Free DITM Podcast With Jeff Cohen-CEO Halt Medical on Medical Device Invention Process

I’m so excited to share with you my latest docinthemachine podcast with Jeff Cohen — serial entrepreneur and current CEO of Halt Medical (a gyn fibroid treatment statup), Voyage Air Guitar (the world’s best foldable guitar),  and Nashville publishers Savannah Music Group just recorded live at the 38th Global Congress of Minimally Invasive Gynecolog in Orlando Florida.

You might recognize Jeff who was recently featured on ABC’s Shark Tank where he turned down the shark’s offer of $500,000 for his guitar idea.  In the podcast we discussed the unique opportunities and challenges of medical device development- and innovation in general.

I was immediately struck by Jeff’s unique perspective and vision when I met him.  He has innovated in so many different areas and has successfully partnered with physician inventors for blockbuster devices.

Topics We Cover in the Podcast:

  • What’s unique about medical device development and how the potential returns differ from other industries
  • Advice for the physician/inventor where to go with your idea–pitfalls, how to protect your intellectual property and how to partner and start a company
  • Is your idea good enough to form a company?
  • The dangers of big companies and the opportunities of start-ups
  • All you need is a fantastic idea and where to go from there
  • What to look for in a business partner
  • What’s similar between innovation in any industry-medical,  music publishing, and internet?
  • What is the unique opportunity in today economic climate?

Hope you enjoy and get inspired…  All you need is a great idea– and as Jeff says- I believe everyone has one.

You can listen to the podcast below or download it in 3 versions — a single file or split into part 1 and 2.

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Meeting Announcement -The Adequacy of Assisted Reproductive Technology Oversight

I received this comunication from the American Society for Reproductive Medicine

MEETING ANNOUNCEMENT  —The Adequacy of Assisted Reproductive Technology Oversight

Monday, December 14, 2009

8:30 am – 3:00 pm
Mandarin Oriental Hotel
Washington, DC
Given the rather high profile incidents in infertility therapies that came to light in 2009, the leaders in reproductive medicine are asking questions about how best to prevent such incidents from occurring again.  While little factual information is available on the specific incidents, we can and should assess where general oversight of the field is, and seek ways to improve it, if necessary

Accordingly the American Society for Reproductive Medicine is convening a meeting in Washington, DC to gather input on this important topic. Information will be exchanged between government agencies, patients, physicians, leading academic experts, and others.

 

Featured speakers will include:

Maurizio Macaluso, MD, DrPHCenters for Disease Control and Prevention
James Goldfarb, MD, President, Society for Assisted Reproductive Technology
Jake Mayer, PhD,  the Jones Institute, Eastern Virginia Medical School
Stuart S. Howards, MD, American Board of Urology

Barbara Collura, RESOLVE, The National Infertility Association
Susannah Baruch, JD, Generations Ahead
Liza Mundy, author
Judith Daar, JD, Whittier Law School

For more information or to register send an email to ekramer@asrm-dc.org.

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Docinthemachine MedTech Podcast!

Here’s the latest installment of the docinthemachine podcast.  In this installment I review new FDA device approvals and then present an interview about HD technology for entertainment and medicine with Bob Ott (vice president of broadcast and professional audio/video products for Sony Electronics) recorded at the National Association of Broadcasters (NAB).

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FDA Update: Ophthalmic Device Panel Meeting To Review LASIK Safety

eyeballLASIK Safety Review

On April 25, 2008, the committee will discuss general issues concerning the experience and quality of life of patients who have had LASIK.

How Serious is the Problem?  Are the Patients Going Blind?

Dr. Daniel Schultz, director of FDA’s Center for Devices and Radiological Health, said a number of concerns have been raised concerning patient satisfaction with LASIK.

Companies that could be affected by such a meeting include LASIK device makers such as Advanced Medical Optics Inc, as well as LASIK providers such as TLC Vision Corp and LCA-Vision Inc.

