See Indian’s Philantropy to create World-Class Cancer Center in Bangladore
By Anuradha Raghunathan
For 30 years Kiran Mazumdar-Shaw and Nilima Rovshen were best friends, since their days as single professional women in Bangalore at a time when Indian career women were rare. After Rovshen was diagnosed with breast cancer in 2002, Shaw watched her friend suffer through a long procession of chemotherapy, radiation therapy and immunotherapy. “She is someone I nursed for six years,” says Shaw, India’s first biotech entrepreneur. Shaw took her on a vacation to Spain for Rovshen’s 60th birthday. She died a few months later after whole-brain radiation therapy. “I saw the struggle that she went through–the crippling financial burden, the treatments, the disease itself. I know how awful it is. I just had to do something.”
So after Shaw’s pharmaceutical company, Biocon, went public in 2004–making her India’s richest self-made woman–she kept her promise to combat cancer. Since 2005 she’s donated some $33 million to philanthropic causes, and diagnosing and researching the disease and caring for patients is a big part of this. The centerpiece is the 1,400-bed Mazumdar-Shaw Cancer Center , built in 2009 in Bangalore and specializing in head and neck, breast and blood-related cancers. In 2011 she added a center for advanced therapeutics with a bone marrow transplant unit. And this year she set up a research center. One area of focus is on devising more effective and safer ways to deliver drugs to patients. “I am constantly trying to add value to what I’ve already built,” she explains.
Meanwhile, Shaw, 60, continues to support her original cause–making affordable health care more available for India’s vast number of rural poor. She bankrolls the eight-year-old Biocon Foundation, which offers a micro-health-insurance scheme for villagers, runs nine primary health care clinics across Bangalore’s state of Karnataka and organizes health camps. While the camps are free, the clinics and the insurance plan charge small fees. “My legacy is going to be in affordable health care,” she declares. “I am willing to invest in developing that model and the policies around it.”
Since 2005 Shaw has turned over at least half of her annual Biocon dividends to these programs. And now she has pledged that 75% of her wealth will go to philanthropy after she dies. She hasn’t been approached to sign the Giving Pledge, an effort by Bill Gates and Warren Buffett to get the world’s richest to give half their wealth to philanthropy. “I would certainly sign the pledge as a way to get others to understand the importance of philanthropy to change our world,” she says.
Shaw’s commitment to her causes hasn’t flagged even though her net worth has plummeted since peaking at $900 million in 2010. Last October FORBES ASIA put her fortune at $625 million after Biocon shares had fallen 40% in two years–thanks to a giant marketing deal with Pfizer falling through and then a Portuguese investment bank questioning Biocon’s accounting policies; the company denied any irregularities. The shares have regained 5% recently. Biocon cut its dividend in 2009 and 2010 during the global financial crisis, but Shaw says she maintained her same level of donations. “So far there have been no cutbacks, only increases,” she says. “I would not cut back as I have a philanthropic mission to build a world-class cancer center. All my plans are on track.”
Her philanthropic goals and business goals are closely aligned. Indeed, her overarching business strategy is to develop affordable therapies for chronic diseases. Biocon, with a $93 million profit on $466 million in revenue for the year ended Mar. 31, develops and markets drugs that fight cancer, diabetes and autoimmune diseases. In 2006 it rolled out India’s first drug to treat head and neck cancers. And this year it received Indian regulatory approval for a treatment of the skin disease psoriasis. Biocon is also investing $166 million in an insulin plant in Malaysia.
Shaw’s dedication to her crusade against cancer has been repeatedly reinforced. In 2007, while the cancer hospital was being built, her Scottish husband, John Shaw, Biocon’s vice chairman, was diagnosed with cancer of the kidney. He was treated in London and is now free of the disease. “But I went through a very traumatic year,” she says. “I realized what a debilitating disease it was.” Then in 2011 her mother was found to have breast cancer and underwent a mastectomy at the cancer center. She has survived. “There’s a lot of personal impact because of cancer, and that drives me to do more and more,” says Shaw.
The need is readily apparent. There are 2.5 million cancer patients in India, and 500,000 die each year. Cancer is the second-leading cause of death, after heart disease. And as awareness of the disease and diagnostic skills increase, some one million new cases are spotted every year. This is expected to triple in 20 years. With more than 60% of cancer patients in the 35-to-65 age group, the economic impact is huge. “The incidence of cancer in India is increasing, and it may be because of changing lifestyles,” says Toral Gathani, head of epidemiology at the INDOX Cancer Research Network, a partnership of Oxford University and 12 of India’s leading cancer centers. “In urban India there’s an increase in obesity, which will have an impact on the risk of developing cancer.”
Kiran Mazumdar-Shaw, chairman and managing director of Biocon Ltd., poses for a photograph at the company’s headquarters in Bangalore, India, on Wednesday, Feb. 29, 2012. Biocon is India’s biggest biotechnology company.
