• Good news for medical devicemakers: “Baby boomers are descending upon the health care infrastructure of the United States like locusts upon a cornfield,” hungry for medical devices. But with regenerative and pharmacogenomic medicine making headway fast (as other sections of this issue show), we think the boom in devices might turn out to be a bust.
• Mini-robots that crawl around the abdominal cavity could end the reign of million-dollar surgical robots within five to ten years, and micro-robots designed for micro-machining, including the “machining” of cells, could conceivably take over from them.
• An anti-malaria wristwatchpricks the wearer’s wrist with a tiny needle four times a day, tests the blood for malaria parasites, and alerts the wearer if the parasite is detected and medication is needed.
• A recently-approved wearable glucose monitor/insulin pumpsystem is a step toward an artificial pancreas.
• A self-adjusting “implant-it-and-forget-it” drug dispenserhas worked in dogs and is three to five years from human trials.
• The world’s fastest nanomotor could be a component of future implantable pumps.

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The fact that the medical device field has become “one of the most innovative and profitable segments of the economy,” as Barnaby Feder puts it in the New York Times , accounts for the recent acquisition frenzy over Guidant. How profitable? “Drug-coated stents like Taxus from Boston Scientific are estimated to have profit margins approaching 90 percent. Heart-regulating devices like those made by Guidant, Medtronic and St. Jude Medical can cost $25,000 or more and carry gross margins as high as 70 percent.”

Feder’s bigger point is that the fight for Guidant “is only one sign of the boom in medical devices,” from disposable syringes to surgical robots. The boom is a sort of pre-shock from the impending baby boom. Feder quotes an analyst at Lazard: “Baby boomers are descending upon the health care infrastructure of the United States like locusts upon a cornfield.”

Meanwhile, drug makers are struggling, in part because devices are increasingly replacing drugs. Says Feder: “Pacemakers and defibrillators correct heartbeat abnormalities that are impossible to manage chemically. Spinal fusion devices and, more recently, artificial spinal disks have become treatments of last resort in patients for whom drugs and exercise can no longer control back pain.” And with side effects less of an issue for devices compared to drugs, regulatory approval is generally swifter and cheaper.

[More batty ideas:]Lilliputian Da Vinci

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Several prototypes of a radio-controlled dexterous mini surgical robots have been used to help perform gall bladder and prostate removal in live pigs at the University of Nebraska. The prototypes are about 15 millimeters in diameter. One has a camera, another has a biopsy needle. Their wheels have a spiral tread, allowing them to traverse abdominal organs without slipping or damaging tissue. They are claimed to give the surgeon a much broader visual field compared to traditional laparoscopic cameras.

In tests on a live pig, the robots were inserted through the animal’s mouth, and once inside the stomach, surgeons cut a small hole in the stomach wall, which allowed the robot access to the whole abdominal cavity.

Newer versions are being developed with clamps and cautery electrodes to stop internal bleeding.

Centimeter-sized Robots

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A German-led team of researchers from eight European institutions is close to finishing the development of five-to-ten micro robots for cell manipulation and micro assembly. Each robots measures only about 1.5 cm by 3 cm, yet has everything expected of a large robot, including actuators for gripping, cell manipulation, and so on. The robots are wireless, contain a two-way infrared control system, and will be able to cooperate with one another as a “swarm” when researchers complete this last remaining task.

The first fully functional robot succeeded in injecting liquid into biological cells, and in soldering parts for micro-assembly.

Anti-Malaria Wristwatch

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An award-winning South African inventor has developed an anti-malaria wristwatch that pricks the wearer’s wrist with a tiny needle four times a day and tests the blood for malaria parasites. If the parasite count tops 50 an alarm sounds and a brightly-colored picture of a mosquito flashes on the watch face. The wearer must then take three tablets that kill all traces of the disease within 48 hours. The watch contains an RFID tag so that as a wearer (say, a miner) passes through a detector, information from the watch is sent to the company clinic or a health department to ensure people who test positive for the parasite take their tablets.

As of January, the inventor’s company, Gervans Trading, had already received 1.5 million orders for the approximately US$280 wristwatch from companies, governments, and aid organization in Africa, he told Reuters’ Rebecca Harrison.

Insulin Pump/Glucometer

Advisory Board (subscription service), Daily Briefing, April 14, 2006″>Source article

The US Federal Drug Administration has approved Medtronic’s “Paradigm Real-Time” combination insulin pump and glucose monitoring system. A glucose monitor attached to the abdomen measures blood glucose levels every five minutes and transmits the readings to a pump that alerts the wearer to administer insulin when necessary. The system costs about US$7,000 and is currently only available for adults.

The system has been called a significant step toward an artificial pancreas.

Implantable Drug Dispenser

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With support from MIT researchers a company called MicroCHIPS claims to have controlled drug doses in dogs for up to six months via implanted “chips” containing 100 reservoirs of medicine released at varying intervals and amounts. Human clinical trials are still some three to five years away, and could involve implanted sensors that would monitor a patient’s circulatory system or blood glucose.

At “about the size of a small cookie,” as AP writer Mark Jewell describes it, the MicroCHIPS device is much smaller than available insulin pumps, and comparable in size to an implantable heart defibrillator. It is also wireless, and could control the release of multiple drugs from a single implant in the abdomen, while also monitoring drug levels and adjusting dosing accordingly.

A Johns Hopkins neurosurgeon (not affiliated with the company) who has experimented with MicroCHIPS chips to treat brain tumors in rats told Jewell the technology “shows great promise.”

Nanodrug Engine

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Italian scientists have created a solar-powered nanomotor to deliver drugs into cells and other potential uses. The nanomotor was designed in Italy, assembled at the University of California-Los Angeles, and then operated at Bologna University.