Poem If - by Rudyard Kipling

If you can keep your head when all about you
Are losing theirs and blaming it on you;
If you can trust yourself when all men doubt you,
But make allowance for their doubting too:
If you can wait and not be tired by waiting,
Or, being lied about, don't deal in lies,
Or being hated don't give way to hating,
And yet don't look too good, nor talk too wise;

If you can dream---and not make dreams your master;
If you can think---and not make thoughts your aim,
If you can meet with Triumph and Disaster
And treat those two impostors just the same:.
If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
And stoop and build'em up with worn-out tools;

If you can make one heap of all your winnings
And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings,
And never breathe a word about your loss:
If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: "Hold on!"

If you can talk with crowds and keep your virtue,
Or walk with Kings---nor lose the common touch,
If neither foes nor loving friends can hurt you,
If all men count with you, but none too much:
If you can fill the unforgiving minute
With sixty seconds' worth of distance run,
Yours is the Earth and everything that's in it,
And---which is more---you'll be a Man, my son! 

Rudyard Kipling

Presentation on Innovation to students

I shared my thoughts with the students of MD University, Rohtak, India. I enjoyed giving it, hope the reader enjoys the presentation as well....

Wound Closure – 3 emerging technologies to watch

There was a time when sutures were the only product for closing wounds. Using sutures requires  considerable skill, is time consuming and painful. The search for easier to use technologies led to the development of staples followed by tissue sealants. Innovations are constantly taking place in this domain both by the key players and the smaller ones to identify new solutions. I have tried to bring 3 most interesting technologies to watch in wound closure domain.

1.    Interlockers

DermaLOC uses a rack and pinion locking mechanism for interlocking the edge of lacerations or incision. Once the device is secured, the strips can be snipped off. After closure, DermaLOC can be released for the evacuation of infected and non-infected fluid. DermaLOC can then be re-locked when medically appropriate.

See the links below for more details.

http://www.wadsworthmedical.com/dermaloc.html

http://www.massdevice.com/blogs/massdevice/wadsworth-medical-can-heal-your-wounds-needle-free

Zipline Medical’s PRELOC aligns the incision edges using the adjustable ratcheting mechanisms. The device is easily removed by simply peeling from skin.

See for details (http://www.ziplinemedical.com/)

Chinese company Sichuan Lichen Medical & Pharmaceutical Technology product also uses ratcheting mechanism for closing wounds.

2.    Zippers

ExoPatents Marketing Ltd. - A zipper-type wound closer attachable to the skin around a skin opening and zipped closed to pull the skin opening closed.

See for details (US 7,591,835 & US 8,066,735)

HUMANITAS HILFE FUER AFRIKA -Wound zip fastener for attending to wounds, particularly in the area of fractures, intended both to secure fast wound care for fractures with accompanying open wounds and to splint the fracture, wherein the application does not have to be removed from the wound during x-ray.

See for details (http://www.woundcloser.eu/; WO2010054776)

3.    Closure patches

Wound closure device from a start-up company Microkoll comprises a flexible pad and an array of a plurality of microposts of shape memory material. Proximal end of the device is configured to be secured to the substrate and a tissue penetrating distal end. The posts have sharpened prongs protruding a distance through the polymer sheet and configured to change shape when exposed to different temperature levels.

Look US20110172760 for details.

Share your thoughts…..

A dialogue between two agnostics

Somewhere in middle of chaos, out of nowhere, two persons who knew each other quite well started the conversation about God. Both Gautam and Ashok were agnostics but Gautam believed that God is there but was not sure of it. On the other hand, Ashok believed that God is not there but again had his doubts. Gautam had read some of the Indian scriptures and Ashok had read many evolutionary theories. Both however, did not completely believe what they read. They were still doubtful, still had questions and still analysed situations around them to conclude the existence of God. So two people, both not sure about existence of God starts talking with each other and let us see how the dialogue goes.....

Gautam: Hey Ashok, why do you say that nature is everything, God does not exist and humans should follow nature. I was reading an article somewhere arguing who should be the inspiration of human society, the nature or the God. The author was arguing that Nature teaches us that strong kills weak, tiger kills deer etc. which we can call the animal society. However, as humans, one should think beyond the animal society and should get inspired from God where Love exits. Humans should and can make their society filled with love and cooperation.

Ashok: Man is also an animal Gautam and when the resources will be less, automatically men who cooperate with each other in today's era will fight each other for resources and will kill each other. We still do not see lack of water, fresh air and agriculture land around us. In African countries, histroy tells us that tribes vanished fighting for limited resources.

