All in all, the Chisti bottle-based ventilator shows what can be achieved by stripping an idea down to its basic principles. Effectiveness, it neatly demonstrates, need not always go hand in hand with high tech.
It's the typical path of "crude conceptual prototype -> complicated advanced solution -> highly optimized stripped-down late version" constantly seen in engineering, especially in software where iterations are fast.
I hope that much of today's advanced, complicated, and expensive tech will eventually make that next step to simplification based on huge accumulated experience and knowledge.
edit: though based on the abstract available at the URL, it's not clear to me which of the mentioned methods is the innovative one, if any (??)
edit 2: Found a youtube video with some actual description of how the machine is built, from the doctor himself, from 2015 (google keywords: "Chisti bubble CPAP"): https://www.youtube.com/watch?v=HM1E8yMJd5Q
It could also be the situation where the loss due to complications due to the equipment are far less than the loss due to the disease.
If you lose 10% to contaminated bottles, 15% to various malfunctions, and another 5% for things related to the procedure I can't even begin to consider, that's 30% mortality rate for this procedure.
But if another has 0% mortality rate but due to some other factor is not available in appropriate quantities, let's say there are only enough resources to service 10 cases a day, then your 11th case can either take a 100% mortality rate for doing nothing, or a 30% mortality rate with the other procedure.
You take the better chance.
Basically, they don't have access to ventilators. The current recommendation still has a mortality rate of 1:7 but the bottle method seems to be around 1:56 (if I'm reading that right).
So, the order of preference is ventilator, shampoo bottle, then low-flow oxygen. In other words, what I said. This is a case of not having access to the best method, but having something that works better than the other secondary methods.
This will not and should not replace ventilators in modern hospitals, but in places where ventilators are unavailable, this is a good solution.
The point dmix makes is that "a lack of regulation is saving lives". The device doesn't have to be tested, it doesn't require licensed operators, etc.
And I was agreeing that it is saving lives, but that it is not particularly indicative that regulation is killing people.
That the incident of a disease may be so prevalent or that access to modern hospitals may be so scarce that in certain cases, taking an unregulated approach is better than no approach.
This is in India. This would never be discovered in a developed nation because there is no need for it. A ventilator has a far better success rate. However, in India, in other developing nations, this is necessary. And the fact that it is simple to set up, that it can be set up by someone with little training, etc are all benefits in those situations. That even with what would be considered a pretty poor mortality rate, it's still better than the alternatives at their disposal.
You say, "A ventilator has a far better success rate." I am skeptical of this statement; what are your sources? I would expect this setup to have the same success rate as any other bubble CPAP machine.
it would be hard to cite source on a new device/discovery/method such as this as there would not be any.
The comment higher up the chain covered some of the potential failure methods of the new system.
If you lose 10% to contaminated bottles, 15% to various malfunctions, and another 5% for things related to the procedure I can't even begin to consider, that's 30% mortality rate for this procedure.
There's no reason to expect that those rates would be higher for this equipment design than for the $15000 one, rather than lower.
That comment also seems to demonstrate a fundamental lack of understanding of what's being discussed, since contaminated bottles are vanishingly unlikely to infect the patient — the air goes from the patient to the bottle, through a dry plastic tube, not vice versa.
You do understand the numbers and examples were made up to illustrate a point, that even if it weren't as good as a modern hospital that it's better than the current alternative.
You are, both literally and figuratively, looking at an example of survivorship bias.
Lack of health regulations can bring about low-cost innovations, but it also bring about all sorts of useless quackery. As a consumer of medicine, I'd first prefer the treatments being performed on me to be proven to work. If that's not an option, due to cost, or lack of data, that's another thing.
