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Stanford-India Biodesign co-founder: “You can become a millionaire, but also make a difference”

Stanford-India Biodesign co-founder: "You can become a millionaire, but also make a difference"

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

4499846308_9f084d26f0_zThe three Indian biodesign fellows who were at Stanford for the past six months have returned to New Delhi, where they’ll finish up their fellowship. They’re the last class of fellows from the Stanford-India Biodesign program, and in India they’ll be joining two teams already in progress as part of the new School of International Biodesign (SIB).

Balram Bhargava, MD, executive director of Stanford-India Biodesign (India), was at Stanford for the fellow’s final presentation of their prototype. He helped establish the relationship between Stanford and India and is now revamping the new self-sufficient program.

How did Stanford-India Biodesign originate?

I was at a retirement party in September 2006 for Ulrich Sigwart, MD, who developed the first stent. He called in some friends from all over the world, including Paul Yock, MD (director of the Stanford Biodesign Program). Paul and I shared a taxi ride to Ulrich’s vacation home and got talking. That’s when the program started. By January 2008 the first batch of fellows was here.

The basic intent was to start this innovative program in India and ultimately make it self-sufficient. We selected students from India and sent them to Stanford, then they finished out their fellowship in India.

How has the program changed over the years?

Our early fellows returned from Stanford with high-end ideas such as robots. I had to pull them all down back to the ground. My role was to give this program a soul, and I think I have been successful at that. After a few years Stanford also accepted that frugal design was the right thing for the world and I’m happy about that.

Many of our students had the intention of setting up a company and becoming millionaires. We’ve given them the idea that you can become a millionaire, but at the same time you can make a difference. That’s the delicate balance we want to teach. The students have been very bright and many of them have really delivered on this dream.

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Neuroscience, Research, Stanford News

Brain connections last as long as the memories they store, Stanford study shows

Brain connections last as long as the memories they store, Stanford study shows

6732863457_4175ebea30_zIf you find yourself forgetting information you have only your synapses to blame. These connections between neurons are what hold on to memories. When they break, there in a flash goes the name of that new coworker.

That’s been the theory for some time now, but Mark Schnitzer, PhD, who is a professor of biology and applied physics, has now shown it to be true. He was able to watch connections form and break in a region of the brain called the hippocampus, where memories are stored for about 30 days in the mice they worked with.

He and his collaborators found that the average synapse also lasts about 30 days in that region, suggesting that the synapse and the memory are related.

For a story I wrote about the work, Schnitzer told me, “Just because the community has had a longstanding idea, that doesn’t make it right.”

He said that his findings, which were published today in Nature, open up the field to investigating other aspects of memory including in stress or disease models.

Previously: Fly-snatching robot speeds biomedical research, Federal BRAIN Initiative funds go to create better sensors for recording the brain’s activityThe rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning and Individuals’ extraordinary talent to never forget could offer insights into memory
Image by Flood G

Bioengineering, Neuroscience, Stanford News, Technology

From brains to computers: How do we reverse-engineer the most mysterious organ?

From brains to computers: How do we reverse-engineer the most mysterious organ?

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So let’s say you want to make a piece of electronics that works just like the brain. Where would you start?

That’s the question neuroscientist Bill Newsome, PhD, director of the Stanford Neurosciences Institute, posed in a recent talk to a Worldview Stanford class on decision-making.

I thought the idea was so intriguing I wrote a series of stories about what it would take to reverse engineer the brain, and how close we are to succeeding at each. We’re still a ways from computers that mimic our own agile noggins, but a number of people are making progress in everything from figuring out where the brain’s wiring goes to creating computers that can learn.

