{"id":1125,"date":"2020-08-10T20:55:00","date_gmt":"2020-08-10T20:55:00","guid":{"rendered":"http:\/\/oscillationss.blogspot.com\/?p=1125"},"modified":"2020-08-10T20:55:00","modified_gmt":"2020-08-10T20:55:00","slug":"healthcare-global-enterprises-ltd-data-is-god","status":"publish","type":"post","link":"https:\/\/oscillations.in\/?p=1125","title":{"rendered":"Healthcare Global Enterprises Ltd.- Data is God"},"content":{"rendered":"<div dir=\"ltr\" style=\"text-align: left;\" trbidi=\"on\">\n<\/p>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">Healthcare Global<br \/>\nEnterprises Ltd (CMP 130 Market Cap 1600 cr)<\/span><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\"><br \/><\/span><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12pt;\">Data is God. I usually say these<br \/>\nwords and recently one friend asked me whether my emphasis was on<br \/>\nquantum of Data. But I told him that quantum is more about linear flow or one<br \/>\ndimensionality but God is multi-dimensional. So what I see when I say \u201cData is<br \/>\nGod\u201d is the ACCESS to the data. Like, we humans have access to 3D world and so<br \/>\nall our experiences and interpretations are impacted (or burdened) by this fact<br \/>\n(or illusions). We have very limited access to the universal Data and that\u2019s why<br \/>\nmost of the times we are unsure about everything. Then there are life forms<br \/>\nhaving much more access to universal data and we call them Deities and that\u2019s<br \/>\nwhy they have better understanding of life compared to us and can do things<br \/>\nwhich are more like a miracle for us. And then the God, the ultimate creator,<br \/>\nhas ACCESS to all the data of the universe. We can\u2019t even guess whether the God<br \/>\nhas created the data or he had access to data with which he created the great<br \/>\ncreation (our universe INCLUDED).<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So creativity is about use of data.<br \/>\nThat day (<a href=\"https:\/\/oscillationss.blogspot.com\/2020\/07\/indian-public-sector-undertakings-psus.html\" target=\"_blank\">click here)<\/a> I have written about the need for investments in R&amp;D if India<br \/>\nwants to capture next leg of growth. R&amp;D is not something where one<br \/>\ncaptures an innovative idea by luck or in some moments of trance or by<br \/>\naccessing the future. Innovation happens when we have data in our mind\u2026vast<br \/>\namount of data is required first.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><span style=\"color: blue;\">Here, I remember one such company<br \/>\nfrom India which is doing great work in the field of Genomics and<br \/>\nBioinformatics by focusing and investing big in R&amp;D. The company is- strand<br \/>\nlife sciences from Bangalore. Genomics and Bioinformatics are just about DATA&#8230;VAST DATA.<\/span> Genomics medicine is a branch of medicine which<br \/>\nuses the complex interplay of DNA and biological expressions in our bodies to<br \/>\nstudy\/diagnose their impact on our health and development of tailor made<br \/>\ntreatments. The firm tracks its humble beginnings when in 2000 four professors from<br \/>\nthe computer science department at IISc joined hands to pursue their passion in<br \/>\nthe field of genetics and biological research. They were- Vijay Chandru (66),<br \/>\nRamesh Hariharan (51), Swaminathan Manohar (60), and Vishwanathan Vinay (56).<br \/>\nThey were inspired to pursue their passion by none other than our great- Ratan<br \/>\nTata. IISc even holds a small stake in Strand. Strand was spun off from Indian<br \/>\nInstitute of Science (IISc) and it was first such instance when a Public<br \/>\ninstitution like IISc invested in a business (I have talked about the similar<br \/>\nmodel in my recent post related to PSUs <a href=\"https:\/\/oscillationss.blogspot.com\/2020\/07\/indian-public-sector-undertakings-psus.html\" target=\"_blank\"> Click here for the post on PSUs<\/a>).<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">Strand Life<br \/>\nSciences- India\u2019s attempt to claim a place in global high end R&amp;D<br \/>\nCapability in Bioinformatics and Genomics<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><span style=\"color: #c00000; font-size: 12.0pt; line-height: 115%;\">I am writing this<br \/>\npost on HCG but I choose to put the focus first on Strand because HCG is having<br \/>\na 38.5% stake in Strand Life and the work Strand is doing in the field of<br \/>\nCancer diagnosis is critical to the success\/survival rate of cancer in<br \/>\nIndia and as HCG is one of India&#8217;s biggest player in cancer care so Strand is<br \/>\ncritical to HCG also.<\/span><\/b><span style=\"color: #c00000; font-size: 12.0pt; line-height: 115%;\"> <\/span><span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Cost effective early stage<br \/>\ndiagnosis is critical in ensuring the high survival rates from cancer and this<br \/>\nis one of the reasons for high survival rates of countries like USA. It is<br \/>\nsurprising that Strand is not covered at all by the market while evaluating HCG<br \/>\nbecause I feel Strand is critical for the growth of HCG as a whole. Hence, in<br \/>\nthe coming paragraphs as I explain the massive technological achievements of<br \/>\nStrand Life in Genomics you are going to feel goose bumps. Strand started as a<br \/>\nBioinformatics firm and developed some path breaking Bioinformatics products<\/span><br \/>\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">for<br \/>\nanalyzing DNA sequences- GeneSpring and Avadis which are used by research<br \/>\ninstitutions worldwide.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">As shared many times<br \/>\nin earlier posts (especially in the post related to value investing-<a href=\"https:\/\/oscillationss.blogspot.com\/2020\/06\/value-investing-dance-without-passion.html\" target=\"_blank\">click here for the post<\/a>) superior technical<br \/>\nabilities in a high growth sector with high entry barriers is the most value<br \/>\naccretive factor for me while choosing a stock for investment not the financial<br \/>\nanalysis of the historical performance. I see most value in the superiority of<br \/>\nthe business model not in the financial ratios. Traditional value investing<br \/>\nseeks to benefit from the asymmetry (so a matter of chance) of the stock market<br \/>\nin pricing a stock accurately near to its real worth. But for me value<br \/>\ninvesting gets most of the value from business analysis; financial analysis is<br \/>\njust for the purpose of ritual, for reverence (or to abandon). <\/span><span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So in order<br \/>\nto understand the superior capabilities of Strand Life and massive scope of<br \/>\nBioinformatics and Genomics in the future world of medicine we first need to<br \/>\nunderstand the application, role, importance and complexity of Bioinformatics and<br \/>\nGenomics in the structural and functional analysis of genomes and in drug<br \/>\ndiscovery. <\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">As this sector is<br \/>\njust in its infancy so it will be premature to evaluate the performance based on<br \/>\nfinancial data because this is going to witness quantum jump in demand and<br \/>\nfinancial performance in the near future. So rather than trying to estimate<br \/>\nmicro level financial metrics like EBITDA or Cash flows I prefer to estimate<br \/>\nthe total size of the industry in the near future and this will give you an<br \/>\nidea about the future potential and after that it is up to the strategic<br \/>\nplanning and execution of the company to capture a big pie of the total<br \/>\nindustry and this we can gauge from the technical abilities and superiority of<br \/>\nits R&amp;D investments. I find it really very strange when I see people<br \/>\nchoosing stocks on the basis of filters- some certain % of EBITDA, NP etc. etc.