Absolutely, the humanitarian implications of making this widely available/accessible are tremendously positive (whereas your average brilliant idea may or may not ever see practical use and additionally the use it eventually sees may be a net negative for mankind on the whole)
Tu Youyou won the nobel prize in medicine for a recipe she found and worked on from nearly 1500 years ago. From Wikipedia:
its preparation was described in a 1,600-year-old text, in a recipe titled, "Emergency Prescriptions Kept Up One's Sleeve". At first, it was ineffective because they extracted it with traditional boiling water. Tu Youyou discovered that a low-temperature extraction process could be used to isolate an effective antimalarial substance from the plant; Tu says she was influenced by a traditional Chinese herbal medicine source, The Handbook of Prescriptions for Emergency Treatments, written in 340 by Ge Hong, which states that this herb should be steeped in cold water. This book contained the direction to immerse a handful of qinghao in the equivalent of two litres of water, wring out the juice and drink it all. After rereading the recipe, Tu realised the hot water had already damaged the active ingredient in the plant; therefore she proposed a method using low-temperature ether to extract the effective compound instead. The animal tests showed it was completely effective in mice and monkeys.
Breathing into water, per se, doesn't help. The air blown into the system is lightly pressurized, and this pressure helps inflate lungs just like inflating a balloon.
The water bottle is there because it's difficult to control the amount of pressure. Sinus tissues and lungs are very delicate, and pressurized air also messes with blood/gas ratios, so it's important to use the minimum pressure you can get away with. The bottle of water allows the pressure to be controlled simply and precisely, by adjusting the depth of the hose.
He and his team should be praised and prized for the achievement and results.
On the other side, this shows how slowly ideas can spread even in globalization times. I'm a pediatrician in Brazil and have used and been taught to use improvised bubble CPAP, with great results, since the nineties. I've heard reports of its successful use since, at least, the 80's decade.
I hope those devices can swiftly be fully scientifically validated and reach all needing regions of the world.
I am always amazed at the quality, intelligence and experience of HN readers on any topic you can imagine. I love being in a community where a pediatrician from Brazil can comment on a medical discovery. I’ll probably be downvotes for a silly comment but feel like HN elevates my life.
I'm always pleasantly surprised by this too. There are experts and hobbyist in every field in this community. It is one of the reasons why I look forward to the comments more than the articles themselves.
I don't know for sure, but I think two important factors are:
1) The lack of proper/popular communication channels between medical communities (apart from the academic ones)
2) The fact that these improvisations are often deemed as undesirable or inadequate (even shameful) without the due scientifical scrutiny, only because they are cheap or simple
I feel like there are deep implications in this article about healthcare costs.
If hospitals don’t compete on price, what really motivates them to find a cheaper ventilator?
If they aren’t all that motivated to find a cheaper ventilator, are the ventilator manufacturers motivated to develop a simpler and cheaper version of their technology? Not so much. They might be more motivated to lobby for regulations making cheaper solutions illegal to protect their business.
If a $15k hospital grade ventilator has a fifty year service life, perhaps the developed world sees little benefit to finding a cheaper ventilator, regardless of competition.
Agree that people like him should get more recognition, maybe even the Nobel Peace prize.
In reading the article, though, I don't think it took him 20 years to make it. Instead, I think it means he made a promise to do something about children dying from pneumonia and it took him 20 years to figure out how to do it. I base this on the following paragraphs in the article:
In 1996, Dr Mohammod Jobayer Chisti was working in the paediatric department of the Sylhet Medical College Hospital in Bangladesh. That evening he made a promise that he would do something to stop children dying from pneumonia.
When asked how he feels to be fulfilling that promise he made 20 years ago he replies: "I have no language to express this."
powerful, this puts everything i do in pale comparison, this person's acts are really changing the world and directly saving lives. i also don't see him trying to profit on this, but instead he's trying to replicate this work in another 3rd world country.
this does put a massive black mark on the medical device industry and medical industry as a whole, trying to profit off what should be basic needs of hospitals. in general, companies making profits is only natural, and some of their research does require heavy research funding, but to the extent where their pricing may be killing off people is a little contradictory. i imagine the device costs have been subsidized by some governments of rich countries, but these standards cannot be applied to all countries. this is certainly a political issue, where are all the funds for bangledesh heading?
this also reminds me of the efforts going on at fourthievesvinegar.org we need more open source medicine and medical devices, this seems to be a lot more meaningful than creating enterprise software or social apps.
