Healthcare Unfiltered
Healthcare Unfiltered is an honest, raw, timely podcast tackling any and all topics in healthcare that affect stakeholders. Dr. Chadi Nabhan uses his dynamic conversational skills to challenge his guests to address controversial and important topics. He also brings on world renowned experts to discuss clinical advances in medicine.
Healthcare Unfiltered
Episode 281: Precision Oncology in India With Sewanti Limaye
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Chadi is joined by Dr. Sewanti Limaye to discuss what precision oncology looks like in India, exploring the realities of access, affordability, infrastructure, and innovation in cancer care. Drawing on her experience training and practicing in the United States before returning to Mumbai to lead oncology and translational research programs, Dr. Limaye explains which genomic tests, liquid biopsies, and targeted therapies are currently available in India, the challenges surrounding out-of-pocket costs and insurance coverage, and why helping even a small percentage of patients access precision medicine can have a major impact. The conversation also covers clinical trial capabilities, lab turnaround times, international players in the liquid biopsy space, and the complexities of FDA-approved drugs that remain unavailable for prescription in India.
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Folks, it's Shadi Nabhan. It's Healthcare Unfiltered. We are in season number six of Healthcare Unfiltered. I appreciate you tuning in every week to Healthcare Unfiltered. I'm a hematologist and a medical oncologist. I have interest in all aspects of healthcare delivery, treatment, leadership, mentorship, and policy. I really value your support. Today's podcast is very exciting, and I'm very I I have a I have a guest that I have admired for her ability to actually bring science, innovation, clinical trials to India, where she is from, after being trained in the US and practicing in the US for 10 years. It is not easy to leave the US after being here for 20 years and go to your homeland and try to bring the science and the innovation to the people there. Dr. Siwante Lime did that, and she is currently practicing in Mumbai. We had met a few times, last time at ESMO 2025, and I've asked her to come on the show to share with you all what does precision oncology look like in India? What type of tests are available? What type of therapies are available? What type of access do patients have? I think a lot of times we get spoiled a little bit in the US because we have access to everything that we need, at least for folks who have insurance. But what about people who don't live in the US? And that's the purpose of today's podcast. What about precision oncology in India, a country that has 1.5, 1.6 billion people? And you could imagine that uh depending on which cancer we're talking about, the absolute numbers that could that are always measured in millions. It's an important podcast episode on healthcare unfiltered to try to understand the science, the medicine, what's happening outside of the United States. So, Dr. Siwanti uh Lime on Healthcare Unfiltered discussing precision oncology in India. Well, folks, you always know how excited I get when I have a first timer on Healthcare Unfiltered. But this episode is so special for me, not because I am interviewing um uh an amazing investigator who I admire a lot, but also because we are like in time difference that's about like 12 hours, and it took us forever to organize this. Siwanti, Dr. Lime, welcome to the show.
SPEAKER_00Thank you. Thank you, Chari, for having me. It's a true honor. And of course, we had to go through so much uh adjustment to figure out our time zones, and finally we are here.
SPEAKER_01So, really we made an opportunity.
SPEAKER_00Thank you.
SPEAKER_01Where are you calling from?
SPEAKER_00I'm uh calling you from Mumbai, India, uh, which is in the southern and western zone of India.
SPEAKER_01And that's where you practice?
SPEAKER_00That's where I practice, that's correct.
SPEAKER_01So that's a good segue to tell us a bit about you and uh and you know your training because you're just multifaceted, you have such a good understanding of the world of oncology, not just like the US, India, Europe. Uh so tell us a bit about you and how did you end up being in Mumbai?
SPEAKER_00So I come from India originally, of course, and uh I trained in the US and I practiced in the US for a while before I came back for family reasons. And uh now I practice at a center called H Reliance Foundation Hospital. It's um it's one of the leading centers in Mumbai, and I've now been here in India for 10 years. Prior to coming back, I was at Columbia Presbyterian working as a faculty. And uh you know, post that I relocated for family reasons, and I've been practicing as precision oncologist and medical oncologist here at RFH.
SPEAKER_01So you really have a good visibility into both worlds, which is really the uh the theme of today's podcast.