These are the steps Newsome outlined to take us from our own grey goo to electronics with human-like capacities:

  1. Map the connections: Neuroscientists Karl Deisseroth, MD, PhD, and Brian Wandell, PhD, are mapping where the brain’s 100 billion neurons go.
  2. Monitor the signals: Biologist Mark Schnitzer, PhD, and bioengineer Michael Lin, MD, PhD, have created ways of watching signals in real time as they fire throughout the brain
  3. Manipulate the system: Neuroscientists Karl Deisseroth, MD, PhD, and Amit Etkin, MD, PhD, are working on techniques to manipulate the way the brain works and watch what happens.
  4. Develop a theory: Not only do we not know how the brain works, we don’t even really have a theory. Applied physicist Surya Ganguli, PhD, is working to change that.
  5. Digitize the circuits: If you want to turn the brain into electronics you need some wiring that mimics the brain. Bioengineer Kwabena Boahen has made just such a chip.
  6. Teach electronics to interact: Engineer Fei-Fei Li, PhD, has taught a computer to recognize images with almost human-like precision. This kind of ability will be needed by electronics of the future like self-driving cars or smarter robots.

Previously: Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more
Image, based on two Shutterstock images, by Eric Cheng

Cardiovascular Medicine, Stanford News, Technology

Stanford-India Biodesign fellows develop prototype device to improve success of pacemaker implants

Stanford-India Biodesign fellows develop prototype device to improve success of pacemaker implants

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

IMG_6136 560When the Indian biodesign fellows observed a pacemaker implantation earlier this year, the surgeon spent four hours trying to firmly insert wires from the pacemaker into the heart muscle. Even after a painstaking surgery, the wires fall out in about five percent of cases. That’s an expensive and risky problem.

The team’s solution, which was officially revealed at the biodesign symposium last week, is a device made of popsicle sticks and a spring that attaches to the long wire that screws into the heart. The spring records the amount of force a surgeon uses when screwing in the wire. If it records a higher force, that likely means the screw went firmly into the heart muscle. A lower force means it might not have inserted well and the surgeon should try again.

The team presented their prototype to an audience of faculty, the program’s alumni and local business leaders. Harsh Sheth, MD, said their inexpensive solution to a widespread problem met with good reviews. “We were strongly encouraged to continue developing this,” he said. The team needs to finish their fellowship, but they say they might return to the idea when they are done.

Sheth and his fellow teammates Shashi Ranjan, PhD, and Debayan Saha, all had prior experience in either surgery or engineering but had never been through a deliberative process that would result in a device that combines medical needs, engineering expertise and business sense.

They’ll take their newfound skills back to India, where they’ll start the process over in the second phase of their fellowship. Their departure marks the end of Indian biodesign fellows spending immersive time at Stanford. Ranjan told me that he’s glad he applied to the program when he did rather than waiting a year, when he would have done the entire program in India.

“Being at Stanford was an amazing experience,” he said. “We had access to Silicon Valley, business, technology. We don’t have anything like that [at home].” In the future, fellows might visit the U.S. or other partner countries for shorter stays, and Stanford fellows will have opportunities to learn about biodesign in India.

Previously: Success breeds success: Early innovators in India created a sense of possibilityA jugaad for keeping pacemakers in placThe next challenge for biodesign: constraining health-care costs and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India
Photo by Amy Adams

Bioengineering, Global Health, Stanford News, Technology

Success breeds success: Early innovators in India created a sense of possibility

Success breeds success: Early innovators in India created a sense of possibility

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

MATERNAL & INFANT MORTALITY IN DEVELOPING COUNTRIESAnurag Mairal, PhD, MBA, director of global exchange programs, joined Stanford-India Biodesign in 2008 to help fellows navigate challenges in designing new medical technology in India, which at the time had great need but little infrastructure for developing and marketing new technologies. I recently spoke with him about the program.

What were the challenges for Biodesign in India when you started?

When I joined Stanford-India Biodesign I felt it was going to be a difficult ride knowing India at that time. The mindset in India is very traditional and doesn’t allow people to step out of the box. Here in the United States what is remarkable is that we have everything across the street. Design, prototypes, animal labs, testing facilities, venture capital — they are all easily accessible. In India none of that existed. We needed to build all of that because it was going to be important to the success of Biodesign.

I had experience in emerging markets and was able to step in when the fellows needed to start thinking about markets for their products. I had a good understanding of the needs and also what challenges a typical medical device would face.

