The Next Generation of Medical Tools May Be Home-Brewed

Innovation can be fast, cheap and

outside corporate control

When you think of MIT, images of ultra-high tech come to mind: Nobel Prize winners and world-class thinkers inventing their way into the future, pushing the boundaries of genetic engineering and robotics.

The future, however, doesn’t always meet our expectations. Take, for example, researcher José Gómez-Márquez, whose big thoughts shape “Little Devices,” the lab he directs at MIT. The Little Devices lab takes a DIY approach to designing and building tools, mainly for healthcare. The diagnostic kits that come out of his hacking have a lot more in common with what you’d read about in Make: magazine than in The Lancet or IEEE Spectrum.

This directed tinkering meets a vital need. Most people on Planet Earth simply do not have the money or the insurance to gain access to the high-tech equipment and specialized physicians enjoyed by the wealthier strata. The little devices Gómez-Márquez champions are low-cost alternatives designed for ubiquity. They share more of the DNA of your child’s Legos than the sleek Apple Watches that hospitals are already offering patients. But don’t let their simplicity fool you.

Gómez-Márquez happens to have the backing of MIT, yet he is joined by a large and often-unrecognized population of DIYers who are practicing low-cost innovation. Historically, the public has looked to research and development labs at multinational corporations, universities and government labs — and has grown accustomed to expensive, complicated devices used more often in elite hospitals than jungles or slums. Not surprisingly, those who make DIY medical devices encounter doubt and even derision constantly.

Such attitudes are a problem, because the DIY tools dreamed up by backyard inventors, part-time tinkerers and academics like Gómez-Márquez could improve — and even save — thousands of lives everywhere, not only in America’s inner cities and rural heartland but in blighted neighborhoods everywhere. To make that promise real, we need to toss out our false assumptions about how, and where, new ideas come from — and recognize that innovation is everywhere.

Gómez-Márquez wows the crowd at HealthFoo Camp. The establishment isn’t so impressed.

If you want to see his temperature spike, just ask Gómez-Márquez whether the objects he’s gathered in his lab — colorful doodads that admittedly look like children’s toys — can make a difference in the lives of patients. Not only is the answer yes, but he insists that there is virtually no alternative, as the traditional medical system is designed to chase profit, not simplicity and affordability.

Consider the nebulizer, a device used to transform a liquid into a mist so that patients suffering from asthma or similar maladies can inhale vital medicines. Commercial systems can cost hundreds of dollars. But Gómez-Márquez has designed a little device that uses standard tubing, a $7-to-$10 filter and a bicycle pump for power. It does the job as well as high-end alternatives — so well that those familiar with the gadgetry now question if the American health system might take a closer look at little devices.

“We received calls in the USA,” says Gómez-Márquez. “They say, ‘My granddaughter cross-country skis and needs to be nebulized’ — and then they ask, ‘Why are they charging me this much?’”

The Little Devices nebulizer may not be pretty, but it could help you breathe.

Gómez-Márquez’s nebulizer may gain a boost in public opinion from an unexpected source, one that has already been changing minds. In 2013 a car mechanic in Argentina named Jorge Odón happened to watch a video on how to extract a cork that had fallen into a wine bottle, when he had an idea: a variation on that technique might be used to safely deliver an endangered baby. Using a jar and a plastic bag, Odón figured out a simple way to extract a fetus without using the common remedies of forceps and vacuums, which in the hands of inexperienced or poorly trained midwives and doctors all too often lead to hemorrhaging, broken limbs, twisted spines, nerve damage and crushed skulls. (About 10 percent of births worldwide involve serious complications, and the option for Cesarian sections does not exist in many locations around the globe.)

Unlike many DIY solutions, this one caught the attention of the doctors working for the World Health Organization (WHO). Eventually the medical device giant Becton, Dickinson and Company adapted the idea to create the BD Odon Device. Should the Odon Device pass clinical trials in Argentina and move into production at an estimated $50 per unit, the car mechanic’s invention will be available to save the lives of perhaps thousands of babies and mothers around the world.

Gómez-Márquez’s lab represents just one challenge to the traditionally costly and sophisticated means of sparking innovation in healthcare. Another way to do so relies on identifying simple techniques that are popular in relatively poorer nations, and then adopting, adapting and scaling them in wealthier countries. This avenue is called “reverse innovation.” Interestingly, this idea has won quicker acceptance from the establishment, as it can complement the traditional ways that governments and corporations have funded research and development.

Indeed, the term “reverse innovation” was coined by General Electric chairman and CEO Jeff Immelt and Dartmouth professor Vijay Govindarajan in a 2009 Harvard Business Review article. Govindarajan is one of the most prominent advocates of reverse innovation, and his research is cited in accounts of reverse engineering’s most successful achievements.

Govindarajan touts Therdchai Jivacate, an orthopedic surgeon in Thailand who invented an inexpensive prosthetic leg that can be manufactured quickly using recycled plastic yogurt containers. In a 2012 Harvard Business Review article on “Health Care for 1% of the Cost,” Govindarajan listed others, including $30 cataract surgery and inexpensive open-heart surgery in India.