Obviously, it’s a technology that has caught on and is used very, very widely. And there have been questions raised in terms of … quality of life and what does it actually do for the patient as opposed to the technology itself,” Schultz told reporters.  Shultz said the meeting will focus on the quality of patients’ lives after surgery.

Known complications from the procedure can include dry eyes, glare, double vision, an increased risk of corneal inflammation or infection, and blindness.

Patients Call for Ban: In July 2007, the FDA responded to petitions from an individual asking for a halt to the procedures and a withdrawal of their approval. The agency said the devices were safe and effective but advisory panel discussions “could complement” its other safety monitoring.

The Boston Globes writes on the adverse effect of the current economic downturn on Lasik numbers and the potential adverse effect of this meeting on Lasik businesses.

But the declining U.S. economy continues to impact the number of laser vision correction surgeries, and Biegelsen cautioned investors that the outcome of the upcoming FDA Lasik advisory committee meeting on April 25 will likely be neutral at best.

“A best case scenario is little-to-no negative headlines in the media and the panel endorses the long safety of Lasik and encourages further use of femtosecond lasers,” he wrote in a note to clients. “On the downside, negative media coverage of unhappy Lasik patients and a panel recommendation to narrow the indications could drive volume down further. We think the most important variable is the media coverage which tends to be negative.”

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FDA Update: Ophthalmic Device Panel Meeting To Review Implantable Eye Telescope

The FDA Ophthalmic Devices Panel will meet Apr 24, 08 8:30 AM – 5:00 PM & Apr 25, 08 8:30 AM – 5:00 PM in the Gaithersburg Holiday Inn, Ballroom – 2 Montgomery Village Ave. Gaithersburg , MD

On April 24, 2008, the committee will discuss, make recommendations, and vote on a premarket approval application, sponsored by VisionCare Technologies, Inc., for an implantable miniature telescope (IMT™). The IMT™, a visual prosthetic device, is indicated for monocular implant in patients with stable, moderate to profound central vision impairment due to bilateral central scotomas associated with end-stage macular degeneration with geographic atrophy or disciform scar, foveal involvement and cataract.

Since these diseases lead to central dysfunction of the retina the implantable telescope spreads the visual image over a larger area of normal retina.

The prosthetic telescope, together with the cornea, acts as a telephoto system to enlarge images 3X or 2.2X, depending on the device model used. The telephoto effect allows images in the central visual field (‘straight ahead vision’) to not be focused directly on the damaged macula, but over other healthy areas of the central and peripheral retina. This generally helps reduce the ‘blind spot’ impairing vision in patients with AMD

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New FDA 510(k) Approvals for March 2008-(pt.1) New Video Monitor Screens

The FDA has published its 510(k) approval letters for March 2008. In terms of surgery, endoscopy, and imaging a few items caught my eye. The first is a pair of high resolution monitors from Eizo.

Eizo is upgrading both monchrome and color workstations to 5-megapixel units. This will be useful for radiologic workstations.

Here is the text from the FDA

DEVICE: 5 MEGAPIXEL MONOCHROME LCD MONITOR, MODEL RADIFORCE GS520 EIZO NANAO CORPORATION 510(k) NO: K080422(SPECIAL)
ATTN: HIROAKI HASHIMOTO PHONE NO : 81 76 2742468 153 SHIMOKASHIWANO-CHO SE DECISION MADE: 10-MAR-08 HAKUSAN, ISHIKAWA-KEN, JAPAN 924-8510(k)

DEVICE: COLOR LCD MONITOR, MODEL RADIFORCE RX211 EIZO NANAO CORPORATION 510(k) NO: K080457(SPECIAL)
ATTN: HIROAKI HASHIMOTO PHONE NO : 817 627 42468 153 SHIMOKASHIWANO-CHO SE DECISION MADE: 20-MAR-08 HAKUSAN, ISHIKAWA-KEN, JAPAN 924-8510(k)

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FDA Ob/Gyn Update: Panel Meeting to Review New Female Condom

I will be posting an ongoing series on FDA reviews and decisions on new devices focusing on minimally invasive surgery, future medical technologies, and Ob/Gyn devices.  What better way to start off the series then with the latest announcement of the FDA Gyn device review panel (Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee) notice of meeting.

