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THE NEXT LIST
Spotlighting Medical Devices Made by Jose Gomez Marquez
Aired April 1, 2012 - 14:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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JOSE GOMEZ MARQUEZ, LITTLE DEVICES LAB, MIT: My name is Jose Gomez Marquez and I use toys to make affordable medical devices.
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DR. SANJAY GUPTA, CNN ANCHOR: Jose Gomez Marquez believes that everyone deserves proper medical care, no matter where they live -- in developing countries and right here in the United States.
You know, as the debate rages on here in the United States, Jose is tackling the problem of affordable health care in his own way by making medical devices out of toys.
With his do-it-yourself medical kits, he's teaching doctors around the world to open up, take apart, and repurpose or hack these toys to save lives. I'm Dr. Sanjay Gupta and this is THE NEXT LIST."
GUPTA: So where are we?
MARQUEZ: You're at the little devices lab at MIT. We're part of the Innovations International Health Group.
GUPTA: You know, when you think of innovations and international health, you expect to see some gleaming laboratory with the latest and greatest things, but sometimes you need easier products to start with.
MARQUEZ: A lot of doctors can heal in sometimes very fundamental ways, so sometimes it's just the little devices that get in the way that they don't have. And we try to provide those whether it's an IV alarm or a foot-powered nebulizer, just simple things.
It's probably not going to get us anytime soon, but that doesn't matter. Our customer at the end of the day is that lonely doctor or nurse in the middle of nowhere or in an overcrowded hospital in a developing world city.
Some of the challenges that they'll face are a cauterizing pen that would allow you to do surgery will short out and not work anymore. A light bulb from the surgical ward will blow out after seven years of faithful service without a replacement part nearby. And nobody's paying attention to them in terms of a design focus. That's what we try to do. GUPTA: I didn't expect to see these when I came to this lab. Why is this important?
MARQUEZ: So these are toys. I actually played with these when I was a little kid. Toys have a great supply chain. You can find these things pretty much anywhere in the world even if they're knockoffs.
We may take a toy helicopter and harvest a pinion mechanism from it. We can take an interactive toy that will have an alarm and make an IV sounding buzzer. So that a nurse can come back and check on patients not every 5 minutes, but only when that IV is actually becoming empty.
We took some nurses to a toy store and we said, OK, what do we want to build? And they picked out an AK-47 toy gun and they say, we want to build an alarm. We help them a little bit. You know, the first time they take something apart that has electronics and we show them, here's the switch, here's the buzzer, here's the lights.
We have this very simple mechanism. It would have a spring. When the spring passes through a certain switch, this is a prototype level. It would trip the wire and activate the little alarm. It may not be that melody, but it could be something else.
But in the absence of them not knowing electrical engineering, mechanical engineering, fundamentals of product design, they don't know how to do any of that. What we try to build are devices that can bridge that gap. They can put together a toy.
I don't think I can go by a toy store unless I'm in a real rush and not go in. These are amazing, little LEDs for your fingers. I'm not exactly sure what to do with this, but I'm sure we can find an interesting idea.
I'll go into toy store and I'll start to look at the subcomponents of toys. We're always looking at the coupling points. How do thinks connect? What are the easy mechanisms I can harvest? For five bucks, you get four little LEDs that already have the clip on and everything.
People already did the engineering here for us. They just didn't know what they were using it for. When you look at a toy today, you're actually looking at an engineered part. It's not the cheap injection- molded plastic of 20 years ago.
There are mechanical bits and pieces. There are electronic bits and pieces. Sometimes there's even chemistry you can harvest from the toys. What are these?
UNIDENTIFIED FEMALE: It's called "Nano blocks" and it's kind of like sly putty. It changes color in your hand.
MARQUEZ: There are some mechanisms in toys that are just too clear and just a really good idea that we'll get them just as inspiration to do something with them later on. I haven't seen these for years.
I didn't even know what these are called. I grew up with these in Honduras. What I would do is take something like this or even something like this and make a cheap metronome so that people would know the pace at which they're pumping.
