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Years ago, a friend of mine was in med school, and headed off for a semester in the rainforest of Ecuador, performing basic medicine and stuff for people who rarely got to the city to see a doctor. He called me up, on a Sunday afternoon, with this question:

"Our dentist in the group just realized she doesn't have a source of suction, you know, like the vacuum that slurps saliva out of the way during a procedure. We're in Houston and our flight leaves in 6 hours. Any solution needs to work off-grid for a month. Got any ideas?"

I thought for a moment, and said "Hit an auto parts store. Get a brake-bleeder kit. This has a hand-pump vacuum with a clear collection jar. Aim for one with a glass jar if possible, since it'll be easier to clean. Should set you back about thirty bucks."

And we didn't speak again for a few months. When he was stateside again, he said the brake bleeder kit had worked so well and was so simple to operate, they'd often just hand it to the patient. Not only did this free up a physician, it also gave the patient something to do during what's often a nervous and fidgety time, and may have thus decreased the need for sedation in some procedures.

Sometimes it really is that simple. He had numerous stories of doctors in hospitals picking the brains of janitors -- they called it a "facilities consult" -- to see if they could MacGuyver a solution to a problem that the medical industry hadn't packaged yet. PTFE plumber's tape apparently comes in a medical grade too, but sometimes you need to toss around ideas with some other hands-on maker-fixer sort of people before you figure out how to apply it.

One prominent example is superglue, which started being used by medics in the Vietnam War to control bleeding until a soldier could get to a hospital. Now you can buy special medical versions of the stuff at any drug store.
I think I've read that superglue was invented in WWI for exactly this purpose.

But beware that closing up a wound increases the chance of infection, so only do this if you're sure that you've been able to sterilize the wound first or if there is no other option for stopping the bleeding.

Otherwise it's best to leave the wound open and wrapped with bandages, and make sure to change the bandages at regular intervals.

There used to be a product (I believe from johnson and johnson) called liquid bandage.

It was a two-part formula, combining a treated applicator like a cotton swab and a bottle of adhesive.

You had a cut, you put a drop of liquid from the bottle onto the end of one of the swabs and touched it to the cut on your finger or wherever. The two parts together formed the adhesive.

It instantly secured the skin together.

It was the BEST. It would fix a paper cut immediately and securely. You would not accidentally dribble adhesive and stick your fingers together.

They pulled it from the market, for some reason shrouded in mystery.

Now all you can find is nexcare nu-skin which is not very good at all. (Basically it sort of covers your skin, but doesn't secure anything)

very sad.

IIRC they use powdered mashed potatoes now.

I'm not sure if there's an official "medical powdered mashed potatoes" that doctors use.

I actually use this one all the time. I do a little wood working and if I slice open a finger, I just grab my Rockler CA glue, put some on, squeeze the slice shut and wait about a minute.

If you purchase liquid bandage in a drug store, it is just sterile CA glue.

Superglue is extremely effective at paper cuts, and sealing cuts in cold, dry weather that otherwise crack further. Any small "slice" type injury I use it over a bandage.
Being able to apply suction on my command seems like an added benefit. Sometimes I think I'm going to choke at the dentist waiting for him to start vacuuming. Could be comforting for people who aren't typically in the sort of situation and feel out of control of themselves.
In a pinch, I've seen third world doctors use super glue to seal cuts.

American culture doesn't allow for anything better than the best outcome in medicine.

The first dialysis machine was made of auto parts.
I strongly believe that we should all be taught ~primitive engineering like this.
I spent the weekend dissassembling a hematology analyzer capable of measuring 17 parameters of the immune system from a large drop of blood. Nabbed it on ebay for cheap.

Was able to unclog a few of the lines and get it running, learning how it works by shooting cells past a laserbeam and looking at scatter. Overall, the complexity of the machine is far simpler than that of a simple laser printer, but its retail value is $10k as a veterinary instrument. Machines for human patients are way more expensive.

My dissappointment however was discovering that it refuses to run unless its barcode scanner can see manufacturer-validated reagent bottles. The chemicals needed to make it run are simple salt-waters that can be easily made for $10 of various powders, but the manufacturer sells reagent sets for $1000k each. Now its clear that getting any useful data out of it will require hacking the ARM embedded system onboard.

Why am I doing this? Certainly not for any kind of regulated medical treatment, but I personally want to know how my immune system changes on a day to day basis. Datasets like this dont exist on such a high frequency sampling rate. What I find however, is that the decades-old tech that powers this relatively simple machine is being held back by an overly restrictive regulatory environment and price gouging of chemical reagents.