But in his lectures and articles, Govindarajan, who also serves as “chief innovation consultant” at GE, prominently touts lower-cost alternatives to traditional medical technology that have little to do with yogurt containers and sound more like high-tech beneficiaries of Moore’s Law and economies of scale.

These gadgets include a low-cost elec­tro­car­dio­gram (ECG) and a portable, compact ultrasound device, both of which were manufactured in response to global demand for less expensive devices. Though these examples are drawn from GE — so Govindarajan has a vested interest in promoting them — they are among the world’s more successful lower-cost alternatives to entrenched technologies.

General Electric’s portable ultrasound device. Courtesy of GE

When the portable ultrasound device, called Vscan, was launched in 2010, GE focused on China and other developing markets, according to Arvind Gopalratnam, a communications director at GE Healthcare. Today, GE has sold over 17,000 portable ultrasound units for use in more than one hundred countries. The average cost of a Vscan device is now between $7000 and $8000, a fraction of the cost of a full-size ultrasound machine.

“This is probably one of the most exciting pieces of technology that GE Healthcare has,” Gopalratnam says. “It was the one that was the first true gamechanger, from the hardware perspective, getting it so small.”

This success also led to more devices: in 2014, GE added a less invasive, more efficient, dual probe version, the first handheld scanner to have that clinical capability; 3,000 are now in use across 50 countries.

Improved access to such devices, however, can produce unexpected, and not always positive, results. In 2012, India banned the use of portable ultrasound devices outside of clinics due to concerns that their use for sex determination was leading to selective abortion based upon gender.

You might think that Gómez-Márquez would be a big fan of “reverse innovation,” but the very mention of the term makes his face go sour. His objection centers on two issues. First, the notion that wealthy institutions, not the original inventors, may capitalize on ideas created in the field doesn’t sit well with him. “If you want reverse innovation to happen in America, fund experiments at the point of natural inception, and then bring it back,” Gómez-Márquez suggests.

Second, he believes, the innovations that work best in the field should also be developed in the field, in similarly resource-constrained environments. Only then should those ideas expand to other markets.

He also chafes at the presumption that inexpensive medical devices in developing countries are valuable mainly in how we can “learn from poor nations and then apply to America.” Instead, he argues, what’s exciting is witnessing people helping themselves to an astonishing degree — and finding ways to encourage them to do more.

Further, developing countries are not the only incubators of scrappy innovation. It happens everywhere, at nearly all times. In a survey of a representative sample of consumers in the UK conducted by Eric von Hippel, Steven Flowers and Jeroen P. J. DeJong, six percent of respondents had “engaged in consumer product innovation,” meaning they had modified an existing item or created something from scratch. In aggregate, these individuals spent more than twice as much on their own product R&D than did all UK firms combined.

Yet the work of potentially talented amateurs often goes neglected, unpatented and insufficiently rewarded. To harness the creativity of individual inventors for broader impact, we need more supportive maker spaces, grand challenges and contests. Some progress has been made in this direction. Since 2011, the use of crowdsourcing by the US federal government has grown sixfold. A White House “Maker Faire” is a notable start, as well, though celebrating DIY innovators at 1600 Pennsylvania Avenue isn’t the same as Congress and state legislatures creating more nimble grants to support it.

Gómez-Márquez and his team are taking another approach to capturing the innovation that is happening at the edges of corporate and government spheres. In September 2013 the MIT researcher and his colleagues started a “Maker Nurse” program to help gather practical insights around the world.

Nurse knowledge is an ideal source of edge innovation. According to research unearthed by Gómez-Márquez’s group, nurses have a long history of improvising to meet patient needs. A century ago, a periodical was even dedicated to sharing the techniques. Now, a 21st century version of this little book is growing online at makernurse.community, where MIT researchers hope that so-called MacGyver nurses will continue to share their hacks and creations with one another.

Looking ahead, the Little Devices lab hopes to make an even bigger splash by taking the principles behind open-source hardware and applying them to DIY medical devices. If they succeed, they’ll deliver more transparent design so that people can compare features and costs to the “black boxes” offered by manufacturers. Specifically, Gómez-Márquez and his team are trying to create kits that let people hack their own testing gear, including markers and sensors.

A distinctive feature of Gómez-Márquez’s thinking is that he works through a technical challenge at a granular level while also recognizing its social context. Consider his lab’s test for dengue fever, now being reviewed by the FDA. The test result is just one piece of information. Who has the disease, and where those people are, is equally informative. “The way we detect it is very different than the way a machine would,” says Gómez-Márquez. “We detect it using people, and the way we collect an overall signal is by hundreds of people having that test and then reporting it over the phone. It’s almost like a ‘Foursquare for disease.’”

A medical lab in a box from Little Devices

With all that experience under its belt, the MIT team is now taking on the disease that only recently has galvanized and terrified the globe: Ebola. Their goal is a simple test that can be done in the field using inexpensive materials, with the results shared via cellphone with public health workers. If Gómez-Márquez’s medical makers create a tool to mitigate the next epidemic, there will be no need to argue about what kind of innovation their invention represents. And the word “little” will no longer apply.

Photos by Alex Howard, except where otherwise credited.

Follow Backchannel: Twitter | Facebook