You know, just one, two, three, or even do something like this, which is kind of a funny sound. But it would work, because it's very, very delicate, very delicate.
When you're using toys, it demystifies the process of medical technology. Often we look at these medical devices and we think that they're a black box that you cannot go and you cannot crack open and you need an expert to even take a screwdriver at it.
And you may not have the courage to hack a $1,000 device, but you definitely have the courage to hack something that's $5 and then if you add a little bit of ingenuity, it becomes something as powerful as that $1,000 medical device, seven bucks.
I would probably use this for an agricultural prosthetic. Knowing that I can wake up and legitimately go to a toy store and buy anything I want for research and then go and take it apart is like being a little kid again.
More importantly, even if we work on boring devices, sometimes we have to work on boring devices that still have a lot of relevance and use in a developing country. And when we get pictures of patients using our devices, it's the best feeling in the world.
I want to create the equivalent of what Legos is today for toys, with I want to do that for medical technologies.
MARQUEZ: We invent every day at the Little Devices Group at MIT. That's where we focus on the DIY experimentation for medical devices. And that's where the medi-kits came out of.
We have right now five different medi-kits. A medi-kit is essentially a collection of Lego-like construction blocks. But instead of coming up with a car, a house, or a doll, you come up with a medical device.
So it's erector sets for medical technologies. And what you would find is a lot of components you might recognize in a doctor's office are going to be accompanied with other components that allow you to modify that core technology.
At the simplest level, we make parts so that anybody can make their own medical technology, particularly health care professionals anywhere in the world.
GUPTA: So this is what one of the kits would look like?
MARQUEZ: We said, why don't we use Legos as a way of using a scientific breadboard, basically, to make our own chips? So each one of these components locks on to a Lego piece and inside is a single feature of a microfluidic circuit. You put each feature together however you would based on what you need.
GUPTA: People need to test blood for all sorts of different things. This is what -- this is a crucial ingredient is to that.
GUPTA: So if you have this sort of kit, you can offer blood testing all over the world, in places where they typically couldn't do it.
GUPTA: Cholesterol, heart disease, diabetes, the biggest killers, really. So when you look at something like this, again, a technology that cost $500,000.
MARQUEZ: And very good technology.
GUPTA: These are Legos that you've made yourselves with kids' toys, essentially. How much does a kit like this cost, just for sake of comparison?
MARQUEZ: So the microfluidics kit, once you kick in the reagents that's about $150.
GUPTA: A lot cheaper.
GUPTA: Is this being used already around the world?
MARQUEZ: In Nicaragua. That was our first deployment.
GUPTA: What's been the response?
MARQUEZ: People like it. People, you know, they call call us and say, we want to put microscopes, so we found these little microscopes that you can get in China for about five bucks. And we said, can we put a microscope in there and put a mobile phone on top of that.
MARQUEZ: And you know we see them struggling in the same way that our students would struggle through a prototype, but what's important is that they're trying. So we try to go back there as often as we can and help and encourage them to continue to do that.
We're encouraging inventors. We believe that invention can and will happen in the developing world and can and will happen in our backyard in America. Invention still matters.
We like to say that a lot, because what people often miss is that they focus too much on bridging gaps in access to health care technologies. There's a fantastic story where somebody donated $25,000 color ultrasound machine and the local maintenance technicians tried to tune into the world cup on it, given that it had a color monitor. And within five hours, they rendered that machine useless. So in our lab, we would have done two things. We would have added a socket, so you could put the UHF antenna and tune in, or added an alarm to that other socket saying, if you pull this cable, you are going to ruin me, so don't.
GUPTA: So if I understand this correctly, I mean, you're thinking processes, you're trying to determine what the need is, first of all.
MARQUEZ: Of course.
GUPTA: And then create a supply chain that is something that people can find, wherever they are, toys, for example.
MARQUEZ: We create an enabling technology. It can use toys. Sometimes it can use other parts. But more importantly, it has to be sustainable at the local level.