The panel will meet May 16, 2008, from 8 a.m. to 5:30 p.m. at the Holiday Inn, Grand Ballroom, Two Montgomery Village Ave.,  Gaithersburg, MD. to discuss none other than the newest version of the female condom (FC2 by Femalehealth).  Hey I wanted my FDA series to satrt off with some new infrared scanner implant but the FDA just gave me a condom.  Notice of the FDA meeting is here.

As an aside as an in-trining Ob Gyn resident I remmber calling the company that made the first female condom and requeesting samples for “clinical testing” and “product evaluation” before it got FDA approval. 

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Top 6 Most Dangerous Medication Abbreviations Now Banned in Hospitals

writing.jpg

Medication errors in the hospital are a major cause of preventable suffering and death. I wanted to share with you the top 6 handwriting errors of doctors in the hospital that have been banned in to prevent these errors.

First some background:  You may recall the landmark Institute of Medicine (IOM) study that found medication errors injure 1.5 million people and cost billions of dollars annually.  Their report found “the extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and  productivity or additional health care costs.”  The press release of the report and summary is here and the enormous full report can be searched and read here

Every hospital I go to has implemented warning sheets (some in bright yellow with red stop signs on them) of the “Top 6 Forbidden Medication Orders”  These are abbreviations so often misread or mistranscribed that they have been banned in the hospital!  (not the drug or the order but the abbreviations have been banned!).  You all know how awful doctor’s handwriting is!

  1. U for units with heparin insulin and pitocin can be misread as zero or cc’s causing dangerous overdoses
  2. IU for nternational units can be mistaken for IV (intravenous) or 10 (ten)
  3. q.d. means once a day in latin but can be mistaken for qid or qod (four times a day or every other day) if the period is written above the line
  4. .1 must be written as 0.1 else 10 fold dose errors can occur
  5. 1.0 should never be written – the decimal can be missed and a 10 fold dose error occur
  6. morphine and magnesium can be mixed up with lethal consequences- the use of MS, MSo4, or MgSO4 have been banned

a fun view of how bad the handsriting is can be read here

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The Bigger Story Behind the 3 Parent Embryo- Human Embryo Genetic Experimentation

embryo-brochure.jpg

Countless sources are reporting on the “three parent embryo” created as a potential treatment for infertility.  What has not been reported is that ther is an almost 10 year history of unreagulated human experimentation in this arena which led to a rare federal ban on specific fertility treatments.  Is this hope, hype or dangerous human experimentation?  Read on to see!

Background- what are mitochondria?  Mitochondria are tiny primite organisms that millions of yers ago became incorporated into human cells.  They exisit in every cell but have their own unique genetic material. They function as the engines of the cell providing energy for metabolism.  I wrote an review of how they got there and what they do that you can read here.  In short mitochondria have their own DNA (similar to that of bacteria) and reproduce independently of the cell in which it is found.  We now have a symbiotic relationship with them.  

First – the details receontly reported by the BBC.  Diseases of the function of mitochondria exist.  “About one in every 6,500 people is affected by such conditions, which include fatal liver failure, stroke-like episodes, blindness, muscular dystrophy, diabetes and deafness.”  Details of their human experiment:  Scientists in the UK experimented on 10 embryos left over after IVF fertility treatments.  They microsurgically removed the nucleus, containing the embryo’s DNA  and implanted it into a donor egg whose DNA had also been removed. The donor egg while missing its DNA still contained its mitochondrial DNA.  They watched these embryos grow in the petri dish for 6 days. 

