Investing in Diagnostics for Better Healthcare: Interview with Carlos Martins - President, Roche Diagnostics, Brazil

Meeting highlights: 

• Increased Speed and Agility: Carlos notes the need for faster decision-making and agility in business, with Roche becoming more agile and collaborative. 
• Public-Private Healthcare Partnerships: opportunities in Brazil for public-private collaborations, especially tech transfers, to improve public healthcare. 
• Need for Diagnostics Investment: Carlos stresses the urgent need for Brazil to boost diagnostics spending from 0.5% to the global average of 2% for better early detection and treatment. 
• Healthcare Payment Challenges: The current fee-for-service model is unsustainable, and reform is needed, though it would impact both public and private sectors. 
• Focus on Innovation: Roche is investing heavily in digital health, AI, and diagnostics, with a focus on cardiometabolic diseases, oncology, and neurology. 
• Meaningful Partnerships: Roche Diagnostics has formed great relationships with patients and society and created true business impact.

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EF: How would you describe 2024, and how have your priorities evolved?  ‍

CM: The pace of change has accelerated significantly in recent times; everything is moving so much faster, from communication to forming partnerships and creating new opportunities. It is like the speed of everything has increased five-fold. This shift impacts all of us, making it crucial to be quicker and more competitive—not just to compete but to seize opportunities and build partnerships before others do. If we do not, our competitors will, without a doubt. 

At an individual level and within organizations, more is demanded of us than ever before. This is especially true compared to a year ago and even more so when you think back a decade. This is not unique to healthcare; it is a trend pushing us all to become high-performing organizations. But being high-performing does not mean doing more—it is about doing less but smarter, making a bigger impact, recognizing achievements, and fostering a feedback culture. These values form the foundation of our organizational culture. 

Reflecting on what has changed within our organization, I see tremendous evolution. We have become better equipped to navigate today’s competitive and fast-paced environment. For example, I recently had a quick alignment session with six team members through Google Chat. In just 15 minutes, we accomplished what used to require a scheduled meeting. It shows how agile we have become, no longer relying solely on formal processes but focusing on what is truly necessary to move forward. 

Externally, the market in Brazil has also shifted dramatically. While these changes started last year, we are now seeing greater openness from the government to engage in tech transfers as a way to boost public healthcare. This involves partnerships between private companies, like ours, and the government for knowledge and technology transfers. The private sector, too, is feeling the pressures—2023 was tough for healthcare insurance companies, with costs rising as a backlog of postponed exams and surgeries from the pandemic hit all at once. While these companies are now recovering, the fundamental issues with the existing fee-for-service model remain unresolved. 

Moreover, new challenges are emerging, like the rise in dementia-related to online gaming addiction. The public sector needs help to keep up with the needs of these patients, many of whom cannot afford private healthcare. Despite all these complexities, Brazil—and Latin America as a whole—remains incredibly resilient. This resilience means that every problem brings new opportunities. That’s the mindset we need to embrace: seeing challenges as chances to innovate and grow. 

EF: How can we change this perspective to view healthcare more holistically, beyond just an expense? 

CM: When it comes to diagnostics, the global average spending on in vitro diagnostics (IVD)—lab testing, which makes up the majority of tests—is about 2% of total healthcare expenditure. A smaller portion, around 20-30%, goes to imaging diagnostics like X-rays and MRIs. Around 70-80% of all exams are done in clinical labs, yet in Brazil, only 0.5% of healthcare spending is allocated to IVD, which is just a quarter of the global average. This is despite the fact that clinical lab results influence 70% of medical decisions, guiding treatments, surgeries, and even routine checkups. 

This underinvestment is a critical issue. For instance, a basic glucose test to screen for diabetes or a complete blood count can yield a wealth of information. Yet, despite their importance, diagnostics remain underfunded. In Brazil, there is an urgent need to increase investment in diagnostics, especially when compared to countries like Mexico, where the percentage is three times higher at 1.5%. 

Investing more in diagnostics means detecting conditions earlier, leading to better preparation for treatment. Take my own experience: I lost my father in 2024 to metastasized prostate cancer. He had been treated for it 13 years ago, but for the past year, he had not been attending his doctor’s appointments. A simple PSA test could have detected his condition earlier, potentially saving his life. If the healthcare system had been more proactive in ensuring regular testing, he might still be with us today. Diagnostics offer answers, such as "Am I sick?" or "Do I have cancer?"—answers that are crucial for early intervention. 