Gautam: I guess you are right. Don't you ever believe that God is there and will protect us from such catastrophy. It sounds scary.

Ashok: Yes it is scary but that's what it is. You know very well that I am doubtful about God's existence.

Gautam: Yes, sometimes even I doubt His existence. Why He created this world? If He is there, why innocent people including infants get killed? Why Satanism exists at all? Why we can not see Him? Questions like this perplex me. Indian scriptures try to answer these questions but they do not sound very convincing. But tell me one thing; India has history of around 20-25000 years. Why no one challenged God's existence?

Ashok: I think people must have challenged but the majority must have dominated.

Gautam: Yes, I think Buddha tried to find God but could not find him but was surely enlightened by deep meditation. He was agnostic, wasn't he? Jainism however, goes on the lines of atheism. They do not believe in God, but believed in meditation.

Ashok: You mean both propounded to achieve the state of tranquillity.

Gautam: I am not sure, if tranquillity is the right word.

Ashok: Fine, tell me more about meditation.

Gautam: Well, we hear about meditation right from the start of Hindu philosophy. Vedas taught humans about it. They also taught humans that God created the nature and jeevatma (including humans) and we can reach Him by meditating i.e. attain Moksh. Later on, one school of thought came that we ourselves are God, we just have to realize this fact by meditation. The world we see around us is Maya, an illusion. These sects of people were called Vedantis. Later on Buddhism and Jainism also continued stressing on meditation but had different thoughts on existence of God. Now it comes to my mind that may be nobody saw God but all these years great saints through meditation reached a different state of mind which some of them called God and some called attaining Moksh.

Ashok: Yes, I think you are right. I have been a pharmacology student and have experienced effects of some neural drugs on my body. Boy, I have done every kind of intoxication, which makes me feel that teasing with mind can take you to higher state but we can’t call it God, can we? It is possible that saints concentrated their mind so much that they reached some sort of higher state which today's scientists are not sure of, but I doubt whether we can call it God.

Gautam: Yes, it might be possible. I have read that after enlightment, people are in such joyous state that nothing around them, good or bad, can affect their joyous state. Also, I remember Sri Aurobindo's philosophy now. He believed that what we see around us are normal human beings and humans will evolve into super humans through meditation. Krishna, he said was such a super human. May be every human being, saints who got enlightened became a super human. By enlightment, I mean that they attained such state of mind that nothing around them disturbed their joyous mental state. In Geeta, such state of equanimity has been termed as Nirwana.

Ashok: Yes, I think you can relate this to today’s scientists and mathematicians as well who are too involved in their work. They sometimes reach different mental state due to their concentration and devotion towards their work. And I have heard classical music singers also reach such higher state of mind while singing.

Gautam: Not to forget, the sufi saints like Bulleshah and saints like Kabir and Tukaram who reached higher state of mind through complete devotion and love for God. I think I can relate this observation to scripture knowledge.

Ashok: Like what?

Gautam: In Geeta, for e.g. three ways have been defined to reach God, which now we can assume this to be the higher state of mind. Gyan yoga, Karma Yoga and Bhakti Yoga. Gyaan Yoga involves deep meditation, Karma Yoga involves doing one's duties without thinking about consequences and Bhakti Yoga involves complete devotion and love towards God. We have discussed examples of followers of each of these disciplines. I think things are getting in line now.

Ashok: Indeed! And I think in Karma Yoga, doing duties without consequences must have been stressed to remove any fear of failure so that mind can concentrate better on work.

Gautam: Yes, you are right. So we can conclude that there is some higher state of mind which has been attained by meditating saints, scientists and devotional saints. But (smiling), mystery of God continues my friend.

Ashok: It always will (smiling)! I personally believe that the concept of God must have come to de-stress people that there is somebody there to protect us, we need not worry.

Gautam: I don't know that but I know this for sure, sometimes it feels very relaxing to know that somebody up there is watching us and protecting us.

My white paper - Innovation for Growth and Role of Innovation Enablers

Accelerated innovation is less of an option and more of a necessity for growth. Fusing core products/technologies with unanticipated technological shifts has redefined the innovation process and has moved it beyond the environs of brick-and-mortar R&D labs.

Apple is considered one of the most innovative companies in the world today. Is Apple a strong technology innovator? Or, has it managed to transform itself by exploring innovations that are at the cusp of evolving, often unrelated, technologies?

