How a shampoo bottle is saving young lives
Looking this up led me to Open Pediatrics, a lovely idea:
https://www.openpediatrics.org
A video going into more of the detail, on reflection the big idea seems to be the air pressure oscillations
Tangential, Openpediatrics seems like a great initiative, are there any other such resources for other medical fields?
There is the FOAM movement (Free and open acces meducation - https://lifeinthefastlane.com/foam/) but I bet there's many more out there.
It feels like there is some foundation for medicine to evolve like software evolved, where there is more and more open source knowledge to build upon, democratizing and lowering the cost of access to that knowledge.
It's not clear to me if he invented a new device, or simply built a 2$ home made version of a 6000$ standard bubble-CPAP. In other word, is this a story about ingenuity saving lives, or about regulation and industry profiting on medical devices killing lives?
(Note that I'm not saying that we necessarily have too much regulation or that medical industry profits too much; I'm just saying that in this specific case they would be failing to save people, while overall they could still be optimal)
I'd say it's about the value of low-cost alternatives from an industry (medical devices) that very often disregards cost entirely.
I understand the precision and expertise that goes into medical devices, and they've saved millions of lives (mine included) — but in countries where $6,000 means something might as well not exist, they need something in-between precision manufacturing or nothing at all.
I think the real story is that there is clearly a market need for a simpler and cheaper (if less effective) bubble CPAP, which will save many lives in countries that can't afford the $6K version. It wouldn't be used here in the US but it'd do a lot of good in Bangladesh.
I don't think it's a story of over-regulation, as I doubt Bangladesh has regulations in place only allowing the $6K version.
> I don't think it's a story of over-regulation, as I doubt Bangladesh has regulations in place only allowing the $6K version.
Well it still could be. It's not because there's no over regulation there that there's the expertise required to build and market an inexpensive CPAP machine there. As far as we know, as soon as they get the expertise, they could just move to another country and get a better wage in doing so.
I'm a software engineer and it's something that I think about. I'm only making 60k$ in Canada while the US the average is higher and in USD. I'm only 2 hours away in car from the US.
My guess: the hack one is less effective but in that area, a $6000 device might as well not exist, way out of reach for 99% of the people. So, maybe less effective in theory, but in reality it is saving countless lives.
It's true that some money goes to designers, lawyers etc etc but when they see an opening, they do rip people off.
Exactly, something that saves 95% of patients but is 0% affordable is worse than something that saves 50% of patients but is 100% affordable.
Accessibility broadens as waste is eliminated from the system. No other manner increases accessibility. Medical device manufacturers would prefer to make a device with less waste, they'd make more money (see empires built on low price commodities). Regulation unfortunately builds in tremendous waste and reduces accessibility. A waste reduction like this is an incredible achievement.
Medical device manufacturers would prefer to make a device with less waste, they'd make more money (see empires built on low price commodities).
This seems like an oversimplification. The people capturing those gains are very often not the manufacturers. Often it's the retailers, not the manufacturers, who build those empires.
Unless it's different specifically in the medical device industry; if so, do you have examples?
The medical device industry (at least in the US) is very special. It does not have retailers per se, but there are a lot of middlemen who take varying, often enormous cuts. Medical device manufacturers make enormous amounts of money though. I am not sure how much of this is specific to the internal US market vs. carries over to US exports.
For a good treatment of this and many other aspects of US healthcare costs, see An American Sickness by Elisabeth Rosenthal.
But are there examples of medical device manufacturers making a killing by selling low price commodities?
I suspect that the manufacturing costs for many medical devices are quite low, e.g. stints, but this is not public data to my knowledge. But the manufacturers make a killing because they charge a high price.
Of course the medical manufacturers do well, they're granted monopoly power from the government through the regulatory process.
> Ever heard of the concept of "jugaad"? It's a Hindi term meaning cheap innovation.
Let's use this word in English as well, as it allows to direct our attention to jugaad immediately.
Eh, I tend to translate jugaad to hack.
Well, a person who creates the jugaads is called "jugaadi". So, Jugaadi News.
I would definitely read that blog!
I find that "hack" is simply a sort of close approximation to "jugaad", though this may just be entirely through the cultural context where it's used.
