Not many outside the medical industry know this, but pediatric surgeons didn’t have their own surgical organization or specialty training requirements until the early 1970s. More, there are still alarmingly few pediatric surgeons practicing today. In 2006, the American College of Surgeons estimated there were 2,474 in the U.S., or one pediatric generalist surgeon for every 108,305 children.
Aside from a ratio that would terrify many more parents were they aware of it, that kind of imbalance means a couple of things. First, because pediatric surgeons often perform between 100 and 200 different types of operations every year on children ages 18 and under, they tend to have competency in many things. In fact, their contributions to the medical field would appear to exceed their numbers. Judah Folkman, for example, who became surgeon in chief at Children’s Hospital Boston in the late ‘60s, is credited with the idea that tumors can be kept in check by choking off the blood they need to thrive. Lucian Leape, who today teaches at the Harvard School of Public Health, is considered the father of the modern patient safety movement.
Pediatric surgeons also don’t get much love from medical equipment companies. “The market is too small,” explains Hanmin Lee, director of the UCSF Fetal Treatment Center and surgeon in chief of UCSF Benioff Children’s Hospital. Device makers aren’t willing produce a “narrow set of tools for a narrow set of indications,” he says.
So what are savvy pediatric surgeons stuck with ill-suited tools to do? In the case of Lee and his colleagues at UCSF, they’ve begun designing new equipment themselves. “When you take a very small field and very capable people who often have to be thinking outside the box, it encourages a very creative way of thinking,” says Lee.
One innovation to come out a device group that Lee has developed with fellow pediatric surgeon Michael Harrison are magnets that can be used in different ways, including to lengthen the bony tissue in children who need longer bones. Harrison has also created a system wherein the magnets, combined with an external brace, can gradually correct a common deformity of the chest wall called sunken chest, which affects about one in 500 people. (Previously, doctors relied exclusively on two types of major – and painful — surgical procedures that required long hospital stays to address the condition.)
The same UCSF group is developing a simple new catheter that better drains bladders. It’s begun employing sensors that help reduce and eliminate pressure ulcers, which appear in the back of the head and heels and along the sacrum when a patient has been by lying supine for long periods. And it’s at work on an implantable artificial kidney for dialysis patients. The project, led by bioengineer Shuvo Roy, now involves 40 researchers in 9 laboratories around the country and was recently welcomed into a new FDA regulatory approval program that aims to bring medical devices to patients faster.
Lee thinks his group is merely scratching the surface, though — that the biggest opportunity in medical devices today centers not on $5 million robot nursemaids but “simplistic design improvements to safety and quality.” And he wants to greatly expand what his group is doing toward that end, in a “sophisticated medical center or university setting with high-level people, rapid prototyping, and input from everybody from doctors to nurses to physical therapists to social scientists.”
Lee believes that there’s money to be made by investors, too, despite their apparent reticence to fund nascent medical device companies right now.
He points to the legislation that President Bush signed in 2006 that now prevents Medicaid from paying for certain preventable complications known as “never events” and that has since pressured hospital systems to offer better healthcare at lower costs. “Universities didn’t pay attention to it initially, because it’s not the kind of thing that gets funding from the [National Institutes of Health],” but that’s changing says Lee.
So is the interest by universities, including UCSF, in “making things commercially tenable,” Lee adds, explaining that though his team’s intellectual property belongs to the university, it “doesn’t mean that we can’t also start businesses outside it” so long as both parties’ interests are aligned.
“If hospitals say, ‘We have to have this [new device]‘ and it’s better for patients, industry will follow,” says Lee.
“It’s not rocket science,” he insists. “You see things get popular. And I see the bandwagon starting to fill up.”