The 19th Medical Innovations Summit
Royal Society of Medicine
The Royal Society of Medicine’s Medical Innovations Summit provides a biannual platform for the presentation and discussion of inspirational ideas and developments in the field of medicine and healthcare, bringing together clinicians, entrepreneurs, policy-makers and VCs. Below is a summary of a selection of talks, presentations and discussions that took place during the event. In the interests of brevity, this post doesn’t cover the full agenda of presentations. Check out upcoming RSM events here.
In recent times, the word ‘innovation’ has become inextricably linked to digital tools and products. The fallacy that something incorporating the latest technology is by definition ‘innovative’ is perpetuated by hype and excitement around emerging technologies, in many cases giving them a veneer of credibility before they have a demonstrable evidence base. This is a clear oversight when some of the greatest innovations in healthcare have been remarkably low tech. Mark Slack, consultant gynaecologist and co-founder of CMR Surgical was able to provide a striking example of the above.
The operating theatre is the most common site for adverse surgical incidents, with errors occurring in nearly 15% of all patients globally. International studies suggest that surgery may be responsible for up to 1 million deaths every year, and an additional 7 million postoperative complications [1]. A simple tool implemented in the operating theatre has been able to address these issues and save countless lives. The solution, far from ‘cutting edge’, has had a drastic impact on patient outcomes. The WHO Surgical Safety Checklist (SSC) is now standard practice within the NHS and other healthcare systems and continues to ensure patient safety is protected.
The development of a new innovation should start with a problem or opportunity (and not a solution). For the WHO, the problem was an unacceptable level of surgical complications, and the SSC was a remarkably simple solution. However the SSC is not a complete solution, and there is always scope to further reduce the complications that may arise from surgical procedures. CMR Surgical are preoccupied with the high level of complications and subsequent costs specifically associated with open surgical procedures. They were aware that minimal access surgery (MAS) was associated with lower rates of incisional hernia, postoperative pain and postoperative infections. However they found that the technical difficulty of this surgical approach was limiting its widespread implementation by surgeons.
The company began designing and building a surgical robot that would empower surgeons to carry out minimally invasive surgery. As their end-users, surgeons told them they wanted something modular, transportable and adaptable, so CMR’s latest iteration — Versius — is a small, portable, transportable, ergonomic, surgical robot with a 4 axis ‘wrist’ design modelled on human anatomy. Although it is by no means a simple solution to surgical complications, it aims to facilitate a surgical approach that, if adopted, can reduce surgical complications by a halve. It is still early days for the company who are undertaking first in human studies in India, however they expect to be trialling the technology in 11 centres around the world by the end of 2019.
Surgery is of course an area rife with innovation that goes beyond the work of CMR and other robotic companies. For those looking to innovate in new domains, perhaps one of the last frontiers within healthcare is human longevity. Although we have enjoyed an ever increasing lifespan throughout much of recent history, life expectancy has begun to plateau or even dip in some countries [2]. What’s more, people are becoming increasingly focussed not so much on their lifespan but their ‘healthspan’ — the number of years they can expect to live relatively healthy and disease free. Although the allure of more years on this earth is universally tempting, if these ‘extra’ years are spent bed-bound or becoming increasingly unwell, the value of that time is less clear.
And so we come to ‘restorative medicine’, the focus of Dr Osman Kibar and his company Samumed. Dr Kibar is targeting the ‘Wnt’ signalling pathway which helps guide the differentiation of embryonic and progenitor cell lines into the differentiated cells that make up the different tissues and organs of the human body. Wnt signalling is an important part of maintaining tissue health such that dysregulation of this pathway can lead to tissue breakdown and even cancer. Having developed treatments to target this pathway, they are throwing their technology at a diverse array of conditions to see what sticks.
Trials for a range of musculoskeletal conditions including osteoarthritis (OA) of the knee, degenerative disc disease and tendinopathy are at a variety of different clinical trial stages. Phase III clinical trials for patients with knee OA have demonstrated cartilage regeneration and increased joint space, whilst compassionate use cases for solid tumours like pancreatic cancer and advanced Alzheimer’s dementia have also had promising results (within the limitations of a single test subject respectively). Clearly the Wnt pathway, which has previously proved difficult to effectively target, holds some degree of promise for achieving true ‘regeneration’ across a variety of different musculoskeletal, oncological and neurological disease types.
Of course, no discussion about innovation would be complete without talking about artificial intelligence (AI). The term AI is thrown around across the technology sphere with increasing abandon — as a way to generate excitement, interest and most importantly — investment. What people mean when they say ‘AI powered’ is becomingly less clear and the onus is really on the founder or company to explain what type of AI they use and for what purpose (see this article for a helpful diagram on different AI technologies, how they are categorised and for what purposes they are used).
Feebris see AI as the third iteration of the evolving use of mobile phones in healthcare. Early mobile phones allowed better communication between patients and healthcare services, smart phones have enabled remote consultations and triage, whilst the AI age now promises the possibility of advanced monitoring and even diagnosis through our mobile devices. With respiratory conditions as a leading cause of morbidity and mortality worldwide, and accounting for a huge number of avoidable hospital admissions, Feebris hope their platform will help detect and treat respiratory conditions in the community before they become more serious.
Through a combination of point of care devices that connect to an AI powered app, Feebris employ machine learning algorithms to extract useful data from these devices and identify patterns specific to different respiratory diseases. Based on the result, they can provide triage recommendations to patients and healthcare professionals. As with similar companies working in disease identification, Feebris is a decision support tool and not a diagnostic device (at least until they await class 2 medical device certification), so healthcare professionals utilising their platform always have the option to override any outcome from the app should they think it inappropriate or inaccurate.
Their aim emulates the new age maxim that healthcare should move from a reactive model to a proactive model, where interventions are implemented early before people get (seriously) unwell. The outcome is less demand on acute medical services and a reduction in morbidity and mortality.
Also aiming to reduce pressure on in-person healthcare services are Arthronica, another AI startup looking to disrupt arthritis assessment and management. Unlike Feebris, they are using ‘AI based visual search’ to monitor patients with musculoskeletal and rheumatological conditions. Effectively, they can take an image or a video of a patient’s hand and accurately assess joint range of motion, contact forces (e.g. between fingers), and joint swelling — all without the use of wearables or point of care devices. The company is supported by MedTech Superconnector (an incubator that receives funding by Research England), and funded by Entrepreneur First, an international talent investor scheme. To date they have raised hundreds of thousands in funding and are currently testing their technology on 20,000 patients in order to further improve their technology and establish it’s role in treatment pathways.
At the start of this article I emphasised how innovation doesn’t always have to be high tech. However much of the preceding discussion has revolved around companies involved in robotics, pharmaceuticals and artificial intelligence. The conference featured many other inspiring and interesting companies and individuals, some of which had remarkably simple solutions for far-reaching problems. Seb Tucknott, a designer with ulcerative colitis, founded IBD Relief, an online resource to ensure people with inflammatory bowel disease have access to high quality and helpful content to guide them through their illness. While Nuala Burke, Clinical Lead for Walk with Path told the story of how her company was able to help sufferers of Parkinson’s disease by attaching laser prompters to the front of shoes — providing the visual cues that these individuals need in order to walk unimpeded.
Ultimately, all those who presented had found, or were working on, innovative solutions for important problems within medicine and healthcare. For all the progress in technology however, we would do well to remember that sometimes the greatest innovations are those that don’t involve frontier technologies or millions of pounds of investment. Just like a series of checks, listed on a page, that makes up the WHO SSC — the right tool applied in the right setting will always provide beneficial outcomes, no matter how technologically advanced it might be.
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