Democratizing healthcare scan by scan

A Q&A with Butterfly Network & Abdul Latif Jameel Health on their new distribution partnership for the Butterfly iQ+ handheld imaging device

More than 4.7 billion around the world lack access to medical imaging[1], from underserved communities in the United States to remote areas of Africa.  The Butterfly iQ+ – the world’s first single-probe, whole-body, handheld imaging device – aims to remedy this situation. 

Fusing semiconductors, artificial intelligence, and cloud technology, Butterfly has made it possible to usher in a new era of medical imaging and with it, healthcare from a device that costs less than US$ 2,400 (in the USA).  The product is designed to dramatically help trained practitioners who need to quickly assess a patient’s condition and provide clinical answers faster and has the potential to expand the capabilities of practitioners working outside of hospitals in developed, underdeveloped and remote areas.  Healthcare providers can collect advanced imaging, perform rapid assessments, and guide critical procedures no matter where they are, and share those images seamlessly with doctors across the globe to help with reading and interpreting scans as needed.

In October 2021, Abdul Latif Jameel Health and Butterfly Network Inc. announced an exciting new strategic collaboration  for the distribution of the Butterfly iQ+ to developing markets across the Middle East, North Africa, Turkey and. 

We spoke to Dr John Martin, Chief Medical Officer, Butterfly Network, Akram Bouchenaki, CEO Abdul Latif Jameel Health, to discuss the groundbreaking technology and the shared objectives behind the collaboration.

Can explain the background to Butterfly iQ and where the idea came from?

JM: The idea came from the founder of the company, Jonathan Rothberg.  He is probably best known for being the father of next-generation DNA sequencing.  He is also a serial entrepreneur in the MedTech field.  Jonathan always starts his companies around something he is passionate about, where there is the clear potential for things to be done differently.  He has a daughter born with a congenital problem that required a combination of imaging and high-frequency ultrasound treatment. 

In the process of taking her through that treatment, he recognized what an issue it was to get access to ultrasound scanning.  That gave him the idea and the motivation to come up with something better.  So, he recruited some exceptionally talented researchers from MIT and got to work. 

One of the biggest challenges was figuring out how to get imaging technology onto a chip.  That alone took seven years, but it was the transformative change that laid the foundations for Butterfly solution. 

Why was getting imaging onto a chip such a crucial starting point?

JM: Every other ultrasound system in the world is built on piezoelectric crystals, basically tiny rocks.  These crystals are shaped in a format to create an ultrasound beam, and you need different crystals to form different shaped beams and different frequency of beams. 

This is why every other ultrasound system in the world requires multiple probes, and sophisticated signal processing to analyze the signals from those different probes, and so on.  This is the way it’s been done for 50 years.  What we wanted was a single device that could scan the full range of different applications, so different configurations, linear, phased, and curved array, and a full range of frequencies, so you could scan the entire body with one device.  That was the challenge in a nutshell.

Butterfly uses a technology called CMUT, which stands for Capacitive Micromachined Ultrasound Transducer.  .  It took a combination of tireless persistence and some really smart people in chip design and imaging to finally make this work.

Why is this so important?  If we think about the way we access imaging today, imaging is a process we order and, more often than not, a location you’re sent to, in order to get a scan.  This introduces the element of time. 

As a doctor, I can’t start your treatment until I know what’s wrong with you.  Butterfly puts an advanced assessment tool in clinicians’ pockets that enables them to answer those questions right away, so they can start the treatment plan much more quickly.  

What are some of the applications where this technology can really make a difference?

JM: I believe this technology could be a step-change in how we address health inequality around the globe.  Two-thirds of people in the world have no access to medical imaging.  Every 90 seconds a mother somewhere dies from the complications of childbirth[2].  Around 700,000 kids die every year from complications of pediatric pneumonia.[3] 

These are things that could be solved if simple imaging was available anywhere at any time. 

Now, with an affordable ultrasound device coupled with a very simple smartphone, you can get imaging to places where it’s not been possible before. 

We’re not only talking about developing countries.  I was in an emergency room in the United States showing our device to some physicians.  A patient came in in full cardiac arrest on a CPR machine.  They wanted to put a catheter in to put them on heart bypass, so they used the Butterfly iQ+ to guide the catheter into the blood vessel and up to the right position in the heart.  It was the first time the doctor had ever seen the device, literally minutes before, and he was able to use it effectively. 

What attracted you to the collaboration with Abdul Latif Jameel Health?

JM: Part of the challenge we have is the geographic reach.  How do you get this device – and the power of this imaging – out to the people who actually need it?  Who can use it on their patients?  Who can spread the message? 

There are 40 million healthcare workers around the world who need our device.  This is the stethoscope of the future, because it’s simple enough that any trained healthcare practitioner can learn it.  We’re developing artificial intelligence tools to make it even simpler and easier to use and interpret.  We need partners who can help us deliver this to the people that most need it, and that’s something that Abdul Latif Jameel Health do remarkably well.

Akram, from your side, what is it about Butterfly that aligns so well with the overall mission of Abdul Latif Jameel Health?