SPEAKER_00That's correct. So, yes, I have uh I feel like I have um uh I've now I have the pulse of India, having worked here for a decade. And um I also feel like I know the way US works, having trained and worked as a faculty in the US for a while before I returned back home.
SPEAKER_01Is there a specific area in oncology? I know you do precision oncology, we're gonna talk about that, but is specific tumor that you focus on, or are you doing more translational uh uh phase one type of thing?
SPEAKER_00So uh my um entry into solid tumors. So actually, I trained at Long Island Jewish uh Northwell uh in Long Island, New York. And uh from there, uh it was I trained at a very hematology predominant program, but um I was very it Dr. Kanti Rai was my chair. And uh but right from the beginning, it was very clear in my mind that my heart was with solid tumors. And um, there was a time during my fellowship that I wanted to do only solid tumors and I wanted to drop out on hematology, but I was good at it. And so my uh you know, my mentors, of course, um had me complete my fellowship as is, and then I went on to um be a solid tumor doc at Dana Farbur. I did uh head and neck. Um, I entered into solid tumors through head and neck, and then I did drug development with Jeff Shapiro. So head and neck with Robert Haddad and uh phase one with Jeff Shapiro, and that phase one actually broadened the outlook into translational medicine. And um uh and it's that day and it's today I never changed because um I came to understand pathways beyond an organ system, and uh that was actually transformative, and from there into Columbia Presbyterian, where I did all of aerodigestive and phase one, and then to India, where um I felt um broadening into all of solid tumors was the need of the hour. I still did not go into liquids, um, but I may have as a translational person, but I uh stayed with uh solid tumors, but I now practice all across different solid tumor types, mainly across solid tumor types, understanding pathways and uh tumor microenvironments and trying to um design therapies based on uh these realizations from um patient profiling and understanding the molecular landscapes.
SPEAKER_01Sijuanti, when you made the decision um to return to India for family reasons, which is very admirable because obviously family always comes first. Um were you did you have some concerns whether you'll be able to um do the same level of research, the same level of uh studies that you were doing in Colombia, the Dana Farber?
SPEAKER_00Yeah, I was very, very concerned. And I remember I had um, you know, back in those days, we still had a lot of uh stuff on um uh you know, de-identified stuff. Um the projects that I was doing, I still had them with me from Dana Farber, from Columbia Presbyterian. I remember telling my friend and mentor, Dr. uh Robert Haddad, I met him at ASCO and I said, Robert, I'm it looks like my research side is done. And uh, here's some data that I have from my previous projects, and uh may I give them back to you. And I remember him taking me in uh on the side and uh telling me, Sivanti, who knows? You know, um, you may be that name in that part of the world that we will look out for when we look out for our clinical trials. So don't uh think in the wrong way. And we have a lot of expectations. And I always remember that uh conversation and um the encouragement that it gave me. And till date, um I am working towards towards that expectation.
SPEAKER_01Tell us a bit on the environment that you're working at in terms of the type of hospital, the just to take us through the the hospital and the institution you're at so you better understand uh what it is.
SPEAKER_00Yes. So I actually work at a state-of-the-art um private center in this part of the world. Um, we I would say cover, we serve uh 1% of India that can um privately afford a lot of the medications and therapeutics that is a requirement in um in cancer medicine. Having said that, my heart lies uh in serving the 99% of India that may not be able to afford, uh is not able to afford a lot of the um novel therapeutics uh that is um a privilege for the rest of the world. So as uh as a clinician investigator that I have been in my life, previous life in the US, that was one of the biggest undertakings for me when I came back here. And I actually then initiated one of the larger um presence of clinical trials in a private corporate setup in India. And one of the first in Mumbai at a private center. So I opened a clinical trial center in my previous hospital. So I'm at a second institution now, in the first institution that I'd come to.
SPEAKER_0122 is small in number when you compare to the being harsh on yourself, that's not small.
