Spotlight on MIT's new Innovations in International Health: LTDC is Institutionalized)

It's almost been a month since my last post. We have been incredibly busy with a whole new program that aims to nurture, discover, invent, and launch the next little devices that could. So hopefully my absence is justified by the some of the offline project you'll read about soon.

MIT's International Development Initiative has launched Innovations in International Health. IIH is a collaborative research program that spans across MIT Departments and brings in partners from around the country and around to world to create a rich multidisciplinary environment to launch medical technology for the next four billion.

I'll let you visit the site iih.mit.edu to learn more.

Back to work for me, but I'm back with the program.

Accidental medical device of the month: The Taser

This one is better than the superglue for toothaches covered a few months back. The WSJ Health blog describes the case of policeman who had to tase man while he was in the ER (it's better than it sounds).

Turns out the Taser jolted his heart back into a normal rhythm.
more at WSJ.com

Combating Cervical Cancer with Cameraphones

This is the start of a small series covering the projects at MIT's D-Lab II, Information and Communications Technologies for Development, or ICT4D short. The results of the semester-long class resulted applications for microfinance, telemedicine, mobile disaster management technoloogies, and rapid pneumonia response systems.


The following is a video highlighting efforts in their project for detection and treatment of cervical cancer.


From their project page

We are developing the process that would facilitate the use of mobile device to transport images taken by nurses at health care centers (point-of-care) in rural Zambia to a server in Lusaka where doctors can access the images in order to provide expert advice on cervical lesions. We would like to explore the use of this approach to facilitate a scalable national cervical cancer screening program. Finally, we would like to design a platform that would allow transfer of the images directly to an electronic medical record database for archiving.

Making sure you eat your Wheaties (and take your meds)

Patient compliance is a $30 billion dollar a year problem according to major pharmaceutical associations (DataMonitor). The challenge is universal, everyone is susceptible to procrastination regardless of GDP. Patient compliance has uneven consequences in different patient populations. We covered a couple of technologies aimed at developing world patients fighting TB. These are low-cost reporting and monitoring technologies that take advantage of widespread cellphone networks. One of the rationales for their use is to prevent the onset of a much more complicated disease. If they become too sick, their public health resources cannot support further treatment.

Closer to these shores, patient compliance takes on a different rationale. Insurers and healthcare sponsors seek savings through preventative medicine.

This has launched what I will term the pillbox technology: simple dispensers that report usage of a dispensing mechanism. Essentially, you get a reminder, a convenient dispensing mechanism, and the time and frequency of the dispensing is reported to a central location. The approach is not limited to pillboxes. It has also been expended to inhalers and glucose meters.

Pillboxes: Gaming the System
A major flaw in this approach is reliance on the Honor System. This is going to make me really unpopular in some circles: trusting on people to behave themselves all on their own is a risky strategy. Some patients require a high level of monitoring to ensure compliance since their life is on the line. Forget about taking your multivitamin everyday (I forget to)---if you don't take your full course of TB meds, you're not going to make it. And if you do, you're going develop multiple drug resistant TB. If you do, and your national healthcare system can't provide, you're not going to make it.

Enter the Adult Supervision Brigades...

The second method goes further and ensures that the medication has actually been taken. We'll call this Detect-and-Report. Detecting metabolized drugs in patients such as University of Florida spinoff Exhale’s breathalyzer technologies enhances compliance by ensuring that drugs have been taken. For some this may be a little too Big Brother, but in the end, one can argue that it’s for your own good. After all, a much higher level of compliance enforcement would be experienced that same patient is hospitalized.

Exhale’s technology is being used to ensure compliance in patients undergoing a HIV/AIDS trials. The noninvasive test relies on adding GRAS (Generally Recognized as Safe) biomarker tags that are detected on an electronic monitor---just like an alcohol breathalyzer. There is no word on pricing, but it could easily pay for itself if can enhance the confidence of a clinical trial.

On the other end of the spectrum of detection-and-monitor technologies is the XoutTB system which I have described earlier. At a cost of a penny a day, the system relies on metabolic testing integrated with a mobile reporting platform.

The recent development of detect-and-report technologies means that the jury is still out on whether the honor system works as well as active detection and reporting systems. We’ll stay tuned.

In the meantime eat your Wheaties, take your statins, and rafampin, and all those little bottles behind the mirror.

