Written by Catherine Bolgar
When we think about medical care in the future, we tend to think about the progress technology will bring us, with cutting-edge machines that let us see what’s happening inside our bodies in ever-greater detail.
That’s true, but there’s another aspect to technological progress. As Moore’s Law brings down the cost of computing, and as consumer electronics become more sophisticated and yet cheaper, there are opportunities to use those advances to make medical devices that can serve the bottom of the pyramid.
The global middle class is estimated at 1.8 billion people in 2009, a number expected to rise to 3.2 billion by 2020 and 4.9 billion by 2030. Years ago, many people in developing countries viewed medical care as out of reach as jetting off on vacation. Today, the new middle class in these countries is going on vacation, and it expects decent health care too.
A new breed of bioengineers sees opportunity in emerging markets for devices that deliver results without costly bells and whistles.
There are still very challenging design and engineering problems,” says Josh Kornfeld, president of Tactile Inc., a Seattle product and interaction design firm. “But until five or 10 years ago, nobody even had an interest in designing for markets like this unless it was an NGO [nongovernmental organization]. Now, they’re not just giving a gift to these countries; they’re companies that are building long-term business models around servicing the needs of these countries.”
Mr. Kornfeld’s company helped Intellectual Ventures Lab and the Gates Foundation engineer a cooler whose proprietary materials make it so efficient it can keep vaccines cold for 30 days using just ice. That’s crucial in places where electricity is at best irregular and at worst non-existent—factors that have left many people unable to get vaccinated.
In the U.S. and Europe, we relish complexity,” he says. “We see technological devices as better the more training they require. We can afford to train people and make sure things get cleaned the right way and police all that stuff. In Africa, they’re highly trained people—the WHO [World Health Organization] does a great job of that—but the facilities they have access to, clean water, the resources for cleaning equipment the right way, aren’t as good. So it requires different design for use in those areas.”
In other words, the future of medical devices will involve, to a large extent, streamlining and simplifying.
Evolving Technologies, or Evotech, of San Francisco came up with a simplified endoscope—an instrument with a camera for looking inside the body. Evotech’s endoscope, called EvoCam, is being used in Uganda and India in keyhole surgery, hysterectomy surgery, ear and nose care such as sinus operations, and complicated cases of vaginal fistulas.
The EvoCam costs about $500, versus $50,000 to $100,000 for the high-tech systems usually used in modern hospitals. These modern systems weigh about 100 pounds, and consist of several devices—an image-processing unit, a light source and other modules, which sit on a big cart. Evotech turned it into a tablet- or laptop-based system.
When modern endoscopes were developed in the mid-1970s, consumer electronics were no match—videocassette recorders were rare and camcorders were huge. Today, a person can add a high-definition camera to a mobile phone for $2.
Evotech put the EvoCam under a Creative Commons license and published a shopping list of off-the-shelf parts, along with assembly instructions, so doctors anywhere can make their own. By not using proprietary parts, repairs are cheap and easy. For example, the EvoCam uses a regular USB cable to connect the device to a laptop; modern systems have special cords that cost about $1,000 to replace and that aren’t easily available, says Moshe Zilversmit, co-founder of Evotech.
Now we want to open-source it so anybody can build it,” Mr. Zilversmit says. “We’re trying to create a community where physicians come back with different ideas about how to improve it. We can gather information on what kinds of surgeries they’re doing. A lot of them are macgyvering it,” referring to the TV character who uses resources at hand to solve difficult problems.
Open-source innovation for medical devices is a new frontier. Even in the information technology industry, open-source hardware is a new, but growing, trend.
When you think of medical devices, it’s about high margins and low-volume sales,” says Avi Latner, Evotech’s other co-founder. “When you do affordable devices, you have to go beyond product design and rethink the business model as well. We decided we wanted to make it open source. Like software—open source revolutionized software. On the common basis of free tools, why not do the same for hardware in medicine?”
The trend is likely to lead to better-designed and better-engineered products adapted to emerging markets. And as fiscally strapped developed countries re-examine health-care spending, medical devices that are cheap, solid and simple are likely to gain favor in certain cases where the benefits of fancier systems is marginal.
For more from Catherine, contributors from the Economist Intelligence Unit along with industry experts, join The Future Realities discussion.