SPEAKER_00So uh where I was coming from, of course. So uh uh and one of the realizations was that even when you opened a trial center at a private center, you actually serve uh the underprivileged. And 90% of the enrollment in those trials were actually people that were below poverty line. And so somehow the word got around for clinical trials, which is not the favorite in India. One of it's not one of the most favorites because people still think of trials as um an experiment. And uh to an underprivileged population, that may be exploitation. So there's a lot of work that has happened in the awareness uh arena for the younger generation to come forward and seek trials. And um, so that is the goal to build larger clinical trial presence in India. And just as of two weeks ago, at one of my uh pivotal meetings that we hosted at our institution, we actually launched the first um clinical trial consortium uh in solid tumors in India. So um so small moves but definite moves, and uh this is towards serving the larger India. Uh, coming back to the center that I work at, um, privileged because we have um access to the 1% of population that can pay out of pocket. Uh, 80% of cancer care in India is still coming out of pocket. And uh these when I say out of pocket, I also include the um patients who are insured with um uh insurances that will cover them across the board. So there are um private insurances that provide for insurance coverage for novel therapeutics across um India as well as cover the insured population if they were to travel outside. So we cover such uh patients, we also cover patients who can pay out of pocket, but we have um already an established clinical trial center, and we are elaborating on that to be able to accommodate uh newer trials, but these are still in very early stages of development.
SPEAKER_01Sijuanji, India is so big. When you say India, does it matter the region? Like, I mean, is the same the same applies in Mumbai versus Delhi versus somewhere else?
SPEAKER_00So, yes, um, I I think uh that way India is very uh uh aligned. You know, if there was a clinical practice or um a rule for um using a treatment in Mumbai, the same rule would apply for that treatment in Delhi or Kolkata or Bangalore or Madras, you know, the the rules would still be the same. The language may change, the application and awareness may change, um, the clinical trial center may be near or far, but the rules, as per the director controller general of India, the regulatory body would still be the same. So approval for um a drug for a particular indication would be the same all across India. I'm gonna give you an example. So let's say we have Nivolomab, and Nivolomab is approved for certain indications, and newer indications uh get approved through DCGI. It would be the same for Delhi as it would for India, for for Mumbai, and it would be the same for Mdabad or Jaipur. It would be homogeneous homogeneously applied.
SPEAKER_01I see. Okay, that's that's very helpful. Okay, let's let's step back a little bit. Um, I know we're gonna talk about the clinical trials. Maybe we'll we'll start there because you mentioning it. Are there specific trials that you can execute on based on resources versus trials that you can't? Uh, in other words, can you do phase one studies, which are more taxing versus phase three versus phase two uh almost open menu, or you have to be very selective which trials you can open?
SPEAKER_00So, you know, uh as a researcher, some of the things that have become very clear to me regarding the uh the thought process of the local population, you know, that is very important. One always needs to keep in mind how the community is thinking when you open a trial or when you open centers of trial, you need to know how your general population is going to behave. What is going to be the receptiveness of a particular idea? So, in that, when we look at uh phase four, it's the vast uh acceptance to phase four, right? It is the best accepted because that's how you present. This is a drug that is already approved in lung cancer, but I'm gonna be able to give it to you for free. And there is not a whole lot of experiment in there. The phase four is being done to collect Indian data. So that's most widely accepted. Then coming to phase three. The phase three will mostly give the patient the opportunity to still get standard of care, but we are building on standard of care by adding this medicine. And there's already so much data, it's safe, and um, there is a certain degree of efficacy that you can quote from the previous trials. When it comes to phase two, you go into a little bit of um unknown zone, but still it's not entirely unknown, and it is um, you know, comes with a certain degree of validation. When it comes to phase one, and especially the dose finding part of it, that is true experiment. And I think um we are in India not yet uh totally ready to get there, it's in a very, very preliminary stage. I think where we are a little more accepting for phase ones is the phase one Bs, where we are already um post dose finding, so the dose expansion mode is a little more feasible, but um other than certain select centers, India is still evolving at demonstrating that they can run the early phase trials in the most organized way. So I think um, other than uh leading centers like ours or Tata Memorial Hospital, uh, we would offer ourselves mainly for late phase trials, and the early phase trials are still a work in progress.
SPEAKER_01Um I love what you said about aligning the available clinical trials with the culture of people that live. That is that is gold. That is absolutely important. So you identify yourself as a precision oncology physician, and I got to know you by you being a precision oncology physician. So that leads me to ask questions about testing. Yes, in precision oncology, you need to have the ability to test what kind of testing available in India for you to be able to conduct precision oncology medicine, either in trials or in practice?