Therefore the resulting embryo will have the DNA of the donated nucleus but the mitochondrial DNA of the host cell- curing and potentially eradicating – the mitochondrial illness. 

This is not the first time this has been done.  The fertility treatment history of human experimentation on this:  While I was teaching at Yale Medical one of my partners and mentors in the fertility department (Dr David Keefe) was actively pursuing research on mitochondrial dysfunction as a cause of human infertility.  At that time a few fertility doctors in the US theorized that one cause of human reproductive aging was accumulated damage to the mitochondria in the egg. They thought the genes of the egg could be healthy but the rest of the egg that supports its become faulty.  They experimented with a technique called cytoplasmic transfer.  Using a microscopic needle tiny drops of fluid were sucked out of a donor’s egg and injected into that of an older infertile woman hoping to breath new energy and life into it.   Unfortunately most research groups found it did not seem to offer any benefit.

Reasons why it likely did not work:

  1. using minute drops of fluid from a donor egg into a recipient is just not enough to correct the metabolic problem or defect
  2. my collegues at Yale found that the mitochondria in the egg is often tightly joined to the nucleus so the cytoplasmic transfer did not move enough of them
  3. a huge proportion of age related egg defects are related to nuclear not mitochondrial DNA defects.

The federal government banned this treatment in 2001.  Some feared that chromosomal abnormalities and birth defects could result if there were three people’s DNA in one embryo.  Federal officials decided that any method involving the transfer of genetic materials without the fusion of egg and sperm requires the oversight and involvement of the Food and Drug Administration.  The US legislation leading to the FDA taking jurisdiction over human eggs sperm and embryos is a whole other topic to be covered in later posts.   A brief overview of this from Rodger Gosden (who I know and respect as a leading reproductive biologist) is posted here from 1999 when this treatment was at its heyday with references justifying its use from mouse research.

The next brouha using the technique in humans in 2003:   Related research on nuclear transfer was again presented at the annual ASRM meeting in San Antonio in 2003.  I was in the audience for the talk and remember it well.  One of the researchers was an American out of NYU Dr Jaime Grifo who also used to be in my ex-department at Yale.  He is also a repected researcher who I know well.  Unable to perform the research in the US- the experiment was performed in China.  as reported here and here 

Researchers at Sun Yat-sen University in Guangzhou implanted three embryos in the womb of a 30-year-old infertile woman… A triplet pregnancy resulted, they announced at the annual meeting of the American Society for Reproduction Medicine in San Antonio, Texas this week. One of the foetuses was “reduced” to ensure the viability of the pregnancy, but the other two died anyway at 24 and 29 weeks.

With this technique, called nuclear transfer, the doctors fertilised an egg from their patient and an egg from a donor. Two embryos resulted. The nucleus of both women’s embryos was extracted, and the patient’s genetic material was inserted into the empty “eggshell” of the other embryo which, however, contained mitochondria with the other woman’s DNA. The procedure gives the infertile woman’s embryo the healthy mitochondria it needs to develop — but it also results in a child with genetic material from one father and two mothers.

Dr Grifo has maintained that he was an advisor and did not partake in the actual experiment.  NYU issued a statement that if the research was performed in China their IRB did not have oversight (different than my department where all work I did anywhere fell under the IRB as a faculty member).  I have never asked him his take on this but do respect him and strongly do not believe he is someone who would knowingly break the law or do what he felt was wrong.

Nonetheless- the ASRM responded with a moratorium on any future presentations on cloning (whether this was cloning is a whole other debate- many feel not). 

