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The Doctor Is Out, but New Patient Monitoring and Robotics Technology Is In

New technology like smart pills, a wireless heart monitor and a robotic surgical assistant could radically reshape patient care
smart pill,medication



COURTESY OF PROTEUS BIOMEDICAL

A new generation of medical devices using wireless communications, sophisticated software and data center-driven "cloud" computing promises to deliver health care in ways previously limited to the confines of fancy hospital rooms.

These advances, ranging from edible sensors to cordless heart monitors to robotic arms that mirror a doctor's movements, presage sharp falls in cost just as consumers clamor for more affordable health care. Around-the-clock tracking through wireless sensors, advanced biochemistry and raw remote computing power to mine and match symptom data with likely causes could help doctors band together to make faster, more correct diagnoses, from wherever they are.

"These developments encapsulate the work of scientists and technologists across many disciplines," says Gordon Edge, an inventor and former chairman of the Cambridge University–MIT Institute Advisory Board. "It's the fruit of electronics, computing, basic chemistry and microbiology coming together."

Smart pill
No advance better reflects this creative collaboration than smart pills, or pills incorporating sensors that send signals and relay vital-stat information after ingestion. At a March conference on innovation hosted in Berkeley, Calif., by The Economist, Proteus Biomedical was singled out for the unconventional materials it uses to make its smart-pill products.

The Redwood City, Calif., company meshes sensors made of materials found in food including copper, magnesium and silicon (traces are in apples and celery) into existing medicines to ensure safe digestion after swallowing and to cut costs by substituting readily available minerals for the more expensive silicon alone. Proteus says its edible sensor—embedded in a pill—would raise the cost of that pill just pennies more when produced in large volumes. The company is targeting medicines in the cardiovascular, diabetes, tuberculosis and psychiatric ailment areas. For now, its sensor could be paired with a pill in many diagnostic areas. (No data is available for the additional cost of comparable pills because this is a new market.)
 
The sensor aims to monitor compliance and track progress in treating ailments by relaying key information back after a pill is swallowed. Proteus's sensors send a low-powered signal triggered by these minerals mixing with stomach fluids to a band-aid style microelectronic receiver placed on the skin. The receiver then time– and date–stamps information about the pill and sends back  activity (to track sleep patterns, posture or falls) and heart and respiratory rate readings to caregivers via e-mails or text messages in real-time.

By ensuring that patients take pills as prescribed, doctors hope to boost the medication's efficacy. The technology is also designed to warn caregivers if a patient's health or behavior deteriorates after a missed dosage. Tracking the effect of these so-called smart pills on vital bodily functions will help doctors perfect their chemistry, says Gartner analyst Wes Rishel who studies technology for health care delivery organizations and hospitals. "People react differently to different medicines," he adds. "If you can react in real-time to a body's response to a medicine you can more quickly determine the correct dosage.”

"We're interested in determining patients' sleep patterns," says John Kane, head of schizophrenia research at Zucker Hillside Hospital in Glen Oaks, N.Y. Kane, who is conducting a Proteus-funded pilot study, says, "For certain mental illnesses, changes in sleep patterns are an early sign that an illness is accelerating."

Proteus's Raisin smart pill (actually as big as a grain of sand) is in late-stage development with backing from Swiss pharmaceuticals giant Novartis and Minneapolis-based medical technology maker Medtronic, Inc. Novartis's research shows that drug compliance rates shot up to 80 percent (from 30 percent) within six months of patients ingesting the hybrid pill, Financial Times reported in September.

Such smart medicine would also address another problem—up to half of patients fail to follow drug-taking instructions at all, according to an article published April 7 in The New England Journal of Medicine. That adds up to roughly $100 billion a year in avoidable hospitalization costs.

"We're expected to manage our health but have no internal speedometer or fuel gauge," Proteus co-founder Andrew Thompson said at the The Economist innovation conference.  "We connect sensors to cell phones to get feedback.”

A heartbeat away
Heart monitoring devices debuted several decades ago, diagnosing slow, fast or skipped beats and communicating that information via wires. Such devices are generally cumbersome and inconvenient to use, so patients often rip off wires attached to their bodies or abandon big boxes they are tethered to when showering or sleeping. This irregular use means doctors sometimes miss signs that would allow them to diagnose disruptions and thereby save lives.

As a potential solution to this, San Jose-based Corventis has developed a water-resistant heart-monitoring device that communicates via wireless technology. The Avivo consists of a disposable sensor that adheres to the chest like a Band-Aid, as well as a cell phone–sized receiver. The sensor sends a steady stream of data on posture, activity, fluid status, and heart and respiratory rates to the receiver using Bluetooth technology. This information is then forwarded over cellular networks to servers at Corventis, where cardiographic technicians analyze algorithms and data. Reports are then posted on Corventis's secure Web site for caregivers or relayed to them via e-mail, fax or phone so they can react immediately to abnormal signals.

"For the first time, a ubiquitous wireless infrastructure allows you to send a signal from in or on someone's body to a secure and reliable cloud-based computer," says Tom Heatherington, a senior executive in consulting firm Accenture's health care practice. "Without the network you can't scale or up do things remotely. The infrastructure is the catalyst." Avivo is available in the U.S., Europe, India, the Middle East and Singapore.

Hands-free surgeon
Robotic surgical equipment has been available for the past decade to help surgeons work with precision in tight spots, but it generally has been too expensive to be used in most operations. Robots could soon play a more prominent role in the operating room as companies develop automated devices with steady hands that help surgeons with non-surgical needs, such as holding lights, cameras and telescopes in the right place during operations.

For instance, the Freehand laparoscopic camera controller made by U.K.-based Prosurgics Limited applies technology from industrial robots to minimally invasive operations including hysterectomies and removals of kidneys and gallbladders. The surgeon wears a sensor much like a climber's headlamp, and controls the robotic arm using head movements and a foot pedal.

Freehand, at about $20,000, costs a fraction of sophisticated robot surgeons including Intuitive Surgical's joystick-controlled da Vinci Surgical System robot, which debuted in 1999. Da Vinci offers surgeons the ability to control three robotic hands (for a camera and instruments) that can make precise "keyhole" incisions and perform complex surgeries via optics and imaging. The downside has been the system's million-dollar-plus price tag.

Freehand says that because its arms do not enter the body but assist with tools other than operating instruments, it is complementary to technology such as the da Vinci robot rather than a competing product and does not face the same hurdles.  "Freehand should be of potential interest in an emerging robotics market that supports the work, technique and role of surgeons," says Edge, now a professor of engineering and mathematical sciences at City University, London and an early investor in Freehand.

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