SPEAKER_00So I just want to give a perspective. India is of is made of a billion and a half population, right? So that's a very large population we are dealing with. Even if one percent of India is able to pay out of pocket, that's still in absolute numbers, a very large number.
SPEAKER_01That's a lot.
SPEAKER_00Yeah, that's a lot. So, you know, initially I used to get discouraged thinking, oh, only this select population is going to be able to pay. But then I truly woke up to what it meant when I internalized the fact. And I feel even that population needs to be navigated, needs to be served, needs to be made aware. So essentially, uh from that perspective, coming on to the fact that a lot of these tests are expensive. So when we talk about comprehensive genomic profiling, it is an expensive uh way of testing. Can we do hot spot panels for um for most tumors? I come from the door of lung cancer. Having been a lung cancer doc at Columbia Presbyterian, uh, a lot of the visualization of precision comes from the door of lung cancer. And when you look at lung, yes, you can do a 52-gene panel, you can do a lung panel, 18-gene lung panel, and get a lot of lead into therapy. But bringing that same meaning into a sarcoma or bringing that same meaning into um esophageal, squamous cell, you know, metastatic esophageal, squamous cell may not be uh happening. And that's where broadening the profiling from an exploratory perspective becomes most critical. So, is are these tests available? Yes, I'm just actually writing a review for JIPO on what tests are available in Asia, and um I I was outlining how uh hotspot panels are definitely available, but we also have the gardens and the foundations and the tempuses available for pickup from India, and we send good um percentage of our samples to international tests that pick up from India, but we also have um we have a CAP and a clear accredited lab sitting here in India, and actually their biggest market is Europe and US, and they are a homegrown Indian company, and we have other Indian companies that are out here that have well-validated comprehensive genomic profiles that are available for much lesser cost.
SPEAKER_01So I think on the tissues, on the tissue side, sorry, on the tissue side, before we go into the liquid, on the tissue side, all of the usual suspects, all of the usual companies you're able to order through them. Yes, as well as you're able to do internal sequencing, internal NGS, like there are some homegrown hospital-based or just homegrown companies.
SPEAKER_00So these are mostly so India is unique that here we have less hospital-based, but more private players. And I think that uh for a precision oncologist like myself, it makes sense because if the hospital doesn't have that much volume and they're not able to improvise on their kits and they'll force us to use the old kits, I would rather work with um, you know, outsourced companies. But these are very competitive companies that have presence in India, they have presence abroad, they're selling in the region, and they are constantly updating their science to present the best kits, um, most uh Updated kits. And so we have uh, I would say not entirely frugal, but very economical availability of uh precision-based testing in the country from these homegrown labs that are very well validated and they cover from germline to smaller targeted hotspot panels to comprehensive testing to whole exome testing. We have a lab performing whole genome testing as well.
SPEAKER_01We have a lab that's amazing. I did not know that. So you have homegrown labs doing whole exome and whole genome. I mean, that because I was gonna ask you actually if you're just outsourcing this, yeah. I mean, I think maybe in the US, maybe they have some labs outside the US. Like, what's the turnaround time?
SPEAKER_00So uh when we look at Indian labs, um, the turnaround time is mostly, if you have Illuminar base, it's mostly two weeks to three weeks. I work with um lab uh very closely uh with Illuminar base that has promised me 12 days. So 10 to 12 days turnaround um is this Illuminar lab. I work extensively with a thermofissure-based lab where the turnaround time is actually five days. So um liquids in three days and tissue in five days. Wow, that's the timeline I work with, and I'm very habituated and and completely hooked to this.
SPEAKER_01I've never heard I've never heard five days.
SPEAKER_00Right. So, you know, this is where five days is a stretch, they get their results in three days. So five days is when I get it in hand, and so very, very fortunate to be working with these labs because turnaround time is very critical in India. India is a large country, people travel from one part of the country to the other part to get some precision knowledge or guidance. And if they've come from outside, you know, funding is less and time is critical, and you need to answer them these questions very quickly so that um then you can guide their therapy in this tight timeline. So I think max we stretch is two weeks, and I'm always constantly on their back to get me an answer sooner than that, and within the week is a luxury, but I do have that luxury.