Have things changed?

One of the remarkable things that happened is that not only was the program successful, it affected other institutions in India in both the private sector and academia. A lot of innovators are now working on new technologies across India. Now we need to help all of them with commercializing the technology.

Success breeds success. When one group has success developing a medical technology it makes other people believe it is possible. That sense of possibility and reality has been a major accomplishment. The success of the early fellows and the ecosystem we built around them brought people together and energized the following batches of innovators. Now there is no doubt that medical device innovation is a real thing in India. It’s a remarkable shift in tone in that marketplace.

What is next for Stanford-India Biodesign now that fellows won’t be spending extensive time at Stanford?

Phase 1 of Stanford-India Biodesign was training fellows in the Biodesign process. Most of those previous fellows are in development mode now, and we see challenges in commercializing their products. I think there is a lot of work that needs to happen before these technologies are successful in the marketplace in India. Phase 2 will focus on training entrepreneurs and innovators on the entire process of developing and commercializing a product.

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Bioengineering, Cardiovascular Medicine, Stanford News, Surgery, Technology

A jugaad for keeping pacemakers in place

A jugaad for keeping pacemakers in place

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

IMG_6308After months of observing clinics and winnowing down the most pressing (and commercially viable) medical needs, the Stanford-India Biodesign team has developed what looks like nothing so much as a very elaborate clothespin. It is intended to help doctors ensure that coiled pacemaker leads that screw into heart tissue stay put. Currently, about five percent of those leads fall out, requiring costly additional surgery. Worldwide, the number of people whose leads fall out is estimated at 80,000 to 100,000.

Debayan Saha says their prototype is a perfect example of Indian Jugaad. It’s made of what looks like the contents of a scrap pile, and he says could both work and be cheap to produce in it’s current low-tech form. But just because it’s inexpensive doesn’t mean it’s not cleverly designed. That’s what the Indian team brings to Biodesign, he said – smart technology at low cost.

“Getting the prototype exactly right made use of all the resources we have here at Stanford,” Saha said. “But the final product is something we could produce at very low cost.” Creating technology in a developing country requires creative solutions to keep that technology affordable.

IMG_6326The group has a provisional patent on their device and they will present their it to the entire biodesign team June 8. Until that presentation they are keeping it’s exact function under wraps. They did recently test the prototype in a lamb heart, with good results. They were consistently able to screw the pacemaker lead more securely into the heart tissue.

Harsh Sheth, MD, said the team (which also includes Shashi Ranjan, PhD) will be heading back to India at the end of June and will repeat the same process there – visiting clinics, assessing needs, and prototyping a solution. He said they might later return to their Stanford prototype or keep working on whatever they design in India.

Previously: From popsicle sticks to improved medical careThe next challenge for biodesign: constraining health-care costs and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India
Photos, of Debayan Saha screwing a pacemaker lead into a lamb heart using their prototype, and of the coiled screw going into the heart, courtesy of Amy Adams

Bioengineering, Research, Science, Stanford News

Fly-snatching robot speeds biomedical research

Fly-snatching robot speeds biomedical research

The drosophila hangs unharmed lifted by the robot’s suction tube.

It looks like nothing so much as a miniature UFO hovering over a plate of unsuspecting flies. When it’s ready to strike, it flashes a brief infrared blast of light that reflects off the animals’ backs, indicating the location of each insect. Then, a tiny, narrow suction tube strikes an illuminated thorax, painlessly sucking onto the fly and carrying it away.

It’s not the greatest new gadget to rid your kitchen of unwelcome pests, it’s the latest biomedical research tool from applied physicist Mark Schnitzer, PhD.

The flies in question are commonly studied in biology labs as a proxy for our own harder-to-access cells and organs. As I wrote in a press release:

Although flies and humans have obvious differences, in many cases our cells and organs behave in similar ways and it is easier to study those processes in flies than in humans. The earliest information about how radiation causes gene mutations came from fruit flies, as did an understanding of our daily sleep/waking rhythms. And many of the molecules that are now famous for their roles in regulating how cells communicate were originally discovered by scientists hunched over microscope staring at the unmoving bodies of anesthetized flies.

