Little gadgets that make a big difference

Devices made by world's largest medical technology company are helping hundreds of thousands worldwide.

tech equip 88 (photo credit: )
tech equip 88
(photo credit: )
At 63, Mike Robbins of Southhampton, England looks perfectly healthy, if somewhat pudgy. Ruddy, cogent, enthusiastic and full of life, he tells how he finally learned a decade ago that advanced Parkinson's disease was to blame for the previously unexplained tremor in his right shoulder and arm. Suddenly, Robbins pulls out a small electronic device that looks like a TV remote control and presses a button. Instantly, his whole body, but especially his right side, trembles uncontrollably - so badly that he can barely press the "On" button to bring a halt to his misery. A look of terror seizes his face, and his audience watches in shock and foreboding. But when he succeeds in reactivating the deep brain stimulation electrode in his head, the former seaman and now wealthy merchant marine simulation software company co-owner immediately returns to his former jolly self. The $22,000 Activa device, developed and manufactured by Medtronic - the world's largest medical technology company - shoots 3.3 volts into his brain 130 times per second for 90 millionths of a second per pulse. It makes him normal, and has given him a new life after previously contemplating suicide. "Ten years ago, I noticed an irritating twitch in my right shoulder," he told journalists from around the world invited to Medtronic's Swiss Manufacturing Operations Center in the little town of Tolochenaz, a 35-minute drive from Geneva. "It got worse; soon I couldn't move one finger. My family doctor said my problem was stress. He told me to play golf. Then a second one advised me to go to the south of France, drink wine and eat cheeses. An industrial psychologist agreed it was stress and sent me to a psychiatrist, who put me on diazepam. "Then I went to a homeopath in Holland who claimed that six generations ago, my family had syphilis. He said I had 'worms in the brain‚' that were causing the tremors when they 'farted,' gave me some stuff to swallow and billed me 1,200. But the shaking was worse." Robbins said he had mood swings and began to cry spontaneously. A doctor blamed a "trapped nerve" and sent him to a chiropractor, who insisted the fillings in his teeth were responsible. But on a business trip to Shanghai, his appendix burst, and in the private ward of a Chinese hospital he met a neurologist who asked if he would help her improve her English. "She saw the shaking, asked me to put my fingers on my nose, and in five minutes diagnosed me with Parkinson's. I was relieved. She said it can't be cured, but the symptoms could be suppressed with medications." Yet Robbins suffered horrible side effects. "Come back in six months," he was told in England. "We have the rest of your life to sort it out." He shook from the second he woke up to the moment he fell asleep, his human dignity smashed to bits. "I made messes at home, and was embarrassed. I didn't want to see anybody." FINALLY, he learned from a neurologist that three surgeons in the UK performed the brain surgery to insert the Activa device, and one at an Oxford hospital was especially recommended. But although the Medtronic device was in the National Health Service's basket of services, his local health authority said it didn't finance such treatments; he had to purchase it on his own and have the operation done privately. Fortunately, he was physically and mentally suitable for it. "I was told I'd have a 1 percent risk of dying, a 2% risk of losing my ability to speak, that I could have a stroke. But I was desperate." While he was completely conscious, his surgeon drilled a hole in his skull and penetrated his brain, which doesn't feel pain. For a moment, Rollins was no longer able to talk, but then his speech returned. "He touched something as big as a peanut - and my shaking stopped dead. I laughed and told him to go no further. He ran a cable to a little computer in my chest, and here I am. Parkinson's doesn't kill you, but it certainly takes your life away. I am extremely lucky I have it only on one side, was a suitable candidate and could afford it," he said, adding that he takes no more medications. ROLLINS IS one of millions of patients around the world who have benefited from products developed by Medtronic. Every five seconds someone in the world receives a Medtronic product that either significantly improves or saves his or her life. On the first regional media day organized by the company for 25 journalists from Europe (and one from Israel), visitors met the firm's international president Arthur Collins, who flew in from world headquarters in Minneapolis to Tolochenaz and then to the Davos Economic Forum. With $11 billion a year in revenue (more than $3 billion outside the US), 36,000 employees and sales in 120 countries (including Israel, whose branch is headed by Judith Gal), the president of Medtronic surely qualified as a participant in the Davos forum. Intended largely for chronic diseases, Medtronic products will be increasingly in demand due to the aging of the developed world's population. The company was launched in 1949 as a partnership between a University of Minnesota engineer and his brother-in-law for repairing medical equipment. But eight years later, a physician asked the partners to design an external