More on Exhale in their website.
Stay tuned for information on XoutTB or get in touch with us directly.

Foldit: Competitive Protein Folding

Most of us are familiar with the Fold@Home project that allows millions of computers to share spare computing cycles to solve protein folding problems. If your screensaver is not set to provide Fold@Home some spare computing cycle, you are not alone.
Move aside Celtics: enter the league of Competitive Protein Folding.

The idea behind David Baker's project, called FoldIt is to employ battalions of gamers to provide what an army of CPUs can't: smarts. Algorithms are great, but they can't match the puzzle-solving abilities of a person dead set on solving a problem. Baker would know a thing or two about algorithms. His research launched the Rosetta@Home project which employed distributed computing power to solve proteins.



I like the concept because it combines the flattening power of the internet, the elegance of distributed computing, and a really cool gaming interface. Watch the video.

Innerspace News: Tiny boats delivery meds to your body

This drug delivery method is elegant, it may very make it to the a global health application one day.

Cheng Luo, an engineer from the University of Texas at Arlington, has developed a tiny device that uses differences in the surface tension of to propel it in water. The hope is that one day, they can take the concept and create micro submarines for delivering drugs inside the blood stream.

More at Physorg.com

Ryan's Bill: Austism Insurance Bill Passes

We focus so much on global health in this blog it is easy to miss sight of those underserved closer to home. South Carolina resident Lorri Unumb can celebrate a small victory towards raising her son Ryan, who has autism. It turns out that most insurance companies won't cover autism therapy. This is ludicrous---you get hurt in a car wreck and you can go get physical therapy to get your walking muscle memory back. You suffer some sort of mental impairment and it's considered "educational therapy". Well, thanks to Unumb, insurers in South Carolina can no longer take cover behind this logic.

"I've met so many other moms who were doing the best they could, and I just wanted to say to them, 'You know, an hour a week of speech therapy for your child is never going to make him better,' " the mother of three says.

"But I didn't want to tell them what they needed is 40 hours a week of therapy, because there's nothing they can do to buy that."

Nothing they can do because most medical insurance policies generally don't cover autism treatment, and it's too expensive for many parents to afford out of pocket. Ryan's therapy costs between $70,000 and $80,000 a year. That's Lorri Unumb's entire salary.

Well, it didn't hurt that Lorri Unumb is both a lawyer and a law professor. She soon turned a sour situation into a solution that helps her family countless others. Professor Unumb, way to go!

More at CNN

Neat Stuff Roundup

• Google for Non-Profits
• Anne Swift on universities as entrepreneurship ecosystems
• The next 11 BRICs according to Goldman Sachs
• Testing vaccines in a jar
• Foreign Policy on the Digital Divide
  

World TB Day

Thanks to Aman at THD Blog, I am informed that today is World TB Day. I'm not sure how you treat this: "Happy TB Day", "May you and yours have a wonderful TB Day" do not seem appropriate.



THD by way of Christine at Families USA has featured an anti-TB game:

In response*, my group at MIT has developed the XoutTB diagnostic paper microfluidic toolset. It aims to keep patients on track with their meds at a cost of a penny a day. X out TB program is currently under continued development at MIT with the assistance of partners in the Ministry of Health in Nicaragua, the InterActive Research and Development group in Karachi, Pakistan, and the guidance of the Poverty Action Center. Funding has been provided by the IDEAS Competition (Lemelson Award in International Technology) and private donations.


*In response to TB, not TB Day, but it is fitting that I make the announcement on LTDC on March 24, don't you think?

2008 NCIIA Annual Conference: Wrap up

3 : Hours in the ER before my DC flight due to Aerovax prototype airborne shrapnel landing in my left eye
7:30 : Scheduled departure from Logan to Dallas on Tuesday
5 : Number of liquid crystal displays on the Airtran Embraer Jet taking me to DC connection
1 : Number of check engine lights that rendered the LCDs useless and grounding the flight
2:30 : Arrival time into Dallas the next afternoonDespite the misadventures of travel, I left the 2008 NCIIA Conference wiser and humbled, having met an oustanding group of individuals and institutions working on fascinating products, educational strategies, and global challenges. I'm going to provide some detailed notes at the expanded Conferences and Lectures version of LTDC.

