An Interview With Dr. Vishal Rao

July 2022

By Catherine Saez, WIPO

He describes the journey that led to the invention, the joy of giving their voice back to patients, his focus on social innovations, access, and affordability, and his belief that innovators should be working to solve individual problems rather than seeking to address masses in pursuit of commercial gains. He underlines the importance of patenting social innovations, talks about broadening access to the device for poor people around the world, and shares his vision of the future of medicine.

Can you introduce yourself?

I am a surgical oncologist, specializing in the head and neck. It is a sub-specialty of oncology that deals with ENT, i.e., Ears, Nose, and Throat. I am also the country Director for head and neck surgical oncology at the Healthcare Global Cancer Center, and the Dean of the Center for Academic Research at the Center. My core competence stems from my identity as a surgical oncologist, but I strive hard to be an innovator, problem solver, and horizon-scanner. I call myself a “possibilitarian”, somebody who is intent on converting possibility into actuality.

Can you tell me about your personal path and what led you to medicine?

It is a very strange story. I was always obsessed with physics and mathematics and always thought I would pursue a career in either astrophysics or mathematics, or find my calling in biking, another fiery passion of mine. However, although I did very well in physics and math, I did exceptionally well in biology, which I see now as a strike of destiny.

My mother, who, at that time was my official career guide, advised me to pursue medicine as she felt I would be able to touch lives and also put physics and mathematics into practice in a holistic manner. Back then, there were fewer career options. I did not have many people around me to give me prudent career advice. Therefore, I followed my mother’s advice. Medicine came in accidentally, and I was unsure of my choice until my last year of studies. It was all about curriculum and studies, and the weird part is you start your first year of medicine in front of a dead body, and in the last year, you see life. It is all very paradoxical!

How did you also become an inventor?

I like problem-solving as mentioned earlier. One of my teachers introduced us to design thinking. He would never give us the solution; he would always put the problem before us and would make us sit before it and move systematically towards a solution. Problem-solving thus became second nature to me.

I realized the founding of medicine lies in biology, which has its secrets in chemistry, intricacies in physics, and its enigma is explained by mathematics. I connected all of this to start looking at medicine in a unique way. I always believed there is nothing such as an invention, I think we are merely rediscovering. We are sitting on the shoulders of giants and standing taller each passing day. Nothing more, nothing less!

How did you turn into an entrepreneur?

The entrepreneurial journey is as complicated as the spelling of the word itself. Entrepreneurship is essentially about studying and understanding how to fail successfully. A successful entrepreneur is someone who has actually scanned the entire horizon of failures. He has understood every aspect of it and he evolves into an entrepreneur because he has actually been through that journey. Through my journey into failures, I think I have secured a Ph.D. from the university of life. I have failed in all aspects of it. I always tell my juniors and students to keep thinking along these lines. I am a proficiently failed entrepreneur.

Can you explain how you had the idea of the Aum Voice Prosthesis?

A few years back I met His Holiness the Dalai Lama and one thing he shared was that an idea comes to you, not from you. An old idea with a new technology can sometimes turn into a very big innovation. Aum Voice Prosthesis was one of them. I always loved working on individual problems. I believe that there is a wrong notion that you should work towards markets. If you take an individual person’s problem, there is a soul to it. A problem has to have a soul to it so you can expand it later to the masses, and the masses can become a market. However, if you try to reverse the process, you will fail. The beauty of an idea comes from the way you look at it.

I looked into the problem of a security guard, a patient who had throat cancer, lost his voice and subsequently lost his job. I was trying to figure out what I could do to help him get his voice back so he could get his job back. That began the journey of Aum Voice Prosthesis. I was sitting in my office pondering ways to help when my friend Shashank Mahesh, who is the co-inventor of Aum, walked in to say hello. He is my biking friend. I proposed that we do a bike ride to raise funds to equip that security guard with one of the two voice prostheses that were then available, one from the U.S., and the other one from Europe. He suggested that I solve the problem myself, asking me how long I was planning to do biking fundraising to help patients. I started thinking and quickly realized that I needed technical knowledge that I did not have, like silicon and machinery expertise. That is when Shashank told me he was a silicon expert. Serendipity brought us together. From 2013 to 2015 we worked on the product, with material experts, physicists, and scientists.

