Ear it comes

“I’ve become pretty good at looking at my inner ear,” Erik Douglas grins. You could be forgiven for thinking this is a contortionist showing off his latest skills, even as you wonder just how that would be possible. Then, Douglas deftly snaps on a small conical plastic piece to the back of his iPhone case and inserts it into his ear. On the screen, facing us, pops up a circular image of a pale, stretched membrane — it’s his ear drum. “This is what a healthy ear drum looks like — I’ve also become an expert on healthy and unhealthy ears,” he says.

Not exactly the area of expertise you’d expect from an electrical engineer-turned-bioengineering post doctoral student-turned-entrepreneur. But then, for the past year and more, the 33-year-old has been working on the Cellscope Oto, an iPhone attachment that transforms the smartphone into an otoscope, used by doctors to look inside ears. His three-year-old start-up, Cellscope, is preparing for the commercial launch of the device next year, even as doctors across the US have been clipping the Oto onto their phones for the past several months as part of an alpha testing programme.

And while it’s still very early days yet, Douglas already has plans to introduce an array of devices using the smartphone platform. “We want to develop a digital first-aid kit with specialised ear, skin and eye devices. When someone’s unwell at home, we want you to just reach for the kit, clip on the appropriate device [to the phone] and collect images,” he says.

Cellscope didn’t start out with a mandate to peek into people’s ears. Rather, it is the outcome of an exam question posed in 2006 by Daniel Fletcher, a professor of bioengineering at the University of California, Berkeley, to his undergrad optics class — how could an ordinary cellphone be made into a microscope? By the time Douglas joined the professor’s post-doctoral class in 2009 (co-founder Amy Sheng came on board the previous year as a project manager), Fletcher and his students had already pioneered cellphone microscopy and were examining the medical possibilities of portable microscopy, with projects in Africa and India.

Recalling testing the device in hospitals in Congo, Douglas says, “We were able to offer new diagnostic services to meet an important healthcare need. That was very exciting.” It was also a business opportunity waiting to be seized — “Mobile phones are proliferating and getting smarter. They can be a terrific asset to meet healthcare needs around the world.” The following year, Douglas and Sheng spun off Cellscope as a separate company, based on the technology they had helped refine at the Berkeley lab.

Paging Dr Mom

While the Cellscope team had taken on licence the technology from Berkeley, they weren’t certain what would be the most commercially viable product for the company. For the next several months, several ideas were tossed around, including blood analysis. Ultimately, the founders zeroed in on the otoscope as the company’s first product, a field where they felt “a small start-up could make a big impact”.

A smartphone-based otoscope is certainly less complicated than, say, a tuberculosis diagnosis system, which was one of the projects initiated at the lab. But that wasn’t the only reason. Ear infections are the most common reason for visits to the paediatrician in the US — research says over 90% of all children in the country will have an ear infection before they turn seven. Ear pain accounts for some 20-25 million doctor visits every year, says Douglas.

With the Oto, parents can capture images of their child’s inner ear and transmit them over a secure server to the doctor who, based on the images, can decide whether or not to call in the patient for treatment; videos can also be made and records saved for comparison. “Such a device can save parents taking time off from work to take the child to the doctor, and perhaps even catch infections at an earlier stage, avoiding antibiotics when not strictly necessary,” Douglas says.

What furthers his confidence about a potential market for the device is the growing popularity of mHealth services. According to a report by consultancy firm research2guidance, the market for mHealth services will reach $27 billion globally in 2017, from an estimated $718 million in 2011. The report adds that in the next five years, 84% of mHealth app revenue will come from related services and products, while only 9% will be from direct app downloads. “Simpler devices are an important first step in building trust that smartphones can take diagnostic-quality images. This is also one way of avoiding going to the hospitals for a simple test,” says Dan Fletcher, professor of bioengineering, University of California, Berkeley.

Health-related iPhone attachments are slowly coming into the market for ECG and blood monitoring, but Cellscope’s “first-aid kit” will be the first of its kind when it is launched. Still, it will be over a year before Otos actually reach medicine cabinets in American homes. With over $2 million in seed funding — from Khosla Ventures and grants from various organisations — the first commercial production of the device is currently underway. But this is targeted at the medical community and pilot consumers; a full-fledged commercial launch won’t happen before end-2014.

A recent study by the Atlanta Pediatric Device Consortium compared the device favourably with standard digital otoscopes, an endorsement Douglas hopes will drive user adoption. Retail cost will also be a critical factor with the otoscope to be priced under $200. Cellscope is also considering a business model where the company will help home users connect with independent, on-call doctors, who could provide diagnostic services based on the images; the revenue-sharing details of such an arrangement are currently being worked out.

Why Cellscope is optimistic

There’s a growing interest in mHealth 

Cellscope’s next device planned is a dermascope, which can magnify skin lesions, moles and rashes. It is still in development, but as an extension of the same technology platform, perhaps it and other extensions — for the eyes and throat, among others — won’t face the same hurdles the otoscope did. At the Berkeley lab, Fletcher, too, is working on mobile-based diagnosis of tuberculosis, blood diseases and oral cancer, apart from sputum analysis and an ophthalmoscope. “My hope is that what we are working on currently are devices that Cellscope or others can commercialise,” says Fletcher. “As academics, we need to do sufficient R&D to show that the technology platform is robust enough and then the companies need to decide in which area the market is most accepting of such diagnostic screening.” 

Background noise

So far, the biggest obstacles the Oto has faced have been technological. Douglas points out that the hardware development alone has taken months — the original prototype had an external calibration system and additional clunky components, very different from the current sleek cone and case. “We’ve also worked around the illumination system, using fibre optics to draw the light of the phone’s LED flash so that the device doesn’t need separate charging,” he adds. “The optical system inside has several lenses — it’s much more complex than it looks.”

Similarly, Oto’s addressable market is deceptively accessible. “It will require changing people’s perspective on where healthcare information is gathered — at home or by a nurse-practitioner, rather than in a hospital setting,” Fletcher points out.

There’s also the fact that Cellscope is currently working only on the iPhone — a premium, expensive gadget by itself. Operating systems such as Android, in contrast, offer far greater choice across price points and device sophistication. Douglas concedes the point. “We just picked a handset and have optimised our device for that. But yes, to capture a wider market, it would be interesting to work on other phones as well.”

Capturing a wider market is certainly part of Cellscope’s gameplan. The original, high magnification technology created at Berkeley labs — and its focus on emerging economies — hasn’t been forgotten. Cellscope wants to market its devices around the world as well as launch other applications in the next five years. Says Douglas, “This is not just a way for rich people to get care faster. We want to create ways to deliver healthcare better, not just a little faster or a little cheaper. We can do that by taking a common device, building in new capabilities and offering it as an extension
to healthcare.”