<br \/>\nand they find their big moment. But I really like this because this has given<br \/>\nme the freedom and time to pick some real gems at peanuts due to market players using this filteration exercise for their stock pickings. Recent case is Laurus Labs where market denounced it due<br \/>\nto its limited ability to understand business model of Laurus where large<br \/>\ninvestments for new business (Final dosages) hit operating margins due to costs<br \/>\nbookings in the form of depreciation, Interest and operating expenditure of new<br \/>\nplant with no revenues. But just see the recent results of Laurus labs where<br \/>\nmost of the topline growth is added to the bottom line and stock price has been<br \/>\nshot up to 1100 from 470 when I advised it last time just 2 months ago <a href=\"https:\/\/oscillationss.blogspot.com\/2020\/06\/value-investing-dance-without-passion.html\" target=\"_blank\">(click here for recent post on Laurus)<\/a>.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Bioinformatics uses tools (software<br \/>\ntools) for computation and analysis to capture and interpretation of biological<br \/>\ndata like that of Genome. It is a field of science in which biology, computer<br \/>\nscience, and information technology merge into a single discipline. <span style=\"mso-spacerun: yes;\"> <\/span>Bioinformatics has its main application in the<br \/>\nanalysis and interpretation of genome.<span style=\"mso-spacerun: yes;\">  <\/span>The<br \/>\ntotal length of the human genome is over 3 billion base pairs. This is massive<br \/>\namount of data like if we took the DNA from all the cells in our body and lined<br \/>\nit up then it would form a strand (extremely thin) of 6000 million miles<br \/>\nlong!!! I was reading that day that total length of Human genome (DNA) is<br \/>\nequivalent to some 70 round trips to Sun and 7000 trips to Moon (may be even<br \/>\nmore)!!! Supreme creator has really done a miracle in condensing this gigantic<br \/>\ndata into every cell (through dense thread like coil structures organized and<br \/>\nstored in chromosomes).<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"separator\" style=\"clear: both; text-align: center;\">\n<a href=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEgOrUUWArbFaADeWrI1uoRQtztou0oiqWIi3QyetpzvfsO09BHPc4UZPZIdYgSsr9ek_1I5KAhIg7bl2fWu5HzWACRRnfgl8Ox65hOJPlfzr1x2emCDjcZiEBXDqOmt7c_OdYddOHGM3sA\/s1600\/DNA+GOD.jpg\" imageanchor=\"1\" style=\"clear: left; float: left; margin-bottom: 1em; margin-right: 1em;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"445\" data-original-width=\"750\" height=\"189\" src=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEgOrUUWArbFaADeWrI1uoRQtztou0oiqWIi3QyetpzvfsO09BHPc4UZPZIdYgSsr9ek_1I5KAhIg7bl2fWu5HzWACRRnfgl8Ox65hOJPlfzr1x2emCDjcZiEBXDqOmt7c_OdYddOHGM3sA\/s320\/DNA+GOD.jpg\" width=\"320\" \/><\/a><\/div>\n<p><span style=\"color: #0033cc; font-size: 12pt; line-height: 115%; text-align: justify;\">And let me tell you<br \/>\none thing- I think when Humans accessed this massive DNA data then that was the first moment of  convergence of science and Theism\/Spiritualism (not<br \/>\nreligion). <\/span><span style=\"font-size: 12pt; line-height: 115%; text-align: justify;\">Our DNA and Genome are highly sophisticated designs<br \/>\nand when we peep deep into the mastery with which our DNA and Genome are<br \/>\ncreated and structured we are left with no doubt that some supreme creator (God)<br \/>\nis behind this. Discovery of DNA proved that life follows a coded path or<br \/>\ninformation in cells not an outcome of complex chemical reactions as was<br \/>\nperceived earlier. Our DNA is not our regular matter or energy but they are<br \/>\ninformation processing centers. Information is not an outcome of natural chaos<br \/>\nlike a pattern of clouds which may resemble a human face. Information is a<br \/>\ncreation and is always created by intelligence beings just like our computer<br \/>\nprogram. We can see some random alphabet in the pattern of clouds but what if<br \/>\nwe see a long pattern of clouds resembling<br \/>\n\u201cHCG is valued at 10 times its EBITDA while others are valued 20 times<br \/>\nEBITDA\u201d. This line is not a pattern but this is a complex set of information<br \/>\nand it is not possible that it can be formed randomly by natural chaos.<\/span><\/p>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Like, each cell of our body has two<br \/>\ncopies of genome (Genome is a complete set of entire DNA (including all genes)<br \/>\nof a being within a single cell, and a gene is a length of a number of DNA molecules<br \/>\nthat codes for a specific protein, genes are structured\/stored in chromosomes)<br \/>\nwith one copy from each of your parent (mother and father). However, the case<br \/>\nis different with sperm and egg cells because both have only one pair of<br \/>\nGenome. But why is this difference? Because if a sperm cell (from father) and<br \/>\nan egg cell (from mother) also have two copies of Genome then this would mean<br \/>\nthat when egg and sperm combine at conception the number of copies of Genome<br \/>\nshall be 4 in every cell of the baby not 2!!! And when this generation will be<br \/>\nhaving babies then number of pairs of genome will be 8 and so on it will rise<br \/>\nwith every generation this DNA burden will eventually crush the cell. That\u2019s<br \/>\nwhy germ cells in our bodies have only one pair of Genome. They do start with<br \/>\ntwo pairs but they eventually divide and in the end left with only one pair and<br \/>\nthis arrangement means that life in every human starts at two pairs of genomes.<br \/>\nSo some supreme being has planned and designed the structure of life in finest<br \/>\ndetails.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\">Bioinformatics<br \/>\nand Genomics- the biggest revolution affecting every sphere of life<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">The human genome sequencing project<br \/>\nwas a massive success and great milestone for humanity to start a new charter<br \/>\nof growth.<\/span> However, <span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">the first genomes to be sequenced were of viruses and<br \/>\nbacteria. So as of now, the genomes of huge numbers of microbial, plant, living<br \/>\norganisms have been sequenced but this vast amount of data generated by genome<br \/>\nsequencing projects was unmanageable due to its sheer size and complexity.<br \/>\nFurther, storage of this genome sequencing data was of not much use because<br \/>\ntheir true worth lies in doing comparative analysis of different sets of genome<br \/>\nsequencing in order to interpret and retrieve useful information which can be<br \/>\nused for some purpose. This is why the role of Bioinformatics is so important<br \/>\nbecause Bioinformatics analysis through its various tools has enhanced our<br \/>\nunderstandings about the genome structure. Without it, it is almost impossible<br \/>\nto manage, compare, analyze and interpret this gigantic data.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"separator\" style=\"clear: both; text-align: center;\">\n<a href=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEhcnRmB9WBO4eJpykS9RjiBayZfhHp3TBpdXEvf4_b1lQTW0m8txHFccnlab9JDvHOFVceOJKNwheOW2_gqm56YOEElqqZqm4QOPQNDmBA_qodZnm9qDe09mbRzO329cXLUUL8nw494xr8\/s1600\/bioinfor.jpg\" imageanchor=\"1\" style=\"clear: left; float: left; margin-bottom: 1em; margin-right: 1em;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"559\" data-original-width=\"1024\" height=\"174\" src=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEhcnRmB9WBO4eJpykS9RjiBayZfhHp3TBpdXEvf4_b1lQTW0m8txHFccnlab9JDvHOFVceOJKNwheOW2_gqm56YOEElqqZqm4QOPQNDmBA_qodZnm9qDe09mbRzO329cXLUUL8nw494xr8\/s320\/bioinfor.jpg\" width=\"320\" \/><\/a><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12pt;\">Bioinformatics uses very complex<br \/>\nsets of algorithms and statistical tools to compare, analyze and interpret the<br \/>\nrelationship among the members of large data sets like comparing sequence data of<br \/>\na gene (say insulin) of a particular human with the already existing sequences<br \/>\nto find out if there is any anomaly. Apart from analysis Bioinformatics<br \/>\ndevelops tools to cost effective storage and efficient access and management of<br \/>\ndifferent types of information.