‘Key is to capture medical tech at the right time and make it cost-effective’

AIIMS to launch a neurotechnology facility with the Vattikuti Foundation, featuring non-invasive MRgFUS treatment for conditions like Parkinson's and addiction.

The All India Institute of Medical Sciences (AIIMS) is set to inaugurate on Wednesday a new facility for advanced neurotechnology in collaboration with the Vattikuti Foundation. At heart of the initiative will be the MRgFUS (Magnetic Resonance-guided Focused Ultrasound) system, a non-invasive treatment technology that combines real-time MRI imaging with precise ultrasound targeting for neurological conditions.

‘Key is to capture medical tech at the right time and make it cost-effective’(Getty Images via AFP)

The technology has the potential to treat a range of conditions, from Parkinsonian tremors to addiction.

In a wide-ranging conversation with HT, Dr Mahendra Bhandari, CEO of the Vattikuti Foundation, discusses the avenues of treatment the new centre opens up, the foundation’s journey in making advanced medical technologies accessible to Indians, and the need to maintain global standards of care and scientific rigor.

Could you tell us about the new technology that the Vattikuti Foundation is bringing to AIIMS?

We’re introducing a revolutionary focused ultrasound technology that represents a significant advancement in non-invasive treatment. The equipment combines two components: a real-time MRI imaging system -- not just static MRI pictures -- coupled with high-energy ultrasound that can target with nanometre precision. What makes this particularly remarkable is that it’s completely non-invasive; patients simply wear a helmet during the procedure, require no anaesthesia, and the entire treatment takes about an hour and a half.

Tell us a little bit more about how it works?

MRgFUS works through precise localisation and targeting. The real-time MRI provides continuous imaging during the procedure, while the high-energy ultrasound can be focused with incredible precision to target specific areas of the brain. One of the most innovative aspects is the development of a low-frequency fragment that’s reversible. This means we can test a target area, and if the treatment doesn’t work or causes any issues, it can be reversed before making permanent changes. This level of precision and reversibility is unprecedented in non-invasive brain treatments.

What conditions can this technology help treat?

The current FDA-approved applications are for essential tremors and Parkinsonian tremors. The results have been remarkable -- a paper published in a leading medical journal demonstrated 67-68% complete, durable relief lasting for three years, achieved entirely non-invasively. What’s particularly exciting is watching patients who come in with severe tremors leave the procedure able to perform normal activities.

But the potential applications go far beyond this. There’s promising initial research work being done on neuropathic pain, brain tumours, and epilepsy. We’re seeing potential applications for substance abuse and addiction treatment. Researchers have published cases where they’ve been able to identify craving centres in the brain using fMRI, showing the patient substances that trigger these centres, and then precisely target these areas. This could potentially revolutionise addiction treatment.

This sounds like expensive technology. What are the cost implications of such treatment?

We’ve negotiated extensively with the company to bring the cost down. We achieved this by showing the company [which distributes the machine] the potential for quick clinical trials in India and the importance of making the technology accessible.

This pricing strategy reflects our broader philosophy: we never want to bring a technology that’s only accessible to the very wealthy. The foundation has always focused on combining philanthropy with practical business sense, selecting high-volume areas where we can make a real impact while ensuring safe, scientific implementation.

The foundation, as I understand it, has had significant role in making robotic surgeries accessible, both in India and the US. Can you walk us through this journey?

The technology’s origins trace back to NASA and DARPA, who invested heavily in developing robotic surgical systems. Initially, they were exploring possibilities for remote surgery applications. When these specific applications didn’t materialize for human use, the technology was made available for civilian applications. This eventually led to the development of surgical systems by various companies, with Intuitive Surgical developing the da Vinci system that would become widely adopted.