The journey Shashank and myself took was essentially trying to help one security guard regain his voice in an affordable manner because we believe that speech and communication in society is a right and not a privilege. We thought a product should be available, affordable, and accessible. Every person across the globe should be given the right to speech, dignity, and quality of life.

Can you explain what it is?

The earliest publication about voice generation dates back to 1935 when Joseph C. Beck published about a person hitting his throat with an ice pick because he had lost his voice box. Contrary to popular perception, the patient did not die and in fact, regained his voice. It has been historically documented that once you lose your voice machine, you could convert your food pipe into a voice box.

Aum voice prosthesis is a special valve made of medical-grade platinum silicone, an implantable device that is inserted into patients’ throats. Throat cancer patients who have undertaken surgery have a hole in the throat through which they breathe instead of their nose. The device is fitted between the air pipe and the food pipe to convert the food pipe into a voice box. In this manner, the device cheats the brain to speak again. The throat does not speak, the throat is the hardware. It is the brain that speaks so if the brain is confused into believing that the food pipe is the actual voice box, the patient can speak again. We invented a voice machine with better clarity and voice modulation compared to the past models.

Why the name AUM?

It is a very interesting thing. In Sanskrit and Indian mythology, aum is a sound, not a word, and it does not belong to anybody. Indian mythology believes that aum is the evolution of humanity. The syllable Aum has four sounds, A’ stands for creation, ‘U’ for sustenance, and ‘M’ for annihilation, and the last one is silent that repeats the earlier sounds all over again. Aum connects to the universe and souls. So, when my first patient spoke, the first thing he said was Aum and I thought I would keep the word because the person that could not speak, spoke, embarking on an empathic journey from silence to sound.

Did you create a startup to launch the product?

We created Innaumation Medical Devices because it is mandatory to create an entity when you launch a product for all regulatory purposes and clearances. Innaumation Medical Devices is now being handled by the Government of India, as we have handed over the intellectual property of Aum Voice Prosthesis to the Government to take the innovation far and wide.

What were the biggest challenges in manufacturing/launching the product?

Every step in the so-called entrepreneurial journey is a challenge. I could write several books on those challenges. There was no paucity of people around me to remind me that it was not possible and that I should stop wasting my time. I heard it all, from it is not going to be patentable, to not being useful, or viable, so I worked even harder. We however all agreed on the fact that the device had to be created and manufactured in India. Last month, Aum voice prosthesis was showcased at the World Economic Forum 2022 in Davos as a “Make in India” invention.

Aum Voice Prosthesis is a social innovation; can you explain why it was important for you that the device is accessible and affordable?

If you look at the Indian scenario, the average revenue is between 1 and 2 US$ per day. For me, the right to speech was more important than anything else. My idea for this innovation was that every person deserves to speak. We did not want the inhibition of cost and money. I am a firm believer in conscious capitalism. It would not be a social innovation if it is not available, accessible, and affordable.

How many patients are equipped with Aum Voice Prosthesis? In how many countries?

Today we have around 1,700 patients who are speaking with the device. Some of them had not spoken for over a decade. We now have reached out to more than 10 countries. Our next target is to take it to 144 countries, to countries that are poor, deprived, and in the low and middle-income bracket, countries that are not able to reach out to the masses and make affordable solutions well and truly available.

You have 18 patents in your name for diverse innovations. Which ones?

I filed various innovations. Most of them in the area of devices, some in the area of software, some for drugs and vaccines, and genetic modulation. I have worked on several aspects of social innovations, innovations that are relevant to society and that I believe will make a difference to the people around me. The goal of education is knowledge, and the end goal of that knowledge should be some form of service to humanity.

How important is patenting for social innovations?

