You want me to swallow... that?” I blurted out to Yardena, the nurse.
In Yardena’s hand was an oversized, oval-shaped capsule, the size of a pill bug – that is, if a pill bug got caught under a radioactive beam and grew in power like a hi-tech Spider-Man.
The bug/capsule had flashing eyes and, instead of DNA, its innards were electronics: sophisticated cameras and a tiny Wi-Fi transmitter that was to send pictures of my gut to a portable device the size of a 1992 Sony Walkman that Yardena instructed me to strap around my waist.
The whole set-up, formally known as “capsule endoscopy,” is part of an Israeli innovation – now celebrating its 20th anniversary – called the PillCam. It’s a (mostly) non-intrusive way to diagnose digestive problems and it can reach parts of the upper gastrointestinal tract that standard colonoscopies can’t.
With my chronic cancer currently under control but the stomach pains that preceded it still raging, my doctor wanted to check to see if my Crohn’s disease – which has been inactive for 30 years – perhaps had flared and was the cause of my ongoing discomfort.
The PillCam is much more convenient and safer than a traditional colonoscopy. Unfortunately, the prep is no different. I’ll spare you the fiery details. Suffice it to say, I couldn’t really leave the house the day before.
Given Imaging, the company behind the PillCam, was an early Start-Up Nation success story. Given Imaging was founded in 1998 and the first version of the PillCam was approved for use by the FDA in 2001. The company was sold in 2014 to Covidien (now a part of Medtronic) for nearly $1 billion.
The PillCam is one of the clearest examples of how technology originally developed for military purposes – in this case, the cameras used to guide missiles – can be repurposed for a new life in civilian healthcare.
Given Imaging founder Gabi Iddan had been working on optics for Israeli defense contractor Rafael. The PillCam started as a side project but eventually became too big for Rafael’s labs and was spun off into its own company. Over two million patients have swallowed a PillCam as I was now being urged to do.
Each video capsule costs about $500, which sounds like a lot until you compare it with a colonoscopy, which can run up to $4,000 per procedure. The camera snaps between two to six pictures per second during its 12-hour exploration of the gut, for a total of 30,000 images when it’s all done. When you return the Walkman-like device the next day, the data is downloaded and the battery recharged.
Thankfully, you don’t have to return the pill itself.
In 2012, reporter Michael Mosley swallowed a PillCam and spent the entire day at the London Science Museum while the movement of the capsule through his body was broadcast live on BBC television.
Only two-thirds of patients who should undergo colonoscopies actually proceed as recommended – either out of fear it will hurt or because it’s too expensive and their insurance won’t cover enough of the cost. Wider adoption of the lower-priced and painless PillCam could increase compliance and save lives.
I stared at my personal PillCam for a few long seconds and rolled it between my thumb and pointer fingers. After all the prep I’d done the day before, I wasn’t considering turning back.
Still, it was a big pill and I have lingering trauma from summer camp in 1972 when I was 11 years old and we were forced to swallow these enormous salt pills every morning at breakfast as a prophylactic to avoid dehydration. I couldn’t do it and had to wrap my pill in peanut butter to get it down.
Since then, I’ve become a skilled swallower.
I picked up the glass of water, but first, Yardena, who was supervising the whole process, had a request.
“Repeat after me,” she said.
I looked at her confused. I’d already signed the paper she gave to me – was some additional verbal consent required?
“May it be your will, Lord my God...” she said, invoking the start of Hebrew prayer.
Wait a minute, I thought. Doesn’t she know who she’s talking to? She clearly hasn’t read my articles on the importance of only saying what you believe and believing what you say.
“Go on, it’s not going to hurt you,” my wife, Jody, who had accompanied me to the Hadassah hospital that morning, urged.
“...that this activity will bring healing to me, for You are the free healer,” Yardena continued.
This prayer, for taking medicine, is an ancient one, dating back to the Talmud and formulated further in the codifications of Jewish Law, the Shulhan Aruch and Mishna Berura.
I didn’t want to be rude. Yardena was just trying to be helpful and, besides, who says no to a “free healer?”
To paraphrase King David, “The Lord is my HMO, I shall not argue.”
I mangled some of Yardena’s words in Hebrew, but that didn’t stop the two religious women in the adjacent room from answering with loud amens.
I took a big gulp and the PillCam’s journey was underway with a little help from above or, more likely, the good folks at Given Imaging headquarters in Yokne’am.
A few days later, I received the results. The PillCam did find old signs of Crohn’s disease but a subsequent test showed it to be mostly inactive. My doctor assured me that’s not the cause of my pain. It’s back to the brainstorming table.
The writer’s book, Totaled: The Billion-Dollar Crash of the Startup that Took on Big Auto, Big Oil and the World, is available on Amazon and other online booksellers.
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