Effect Measure

With health care costs growing without bounds, the medical devices industry and President Obama are hard at work. Not hard at work reducing costs. Hard at work convincing us that the solution to the cost crisis is more technology. Right, Mr. President. And John McCain is a maverick and Sarah Palin is a genius. Almost everyone else believes advanced technology is a significant driver of health care costs and the idea that it will drive down costs is not just a fantasy but steaming pile of crap. That doesn’t mean there’s no room for innovation to lower costs. On the contrary:

Nobody knows precisely why it works, but doctors have known for decades that the healing process for open wounds can be greatly speeded up by applying negative pressure ? that is, suction ? under a bandage sealed tightly over the affected area. The speculation is that it helps by drawing bacteria and fluid away from the wound, keeping it cleaner.

For patients, there is a benefit even beyond the speedier healing. Traditional dressings need to be removed and replaced ? sometimes painfully ? up to three times a day, but with the negative pressure system dressings can be left in place for a few days. But in the developing world, there’s a problem: The systems are expensive, and they need to be plugged in or powered by batteries that last only a few hours. In many developing nations, a reliable source of electricity is rarely available.

[snip]

The device, a cylinder with accordion-like folds, is squeezed to create the suction, and then left in place, connected to the underside of the wound dressing by a thin plastic tube. At that point, it requires no further attention: “It holds its pressure for as long as there’s not an air leak,” [MIT Masters Degree student Danielle] Zurovcik explains. For that reason, a suitable dressing that can hold the seal is a crucial element of the system. (MIT News Office, h/t Boingboing)

If this is such a good idea, how come some high entrepreneur hasn’t made such a device? Apparently they have. You can rent one for $100 a day, but the batteries have to be recharged every 6 hours. Or you can try something like this, where each unit costs about $3 and doesn’t require and power or attendance. It was designed by a class of student engineers and developed further for a Masters degree by one of them. It’s been field tested and is being refined further to improve the dressing seal. There are already plans to manufacture it locally in Rwanda in an ambulatory version small enough to carry in a pocket.

There is a lot of scope for reduced cost technology, even in the high tech area. Recently we were interested in using x-ray fluorescence (XRF) for exposure estimation in an epidemiological study. We have a device but it costs around $30,000. It seems it isn’t much more than an x-ray source and a detector with suitable ancillary circuitry. Asking around it sounds like something an undergraduate electrical engineering student could build for under $1000. We’re looking into it.

While the difference between $30,000 and $1000 seems an improbable gap, consider the difference between $100 a day and $3 to purchase in perpetuity. Technology might very well drive down costs. But not the way we are going about it via private sector entrepreneurs and venture capitalists hoping to milk the health care cash cow.

How about some open source health care technology projects?

Comments

  1. #1 Tony P
    April 18, 2010

    As a database guy I can tell you they’re looking to find commonalities among varying diseases and issues. Whether that will lead to improved treatment is up in the air at this point.

  2. #2 Keith Harwood
    April 18, 2010

    How does the suction device described (the accordion-like folds one) differ from the drains routinely placed in surgical wounds?

  3. #3 revere
    April 18, 2010

    Keith: Drains aren’t under negative pressure.

  4. #4 D. C. Sessions
    April 18, 2010

    How about some open source health care technology projects?

    All well and good if it’s going to be manufactured and used in Rwanda. To market it in the USA it you’re up against the usual barriers to entry into the healthcare products market, where the up-front expenses are prohibitive unless you can promise a backer brazillions.

    That’s assuming that some can’t-stop-doing it inventor like Steve Wozniak does it on donated time. If you’re looking for an academic project (e.g. undergraduate engineering class) you’re up against Bayh-Dole and the institutional requirement that the University control it and be able to successfully market it (see “backer” above.)

  5. #5 Keith Harwood
    April 19, 2010

    The ones they’ve stuck in me on several occasions were under negative pressure. A daily activity, nurse opens them, air goes in with a hiss, they expand, nurse empties them and measures the amount of yuck coming out, compresses them and seals. They expand slowly until the next day’s “doing the drains”. The actual sucking bits vary in diameter from about 2cm (with a very thin tube) to 10cm (with a 16 or 20 french tube). Expanded they are about as long as their diameter, compressed about one fifth of that. Generally, depending on the amount of yuck, they don’t expand much in 24 hours, so they are still under noticable negative pressure the next day.

  6. #6 skeptifem
    April 19, 2010

    I totally agree. Private industry and profit motive make for awful health care, all the way down to actual patient care.