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Like, let\u2019s take the example of the<br \/>\nhemoglobin gene which is found on chromosome 11 which contains some 1500<br \/>\ndifferent genes (in 135 million DNA letters) apart from hemoglobin gene. Hemoglobin<br \/>\ngene is composed of some 1600 DNA letters. A normal hemoglobin gene starts with<br \/>\nfollowing DNA letters (in pair of 3):<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">ATG GTG CAT CTG ACT CCT GAG GAG&#8230;<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Each of this 3 letter word tells<br \/>\nthe cell to produce a particular amino acid (protein). We need the production<br \/>\nof these various amino acids in correct order or we will end up With a disease.<br \/>\nLike a fellow with Sickle cell anemia disease has the following pairs of DNA<br \/>\nletters:<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">ATG GTG CAT CTG ACT CCT G<b><span style=\"color: #0033cc;\">T<\/span><\/b>G GAG&#8230;<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">As we can see there is a change in<br \/>\nthe second last pair (letter T in place of A) and this change of just one<br \/>\nletter in 3 billion letters can create a life threating disease!!!<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So with Bioinformatics these types<br \/>\nof comparisons and analysis can be accomplished in remarkable short span of<br \/>\ntime and this analysis serves as the building block for the search of the cure<br \/>\nfor the disease. <\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">And this knowledge is playing vital<br \/>\nrole not only in human well-being but it is extending far beyond covering every<br \/>\naspect of human life whether it is agriculture, Nutrition and Food Microbiology,<br \/>\nBio-energy etc. Like, for example, the use of Bacillus thuringiensis (BT) gene<br \/>\nin making cotton crop insect resistant. BT gene was extracted from a bacteria<br \/>\nand after mapping its entire genome, scientists inserted its genes in various<br \/>\nplants to make them insect resistant. So now BT has been used for making crops<br \/>\nlike Cotton, Corn, potatoes insect resistant which has resulted in very less<br \/>\nuse of poisonous insecticides on crops.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">And as we can see and guess the<br \/>\npossibilities are endless where we can use the knowledge of Genomics for<br \/>\nachieving remarkable feats earlier though impossible like, for example, regeneration<br \/>\nof limbs. Humans can\u2019t regenerate their limbs\/organs after their amputation\/damage (barring some exceptions like Liver and bones when pieces are joined but still<br \/>\nthese are cell\/tissue regenerations because<\/span> <span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">if entire liver is lost then it<br \/>\ncan\u2019t regenerate.). But many others like Axolotls (salamanders) flatworms,<br \/>\nzebrafish can do. Axolotls are the champion here as they can regenerate complex<br \/>\nbody parts lost at any age. Some Salamanders species can also stay young<br \/>\nforever. So by understanding how their genomes respond to any such injury<br \/>\nresulting in the loss of a limb\/organ we can progress on to replicate the same<br \/>\nin humans. In Regeneration, real time genomic response is required and so real<br \/>\ntime study is required to study the activated genes when faced with limb loss.<br \/>\nAnd before anything first of all we need to sequence the entire DNA of<br \/>\nthat particular being like Salamander  andwe can see the difficulties here in<br \/>\nstudying\/sequencing the genome. And after sequencing the next challenge is the<br \/>\nidentification of all the genes because genes are a specific length of DNA and<br \/>\nit is extremely difficult to identify which length of a DNA code is a gene.<br \/>\nBefore Bioinformatics, only way to identify the genes is to study their<br \/>\nbehavior in the organism or by studying DNA in the laboratory which is an<br \/>\nextremely time consuming process. But Bioinformatics helps in identifying the<br \/>\ngenes by analyzing the sequencing data in the computer by comparing the<br \/>\ndata\/experience of other beings.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">Because if we can<br \/>\nsee, technically human should also have <span style=\"mso-spacerun: yes;\"> <\/span>this<br \/>\namazing regeneration capability because once we were a small embryo ( a single<br \/>\ncell) with genome and then with this genetic code we were developed into a<br \/>\ncomplete being with all the complex organs and limbs. <\/span><span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So we can<br \/>\nsee that there is not much difference in the presence of genetic information in<br \/>\na human and Salamanders but there are some steps which are missing in Humans<br \/>\ninhibiting our capability to regrow complex limbs. Some genes are switched off<br \/>\nin humans which are responsible for growing\/re-growing limbs in these animals. <\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"separator\" style=\"clear: both; text-align: center;\">\n<a href=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEhBXXyykcRKBrGDVDAAKXsOuToNEOQddSce9DG9U9YcSJZv9aOqumWphW2ZHcigvB-_gX2bKLGyQOEMehyRZ-m34My4vdT-DsyX-gNDQiYu-6CoRJ4XVtTsx8zXXx77hmKuy2DpqKXg1Q0\/s1600\/DNA-01.jpg\" imageanchor=\"1\" style=\"clear: left; float: left; margin-bottom: 1em; margin-right: 1em;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"728\" data-original-width=\"1296\" height=\"179\" src=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEhBXXyykcRKBrGDVDAAKXsOuToNEOQddSce9DG9U9YcSJZv9aOqumWphW2ZHcigvB-_gX2bKLGyQOEMehyRZ-m34My4vdT-DsyX-gNDQiYu-6CoRJ4XVtTsx8zXXx77hmKuy2DpqKXg1Q0\/s320\/DNA-01.jpg\" width=\"320\" \/><\/a><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12pt;\">So, first step is to understand the<br \/>\ngenomics of these beings and this was not an easy task itself. Why?? Because<br \/>\nits genome is massive\u2026some 32 billion base pairs which is 10 times of human<br \/>\ngenome!!! But number of genes of both humans and Salamanders are same<br \/>\n(20000-25000) so we can understand the difficulty in identifying these genes in<br \/>\nsuch a massive genome even after sequencing of the entire genome is done. But<br \/>\nthat day I read that thanks to Bioinformatics scientists have finally sequenced<br \/>\nthe entire genome of Salamanders so the day may not be far when we will hear<br \/>\nsomething great in this front. Now they will study whether limb in these<br \/>\nanimals is regenerated with the help of some novel genes (not presented in<br \/>\nHumans but then we can insert them with genetic engineering) or same genes but<br \/>\nthey control them better than humans. Regeneration of limbs mean high growth of<br \/>\ncells which is identical to cancer but it surprising that Salamanders do not<br \/>\nget cancer at all and this is what keeping scientists very excited for a<br \/>\npossible solution of current human epidemic-cancer.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"separator\" style=\"clear: both; text-align: center;\">\n<a href=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEiZ2r13o3gZI8NlahfTJJpwAB3rYil10ZSga9uf5ykMpOez_l6NmfkktNlNxCS15ab9Xjy0cLre8R_j5C0piK7wZ1Ei_nquuKG8VeWSOFBuy0VDv-IbMrnTR0svRo3DZV2VKawjQJdcDMg\/s1600\/salamander.jpg\" imageanchor=\"1\" style=\"clear: left; float: left; margin-bottom: 1em; margin-right: 1em;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"1067\" data-original-width=\"1600\" height=\"213\" src=\"https:\/\/blogger.googleusercontent.com\/img\/b\/R29vZ2xl\/AVvXsEiZ2r13o3gZI8NlahfTJJpwAB3rYil10ZSga9uf5ykMpOez_l6NmfkktNlNxCS15ab9Xjy0cLre8R_j5C0piK7wZ1Ei_nquuKG8VeWSOFBuy0VDv-IbMrnTR0svRo3DZV2VKawjQJdcDMg\/s320\/salamander.jpg\" width=\"320\" \/><\/a><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<i><span style=\"font-size: 12pt;\">Image:<\/span><span style=\"font-size: 16px;\">Salamander<\/span><\/i><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12pt;\">That day my eight year old son<br \/>\nasked me that he did not want to see his mother getting old. And I showed him<br \/>\nthe image of the holy Salamander and gave him a brief note on DNA\/Genes in case<br \/>\nthis can be a motivation for choosing Genetics as a career for him.