They way English rifles through the pockets of other languages looking for vocabulary, just start using it and see if it sticks. :)
Many languages do this as far as I can tell. I speak Indonesian and my girlfriend speaks Hindi, we come across words the languages share every so often. I’ll also catch a word in Tagalog or Dutch that I understand in Indonesian from time to time too.
My partner is Hungarian and her language and mine (I'm English) share very few words, it's strange with most languages I hear from other Europeans I can at least get one or two words fairly often but Hungarian is just straight Klingon.
It's an interesting hidtory, it basically shares no (known) common roots like most languages around Europe do.
that's just not truth, they have pretty much same international words for paprika, balcony, auto etc.
> They way English rifles through the pockets of other languages looking for vocabulary, just start using it and see if it sticks. :) reply
I do this in my native language (Dutch) as well. My favorite one I came up with is "search term scavenger hunt" in Dutch it is one word as "zoekwoordspeurtocht".
What a nice story about keeping things simple.
Also, damn, neonatology must be brutal to work in at times.
Yes, I cannot imagine how people work in some of these fields. A lot of the pediatric specialization comes to mind also like oncology, cardiology. That some people can and do take the burden is the reason lots of those kids get to live.
I could never work in a vet office, obstetrics, neonates, or early paediatrics. I don't know how people do it.
I once asked the nurses in the intensive care ward, where my baby son was, why they didn't work with adults rather than children. Surely the heartbreak was hard to cope with? They said it was because children didn't know they were supposed to be ill so they didn't lie around moaning like adults did—as soon as they felt a little better they would jump up and go and play with their toys. It was much more satisfying having patients who (if they got better) you saw go from coma to running around again full of joy.
Management of and varying response to compassion fatigue.
There's a happy period where you're doing extremely fulfilling work, then a difficult time when you're distraught at your failures, then a complete indifference to suffering that you've normalized.
Managing fatigue and stress in any job is extremely important, managing compassion fatigue is even more so.
Like everything else, it’s a job that you must emotionally separate yourself from to do it good.
My mom worked in the neonatology ICU for years, and while every once in a while there was a tragedy which made her very upset, not many bad (and unexpected) things happen these says. It's a very rewarding job, as you help start a life.
Alas this can only be said about the first world. In less developed parts of our world this would be the complete opposite I imagine.
"His invention was inspired by something he saw while visiting Australia."
Exchange visits(+) a good use of money perhaps? - spark that innovation.
(+) not necessarily just to 1st world countries by the way
Of course! Free of people and ideas is a great benefit to each of us. Some folks give into resentment but most of that's caused by the central banks not actual immigration. It's caused by central banks bc they have kept the substitute for labor cheap. Low interest rates, as far as I can see, are one of the principal causes of populism. Populism is the premise most folks would use to argue against exchange visits.
it's not really innovation if he just copies something he saw abroad
i guess they could get inspired by military solutions in emergency situations which must be also hacked from what's available
>>The hospital now deploys it routinely and the number of children who die there from pneumonia has fallen by three-quarters. That means the survival rate in the Dhaka Hospital is today almost on a par with that of children treated in rich-world facilities, using conventional ventilators.
Innovation like this is facilitated by the lack of medical device regulations in Bangladesh.
I don’t think you deserve to be downvoted for this. A $5 hack is not really possible in the west, and that is definitely a thing worth thinking about.
You might not get stopped from doing it if it was immediately obvious that it was effective but eventually hundreds of thousands if not millions would be spent on studies or approvals before a “proper” device made its way into the supply chain at 10000x markup over injection moulding cost.
Also, is it really worth it to a doctor in the US? Even if I _know_ for a fact that it would work 100% absolutely the same as the multi-million dollar device, that's not the accepted procedure. I could still do it and save thousands of lives, but as soon as _anything_ goes wrong there's going to be a lawsuit and the fact that I used this crappy looking $5 thing is going to be a huge part of it, even if it had absolutely nothing to do with the death.
Even if your motives were good, you were arguably doing what is best for society, and the device had nothing at all to do with the situation your career is over... Who in their right mind is ever going to do that?