SPEAKER_01So, so and this is when you order these tests, at least in the hospital you're working at, it's paid out of pocket by the physic by the by the patient. Um other patients who are not paying out of pocket, is there a public system where the government pays or private insurance? Like what do the other 99% of people do?
SPEAKER_00Yeah, so um, you know, there are uh there is coverage uh from insurance for 20 to 30 percent of people, right? Um, that that seek cancer care. And government has launched a nationwide program um under which post-diagnosis of cancer the funding comes for testing. And um so certain guidelines, local guidelines, Indian guidelines are in the making where um smaller panels are getting funded by the government, and um uh both from the perspective of um uh government uh uh funding happening for the uh post-diagnosis coverage of genomic analysis, as well as some pitch now from the policymakers for helping with the diagnostic testing as well, because diagnosis, post-diagnosis testing is there, but diagnosis gets delayed because we don't have the national programs covering that. So a lot of work happening in that area. There are also companies in India through different initiatives that are giving the tests for almost negligible prices. So 80% covered by the company, 20% covered by the patient, like a copay, but very, very meager pricing for these tests, uh, especially covering the hotspot panels, which are mostly the druggable panels. And um, those are of meaning when you look at uh quick action, quick targeted action for these patients. So a lot of work happening through um public-private partnerships as well.
SPEAKER_01We talked about the tissue testing. I want to just talk about liquid, and there are obviously, at least in the US, we know the Netera, we have all of the other companies, you know, Gardent, we exact, and every company has a liquid thing. What are you doing for liquid biopsy in India?
SPEAKER_00So the most uh um prevalent international players that have a good amount of pickup from India are uh Garden and Signatera, and we have Tempest XF also from here, and we have uh Liquid Foundation. So all these four are definitely there. These, um, of course, you can understand, is only serving corporate centers that are um able to pay out of pocket and want uh world-class standard testing. Uh so we have a good amount of business happening from the um, but we have again, we have very, very um strong presence of local labs and these local labs.
SPEAKER_01Okay, but how would you like why would you even choose any lab that is not local? Because it seems to me that you have the ability to get the local lab for tissue and liquid at the frankly a record time, like why would you even use any outside lab?
SPEAKER_00Yeah, so you know, because of certain um strong points of these outside labs, that um uh one very strong point is a lot of these tests are actually validated in clinical trials. So if I were to use limit of detection for MRD, I would be much more comfortable using the signatera uh limit of detection.
SPEAKER_01I see, I see what you're saying.
SPEAKER_00And a local trial that has local test that has um yeah uh has launched, has validated and launched, but has never run their LOD.
SPEAKER_01I hear the validation. Okay. I have good understanding of this. You have you have access to testing. Yes. So now this takes us on the other side. Now, if you have the test results, we need to have the drugs that you treat. Are there any drugs that we have in the United States that are approved by the FDA that you cannot prescribe in India?
SPEAKER_00Many, many I can prescribe, but it's just not available. And uh, you know, one star drug right now, which is a heartache for each one of us, is sacetosum avgovatican. So Trodelvi is is being imported in India for humongous amounts of costs. And um, you know, are people importing? Yes, but why is it a heartache? Because I can tell you that even out of that one percent that is elite, only 10 to 15 to 20 percent will be able to afford such a cost.
SPEAKER_01So they're not cheaper in India, they're not cheaper in India.
SPEAKER_00No, because we are importing, whenever you are importing, the cost is at least um you know, four times to six times the cost of when it will be a part of the Indian drug system, the cost will be at least six times cheaper. Even for a novel molecule like uh Sassetuzumam, it would become five to six times cheaper when it's launched in India versus what it is when we import. And we have NHER2 that we had to go through a similar process around uh two years back, it was launched in India. And the price, the difference between when we were importing to when we are buying out of pocket in India is three times less. So that's how it becomes, it becomes much more reasonably priced, even if you're buying out of pocket when it launches in the country.
SPEAKER_01It must be very difficult for you sometimes when you have the actual results. You want to prescribe a treatment that you know it works and you can't.