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">Further, as now we<br \/>\nunderstand the role and capabilities of Bioinformatics and genomics so we can<br \/>\nhope to see a cure for Covid-19 soon in the near future because these days we<br \/>\ncan analyze the DNA of Covid-19 virus in its minute details and this will<br \/>\nenable us to find a cure to destroy the DNA of Covid Virus. Further, as now we<br \/>\nalready have huge data base of the genome of many other hundreds of viruses<br \/>\nalong with the treatments being used and tried (not successful though) so there<br \/>\nis a high chance that with Bioinformatics we will be able to compare the genome<br \/>\nof Covid Virus with the existing data base and in case the same is matching<br \/>\nwith an exact genome or similar type of genome then we can have an idea about<br \/>\nwhere to look out for the cure.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 16.0pt; line-height: 115%;\">Cancer,<br \/>\nGenomics and Strand life<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 16.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Cancer is a genetic disease and all<br \/>\ncancers are caused by damaged or mutated genes. Cancer is a very individual<br \/>\ndisease and cancer of one person can be very different from the cancer of the<br \/>\nother. So, genomics is the Holy Grail for the cure of cancer. Traditional<br \/>\ncancer treatments use chemotherapy, radiation and surgery to kill\/remove the<br \/>\ncancer cells but they also kill healthy cells along with cancerous cells and have<br \/>\nsevere side effects. And that\u2019s why for early stage cancers chemotherapy is not<br \/>\nused.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Chemotherapy uses deadly<br \/>\nDNA-damaging chemicals\/compounds to kill the cancer cells by damaging their<br \/>\nDNA. But it doesn\u2019t work on all the patients uniformly and in some cases where<br \/>\nit is non-responsive it does more damage in the form of killing healthy cells.<br \/>\nAnd it doesn\u2019t work on all because humans are genetically very different so<br \/>\nresponse to the therapies focusing on cell work differently.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So no doubt that genomics will<br \/>\nprovide the much needed details about the genetics of cancer in a particular<br \/>\nhuman being and then on the basis of such analysis individual targeted<br \/>\nmedicine\/cure can be devised. Hence, there are high chances that the<br \/>\nchemotherapy will not be used in the near future and personalized precision treatment<br \/>\nbased on genomics analysis will be used instead. In fact, even now genomics is<br \/>\nbeing used extensively and it has already made a marked difference in the<br \/>\ncancer treatment. Genomics enables health professionals to see the genetic<br \/>\nabnormalities in an individual after comparing the genome of that fellow with<br \/>\nthe data base of genome of a healthy human. Then they can study whether the<br \/>\ngenetic abnormality is inherited like some types of breast cancer are inherited<br \/>\nor DNA damage has happened due to external factors like smoking. Also, as now<br \/>\nwe already have the genetic information about the inherited breast cancers so<br \/>\ndoctors can warn and advise for the precaution and advance treatment for their<br \/>\ncurrent and future generations. So in order to assess the cancer risk factors,<br \/>\ngenetic diagnosis will play a huge role.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Hence, we can easily see that the<br \/>\nfuture of medicine is only about-Genetic diagnosis and genes based personalized<br \/>\ntargeted medicine\/treatment. But as I have told earlier, right now we are not at<br \/>\nthe end of this genomics miracle but we have just scratched the surface of it.<br \/>\nIn Human Genome project from 1990 to 2003, scientists were estimating the<br \/>\npresence of some 100000 genes in human genome and they were hopeful that once<br \/>\nwe had the genome sequenced then we would decode\/interpret all the genes very<br \/>\nfast but things were not that easy. The reasons: inherent complexity in the<br \/>\ninterpretation of massive data and changing definition of Gene which also<br \/>\nincludes non-protein coding genes. <span style=\"color: #0033cc;\">Only 1.2% of<br \/>\nentire human genome account for protein encoding genes. The rest of 98.8% is<br \/>\nnon-encoding DNA and earlier was considered useless and junk but now the<br \/>\nevidence is emerging that these are also vital for our survival and well-being.<br \/>\n<\/span>Many of these are responsible for the regulation of DNA\/genes in cells<br \/>\nlike switching on and off a gene. But I find it hard to believe that 98.8% is<br \/>\nless important than 1.2% and so I think this non-coding regulatory DNA may turn<br \/>\nout to be more important.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Result- we are still not sure about<br \/>\nthe exact number of genes in human genome and there are competing human genes<br \/>\ndata bases with differences of thousands of genes among them (estimates are<br \/>\naround 20000-25000 genes). And in the absence of consensus, it is very<br \/>\ndifficult to interpret whether a new gene (marked by Bioinformatics) is a<br \/>\n\u201cnormal\u201d human gene or some disease generating mutated gene. There is still<br \/>\nmassive work required to interpret entire human genome. <\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Still, even with these numbers,<br \/>\nmost of the times researchers are working and focusing only on some 2000 genes<br \/>\nout of 20000. This information is provided by Bioinformatics analysis. Until<br \/>\nnow, the main focus is always on large genes with codes for many proteins or<br \/>\ngenes which are prone to dangerous mutations so there is not much work on other<br \/>\ngenes with potential for new drugs and treatments but are ignored. The need<br \/>\nhere is the funding of more research into these ignored and unknown genes. Though<br \/>\nwe are yet to uncover 98% of our genome but if you ask me it is not a drag but<br \/>\na great opportunity. So there is no doubt that with more study and research<br \/>\nthis field of medicine will only get better and precise and in future humans<br \/>\nwill be healthier and live much longer.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\">Path breaking<br \/>\nwork by Strand life in Genomics and Genomic\/Genetic diagnosis<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">As of now, cancer<br \/>\ntreatment and Genomics were not advanced and even genetic diagnostic tests were<br \/>\nnot available in India and this is one of the reasons we always see our<br \/>\ncelebrities going to USA for their treatment. But even this tour to USA may not<br \/>\nbe enough because we Indians are different at genetic level from the fellow<br \/>\nAmericans. Genomic database of Americans may not provide for the proper<br \/>\ncomparison with Indian people visiting for treatments. So India needs to have<br \/>\nthe genomic data base of its vast population in order to devise the cancer<br \/>\ntreatments. But India with high genetic diversity with 17% population still<br \/>\naccounts for just .2% of the genome database collected across the globe. So keeping<br \/>\nin view the genomic diversity and variability in our populations across<br \/>\ncountry, Indian genomes can provide very interesting and vast sets of genetic<br \/>\nmutations and variations. One such initiative for human genome mapping project<br \/>\nnamed Indigen project (some 10k-20k people) in India is already underway by the<br \/>\nGovernment (also for agriculture) and Vijay Chandru of Strand Life was one of<br \/>\nthe members of the team who prepared the draft proposal. However, due to<br \/>\ngenomics testing already done by firms like Strand, Medgenome and other<br \/>\nindependent research bodies have the database of some 500000 Indians and that\u2019s<br \/>\nwhy the likes of Strand and Medgenome have better chances to make good<br \/>\ndiagnosis products.