India, the world’s largest democracy, with its fast growing economy, has a major impact on world health, particularly with its formidable manufacturing base and its ability in recent times to offer treatment for the HIV epidemic in Africa when no other option was available. India is a world leader in many aspects of traditional medicine and is focused on combining it with modern advances in the field to offer all-inclusive healthcare.
In 2009, a bilateral strategic partnership was proposed between India and Australia. This was formalised in 2014, and elevated in 2020 to a comprehensive strategic partnership. This partnership, based on “mutual understanding, trust, common interests and the shared values of democracy and rule of law,” led to the establishment of the Centre for Australia–India Relations to foster new ties and support expanding exchange and cooperation with India. The partnership defines many areas of cooperation, including terrorism, maritime safety and defence. In the area of enhancing science, technology and research collaboration, there is a commitment towards strengthening healthcare systems in the two countries and globally.
Both India and Australia recognise the importance of global cooperation for saving lives, managing the economic impacts of healthcare and alleviating future global challenges, including pandemics. Both nations are committed to sharing the benefits arising out of scientific and medical research and development, and the strengthening of healthcare systems. Both countries recognise the importance of collaborative efforts in research, innovation and healthcare delivery to improve health outcomes not only within their borders but also on a global scale.
Under the partnership agreement, India and Australia have resolved to work through multilateral, regional and plurilateral mechanisms to strengthen and diversify supply chains for critical health and technology services. This is also consistent with the initiatives taken by India’s G20 presidency and the G20 Health Ministers’ meeting to identify the three major health priorities to strengthen the global health infrastructure and deliver universal health coverage. This will be done by consolidating the existing digital health initiatives and ensuring preparedness for future health crises such as pandemics and antimicrobial resistance.
Within the healthcare system of both countries, there is an urgent need for better therapeutic interventions for many intractable diseases that have few or no pharmacological treatments, such as metabolic diseases, chronic kidney disease, diabetic wounds and ulcers, traumatic brain injury, concussion and stroke, neurodegenerative diseases and chronic pain. Included in this is long COVID or post–acute COVID conditions. While most people with COVID-19 recover completely, long COVID conditions can affect up to one in eight people, according to a large study published in The Lancet. However, a recent study suggests that numbers could be much higher in India, with up to 25 per cent of COVID patients having symptoms that persist for at least a year. These symptoms could include brain fog, headache, sleep problems, dizziness, change in sense of smell, and depression or anxiety.
The incidence of chronic kidney disease in India ranges from less than 1 per cent up to 17 per cent, depending on the region. Further, incidence of the disease is increasing due to the nationwide rise in cases of diabetes. This is a major health problem, with the only possible treatment options at the later stages being dialysis and transplantation, both of which are expensive and not universally available. Parkinson’s disease is another cause of concern. While the incidence of this disease in India is low compared to Australia and the US, the absolute numbers are high due to India’s large population. There are more than 7 million patients suffering from Parkinson’s and only very few trained neurologists to care for them. Chronic pain is another problem in India, with up to 20 per cent of the population being affected. This places a significant burden on employment and quality of life. In the case of chronic pain, the effectiveness of the available modern medicine treatment of opioid and non-steroidal anti-inflammatory drugs is limited.
There is a need for alternative treatments for diseases and conditions that have few options in modern medicine. India, more so than Australia, embraces traditional, complementary and integrative (TCI) medicine due to its multicultural society. There appears to be a growing trend to integrate TCI with standard medicine to offer holistic and more individualised treatment. This is consistent with the World Health Organization’s (WHO) approach to TCI medicine with the traditional medicine strategy for 2013–24.
Traditional, complementary and integrative medicines in India include Ayurveda, yoga, naturopathy, Unani, Siddha and homoeopathy, which are used by hundreds of millions of people, including in primary healthcare settings, either alone or alongside modern medicine. The history of Ayurveda massage treatments has strong parallels to manipulative physiotherapy as well as light therapy. The therapies that we research and use clinically are light-based therapies based on low-power lasers or LEDs, which is now called photobiomodulation (PBM).