Why the artificial construction of a $100 lab test, when the actual value to perform such a test is much much lower? Why can't we live in a world where such self-experimentation is allowed outside of the strict guidelines of diagnostics?

I happen to do some IT field support for my vet - she has one of these machines too, with the same problem of expensive reagents.

The problem space here is: of course anyone can mix the fluids together from powder... but under what conditions? Tested for impurities, contaminants or unevenly mixed/clumped powder? For a clean water source? Regular batch checks to ensure the stuff is up to spec? Mess up one of these things, the system doesn't work/produces false results, a pet or a human dies and the payout sums can be enormous.

The latter risk and the insurance premiums as well as mitigation risks are why medical stuff is so insanely expensive.

And another thing: at least when someone dies, it's over. Bit of a lump sum to relatives of the deceased, funeral cost, that's it. Now, when someone does not die, but gets stuck with brain damage, in an awake coma or bedridden for life, the costs of keeping that person alive can well run into double-digit millions of euros whereas 50 years ago that person would simply die sooner or later. Midwifes in Germany are retiring in droves because insurance premiums have skyrocketed - due to exploding costs for newborns requiring extensive care after e.g. being stuck in the vaginal canal during birth.

That's a pretty awesome project. Instead of hacking the ARM, could you just call up a vet to ask if you can have some of their empty reagent bottles, and fill those with your homemade reagents? (As a bonus, if you can get it to work, the vet would probably be interested in knowing the reagent recipe as well.)

There's a movement towards open-source designs for relatively simple biological instrumentation- perhaps this sort of machine will be in range of those efforts someday soon.

I don't know anything about this particular case, but systems like that based on controlling "consumables" are very common.

Sometimes it's simple price gouging, sure, or at least partly. Often, though, it was in response to capitol equipment budgeting and per-procedure pricing (& insurance). It can be easier for organizations to justify/budget the cost (and pass that on) amortized over N exams than all up front, so device manufacturers figured out ways to do this. These days some devices are entirely funded by contracted use (i.e. free razor, pay for the blades), much like office printers etc.

You are right that the industry as a whole has little interest and no incentive to allow experimentation and re-purposing. Part of this is liability, a lot is lack of any incentive. On the other hand, research lab equipment with similar functionality is often far more accessible (and more expensive)

Maybe you could get your hands on some spent reagent bottles, or even just photos of them. Reset the system's memory in between uses if it requires new bottles each time.

Hacking the controller could be challenging if it's been deliberately hardened.

Those reagents are like printer ink and the manufacturer makes plenty of money off of them. Also, the whole thing is supposed to be run with sterilized lines and sterilized water.
Very cool. Love to chat at some point. I run a makerspace in Victoria, BC and we have done some medical device hacking. Derekja at makerspace dot ca
That is absolutely awesome, I've always wanted to do some kind of higher frequency analysis of my body's internal processes via blood sampling. It's cool to hear somebody doing that.
Typo maybe? $1000k as in $100k or $1m?
The answer to the headline is astoundingly obvious yet the article doesn't mention it once. The reason is regulation: you can't use a medical device that you've hacked together unless it has been cleared by the relevant authorities as being safe. Sometimes it's a matter of simply getting a cheaper alternative through regulatory approval, but other times its just not worth the cost to prove a cheaper alternative is as safe as the more expensive one. Very annoying article about an interesting subject.
The agonizing part is that having incredibly expensive medical tools isn't safe either - it leads patients to avoid medical treatment because of the cost.
The problem is ethical: How many hours of peoples lives must I improve for every person I kill?

If for example, you had a guaranteed treatment for obesity, but it killed 1 out of every 100 people it was used on, is it worth it? More than a few morbidly obese people would take those odds.

I was at CES many years ago, and a doctor had developed an asthma monitor for his daughter. This monitor would alert him and the school nurse immediately, and possibly 911 immediately if the episode was bad enough.

He couldn't get anybody to touch it because, at some point, it will miss an asthma event or the network will fail to deliver the event. And that child will die. And whoever sold the device will lose a multi-million dollar lawsuit.

As soon as some company with really deep pockets figures out that "indemnification" would allow them to generate scores of medical devices that nobody else can take on, we're going to witness an instant monopoly.

You mischaracterize the article. It mentions the FDA, and perhaps more importantly other disincentives.

Hospitals desire more expensive solutions because they get paid more for them. That is a second, enormous barrier.

The incentives are clear here. The costs are high, between regulations, marketing, out-maneuvering rent-seeking incumbents, and cultural issues. The reward is low. No one will become a billionaire for doing this work.

Yep.

And then you have to breach a very ugly topic most people don't like to discuss.