In my experience, most facilities that have oxigen flow also have compressed air flow with cheap controllable fluxometers, but a blender is often lacking or too expensive.
In those cases we use a Y piece connecting air and oxigen flows to the inspirarory limb.
The role of the blender is to control the percentage of oxigen offered. With the Y piece we can control that by the equation:
%O2 = (O2flow + Airflow * 0.21) / Total flow
If you can use Total flow of 8L/min (reasonable in most cases) the approximations table below is of easy memorization and precise enough:
All in all, the Chisti bottle-based ventilator shows what can be achieved by stripping an idea down to its basic principles. Effectiveness, it neatly demonstrates, need not always go hand in hand with high tech.
Can't be said enough.
It's the typical path of "crude conceptual prototype -> complicated advanced solution -> highly optimized stripped-down late version" constantly seen in engineering, especially in software where iterations are fast.
I hope that much of today's advanced, complicated, and expensive tech will eventually make that next step to simplification based on huge accumulated experience and knowledge.
Last year's news: https://www.bbc.com/news/business-40498395
This article actually contains the link to the paper too: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... — though behind a Lancet register-wall apparently
edit: though based on the abstract available at the URL, it's not clear to me which of the mentioned methods is the innovative one, if any (??)
edit 2: Found a youtube video with some actual description of how the machine is built, from the doctor himself, from 2015 (google keywords: "Chisti bubble CPAP"): https://www.youtube.com/watch?v=HM1E8yMJd5Q
pdf of the paper : https://www.researchgate.net/profile/Mohammod_Chisti/publica...
This is news that lasts more than a year. It's nice to see that article, though, because it adds more background—thanks!
One of the situations where a lack of strict health regulations on medical devices is saving lives.
It could also be the situation where the loss due to complications due to the equipment are far less than the loss due to the disease.
If you lose 10% to contaminated bottles, 15% to various malfunctions, and another 5% for things related to the procedure I can't even begin to consider, that's 30% mortality rate for this procedure.
But if another has 0% mortality rate but due to some other factor is not available in appropriate quantities, let's say there are only enough resources to service 10 cases a day, then your 11th case can either take a 100% mortality rate for doing nothing, or a 30% mortality rate with the other procedure. You take the better chance.
Why should there be a loss due to a contaminated bottle when the children are only breathing INTO the bottle?
The bottle and the water in it are physically connected by tubing right into the patient's airways. Infection is definitely possible.
Most hospitals have access to an autoclave ! It seems trivial to sterilize the bottles
In USA the large companies who will lose profits from simple alternatives will make up reasons to not lose their profits.
What about in the EU?
From an article without a paywall:
https://www.bbc.com/news/business-40498395
Basically, they don't have access to ventilators. The current recommendation still has a mortality rate of 1:7 but the bottle method seems to be around 1:56 (if I'm reading that right).
So, the order of preference is ventilator, shampoo bottle, then low-flow oxygen. In other words, what I said. This is a case of not having access to the best method, but having something that works better than the other secondary methods.
This will not and should not replace ventilators in modern hospitals, but in places where ventilators are unavailable, this is a good solution.
Hospital-acquired infection is common enough.
I think there is confusion, on the videos and picture they are using medical equipment, it's just used in a different way.
The point dmix makes is that "a lack of regulation is saving lives". The device doesn't have to be tested, it doesn't require licensed operators, etc.
And I was agreeing that it is saving lives, but that it is not particularly indicative that regulation is killing people.
That the incident of a disease may be so prevalent or that access to modern hospitals may be so scarce that in certain cases, taking an unregulated approach is better than no approach.
This is in India. This would never be discovered in a developed nation because there is no need for it. A ventilator has a far better success rate. However, in India, in other developing nations, this is necessary. And the fact that it is simple to set up, that it can be set up by someone with little training, etc are all benefits in those situations. That even with what would be considered a pretty poor mortality rate, it's still better than the alternatives at their disposal.