From the legal and regulatory standpoint, it is crucial to patent products, and then decide on the social aspect of the innovation in terms of the commercialization of the product. A patent gives the product commensurate legitimacy to ease its acceptance in the global community.

India has been famous for understanding how to repurpose a particular product or an idea for another purpose. We have a popular Indian word to describe this: “jugaad”. It is important to differentiate whether you do research, innovation, invention, or jugaad. Those are four categories that I distinctly look at. It is important to understand patenting for social innovations. They have a social purpose but need to be legally appropriate. Patenting an invention keeps its novelty and makes sure it is not infringing on someone else’s patent rights. Aum voice prosthesis is patented in India and the United States.

Would you say the same about other IP rights like trademarks/copyrights?

I would say it is the same. I am also a strong believer in copyleft, not just copyright. Copyleft is about sharing your ideas to make the world a better place. I have been running this forum for the last couple of years where we crowdsource ideas by “stealing” each other’s ideas, in agreement. The beauty in this kind of principle is to show the world that sometimes ideas become more powerful when they are shared. It is essential that we share ideas more openly and freely and create a world that is friendly to copyleft, with copyright.

What is your business model for Aum voice prosthesis?

We have created various models through which we worked with governments to ensure that the poorest of the poor are getting these devices for free. At the same time, we can sustain the manufacturing and the quality to meet the regulatory requirement through the commercialization of the device to the private sector with a for-profit intention. We call it “profit for purpose” addressed in the conscious capitalistic way, in which we can deliver the device to people who can afford it, and that makes it commercially sustainable. People who do not fall into either of these categories can apply to the company and explain their social-economic status and we can address it through crowdfunding, social entrepreneurship, and NGOs.

How much does the device cost for patients?

Under the government scheme, it is given free of charge. We continue the 1 US$ initiative through the AUM Foundation, a non-governmental trust who gives the device to poor persons who apply to the trust. Through the national pricing policy, we are working towards creating some bare costs to define how much the private sector, which includes retailers, pharmacies, and distributors, should pay for the device.

What is in the future for Aum Voice Prosthesis?

We are working with the Disabilities Ministry of the government of India so that people who have undergone laryngectomy are recognized as diffable. The aim of this entire journey has been to adopt the conscious capital approach, to make sure that the poorest of the poor get the device and are not considered an economically invalid group. They can come back to serve society and contribute not only to the Gross National Product but also to the Gross Happiness product. We are also reaching out to the World Health Organization and the United Nations to recognize these groups of patients as diffable.

We have been expanding the pipeline of products to address various issues like Aum, which people need. Some of our other inventions include Tracheostomy Tube (enabling device for throat cancer patients), Dr. VR (immersive healthcare solution), Glove Talk (ICU communication solution), ANS Explorer (HRV evaluation solution), and Snap Health (heath record management solution). We believe that in the coming months we can reach out to all the countries of this world to ensure that the poorest of the poor can access this kind of device and are able to speak again. That would serve the larger cause effectively.

The ultimate goal would be to create a situation where Aum Voice Prosthesis is not required any longer by attacking the root cause, i.e., by eradicating tobacco and smoking from our lives which cause cancer. Real success for me is to ensure that a person retains his/her natural voice box, thereby making Aum prosthesis redundant. I think that is the true goal of conscious capitalism and I will be busy inventing something more relevant and solving other sticky problems.

What would you say is the future of medicine?

Medicine and medical care cannot be looked at in a venture capitalistic manner because we are talking about health. The future of medicine would be to go from illness to wellness, to create a society with fewer hospitals, fewer doctors, and fewer illnesses. New technologies can play an important role in this. The world post-Covid will be divided between BC, which is before Covid, and AD, which is after disease. The post-Covid era will be people-centric, around conscious capitalism, with value and wellness addition. This is the era that is going to define how we will make a difference in the lives of people in a more holistic manner by balancing ambition and purpose. There is never a better time in history to enhance and accelerate human hand healing through the enabling power of technology.