SPEAKER_00Yeah, all the time. That is all the time, and uh the volume is so huge, Chadi, that now um I've been here for a decade and it actually feels like being at a battlefield. And I say this all the time. Those who um one can save, one saves those who one is not able to save uh because of lack of clinical trials, lack of drug availability. Um, even young patients perish. And uh that's the biggest heartache of an oncologist.
SPEAKER_01Yeah, I mean, I could really only imagine. I do think that uh maybe the opportunity is for some of these drugs, like you said, to be manufactured there, because then it actually the access becomes easier. Much easier. What you're saying, some of these drugs, even if you can, even if you can buy buy it, it's just not even even feasible. Do you see that changing anytime? Like, do you see, I mean, you've been there for 10 years. Do you see any changes? The government is doing anything to make that uh different or accessible?
SPEAKER_00There is a lot of uh movement around that. When will it actually happen? Uh, we will only find out once it starts to happen. There is a lot of um uh Me Too drugs um that are here in India, and when I say that, it is mainly the you know, Nivolumab was actually launched. Uh, it's still not off patent, it is going to be off patent in June, but there is a company that has manufactured um and there is uh an ongoing litigation on it, but always yeah, but it what it tells you that these Me Too drugs are are happening. What is not happening is how we see things moving in China. That's not happening in India yet, and the hope is that in the next uh year or two years, that movement will actually begin where the novel drug development will begin in India. It is still not happening. I there is a lot of uh discussion around it, there is a lot of movement around it, but the real uh movement will be when you see such GMP facilities uh uh going ahead and producing novel molecules, but that's not happening yet.
SPEAKER_01You mean in China they are producing these novel monoclons?
SPEAKER_00Yes, we actually just India just launched three PD uh one inhibitors that are novel inhibitors uh uh that coming out of China. We launched it in India uh just recently, three months back or six months back, but uh we are still not manufacturing our own.
SPEAKER_01Yeah. Well, this was very helpful, by the way. I mean, thank you for enlightening us with this. Uh, maybe in the last few minutes, I'm curious about, I mean, you said you serve obviously the you know this one percent. I know you have a passion to be able to serve the remainder of people that you can, and you're bringing trials to the country. I mean, this is really amazing and admirable. But anytime that you are seeing these um 1% and so on, you are going to encounter celebrities, you are gonna encounter people who sometimes could be a bit more difficult, and their expectations are not always easily matched. Have you encountered something like this? Uh, and can you share with us some stories?
SPEAKER_00So um actually, uh, because I live in the Bollywood town, we serve um celebrities from Bollywood, we see we serve leaders from the country as well because of the hospital that I work at. Um in general, I found them very humane, you know, and uh cancer is also a very humbling disease. Um, so I feel that as long as um we as clinicians don't get drawn into the frills and uh the um the celebrity or the leader is also coming to us for what we are made of and what skills we have and what how we can anchor their case and their disease. Um, it is a journey that we walk together. Um, but uh my uh biggest uh revelation into that has been with working uh with some of the celebrities who are actually uh really um the nicest human beings. And one of one such celebrity is Mr. Sanjay Dat, who is um uh you know, he's a megastar in this part of the world and globally, I would say. And uh we treated him for lung cancer, he's done very well. He got the keynote 189 regimen with Pembrolizomab and chemotherapy, he's been very open about his uh diagnosis, his treatment um right from the beginning. So, a few things that I learned from uh taking care of him when I initially, when he had come to me with diagnosis and I had asked him, Sanju, how would I how would you want me to present it to the media because um you've gone out and spoken to them and that now they know that I'm your doctor and uh we have been approached multiple times, but I don't want to say anything that you would not want me to say. And I remember till this date him telling me, please say as is. I do not want to present anything differently, please say as is. And so I I think that um they are also uh uh uh human beings like us and many times uh more brave. I think that was very brave of Mr. Sanja Dats to have uh come out and stood in support, in solidarity with the disease diagnosis, with precision, with the treatment from immunotherapy. And he's actually been one of the biggest patient advocates from this region since his diagnosis. So um I feel there is a tremendous, I feel tremendous regard and respect for uh such a person who may um be you know temperamental or different in their own um uh work environment. But when coming to the cancer journey, I've actually only learned from him. He's also a very big proponent of exercise, and himself, he exercises two to three hours a day and uh you know speaks very openly about that. And I think uh with the new uh data coming out, especially the New England Journal publication uh with colorectal cancer and exercise and improving outcomes and survival, I think that uh really cannot be underlined enough. So a lot of uh great experiences with um the uh celebrity world, but also one message that goes out they are true influencers. So if someone is uh brave enough to um leave the privacy of diagnosis and treatment and come out in media and speak in support of the cancer awareness and cancer movement happening in India, I'm absolutely for it and I um welcome that thought and put forward myself to support their movement wherever I can and their support mine as well.