In recent years, organizations are finding new ways to innovate successfully and frequently. Such organizations, often struggle with two key questions while embracing the culture of innovation. These questions are:

• Within an organization, whose responsibility is it to innovate?
• How can an organization constantly bring out new innovations, given the limitations of the internal R&D?

This paper aims to address the above two questions, and highlight the role of technology surveillance as an innovation strategy.

Download the white paper which I co-authored with Nitin Chaudhary.

http://sandhill.com/white-papers/innovation-for-growth-the-challenge-of-sustained-growth-and-the-increasingly-important-role-of-innovation-enablers/

An inspirational hindi poem - Haar Nahin Hoti

An inspirational hindi poem by Harivansh Rai Bachhan...

Source: http://www.4to40.com

Urinary Catheters - $2 billion problem waiting to be solved

Patients may be recommended to use Urinary Catheters if they are suffering from Urinary incontinence (leaking urine or being unable to control when they urinate) or Urinary retention (being unable to empty their bladder when they need to).

If we look at the big picture, and try to see this from a problem (urinary incontinence & retention) and solution (urinary catheters) perspective, we should strongly ask this question - Is this solution (Urinary Catheters in current form) a good solution? Are the patients completely satisfied? At the end of the day, a business is created and sustained as long as a better solution is provided to the customers.

There are mainly two types of urinary catheters – Indwelling and Intermittent. An indwelling catheter is the one that is left in the bladder and is for long term use (4-6 weeks). The catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out of the patient’s body. When the catheter needs to be removed, the balloon is deflated. First prototype of an Indwelling catheter was designed by a US based surgeon, Fredrick Foley, in 1930s and the catheter was named in his honour – Foley Catheter (see image of the basic design below). 

Foley catheters have been in use from last EIGHT decades now. According to a data, around 90 million Foley catheters are being used worldwide. It would have been fine if these catheters were a good solution and patients were happy and comfortable using it, which is not the case. Patients using these catheters report many problems the worst being urinary tract infections (UTI). Some of the additional ones are following –

•          Higher rate of stones
•          significantly increased risk of bladder cancer
•          odour, leakage
•          urethral damage

One could see a major attempt to solve this problem with a complete new solution in 1997, when a multidisciplinary partnership between academia and industry was set up to design and develop suprapubic catheters. The product however, is not prevalently used and it can be safely said that this solution failed to impress the patients/caregivers.

Intermittent catheters on the other hand are used when one needs to use a catheter sometimes. These catheters are removed after the flow of urine has stopped. Although, these catheters do offer a better solution compared to indwelling, it is still not a very comfortable solution as patients

•          have to monitor fluid intake
•          have to remember to catherize on time and adjust to fluid intake
•          may have to wake up at night to catherize
•          problems for those with limited hand function (elderly patients)

Despite of such problems, over 100 million intermittent catheters are used each year and they have been eating market share of indwelling catheters (which will still be used by the patients who cannot self catherize themselves).

If we look back in last eight decades, this space has seen very few innovations most of them are incremental (improvement in material, adding anti-infective agents, coating etc.). It seems that these are not enough. The patients have still lot of issues as they are still unhappy or uncomfortable with the current solutions (products). The big players should bring either breakthrough or disruptive innovations (What I mean by this) otherwise they are leaving a door open for small players & new entrants and the open door is unsolved problem and unsatisfied patients.

Urinary catheter market is around $2 billion. Small players/new entrants must have in their minds that it will be hard to capture a significant market share with “me too” products. If they can develop a good solution (probably a non-invasive one) then the opportunity is HUGE. 

Create your innovation ecosystem the iWay

Everybody in the technology and the business world has been astounded to see the growth Apple has seen in the last decade. Some say it is marketing, some say it the design brilliance, and a lot of people say it is the brilliance and vision of Steve Jobs. One of his brilliance was to create an innovation ecosystem around Apple’s products. He wasn’t content with only changing the music industry. He went on to change the mobile and computing industry as well. 

The graphic below will help us understand the innovation ecosystem better.

If we look closely, Apple did not start everything from scratch. They evolved iPod with flash memory and touch screen technology which were developed outside. Now, add a mobile phone and an internet communications device to iPod, you have an iPhone. Widen the screen of iPhone and increase computing capacity, you have an iPad. Usually, companies add features to their products, Apple added products (phone, tablets) to their existing features/technologies. Strange, isn’t it? Next in the ecosystem would be widely rumoured iTV? Very smartly, they created an innovation ecosystem and developed products that were disruptive for mobile and computing industry. Next in line is $100 billion TV industry.