GUPTA: They can build it and fix it themselves.
MARQUEZ: And modify it and make a better one.
I want to create the equivalent of what Lego is today for toys. I want to have not just the medi-kits, but the movement of democratized innovation in health care.
I want to do that for medical technologies. It's a little renegade, but we've learned that if you don't make somebody uncomfortable in what you're doing, it's probably not that innovative to begin with.
Most of the doctors were ready to just give up on me, and they even bought a coffin.
MARQUEZ: So this is a typical nebulizer. Most people, we tell down to wherever and they tell us, please fix the nebulizer, it's broken.
And they point at this device, and this device is about an $80 device. And it basically does this, it just produces a very small amount of small-sized particles that you can inhale, such as albuterol the --
GUPTA: Somebody who has asthma, lung disease.
MARQUEZ: Pneumonia, sometimes they use it. Lots of different indications, well, what we recognized is we tell them, you know, when you say the nebulizer, don't point at this. This is just a compressor.
At the end of the day, the magic happens in this device. This is a very simple device, this is two bucks. You can get them locally. So we showed them how to connect this one to a simple bicycle pump. Nothing changes. Just your air source. This is a ubiquitous air source, made in China, $5, bought locally in country and so then it does the exact same thing.
GUPTA: That's great.
MARQUEZ: So no electricity, it's cheap, and that patient could practically have one at home instead of having to run down to the hospital.
GUPTA: How big a difference does this make?
MARQUEZ: My grandfather died of an asthma attack, and he was a block from the hospital. For somebody who has an asthma attack and they don't have the Advair inhalers, it's a lifesaver.
I was born in Honduras. I was born a few weeks premature. The doctor thought that my mom is going to have twins and so they induced labor and without the aid of an ultrasound, even if it was the mid-1970s, I was born not ready to be born with some serious health conditions.
GUPTA: You were born very prematurely.
MARQUEZ: Yes, I was born between seven and eight months. Most of the doctors were ready to give up on me. They even bought a coffin and had a death certificate signed. And my mom kept on believing, but for the longest time, the odds were against me surviving.
GUPTA: You had your own personal experience of being in hospitals a lot. Was there a point in your life where you said, look, there's got to be an easier way to get people the supplies they need, because it's not working for everybody around the world right now.
MARQUEZ: I think having substantial medical intervention when you're that little gives you a very real understanding of what a doctor does.
As soon as I learned to drive, my mom would call me every other month to go pick up little kids that had an asthma attack that needed nebulisation because they didn't have one at home. So that was very real experience as a 16, 15 year old.
GUPTA: Do you have any medical background yourself?
MARQUEZ: Not at all. My family was all doctors. My grandfather was a doctor from Spain and my uncles are doctors so I grew up understanding medicine.
I had a very unorthodox way of getting to where I am. My original background started in mechanical engineering. Then I moved very quickly to policy. Well, I came to MIT almost by accident for a design competition.
We worked on a device for inhalable vaccines, a precursor of the foot- powered nebulizer and entered into something called the ideas competition. We won. I wasn't even going to MIT at the time. And then when we entered the next year with another device and we won again, and then we won again. So I kept coming to the institute to work on these projects, but as a freelancer, basically.
I had a day job doing really boring work in the city and having to support myself and coming in at 7:00, rolling up my sleeves, sometimes in a suit and sneaking into the basement of certain labs and using their laser cutters, I started to just learn how to assemble design teams and put together different devices.
So in a sense, I'm a product of my own philosophy. I just learned on the job. After a while, somebody in charge of international development at MIT called and said, you know, we have this new global health group that we want to launch.
They said, do you just want to run this and head this? And I said, absolutely and I've been here ever since. We went sledding afterwards. It was an amazing day.
We get people in the lab who give us a pat on our back and say, instead of using a toy, why don't you use a real engineering instrument?
MARQUEZ: I think we definitely get scoffed at if we're not running that rat race of ivory tower academia. We get people in the lab who give us a pat on the back and say, you know, this is great, but this is not real research.