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Strand life was a pure research<br \/>\nbased firm and it achieved great success with its Bioinformatics products<br \/>\n(based in complex algorithms) which were lauded globally and still are the<br \/>\nleader across the globe. But in 2013 Strand Life decided to enter the field of<br \/>\nGenomics diagnosis after they get the funding of $10 million from San Francisco-based<br \/>\nfinancial firm Burrill &amp; Co. Strand launched personalized Genomics<br \/>\ndiagnosis tests in India in collaboration with hospital chains like Max, Mazumdar-Shaw<br \/>\nCancer Center, HCG etc. In the 1990\u2019s India lagged behind the genomics based<br \/>\ntreatment because of the high costs. But the likes of Strand have done massive<br \/>\nwork in bringing down the costs to Indian standards. Like, Strand has brought<br \/>\ndown the costs of these genomic diagnosis tests to some 20000-30000 Rs. which<br \/>\nearlier was 3-4 lac rupees. These tests are instrumental in the devising of<br \/>\npersonalized targeted medicines and saved the lives of many cancer patients in<br \/>\nIndia. Now thanks to these genomics tests, India has cancer survival rates<br \/>\ncompared to the best across the globe.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">In 2014, Strand secured the patent<br \/>\nfor its Virtual Liver product-HepTox which allows the pharma industry to assess<br \/>\nthe side effects of a potential drug on the liver in pre-clinical studies which<br \/>\ncuts down the time and expenditure related to human and animal trials. Later on<br \/>\nthe same was acquired by Biocon owned Contract research firm Syngene<br \/>\nInternational Ltd. Strand counts the likes of Kiran Mazumdar-Shaw of Biocon,<br \/>\nDr. GV Reddy of Dr. Reddy\u2019s as its shareholders. In Bioinformatics, once it was<br \/>\nhaving some 30% share in the global Bioinformatics industry.<\/span> <\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Also, the genomic diagnostic firms<br \/>\nlike Strand already has vast data base of genomic data of Indian population.<br \/>\nAnd this gives it an edge in devising genomic diagnostic tests and personalized<br \/>\nmedicine. So Strand is a pioneer in genetic testing in India and is working on<br \/>\nto detect cancer early from blood and saliva. In 2017, it introduced a cost<br \/>\neffective liquid biopsy diagnostic test which helps in the detection of tumor<br \/>\ntraces from a simple blood sample instead of doing costly invasive biopsies or<br \/>\nradioactive scans. The success rate of this test is around 35% for early stage<br \/>\ncancer and 70-90% in fairly advanced stage cancer and these scores are at par<br \/>\nwith the best in the world. As costs are coming down, more and more Indian<br \/>\npeople are getting interested in getting their genome mapped to find out the<br \/>\npotential dangers to them in the future. <span style=\"mso-spacerun: yes;\"> <\/span>Also, as more genomic diagnostic tests will be<br \/>\ncovered under Insurance policy this industry will see huge growth going<br \/>\nforward.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">In the early days of Genome<br \/>\nmapping, the costs were prohibitive (lakhs of Rupees) and it took around 2<br \/>\nyears to complete a genetic testing but now even in India these can be done in<br \/>\n2-3 weeks with costs ranging from 3000 to 50000-60000. So India now is at the<br \/>\nstart of a revolution in the genomics medical diagnostics. Indians are prone to<br \/>\nmany genetic diseases related to blood, heart and eyes. Accurate genomic<br \/>\ndiagnosis and DNA sequencing is leading to many innovative genomics treatments<br \/>\nlike precision medicine and Gene editing. Gene editing is the next big thing in<br \/>\nthe precision treatment of genetic disorders where a scissor like enzyme (found<br \/>\nin a Bacteria) cuts out the malfunctioning DNA of a gene and then replaces this<br \/>\nby good piece of DNA developed in lab. <\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">A time will come in the near future<br \/>\nwhere a doctor would look into the DNA sequencing\/genes mapping of an<br \/>\nindividual before prescribing any medicine to him. Genetic tests costs of<br \/>\n10000-60000 are within the reach of most of Indian middle class and very soon<br \/>\nwe\u2019ll see this as the first test to be done on a newborn in India. There are<br \/>\nmany instances where a baby has inherited deadly genetic disorder from his<br \/>\nparents although his parents were not having the same disease. But it happens<br \/>\nbecause both the parent can have one copy of a faulty gene and they can pass on<br \/>\nthis faulty copy of the gene to their child. So genetic testing\/mapping can<br \/>\nlist out the potential dangers in the genes. This will enable parents to take<br \/>\ninformed decisions during early pregnancy or whether to plan future pregnancy<br \/>\nor not. So a person with one faulty gene in its genome has to make sure not to<br \/>\nmarry a person having similar faulty gene\u2026and you people have guessed right<br \/>\nthat time is not far when instead of Kundali matching people will resort to<br \/>\nGenetic matching.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\">Genomic<br \/>\nDiagnosis is next big thing in medical diagnosis<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So we can easily see that genomic<br \/>\ndiagnosis and sequencing is going to be a huge market in India. Right now the<br \/>\nindustry size is small and it is around 300-400 cr only but it is only a matter<br \/>\nof time when this industry will see exponential growth. As per estimates this<br \/>\nindustry will touch around 1500-1800 cr in next 2-3 years. As these tests are<br \/>\nbeing available cheaply in India we\u2019ll only see their adoption at faster rate.<br \/>\nIndia is already staring at a potential cancer crisis in the country as most of<br \/>\nthe cancer cases are left undiagnosed due to lack of awareness and availability<br \/>\nof early stage testing. But now as they are available so it is only the matter<br \/>\nof time when players like Strand Life will open more labs across India<br \/>\nspreading awareness about genomics diagnosis. Here, Government has to play a<br \/>\nmajor role in supporting. Insurance companies will also need to come forward to<br \/>\nsupport this and they will come forward as early detection of potential genetic<br \/>\ndisorder risk will enable them to provide for early treatment of their<br \/>\ncustomers and pricing their products. So they have a huge stake in the<br \/>\nwidespread growth of this industry.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">Indian diagnostic<br \/>\nindustry is still about normal pathological tests which are 90% of the total<br \/>\nmarket. Genomic diagnosis is just 10% of the market but it is growing very<br \/>\nfast. For example, USA did 1.6 million genetic tests in 2015 but the figure<br \/>\nrose to 26.5 million in 2019!!! So, right now genetic testing market is nowhere<br \/>\nnear the potential if we see the USA market or routine diagnosis market of Rs.<br \/>\n40000 cr. We will see similar type of growth in India also. <\/span><span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Also,<br \/>\nStrand bought the routine diagnostic testing business of the USA based Quest<br \/>\ndiagnostic in India in 2018 in order to offer comprehensive diagnosis services.<br \/>\nStill, Bioinformatics is the biggest revenue generator for Strand but there is<br \/>\nno doubt that the future lies in Genomics. Strand now has around 27 testing<br \/>\nlaboratories in India and recently one of its biggest labs in Haryana was approved<br \/>\nfor the Covid-19 testing. <\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Strand\u2019s NGS laboratory is the<br \/>\nfirst and only facility in India to have the accreditation from the College of<br \/>\nAmerican Pathologists (CAP), and the National Accreditation Board for Testing<br \/>\n&amp; Calibration Laboratories (NABL), respectively. In 2019, it joined the<br \/>\nGlobal Diagnostics Network (GDN) which is a strategic working group of 10 major<br \/>\ndiagnostic laboratories collaborating to generate enhanced diagnostics insights<br \/>\nto improve the delivery of global healthcare.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Bangalore based Medgenome is the<br \/>\nbiggest player in India followed by Strand Life. In early 2018 Strand raised 80<br \/>\ncr from Quadria Capital for its genomics business. Not much data is available<br \/>\nabout the financial performance of the Strand Life but its topline should be around<br \/>\n70-100 cr however this figure does not capture the inherent strength of Strand.