Category Archives: Future

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

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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.

DITM Podcast Jeff Cohen CEO-complete interview [ 26:09 ] Play Now | Play in Popup | Download
DITM Podcast Jeff Cohen CEO-interview part 1.mp3 [ 12:32 ] Play Now | Play in Popup | Download
DITM Podcast Jeff Cohen CEO-interview part 2.mp3 [ 13:37 ] Play Now | Play in Popup | Download
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The Future of Medical Video: DITM Reports From NAB 2008

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I had the distinct pleasure of attending the 2008 National Association of Broadcasters (NAB) meeting last week in Las Vegas. As the foremost event for the TV, broadcast, and media industries this is the venue to see and explore the future of all things video and media.

The Floor of the Meeting and a Sea of Humanity- Why I Went

the floor of the nab 2008 meetingBeing probably the only physician in a sea of 105,000 TV and media folks raises the inevitable question- why did I go?

Endoscopic surgery (laparoscopy hysteroscopy arthroscopy etc) all share the common use of video equipment. Since the late 70′s these procedures are performed as remote surgery looking through a thin telescope inserted into a body cavity and observed on a TV monitor.

The progress we make in medical video surgery is a direct trickle down of innovations from the broadcast arena. From the first CCD camera hooked to a laparoscope and suspended from the ceiling via a jerry-rigged boom to the first use of HDTV in the OR – broadcast and TV technology drives innovation in surgical video.

I thrive on researching new technology and then extrapolating new solutions to medical problems using these developments. This meeting provides the raw material for my creative process.

I was honored to accept invitations from several major broadcast, video, computer, and even surgical companies to attend the meeting, walk the floor with them, brainstorm new ways of helping patients with new devices and predict future needs and uses for technology in medicine.

Everybody kept asking me: What was the most important development I saw at the show? What future technology do I predict is poised to transform medicine?

Beyond the entire rooms filled with the latest newschoppers and remote satellite trucks

I was most impressed with the following technologies which have the potential to transform both consumer entertainment and medical devices- I will be posting further about each of these and what I saw (including a series of interviews):

  1. Beyond HDTV- “ultra HD” 4k cameras and displays
  2. 3D video technology in SD and HD
  3. OLED display technology
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FDA Update: Ophthalmic Device Panel Meeting To Review Implantable Eye Telescope

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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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Top Scientists Using Performance Enhancing Drugs

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This is your brain on performance enhancing drugs

Perhaps the top science journal in the world - Nature – reported today on epidemic-like levels of cognitive performance enhancing drug abuse by top academic scientists.

why they began the survey

The survey was triggered by a Commentary by behavioural neuroscientists Barbara Sahakian and Sharon Morein-Zamir of the University of Cambridge, UK, who had surveyed their colleagues on the use of drugs that purportedly enhance focus and attention (Nature 450, 1157–1159 ; 2007). In the article, the two scientists asked readers whether they would consider “boosting their brain power” with drugs. Spurred by the tremendous response, Nature ran its own informal survey. 1,400 people from 60 countries responded to the online poll.

They looked at illegally obtained (no prescription) use of three drugs: methylphenidate (Ritalin), a stimulant normally used to treat attention-deficit hyperactivity disorder but well-known on college campuses as a ‘study aid’; modafinil (Provigil), prescribed to treat sleep disorders but also used off-label to combat general fatigue or overcome jet lag; and beta blockers, drugs prescribed for cardiac arrhythmia that also have an anti-anxiety effect.”

One in five respondents said they had used drugs for non-medical reasons to stimulate their focus, concentration or memory. Use did not differ greatly across age-groups

Favorite drugs of the performance enhancing professor:

For those who choose to use, methylphenidate was the most popular: 62% of users reported taking it. 44% reported taking modafinil, and 15% said they had taken beta blockers such as propanolol, revealing an overlap between drugs. 80 respondents specified other drugs that they were taking. The most common of these was adderall, an amphetamine similar to methylphenidate. But there were also reports of centrophenoxine, piractem, dexedrine and various alternative medicines such as ginkgo and omega-3 fatty acids.

