A new frontier for smart active implants

by John Genova | Nov 13, 2023

To my mind, there are two types of medical implants; ‘smart implants’ and the set and forget ‘dumb’ implants. Some sit in the body, functioning as designed, but doing nothing more. Take, for example, a humble, yet vital stent. It’s a dumb implant, right? It is just there, doing its job.

But what if that stent could become smart? If it could measure, say, blood flow in an artery and then send the data to patient and clinician. Highlight issues before they became problems. Then that simple stent would become a smart implant. Going even further, what if that same stent could not only measure blood flow but also do something about it? If it could trigger actions within the body to improve the flow if needed? Then you would have a smart implant that is operating a closed loop system, both monitoring and regulating within the patient’s own body. All that the patient would know is that they felt healthy and were able to get on with their lives.

It’s no exaggeration to say that right now we are on the brink of this edgy technology becoming commonplace. Smart active implants are, in my opinion, the new frontier in medicine. The possibilities offered by such medical devices within a patient’s own body are game changing. Implants could soon improve and, indeed, save lives on a dramatic scale.

Take pancreatic cancer, for example. Usually a silent killer, it rarely shows any symptoms until it is too late. But what if people with a family history of the disease could have medical implants within their pancreas, waiting like a military sentry, ready to raise the alarm? Then pancreatic cancer could be caught early, treated and, in many cases, survived. Whereas today, it is all too likely to be detected late, when the chances of recovery are slim.

Smart active implants team

I have headed up the smart active implants team at Cambridge Consultants for over 15 years and in that time, we have achieved remarkable advances. Our incredible engineering team were the first medtech company to successfully place Bluetooth communication technology deep into the body by using bone, muscle and fat to accentuate the antenna signal. This became a game changer; our team enabled a medical implant to communicate directly and securely with a patient’s smart phone from deep inside a body. This opened one of the many doors that enabled edgy implant development.

Our industry has already made so many breakthroughs. But I believe we have only just scratched the surface of what is possible. In the same way that a modern car can sense if it is raining and activate windshield wipers accordingly, I believe that in the future, implantable medical devices will gather information within the body and act on it. Implants will regulate processes within the patient automatically, giving them more freedom and better health than ever before.

So, what is holding us back? The standout issue is, of course, funding. The question is, who will pay to explore this exciting new world of medical possibility? If a dumb stent cost let’s say $100 and a smart one costs $150, who will pay for that? Is it something that governments, insurance companies and patients themselves want enough to pay a premium for? The information gathered by a smart implant must be of value and actionable, otherwise there is no financial incentive in gathering it.

Right now, A significant roadblock to progress that we are addressing at CC is the longevity of devices. No-one is going to accept and pay for a small smart sensing implant that only lasts six months to a year due to its inability to withstand the harsh environment of the inner body. The device needs to go safely into the body and function there for years. To this end, we are working hard on the issues around protecting the sensors and the difficulty of powering and charging smart implants. Another key aspect is miniaturisation, which we are also addressing.

Not only do smart implants need to be unobtrusive within the body, but they also need to require less power to work. Possibly harvesting energy internally or even by motion could be a breakthrough that changes the way implants are designed. Again, we look at the automotive industry in the way they have increased miles per gallon (MPG) by becoming more efficient through technological advances and aerodynamics.

Knotty as those practical issues are, I believe they will be overcome. The medtech industry is on the edge of a huge leap forward. I am reminded of what automotive genius Henry Ford said about his customers in the last days of horse-drawn carriages: “If I ask my customers what they want, they will say a faster horse.” People did not know they needed a car, until he offered them one. In just the same way, the world’s largest computer firms scoffed in the 1970s when Steve Jobs and Bill Gates predicted a time when every home would have its own computer. Who knew what a good investment Apple stock would have been back then?

Tiny but effective active implants

I truly believe that today’s space race is happening now, it is not an outer space race, but rather an inner space race within the human body. Just think what could be achieved if we were able to have tiny but effective implants which both spot and solve health problems almost before they start. The lives that will be saved, the quality of life that will be enabled. If, say, someone with epilepsy had an implant that spotted the signs of an impending seizure hours or even days before it happened, then they could take action to prevent it taking place at all.

What is needed now is the sort of vision that President Kennedy had in the early 1960s, when he announced that the USA would get a man on the moon by the end of the decade. To achieve that, a new sort of industry was created for the space age. NASA was formed, uniting transportation, rocket science and communications to name a few. Disciplines which before then had never worked together were brought under the same roof. The results, as we know, were extraordinary.

Working as I have for so many years in the medical device industry, I am acutely aware of the stumbling blocks ahead. A major one is the appetite for risk. Medtech companies are generally fairly risk averse and do not readily spend millions on research only to see it fail. This contrasts strongly with pharmaceutical firms, who are used to doing just that. Their acceptance of failure is far higher, because the rewards are potentially so great. Somehow, we must get some of that pioneering spirit into the medtech space, so that projects become more ambitious, and we no longer play it guarded. We must overcome the fear of failure.

To free up thinking in this way takes funding and a lot of it. The medtech industry needs investment and serious amounts of venture capital. For this, we need to look to Wall Street and convince investors of the incredible potential on offer right now (think Steve Jobs and Bill Gates in the 1970s). We also need our very own NASA, by which I mean disparate industries working together. The automotive industry, with its expertise in creating closed loop systems in cars, has so much to offer medtech. Add to that the financial clout and ability to manage risk of the big pharmaceutical companies and we could really see some progress.

We will need innovative medical engineering and above all, biologists. Beyond that, these new smart devices will need an ecosystem of their own in which to flourish, which will take computing skills, AI and machine learning to a new level. Unlocking tremendous growth and opportunity. But the real winners will be those whose lives will be extended by early detection or enabled a better quality of life.

If we can get all this expertise working together, we will create active implantable medical devices that can truly enhance and save lives. I believe that within 15 years smart active implants will have transformed the medical world beyond all recognition. This is certainly a very exciting time to be working in the medtech inner space. I look forward to being amazed and impressed in the coming years, hopefully sooner rather than later.

Expert authors

Senior Vice President, Commercial Head Smart Implants | View profile
John is a Senior Vice President and the Head of Neuromodulation here at Cambridge Consultants.

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