Defining Success in Appropriate Medical Design

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I tweeted this during a lecture from the wonderful Dr. Bob Malkin, who founded Engineering World Health and does some great research identifying actual barriers to use of medical equipment abroad (disclaimer: I may have taken that from his slides, I don’t remember). I’ve worked on a neonatal device that won some big design competitions, so this resonated strongly with me. It got a little bit of traction, so I’m guessing it struck a chord with a lot of other people in this niche, too.

Of his selection of the top 10 or so neonatal devices deliberately designed for resource-poor settings (hospitals with irregular electricity, for example, or clinics that are short-staffed), zero have African manufacturers or distributors. Zero have reached one million treated patients. All won major design competitions. These goals should not be outlandish – try getting VC funding for an app in the Valley without a million projected customers – but it’s been at least three or four years since this type of focused design for hospitals abroad became a Big Thing in university circles, and achieving those goals on this timeline would frankly be small potatoes in the private sector.

If you sit in on any business school competition, you’ll find a Saving Babies Device among the winners. A quick google search will come up with tens of biomedical competitions either specifically for low-resource settings or with a category for the arena. Don’t get me wrong, I’m glad to see the attention – even Y-Combinator opened to nonprofits recently*. But I think they tend to capitalize on the feel-good factor rather than on what can actually get to market.

It’s worth noting that I think the two companies that have gotten the closest to these goals (Embrace and Brilliance) do mimic private-sector distribution channels by selling equipment rather than donating and maintaining strong R&D teams. The less successful products either linger in university tech transfer offices or get shuttled into nonprofit models, where funding is frankly not sufficient to support health research. In fact, overhead costs for most life science companies can reach 50% – far beyond what most donors are willing to stomach. The perception of low overhead costs as the hallmark of a worthy philanthropic venture is beginning to change, but there’s no denying that the type of people capable of designing neat medical equipment have particular skills with a much higher market value than those of other nonprofit employees, and that lab costs are high for quality products. This shouldn’t even out anytime soon.

So, potential next steps:

1) Design competitions are nice but they need to come with more solid backing. Make prize money contingent upon licensing or formation of an LLC, or deliver it in stages based upon patients reached.

2) Focus more on designing efficient back-end systems that support local manufacturing (another gem suggestion from Dr. Malkin – mass paint systems! None in Afria). “Industrial engineering for the developing world” doesn’t sound sexy, but there would be a WHOLE lot of money there.

3) Continue the shift towards low-level prizes contingent upon iteration and scaling (the DIV model**, basically). I’m all for designers patting themselves on the back, but it’s most rewarding when in service of work milestones, anyway.

4) Do. Not. Donate. Devices. Don’t do it. I don’t care who you are or how much money you have or how good it makes you feel or how right you think it is. Donate money to the hospitals, sure, but don’t undermine the economic chain that leads to the creation of better technologies within this sphere.

*I think Watsi is really dumb though, but that’s a post for another time.

**Disclaimer, I intern for them

Defining Success in Appropriate Medical Design