Photobiomodulation is well documented over the last thirty years to be an effective treatment for wounds that heal with difficulty, such as diabetic and venous ulcers; inflammatory conditions such as osteoarthritis; tissue repair such as tendinopathies; and for pain relief, including chronic pain. As such, there is a huge opportunity for this therapy in India, and PBM is currently being used and taught at several institutions across the country.
It is worth emphasising the significance of international collaboration in driving advancements in medical research. I recently attended the World Association of Photobiomodulation Therapy (WALT) Congress at the Manipal Academy of Higher Education (MAHE), which was a fantastic example of international collaboration, underscoring the potential for transformative research and treatments. It brought together researchers and clinicians in the field of PBM from across the globe and opened up new opportunities to expand and promote PBM therapy.
This was my first visit to India, and I was struck by the long and impressive history of both education and medicine, as well as the strong interdisciplinary structure of the university with its dental, medical and allied health therapeutic fields. MAHE was founded by Dr T.M.A. Pai as a private college in 1957, after the establishment of the Kasturba Medical College in 1953. It is an institution of eminence and a deemed university, with an international reputation for education, healthcare and pioneering research.
The convenor of WALT was Dr Arun Maiya, who is an active researcher and contributor in the field of PBM and a strong advocate of collaborative research. The Manipal Hospitals attached to MAHE use PBM to treat patients with diabetic foot ulcers and wounds as well as patients of chronic kidney disease with neuropathy symptoms. Megha Nataraj, a PhD candidate, gave a very enlightening presentation on her clinical study of PBM and diabetes-induced kidney disease. Research conducted at MAHE also offers new understanding of the role of the microbiome in Parkinson’s disease in the Indian population and the implications for treatment.
Professor Rene-Jean Bensadoun, the president of WALT, recognised the contribution of MAHE to PBM by announcing the Centre for Podiatry and Diabetic Foot Care and Research at MAHE as a centre of excellence for PBM. It was also truly inspiring to attend the celebration for the inauguration of the first Chair of Photobiomodulation at MAHE, with our WALT colleague Professor Praveen Arany taking up the position. Professor Arany also teaches at the University at Buffalo in the USA and is a former president of WALT. I have been collaborating with him on research on PBM cellular mechanisms for over ten years. He has made significant contributions towards the acceptance of international guidelines for PBM in supportive cancer care.
I have had the opportunity to visit several hospitals in southern India and see first-hand the manner in which PBM therapies are being trialled and used clinically. I have also seen groundbreaking research being conducted on diseases such as Parkinson’s disease and chronic kidney disease, including the connection between the gut microbiome and the brain in these diseases.
MAHE’s commitment to the use of PBM and further research on its uses, the hospitals that I visited, the colleagues that I saw, and the emerging Indian med-tech industry representatives with whom I met presented a very promising story for an India-based collaboration to drive this exciting and necessary field forward.
As an Australian clinician scientist and the head of a laboratory group in Sydney, I would like to outline a perspective on the importance of PBM for mitigation of intractable diseases and the opportunities that exist for global collaboration on innovation between Australia and India. I have a particular interest in many aspects of light therapy, which we now call PBM. We have been conducting clinical trials using PBM for various conditions as well as researching some of the basic mechanisms of how PBM works.
Light therapy has its roots in ancient times. The evolution of light as a therapeutic modality can be traced back thousands of years to the Egyptians and to the practitioners of Ayurveda, or the science of light, which combines the healing powers of light and colour with plant extracts. The modern world embraced the use of light, including heliotherapy, in Europe in the nineteenth century and with the work of Florence Nightingale, who advocated sunlight and fresh air. Indian scientists such as J.C. Ghosh, N.R. Dhar and Bawa Kartar Singh pushed forward the boundaries of photochemistry in the 1920s and 1930s, and Manapurathu Verghese George established a photochemical research group in the early 1960s to study photo-organic transformations.
The effectiveness of PBM as a medical treatment was first demonstrated in 1967 by Dr Endre Mester in Budapest. While investigating whether laser was harmful and could cause cancer, Dr Mester serendipitously found that when applied to a wound on a rat, laser caused the wound to heal more quickly and led to accelerated hair regrowth. Since that time, laser—and LED treatment, now known as PBM—has been quietly revolutionising healthcare practices. Despite its technical name, the concept behind PBM is elegantly straightforward. It harnesses the energy of light to influence cellular responses within the body, especially stimulating the mitochondria, which are the powerhouses of cells, to produce more energy. The process uses a low power of light and is non-thermal, but the wavelength or colour of the light is important, with certain red and near-infrared wavelengths being the most effective to trigger a cascade of biochemical and cellular changes.