<br \/>\nUntil now, Strand has primarily focused on investing big in path breaking<br \/>\nresearch and achieved remarkable capabilities in the field of genomics. But it<br \/>\nis yet to commercialize its achievements in Genomics and this is where the<br \/>\npartnership with HCG will prove to be a big catalyst.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\">Clinical<br \/>\nResearch:<\/span><\/u><\/b><span style=\"color: #0033cc; font-size: 12.0pt; line-height: 115%;\"> <\/span><span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Another field where I think Strand<br \/>\ncan achieve big success is the clinical research. Global drug giants are<br \/>\nlooking at india for clinical trials and India is well placed for high growth of<br \/>\nclinical research due to presence of superior healthcare system and vast patient<br \/>\nbase for variety of diseases like life style diseases, cancer and neuro<br \/>\ndisorders. So, clinical research is best placed to become the fastest growing<br \/>\nsector in the life sciences. Strand life has unique capabilities to achieve big<br \/>\nin clinical research in the form of Bioinformatics, Genomics and laboratory<br \/>\nanalysis, large database of Indian genome and vast network of hospitals in<br \/>\nIndia (HCG). So this is one area which can really grow fast in India and there<br \/>\nis no reason why Strand Life shouldn\u2019t do well here.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\">HCG-Well<br \/>\npoised for the growth of Cancer care and Genomics in India<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Cancer care in India is way<br \/>\nunder-penetrated and under-served and this is one of the reasons for the high<br \/>\ncancer mortality rates in India (.68 vs .38 in USA) as detection of cancer is<br \/>\ndone at an advanced stage when it has already spread to other parts of the<br \/>\nbody. But Cancer crisis is getting very severe in India. WHO has estimated that<br \/>\n1 out of 10 Indians will suffer from a cancer in their life time and 1 out of<br \/>\n15 will die of cancer. Every year some 8 lac people die of Cancer and around 13<br \/>\nlac new cancer patients are added every year which is going to increase fast.<br \/>\nThese are very scary statistics. Apart from the fact that Cancer care is<br \/>\ninadequate, the situation is made worse by the concentration of around 95% of<br \/>\ncancer facilities in Tier 1\/2 cities and small cities and rural people do not<br \/>\nhave timely access to cancer care.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">The likes of HCG and Tata Memorial<br \/>\nHospital have focused on Hub and Spoke model to penetrate deeper into small Indian<br \/>\ncities\/villages. In Hub and Spoke model, Hubs which are capable of treating<br \/>\ncomplex forms of cancer are connected to other spokes capable of treating less<br \/>\ncomplex forms of cancers.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">But in Cancer care, timely<br \/>\ndetection is the most critical factor. Further, Indian people are mostly suffered<br \/>\nfrom cancers of breast, Cervical and Oral which have almost 100% survival rate<br \/>\nif detected on time and these are easily preventable. Like, skin cancer survival<br \/>\nrate is 100% if detected early but it drops to 30% and 16% if detected in stage<br \/>\n3 and 4 respectively. That\u2019s why Hub and Spoke model is critical for the Cancer<br \/>\ncare in India and as Spokes can easily provide cost effective cancer diagnosis.<br \/>\nCompared to other healthcare streams like Heart care, cancer care is still not<br \/>\nthat advanced and still huge efforts are underway to achieve better progress in<br \/>\nthe survival rate. Like, cancer diagnosis tools bases on Blood\/saliva are a massive<br \/>\nsuccess to ensure the early cancer detection and Strand has already done path<br \/>\nbreaking work in this and is ready to reap the benefits of superior efforts and<br \/>\ninvestments in research.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">India is not far behind technically<br \/>\nin cancer care compared to the likes of USA. USA has lower mortality rate because<br \/>\nof high rate of diagnosis. Failure to diagnose cancer is a major lawsuit<br \/>\nagainst hospitals in USA so healthcare professionals in USA do not take any<br \/>\nchance when it comes to cancer and that\u2019s why there are some studies which say<br \/>\nthat USA is over diagnosed and over treated for cancer because they do<br \/>\nprocedures like Chemotherapy even for early stage cancers which are not recommended<br \/>\nat all. So these survival cases raise the survival rates. Still it does not<br \/>\nmean to say that we are at par with USA\u2026we have vast distance to travel. But our<br \/>\ndeficit is related to penetration, technically we are not far behind like in<br \/>\n2018 India received the approval for using <b>Immunotherapy<\/b> for treating cancer<br \/>\nlike kidney cancer, urinary cancer, breast cancer within one year of its<br \/>\napproval for use in developed countries like USA (HCG is also using this). Similarly, I remember in 2018<br \/>\nIndia got Digital pathology solution produced by Philips Intellisite Pathology<br \/>\nSolutions within one year of its launch. HCG got the same in Apr-2019<br \/>\nand in Dec-2019 HCG became the first in India to fully digitize its HCG-Strand<br \/>\nLaboratory in Bengaluru.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Government role is going to be a<br \/>\nbig factor as Cancer care is very costly and still beyond the capacities of<br \/>\nmost Indians. Government is already on this and some cancer treatments are<br \/>\ncovered under Ayushman Bharat scheme. But still more work is required on this and<br \/>\nGovernment support will further pave the way for deeper penetration and growth of<br \/>\ncancer care in India.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">But major positive for India is the<br \/>\nlow cost of Cancer treatment which is in many cases is around 1\/10<sup>th<\/sup><br \/>\nof cost in USA<\/span> and on an average it i<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">s about 2 to 5 times cheaper than<br \/>\ncountries like USA and Canada. Hence as I have explained in detail in my Post<br \/>\nrelated Narayana healthcare, India is going to be a favorite destination for<br \/>\nmedical tourism for cancer care also. India is already getting large numbers of<br \/>\ncancer patients from Middle East, Africa and SAARC nations but still we need to<br \/>\nbreak some myths related to backwardness of Indian cancer care as in cancer<br \/>\ncare India is regarded as a secondary destination as compared to other Asian countries<br \/>\nlike Taiwan, Singapore.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\">Finally time<br \/>\nfor some Rituals- Financial Analysis<\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<b><u><span style=\"color: #0033cc; font-size: 14.0pt; line-height: 115%;\"><br \/><\/span><\/u><\/b><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">It may appear on the surface that<br \/>\nHCG is doing badly operationally when one looks at its financial performance-<br \/>\nTurnover of Rs. 1100 (hit by Covid) cr in 2019-20 and Losses before tax of Rs.<br \/>\n119 cr. But just a little bit of scratching of the surface and things will<br \/>\nunfold into a new dimension.<\/span><span style=\"color: #0033cc; font-size: 16px;\">First of all, there is an impact of Rs. 40 cr due to implementation of new lease standard 116 otherwise the losses are much lower than the reported figure of 119 cr (loss before tax). <\/span><span style=\"font-size: 12pt;\">Most importantly, HCG has done massive expansions in last 3 years by investing some 700 cr in creating new facilities across India. Numbers of beds<br \/>\nunder its network are at 2071 in Mar-20 as compared to 1364 in 2017. Its gross<br \/>\nblock is around 1200 cr in 2020 as compared to some 600 cr in 2017. It was a<br \/>\nprofitable company in 2017 with NP of 23 cr on revenues of 700 cr. Now, I think<br \/>\nyou can easily guess why its performance could have suffered after that-<br \/>\nbecause of costs related to new expansions hitting the profits with relatively<br \/>\nmuch lesser growth in topline. Like, its topline growth is around 50% from 700<br \/>\ncr to 1100 cr however depreciation is at 104 cr in 2020 (excluding lease<br \/>\nimpact) vs 57 cr in 2017, interest cost of 82 cr vs 23 cr, Employee cost at 208<br \/>\ncr vs 121 cr. <\/span><span style=\"font-size: 12pt;\">So as<br \/>\nmaturity profile of recently commissioned hospitals is low hence they are not<br \/>\ncontributing much to the topline but their expenditures are hitting P&amp;L<br \/>\nbadly as turnover growth is just 50% but most of the expenditures have been<br \/>\ngrown up by more than 100%.