Medical Technologies Not Always Perfect but Always Getting BetterÂ
There is an inherent nature to medical technologies, as weâ€™ve discussed before, that distinguishes them, sometimes negatively but (it seems) more often positively, and that is that medical technologies are fundamentally focused on symptoms. While this blunt targeting of the manifestation of a disease or disorder rather than its root cause is precisely what drives the biotech arena to conversely pursue, at great expense, solutions to the causes of diseases/disorders, the medical technology industry relentlessly addresses symptoms, becoming more and more thorough and perhaps taking a bit of the steam out of the ideal-but-often-unattainable goals of biotech.
Cases in point:
â€¢ At the 74th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), Dr. Daniel J. Berry, professor and chairman of Orthopedics at the Mayo Clinic in Rochester, MN, reported on the use of image-guidance technologies to produce near-perfect alignment of knee implants. Conventional knee implants require the insertion of an intramedullary rod in the length of the femur to ensure implant alignment, which carries risk, morbidity and expense. As Dr. Berry reported, the use of image guidance in total knee arthroplasty (300,000 knee replacements are done annually in the U.S.) not only obviated the need for intramedullary rod insertion but also enabled smaller incisions and resulted in the same or even better outcomes. The use of image-guidance to enhance the performance of medical/surgical procedures has widespread potential, increasing accuracy and reducing associated trauma and complications.
â€¢ We note the development this month (in â€œEarly Stage Companiesâ€) by Crux Biomedical in the low-profile, self-centering inferior vena cava filter, which dramatically reduces the capture and retrieval times compared to alternative vena cava filters. It is a rare merger of technical innovation and clinical expertise that has enabled innovators like Dr. Thomas Fogarty to envision and implement medtech solutions to clinical problems.
â€¢ We also note this month in â€œEarly Stage Companiesâ€ the clinical trial enrollment for Tryton Medicalâ€™s Side-branch Stent for the treatment of bifurcated lesions in coronary artery disease. In the event that the biotech industry is one day able to introduce a perfect atherosclerosis-eliminating compound, the development of different types of coronary stents will become irrelevant, but for now, medtech continues to add to patients for whom life-saving treatments are possible. It is perhaps to medtechâ€™s advantage that sometimes there are more symptoms than there are diseases, with there being little actual difference in atherosclerosis of single versus multiple versus bifurcated lesions, but each represents medtech opportunity.
â€¢ Researchers at Washington University School of Medicine have developed a device to shorten and simplify the Cox-Maze procedure in which electrical signals in the heart are re-routed for patients with atrial fibrillation (AF). The researchers, supported by both Medtronic and AtriCure, demonstrated that in the new version of the procedure, called Cox-Maze IV, the use of radiofrequency ablation can create lines of ablation, or scar tissue, on the heart muscle that will channel the electrical flow in treatment of AF, whereas in Cox-Maze III procedures, the ablation was produced by making incisions in the heart muscle that were then sutured to result in the desired scar tissue. While this innovation does not even change the fundamental nature of the outcomeâ€”the blockage of aberrant electrical conductivity in AFâ€”the application of RF ablation to Cox-Maze reduces potential complication (e.g., bleeding), simplifies and shortens the procedure (increasing the number of surgeons willing to perform it) and increases access of the procedure to AF patients.
There is no question that addressing a diseaseâ€™s cause is better in principle than treating merely its symptoms. Biotechnology aspires to such â€œperfectâ€ solutions. But the advantage of many medical technologies is that they are indeed not perfect, and are therefore capable of an almost steady stream of improvement. One need not recommend to the medtech manufacturer that product line extensions, R&D focus on improving outcomes, minimizing trauma or other improvements achieved through continued development are near-endless sources of opportunity.
AtriCure (Cincinnati, OH; http://atricure.com)
Crux Biomedical (Portola Valley, CA; http://cruxbiomedical.com)
Medtronic (Minneapolis, MN; http://medtronic.com)
Tryton Medical (Newton, MA; http://trytonmedical.com)
From February 2007 MedMarkets.