As I have srtten many times before. Prepare for the upcoming epidemic of performance enhancing drug abuse. I predict these drugs will be used at rates surpassing any other illegal drug in history. They have minimal side-effects and are becomming increasing viewed on college campuses as nothing more than a no-doze.

Read my previous posts on this topic here:

  1. New Drugs Enhance Performance, Eliminate Need to Sleep
  2. New Generation of Performance Enhancing Drugs
  3. How far would you enhance your body for performance?

Would you use it? My history of working to the limit. I was in an accelerated 6-year combined college and medical school program. Balancing the advantage of being accepted to medical school while still in high school was taking full years of college courses ever summer to catch up on the skipped time. At one point I had medical school 8-5 followed by college classes from 6-10. All was manageable until med school finals hit the same week as college midterms. I remember giving up sleep and filling 2-liter soda bottles with iced coffee to get through the day. We moved onto iced coffee in Captain Crunch next. I stopped at this point (actually at two of these bottles a day= 3000 mg caffeine). I knew others who went the route of amphetamines no-doze and pizza. While an intern my worst shift ever in the hospital was 7AM Friday until 4PM monday= 81 hours. By sunday night I was unwell to say the least. Will drugs help this? I have a good friend who is a leading academic physician. He is a brilliant physician, professor and inventor. He could not believe I had not taken modenifil and raved about how well it worked for him.

Apparently other experts agree with me:

“Neuroscientist Anjan Chatterjee of the University of Pennsylvania in Philadelphia predicts a rise in the use of these drugs and other neuroenhancing products and procedures as they become available (A. Chatterjee Cam. Q. Healthc. Ethics 16, 129–137; 2007). Like the rise in cosmetic surgery, use of cognitive enhancers is likely to increase as bioethical and psychological concerns are overcome and as the products gain cultural acceptance. One difference, Chatterjee says, is that use of cognitive enhancers doesn’t rely on training of medical specialists such as surgeons. Internet availability will also greatly accelerate use, he says.”

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Pills That Monitor If You Took Them

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Compliance with taking medications is a huge problem in medicine. Studies show more than half of all prescriptions are either not filled or not taken. Everyone is familiar with how easy it is to forget to take medications. This problem becomes overwhelming in complex diseases such as cancer or HIV where patients are on rigorous schedules throughout the day. Even worse is the situation where the
patient may have compromised cognitive abilities.

A new development is a chip containing networked pill that reports back on medication taking and the dissolution of the pill as reported by MIT technology review.

The company behind the technology, Proteus Biomedical, of Redwood City, CA, calls its technology the Raisin system.

In the Raisin system, each pill contains an “ingestible event marker” (IEM). The IEM consists of a sand-grain-size microchip with a thin-film battery that is activated on ingestion, as it is exposed to water. The battery, Proteus says, is nontoxic because it is made from materials similar to those in a vitamin pill. Once swallowed, the IEM sends through the body’s tissues a high-frequency electrical current that’s modulated in such a way that it provides a unique marker of the pill. It’s not an RFID technology: it uses the conductive tissues of the body to conduct the signal, rather than a radio, and the signal is confined within the body.

I previously wrote about about the development of swallowable RFID chips- a technology I like better.

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New Technique Sees Inside Blood Vessels in a Microsecond

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Technology Review is reporting on a new technology to look inside the tiniest spaces such as blood vessels in a microsecond. Up until now endoscopic surgery has been limited as engineers tried to shrink telescopes to ever smaller diameters shifting from glass lenses to fiberoptic scopes to newer technologies. You can read my brief history and overview of microendoscopy here.

The new scope is based on optical coherence tomography but now uses new mathematical image analysis. Read the full article if you are interested in the heavy technical foundations of the system.

