Category Archives: laser

New Medical Technologies at Startups, May 2015

Below is the list of technologies under development at medical technology companies identified in May 2015 and included in the Medtech Startups Database.

  • Nanotechnology-based diagnostic
  • Bone fixation devices, including for post-sternotomy closure
  • Devices and materials for bone lengthening
  • Nanopolymer drug delivery
  • Developing an artificial pancreas; combined blood glucose monitor and insulin pump
  • Terahertz radiation-based measurement of blood glucose
  • Patient-specific orthopedic implants
  • Undisclosed medical technology
  • Novel energy delivery-based medical technology
  • Device for early detection of cardiovascular disease based on endothelial dysfunction
  • Facet joint surgical instruments
  • Neuromodulation technology
  • Electric stimulation in wound healing
  • Mesenchymal stem cell treatment in cardiology, transplantation, and autoimmunity
  • Integrated blood glucose monitor, insulin dosing
  • Surgical instrumentation

For a historical listing of technologies at medtech startups, see link.

 

Ablation technologies to reach $16.8 billion

In 2013, energy-based tissue ablation tools and techniques were used in hundreds of millions of procedures required, generating an estimated $12.4 billion in cumulative global sales. These total sales are projected to register a healthy growth over the forecast to the year 2020, reaching $16.8 billion by that time.

A new report published by Smithers Apex covers the global market for energy-based tissue ablation products. See link.

Reconstructive surgery is increasingly aesthetic

Reconstructive surgery is the subset of “plastic” surgery focused on correcting the anatomy, aesthetics, or both, for patients who have been treated for disease or trauma, which sets it apart from purely aesthetic procedures performed for people wishing to improve their appearance above and beyond what they were given by birth (excluding congenital defects) or to reduce the signs of aging.

Given the volume of the non-clinically-indicated aesthetic procedures, and their increasingly sophisticated techniques and technologies, reconstructive surgery specialists have integrated aesthetics advances and can now achieve spectacular results that go well beyond the simple reconstructive procedures of the past, which were much less effective in concealing the trace evidence of disease and trauma.

By far, the most common reconstructive procedures are to address the physical appearance resulting from the removal of tumors. In the U.S. alone, reconstruction for tumor removal is performed over 4 million times annually. The remainder of reconstructive procedures covers a gamut of major and minor trauma and diseases.

Below is the distribution of non-aesthetic (only) reconstructive procedures in the U.S.

reconstructive-pie

Source: MedMarket Diligence, LLC; Report #S710.

Through 2018, the global medical reconstructive and aesthetic products market is expected to reach a value of about $10.7 billion. Energy-based products such as lasers will experience the highest growth level. In most geographical regions and particularly in the U.S. and Europe, there is a growing consumer demand for medical cosmetic procedures and through 2020, even the lower income groups are likely to demand for more procedures, as the treatments become increasingly main stream. During the past few years, practitioners in the U.S. were rather forced to implement discounts and now with the revival of the economy, the total fee growth is likely to rebound. Successful companies in the sector mostly rely on a formula for continued research and development, pursuing additional, new business opportunities to increase expertise and product offerings. These companies remain solidly active in the eyes of high-end dermatologists, plastic and cosmetic surgeons.  As the aesthetic market is all about new products, the companies will be left behind, if they do not come up a new product every now and then.


This post is drawn from, “Global Markets for Products and Technologies in Aesthetic and Reconstructive Surgery, 2013-2018″, Report #S710, published by MedMarket Diligence, LLC.  For details, see link/a>.

Where will medicine be in 20 years?

(This question was originally posed to me on Quora.com. I initially answered this in mid 2014 and am revisiting and updating the answers now, in mid 2015.)

An important determinant of “where medicine will be” in 2035 is the set of dynamics and forces behind healthcare delivery systems, including primarily the payment method, especially regarding reimbursement. It is clear that some form of reform in healthcare will result in a consolidation of the infrastructure paying for and managing patient populations. The infrastructure is bloated and expensive, unnecessarily adding to costs that neither the federal government nor individuals can sustain. This is not to say that I predict movement to a single payer system — that is just one perceived solution to the problem. There are far too many costs in healthcare that offer no benefits in terms of quality; indeed, such costs are a true impediment to quality. Funds that go to infrastructure (insurance companies and other intermediaries) and the demands they put on healthcare delivery work directly against quality of care. So, whether it is Obamacare, a single payer system, state administered healthcare (exchanges) or some other as-yet-unidentified form, there will be change in how healthcare is delivered from a cost/management perspective.

