only illness-driven. People didn’t really want to take the trouble or want to know what’s going on with them.

And therefore, preventive healthcare was a very small part of it. I think with COVID, there was so much focus on health and just health awareness. And I think, more than anything, a few companies came to the industry that really wanted to create a space for themselves.

And they found that consumer wellness and preventive healthcare is the easiest way to do it, because on the illness side, it’s a very long journey because you have to really earn trust from doctors. And that’s very difficult to do, because you not only have to build a relationship, but you have to be really good at what you do scientifically. So consumer wellness was sort of the easier way, which sort of engaged technology and, you know, a little bit more easier things to build.

And that’s how really we saw the market expand. So we’ve seen, I think, even for Metropolis, I think less than 2% of our revenue came from wellness pre-COVID, which, of course, at this point of time is closer to 20%. So big shifts that we’ve really seen in terms of the preventive healthcare and wellness.

The transformation has been building for a long time, right? It’s not suddenly overnight. But, you know, simple things like home collection became something which is more common, even though today, while consumers may, some consumers may prefer home collection, we still find a large percentage of people walk into centres.

And the reason they do this is because some people have still some disbelief or doubt around, you know, is the collection done properly, is the sample transported properly, etc. So, you know, home collection has definitely been one sort of change that we’ve seen in the consumer trend. Second, of course, like I said, is preventive healthcare.

And third is the usage of technology in healthcare. Before COVID, everybody wanted hard copy reports, doctors wanted hard copy reports, and nobody wanted to deal with technology at all. And that’s changed a lot.

And now everybody wants, you know, sort of an Uberized version, you know, everything they do on Zomato and Uber and every tech app they wanted in healthcare as well. So I would say these are the broad three shifts that we’ve seen.

Kudrat (Host): Okay, great. Thanks for that. So just to clarify, when you say wellness and preventative healthcare, what exactly are you talking about?

Ameera: So, you know, usually once a year, you need to find out what’s going on in your body, right? You need to check, you know, how your heart is doing, your liver, your kidneys, your, you know, any infection in the body, your sugars, your potential diabetes, thyroid, etc. So an annual checkup is something you do when even if you’re not sick, and you’re actually perfectly fine, you’re going to get information that you can then empower yourself, because usually even when you go and do an annual checkup, you will find some marker which may not be perfect.

You know, I’ll give you a simple example. A close friend of mine recently just did an annual checkup and he found that, you know, his heart, even though he had done a cardiac CT, and there was no calcium scoring. But suddenly when he went for an annual checkup, and Metropolis does not only pathology, but other things as well, he found his BP was actually quite high.

He also found that even though the cardiac CT was normal, when he did his lipoprotein, when he did his triglycerides, they were all very, very high. So this sort of gives some indication, because even in the heart, you can have different kinds of heart problems, just because you don’t have calcium buildup, doesn’t mean that nothing is going to happen, right? So, you know, there are, there are, these are worth doing, because they only alert you, they give you a red flag that, hey, there’s something going on in your body, which is not right.

But if you just fix it, you can make it fine. And you’d rather do that than what we are seeing happening, unfortunately, fairly often, which is 40 year old Indian men going to the gym and running and working out like crazy, and then falling off the treadmill and dying, right? And that’s happening, because from the outside, while they may look really fit and really strong, they’re putting sometimes so much pressure on the heart, and they don’t know whether their heart can take it.

So when you do your blood test, and you do your checkup, you actually are able to assess how strong is your heart, and therefore what you should do.

Kudrat (Host): Okay, got it. And, you know, you mentioned the 2% of revenue to 20% of revenue. So where, like, I wanted to know, I mean, in terms of geography, where in India are you seeing more of this rise, mostly in bigger tier one cities or elsewhere too?

And also among consumers, is there a particular kind of demographic that’s more interested in this wellness and preventative healthcare versus others?

