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An Inventor At Heart
A Heart Center for Excellence cardiologist and director of cardiac research at the Borgess Research Institute in Kalamazoo, Fischell’s focus is relentless: How can we do this better, faster, cheaper?
His name is on dozens of medical device patents, including a stent design purchased by Johnson & Johnson’s Cordis Corp., sold under the brand names Bx Velocity and Cypher and used in millions of arteries around the world. Cypher, a drug-eluting stent, generated about $800 million in revenue for Johnson & Johnson in the first quarter of 2008.
“He can’t sit still,” said R. Kevin Plemmons, Fischell’s friend and business partner.
“He’s always thinking, and he’s got lots of energy.”
To say the least. In his book-shelf-lined office that overlooks the hospital’s pastoral grounds, Fischell waved a thin nickel titanium wire in the air. At the end of the wire was a gold-plated tip, which fanned out like a mole’s nose, retracted into a tiny housing, and then popped out again.
This is the Ostial Pro, one of Fischell’s recent inventions. To the untrained eye, it’s just an expensive wire. To Fischell, it is a solution to a medical problem, born of his frustration with installing stents in hard-to-reach locations in the human cardiovascular anatomy.
“It’s a very simple device, but it allows placement of a stent at the origin of an artery,” said Dr. William Campbell of Borgess Cardiology Group and an investor in Ostial Pro Solutions, the Kalamazoo company founded to develop and market Fischell’s invention. “This little device helps you place it exactly.”Another project, which Fischell has undertaken with his father, Robert, and brother, David, both Ph.D. physicists, is the AngelMed Guardian System. Similar to a pacemaker, this device is implanted to monitor cardiovascular function. When it detects an electrical irregularity in the heart, it buzzes inside the patient’s chest. The patient then can call for help, and the device sends out a cellular signal to a trained operator. It’s like GM’s On-Star communications system for vehicles, but for heart patients, Fischell said.
“Within 90 seconds of closing off one of your heart arteries, the thing buzzes in your chest. … You push a button and the voice says, ‘Hello, this is John, your cardiac concierge. How are you doing, Mr. Smith? You’re now 90 seconds into a heart attack.’”
The “cardiac concierge” proceeds to call 911 and the patient’s cardiologist, and preparations for cardiac catheterization are launched at a hospital. And that’s the crucial point: The sooner a patient receives treatment to re-open a diseased artery, the better.
The average time between the onset of symptoms and opening a blocked vessel with angioplasty is five hours, Fischell said. But heart tissue can be destroyed within four hours, possibly leading to debilitating — and expensive — long-term congestive heart failure.
“The really exciting thing is that it’s not just picking up the big heart attack. It’s picking up the big heart attack two days before you have the big heart attack,” Fischell said, his voice rising for emphasis.
The device already has been implanted into 40 people and saved five lives, Fischell said.
Initial study is being conducted at five U.S. medical sites, including Borgess. A larger trial for Food and Drug Administration approval is scheduled to begin this summer. The Guardian may be ready for the U.S. market by late 2010.
“This is probably the most exciting thing we’ve ever done,” he said. “This is big. This is very big.”
Fischell said he doesn’t remember the day he cooked up the idea for the Guardian system with his father and brother, with whom he also shares the patent for the drug-eluting stent.
He was born 52 years ago, the middle of three sons of Robert and Marian Fischell, in Silver Springs, Md. Robert Fischell worked for the Naval Ordinance Laboratory and then for the Johns Hopkins Applied Physics Laboratory. His work included development of satellite stabilizing and global positioning systems. He then turned his attention to medical devices, inventing a rechargeable pacemaker, the implantable insulin pump and an early warning system for epileptic seizures.
After a radioactive stent invention didn’t take off, Robert Fischell and his sons sold the rights to their design to Cordis, which based its drug-eluting stent Cypher on it. The payoff from that patent and others allowed Robert Fischell, now 78, to donate $30 million to establish a biomedical engineering department at the University of Maryland. The Sapling Foundation awarded him the TED Prize, which honors innovative ideas, in 2005, the same year it was won by rock star Bono.
“He’s instilled in us the thought that when you see a problem, don’t say, ‘Damn it, that’s really a tough problem. I wish that problem would go away,’” said Tim Fischell. “The way we think is, ‘That’s a tough problem. That’s an opportunity.’”
The Fischells have been working together on medical device inventions since the mid-1980s, with Robert and David providing the engineering know-how and Tim providing the medical and research prowess. Family Thanksgiving gatherings are as likely to produce four or five ideas for new inventions as they are turkey leftovers, Fischell said.
“They all share that same passion about bringing devices to the market to help people,” said Plemmons, who is CEO of Ostial Pro Solutions and has vacationed with the Fischells. “They push themselves as to who can come up with the next big idea. When you get them in a room together, it’s like a thunderstorm.”