You say, "A ventilator has a far better success rate." I am skeptical of this statement; what are your sources? I would expect this setup to have the same success rate as any other bubble CPAP machine.
it would be hard to cite source on a new device/discovery/method such as this as there would not be any.
The comment higher up the chain covered some of the potential failure methods of the new system.
There's no reason to expect that those rates would be higher for this equipment design than for the $15000 one, rather than lower.
That comment also seems to demonstrate a fundamental lack of understanding of what's being discussed, since contaminated bottles are vanishingly unlikely to infect the patient — the air goes from the patient to the bottle, through a dry plastic tube, not vice versa.
You do understand the numbers and examples were made up to illustrate a point, that even if it weren't as good as a modern hospital that it's better than the current alternative.
Discussing the minutiae is immaterial.
You are, both literally and figuratively, looking at an example of survivorship bias.
Lack of health regulations can bring about low-cost innovations, but it also bring about all sorts of useless quackery. As a consumer of medicine, I'd first prefer the treatments being performed on me to be proven to work. If that's not an option, due to cost, or lack of data, that's another thing.
If this is reproducible and legit I’d love to see him win the Nobel Prize in Medicine instead of the basic science people who usually win.
Absolutely, the humanitarian implications of making this widely available/accessible are tremendously positive (whereas your average brilliant idea may or may not ever see practical use and additionally the use it eventually sees may be a net negative for mankind on the whole)
Well, I think there's also a pretty great track record of basic medical research making it to practical use.
Tu Youyou won the nobel prize in medicine for a recipe she found and worked on from nearly 1500 years ago. From Wikipedia:
its preparation was described in a 1,600-year-old text, in a recipe titled, "Emergency Prescriptions Kept Up One's Sleeve". At first, it was ineffective because they extracted it with traditional boiling water. Tu Youyou discovered that a low-temperature extraction process could be used to isolate an effective antimalarial substance from the plant; Tu says she was influenced by a traditional Chinese herbal medicine source, The Handbook of Prescriptions for Emergency Treatments, written in 340 by Ge Hong, which states that this herb should be steeped in cold water. This book contained the direction to immerse a handful of qinghao in the equivalent of two litres of water, wring out the juice and drink it all. After rereading the recipe, Tu realised the hot water had already damaged the active ingredient in the plant; therefore she proposed a method using low-temperature ether to extract the effective compound instead. The animal tests showed it was completely effective in mice and monkeys.
[Dupe] of https://news.ycombinator.com/item?id=17931801
On HN it doesn't count as a dupe if the story hasn't had significant attention yet. This is in the FAQ (https://news.ycombinator.com/newsfaq.html). More explanation at https://news.ycombinator.com/item?id=16403654 and https://news.ycombinator.com/item?id=16344002.
Here's a schematic of how traditional bubble CPAP works: http://www.i-ma.com/images/INCA-Setup-Components.jpg
I didn't understand from the article about a "shampoo bottle with bubbles left in it". This diagram seems simple enough.
I can't even understand the diagram: how is exhaling into a glass of water supposed to make breathing easier?
Increasing the pressure in the lungs, by increasing the back pressure in the exhaled air.
Breathing into water, per se, doesn't help. The air blown into the system is lightly pressurized, and this pressure helps inflate lungs just like inflating a balloon.
The water bottle is there because it's difficult to control the amount of pressure. Sinus tissues and lungs are very delicate, and pressurized air also messes with blood/gas ratios, so it's important to use the minimum pressure you can get away with. The bottle of water allows the pressure to be controlled simply and precisely, by adjusting the depth of the hose.
My understanding is that having water at the terminal side of the air flow creates back-pressure, which helps prevent the lungs collapsing.
Is this sort of system used for gunshot or stabbing victims where the lung was punctured?
He and his team should be praised and prized for the achievement and results.
On the other side, this shows how slowly ideas can spread even in globalization times. I'm a pediatrician in Brazil and have used and been taught to use improvised bubble CPAP, with great results, since the nineties. I've heard reports of its successful use since, at least, the 80's decade.