SPEAKER_01Well, anytime uh you and your patients want to come back, you know, you can bring them with you. I mean, we're happy to have them.
SPEAKER_00I would love to do that and and see see their, you know, bring bring out their perspective because there's always a different perspective.
SPEAKER_01Yeah, I've had actually patients and caregivers on my show. I think it's always important to do that. So we're always welcome to have them on. Uh Sivanti, this was really amazing. I last question, I promise. Uh, you've had 10 years in the US, 10 years in India. I'm nothing replaces family, obviously, you know, being close and so on. Um uh when you look back, would you have done it all over again and left the US and went back to India?
SPEAKER_00So you you know I was gonna ask you that.
SPEAKER_01You know, I was gonna ask you.
SPEAKER_00So 20 years in the US and 10 years in India, you know, it was a very long time in the US. So I have a very soft corner for New York and US. And uh, if I had to do it again, I'm not so sure if I would have come back because this is this was a huge challenge. So um I probably would have done it slightly differently. I still do have uh an American company. I run a precision, uh private precision company with which we do concierge consultations for patients and help them navigate to clinical trials and therapies. Uh, so I still uh do operate in both worlds, but I feel that uh there is much more service in India and life fulfilling goals for what one can do for the Indian community and so much work that needs to be done that I'm not able to pinpoint because we are all naturalized, we could go back um in a jiffy, but I'm not able to pinpoint why we continue to be here and serve. And uh, you know, with the uh with with the clinical trial consortium launch, we also launched a patient advocacy alliance. And the idea is to really wake up uh the community, the nation, wake up to not just cancer awareness, cancer therapies, and precision-based therapies, but also to um early diagnosis. And who knows, we may be able to bring back to the world a lot of work done in uh methods of early diagnosis and especially looking into precision-based uh screening methods, especially into liquid biopsies. And so uh a whole lot to do here and uh uh a lot of excitement, but I think the answer is going to be bridging the gap. We have to figure out methods to bridge the gap between India and the West, and that is going to have the answer.
SPEAKER_01Well, Sivanti, congratulations on everything you're doing, and a big I'm a big fan. You're doing amazing, amazing work, and I really appreciate taking the time to join me today.
SPEAKER_00So, needless to say, I am a big fan and thank you for having me, Chaddy. And you are doing great work by bringing to light and bringing people like us uh into your conversation and uh allowing us the voice and the podium. So, true gratitude and thank you for having me, and more power to you in the work that you're doing. Thank you.
SPEAKER_01Okay, folks, thank you so much for being on today's podcast. Thank you, Sivanti, for joining me on today's podcast. I appreciate the time that you provided and the insights that you gave us. Uh, thank you to my listeners for staying with us on today's show, and thank you for subscribing to Healthcare Unfiltered. Please do tell your friends and colleagues about the show. Please let them know to subscribe, join the conversation, comment. You can watch all of these episodes on YouTube. You can check out my website, shadinabhan.com, where all of the episodes are actually present. Folks, check out my books, The Cancer Journey, Understanding, Diagnosis, Treatment, Recovery and Prevention, and Toxic Exposure, the true story behind the Monsanto Trials and the Search for Justice. My next book, AI and Cancer Care, When Machines Meet Modern Medicine, coming out in September 2026. And my first novel, Fiction, is coming out later in 2026 this year. Before I let you go, I'm gonna leave you with a saying by a Lebanese poet Khalil Jibran. Out of suffering have emerged the strongest souls. The most massive characters are seared with scars. Until next time.