Central to the effect of PBM is the involvement of a vital enzyme known as cytochrome c oxidase, which plays a pivotal role in the electron transport chain within the mitochondria. When exposed to specific wavelengths of light, cytochrome c oxidase undergoes a series of conformational changes, leading to enhanced mitochondrial function. This process culminates in a plethora of physiological responses, including heightened energy production, improved oxygen binding, augmented cellular signalling pathways and reduced inflammation. The cellular effects that PBM produces make it amenable to treating a multitude of conditions.
Over the past five decades, PBM has evolved into a versatile tool for the management of various medical conditions, including tissue healing (particularly in the context of wounds, burns and chronic ulcers), pain relief, deep tissue repair such as for tendons and cartilage, and attenuation of inflammation in conditions such as osteoarthritis.
Photobiomodulation now has a small but important and increasing place in modern clinical practice. The increasing acceptance of PBM in mainstream medicine has been helped by it being established as an accepted treatment for the side effects of oral mucositis and radiation dermatitis, which are side effects of radiation therapy and chemotherapy for cancer, under both the MACSS and NICE guidelines.
Recent years have witnessed the emergence of new areas of PBM therapy. Transcranial PBM, or PBM directed to the skull and brain, is an important area that has the potential to address a spectrum of brain-related ailments. Transcranial PBM has been shown in pre-clinical animal studies as well as in some clinical studies to be effective in treating traumatic brain injury (TBI) and stroke. It is also useful in managing neurodegenerative diseases and neuropsychiatric conditions, such as reversing cognitive impairment, post-traumatic stress disorder (PTSD), anxiety, depression, Alzheimer’s disease and Parkinson’s disease. Pre-clinical models have also underscored its neuroprotective and neuro-regenerative potential, offering new avenues for therapeutic intervention. Importantly, the safety profile of transcranial PBM remains exemplary, with reports of only minimal and transient side effects. The potential therapeutic benefits of PBM in diverse neurological disorders offer a ray of hope for patients confronting diseases with limited pharmacological options.
The importance of PBM therapy to the Indian population cannot be overstated. The proven effectiveness of PBM for healing wounds, tissue repair and pain management shows that there is a place for PBM as a much needed additional therapy for chronic pain, diabetic and venous ulcers, and other conditions prevalent in India. It is also projected that the number of people who will develop neurodegenerative diseases, including Parkinson’s disease, will rise due to an ageing population and increasing risk factors for the diseases, which makes PBM, a non-invasive, safe and potentially effective therapy, very attractive. By adopting PBM for mainstream diseases and conditions that Indian patients suffer from, India can build upon its leading role in the supply of generic medicines to poorer countries. At the same time, it can stake out a prominent position in the use of PBM.
There is no doubt that there is a very promising opportunity for local research and clinical collaborations to extend this exciting therapy in India. The country is particularly well placed to make a substantial contribution to this burgeoning area of medicine and to deliver on many of the recent health aims and objectives articulated at the G20 summit and the Indian–Australian Comprehensive Strategic Partnership. International collaboration between India and Australia and the international research setting in PBM provides a framework for an exciting area of treatment of intractable diseases, as well as providing further technological innovation that can address complex health challenges and be at the forefront of world health initiatives.
As we navigate the complexities of modern healthcare, it is imperative to harness the power of collaboration and innovation to build a healthier and more resilient world.
Ann Liebert is a clinician–scientist and Coordinator of Photomolecular Research at the San Hospital, Sydney, Australia. She has research positions at Sydney University and the University of Western Sydney and teaches in the Diploma of Photobiomodulation at Université de Montpellier, France. Ann researches the mechanisms of photobiomodulation and the treatment of Parkinson’s disease and kidney disease and has published many papers on these and other topics. She continues to treat patients in her photobiomodulation clinic. Ann is Co-founder of the med-tech company SYMBYX Biome, which produces photobiomodulation devices to treat Parkinson’s disease and other neurodegenerative diseases.