The technique is still undergoing related research:  I chair the video committe of the American Societry for Reproductive Medicine (ASRM) the largest international fertility research society.   Just this past year we accepted a video presentation on how to technically perform the procedure from a research team in Japan.  The paper- Embryonic Development Following the Nuclear Transfer of In Vitro Matured Metaphase-II Oocytes into Enucleated Freshly Ovulated Metaphase-II Oocytes by Tanaka and collegues investigated the possibility of repairing either mitochondrial diseases or female infertility due to ooplasmic deficiency and abnormalities. They demonstrated embryonic development following the nuclear transfer of in vitro matured metaphase-II oocytes into enucleated freshly ovulated metaphase-II oocytes and concluded it could be applied to the treatment of mitochondrial diseases or female infertility due to ooplasmic deficiency and abnormalities. 

More is certainly to come. 

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New Laparoscopic Device Stops Harpooning of Patients

moby  lapcap.jpg

While at the Global Congress of Gyn Endoscopy I saw a really neat new device called LapCap designed to reduce the risk of entering the abdomen in laparoscopic surgery.

What is the problem- why is this needed? In laparoscopy the first step where the surgeon gains access the abdominal cavity is often a blind entry step.  There is a risk of injury to internal organs such as the bowel, bladder, or blood vessels.  While rare, these injuries can be severe or even life threatening.  If you want to read more about laparoscopic access and the risks of entry into the abdomen here is a link to an article I wrote for a Master’s Class in Gyn Surgery on this topic.

What is done in standard surgery: The most common method used by gyn surgeons is the insertion of a needle (the veress needle) which fills the abdomen with carbon dioxide gas (called insufflation).  Then a tool called a trocar is inserted into this space and the instruments go through this.  The needle insertion step is the most dangerous because it is the blind step.  various techniques are used including elevation of the abdominal wall to lift it off of and away from the underlying organs expecially the large vessels like the aorta nad vena cava.  The second common method  is the open or Hasson technique (invented by my good friend Gyn surgeon Harry Hasson) where the surgeon opens a small 10 mm incision and then inseted the trocar.  Injuries occur with all known techniques.

The New System:  The LapCap is a new system that puts a plastic dome on the abdomen attached to suction that then pulls a full thickness of the abdominal wall high up into it then allowing the veress needle to be inserted into a potentially larger and they claim safer spot.  The LapCap device received 510(k) approval from the FDA and is sold by Aragon Surgical.  It won an award from the SLS for new device innovation.  Here is a video from the company of it in operation.  I know surgeons who have used and were quite impressed and I will likley be involved with surgery using it soon.  I know that laparoscopic innovator and friend of mine Camran Nezhat is one of their advisors.  I will be speaking with him more about his experience.

Potential problems:  Two major issues- first statistical proof of demonstration of increased safety is nearly impossible for access devices such as this because the injury it might reduce so very rarely happens.  One study on this problem estimated that it would take a study of more than 200,000 people having the operation to adequately demonstrate reduced injuries statistically.  Second- one of the major risks for this sort of injury is when the bowel is adherent to the abdominal wall at the site of entry from previous surgery.  I would not expeect this device to help at all in this situation because the adherent bowel will be picked up with the abdominal wall.  However it is the vessel injuries that ar emost dangerous and this device might reduce the risk of those if it places the needle much farther away.

About the company:  They appear to have acquired the device via an acquisistion of starup Verisure. It was reported last month that they “raised $25 million in a Series B round of venture capital with the hopes of having five products on the market within two years.  In a statement on Monday, Jan. 7, Aragon said new investors Bay City Capital of San Francisco and Integral Capital Partners of Menlo Park, Calif., joined original investors Delphi Ventures and Onset Ventures, both of Menlo Park. They formed Palo Alto, Calif.-based Aragon in May 2005 to advance radio frequency technology developed at Stanford University Medical School for use in laproscopic and other surgeries. Bay City Capital was the lead investor in the most recent round.” 

I have spoken about the use of RFID for surgical and laproscopic procedures for several years and look forward to seeing where they go with it.  I know they also have tissue sealing and dividing technology and are part of the Delphi portfolio.  I had a phone call with Delphi last year as part of due diligence they were doing for another company and did think highly of them and their approach.  More details of the deal are here.

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