Sunday, January 21, 2007

Howtopedia, technology goodness gone wiki!

This is the first unsolicited email that I've been pleased to get in a long time. In fact, this is really neat.

Think of Instructables meets Hackaday meets Wikipedia within the development context. The very elegant outcome is something called Howtopedia. It's wonderful how-to list arranged in a wiki fashion covering topics that include Healthcare, Energy, Small Business, Food Processing and others.

The email they sent states that Howtopedia is a Swiss non-profit supported by Practical Action (which we covered earlier) and the International Network for Technical Info (INTI). When you look at the site, some of the articles will look familiar if you've checked out Practical Action's technical briefs.

It's community geared and thanks to the wiki metaphor, I can't wait to see what other users contribute. Who knows, I might throw in a recipe or two.

This ties in very well into our previous coverage of open source design initiatives. I hope Howtopedia fares well.

The excerpt below shows a method of refrigeration.

AIDG has lists a similar repository called Appropedia. I'm less familiar with them, but at first glance, Howtopedia seems to have many more articles. They are also available in English, French, and Spanish. Way to go Howtopedia and Practical Action. I'm a fan.

Learn more here.

Jiva Health and Teledoc

In keeping with our theme today, here is an interesting link to Jiva doc, an enterprise based in India and bringing affordable health to people in rural areas.

TeleDoc—a Jiva Health initiative, funded by the Soros Foundation, which seeks to bridge this critical gap between rural populations and quality health services by using Java-enabled mobile telephones to provide village-based healthcare workers with real-time ability to record and transmit diagnostic information.

Jiva’s expert panel of doctors analyzes this data, and then prescribes medication and treatment. Medicines are compounded at a regional office, picked up by TeleDoc field workers, and delivered to rural patients in the comfort of their homes—all for 70 rupees or US $1.50 per consultation.

Jiva's TeleDoc Program seeks to:
  • Deliver low-cost diagnostic and prescription services to rural villages currently underserved by existing healthcare systems
  • Improve treatment of prevalent diseases in rural settings
  • Increase the workload capacity of doctors, enabling sustainable operations with unit-price reductions in the cost of services
  • Provide employment opportunities for rural villagers
  • Afford networked health-care recordkeeping and intake mechanisms to improve lifetime care for individuals and facilitate large-scale epidemiological analysis
  • Attain a positive cash flow in three years and generate revenues sufficient to fuel growth of the system by the end of the fourth year
  • Saturday, January 20, 2007

    Intel Telemedicine: Wi-Fi solutions

    The geeks at Intel and Berkeley have teamed up to provide a comprehensive solution to impact the developing world. TIER is a research group at the University of California at Berkeley, investigating the design and deployment of new technologies for emerging regions. This is a multi-disciplinary project that includes both technologists and social scientists and real deployments to ensure that the work seeks real-world solutions. Primary funding comes from the National Science Foundation, with additional support from Intel, HP, Microsoft, UNDP, IIT Delhi, IIT Kanpur, Grameen Bank and the Markle Foundation.

    One of the projects from this huge effort is a partnership with the Aravind Eye hospital in India providing a useful telemedical application to reach rural populations. Read more about it here.

    Hacking Meds to Make a, eerr, New Drugs!

    Scientists find way to slash cost of drugs by reverse engineering existing molecular structure and tweaking it to form a technically new and patent free drug

    In other news: Porsche dealers project shortage due to meteoric rise in 2007 patent attorney fees

    A couple of scientists at Imperial College have devised a way to analyze and recreate the molecular structure of a new drug, tweak it and make it into a "different" drug---thereby skirting the rights of the original patent holder, releasing into the world, and saving lives.

    That's the general gist of the story, as reported by The Guardian this week. How I undertand, it's making generics out of proprietary drugs before their 20 year patent reign. This is possible because they are essentially a different compound.

    We like a good hack just as the next person, but there's some issues with the approach:

    1. We're not hacking the Colonel Sanders KFC's 11 secret herbs and spices to yummy fried chicken. These are drugs and they involve clinical trials. Last I checked, clinical trials still matter when you're talking about new drugs.

    2. Yes, they can argue that these are generics, which may be eligible for fast track approval (505(b)(2). Wait, if they are generics, then how does that differentiate them from the original drug in terms of patent law? I'm not a lawyer, but I can see a good one arguing this. If it walks like Lipitor, smells like Lipitor, tastes like Lipitor (wait what is that I see under the microscope? Lipitor-like strucuture?) shouldn't it be Lipitor? No, judge, that's Lypytore, Lipitor's estranged half brother.