Treatments have a big impact, and before you treat, diagnostics are fundamental. Investing more in diagnostics shifts the focus from being reactive to being proactive, from managing sickness to managing health. That is why I am passionate about diagnostics, even after 17 years in the field at Roche. While treatments are vital for saving lives, diagnostics is the first step, and it sets the stage for better outcomes. 

In Brazil, we are fighting hard to raise awareness of this need. It is a key part of our communication strategy, and I emphasize this message in every speech. We must invest more in diagnostics. The shift from viewing healthcare as a cost to seeing it as an investment requires a long-term perspective. It is about recognizing that while returns may not appear in the next five years, by year six, the benefits will become clear: better quality of life, more effective treatments, and healthier populations. People often only understand the urgency of healthcare when they or their loved ones fall ill. My hope is that we can instill this understanding before that point, making diagnostics a true priority. 

We need to act now. It is imperative to increase the healthcare budget immediately, focusing specifically on IVD (in vitro diagnostics). Our proposal is to contribute to this increase over the next three years, which will help elevate the current spending from 0.5% of the healthcare budget to around 1% as a progressive path to achieve the global average of 2%. This progress will not happen overnight—it requires structural changes and strategic planning. 

These decisions cannot be made unilaterally by the government. They must involve the industry because, while the government has a plan, it lacks the technology and solutions that we, in the industry, possess. Without our collaboration,  public health plans will likely fall short of what is needed or feasible. For effective and sustainable change, a strong partnership between the private and the public sectors is crucial. 

In Brazil, the private sector is a different story. It accounts for 25% of the population yet generates 75% of the total healthcare market value. This disparity clearly highlights the lack of investment from the public sector in diagnostics, and it is a trend that extends beyond diagnostics into other areas of healthcare. The public healthcare system is highly uneven—patients in regions like São Paulo or Belo Horizonte may access advanced treatments and testing, but many others across this vast country, which makes up about 36% of Latin America, are left without real access to essential healthcare. The SUS is a big bet from the Brazilian government and entails a very impactful vision, that's why we need to contribute to this very well-thought-out concept. 

We urgently need a unified strategy that integrates both public and private efforts, and the industry must play a central role in shaping this approach. This collaboration will ensure that the entire population—not just a select few—benefits from improved healthcare infrastructure and access to critical diagnostics. 

EF: With the aging population and the rise of non-communicable diseases like cancer, diabetes, cardiovascular conditions, and neurological disorders becoming more noticeable in Latin America, including a projected doubling of those aged 65 and above in the next 30 years, how is Roche preparing for this shift? And how do you evaluate your forward-thinking strategy in Brazil? 

CM: In October 2024, in Switzerland, we unveiled Roche's new "One Roche" corporate strategy. This approach highlights our unique end-to-end capabilities for patients, integrating leadership in both diagnostics and treatment. Thomas Schinecker, our CEO, emphasized that we are positioned to address patient needs comprehensively, from diagnosis through advanced treatment solutions. With a strong track record in innovation, we have consistently been the top healthcare R&D investor for the past decade, investing around 13,6  billion Swiss francs last year, rivalled only by Johnson & Johnson among top non-tech R&D spenders. 

Our focus on innovation is essential because it is the key to addressing the challenges of an aging population. Without advanced solutions for diagnosis and treatment, people would face higher risks of serious health conditions as they age. It is a dilemma: as life expectancy increases, so do the complexities of healthcare. Yet, as humans, we are inherently driven to pursue a longer life, and not just longer, but one with quality. 

This perspective shapes Roche's strategy, which has been built over its 128-year history and is committed to lasting innovation. We are determined to make a significant impact across our Diagnostics and Pharma divisions. Cardiovascular and cardiometabolic health, encompassing conditions like heart disease, obesity, and diabetes, remains a major burden for society, including in regions such as Latin America and Brazil.  

Equally critical is our work in oncology, tackling the increasing prevalence and complexity of cancer diagnosis and treatment, a challenge that requires both precision and innovation. In neurology, we are addressing the rise in dementia cases, especially Alzheimer’s, recognizing the need for new diagnostic and therapeutic solutions. 