Or they'll say, instead of using a toy, why don't you use a real engineering instrument, that way you can get real results and publish it? I'm not on the tenure track for professorship or anything that sorts, I'm actually ranked really low in terms of the totem pole in a traditional university.
We're at the MGH Center for Global Health at the Technology Innovation Laboratory. We are definitely in the middle of an Ivy Tower. Really old-fashioned, but what we found is this bootstrapy group of scientists and doctors who are renegades.
That are definitely a niche within that institution. They get what we do, and we learn a lot from them, because at the end of the day, they're the ones that treat patients. So we like to work with these guys.
UNIDENTIFIED MALE: Will I be taking this actual device with me on Wednesday?
UNIDENTIFIED FEMALE: Yes, that's the plan.
MARQUEZ: That's the plan. This is a start-up lab. We often call it a pop-up lab. The new emerging lab is exciting. Because what's happening is we are already launching several devices. We're working on a refrigerator for tuberculosis patients powered by a solar cell, so they can keep their pills cool.
UNIDENTIFIED MALE: If this is in their own home, whenever they get their medicine, they put it into the cool box. My name is Chris Olson. I'm the director of technology innovation at the Massachusetts Center for Global Health. I'm a clinician in the hospital and I work in Ethiopia and Uganda.
MARQUEZ: So Dr. Chris Olson was somebody I met at a conference once. He's the type of technologist that can put together incubator out of car parts.
UNIDENTIFIED MALE: Am I taking one or two?
UNIDENTIFIED FEMALE: Hopefully two.
UNIDENTIFIED MALE: Great. Great. What we're doing today is talking about how we solve problems to deliver health care to the world's most vulnerable people.
MARQUEZ: Maybe at this stage, just getting a little bit more conservative and not doing 30 at a time, but maybe doing 15.
UNIDENTIFIED MALE: So Jose is an integral part of what we're all trying to do together. Because then we have to cool a much smaller space. There's not one single entity that is taking an idea and then going to prototype and really working with end users and making sure it's the right device.
MARQUEZ: Chris is great because in the same way that I'm no longer afford to ask dumb questions about medicine. He's no longer afraid to ask silly questions about engineering and design. So in that back and forth, we often come up with really good ideas.
UNIDENTIFIED FEMALE: And the guys already have all of the sensors to install over there.
Working with Jose, it's an adventure, every day. Whether we're in the lab, build, prototyping, you know, 10:00 at night, laser cutting sessions, or, you know, hijacking an emergency room ward at a hospital in Nicaragua. The sky's the limit in terms of what we can build and the types of challenges we can work with on.
MARQUEZ: I think I spend about a third of the year in the field. If we can't go there, we Skype, we do a lot of online communication. We pick up the phone and text them.
We are at the beginning of learning what are the limits and possibilities of using medi-kits for health care innovation. America's health care problem is becoming much, much more expensive lately. Affordability is now very closely linked to quality when we have a discussion about health care in America. And if we can distribute that ability to innovate to everyday doctors in that rural place in Kansas or Michigan or Appalachia, that will have implications in our local health care.
The DIY movement and the you not to make things accessible based on what we identify are enabling technologies, 3-D printers, laser cutters, with 3-D scanners, microprocessors that we weren't even talking about five years ago, have the ability to impact health care in a way that we've never explored before, because we always felt we didn't have permission.
And I think we probably still don't have permission, but that doesn't mean we can't do something about it.
GUPTA: Jose Gomez Marquez believes that everyone deserves proper medical care, no matter where they live. He and his team at MIT's Little Devices Group are creating do-it-yourself health technologies that defy conventions and saves lives. That's what earns him a spot on THE NEXT LIST.
For more on this episode and other agents of change, please go to cnn.com/thenextlist and join me on my live stream at cnn.com/sanjay. It's a one-stop spot for all my blogs, tweets, and behinds-the-scenes photos. Thanks for joining us. I'm Dr. Sanjay Gupta. We'll see you back here next Sunday.