Healthcare, medicine & pharmaceuticals

Frugal medical devices

Sales of medical technology in China are brisk and forecast to grow 15% every year to 2015. But the Chinese are making their own, much more cheaply than western companies can. Dubbed “frugal innovation”, they are making inexpensive, new products in a way that is sharply competitive. There are no fancy offices, for a start.

While American companies have led the way in medical technology, PWC forecasts that China could lead Europe by 2020 in the manufacture and use of medical devices. Medtronic, an American maker of medical devices, began a joint venture with a Chinese firm two years ago. It was persuaded to move to China because of strong local demand, government encouragement of “indigenous innovation”, and the need to localise because of strong, local competition.

One example of frugality is, instead of selling lots of disposable sutures, Chinese firms have manufactured reusable ones. A new Chinese firm, MicroPort, makes heart stents 40% more cheaply and now owns 70% of the Chinese market. Conversely, a commentator at GE says American companies are not well set up for selling cheap devices, and rely on an “emotional kind of sale” rather than evidence of value. This is further complicated by risk-averse regulation and the US system of financing health care.

Frugality is not everything. Companies in emerging markets can jump to the latest technologies, such as advanced materials, mobile communications and miniaturisation, and are not left with expensive legacy systems. At the moment, China seems to prefer to make simple, non-invasive devices, rather than the more sophisticated ones, such as implanted defibrillators. But as health budgets blow out in the US, perhaps frugality and simplicity are the way to go.

Who’s the daddy?

It had to come to a chemist near you: a DNA testing kit so you can tell who your real dad is. Boots (UK) is selling the AssureDNA kit for 30 pounds, which doesn’t sound like much. But once you’ve collected cells from the inside of the cheek, you pay 130 pounds for results in five days (or 329 pounds for a 24 hour result). So much for the financial cost.

Then there’s the social cost. Many families are blissfully unaware of who really belongs to whom and it doesn’t really matter. Innocence is bliss. It’s estimated that the national rate of 4% infidelity is likely to mask some marked variations, especially in “deprived” areas where it can be 30%. But you might also argue that children have a right to know who their parents are, whatever the circumstances – blood is thicker than water.

Those organisations concerned with ethics or religious beliefs will struggle with the possible social implications of a paternity testing kit. Its use could unleash a great deal of bitterness and disappointment, and unnecessarily poison a growing relationship between a father and son. So like any other invasive medical technique, it will have consequences. It’s rather like pregnant women who choose to find out the sex of their child. But my guess is it could be a lot more disturbing that knowing “it’s a girl”.

Talking teddy bears for dementia

Japan is not the only aging society (already 23% are over 65) but it certainly does a good line in robots. The latest idea from Fujitsu is a teddy bear robot that, when touched, moves its ears and eyes, nods, and cocks its head. It says: “Will you caress me?” (rather odd, I thought), “Hold me”, and “Thank you grandma”. But teddy appears to have great appeal for dementia patients.

NEC has developed PaPeRo, a small robot 38cm high, which was tested with dementia patients. More than 90% of the time, elderly residents could have a proper conversation with PaPeRo. Some seemed much more expressive after talking to the robot. NEC now offers a robot leasing service for companies, at $US590 a month. This is much cheaper than paying a human being. The next step is to attach a telecom device to the robot so it can, for example, inform relatives or the hospital when the patient falls.

Perhaps the hardest thing for old people living alone is having nobody to talk to. Robots are able to have simple conversations, as well as help people take medicine on time, or assist when guests arrive. Old people with dementia also have a need for conversation but very little memory for it. Robots can willingly have the same conversation over and over, without getting annoyed. We hope to one day have a robot teddy bear too – without the dementia!

Let the machine do it for you

We increasingly rely on machines to do things for us, which may take away some of the drudgery. At the same time, they can distance us unnecessarily from each other and, in some cases, reduce our natural skills. The trend towards using medical technology for diagnosis, for example, means that medical trainees never learn how to diagnose using their own hands or stethoscopes, as happens in poorer countries.

Sometimes machines do it better. For example, Watson, IBM’s supercomputer, beat the two best “Jeopardy!” players. Some argue that this was not through any deep understanding of semantics, but the ability to crunch terabytes of data quickly to arrive at statistically probable results. Even so, the next step for Watson – and a more serious one - is to help diagnose and treat patients by processing reams of data.

What about the ability to persuade? This is an area where machines are bound to fall down unless they tell great stories. Peter Gruber, author of "Tell to win: Connect, persuade and triumph with the hidden power of story" spent some time in Papua New Guinea to see how tribesmen related to one another through stories. He took what he learned to Hollywood when he was trying to get funding for Gorillas in the Mist, by flopping down on the floor with his arms out saying: I’m a wounded gorilla! He didn’t get up until they gave in. That’s Hollywood.

The lesson in this story has nothing to do with gorillas and everything to do with empathy. Machines don’t have empathy and we’d better be careful what we get them to do. It’s still OK to use a daily activity meter to count how many calories you’re eating and burning (the latest gadget from Japan). But much of our medical technology and robots for old people (see Talking teddies for dementia, above) are a slippery slope down to forgetting the human touch.

Nanotech + healthcare

Nanotechnology is finding its way into food because it can offer longer shelf life, more safety, and benefits for product reformulation and functional foods. Nanomaterials are less than one millionth of one millimetre in size. To many of us, it’s hard to grasp the idea of something so tiny, yet so active.

Nanomaterials are currently used in antimicrobial packaging, which stops bacteria from sticking to food and improves shelf life by making the packaging less permeable. Some beer bottles contain nano silica, which hinders oxygenation and stops the beer from going off. But future uses could include using nano salt particles that give the salty flavour without the hit of too much salt. Another is (our modern obsession) to reduce the amount of fat and sugar in products.

Last year, the European Parliament called for nanomaterials to be subject to Novel Food regulations, but this has not happened. If it had, there would have been mandatory labelling, which would have piqued consumer concern. In a consumer study by the Food Standards Agency (FSA) people understood the need for nanomaterials in packaging, but not in their food. They were as suspicious of it as they were of Genetically Modified food and cloning meat.

It’s ironic how nanomaterials are claimed to add to food safety and yet safety is exactly what will concern consumers. Do we want to put these minute substances in our mouths? And if we do, exactly where will something so small end up?