A quick preview:

• Paul Polack on Design for the Other 90% (it's not just the museum exhibit, it's going to change the face of business and products for folks in emerging markets)
• Sir Ken Robinson on creativity.
• The Small Engines group from the Global Innovation Center in Energy, Health and Environment at Colorado State University (guys I need a link here).
• Baylor University's efforts of transforming coconuts into Home Depot products
  

More after coffee break (Dallas has a severe deficit of Starbucks, though).

TB Compliance the "smart pillbox" way

Those nerds at the Massachusetts Institute for Technophobes have done it again by inventing the "uBox" - a souped up version of the humble pillbox, that tracks how often people take their medication and improves compliance with drug dosage. The device comes with a USB that enables healthcare workers to plug into the pillbox and download the compliance record. Read more..

DIY drilling: Neurosurgery in the developing world

Who knew that a Bosch drill could have so many uses? When working for the National Health Service, Marsh uses a £30,000 compressed-air medical drill, but he uses a £30 drill with the standard medical drill bits when operating in less ideal settings in Ukraine. How does he ensure patient safety? "The traditional way... by talking to them throughout the operation." Read more...

Thanks to Kevin MD via Medgadget

Telemicroscopy

The folks in the Blume Center for Developing Economics have devised a nifty little device that can provide 50x magnification by adding $50 in off-the-shelf components to a cellphone camera. Called the 'Cellscope', this initiative "extends the reach of modern microscopy by turning the camera of a standard cell phone into a clinical-quality microscope. With a magnification of 5-50X, cell-phone microscopy will enable visualization of patient samples critical for disease diagnosis. Images captured by health workers on a microscope-equipped cell phone could be annotated, organized, and transmitted to medical experts at major medical centers for analysis and recommendation. Preliminary work has demonstrated the technical feasibility of this ‘telemicroscopy’ concept." Read More about it here or visit the project page.

Hat tip to Medgadget

The OR Channel: TV dinners are never gonna look quite the same

When I was 3 or 4 year old, I ran into my grandfather's collection of 35mm projection slides of surgical procedures that he used to teach his students in medical school. I remember that the images were fascinating (at least for me) and left an indelible mark on my view of the human body: Try to understand a 3 year old who goes "eyes, nose, ears, hands, feet, liver, pancreas, vein." Fast forward a long time and instead of becoming a vascular surgeon like Pepe, I grew up to design devices that he could have used. Problem is that I am out of 35 mm projection slide discovery opportunities...so I ran into this today:



OR Live is a website offerings video streams of 600 different surgical procedures.
Each procedure comes from different institutions so you can get a good sense of how each procedures varies by physician and hospital.

Play doctor online using CureHunter

Before you send me your letters, don't try this at home without adult supervision and please don't start Googling your symptoms. Okay, now the fun part.

CureHunter is an online web service that provides access to medical literature in a straight forward interface. So next time you are arguing about the performance of Cimetidine and Omeprazole, do yourself a favor and go to CureHunter's Mobile site. Type in a disease or a drug, and it will tell you what is the generally accepted therapy. I know, it takes an MD to really figure out what a person has, etc. etc. This is a tool and timely one.

Healthcare workers with GPRS access will find it invaluable.

More at Medgadget

A Cancer Breathalyzer

Researchers at Swansea Univrsity in Wales are developing a method for detecting cancer and other diseases using your breath. Medgadget reports that Dr. Masood Yousef and his research team have been working on improved volatile marker-based diagnostics. This has been tried before but the improved analytics are bringing them closer to being a reality. The impact for global health could be huge if the costs of the test remain reasonable (no word on pricing yet). Imaging a scenario where a nomadic patient can be given a test result that would usually take a week to come back from the lab—and an additional two weeks to go back and track the person. I'll keep my tabs on this one. Dr. Yousef, if you are reading this, we'd love to chat and introduce you to some cool cellphone technology we're developing with these types of technologies in mind.

Dr Yousef [Dr Masood Yousef, senior research assistant in the Welsh Centre for Printing and Coating at Swansea University -ed] believes that the breath test will provide a more convenient and rapid method for diagnosing serious diseases than blood or urine analysis, and will require minimal medical intervention.

He said: "Breath samples are much easier to collect than blood and urine, for the patient as much as for the person collecting the sample. They can be collected anywhere by people with no medical training, and there are no associated biohazard risks."