Initially, it was developed for cardiac surgery. Dr. Mani Menon [Vattikuti Foundation’s founding director] was among the first to see its potential for urology, particularly for prostate surgery. The company was initially reluctant -- they told him the robot was only FDA-cleared for cardiac surgery. But Dr. Menon persisted, and the first operation was actually performed on a Ford employee in Detroit, which was fitting since Detroit was where robotics was first used in the car industry. The patient’s response was memorable -- he said he would trust a robot any day over human beings because he had been using robots for 20 years in the industry.

Dr. Menon then developed what became known as the Vattikuti Institute Prostatectomy (VIP), which is now the standard of care for prostate cancer surgery worldwide. When I joined in 2006, only prostate operations were being done. We then worked to develop procedures for other urological surgeries.

Where does the India story begin when it came to robotic surgeries?

In India, there were six robots until 2010, and in those 10 years, they had performed only about 200 surgeries combined. The last robot had been sold three years prior. We saw this as an opportunity to develop a different model , what we called a multi-specialty model. We wanted to exploit high patient volumes here and maximize capacity utilization, making it more like a Walmart model with low margins but high volume.

How do you ensure appropriate use of the technology?

This is crucial to our mission. We’re very clear that no modality is good unless it improves patient outcomes. I always tell our surgeons: “Think of the patient -- they don’t know what happens in the four walls of your operating room.” The technology doesn’t compensate for poor surgical technique. There’s a saying that “a fool with a tool is still a fool.”

We’ve been quite strict about preventing the overuse of robotic surgery for simple procedures. For instance, if a simple nephrectomy or gallbladder removal can be done effectively with a small incision, why make the patient spend more money for robotic surgery? My personal acid test was always: if this were my brother or father, would I recommend this same procedure?

In recent years, the technology boom has also been accompanied with hype bubbles. How does the foundation evaluate new technologies?

Our evaluation process is patient-centred. We look at technologies not just for their business potential, but for their ability to make a real difference in patient outcomes. We maintain extensive databases and have published over 40 papers to provide evidence-based validation of our approaches.

Take our current focused ultrasound project ; we waited until there was sufficient proof and FDA approval before bringing it to India. We’ve been monitoring this technology since 2013, but we only decided to move forward when we saw conclusive evidence of its effectiveness through peer-reviewed studies.

What’s your vision for the future of medical technology in India?

Our vision is to capture these technologies at the right time -- not prematurely, but when there’s enough proof -- and make them cost-effective by combining philanthropy with business sense and scientific rigor. With the focused ultrasound technology, for instance, we’re already thinking about its potential application for addressing the addiction epidemic in places like Punjab.

We’re also working to encourage innovation in medicine. What we’ve found is that European and British medical students tend to be more innovative in their programs, while in India, everyone is primarily focused on postgraduate seats and NEET exams. That’s why we started a competition for medical students, we call them the explorers. We select teams from around the world, and this year we have participants from the United States, Italy, Romania, India, Belgium, and Turkey.

Our experience shows that with the right approach, we can make advanced medical technologies accessible while maintaining high standards of care. Everything we do must ultimately benefit the patient - that’s our constant focus.

Lastly, the story here is also of three immigrants from India having had a major role in life-saving technology and procedure. The story has been featured in the Smithsonian too. Tell us a little about that.

During the Trump administration’s first immigration debate, the Smithsonian found our work compelling because it involved three immigrants who contributed not just to the US but to the whole world. First was Mr Raj Vattikuti, who came to America as a student to do his masters in computer science. He became an entrepreneur, created successful companies, and then chose to give back through philanthropy. Then, Dr Mani Menon, from Kerala, was recognised for developing robotic surgery. And I was recognized for bringing these advancements back to our country of origin.

Did this immigrant perspective shape the foundation’s mission?

We had this unique perspective from the beginning . We knew these technologies would take 20-25 years to reach countries like India if we followed the traditional path. But being immigrants who understood both worlds, we could envision ways to accelerate this process. We knew how to adapt these technologies to different health care systems while maintaining the highest standards of care.