An example of our commitment to these areas is our acquisition of Carmot Therapeutics, which has strengthened our capabilities in cardiometabolic care with promising pipeline candidates, including an oral GLP-1 therapy. Our strategy is aimed at supporting healthier aging by providing solutions that enable people to live longer, healthier lives. We are making significant investments in cardiometabolic and are currently launching a Continuous Glucose Monitoring (CGM) solution for patients with diabetes, especially those with concurrent cardiac conditions.  

This new solution represents a major leap forward in glucose monitoring by integrating artificial intelligence through an app. The app can predict the likelihood of hypoglycemia occurring during the night, providing patients with actionable insights—whether it is to eat an apple, adjust insulin, or take another preventive action. 

This innovation addresses a critical issue many people with diabetes face: the fear of sleeping due to the risk of nocturnal hypoglycemia. Many struggle with anxiety over the possibility of a dangerous drop in blood sugar levels while they sleep. Our CGM solution aims to provide peace of mind by offering real-time, proactive guidance, ensuring safer and more restful nights for patients. This is the kind of meaningful, patient-centric innovation to which we are committed. 

The acquisition of Carmot and the launch of CGM  represent a fantastic bundle that we are introducing. On the oncological diagnostics front, we recently introduced digital pathology into the Brazilian market, which is truly a game changer. Let me simplify this: the only definitive way to diagnose cancer is through an anatomical pathology test, whether it is a tissue biopsy or a liquid biopsy. While other methods like imaging or observations can provide information, a confirmed diagnosis requires anatomical pathology.  

However, there is a significant global shortage of anatomical pathologists, not just in Brazil. These specialists are the only ones qualified to analyze biopsy images under a microscope and diagnose specific cancers, such as prostate cancer or HER2-positive breast cancer. 

Recognizing this challenge, Roche initiated a project six years ago, which is now being deployed globally, including in Brazil, with some remarkable results. For example, we recently partnered with Albert Einstein Hospital where the time for diagnosis—previously dependent on anatomical pathology—was reduced from one hour to just 30 seconds. This partnership has even been highlighted in several healthcare publications in Brazil. Our AI-based solution can now analyze a biopsy in just 30 seconds, thanks to a high-resolution scanner that we developed. This scanner, combined with AI, compares new biopsy images with a vast database of previous results to provide accurate diagnoses. 

This innovation has dramatically increased our ability to provide timely diagnosis. In Brazil's public sector, where millions of patients are waiting for oncologist appointments, the bottleneck often lies with anatomical pathology, not with the oncologists themselves. By investing strategically in digital pathology infrastructure and deploying this technology in key areas with long waiting lists, we can make a significant impact. While this will not happen overnight, we can start with targeted locations and gradually expand. 

On the oncology side, we also have a robust molecular pipeline with numerous candidates for both existing and new molecules. Additionally, in neurology, particularly dementia and Alzheimer's, we have made notable strides. Roche is the only provider offering a fully automated biomarker for the prognosis of Alzheimer's.  

This test can predict an individual's likelihood of developing Alzheimer's over the next 10 years, which is a major contribution. However, it currently involves a somewhat invasive process, requiring the collection of cerebrospinal fluid through a spinal tap under anesthesia. We are working to scale this test, with plans to launch a version that will use serum in the second half of 2025. This means that similar to how you get a glucose test with a quick turnaround time, you will soon be able to get the same Alzheimer's prognosis result using a serum test—essentially, a simple blood test. This will make the process much less invasive and more accessible to the patients.  

There is a lot of innovation on the horizon, especially in these three areas, but there is also a critical need for sustained investment in certain diagnostic areas. In addition to the three key areas where we collaborate extensively with pharma, we are also focusing on infectious diseases. I recently highlighted on LinkedIn the severe pollution levels in São Paulo, which recently ranked as the most polluted city in the world for about ten days. Poor air quality has made populations more susceptible to infectious diseases and respiratory, creating an environment where new respiratory viruses can emerge. Addressing this requires staying ahead of both existing and emerging pathogens. 

To tackle this, we are launching a new series of syndromic panels. Unlike the current approach, where tests are designed to diagnose a single condition—such as influenza or COVID-19—our new technology will enable doctors to assess multiple targets with just one test. This process, known as multiplexing, allows for a broader, more efficient diagnostic approach. This new technology, called Eplex, is set to be launched in Brazil in early 2025. 