Until now, scientists have had to anesthetize the flies and painstakingly assess them by microscope. The robot and its machine vision can assess physical features more quickly and in finer detail than lab personnel and can carry out behavioral studies of awake flies.

I spoke with Joan Savall, PhD, a visiting scientist from the Howard Hughes Medical Foundation, who led the development of the robot. He says it will speed research because the robot is both faster and less sleepy that your average graduate student, but what’s really cool is that it opens up entirely new areas of research.

“In the end you can really push many fields at the same time,” he told me.

Previously: Thoughts light up with new Stanford-designed tool for studying the brain and New tool for reading brain activity of mice could advance study of neurodegenerative diseases
Image by Linda Cicero

Bioengineering, Cardiovascular Medicine, Stanford News

From popsicle sticks to improved medical care

From popsicle sticks to improved medical care

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs

IMG_6141 300Shashi Ranjan, PhD, and Harsh Sheth, MD, fiddled with popsicle sticks and tiny wires in the final throes of prototyping possible biodesign solutions for two medical needs: fixing pacemaker leads or improving catheter urine drainage.

The popsicle stick device hardly looked like something that would inspire confidence in a person undergoing surgery, but if it worked and could be miniaturized and made out of more durable materials it could provide a solution for the pacemaker leads that are prone to coming unfixed after they are inserted.

The team had narrowed their search down from the 315 medical needs they had originally identified using a weighted matrix of requirements. Sheth told me that what stood out about addressing the final two needs was the large number of people who could benefit, lack of other solutions and lack of competing products.

All of those add up to a product that could inspire venture funding and eventual development, which is the goal of the biodesign process.

Sheth said the prototypes they were building now would help determine which of the two needs the group eventually chose to address, and how. They had four ideas to try out for the pacemaker leads and five ideas for improving urine drainage. “We’ll know which of these ideas have value after this step,” Sheth told me.

The group (which includes Debayan Saha, who was elsewhere during this prototyping session) returns to India after the Stanford phase of the fellowship ends in June. At that point they’ll repeat the process of identifying medical needs and prototyping solutions in India. Sheth and Ranjan said they hope to have patents in place for their Stanford prototype, with the idea of potentially returning to it after the fellowship.

Previously: The next challenge for biodesign: constraining health-care costsFollowing the heart and the mind in biodesign and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India

Ask Stanford Med, Bioengineering, Cardiovascular Medicine, Stanford News, Technology

The next challenge for biodesign: constraining health-care costs

The next challenge for biodesign: constraining health-care costs

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

5445002411_0f22229afd_z 300Founder and director of the Stanford Biodesign Program Paul Yock, MD, describes himself as a “gismologist.” His inventions include a balloon angioplasty system that is in widespread use and many other devices primarily related to ultrasound imaging of the vascular system. I recently spoke with him about the program he helped found, the iterative biodesign process, and the ongoing relationship with the Stanford-India Biodesign Program.

What’s next for the Stanford Biodesign Program?

We’ve been really pleased with the results of the Biodesign Program so far in terms of being able to take newcomers into the process, then repeatedly and reliably seeing good ideas coming out and seeing patients getting treated from those good ideas.

The challenge is that the world has changed profoundly since we founded this program. There’s no question that new technologies – despite being good for patients – contribute to escalation of health-care costs. We are in a phase of reinventing our process to take into account the fact that the sickest patient in the system is the system itself. We have to invent technologies that help constrain costs. We will need to modify the process of needs-finding not only to look for important clinical needs but important value needs as well. Inventors in general don’t like thinking about economics and so we have to not only figure out how to update the process but also figure out how to make it attractive for our fellows to learn and practice.

Could the India fellows help you incorporate affordability into the process?

One of the big reasons we decided to do the India program in the first place was to shock our system into thinking about really affordable technology innovation. It is remarkable how good our fellows from India are at thinking this way and how immersed they have been from an early age with value-based design and invention.