Trying to address the scourge, Shaw aims to blend good-quality cancer treatment with affordable care. “The way we look at cancer in India, the way we diagnose it and the way we treat it is so ad hoc,” she says. “It doesn’t give patients confidence that the doctors know what they are doing.” So her Bangalore cancer center takes a systematic approach. There’s a tumor board where each case is evaluated by a team that includes a radiotherapist, a medical oncologist, a pain specialist, a speech and swallowing expert, a financial expert and a sociologist. The board determines the treatment regimen for every patient.
It turns out that Shaw’s upper-middle-class upbringing in Bangalore prepared her well for a business and philanthropic career. Her father was the managing director of spirits company United Breweries, and she studied at Bishop Cotton Girls’ School and then at Bangalore University, where she majored in zoology. She started work as a brewing consultant, armed with a master’s degree in brewing from Ballarat University in Australia. But she couldn’t get a full-time job as a brewer, so in 1978 she veered into specialty enzymes, starting with around $1,000 in seed money. She set up a manufacturing unit with an Irish partner, and it became India’s largest enzyme company. Eventually she transformed it into a biopharmaceutical company in the early 2000s. She says her business training helps her understand the economics of philanthropy: “Philanthropy is not charity; it is about social impact.”
Cancer is a vast field and Shaw is finding her own niches to target. For example, India is the world capital of oral cancer, reporting up to 80,000 new cases a year and 86% of the world’s cases. The widely accepted practice of chewing betel quid, betel nuts and tobacco is primarily responsible. And many poor people use a popular product called “gutka”–a sweetened mixture of tobacco, betel nut and palm nut–as a mouth freshener. Many states ban gutka, but the bans are often ignored. “This is India’s cancer,” says Shaw. “So we must be world leaders in diagnosing, understanding and treating it. In the next few years I want this to be a global center for head and neck cancers.”
The problem with oral cancer, however, is that it’s often spotted at a late stage. One out of three patients dies. So Shaw’s foundation is putting its energy into early diagnosis. Last year it reached out to nearly 2,000 high-risk–read tobacco-consuming–people in rural Karnataka. It trained community health workers to take surveys on their smartphones about tobacco-chewing patterns, among other items. Health workers photographed suspicious lesions right on the spot and sent the images to an oncologist sitting at the cancer center. Two cases of cancer were found. One person is pursuing treatment; the other died because the disease was too advanced.
Now the Biocon Foundation wants to scale up this pilot project to reach 20,000 more people in rural Karnataka. It also collaborates with dental colleges and dentists to find problems so biopsies can be performed on suspicious lesions. And doctors at the foundation’s clinics are always on the lookout for oral cancer. “I’ve referred a few cases–people come in for something else, and then I see some symptoms [of oral cancer],” says Dr. Sankalagere Chikka Putta Swamy Prakash, who runs the clinic in the village of Huskur. He sees 70 patients a day. “There are a number of patients–men and women–who chew tobacco.”
With early diagnosis in the field in full swing, Shaw also sees research as an important piece of the puzzle. At her hospital’s research center, scientists are looking at how to find oral cancer through saliva tests. Also, researchers are building a huge cancer-tissue repository. This will be used to personalize cancer care–to understand who responds best to what type of drug or treatment before administering it. In another advance the research center did a genome sequencing of tongue cancer to learn how the disease progresses. Shaw sponsors two oncology fellowships at the Koch Institute at the Massachusetts Institute of Technology each year. “Through these fellowships I am hoping that we can build a new breed of scientist who will come back to India and work,” she says. “We need people with original research capabilities, not me-too research.”
Meanwhile, the cancer center does roughly 80 cancer surgeries a month. Shaw financed the buildings, the cancer wards and the specialty units, but the center is run as a for-profit business. Low-income patients get free or subsidized care, sometimes covered by the Mazumdar-Shaw Medical Foundation, which Shaw launched this year with $1 million in funding. One patient who benefitted is Appi Reddy, 66, who recently was treated for a brain tumor. He’s covered under a government insurance scheme, but it pays up to $740 only. His bill: nearly $24,000. His family is dependent on a 4-acre farm that grows groundnuts and millet, but with little rain this year and Reddy often in the hospital, there’s not much income. His son, Prabhu, earns just $300 a month at his job, so he can’t pay the hospital bill either. But hospital officials took note and waived many of the charges. “We do our best to accommodate every needy patient,” says Dr. Paul Salins, the center’s medical director.
That’s something Shaw’s friend Nilima Rovshen would have appreciated as her enormous bills were piling up. Her name will soon grace the center’s breast cancer unit, which is under construction. It’s a reminder of her spirited battle with cancer and also of the two women’s long friendship.