From the clinical practice and technology side, there will be enormous changes to healthcare. Here are examples of what I see from tracking trends in clinical practice and medical technology development:

  • Cancer 5 year survival rates will, for many cancers, be well over 90%. Cancer will largely be transformed in most cases to chronic disease that can be effectively managed by surgery, immunology, chemotherapy and other interventions.
    [View Aug. 2015: Cancer has been a tenacious foe, and remains one we will be fighting for a long time, but the fight will have changed from virtually incapacitating the patient to following protocols that keep cancer in check, if not cure/prevent it.] 
  • Diabetes Type 1 (juvenile onset) will be managed in most patients by an “artificial pancreas”, a closed loop glucometer and insulin pump that will self-regulate blood glucose levels. OR, stem cell or other cell therapies may well achieve success in restoring normal insulin production and glucose metabolism in Type 1 patients. The odds are better that a practical, affordable artificial pancreas will developed than stem or other cell therapy, but both technologies are moving aggressively and will gain dramatic successes within 20 years.
    [View Aug. 2015: Developments in the field of the “artificial pancreas” have recently gathered considerable pace, such that, by 2035, type 1 blood glucose management may be no more onerous than a house thermostat due to the sophistication and ease-of-use made possible with the closed loop, biofeedback capabilities of the integrated glucometer, insulin pump and the algorithms that drive it, but that will not be the end of the development of better options for type 1 diabetics. Cell therapy for type 1 diabetes, which may be readily achieved by one or more of a wide variety of cellular approaches and product forms (including cell/device hybrids) may well have progressed by 2035 to become another viable alternative for type 1 diabetics.] 
  • Diabetes Type 2 (adult onset) will be a significant problem governed by different dynamics than Type 1. A large body of evidence will exist that shows dramatically reduced incidence of Type 2 associated with obesity management (gastric bypass, satiety drugs, etc.) that will mitigate the growing prevalence of Type 2, but research into pharmacologic or other therapies may at best achieve only modest advances. The problem will reside in the complexity of different Type 2 manifestation, the late onset of the condition in patients who are resistant to the necessary changes in lifestyle and the global epidemic that will challenge dissemination of new technologies and clinical practices to third world populations.
    [View Aug. 2015: Despite increasing levels of attention being raised to the burden of type 2 worldwide, including all its sequellae (vascular, retinal, kidney and other diseases), the pace of growth globally in type 2 is still such that it will represent a problem and target for pharma, biotech, medical device, and other disciplines.] 
  • Cell therapy and tissue engineering will offer an enormous number of solutions for conditions currently treated inadequately, if at all. Below is an illustration of the range of applications currently available or in development, a list that will expand (along with successes in each) over the next 20 years.

    [View Aug. 2015: Cell therapy will have deeply penetrated virtually every medical specialty by 2035. Most advanced will be those that target less complex tissues: bone, muscle, skin, and select internal organ tissues (e.g., bioengineered bladder, others). However, development will have also followed the money. Currently, development and use of conventional technologies in areas like cardiology, vascular, and neurology entails high expenditure that creates enormous investment incentive that will drive steady development of cell therapy and tissue engineering over the next 20 years, with the goal of better, long-term and/or less costly solutions.] 