AB: Butterfly is a great example of what we are trying to achieve at Abdul Latif Jameel Health.  It is a technology that will have an immediate and profound impact on healthcare globally.  I was talking to John the other day and he explained Butterfly perfectly.  He said, “As physicians, we used to listen and guess.  Now we can see and know what’s inside the body.”

The mission that is so clearly driving the development of Butterfly Network and the innovation on display is entirely aligned with our vision, of how to improve access to healthcare for those who need it most and drive inclusive healthcare through innovation. 

It is not about selling a new gadget.  It’s about showcasing a device that will profoundly impact the way medicine is practiced. 

The capabilities of this small, agile handheld device know no bounds and we are committed to delivering this technology to serve communities of over 2 billion people across the Middle East, Africa, Turkey and India.  It is our mission to collaborate with sector disruptors – those who question how healthcare services have traditionally been delivered, and how the billions of people in underserved communities can be better served.

Why did you decide to focus on the markets of the Middle East, Africa, Turkey and India?

AB: These are large territories, with huge disparities in medical infrastructure.  India, Turkey, the UAE, for example, they all have very different infrastructures, volumes of patients, disease profile and epidemiology.  But for all of these markets, the Butterfly probe presented, introduced, commercialized properly will bring massive benefits to numerous patients and hope to their families.

JM: Building on what Akram said, there is such a great need in these territories.    Butterfly’s mission is to democratize medicine.  Wherever there’s a clinical need, we want to be.

It’s not about turning every doctor into an ultra-sonographer.  The point of this device is that you don’t need to be a sonographer to use it or to understand the information it provides.  It’s about clinicians having the right information at the right time to make a quick decision, and it removes the barriers – like affordability and availability – of having access to that information. 

Who do you see as the primary users of Butterfly?

JM: It addresses a very broad audience.  The emergency room doctor, the cardiologist, the orthopedist, the obstetrician-gynecologist, for example.  But we’re also keen to put this device – not least because it’s so affordable – into the hands of medical students and nursing students, to help them through their training and familiarize them with ultrasound imaging, so they become expert users as they grow throughout their learning careers allowing Butterfly to become part of the way they practice medicine.

Abdul Latif Jameel Health has decades of experience in the Middle East, North Africa, Turkey.  How are you hoping to leverage that experience to get the Butterfly iQ+ out to the market?

AB: Our goal is to be a partner to Butterfly that allows them to reach a broader audience by amplifying their message and opening new channels in these markets.  The deep understanding that Abdul Latif Jameel Health has developed over the last 75 years in the region means we are well placed to manage the introduction of new technologies, leveraging our past experience with different functional areas, dealing with different organizations, the different policies and the complexities of each market. 

We deal with this complexity to make sure the device gets into people’s hands quickly and affordably.

The digital infrastructure in some of the target markets will be very variable in terms of scale and quality.  Could that be a problem for the take-up of Butterfly iQ+?

JM:  Definitely not.  One of the benefits of Butterfly is that it doesn’t need a big digital infrastructure to work.  Of course, there are various different levels it can operate at, with increasingly sophisticated functionality.  But at its most accessible level, it can still answer complex clinical questions in the middle of nowhere.

There is a Butterfly on the space station right now.  It’s been in extreme environments with the military.  All you need is power and a smartphone to plug it into, so it is ideally suited to remote locations. 

This collaboration with Butterfly is the latest in a series of collaborations & partnerships for Abdul Latif Jameel Health.  How does it fit into the portfolio of technologies you are building?

AB: It’s a really important collaboration for us because it is such a breakthrough technology.  It is such an advance in the medical imaging space, so we’re focusing a huge amount of energy and infrastructure around the Butterfly probe to make sure it gets the best possible launch and introduction into markets.  It will sit alongside other exciting products in our portfolio like the exoskeleton of Cyberdyne, the mobile fetal monitor of Melody International and the extended reality surgical support technology of Holoeyes, with more to come in 2022, as a centerpiece in our commercial strategy for driving health inclusivity in the Global South.

Do you see a time when ever doctor will have a Butterfly in their pocket?

JM:  Yes, 100 per cent.  Already, medical schools across the United States are providing all of their students with Butterflies, and many of them in the first year.  They are learning from the beginning of their careers what this technology can do and how it can help their medical practice.  If we can all carry something that looks inside the body and have the knowledge and expertise to capture and use those images, it’s not a question of should we do it. The bigger question is, why wouldn’t we?

AB: An added benefit is the affordability factor.  The Butterfly is deliberately priced to be as widely accessible as possible.  It is magnitudes cheaper than a traditional ultrasound machine, which is another key driver for mass adoption.  That’s why it’s so easy to put it in students’ hands and help to democratize this area of healthcare.

The Butterfly probe is part of a new wave of advanced MedTech that’s transforming healthcare. How do you see the sector developing over the next few years?

JM: The digital transformation of healthcare could not be more exciting.  It will enable us to detect diseases earlier and earlier in ways that are cost-effective and safe.  The earlier you diagnose anything, the better it is in terms of outcomes, and the more cost-effective it is. 

This is an area where MedTech has the potential to make huge leaps forward and it’s an incredibly exciting time to be involved.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704652/#R3

[2] https://www.amnestyusa.org/themes/womens-rights/maternal-health/

[3] https://www.who.int/news-room/fact-sheets/detail/pneumonia