wearable pacemaker for children. When a baby was born with a hole between the ventricles, it could be fixed with surgery but it often caused electrical problems. A large vintage box, worn outside the body but attached with wires to the heart muscle, is displayed at the company's small museum, along with a large photo of comedian Jerry Lewis, who underwent the implantation three years ago of a Medtronic neurostimulation system to relieve the severe back pain he got from too many falls during his stunts. "Thank you," Lewis wrote, "for giving me a new life." Many other famous people, and ordinary ones, "thank us but don't want their medical problem to become known," Medtronic officials said. The first implantable pacemaker for too-slow, irregular or too-fast heartbeat was developed by the company in 1960. But Medtronic, said Collins, almost went bankrupt as a result of expanding too broadly. "It could have been bought for $1 million in 1960. It had to refocus, and it set down the mission that remains in place today: to contribute to human welfare by applying biomedical engineering in the research, design, manufacture and sales of instruments or appliances that alleviate pain, restore health and extend life." Today, pacemakers are produced with defibrillators that automatically detect a halt in heartbeat and administer an electric shock to restart it, often without the patient being aware of it. Medtronic spends a 10th of its revenue, or about $1 billion a year, on research to miniaturize, invent new materials, increase longevity and raise the efficiency of products - and the publicly traded firm has been hailed by independent analysts as one of the "world's best companies to work for." About two-thirds of revenue is generated from new products put on the market in the past two years. Aside from pacemakers and deep-brain stimulation electrodes, the company also makes the Minimed insulin pump for diabetics (with the option of a sensor that automatically detects blood sugar levels), heart valve prostheses, heart-lung machines, peripheral stents for clogged vascular arteries, stents for aortic aneurysms and drug-eluting ones for clogged coronary arteries, neuromodulators for patients who cannot control their rectum or bladder, disk prostheses for degenerative diseases of the spine, a device that shrinks benignly enlarged prostate glands, growth factor delivery systems that fuse vertebrae, cancer treatments and numerous others. THE COMPANY has captured 45% of the European market for implantable defibrillators, 45% for pacemakers, 80% for neurostimulators, 95% for implantable drug pumps, 50% for insulin pumps, 95% for incontinence implants and 20% for coronary stents. Treating patients suffering from congestive heart failure - in which the heart muscle is weakened by disease and unable to pump enough oxygen-rich blood through the body, causing the lungs to fill with fluid - is becoming increasingly expensive, said Medtronic official Kathy Cargill. "Patients suffer from shortness of breath, swelling of feet and legs, a chronic lack of energy, difficulty sleeping, increased urination at night and confused or impaired memory. Eventually it is fatal, as victims' hearts beat too fast or the heart gives up. Half of them die within a year of diagnosis. Medications quickly lose their efficacy." But Medtronic's implanted device, called Concerto, can save them by detecting the first sign of fluid buildup, treating it and preventing costly hospitalizations. The Tolochenaz plant has an on-site virtual catheterization lab for teaching thousands of doctors whose hospitals buy their cardiac equipment. A human-shaped mannequin lies on a surgical bed as imaging systems help doctors the insert tiny wire leads of cardiac resynchronization therapy devices to the heart muscle. The on-site factory for pacemakers and implantable defibrillators has masked, goggled and robed employees working with robots, painstakingly soldering them shut with lasers and ensuring that there are no scratches or leaks. As any small defect could endanger a life, the devices are checked many times by humans and machines, with each staffer rotated among three to five tasks to reduce the risk of boredom. Medtronic officials complained that governments and health systems, as well as the general public, show a "general lack of understanding of these therapies, and even of illnesses. This cardiac resynchronization therapy for chronic heart failure, for example, has been proven cost effective and a boon to quality of life. Innovation really can save lives and reduce hospital stays," stressed Cargill, whose own active grandmother developed this condition and died young, before the Medtronic device was available. "Fully 93% of European heart failure patients suitable for the implants are being denied this therapy, which is vastly underused," she added. "Expert guidelines are being ignored, as health providers think about short-term expenses rather than long-term benefits and cost savings." This tendency is often seen in Israel. With an estimated 2 billion of the world's people expected to be over 60 in the year 2050, and the costs of coping with chronic illness increasingly burdening health systems, governments and medical administrators will have no choice but to consider how to prevent and delay complications with the latest medical technologies. The author was a guest for one day of Medtronic in Switzerland.