I hope those devices can swiftly be fully scientifically validated and reach all needing regions of the world.
edited: grammar
I am always amazed at the quality, intelligence and experience of HN readers on any topic you can imagine. I love being in a community where a pediatrician from Brazil can comment on a medical discovery. I’ll probably be downvotes for a silly comment but feel like HN elevates my life.
I don't see how your comment is "silly".
I'm always pleasantly surprised by this too. There are experts and hobbyist in every field in this community. It is one of the reasons why I look forward to the comments more than the articles themselves.
That's surprising. Why do you think this kind of information diffuses so slowly?
I don't know for sure, but I think two important factors are:
1) The lack of proper/popular communication channels between medical communities (apart from the academic ones)
2) The fact that these improvisations are often deemed as undesirable or inadequate (even shameful) without the due scientifical scrutiny, only because they are cheap or simple
Reminds me of the great story of the ingenious baby incubator developed from Toyota 4 Runner parts: https://wheels.blogs.nytimes.com/2010/11/23/neonurtures-car-...
Absolutely brilliant! Take a bow, Dr. Chisti.
I feel like there are deep implications in this article about healthcare costs.
If hospitals don’t compete on price, what really motivates them to find a cheaper ventilator?
If they aren’t all that motivated to find a cheaper ventilator, are the ventilator manufacturers motivated to develop a simpler and cheaper version of their technology? Not so much. They might be more motivated to lobby for regulations making cheaper solutions illegal to protect their business.
And so forth.
Fascinating. Demoralizing.
If a $15k hospital grade ventilator has a fifty year service life, perhaps the developed world sees little benefit to finding a cheaper ventilator, regardless of competition.
I think this article forgets to mention it took him close to 20 years to make this.
https://www.bbc.com/news/business-40498395
People like him should win the Nobel Peace prize.
Agree that people like him should get more recognition, maybe even the Nobel Peace prize.
In reading the article, though, I don't think it took him 20 years to make it. Instead, I think it means he made a promise to do something about children dying from pneumonia and it took him 20 years to figure out how to do it. I base this on the following paragraphs in the article:
In 1996, Dr Mohammod Jobayer Chisti was working in the paediatric department of the Sylhet Medical College Hospital in Bangladesh. That evening he made a promise that he would do something to stop children dying from pneumonia.
When asked how he feels to be fulfilling that promise he made 20 years ago he replies: "I have no language to express this."
The article said the following:
After two decades of research, Dr Chisti has now come up with a low-cost device with the potential to save thousands of babies' lives.
powerful, this puts everything i do in pale comparison, this person's acts are really changing the world and directly saving lives. i also don't see him trying to profit on this, but instead he's trying to replicate this work in another 3rd world country.
this does put a massive black mark on the medical device industry and medical industry as a whole, trying to profit off what should be basic needs of hospitals. in general, companies making profits is only natural, and some of their research does require heavy research funding, but to the extent where their pricing may be killing off people is a little contradictory. i imagine the device costs have been subsidized by some governments of rich countries, but these standards cannot be applied to all countries. this is certainly a political issue, where are all the funds for bangledesh heading?
this also reminds me of the efforts going on at fourthievesvinegar.org we need more open source medicine and medical devices, this seems to be a lot more meaningful than creating enterprise software or social apps.
The shampoo bottle CPAP is described here in diagram form:
https://www.semanticscholar.org/paper/CPAP%3A-a-guide-for-cl...
In my experience, most facilities that have oxigen flow also have compressed air flow with cheap controllable fluxometers, but a blender is often lacking or too expensive.
In those cases we use a Y piece connecting air and oxigen flows to the inspirarory limb.
The role of the blender is to control the percentage of oxigen offered. With the Y piece we can control that by the equation:
%O2 = (O2flow + Airflow * 0.21) / Total flow
If you can use Total flow of 8L/min (reasonable in most cases) the approximations table below is of easy memorization and precise enough:
Edited:formatting