    There is also the issue of top down decision making structures, where the people who make decisions about what to buy or how to do something are rarely the people who actually know the work. This is a problem in most industries, but still worth examining IMO.

  7. #7 Dr Denise
    April 19, 2010

    I like the idea. I know people who would be delighted to work on such things but they will feel really burned when a major corporation steals their elegant idea, jacks up the price and makes a brazillion dollars off of it.

    How can this be prevented with respect to open source technology?

    Perhaps if it is patented? But the corps have ways around patents by making minor changes in the product and patenting them. However, if the idea catches on and open source is cheaper that may propel it forward. Still, with the government plans mandating brand name meds over generic (I sometimes have to do a prior approval to get my medicaid patients available generic meds, no review required for brand) one wonders if the cheapest alternative is really what they want.

    nuf said.

  8. #8 Hand Gel G
    April 19, 2010

    The accordion design is one of the most elegant pieces of engineering solutions I’ve seen – you’ve got to love the beautiful minds at MIT who conceived it.
    On the side of reducing costs, the most recent Science Show on ABC (http://www.abc.net.au/rn/podcast/feeds/science.xml) covers an interesting theory that the immune system is subject to cycles and, that the timing of certain treatments may have an impact on their efficacy; and cost.

  9. #9 Mark Spohr
    April 19, 2010

    I think we need to make a distinction between “device technology” and “information technology”.
    Device technology has been a major driver of costs and due to the way health care in the US is funded is a scam… i.e. MRI in France $250 and in the US $2500.
    Information technology has the potential to lower costs by providing better information at the point of care and for operational research. (However, most health care software is poorly designed from just about every aspect resulting in higher costs, frustration, and reduced benefit.)

  10. #10 beriukay
    April 19, 2010

    There are groups of people doing open projects for medical stuff. The one that comes to mind is an open EEG system. I know there are people at https://www.noisebridge.net/wiki/Noisebridge working on just that.

  11. #11 Nomen Nescio
    April 19, 2010

    i played nursemaid to a friend who underwent reconstructive chest surgery a couple years ago, and those drains were also under negative pressure — same sort of rubber-bladder, empty once or twice daily and measure the output affair that Keith Harwood described. emptying them were part of what i helped with, in fact.

  12. #12 Keith Harwood
    April 20, 2010

    I’ve just looked at the reference to the MIT device. It looks, except for the colour and being rather more robust, pretty much like the ones I had. But, when were the MIT ones invented? The text is dated 2010 and reads as though the invention was recent. A date of ’07 is in the text, but it’s not clear that that relates to the invention or the inventor.

    However, I got my first lot in 2004 and at the time I got the impression that they were standard operating procedure, not new, not experimental, this is the way we always do it. So either these are not known to the MIT students and American medical practice or the MIT article is much older than it appears.

  13. #13 suzyf
    April 21, 2010

    If you love the idea of producing a $1,000 version of a $30,000 machine, then check out what is going on in Africa, at http://www.afrigadget.com/ – a home-made welding machine, for example, or a lamp made of a couple of batteries, a cut up flip-flop, and a milk can – mostly from the low income (aka slum) areas of Nairobi. These guys could probably do it for you, and from scrap metal and junk! Enjoy the ingenuity!

  14. #14 thelastdemocrat
    April 21, 2010

    great post, great point. people are motivated by incentives. people get sold on tech factor. to prevent sacr tissue post-ACL reconstruction, they home-delivered a gismo that you set your leg on, and it scissors your leg, at the knee, up and down continually. It was a metal frame, with hinged deelio for knee, fake lambs-wool for comfort, actuator, electric motor, cord, and transformer.

    Spec that your self. Max $500?

    What was my insurance co. charged?

    $1,000 RENTAL for one week.

    For grins, I got on the web and clicked in a Mercedes rental for one week, local pickup and delivery.

    Yes. $1,000.

    For the same $$, I could have sat in a Mercedes, operating the seat-moving thingio back and forth, enjoyed heated seating, the awesome stereo, leather seats, etc.

    How can Enterprise rent me that car for a week, and the medical equipment renter “requires” the same dollars?

    Because each of us is spending other people’s money.

    My premiums have already been paid. So, it is not my money.

    The doc orders, but does not pay.

    The ins company does not lose: it is just income/outgo ratio, and they raise rates as outgo gets higher.

    The rental company covers their cost to buy the machine – obviously, they have to be clearing way more than Enterprise rent-a-car is doing on the Mercedes.

    In the distant future, health care reform could address some of these issues. But from my studying the plan, I don’t see the direct way we will reap great savings from technology.

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