    3. The drug companies probably saw this coming a while back. There's an interesting company in Australia called iCeutica who's doing some reverse engineering of their own on behalf of drug companies. The idea is that they can shrink the formulation of the compounds to nanosizes, which affects how it gets absorbed in the body. Since it's a new type of formulation, that makes it a new drug (sound familiar?) In this case, the strategy extends the lifetime of the patent another 20 years. Watch for nanosized Aleve that gets absorbed a lot faster than the generic naproxen right besides it.

    There's good coverage of the story at the THD blog and some compelling arguments about collaborative innovation versus reverse engineering at the New Paradign Innovation Blog.

    Update: Perhaps this is like the perfume knock-offs that cost $10 instead of $45. Sometimes you really can't tell the difference. Although, I'm told the knock offs don't last as long. Again, an argument for #1 here.

    Telemedicine - another variant

    We recognize that Telemedicine is a concept that has been around for a long time. However, the harsh reality of this healthcare concept is that it has not yet been widely adopted primarily because of the lack of a supporting infrastructure: equipment, maintenance and training for end-users. This effort by the CSAIL group at MIT has built an email client that is optimized for image annotation and sharing over email rather than the telecommunication intensive real-time video telemedical systems that permeate the landscape.

    An interesting paper with an overview of the technical details is here

    Low-cost CD4 counters for Africa

    Professor Robinson and his team at Purdue are developing a low-cost CD4 counter for AIDS patients in Africa. The goal of the project is to reduce the cost from $12 to under 50c. This effort is being supported Parker Hannefin.

    Dr. Robinson makes a key observation that we feel is important to keep in mind when developing technologies for low-resource settings:

    "The fancy $100,000 machines are very complicated because they are designed to perform a hundred different tests, but you only need one," Robinson said. "So you are paying for an instrument to do a hundred things when it only needs to do one, and then, at the end of the day, it's not even doing one thing. It's a real tragedy. Our cell analyzers will do only one test and do it well."

    Read more about it here

    Berkeley and CITRIS: Network Imaging

    The novel idea is that instead of having the expensive hard-to-maintain computing power sitting at a remote site, why not have cheap data imaging collection at the remote sites and then utilize an urban hospital to do the heavy lifting. The first Distributed Network Imaging experiments were based on electrical impedance tomography (EIT), an imaging technology that constructs 3D visualizations based on the electrical resistivity of the tissue under study. The data is painlessly gathered through an array of inexpensive electrodes placed on the body. Read more about it here

    Here is a link to Professor Rubinsky's homepage

    Update: From Boing Boing---
    Medical imaging via modem that will enable remote village doctors to perform minimally-invasive cancer surgery.

    Prosthesis in the Developing World

    We've all heard about the Jaipur foot project and its founders Dr Sethi and Chandra, the sculptor who made it happen. Recently I came across this link from 1989 that shows that mechanical engineers attempted an intriguing solution: using laser scanning with a CAD system to try to make fitted prostheses. This was an ambitious attempt to do the following:
    (1) Develop a non-contact imaging device capable of capturing a three-dimensional topographical record of the amputees' residual limb
    (2) Develop a computer software system that would allow the prosthetist to design a prosthetic socket that is biomechanically correct for production by a numerically computer controlled milling machine
    (3) Develop production molding tools for the manufacture of lightweight prosthetic plastic components
    (4) Field test the new lightweight all plastic system.

    Read more about it here

    Friday, January 19, 2007

    Global Health technologies at Northwestern

    It appears that Professor David Kelso and Professor Matt Glucksberg had a vision to engineer devices specifically with the developing world in mind, way before Jose and myself :)

    From the Univ of Illinois at Urbana-Champaign Fall 2006 Bioengineering Series
    Most medical devices have been designed for industrialized, high-income countries, and as a result, are not affordable in the developing world where per capita healthcare expenditures are less than $100 a year. The high cost of these devices is not inevitable; it is simply the result of decisions made by the design team in addressing the needs of their stakeholders. Given a different target market and set of user requirements, more affordable devices could be designed with available technologies.
    Read more about what the Center for Innovation in Global Health Technologies (CIGHT)is doing here

    We're inspired by people like Dave Kelso and we hope that more elite engineering schools will take the lead in developing appropriate medical technologies to improve health outcomes in the developing world.

    Thursday, January 18, 2007

    Retinal Camera

    Vision Instruments is developing a cost effective instrument for capturing digital images of the retina (inside surface) of the eye for public health and developing world retinopathy (retinal eye disease) screening programs. This ‘retinal camera’ is non-mydriatic (i.e. does not require pharmacological pupil dilation), portable and will require minimal training for use by paramedic staff.

