Stanford Whizzes Develop an Astoundingly Cheap Fix for Clubfoot | Hacker News Reader

Stanford Whizzes Develop an Astoundingly Cheap Fix for Clubfoot

wired.com

This passage:

> Before this brace becomes the standard of care, it will face challenges. In parts of Brazil, doctors often stay faithful to less effective solutions because they make more money delivering them.

Struck me as mildly derogatory; my impression (I'm not from the US, but I parse Wired as speaking from a US perspective) is that it's not ... completely rare to make that accusation for US doctors, too. :|

Of course, saying "this is a problem in Brazil" is not the same as saying "unlike in the US, this is problem in Brazil", but that's how I read it, for some reason.

Thanks for the note. Just FYI, I'm the writer and there was no malice intended in my description. The sense I got in the interview was that the medical system in Brazil is fragmented to a much greater degree than in the US/EU where national healthcare establishes a more uniform standard of care. Of course there are cases of this same behavior in the US, but I'd wager they're far more rare.

You can probably find Brazilian examples that have no direct equivalent in USA, but USA has plenty of cases of physicians: accepting large gifts from drug companies in exchange for prescribing certain drugs, ordering expensive tests to pay for expensive test machines, performing procedures based on cost rather than efficacy, etc. In future you're advised to write in a less biased manner, and to make fewer foolish wagers.

How much are you willing to wager? :)

There is no national healthcare system in the USA.

About 1/6th of the country is covered by Medicare. Medicaid covers another 20%+ and increasingly being nationalized. All told, we're looking at 1/3 of the US population's healthcare being paid for by the Government. The prices set by the government tend to drive the price levels adopted by the private payers. So while there is no NHS equivalent, the US government is critically important in the set up of the reimbursement structure.

Heh. Point. Let me amend that to - the majority of Americans are not covered by a national health care system.

The USA actually has one of the largest single payer healthcare systems in the world: The VA.

there is a national healthcare system, just not 'free' healthcare.

I'm from the US, and I got the impression that the passage was meant as an objective observation.

There are a lot of criticisms to be aimed at many levels of the US healthcare industry, and I don't think anyone would claim otherwise.

University of Iowa Hospitals and Clinics "whiz" Dr. Ignacio V. Ponseti developed this astoundingly cheap fix for clubfoot in the 1950s: http://en.wikipedia.org/wiki/Ponseti_Method

Of course, these guys are doing good work and don't claim to have cured clubfoot. But the Wired coverage is, unsurprisingly, sensationalized and misleading.

> Adding insult to injury, these thoroughly low-tech braces cost more than iPads, generally coming with a $300-700 price tag.

I think "astoundingly cheap" is the important part here. While the title might lead you to believe that these students came up with the idea for using a brace to fix clubfoot, the article itself doesn't give that impression. These students came up with a low cost implementation of the Denis Browne bar. This means that the Ponsetti method will be available to the masses. Since the brace they developed is more comfortable than other braces, and more like a toy, it will also lead to more effective treatment of clubfoot through better compliance.

It said elsewhere in the article that many braces were not well made with a doctor bending a metal bar over a chair as he gave the diagnosis. Does not compute.

The brace is part of treatment using the Ponseti Method. They talk about it in the video at about the 1 minute mark. It looks like what these guys have done is created an injection molded version of the Denis Browne Bar.

http://en.wikipedia.org/wiki/Denis_Browne_bar

Do you mean "this same fix" or do you mean "this other cheap fix"? Because they read to me as similar techniques but with drastically different tools, and the older treatment uses more labor and material (thus one would expect it to me more expensive.)

just googling "club foot brace" seems that there are similar solutions already out there and some look better at first look (not a specialist, so may be missing the point of Wired's excitement). Nothing in all these other braces looks like it costs much (i.e. BOM and manufacturing-wise). With regard to price to end-user, especially in US, - it doesn't matter whether your device costs $20 or $200 - it will be sold for the same $700, and thus expandable braces may be more cost effective because they minimize the occurrence of that $700 charge. Though, again, i'm not a specialist and may be really wrong - the guys most probably did improve the situation, just hard to see it behind the hype.

Excellent point, often when people talk about disrupting the medical industry, it looks like what they are really doing is making a similar product to what exists, but choosing not to collect the monopoly rent like other players.

Can we PLEASE stop posting sponsored ads from wired.com?

Surprised they didn't use 3D printing.

If you already have a form for the shape, casting is faster and easier.

And way, way cheaper for mass production.

True, but I don't think these are mass-produced (yet). One of the advantages cited was precise calibration of the angles for each user.

They did! The images featuring the more transparent plastic parts are actually 3-D printed models of the final design.

This is totally off topic, but the woman in the video, Chesca Colloredo-Mansfeld, has a really distinctive accent that I can't place at all. Does anyone recognize it?

Her facebook page says she attended college in Australia. But she has lived in the US ever since, so... a well-sanded Australian accent?

v cool

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