Another major area of focus is digital investment. Out of the 13,6 billion Swiss francs we have allocated for R&D, a significant portion is specifically directed to digital solutions. Some of these are internal projects, like digital twins, which help accelerate the R&D process, making it more efficient and cost-effective. However, the majority—about 65-70%—is invested in creating our own digital ecosystem. This involves managing clinical labs, handling the complexity of laboratory processes, and integrating systems, robotics, and AI to analyze and validate results. 

We are indeed using AI to assist in tasks that were traditionally the domain of doctors, but it is crucial to note that doctors will always have the final say. The goal is not to replace them entirely but to enhance the speed and accuracy of diagnostics and clinical decision-making, making the entire process faster, more efficient and assertive. 

We are moving from operational support to providing advanced clinical decision support, helping doctors make more informed decisions. But our vision extends even further into a third pillar: disease management. For instance, continuous glucose monitoring for diabetic patients, combined with an automated insulin pump concept, are examples of how we are positioning ourselves for the future. 

Roche's strategic approach is a key reason I have been working here for 17 years. Before this, I spent five years at J&J, another highly innovative company. J&J has a more top-down, hierarchical culture, typical of American organizations, while Roche's European culture fosters inclusivity and openness. At Roche, decisions might take longer due to this collaborative approach, but once a decision is made, it is fully aligned and moves forward like a powerful train—unstoppable once in motion. It is a different style of management and leadership that I find very effective. 

EF: Reflecting on your three years in Brazil, what key moments or achievements stand out to you during this time? 

CM: One of the key achievements over the past three years has definitely been the successful partnerships we’ve established, as well as the internal transformation of the organization. We managed to shift the cultural mindset within the company, which was crucial given the challenging times we faced earlier. Today, both the country and the organization are in a different place. We have made a significant turnaround, not just in terms of business but also culturally. For instance, we have achieved substantial growth this year, expanding by 16% in a market that is growing at 5%. This reflects the strength of our strategy and the partnerships we have built. 

A standout example is our collaboration with the Ministry of Health, which began last year. This partnership led to equipping 83 public labs across Brazil with our molecular technology to support the HIV-positive population. It’s a major initiative with a deep impact, extending beyond HIV to include hepatitis, and we are now looking to add more testing capabilities, like CTNG, for women’s health and potentially HPV. The beauty of this initiative is that once the framework is established, it allows us to expand and include more diagnostic capabilities, broadening our support for public health. 

Roche has been a driving force behind several critical initiatives, such as leading the inclusion of the DNA-HPV test (PCR test) in the Brazilian Public System. HPV, or human papillomavirus, is a primary cause of cervical cancer in women, and we took the lead in getting the necessary approvals from ANVISA and CONITEC (Brazilian health regulators). The approval has already been secured, and we are now working on integrating this technology across the country. This integration will potentially build upon our existing infrastructure, enabling the addition of DNA-HPV testing to our installed base of systems nationwide. While the full implementation is still in progress, getting the approval was a significant milestone that we’ve already celebrated. 

I take pride in Roche’s science-driven approach, with medical doctors as part of our team. Our focus is not just on commercial success but on ensuring access to care, starting with patients' needs. We have also established strong partnerships, like building a state-of-the-art lab in São Paulo’s Syrian-Lebanese Hospital and forming a digital collaboration with Hospital Albert Einstein to enhance our AI capabilities. Additionally, we have expanded our partnerships with key players like Dasa, one of Brazil’s biggest lab networks, and we're now the sole provider of comprehensive lab solutions to Sabin, another leading lab in Brazil. Our collaborations with DB and Fleury Pardini have also grown significantly. 

All of these achievements over the past three years were possible because we laid a solid foundation within our organization. This transformation was centred around changing the mindset, fostering a culture of collaboration, and building a high-performing organization. As I reflect on this journey, I see that the groundwork we laid has led to tangible results: broader access for patients, increased reach of Roche diagnostic solutions across Brazil, and improved financial sustainability. Our work not only benefits patients but also strengthens healthcare ecosystems and society as a whole. 

In short, Roche is making a significant impact in the healthcare space in Brazil, both through innovation and through our deep commitment to advancing patient care and access. This impact goes beyond just Roche Diagnostics; it extends to the larger contribution that Roche Group brings to the healthcare environment, making us a key player in driving progress and positive change.