Yet, David Fischell said, he and his two brothers grew up without paying much attention to their father’s ground-breaking work. “We didn’t think about it much. We were all pretty focused on the things you have to do as a young person growing up,” he said. David Fischell is chief executive officer at Angel Medical Systems, the New Jersey company founded by the Fischells to develop and market the AngelMed Guardian System.
He said his brother was inspired to become a doctor by their mother’s uncle, Dr. Samuel Standard, who emigrated in the early 20th century from the Ukraine to New York and became a vascular surgeon in New York City.
“Uncle Sam used to visit us, and really inspired Tim,” David Fischell said. “He was like 8 when he decided he wanted to be a doctor.”
Tim Fischell graduated in 1981 at the top of his class from an accelerated medical program at Cornell University in Ithaca, N.Y., after studying neurobiology and psychology as an undergraduate there. He was an intern and resident at Massachusetts General Hospital in Boston before moving to Stanford University in California for an interventional cardiology fellowship. He then became director of interventional cardiology and research at Vanderbilt University in Nashville.
Campbell recruited Fischell from Vanderbilt — where, Fischell said, he was unhappy with restrictions on his device work — to Borgess Hospital in the mid-1990s.
“We were looking for what we considered one of the top 20 cardiologists in the nation to come to Borgess and start a research program,” Campbell said. “I flew down to Vanderbilt to meet him. We offered him a research position with an animal lab and the ability to do both human and animal research. We pretty much gave him a blank slate as far as what he could come up with.
“It was right at the time they were negotiating with Cordis regarding the stent. We were very fortunate at the time that he came here.”
Borgess was the fifth hospital in the U.S. to host a balloon angioplasty procedure when it was first introduced more than 20 years ago. Campbell said when stents came into use in the 1990s, Borgess wanted to be at the forefront of that trend, too.
“How many private hospitals have a department of cardiovascular research like this? Like, almost none,” Fischell said. “This is a very unusual situation. I saw that unique potential for me to do what I love to do with less hassles than a university.”
One of the challenges in luring Fischell to Kalamazoo was promising the right pigs for his research, Campbell said. Southwestern Michigan hosts plenty of pig farms, so, he said, he called one of them and was referred to MPI Research, which pointed him to the proper porcine. “They are a special breed,” he said. “They’re shipped from afar.”
The 15,000-square-foot Medical Device Research Lab, located in Portage, today employs 17 people.
Doctors who invent medical devices are a special breed, as well, said Mark E. Brager, director of communications for the Advanced Medical Technology Association, a trade association for medical device manufacturers.
“Some of the most innovative ideas in medical technology come from physicians,” Brager said. “They are the ones on the front lines, working with patients. They see a clinical need for the right tool or that a more effective tool needs to be made, and they take it on themselves to do so.”
Inventing is not all that Fischell does. He performs about 400 stent procedures a year in Borgess’ cardiac catheterization labs, one of which was donated by he and his wife, Dr. Anne Fischell. He has a role in 36 research studies now underway. As a Michigan State University professor, he is director of an interventional cardiology fellowship program. He has delivered dozens of lectures around the world, published dozens of articles and book chapters, reviews articles for 15 medical journals and sits on the editorial boards of two.
Never still, Fischell loves sports. He has run marathons in New York City and Boston, swam competitively, skiied and played tennis and basketball. Then his knees gave out, and he underwent three arthroscopic surgeries on the right one. Now he plays golf. “Golf is one of my absolute obsessions,” he said. Recently he played the course at Augusta National.
“He encouraged me to pick up golf,” added David Fischell, noting that growing up, the brothers vied fiercely in tennis and ping pong. “I said, ‘The last thing is I need is another sport that you are better at than I am.’”
Tim and Anne Fischell live in Kalamazoo with their three children, 17-year-old twins, Evan and Jonathan, and 6-year-old Emma.
“He’s a real generous person. He gives his time and he gives financial assistance,” Plemmons said, noting that royalties on patents have provided Fischell with a comfortable income beyond the typical doctor’s compensation. “He’s a really good doctor, compassionate with his patients.”
Fischell said he plans to leave Borgess to return to Stanford University in California within the next several years, perhaps as early as 2009.
“This is the best job I’ve ever had,” Fischell said. “I’ve been here 11 years, and it’s been just fabulous.”
The legacy of Fischell’s tenure in West Michigan may echo that of orthopedic surgeon Dr. Homer Stryker, who founded Kalamazoo’s $6 billion Stryker Corp. in the 1940s on the risk of his own inventions.
“I am passionate about what I do,” Fischell said. “Doctors need to focus on the target, and the target is the patient. Is that a maverick? If it is, I’d like to lead the charge of mavericks of doctors who care about their patients first.” HQX