    There is a growing appreciation of the need for retinopathy screening to reduce preventable blindness through early diagnosis of diabetic eye disease, glaucoma and macular degeneration. The Vi retinal camera has a uniquely intuitive alignment system and an autofocus capability to facilitate ease of use by paramedics. It will be robust, sealed against adverse environments and portable for application in remote areas and the developing world. The new retinal camera will be available directly from Vision Instruments at a significantly lower cost than other retinal cameras. Although developed for retinopathy screening, the retinal camera will also be suitable for Optometry and Ophthalmology practices. A first prototype has been completed and the definitive Prototype 2 will be completed by early 2006. The production model Vi R3 retinal camera will be available in the second half of 2006.

    You can read more about Vision Instruments here


    Recently I corresponded with Matt Smith who is the founder of "Developaid." Matt was a key developer of "Multivent", a ventilator designed specifically with the needs of the developing world in mind. Unfortunately, "Multivent" did not go into production and Matt offers this explanation:

    "The problem seemed to be that it was virtually impossible to promote such a product directly into the target third-world “market”. Even if that was possible, there’s very little money available locally to purchase equipment in any significant quantities. To promote such a product directly to Aid Agencies, charities, and NGO’s that tender for governmental aid contracts for example, a company would have to totally change their sales strategy. When it is also taken into consideration that such manufacturers are generally focused on their higher cost, developed world equipment, which will also sell associated add-ons. It becomes clear as to why products designed specifically for the third and developing worlds have a lower commercial priority, and it is hard for competitive companies to justify putting work and advertising budgets into products that don’t produce immediate profits."

    As a result of his experience Matt started Developaid. "DevelopAid aims to provide a database of appropriate technology products specifically designed for use in the third or developing worlds. We hope to help manufacturers by giving them a forum to showcase their products. We are here to help Doctors in the third and developing worlds by bringing them information on products that are functional, reliable, affordable and specifically designed for these challenging environments."

    Kudos to Matt for his dedication to making affordable devices to improve health outcomes in the developing world. You can read more about developaid and the story behind "Multivent."

    Monday, January 15, 2007

    IEE Resource

    It's great to see that IEE has taken up the unique challenges and opportunities to make a difference in health outcomes in the developing world. Apparently, they have organized biennial seminars in the UK since Feb 2000. Some of the fruits of these seminars have been suggestions to design the following:

    Malaria Rapid Diagnosis

    WHO has a great little guide on "Rapid Diagnosis of Malaria." This is a nice introduction to the subject and includes:
    - Cost-effectiveness of various approaches
    - Use of dipsticks for rapid diagnosis
    - Manufacturers of these kits
    - Designing clinical trials for RDTs

    You can find more information here

    Sunday, January 14, 2007

    Artificial Lungs on the Go

    On the left, a traditional mechanical ventilator. (~$6K+, no chance it will get to a village gurney). On the right, Germany's Novalung, a passive gas membrane Intervententional Lung Assist device that can supply the body with oxygen and necessary CO2 removal. We like the fact that it doesn't require moving parts, and blood flow is powered by the patient's own heartbeat. The Novalung has seen service in Europe and notably at the Balad Theatre Hospital in Iraq. No power requirements, the size of about 5 CD cases stacked togethor, and no moving parts makes this an excellent field medicine tool. No word on pricing, but we would love to see these coming to a village hospital near you.

    More from Stars and Stripes


    Offbeat: What if they made a smaller model that you can hook up to your arm to give you that extra boost of oxigen? Nevermind that it's not FDA approved (thankfully, the brave soldier whose life it saved was in Europe where it had a CE mark). Nonetheless, I can see athletic organizations cracking down on "portable lung assist cheaters" hidden inside their iPods. I'm not a physician, so I get to daydream.

    Tuesday, January 9, 2007

    Have Dremel, Will Operate

    The book Surgery and Healing in the Developing World offers great insight into how surgeons operate under extreme conditions. Published by Landes Biosciences, they offer it as a free ebook.

    Here's a description for an OR tourniquet:
    A standard football or bicycle pump can be used for inflation. With a little imagination a manometer can be palced in the system using a 3-way stopcock will all 3 ways opened.

    After the correct pressure is obtained while pumping, the tube going to the tourniquet proper is clamped securely. The pressure that you set will be maintained quite well as long as the tourniquet has no leaks and the clamp is tight enough. A rechargeable cordless drill can be gas sterilized after proper charging and used on low speed (to prevent burning of the bone) for orthopedic cases requiring a lot of drilling such as external fixator placement. An assortmnet of drill bits from the hardware store is helpful.