After my morning in central Lund, I walked to Medicon Village, the life science research park on city’s outskirts. I was there to meet with Mårten Svensson, the CEO and founder of Emmace Consulting, a company that tests inhaler performance. In the development timeline of inhalation products, they are the step before clinical studies with real humans. Though focused on the chemical efficacy of inhalers rather than end users, Emmace was still an interesting company to learn about.
When I described my Watson project to Mårten, his initial reply was, “We call these human factors.” It sounds so obvious, but it’s true, and it’s a phrase I haven’t been using when describing my project. My research questions are very related to the field of ergonomics and human factors; design that is focused on the user’s comfort and happiness (user-friendly products).
However, Emmace does not meet with end users or asthma patients. They work with companies developing inhalers, testing those inhalers to make sure that they will deliver the appropriate amount of asthma medication to a patient’s lungs. First, Mårten and I discussed the goals when designing an inhaler. Using an inhaler is all about the number of steps it takes for the user, so the goal when creating a new inhaler is to minimize the number of necessary steps. Today, an asthma patient can pick up their inhaler, open it (remove its cover), and inhale; there are no solutions with fewer than 3 steps. Some inhalers require 10 steps, such as the ones that use a capsule in a blister pack, which you must open by piercing with a needle and put in the inhaler before using it.
Most inhalers, including the ones we see all over the US, require 4 steps: pick it up, remove the cover, shake it, and then inhale. I’ve seen many people go through this process, but for some reason I remembered it as two steps – picking up and inhaling – without paying attention to the cover-removal and shaking. Once Mårten mentioned them, I realized that he was right. This is why it’s so important to think of the little details, every small step that the user has to perform, when you are designing products for an illness that you don’t have.
Next, we talked about the different types of inhalers available. There are the little portable ones that most people picture when they think about asthma inhalers, pressurized metered dose inhalers. There are also larger, heavier inhalers, which sit on a table and use propellants. They must be loaded by depressing a piston with the full palm of the user’s hand, which makes a click sound when it reaches the bottom. Mårten said that many older patients prefer this inhaler for its ease of use, satisfying click feedback (a happy design accident), and the lack of small buttons. The small, portable inhaler can be challenging to use for someone with stiff, arthritic fingers. Overall, he said that more and more people are using the little portable ones, since propellants are not as environmentally friendly. Still, there are multiple designs for the little ones; older patients prefer more modest colors, while younger patients might be happier with “disco ball” color schemes or fancier models.
I realized that there is no one “ideal” inhaler design. While all inhalers should require the fewest number of steps possible, there are many other factors that can, and should, differ to appeal to a great variety of asthma patients: color, size, weight, and shape, for example. This is why there are still multiple different inhaler types on the market, as there have been for the past few decades.
In terms of future designs, Mårten thinks that mobile phones with asthma-specific apps will be included. An app would communicate with an inhaler over Bluetooth so that “when the patient inhales and loads a dose, you monitor that and you can send it to a doctor who sits remotely and inspects it. They can say ‘Why didn’t you take your dose Wednesday morning?’ and so on.” While he believes that people would be willing to pay for a Bluetooth-enabled inhaler, both costs and regulations prevent it from being a choice for Swedish asthma patients at the moment. (A quick Google search reveals that a patient in the US could get a Bluetooth inhaler, but in Sweden it would have to be marketed and sold to the government and the pharmacies before patients would have it as an option).
Finally, we discussed the Swedish health care system at large, and I asked Mårten what he would change about it. Overall, with the low cost for end users and the quality of the hospitals, he thinks Swedish health care is “fantastic.” But it is frustrating to have to wait for care. “It’s still the government and the state,” says Mårten, “and the efficacy in the administration can be very bad, with long queues at hospitals. Waiting for very simple operations can take half a year.” A private hospital that’s not controlled by the government might have more flexibility to adapt to high demands and long queues. Also, government hospitals might spend too much money on the administration and not enough on the nurses and doctors; “I don’t have any data there, but I suspect that too much money goes to the bureaucracy.”
Mårten told me the story of one man who went to a hospital in Sweden for a throat illness but was told that he would have to wait 3 hours before getting the chance to talk to anyone about it – too many people were already waiting at the hospital. Instead of waiting, he went home and found a virtual doctor online who was based in India. Over Skype, the Indian doctor was able to diagnose him and write a prescription. Within the following hour, a Polish firm delivered the medication to his home. The whole process took less than the 3 hours he would have spent waiting in line at the hospital. Perhaps even here in Sweden, telemedicine is the future of medical technology for diagnostics.