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">In Healthcare there is high<br \/>\noperating leverage as most of the expenses are fixed so when a hospital is new,<br \/>\nrevenue will be lower but fixed charges like depreciation\/lease rentals of<br \/>\nbuilding, machinery, staff payments hit hard. Healthcare uses very expensive<br \/>\nmedical equipment so upfront fixed expenses are high so this gives a false<br \/>\nimpression of losses. But as most charges are fixed so most of the incremental<br \/>\nrevenue goes to bottom line. We can look at the superlative performance shown<br \/>\nby NH this year which will show the operation of operating leverage. I am<br \/>\ntaking the performance of 9 months ending Dec-2019 to eliminate the Covid<br \/>\nimpact in Mar-2020. Up to Dec-19 the topline of NH was Rs. 2385 cr vs 2096 cr growth<br \/>\nof 14%. But its NP was 107 cr vs 22 cr\u2026a massive jump of 500% as compared to<br \/>\ntopline growth of just 14%. And stock price of NH increased from 200 to 400 in<br \/>\nJan-2020 (<a href=\"https:\/\/oscillationss.blogspot.com\/2019\/11\/narayana-hrudayalaya-ltd-axis-mundi-of.html\" target=\"_blank\">click here for the post on NH)<\/a>. We can see similar impact of operating leverage on the performance of<br \/>\nHCG anytime in this year.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><span style=\"color: blue;\">For valuation, EBITDA can be used but as it has just completed a<br \/>\nmajor expansion in last 3 years so I do not think it is wise to try to assign a valuation<br \/>\nto it even on the basis of EBITDA. I have seen people using this metric blindly in all situations. Similarly I have seen attempts to value HCG on the<br \/>\nsame basis. But as I have told you hospitals are a very different business and it is not easy to apply traditional valuation models on it. Like, for<br \/>\nEBITDA based valuation we can see that the value will be heavily distorted by<br \/>\nthe presence of newly commissioned hospitals (large numbers) which are having<br \/>\nnegative\/break even EBITDA as of now. So these facilities which do not add<br \/>\nanything to the EBITDA of the company will not get any valuation at all!! So if<br \/>\nwe try to value HCG on the basis of EBITDA (it shows some 135 cr for Hospital<br \/>\nbusiness in 2019, 121 cr in 2020) then the result will give extremely wrong<br \/>\nvaluation because it will not assign any valuation to the loss making\/break<br \/>\neven hospitals. In fact, loss making hospitals will further reduce the overall<br \/>\nEBITDA of the company and this will result in the assigning of negative value<br \/>\nto a hospital like -50 cr for its Nagpur hospital. But can a hospital has<br \/>\nnegative value or a zero value?? <\/span><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">So I think the better approach to<br \/>\nvalue these growing hospital chains is- use EBITDA for matured hospitals with<br \/>\npositive EBITDA and use replacement cost based or revenue based approach for<br \/>\nthe loss making\/breakeven facilities. Last year Max healthcare was sold at some<br \/>\n25 times EBITDA. But Cancer hospitals are much more expensive to set up and due<br \/>\nto costly equipments the capital cost is very high. Further HCG is a young<br \/>\nentity so I would take 30-35 times EBITDA for valuing HCG. Its mature center<br \/>\nEBITDA is 160 cr (including IVF business) so at 30 times EBITDA the value is<br \/>\n4800 cr. I<\/span><span style=\"font-size: 12pt;\"> do not have the value for cost<br \/>\nincurred on new hospitals but they have given the debt taken for new hospitals<br \/>\nand the same is 432 cr as on mar-20. We can move ahead with this figure by<br \/>\nadding some value addition in the form of expertise in setting up\/planning and<br \/>\nalso in the form of first mover advantage in setting up a new hospital in a small<br \/>\ncity because this acts as a deterrent against new investments by competition. I<br \/>\nthink we can easily take the same at minimum 500 cr.<\/span><br \/>\n<span style=\"font-size: 12pt;\"><br \/><\/span><\/p>\n<p><\/p>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Let\u2019s also try to value on the<br \/>\nbasis of revenue which is 150 cr for loss making centers. Max deal has happened<br \/>\nat some 2.5 times of revenue that too of mature hospitals. So I think we can<br \/>\ntake this at 3-4 times for HCG loss making centers which will take the value at<br \/>\nsome 450-600 cr which is near to 500 cr we derived on the basis of cost. So<br \/>\nValue of Mature hospital 4800 cr+ new hospitals 500 cr-Debt of 700 cr will make<br \/>\nthe value around 4600 cr. It is very high compared to the current market cap of<br \/>\nRs. 1600 cr. So let\u2019s try to lower the EBITDA multiple to 20 thinking wrongly<br \/>\nthat this is due to covid. So at 20 multiple, the value of mature centers<br \/>\nexcluding debt is 2500 cr and by adding 400 cr (only debt no value addition) for<br \/>\nloss making centers the value is 2900 cr still 80% higher than the current<br \/>\nmarket capitalization which shows that it is way undervalued.<\/span><br \/>\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><br \/>\n<span style=\"color: blue; font-size: 12.0pt; line-height: 115%;\">Further, other comparative players like Narayana and Apollo are trading at 6 times of their book value while HCG is trading at 3 times its book value. The likes of Fortis and Aster are trading cheap (at one time and 3 times) but Fortis is fighting its own set of problems and Aster DM i think gets more than 50% revenues outside India so i have left both. Further, as i have shared earlier Cancer hospitals require more capital investments but still if we take 6 times of book value as the basis the valuation of HCG will be some 3200 cr aswhich is near to our other valuations so we can say that our valuation of HCG is on right track. Some people ask me why for some stocks market pays such a high valuation compared to its book value&#8230;5-6 times is a big value. Actually stock valuation is where market sometimes shows great creativity. Like, if we can see low book value in case of hospitals in their infancy is an illusion because hospitals are a high capital investment business so in the initial period (say 4-5 years) there are losses due to the impact of high depreciation and other high fixed expenditures which results in big losses and so reduction in the book value. But this reduction in book value is not real as company is building business and growth catalysts are still intact. And with better performance in future due to operating leverage book value will be restored to normal levels. That&#8217;s why in the initial phase market assigns high valuation multiple to book value but as they are matured this valuation multiple is normalized.<\/span><\/div>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><span style=\"color: blue;\"><u><b>Strand Valuation<\/b><\/u><\/span><\/span><\/div>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">But above valuation of HCG is excluding the<br \/>\nstake of 38% in Strand life which for me will be one of the biggest growth catalysts.<br \/>\nAs I have told you earlier there is not much information about the revenues and<br \/>\nvaluation of Strand. Like, in Feb 2018 Quadria acquired stake in it for 80 cr<br \/>\nbut how much stake it acquired is not known. But as 38% is with HCG, then there<br \/>\nare investors like Kiran Shaw, Reddy, and Promoters etc. So I think Quadria<br \/>\nmuch have acquired somewhere 10%-20%. At 20% the value is some 400 cr and that<br \/>\nwas 2 years ago. After that Strand has acquired the diagnostic business of USA<br \/>\nbased Quest in India. But if you ask me sometimes it is better not to try<br \/>\nevaluating something as revolutionary as Strand.