If the doctor was doing good work, they should have no issue defending the work in a civil trial. Of course that's costly, but then again we have given a state-granted monopoly to lawyers: private bar associations that grant access to courts.
Well in an ideal world, sure.
Waiting five years for it to go to any kind of trial and then potentially being found guilty anyway because the jury sees an evil insurance corporation and an evil for-profit corporation and an evil, manipulative doctor trying to further his own career...
You’re going to lose anyway, and in the intervening 5 years you’re unemployable... and no matter how the trial turns out you’re also unemployable. That’s a lose-lose, and that’s why they always settle.
This hack isn't necessary in the US because the hospitals can afford (and already have) the proper bubble CPAP devices, which are more effective than hacked-together shampoo bottles anyway.
It's a good thing there's regulations in place here preventing the use of less effective hacks when better devices exist. And yeah, it's not just regulation but also legal liability that comes into play here; in the long run it's more expensive to use cheap hacks and risk many-million-dollar lawsuits if they kill someone than to pony up the thousands of dollars for the correct equipment.
>This hack isn't necessary in the US because the hospitals can afford (and already have) the proper bubble CPAP devices, which are more effective than hacked-together shampoo bottles anyway.
They can only afford it because we spend such an absurd amount of money on healthcare.
In this case it’s arguably one of those “well, it’s worth it” scenarios because there is evidence that the expensive version is better than the cheap version (though arguably perhaps not better enough to justify the cost).
The situation gets turned on it’s head when it’s an experimental procedure, though. “Insurance wouldn’t pay for x because it was experimental!” is an all too frequent complaint (it’s even the entire catalyst for the show Leverage).
Well, why do you think they don’t pay for it? Not only is it always insanely expensive, but it’s also got a 40% chance of success according to the doctor who wants to perform it (who is incentivized to keep his stats up) and it’s not endorsed by anyone... and that is a huge liability.
So I suppose my point here is that, for the armchair physicians online, every chance there is to save $1k there’s a chance to spend $100k. If you remove regulation you’re not just accomplishing savings on one thing, you’re opening up a pandora’s box of expense on another.
No, it can be afforded because a multi-use $6k device is well worth it if it can help save infants' lives.
I don't understand your argument at all. Of course it's worth it that this device exists. It works. And it only exists because we've spent money on development and acquisition. This is exactly when higher spending on healthcare is beneficial. Contrast with Bangladesh, where they can't afford these devices and as a consequence many more infants die (or they have to hack together inferior replacements from shampoo bottles that don't work as well).
My argument is that if this device could be produced and work using a shampoo bottle then it can be produced for less than $6000 and still be as effective. The problem of course is all of the hoops that need to be jumped over to get approval for even the simplest devices.
The challenge is that without regulation you get $5 life-saving shampoo hacks, but you also get lots of shake oil that is useless or harmful.
And with regulation you get...lots of snake oil this is useless to harmful. Prozac, Phenfen, etc. Even device and equipment makers like Theranos.
You also get Pharma-Bro types selling medication WHO considers "essential" for 750 dollars a pill. Only the one company has(had) the regulatory approval to make a drug so basic Aussie school kids can make in chem class[0].
[0] https://qz.com/851416/why-martin-shkreli-and-turings-darapri...
Yep, or extra deaths like Vioxx: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779871/
Or, take high insulin prices caused by a government-granted oligopoly from the FDA. The FDA maintains high barriers to entry. We all suffer from artificially high prices and reduced access.
Actually a doctor could probably do this in the us too. Weird stuff gets rigged up all the time, it’s just not as common as elsewhere because bugbhospitals have a ton of random stuff in inventory and cost is not constrained.
Also physicians can file INDs with much less paperwork than a company could. But it’s nonzero, so doesn’t happen all that often.
US doctors would lose their license, savings and home. As soon as a child dies--bound to happen--they'll look for a reason to sue. I guess a US doctor might do a hack like this and called a hero, if the child was born in an airplane or cave somewhere and had no access to a hospital.
Have you ever been in a US emergency room, especially a rural one? The regulations are stiff, but not necessarily rigid, as the law is not a theorem-proving system.