When does regulation kill more people by not having the $thing versus having the $thing? And how many people would suffer complication/dying with the $thing?

It's a very delicate balance, especially when you consider capitalist forces that encourage "move fast and break ~things~ people". The FDA is the chopping block for that... But also FDA overaction also kills people.

"Other time its just not worth the cost to prove a cheaper alternative is as safe as the more expensive one"

Sounds like a fatal flaw in the system which benefits manufacturers and insurance companies at the expense of consumers.

Hmm, why would an industry based on profiting from high margin expensive medical technology not sufficiently promote low margin inexpensive technology? It's a mystery.
A related mystery: what's stopping greedy practitioners from using the cheap device but still charging the old price increasing their margins even more?
Because people don't keep track of all the buzzwords.

FTA: > “reverse innovation”: taking a technology or solution born of the resource constraints in developing countries and adopting it in wealthier ones.

Nothing "reverse" about it; the question is why rich countries don't import low-cost low-tech solutions from poor countries.

I presume the answer is profit motive.

The classic example that has been hiding in plain sight for decades is "so many expensive drugs that are about as good as cannabis, and cannabis still illegal."

Presumably because wealthier nations are cost insensitive. They don't feel the need to reduce wastes in their healthcare system when they can 'afford' it.
> Nothing "reverse" about it; the question is why rich countries don't import low-cost low-tech solutions from poor countries.

Simple: Because you will never make your money back running that device through FDA approval. Especially if there is already another device in that space.

If you want the cheaper versions available, just get some charity like the Gates foundation to shepherd them through the FDA approval process. After that, lots of manufacturers will be happy to build them.

I just want to say the title on yc is so much better than the original. Making something cheaper and simple is innovation. Reverse innovation is ambiguous and confusing.
Like Theranos'? Medical science is slow but steady for a reason.
"People are not necessarily comfortable with the price of medicine dropping?" Sorry, which planet are you from? Earth, you say? The US even? People in your country would do anything (and have) for affordable medicine.
No, they won't. As comments above pointed out, Americans will sue when something goes wrong and it's found that the medical provider didn't use the most expensive option available. And Americans do NOT do what they can to obtain affordable medicine: if they wanted this, they'd be demanding laws to rein in costs, to provide socialized medicine, etc., just like most other developed nations have already done. Instead, we got ObamaCare, and half our population wants it to be repealed.
A world where people don't have a good way to judge the quality of medical services and so they use price as a proxy for quality. Here is a 2-minute video where a very popular speaker explains the position, to the agreement of a large crowd: https://www.youtube.com/watch?v=kPsfo8-FhB0
Why would Americans physicians stand for this when they can make loads of profit off of backroom deals with device manufacturers and their expensive doctors?
Entrenched interests, innovator’s dilemma. Orgs and people get addicted to their revenue stream.
I've come across the ORT (ORS in other countries) problem in the US. They're often hard to find, and incredibly overpriced. In the past, many pharmacies simply did not carry them. I was sometimes told to buy Gatorade instead.
Buy them online and keep them on hand just in case?

https://www.amazon.com/Rehydration-Organization-Poisoning-El...

As per my understanding- sophisticated and expensive medical devices have sophisticated algorithms for processing raw data. I would love it if cheap devices just exposed raw data and I could use my own algorithms, arguably newer and better, to process them.

I don't know if cheap devices are much worse as far as raw data is concerned.

> "People in emergency medicine often joke “that you can figure out a solution with a couple of popsicle sticks."

But that wouldn't be covered by insurance without a going through a bunch of red tape. But the approved $1000 alternative is.

Just don't call it a medical device. Call it a "dietary supplement"
To be used inside a hospital an innovation needs official blessing. There are a lots of examples of everyday things like fish oil being rebranded and put through FDA trials so that they can be used by doctors.

https://slatestarcodex.com/2014/06/15/fish-now-by-prescripti...

Something called a dietary supplement just isn't going to be used. Both because they sound sketchy and because nobody is going to use expensive food to bribe doctors to sit through a 2 hour training course in some cheap dietary supplement.

This reminds me of Victor Papanek's Design for the Real World.
Root cause analysis:

1. Developed world: Profit motive(i.e. greed).

2. Developing world: Profit motive(i.e. greed) and Bureaucracy(greed, but oft times incompetence).

Greed and incompetence are deeply rooted creations of concentrations of economic incentives in the hands of a few. Capitalism and Socialism are just two ways creating those things, just by slightly different routes. One needs true democratization of technology and its distribution to succeed. Its the only reason why the internet is so powerful and empowering.

What an awful headline.