<\/span><\/div>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Once I was talking to a friend who<br \/>\nwanted to make a career in Astrology. During our discussions I shared my view<br \/>\nabout Astrology that it has lost its credibility because it tries to answer (and<br \/>\nchange) everything. Further, most of the things look beyond its reach and<br \/>\nillogical keeping in view its current technical\/theoretical advancements. Like<br \/>\nthe sun we see in the sky is the sun that existed 8 minutes ago because it<br \/>\ntakes around 8 minutes for the light to travel from sun to earth. Same is for<br \/>\nall the stars. A person comes into this world 9 months before taking birth.<br \/>\nSimilarly I always feel that equity investing starts to behave like Astrology<br \/>\nwhen it tries to put a value on everything. Some things are unfolded only on<br \/>\ntime and it is better not to make a crude guess of what may unfold especially<br \/>\nwith outdated techniques. CAGR, DCF etc. have outlived their lives and for<br \/>\nemerging businesses they have very limited utility. We need something better<br \/>\nnow (Even for settled businesses targets announced by brokerage houses do not<br \/>\nhit 95% of times). The likes of Quadria has acquired stake in Strand so they<br \/>\nhave to put a value on it but most of the times that value is purely arbitrary<br \/>\nand does not have much perspective. That\u2019s why we see cases like Quess<br \/>\nCorporations where Thomas Cook has made astonishing returns. Thomas cook<br \/>\ninvested in Quess in 2013 and by 2020 the value of its investment increased by<br \/>\nsome 25 times!! But in 2013 nobody could guess that by 2020 the same can be 25<br \/>\ntimes. In fact everybody would have laughed at. So the price paid by Thomas<br \/>\ncook was just the funds needed by Quess for their future growth and so the<br \/>\nvaluation was arrived for the sake of valuation not out of some precise<br \/>\ncalculation. Nobody can evaluate a disruption and innovation early in its life.<br \/>\nSame thing I feel for Strand and I think it is good that we are not required to<br \/>\nput a value for strand. I only wish for HCG to raise its stake in Strand in the<br \/>\nfuture.<\/span><\/div>\n<\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><br \/>\n<span style=\"color: blue; font-size: 12.0pt; line-height: 115%;\"><b><u>CVC Investments will be a game changer<\/u><\/b><\/span><br \/>\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">Further, to make the valuation<br \/>\nexercise more confusing the company has sold 31% stake to a private equity player<br \/>\nCVC at a valuation of 1600 cr. So, one can feel that the valuation offered is<br \/>\nquite lower. But I think there may be some valid reasons for this. Main reason<br \/>\ncan be the devastating impact of covid on all businesses and healthcare was<br \/>\nalso badly affected and there are high chances that healthcare will remain<br \/>\nstressed due to negative impacts on the incomes of people and this will hit<br \/>\ntheir capacity to spend on healthcare services. HCG was having a debt of 700 cr<br \/>\n(some 30-40% in foreign currency) and with not much help from government for<br \/>\nhealthcare sector I think even their survival was at stake. So there was high uncertainty<br \/>\nin Apr-may-2020 about the impact of Covid and this might have affected the debt<br \/>\nreduction plans of the management in 2020-21 as Covid will easily wipe out 2-3<br \/>\nquarters this year. HCG stock price was beaten down to some 60 levels in<br \/>\nMar-20. Hence, management realized the urgency to reduce the debt and this<br \/>\nmight be the reason for going for the stake sale. In May-20 price offered was<br \/>\n100 which was increased to 130 in June-2020. HCG has got some 500 cr from the<br \/>\nstake sale and this they will use for the debt reduction and this will make<br \/>\nthings much better for them.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">I also think that the present<br \/>\nsituation created due to Covid crisis will hit the business of many hospital<br \/>\nchains and those with weak balance sheets will feel the more pain and this may<br \/>\nhelp HCG doing much better even in tough times and we may see some management<br \/>\ncontracts happening with other local hospital chains. Further, the scope of<br \/>\ndeferment of cancer care is very less as compared to other healthcare problems<br \/>\nso HCG should not face that much difficult time as may be felt by other<br \/>\nhealthcare services.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\">HCG is planning to sell its<br \/>\nfertility business under Milann brand which is having revenues of 70 cr. I<br \/>\nnever liked HCG doing this unrelated business especially when the scope of<br \/>\ngrowth in the core cancer care is so high which requires huge capital<br \/>\ninvestments. Actually these types of unrelated acquisitions raise the doubt of<br \/>\nfund leakages by the management because why a wise man would attempt this type<br \/>\nof adventure when they are hard pressed in their core area. Still, I want to<br \/>\ngive them the benefit of doubt keeping in view the otherwise good reputation and credibility of the management and the fact that HCG did this in 2013 way before their<br \/>\nIPO and most importantly the presence of marquee investors in the form of IFC, Tamasek,<br \/>\nCVC raises the trust factor to great extent. Now, they have decided to sell<br \/>\nthis fertility business which is a good decision. So I hope that things are<br \/>\ngoing to get better for them from hereon because HCG has already suffered quite<br \/>\na bit. They went for massive expansions but were hit badly by the onslaught of<br \/>\nCovid. But current valuations are already discounting (over-discounting) all<br \/>\nsuch sufferings and it is one of the best play on the growth of Genomics, Genomic<br \/>\ndiagnosis and Cancer care in India.<\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><br \/><\/span><\/div>\n<div class=\"MsoNormal\" style=\"text-align: justify;\">\n<span style=\"font-size: 12.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;\"><span style=\"background-color: white; color: #0033cc; font-family: &quot;arial&quot; , &quot;tahoma&quot; , &quot;helvetica&quot; , &quot;freesans&quot; , sans-serif; font-size: 13.2px;\">(Views are personal and should not be taken as a recommendation for buying or selling a stock. Stock markets are inherently risky so kindly do your Due Diligence before investing. I am not a certified SEBI Analyst and holding the shares discussed in this Post. reach me at oscillationss@yahoo.in).<\/span><\/span><\/div>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Healthcare Global Enterprises Ltd (CMP 130 Market Cap 1600 cr) Data is God. I usually say these words and recently one friend asked me whether my emphasis was on quantum of Data. But I told him that quantum is more about linear flow or one dimensionality but God is multi-dimensional. So what I see when I say \u201cData is God\u201d is the ACCESS to the data. Like, we humans have access to 3D world and so all our experiences and interpretations are impacted (or burdened) by this fact (or illusions). We have very limited access to the universal Data and&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1125","post","type-post","status-publish","format-standard","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/oscillations.in\/index.php?rest_route=\/wp\/v2\/posts\/1125","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oscillations.in\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/oscillations.in\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/oscillations.in\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/oscillations.in\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1125"}],"version-history":[{"count":0,"href":"https:\/\/oscillations.in\/index.php?rest_route=\/wp\/v2\/posts\/1125\/revisions"}],"wp:attachment":[{"href":"https:\/\/oscillations.in\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1125"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/oscillations.in\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1125"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/oscillations.in\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1125"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}