  • Gene therapy will be an option for a majority of genetically-based diseases (especially inherited diseases) and will offer clinical options for non-inherited conditions. Advances in the analysis of inheritance and expression of genes will also enable advanced interventions to either ameliorate or actually preempt the onset of genetic disease.
    [View Aug. 2015: It’s a double-edged sword with the human genome. As the human blueprint, It is the potential mother lode for the future of medicine, but it remains a complex set of plans to elucidate and exploit for the development of therapies. While genetically-based diseases may readily be addressed by gene therapies in 2035, the host of other diseases that do not have obvious genetic components will resist giving up easy gene therapy solutions. Then again, within 20 years a number of reasonable advances in understanding and intervention could open the gate to widespread “gene therapy” (in some sense) for a breadth of diseases and conditions.] 
  • Drug development will be dramatically more sophisticated, reducing the development time and cost while resulting in drugs that are far more clinically effective (and less prone to side effects). This arises from drug candidates being evaluated via distributed processing systems (or quantum computer systems) that can predict efficacy and side effect without need of expensive and exhaustive animal or human testing.
    [View Aug. 2015: The development of effective drugs will have been accelerated by both modeling systems and increases in our understanding of disease and trauma. It may not as readily follow that the costs will be reduced, something that may only happen as a result of policy decisions.] 
  • Most surgical procedures will achieve the ability to be virtually non-invasive. Natural orifice transluminal endoscopic surgery (NOTES) will enable highly sophisticated surgery without ever making an abdominal or other (external) incision. Technologies like “gamma knife” and similar will have the ability to destroy tumors or ablate pathological tissue via completely external, energy-based systems.
    [View Aug. 2015: By 2035, technologies such as these will have measurably reduced inpatient stays, on a per capita basis, since a significant reason for overnight stays is the trauma requiring recovery, and eliminating trauma is a major goal and advantage of the NOTES technology platform. A wide range of technologies across multiple categories (device, biotech, pharma) will also have emerged and succeeded in the market by producing therapeutic benefit without collateral damage.] 
  • Information technology will radically improve patient management. Very sophisticated electronic patient records will dramatically improve patient care via reduction of contraindications, predictive systems to proactively manage disease and disease risk, and greatly improve the decision-making of physicians tasked with diagnosing and treating patients.
    [View Aug. 2015: There are few technical hurdles to the advancement of information technology in medicine, but even in 2035, infotech is very likely to still be facing real hurdles in its use as a result of the reluctance in healthcare to give up legacy systems and the inertia against change, despite the benefits.]
  • Systems biology will underlie the biology of most future medical advances in the next 20 years. Systems biology is a discipline focused on an integrated understanding of cell biology, physiology, genetics, chemistry, and a wide range of other individual medical and scientific disciplines. It represents an implicit recognition of an organism as an embodiment of multiple, interdependent organ systems and its processes, such that both pathology and wellness are understood from the perspective of the sum total of both the problem and the impact of possible solutions.
    [View Aug. 2015: This orientation will be intrinsic to the development of medical technologies, and will increasingly be represented by clinical trials that throw a much wider and longer-term net around relevant data, staff expertise encompassing more medical/scientific disciplines, and unforeseen solutions that present themselves as a result of this approach.]

There will be many more unforeseen medical advances achieved within 20 years, many arising from research that may not even be imagined yet. However, the above advances are based on actual research and/or the advances that have already arisen from that research.

Reference reports in Ophthalmology, Coronary Stents and Tissue Engineering

MedMarket Diligence has added three previously published, comprehensive analyses of  medtech markets to its Reference Reports listings. The markets covered in the three reports are:

  • Ophthalmology Diagnostics, Devices and Drugs (see link)
  • Coronary Stents: Drug-Eluting, Bare, Bioresorbable and Others (see link)
  • Tissue Engineering, Cell Therapy and Transplantation (see link)

Termed “Reference Reports”, these detailed studies were initially completed typically within the past five years. They now serve as exceptional references to those markets, since fundamental data about each of these markets has remained largely unchanged. Such data includes:

  • Disease prevalence, incidence and trends (including credible forecasts to the present)
  • Clinical practices and trends in the management of the disease(s)
  • Industry structure including competitors (most still active today)
  • Detailed appendices on procedure data, company directories, etc.

Arguably, a least one quarter of every NEW medtech report contains background data encompassing the data listed above.  Therefore, the MedMarket Diligence reports have been priced in the single user editions at $950 each, which is roughly one quarter the price of a full report.

See links above for detailed report descriptions, tables of contents, lists of exhibits and ordering. If you have further questions, feel free to contact Patrick Driscoll at (949) 859-3401 or (toll free US) 1-866-820-1357.

See the comprehensive list of MedMarket Diligence reports at link.

 

Ablation technology regional growth to 2019

In our analysis of the global market for the spectrum of ablation technologies — Electrical, Radiation, Light, Radiofrequency, Ultrasound, Cryotherapy, Thermal (other than cryo), Microwave, and Hydromechanical — we assessed the size and growth of sales of these technologies with specificity to a large number of regions and countries:

  • U.S.A.
  • Canada
  • Brazil
  • Mexico
  • Germany
  • United Kingdom
  • France
  • Italy
  • Spain
  • BeNeLux
  • Japan
  • China
  • India
  • Australia
  • Rest of World

Below, we illustrate, ranked from low to high, the compound annual growth rates of each geography/technology combination.  This data reflects the strong trends that exist for clinical adoption and sales growth of specific technologies, driven by the unique combination of country-specific and technology-specific forces.

