Like virtually all cataract surgery patients, my parents were thrilled with their cataract procedures. Why not? After a quick office procedure, their new intraocular lenses (IOLs) gave them better vision than they had experienced for more than a decade.
Now imagine a world with no devices for cataracts, only drugs. Imagine taking one or more medications every day for the rest of your life – drugs which could not cure cataracts, but which slow the inevitable progression towards blindness. Imagine the typical chronic-medication side effects: somewhere between minor discomfort and an increased risk of cardiovascular mortality. How does that sound?
When given a choice, I’ll take medical devices over drugs every time. Here’s why.
Devices act locally. An intraocular lens fits in your ocular capsule, in place of your native lens. The Essure contraceptive device blocks your fallopian tubes. A stent sits in your artery.
Drugs act systemically. Look at the side effects of drugs for stable angina here or here.
Devices correct underlying pathologies. Cardiac ablation gets rid of a small number of misfiring heart muscle cells. The lap chole removes an offending gallbladder. Laproscopic hernia repair puts your intestines back where they belong.
Except in rare cases (antibiotics and antifungals, most notably), drugs don’t correct underlying pathologies. They can’t. Almost all drugs up-regulate (agonists) or down-regulate (inhibitors) some naturally occurring biochemical process. Because this re-regulation only happens in the presence of the drug, medicine must be taken chronically. Because the same biochemical processes exist throughout the body, systemic side effects of drugs are inevitable.
Industry and academia spend a ton of money every year on pharmaceutical research and development. At the same time, according to the CDC, “among older Americans (aged 60 and over), more than 76% [take] two or more prescription drugs and 37% [take] five or more.” Does anyone really think patients want yet another drug to add to their daily regimen? Patients suck at compliance.
Devices can reduce the need for drugs. Renal denervation reduces the use of anti-hypertensives. GERD surgery reduces the use of PPI’s. I can’t think of a better solution to the compliance problem.
No patient wants to take a medication every day for the rest of their life. As a health care entrepreneur, I’d prefer to tell patients and physicians, “There’s a device for that.”
Medical devices are changing the world. That’s why I do what I do.
Jay Caplan on Medical Devices 
Hi Jay, thanks for the thought-provoking post
I’m in the medtech space but have a finance background, so, I apologize in advance if this comment is naive. From what I understand, drugs work via a chemical mode of action, and work to solve chemical problems. Devices work via a non-chemical mode of action (i.e. physical or electrical) and therefore, can be substitutes for drugs only to the extent that a non-chemical solution solves a chemical problem. So, much depends on the nature of the problem. I imagine that some problems can only be addressed chemically (i.e. difficult to produce a device that does the work of a monoclonal antibody), but, given the many good reasons you mentioned, perhaps we should be looking for more non-chemical solutions to chemical problems.
Hope this makes sense and keep up the good work!
– Stefano
Thanks Stefano. I think the examples of Asthmatx, Ardian and others show us that we often define diseases as chemical problems (e.g. asthma and hypertension), but our definitions can be changed by innovative thinking, leading to device-based approaches.
How should we consider the replacement of microbiomes? I think that much of what we are “fixing” with medical devices we may be able to prevent.
Great thought Karl. I think the role of the microbiome remains to be seen, with pioneers like Rebiotix leading the new way.
http://www.businesswire.com/news/home/20130624005992/en/FDA-Grants-Fast-Track-Designation-Rebiotix-Microbiota
“Fecal Transplants: An Inside Look at the Potential, Progress and Pitfalls” is a good read, too:
http://www.huffingtonpost.com/colleen-r-kelly-md/fecal-transplant-progress_b_3569342.html
Interesting take by the FDA to classify fecal transplants as a drug vs an equivalent of an organ transplant. I’m not sure I understand the full impact of that for patients, companies, and doctors.
Clostridium difficile infection is just the tip of the iceberg as far as treatments go. I think that we will see a fair amount of money and research going to microbiomes in the next 10 – 20 years. And when all the hype goes away, I believe that we will have some very important new treatments for things we are only getting glimpses to today.
Thanks for the Huffington Post article. It’s well written and brings speaks well to both the potential benefits and dangers of transplants. I do worry about the unintended consequences that won’t be understood for 40 years. But that shouldn’t stop the progress of taking risks and moving forward.
Thanks Karl.