Suffice it to say, the system is a sort of “ultrahigh resolution optical ultrasound” and the new modification allows it to process the signal so fast that it could be used inside blood vessels without needing to interrupt blood flow and flush out the blood. The players in this development are two compnaies – LightLab and CardioSpectra of Austin, TX. The latter company was recently purchased by Volcano, one of the leading manufacturers of IVUS products for $25M.

Example of an OCT image of a fingertip (standard old OCT system)

Basic Explanation of How the Foundation Technology of OCT Works from wiki

“OCT is a technique for obtaining sub-surface images of materials at a resolution equivalent to a low-power microscope. It is effectively ‘optical ultrasound’, imaging reflections from within tissue to provide cross-sectional images. It is attracting a great deal of interest in the medical community, because of its potential to provide images at a far higher resolution (better than 10 µm) than is possible with other imaging modalities such as MRI or ultrasound.”

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Interactive Objects and Gesture Control-Microsoft Vision of Medical Future

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Microsoft produced this video as a demo of their vision of the future of healthcare.  I was delighted to see that they share so much with my vision of technologies that will be key transformers in the future of medicine.

Key technologies I predict will change health care that I see in the video include:

  1. implantable glucose monitor sensors
  2. display surface
  3. wireless charger
  4. gesture control
  5. interactive smartwalls that become displays
  6. RFID taggged medicine bottles
  7. Digital examination tols interfacing with EMR’s
  8. LCD opaque windows
  9. Digital wallets
  10. Biometrics

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Bizarre Russian Interactive Art is Surgery Control Concept!

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I have written many times on the concept of what I call “gesture control”. This is the idea of waving your arm or hand in a movement that is picked up by sensors (optical or other tracking) and which is then translated into the movement of a robotic surgical device, OR room or equipment control, or energy delivery system. You can see all these posts by clicking gesture control on the category drop down on the sidebar. Some faves are here here and here.

Lily Chaos has reviewed a bizzare interactive Russian art display that employs gesture control concepts.

She writes

A new video art installation by Russian media artist Sergey Kotsun invites the viewer to become the author and main character of an interactive audio-visual performance.

The viewer’s image is captured via a webcam and thrown up onto a projection screen. On the screen, two lines of transparent square boxes are also displayed, with the lines approaching each other at the top and veering away at the bottom, almost forming two sides of a triangle. Inside the boxes are different geometrical shapes.

As the viewer waves or makes other motions that can be picked up by the webcam, a computer program analyzes those movements. Any time a movement is perceived to intersect with one of the transparent squares, the corresponding geometrical shape displays onscreen and the sound of a musical instrument is played.

The viewer, in effect, becomes the artist as well as an integral part of the performance, creating movements that translate into sounds and abstract compositions of circles, squares, lines and half-moons. Kind of like playing an air banjo from inside a colorful kaleidoscope.

Here is a video of it in play- too Yoko Ono for my musical taste but pay attention to how the participant’s gestures are picked up by the camera and converted into actions- the same principle I advocate in the OR.

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If you have a webcam you can try a home demo!

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Glimpse the Future of Medicine at a Cell-Phone Convention: What is 4G?

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The annual cell-phone (I should say wireless) convention of the year just wound up over at CTIA in Vegas. Usually these meeting spark some idea in me due to a new device or new wireless technology such as a universal wireless device charger, or an image recognition and analysis system that can lead to a future medical device. No such individual device or software at this meeting- but much bigger I am amazed at the awesome potential of the next generation wireless system in general: 4G wireless. This always on technology promises a wireless future where multiple devices that are always on will pull and deliver all sorts of data from your patients or surgical devices. A 4G system will be able to provide a comprehensive solution where voice, data and streamed multimedia can be given to users on an “Anytime, Anywhere” basis, and at higher data rates.

My analysis of the awards given out at CTIA was struck by the focus on developing 4G technologies.