Ameera: Look, I mean, I think right now, this is still a metro city phenomenon, right? We haven’t really seen wellness and preventative healthcare become so common in smaller towns. So in smaller towns, the way it’s happening is more bundling, which is that if somebody goes for two, three tests, you know, for normal sort of illness, and then they say, okay, you’re getting pricked, so you might as well, you know, do a bundle and do more tests right at the same time.

So that’s happening. But what we are not necessarily seeing yet in a big way is that consumer awareness driving preventive healthcare. So that I think will still take some time from a tier 3, tier 4 towns.

Kudrat (Host): Okay, and what about the demographics of consumers, any specific age group or gender or profession?

Ameera: Largely, you’re seeing actually that the, you know, 40 to 55, I would say 55-60, is the kind of age group that people feel like, oh, I need to now start doing something. Usually, when you’re 20 to 40, most people feel I’m sort of super healthy, and I’m fit, and I’m energetic, and I don’t need to check. So usually, I think that starts, I would say, 35, you know, 38 plus, and then goes on to about 60.

And then obviously, by 60, usually everybody has some illness. So usually, then they’ll monitor that illness most.

Kudrat (Host): Okay. And what about, you know, corporate wellness perks, as well as reimbursements for getting tested? Have those also played a role in this rise?

And as well as, has there been a reduction in prices of testing? Has that also played a role?

Ameera: Well, look, I mean, I think when prices in India come down, it certainly helps to create more market, because you’re just able to cater to different cohorts, different segments of customers. So certainly, it has expanded the market as pricing has come down.

As far as, you know, the next wave of sort of wellness, and where it’s sort of going to go, I think, right now, if you still see, while we are checking what’s happening in, you know, some of the organs in our body, we still are not necessarily able to pick up, we’re not able to integrate our health, right.

So, for example, we all, you know, sometimes some of us will wear a hoop, some will wear a roller ring, some got something else going on. Our information from our sleep, our information from our calories, our information from our steps, you know, all of that is not merging yet with our pathology data to get a holistic view on where we stand. And I think that’s going to be the next step of wellness, which is to really say, how do I incorporate all parts of my life, you know, along with my blood pressure, along with my weight, along with everything and bring it together in a sort of score or in a way of me monitoring it, a quantifiable way to see whether I’m going in the right direction or not.

So some of the key things are already there, right? Like some of us will watch your muscle mass percentage, some will watch fat mass percentage, some will look at BMI. But all of these are right now separate pieces.

So bringing it together is important. And I think the second thing is you’re going to see predictive testing also start to pick up. So right now, the science behind that is not super strong.

If you get reports from some of these companies which tell you, oh, you’re 65% chance of getting diabetes, frankly, there’s nothing much you can do about it, right? So that information is, frankly, not so useful, and lands up creating anxiety for people. But if we can make it more scientific by saying, look, this is the kind of foods that are going to create inflammation in your body.

And therefore, because you have a chance in a family history of diabetes, avoid this. If we can give more specific recommendations, I think this will become more useful information for people. So predictive that time when we are able to not only bring in genetic screening into it, because genetically, we can then tell you what works for your body, what doesn’t work for your body, is when that will also lead to good predictive screening.

And it has to be done scientifically. Unfortunately, we’ve seen, because the market is growing, we’ve seen lots of, you know, people who are not necessarily doing things in a very scientific way into the market, into the industry, a lot of scamming going on of patients, people just being paid to make money for no reason, when actually they don’t need it. Or sometimes the science is not correct, tests are being sold, which we would not recommend.

So I think at Metropolis, our goal has always been patient first. So whatever we recommend is very scientific. If it’s needed by the patient, we’re not here to just make a quick buck.

And it’s all based on some really fundamental science. So my only urge to consumers always is, you know, it’s good to be health aware, it’s good to get these tests done. But considering we all very comfortably spend 1000 rupees or 2000 rupees on a movie, and eat popcorn, and, you know, sit in our comfortable chairs, we really should not be so conscious about whether we are spending 1000 rupees or 2000 rupees on our annual health checkup.