May be some innovative organizations can take out some lessons from the Apple way (or iWay). First of all, the organizations need to have a vision, a vision that is not restricted by the existing limitations. The vision should be of an ideal product or solution in their domain. Once the vision is there, solutions should be looked both inside and outside the organization. One should be ready to go beyond their expertise and technology domain to bring the outside solutions and integrating them into their products. It might be a new product altogether.

Also, the organizations should think about creating an ecosystem around their existing products or solutions. If they modify their products a bit, can they solve some other customer need which is not their existing focus? For e.g. an insulin delivery device, if it is modified a bit, can it be used for diagnosis as well? Can it be used for delivering fluids during surgery? Can it be used for fluid extraction instead of delivery or both? Can it be used for delivering fluids in aerospace or auto industries where precision is the key? Possible I guess. If you could do that, you could create an altogether different market and create disruptive products.  

Start thinking about creating your own innovation ecosystem, the iWay.

J&J exists stent business - Lessons to be learnt

A  very nice article on how J&J missed the first mover advantage in stent business...twice!

http://www.medcitynews.com/2011/06/end-of-jj-stent-business-carries-lessons-for-medical-device-innovators/

Innovation Strategy – Are you ready for all types of innovations?

These are my initial thoughts on the points which should be taken into account when an organization is preparing their innovation strategy. I am sure with your discussions and inputs, these thoughts will get fine tuned over time.

I would like to define or classify different types of innovations as following :

As organizations increase in size, they should prepare themselves for all three types of innovations.  

Internal R&D team can focus on incremental innovations. Innovation managers, with broader outlook and diverse technical skills, should be responsible for breakthrough innovations. The managers should go beyond their technical domain and look for technologies which can be integrated with the existing product line. If we look at Apple products, they brought flash memory created by Toshiba for their iconic iPod. Then they integrated the touch screen technology and lot more. An organization should always try to make their product better and in addition to the internal R&D, they should keep on looking for technologies developed outside. The technologies which are difficult to integrate can be used to get inspiration for the product development by internal R&D team.

The job of innovation manager should also include tracking the alternative solutions that are being developed to cater the same need as of their products. Disruptive Innovations come as a real threat and can take you out of business. They are also generally not tracked much. However, they should be monitored on a frequent basis and their progress should be reported to the Strategy team for decision making. The key to success lies in identifying the successful innovations early and acquiring such companies.

This is just an overview. My next articles will discuss these thoughts in details with case studies. I welcome all the suggestions and inputs. 

Disruptive Innovations in Ostomy Care - Time we look at it?

Ostomy care market is currently estimated at $2 billion with about 1.5 million patients worldwide. Currently, about 90% of the market share is captured by three key players – Coloplast, Convatec and Hollister.

Ostomy care products revolve around ostomy bags/pouches and skin barriers. The products come with the features such as odour control, leakage, bag cleaning, adhesions and many more. This has been working well for the industry for quite some time and I wonder if this is the right time to think about alternative solutions as well.

One such solution has come from an Israel based startup, Stimatix GI. The company has developed a device named Artificial Ostomy Sphincter (AOS-1000™) that provides continence and bowel control to the patient without the need to wear a traditional ostomy pouch. This device is currently under clinical trials and expected to be launched in the market in mid 2012. The company claims to bag 15% of the market share within the first few years of commercialization.

This concept itself is not new. Artificial sphincters have been successfully used for fecal incontinence. However, it was difficult to replicate the same with stoma as there was the risk of ischemia and necrosis of the intestinal wall because of excess pressure. Stimatix’s device solves this problem by controlling the pressure exerted on the intestinal wall using pressure gradients.

Stimatix is not the only one. Another small firm, Zassi Medical (now Leto Medical) has been working on restoring bowel evacuation control by artificial stoma sealing devices. Alternatively, they are also looking at electrical and chemical stimulation of the intestinal musculature for temporary continence.

Interestingly, one of the key players, ConvaTec, also has a product in market which is on similar lines. The product, Vitalla Continence Control device, enables the patients to be continent for around 8 hours. The device uses pressurized chambers to avoid excess pressure on intestinal wall.

These disruptive innovations are knocking on the doors in Ostomy Care domain. It will be interesting to watch this space in next 2-3 years.  Will the big players be interested at this stage or they will be in wait ‘n’ watch mode?