First some background definitions – What is 4G: The History of Wireless Cell-phone Technologies: Briefly the first generation systems were analog based (1G). 2G second generation systems were the first that were all digital. Reported advantages of digital 2G systems are voice data can be compressed more effectively than allowing more calls to be packed into the same amount of radio bandwidth and they required less radio power.

3G systems promised: (such as Verizon’s EV-DO)

  1. Enhanced multimedia (voice, data, video, and remote control).

  2. Usability on all popular modes (cellular telephone, e-mail, paging, fax, videoconferencing, and Web browsing).

  3. Broad bandwidth and high speed (upwards of 2 Mbps).

  4. Roaming capability throughout Europe, Japan, and North America

Why 4G Will Transform Medicine & Surgery: Let me be the first to ring the bell for the promise of 4G in medicine. It has been written that it is expected that end-to-end intenet lanuage (IP) based system and high-quality streaming video will be among 4G’s distinguishing features. Fourth generation networks are likely to use a combination of WiMAX and WiFi- like your high speed wireless internet at home. The explosive potential is:

When fully implemented, 4G is expected to enable pervasive computing, in which simultaneous connections to multiple high-speed networks provide seamless handoffs throughout a geographical area. Network operators may employ technologies such as cognitive radio and wireless mesh networks to ensure connectivity and efficiently distribute both network traffic and spectrum.

4G networks, when coupled with cellular phones equipped with higher quality digital cameras and even HD capabilities, will enable vlogs to go mobile, as has already occurred with text-based moblogs. New models for collaborative citizen journalism are likely to emerge as well in areas with 4G connectivity.

In medicine this means you can have surgical devices, electronic medicial records, imaging devices, and your cell-phone like handheld all communicating and sharing info at broadband speeds in HD.

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Can Vision Testing Improve Surgical & Athletic Performance?

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visual testing Gizmodo is reporting today about how White Sox catcher A.J. Pierzynski said he improved his performance though the daily use of a Nintendo video game. This reminded me of research I did while at Yale on similar visual testing on surgeons. We found back then that for both athletes, and surgeons (especially endoscopic surgeons) visual acuity correlated with performance and both could be improved with exercises.

First the report on the catcher and the video game. Gizmodo writes:

We were just about to stuff Nintendo’s Flash Focus vision game into the snake oil file when White Sox catcher A.J. Pierzynski revealed he actually improved his hitting through daily use of the software. Like many of the White Sox batters last year, Pierzynski stunk, and to come around he played Flash Focus in the off season. Now, one week into the 2008 schedule, the hapless catcher has two home runs, a .529 average and a team-leading seven RBIs.

What is Flash Focus?: Flash Focus is a video game for the Nintendo DS. Basically it is a series of hand eye coordination exercises designed to improve overall visual acuity through vision “exercises”. A review of the game and screen shots are here.

The Concept of Optomeric Testing for Athletes and Surgeons: The idea behind optomic testing is two fold. First, there are innate differences in visual performance between people second, elite athletes perform significantly better on objective tests of visual performance and hand-eye coordination, and third, specific testing and exercises can identify areas of optical performance weakness and improve them- and performance.

A review of optometric testing in general for athletes can be read here:

The basic tests they mention are:

  1. Visual acuity – right and left eye separately without an occluder
  2. Stereopsis at distance – contour and random dot
  3. Ocular dominance – independent of handedness
  4. Letter contrast
  5. Contrast sensitivity – at spatial frequencies known to be related to sport performance
  6. Contrast sensitivity with glare
  7. Reaction time
  8. Reaction time with varying targets

Our experiments with surgeons- Some years ago whenI was at Yale My Partner David Olive and I conducted a lerge study of novice and expert endoscopic surgeons using the validated athletic optometric testing tools. We testing a very large group of trainees as well as experts at an international AAGL conference. We found similar patterns as with the athletes. Namely significant differerences existed between visual ability and eye hand coordination skills and these were related to measures of performance and skill. We also found that with exercise performance could improve.

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