Because honestly, your annual health checkup is going to tell you what’s going on in your body, and direct you in the right direction to take care of your health. So in my mind, it’s a few 1000 rupees a year for those who can afford it, is really a very small investment in something so important in our life, which is our life itself.

Kudrat (Host): Okay, great. Thanks for that. So, you know, I understand the importance of a full body health checkup.

And I also like, while I was doing reporting for our preventative health care testing story, I also came across some of these tests, like the gut microbiome test, and the genetic testing, something called an oligo scan, and so on, which are one very expensive, and then a lot of medical doctors also don’t recommend getting them done. So can you maybe give examples of tests that, you know, are not necessary, that are maybe seeing growth, and that you would recommend consumers to stay away from or think twice before getting them done?

Ameera: See, you brought up a few names, right? Like gut microbiome is the new sort of in thing to do, right? Now, let’s think about it rationally.

How can I tell you whether your gut microbiome is healthy or not? The only way I can tell you is if I have a benchmark for what is healthy. Now, the benchmarks that are there today in the world are the ones which are for Americans, the Europeans, not for Indians.

And our food, our water, our environment is completely different in India. So therefore, if I am looking at your gut health compared to an American or a Caucasian, I’m actually giving you wrong data. Right?

So the only people who can actually give a correct microbiome are the ones who have Indian data, and in large quantities. So companies like us who have had large quantities of Indian data can validate it and say, okay, this is the benchmark. Now, let’s benchmark you against this.

And more importantly, let’s benchmark you to where you will be five years later. Right? So it’s about going with companies that you believe will be there five years later, as we know, unfortunately, in the startup world, suicide rates and death rates are very high.

So you want to be with a company where your data is actually stored for using five years, 10 years, 20 years later. So hopefully, a more stable, a market leader, second, somebody who’s got access to Indian data that actually can give you correct results. So I would only urge consumers not to jump into these sort of fads.

There are lots of longevity clinics, lots of gut microbiome centres, lots of things coming up by people who are not necessarily completely equipped in healthcare. And therefore, they tend to be, you know, more about sort of wild seller package rather than actually giving some real data. So we’ve got to be cautious from that angle.

You know, I already mentioned to you about the predictive genomics, the information, the science is still developing. It’s not there. You know, as yet, you know, I know, there’s like a couple of few firms who do something like they say, okay, you know, do a full MRI, or do a full CT of your body.

I mean, a full MRI of your body is completely unnecessary, because that radiation is not needed for your body at all. Full CT of the body. Now, when you do a full CT of a body, you’re using something called a low dose CT, right?

Because you’re trying to keep radiation low. Now, low dose CTs can only pick up something which really stands out as like really badly wrong. But it cannot pick up something which is like, small, right?

Let’s say you’ve got a small lump in some organ, a low dose CT is probably not going to be able to pick that up. It can probably pick up if you have something very large. So something very obvious.

So again, these low dose CTs, when you do a screening, people take those reports, go home, and then feel very happy. You know, I’m absolutely fine. But you don’t know that, because you have only covered sort of 10 or 20% of your body by doing sort of a full CT scan and not doing sort of other things.

So that doesn’t really necessarily give you, you know, all the accurate data that you need. So I think again, you know, the ideal things to do when they are scientifically correct, at some point will be the genomic screening when it’s scientifically ready. But today, I would say an annual checkup with a cardiac CT for those with family history, you know, with a sonography, with a colon, you know, sort of a colonoscopy.

I would say if you’re able to do an annual health checkup, plus these three, right, you’re actually in a good state. And you don’t need to necessarily go straight for a cardiac or an MRI, I mean, a CT or an MRI or all of those things at this stage. Frankly, it’s unnecessary.