Affordability is very much a part of the Indian culture and technology innovation is clearly something that we are very good at here. I think we have only started to capitalize on the fusion of their culture and ours. I think there is a hybridization here that really is going to be cool. Our grand strategy is to have a number of different platforms – it could be companies, incubators, or other experiences – where our fellows can get a deep exposure in India. We aren’t fans of parachuting people in for two weeks to invent something good to give to India. What we really want to do is have trainees get a deep experience in what it’s like to invent and develop technologies in that setting to influence the way we invent here.

How did you arrive at the drawn out, iterative process the fellows use to identify medical needs they want to address?

There’s a long tradition of what is called user centered design that says if you want to design a product you need to talk to the user and understand what their needs are. That’s essentially where our process starts. What’s fundamentally different with health care is that there isn’t just one user. There’s this really complex network of stakeholders who influence whether a technology will actually make it into patient care. You can’t just design for the patient because there are also the doctors, nurses, hospitals, insurance companies, regulatory agencies and financers to name a few. To make it all still more complex, this whole system is in tremendous flux because of health-care reform.

So what we’ve done is blow out the needs characterization stage to take all these stakeholders into account in a rigorous way, up front, before any inventing happens.  There’s also a bit of psychology at play here. In health care it is really easy to fall in love with the first need that comes your way. Looked at in isolation, pretty much any clinical need looks compelling. You need to put in a disciplined process, a semi-quantitative way of weighing one need against the other in order to make a good decision about which need to pursue. It is easier to get rid of the one you thought you loved if it really doesn’t meet the criteria you set out.

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Bioengineering, Cardiovascular Medicine, Stanford News, Technology

Defining a new way of thinking: Slower decisions could result in better medical devices

Defining a new way of thinking: Slower decisions could result in better medical devices

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

2331754875_e6a2a81429_zIt’s now early April – half way through the six-month fellowship – and the Stanford-India Biodesign fellows are still figuring out what medical need they’re going to address during their time at Stanford. On June 8 they’ll be revealing prototypes. For many past students in this program, those prototypes have gone on to launch successful companies.

That’s not to say that the fellows are slow, it’s just to say that the Biodesign process the fellows are learning takes time – more time than I, for one, had expected.

I asked the fellows if they thought they would be able to take this painstaking approach into the real world, where people make much faster and often less careful decisions when developing medical devices.

“We hope this will define a new way of thinking,” Debayan Saha, one of the fellows, told me. As a group they also said they were learning a lot about the value of slow decisions.

As an example, they pointed to one of the 35 medical needs still on the “maybe” list, down from more than 300 they had identified during clinical visits. This one had to do with measuring levels of molecules in the blood. At each step, they’d scored the medical needs on their list against a criterion, like the number of people it applied to or the cost of letting that need go untreated. That allowed them to strategically eliminate needs that seemed worth addressing at first blush, but that wouldn’t make business sense.

At each round, this one medical need scored near the top. It had been looking like a real contender for the one they might eventually chose to address.

Then came today, when the fellows were scoring whether other devices already address the need and the cost spent each year if the need wasn’t addressed. That gave them a sense of whether there was a market for any device they might develop. That need, which had seemed so strong, scored low, much to the team’s surprise.

“This had been a favorite but this is the first time we are seeing that it is maybe not a great need,” Shashi Ranjan, PhD, told me. Harsh Sheth, MD, emphasized that in other settings where people make much faster decisions they might have ended up wasting time prototyping a device that would never find a place in the market.

To my eye, this careful approach makes the final selection almost seem inevitable (though not obvious at the outset). The team knows the criteria they have to meet (good market size, few competing devices, no patents standing in the way of eventually marketing their device) and they have a list of options.

From there, it’s a matter of slowly assessing which option best fits the criteria, which seems like a lesson that goes well beyond designing medical devices: Choosing health insurance. Buying cars. They are learning a lesson in good decision-making along with how to develop and market devices.

Previously: Following the heart and the mind in biodesignWriting a “very specific sentence” is critical for good biodesign and Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India
Photo by John Morgan

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