Disclaimer: I am not an MD, but I used to work in drug and medical device development, where the regs did have to be followed strictly to the letter, and became quite familiar with where flexibility was and was not).
(And I meant IDE -- device exemption -- not IND, which is a drug exemption).
More like it was facilitated by the need.
Had they had as low fatality rate as developed countries, I doubt weak regulation would have spurred innovation.
Which is supported by the fact that fatality rates now almost match developed countries. If it was the weak regulation that spurred innovation, the rate should continue to fall.
Relatively weaker regulation (coupled with need!) allowed a doctor to deploy an unapproved pediatric device. You might get away with this once or twice but if you were a company making this thing in the west you would get rightfully sued into a smoking crater.
I think the fallacy in your reasoning is to assume that innovation is “proportional” to death rate somehow. Doing it cheaper (or even at all!) under the constraints you have is still innovation. Put another way I think we have different definitions of innovation. The way I think of it, equivalent outcome for way less cost still counts.
More likely it is facilitated by the cheapness of labor in Bangladesh. Bubble CPAP takes a lot of work to get set up correctly. In rich countries, it's not worth it to use a cheaper device if it takes more labor to get it to work. In Bangladesh, where labor is a tenth of the price, it is worth it.
Outlined: https://outline.com/Yb8sLG
Didn't News Genius run into trouble by copying articles for annotation like this?
https://glog.glennf.com/blog/2016/3/25/citation-appropriatio...
For sure they're going to go down in flames at some point. Enjoy the free mirrors while they still work though.
Thanks for this.
This reminds me of the $0.68 microscope: https://www.youtube.com/watch?v=Qf-D1Upn-KU. I love how a slight change in perspective can result in such drastic applications of the same idea.
Blessed be this man and his inspiration that is now saving many lives. Seeing that little child entubed like that is so heartbreaking. I wonder why he can make a device with a plastic bottle and a similar device costs thousands of dollars more.
One reason is regulation. Regulation builds waste into the price and reduces accessibility: https://news.ycombinator.com/item?id=18733284
I tried to find out the name of the manufacturer of the low-flow oxygen delivery approach recommended by WHO, but couldn't. Anybody else able to figure it out?
There is no manufacturer because there is no equipment needed for low flow oxygen, beyond an oxygen supply (from gas bottle) and a tube with two nozzles that go into the patient's nostrils.
That's why WHO recommends it to hospitals who can't afford anything else.
Why do I read this headline to myself in Adam Sandler's voice???
Saving lives at a medium pace...
The Economist article is paywalled for me, but BBC news has a piece at https://www.bbc.co.uk/news/business-40498395 that describes the shampoo bottle hack.
The BBC article also has a video that shows how the device works.
Adding it to Pocket, then lets you read it.
You can use a private window too.
Disable JavaScript. Without JavaScript, no paywall pops up on The Economist.
Honestly the amount of screen space the economist takes away is ridicolous.
(Yes I have an adblocker installed)
I find it slightly ironic that when I view that imgur image to see how much screen the economist takes away, ~30% of the window is obscured by a cookie warning and the content is dimmed.
Not a critique of the thecatspaw.
Interesting, I dont see those, even in private browsing with my adblocker disabled
Did you make it worse on purpose by clicking the little "up" arrow that opens the bottom panel? (on my computer, it's collapsed - but I don't know whether it's the default setting or it was remembered from a previous visit).
Though I agree the cookie banner + "free special report" popup + the bottom subscription banner takes an absurd amount of space.
Not to mention these "please subscribe" and "you have no free articles left" popovers and alerts. Whats even worse is that Google News now includes paywalled publications with these spammy dark patterns. I don't mind paying for Quanta or Nautilus and other high quality publications. But sorry [Generic Copypasta News.] Most of the time all you do is copy the PR off Associated Press - I am not going to pay for freely available current events or your shitty OP-eds.
This is The Economist. I doubt they use any AP material. They also get nearly all their revenue from subscriptionz, not ads.
The Economist should be held up as the pinnacle of quality writing worth paying for. Very few ads (maybe a full pager for lear jets and some classifieds). It may cover some of the same current events as AP or other news services, but their content isn't available anywhere else.