You’re putting your body into radiation and you’re spending money that you probably don’t.

Kudrat (Host): Okay, understood. And so my last question is, you know, you mentioned sort of more scientific testing as well as AI and predictive genomics, step counters, and so on, and kind of putting those together, like that would be the future. So would you, I mean, isn’t there a risk of more information, kind of an information overload, and consumers kind of self-diagnosing using AI, and not really coming to, you know, accurate or useful conclusions, and then getting unnecessarily anxious, because that’s also something that we’re seeing among very small populations.

But, yeah, I was just curious what your thoughts are on that.

Ameera: No, you’re absolutely right. I think there’s a lot of self-diagnosis happening. And, you know, earlier, there used to be Dr. Google, and now there’s Dr. Chad, GPT, and Claude. And, you know, the reality of what’s happening, there’s a combination of things, right? Like patients, people want to understand, they’re seeking information, they don’t necessarily have a space to go. Sometimes doctors don’t have enough time to sit and explain every single step, understandably so, because doctors also have so many patients waiting for them.

So people go and start to make decisions by themselves. People also don’t want to spend the money, and they therefore start diagnosing themselves at home, popping pills, and all of that is, you know, really damaging for the body, right? But we are seeing that a sort of a large primary care is, a lot of it is happening sort of by self-diagnosis, and sort of Chad, GPT, etc.

Obviously, that’s very dangerous, because the reality is, if you go on Google, or you go on any site, most things lead to cancer, according to all these websites, right? And you actually land up freaking out consumers, when something may be totally benign, and nothing to worry about, they get panicky about, oh, my God, this could be cancer. Or sometimes they look at things, and they don’t know how to interpret it.

And sometimes they miss out on something, which is very important, only a doctor with very good wisdom and experience will be able to pick. So it goes both ways. Right? It’s definitely, it can be a tool for you to understand, but it cannot be a tool for confirmatory diagnosis.

And I think that’s the separation that we as consumers have to do. Each one of us works, each one of us thinks we’re an expert at what we do. So the same way in the legal field, we don’t go and chat GPT and start, you know, checking, we may ask our legal position on things, but you’re not making decisions based on that.

Neither are you doing that for taxes, neither are you doing that for anything else in life, right? So the same way, I think, for medical areas, you got to rely on your expert. But I would say that India is got a very mixed bag of very, very good doctors.

And unfortunately, not all doctors are very, very good. So the important thing is also how you choose your doctor and how you engage with your doctor. Indians are also very worried about what questions they ask, you know, they’re very timid about saying, Doctor, I don’t understand this or what medicines, what is the dosage?

You know, so there’s also a lot of diffidence in doing that. So I think really engaging with our health doesn’t mean self-diagnosis. It means going to the doc, asking the right questions, doing our research, checking up on everything, choosing the right doctor.

Often people choose doctors just because they’re next door to them. Right? That’s not the way to choose a doc.

You know, you do your research and really find out from friends, family, other sources as to who’s really the best doctor in the space.

Kudrat (Host): Thank you so much. That’s all from my end. Is there anything else that you’d like to add?

Ameera: No, I think, look, I think the market is going well and I think people are becoming more aware, which is great. As the only thing I hope that people enrich themselves with more information, because consumer awareness is the single reason why more people don’t test and the single reason why people sometimes test the wrong things in the wrong places and then don’t have an interpretation. I’ve also seen a lot of people do their annual checkups.

They get their reports, but don’t follow up. Right. And that’s one of the reasons why Metropolis, we do a consultation after every wellness checkup is because fine, you get your reports, but then do you know what to do next?

That’s the most important part. So I would only urge people that, you know, we really take care of ourselves and we all want to live long, healthy, happy lives.

Kudrat (Host): Okay, great. Thank you so much, Ameera. Appreciate it.

Kudrat (Host): The Core produces The Signal Brief. Follow us wherever you get your favourite podcasts.

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