Source: Report #A145, MedMarket Diligence, LLC.

Global Energy-based Ablation Devices Markets, Forecast to 2019

The global market for energy-based ablation devices in 2011 stood at $11.5 billion.

“Ablation” is considered in the context of medical technology to be a therapeutic destruction and sealing of tissue. As general as this effect on tissue can be, its clinical applications — from cancer to cardiology, urology to ophthalmology and all manner of general surgical procedures — is as broad a therapeutic range as any medical technology on the market.

The technologies represented in clinical practice are, by type of energy:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

The MedMarket Diligence report #A145, “Ablation Technologies Worldwide Market, 2009-2019″, is considered the most comprehensive global report on the products, technologies, and the current and forecast global, regional and country-specific markets.  In this report, the market for the spectrum of ablation technologies has been analyzed, considering current and emerging products and companies, by modality (energy type) and country to 2019.

The dominant market is the U.S., representing a full 43% of the global market (and for this reason needs to be shown on a different y-axis scale than all other country markets for ablation) :

US_Ablation

Source: Report #A145.

 

Ablation technologies in cancer

Cancer represents a major target of the clinical applications of ablation technologies, as illustrated by the share of each modality’s 2011 revenues that are used in cancer:

Source: Report #A145, “Ablation Technologies Worldwide Market 2009-2019″, MedMarket Diligence, LLC.

Considering the utility of the different ablation types for treatment of cancer, it’s not surprising that radiation is the dominant source of ablation technology revenues for cancer in 2011.

Share of All Ablation Revenues in Cancer, by Modality, 2011

Source: Report #A145, “Ablation Technologies Worldwide Market 2009-2019″, MedMarket Diligence, LLC.

Ablation technologies global growth (electrical, radiation, light, RF, ultrasound, cryo, thermal, microwave, hydro)

The global market for ablation is in steady growth, but also is shifting in the balance of technologies employed.

The global market for energy-based ablation Devices in 2011 was estimated at almost $11.5 billion. For purposes of definition, ablation is considered to be a therapeutic destruction and sealing of tissue. The technologies that fall into this segment to nine different types based on the energy modality employed:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

Below is illustrated, first, the 2009 and 2019 revenues ($millions) for ablation by energy type and, second, the 2009 and 2019 revenues by energy type as a percent of total.

 

Source: MedMarket Diligence, LLC, Report #A145, "Ablation Technologies Worldwide Market, 2009-2019".

 

Although the applications of ablation devices include a number of aesthetic treatments, the majority of applications remain chronic disorders in areas which include cancer, cardiovascular, urology, gynecology and orthopedics. Many of these disorders are age-related, and the related device segments are driven by the aging of the global populations.  Other market drivers include the Chinese government’s push to modernize its healthcare facilities by building 400 hospitals per year, and developed country populations which are demanding anti-aging treatments, to which physicians are responding by purchasing equipment

Clinical trends and market growth in ablation technologies

The number and type of clinical applications for tissue ablation are proliferating almost as fast as the number and type of technologies and manufacturers.  These versatile technologies have clinically demonstrated ability to provide therapeutic destruction of tissue, excision of tissue, formation of therapeutic lesions and other therapeutic benefits across a wide range of clinical specialties.

Over the past decade, the application of ablation technologies has been propelled by clinical evidence, indeed.  The ability to precisely target malignant tissue (e.g., tumors, errant pathways in arrhythmia, fibroids, etc.) while producing minimal "collateral" tissue damage has validated many specific ablation modalities (e.g., laser, radiofrequency, microwave, cryo, etc.) for specific clinical applications. Those benefits notwithstanding, the growth of ablation technology in the medical device industry has been even further propelled by innovative manufacturers who have aligned their product development with the specific needs of clinicians and healthcare systems to produce instrumentation and equipment that facilitates the effective management of large patient caseload at reasonable cost and attractive clinical outcomes.

The future of ablation technology markets will be dictated by recent trends and the continued development of products that offer clinicians with effective tools in their armamentaria to manage growing patient populations in cost effective and clinically advantageous ways.

Below is illustrated the 2011 worldwide ablation technologies market and its forecast growth by modality type.

Source: MedMarket Diligence, LLC; Report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."