Medical devices have been used for thousands of years – Hippocrates had a ladder-type device to help alleviate dislocated shoulders. Although his device is no longer used, his method is. Early but effective medical devices like spectacles, syringes and stethoscopes were all fairly basic. What strikes me is how some very simple ideas have changed so many lives for the better.
Looking into the past, I wonder how many people would have lost their lives were it not for simple medical devices. Of course, all of these devices have been improved and modified from their simpler origins in the past. Such progress is not at an end: if we look at the present state of medical devices, how can we improve them so that they have an even greater positive impact on people’s lives? What will the future be like for these existing devices? Let’s travel back in time to the past, assess the present and possibly predict the future of medical devices!
It’s hard to imagine anyone who hasn’t had contact with spectacles, syringes or a stethoscope in their life. I, for one, am delighted that spectacles exist! If not for the invention of this device, I suspect that my family tree would have been very short: my parents, grandparents and great-grandparents were myopic; without glasses surely one of my ancestors would have stepped off a cliff, eaten poisonous berries or merrily approached a dangerous animal.
My short-sighted family members aren’t alone; scientists have identified twenty-four genes that pass on myopia (King’s College London – Chris Hammond). Now in the developed world, 60% of people need to wear glasses/contacts or have corrective surgery, and this percentage is increasing – possibly caused by too much time looking at screens or studying (Hammond et al – King’s College London).
But even as alternative treatments for poor eyesight become more common, not everyone is ready to bid farewell to glasses. My own father, who has worn glasses since adolescence, needed cataract surgery once he reached his 80s – for his age group, 70% of white, American men have cataracts (this figure varies significantly by race). After successful surgery, he had 20/20 vision, and yet he still refused to give up his glasses. ‘Why?’ I asked him – was it his vision? His answer was simple: although his vision was fine now, wearing glasses was a lifetime’s habit that he just couldn’t break; he felt exposed and he said he needed his glasses to protect his eyes.
Sometimes psychological factors of habit and comfort may lead people to stick with a medical device when it is no longer needed. With glasses the consequences are unlikely to be serious – glasses can just be a fashion statement! – but the same is not necessarily true for all medical devices. Such psychological attachments are worth bearing in mind in the development process.
Having had ankle surgery in recent months, I myself have had need to use syringes. After my surgery, I was prescribed blood-thinning medication. This was not prescribed, as I’d expected, in pill form but instead came in pre-filled syringes. Injections don’t usually bother me but an array of twenty-eight syringes – all my responsibility to administer – was a little daunting to see.
I wasn’t allowed to leave the hospital until I had given myself the first injection. The nurse gave careful instructions to pinch an area of skin on my stomach and then insert the syringe into the subsequent fold. Once at home and needing to give myself the next shot, I saw that I had bruised badly from my first injection. Had I done something wrong?
I hurriedly consulted the written instructions and realised they were somewhat different from what the nurse showed me to do. I gave the new instructions a go . . . and still ended up with considerable bruising. Over the course of my twenty-eight injections, I never quite managed to find the correct technique for me, one that delivered the full dose with a minimum of discomfort and bruising.
The instructions that came with my medicine seemed factually correct but unhelpful. I was certainly relieved when I came to the final dose, and I had new respect for those who must give themselves regular injections for life. But what else did I learn from the experience? It made me appreciate how well Team considers the user’s experience and just how important the packaging and instructions are.
Prediction is a tricky business, especially in an evolving field like medical devices, but it is interesting to consider what the future holds for medical devices. How many will still be used in five, ten or twenty years? With advances taking place in gene therapy the need for glasses might be reduced for future generations.
However, we can safely assume that some devices will be around for a very long time. What modifications and improvements might they face in the short term? As an example, let’s consider the stethoscope. First a little historical background: the stethoscope – from the Ancient Greek stethos (chest) and scopos (examination) – was invented in 1816 by René Laenne, who gallantly devised a wooden tube that allowed him to listen to the heartbeats of his female patients without the need to put his ear directly on the patient’s chest! In 1851 an Irish physician Arthur Leared designed the now-familiar shape of the bi-aural model, one further refined in 1852 by George Cammann.
What could the future hold for the stethoscope?
A smart device
One smart stethoscope is already available and FDA-approved. It looks similar to a traditional stethoscope but has hidden powers! The Eko Core by Eko Devices is a digital stethoscope offering both analogue and digital modes. With the analogue/digital toggle, users have “a calibrated high-pass audio filter, and a re-engineered dynamic driver, providing superior audio quality, white noise reduction and enhanced 40x amplification.” The stethoscope is Bluetooth connected to help analyse and share patients’ heart sounds, murmurs, bruits and other heart and lung sounds. The data can be analysed on a laptop, tablet or smart phone.
A new shape
The Ekuore is a hand-held device which records auscultation (the listening to the body’s internal sounds as part of a medical diagnosis). The data is collected and sent securely through a WiFi connection. The auscultation sounds can be recorded, edited, shared, displayed on a device or simply listened to. The data is seen on the Ekuore App. Ekuore has joined with SensiCardiac to develop this device further in determining heart murmurs.
A new use
Lithocheck, devised by Tim Leighton (Southampton University) and Andy Coleman (Guys and St Thomas’ Health Trust), is a probe that looks much like a stethoscope to the patient but instead of a doctor listening to the sounds, the information is directly uploaded to a computer which automatically makes a diagnosis.
The Lithocheck is currently used to assess the success of Shock Wave Therapy (SWT) for kidney stone sufferers. SWT breaks up kidney stones by sending 3000 shockwaves into the human body. It’s difficult to assess whether this treatment has been effective in removing the kidney stones: most clinicians use x-rays to assess the success of surgery, but over a third of the patients need to be retreated. “The Lithocheck correctly diagnoses whether the SWT has been successful by listening to the echoes that are created when the shocks are sent through the body. Sensors are placed on the abdomen. The Lithocheck correctly interprets what the sensors “hear” and whether the SWT was successful. Its prediction rate is correct 94.7% of the time.”
With so many exciting new developments to the stethoscope, it will be fascinating to see what future modifications and improvements are made. What will be the next ubiquitous medical device? What simple device will help future generations?
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