Hacking Healthcare

Joan Somers Donnelly explores the recent innovations coming from the ‘hacker’ and ‘maker’ movements in the field of medicine.

DIY medicine might not sound like best practice, but in reality the recent innovations coming from the hacker and “Maker” movements in the field of medicine have the potential to revolutionise healthcare, particularly in developing countries. Medical aid given by rich countries to poorer ones is a nice news story.

What we read about less often, however, is the fact that this top of the range equipment frequently fails or is impossible to maintain. Rather than donating cheaper models of the same equipment, Jose Gomez-Marquez of MIT argues that there is a need to look towards cheaper materials, and design hardy devices with the same functionality but for a different environment and at a more affordable cost. His Little Devices Lab at MIT hack simple objects, making nebulisers for medication from bicycle pumps for example, and assemble DIY medicine kits.

The work of such groups, which exist at several U.S. universities, is not only making a difference to health workers in developing countries but is also challenging the medical devices industry, which mainly markets devices that are expensive and designed to prevent hacking.George Whitesides and his team at Harvard have been working with an extremely ordinary material: paper. They have created microfluidics devices, which test body fluids to diagnose for a particular disease or detect for a particular hormone, such as in a pregnancy test.

“Another ingenious paper tool is Manu Prakash’s foldscope, developed at Stanford. Essentially an origami microscope, it fulfills the need for a light, portable microscope for diagnoses and testing water.”

Paper naturally draws in liquids through tiny capillaries, eliminating the need for a mechanical pump. The team embeds polymers that shun water on a piece of paper the size of a postage stamp to create channels than a drop of blood or urine can travel through to meet small pools of chemical reagents. Paper is not only cheap, it is also easy to produce and store in high volumes, and can be burned after use, which is a great advantage in areas where medical waste disposal is a problem. The lab’s first test is for liver disease, a frequent side effect of AIDS medications. Where no medical personnel are at hand, a photo of the result taken on a camera can be sent to a lab, and a diagnosis will be sent back in a text message.

Another ingenious paper tool is Manu Prakash’s foldscope, developed at Stanford. Essentially an origami microscope, it fulfills the need for a light, portable microscope for diagnoses and testing water. The pattern is printed in several die-cut pieces on a sheet of stiff, water-resistant paper. The sections are colour coded, making the microscope fast and easy to put together without the need for written instructions. Once folded, it stacks two polymer lenses over one another, magnifying the image on a slide up to 3000 times.

The Little Devices team make five types of MEDIKits, including the Drug Delivery Kit. It contains core devices: syringes, nebulizers, inhalers, transdermal patches, pills. Then there are modifier elements: colour coding, shape coding, springs, plungers, compressors, tilt sensors, buzzers, timers, bicycle pumps, and template cutters.

These allow users to change the functionality of the devices. Also included are general supplies like Velcro, tape, paper, tubing and needles. Soon after field testing the kits in Nicaragua, Gomez-Marquez and his team realised that users were hacking the kits themselves, cutting parts like tubing, and taking parts from one kit and using them in other ones. They concluded that for the kit to be successful, they would have to design for hacking.

Instead of trying to change the global supply chain for medical devices, the Little Devices team has embraced the huge and far-reaching toy supply chain of cheap plastic and electronic mechanisms. Gomez-Marquez describes what they dubbed the Glucometer/Gameboy paradox: both devices have equally complex electronics and comparable retail prices, but while gameboys are available worldwide, 16 clinics in Nicaragua have to share a single glucometer (a device used to test the level of glucose in a patient’s blood).

Getting these frugal technologies out of the lab and into the hands of those that need them is still a challenge. Getting entrepreneurs to invest in these kinds of projects, whereby devices constructed for 50 dollars can perform the same function as one that costs 100,000 dollars, is another huge challenge. DIY medicine subverts the capitalist system that is entrenched in healthcare as much as any other industry.

These technologies have applications not only in developing countries but also wherever there is unequal access to healthcare, hospitals striving to save money on routine procedures, or patients wanting to adapt their own healthcare to their specific needs. Medical tools still need to be safe and rigorously tested, but necessity is the mother of invention.

With many healthcare professionals working in challenging conditions already taking DIY action, it’s time for more research groups to weigh in and help put health hacking into the hands of the people who have the most to gain from its affordable innovations.