The world’s top medical technology companies are turning to robots to help with complex knee surgery, promising quicker procedures and better results in operations that often leave patients dissatisfied.

Demand for artificial replacement joints is growing fast, as baby boomers’ knees and hips wear out, but for the past 15 years rival firms have failed to deliver a technological advance to gain them significant market share.

Now U.S.-based Stryker and Britain’s Smith & Nephew believe that is about to change, as robots give them an edge.

Robots should mean less trauma to patients and faster recovery, although they still need to prove themselves in definitive clinical studies, which will not report results for a couple of years.

Fares Haddad, a consultant surgeon at University College London Hospitals, is one of the first in Britain to use the new robots and has been impressed. However, he agrees health care providers need decisive data to prove they are worth an investment that can be as much as $1 million for each robot.

“The main reason for using a robotic system is to improve precision and to be able to hit very accurately a target that varies from patient to patient,” he said. “It is particularly useful in knees because they are more problematic [than hips] and there are a chunk of patients that aren’t as satisfied as we would like with their knee replacement.”

Satisfaction rates are only around 65 percent for knee operations, against 95 percent for hips, according to industry surveys.

The rival types of robots vary in cost and sophistication, assisting surgeons with precision image guidance for bone cutting and the insertion of artificial joints.

Prestige machines

Orthopedic companies hope to emulate the success of Intuitive Surgical, an early pioneer of robots in hospitals, which now has more than 4,000 of its da Vinci machines installed around the world for procedures including prostate removal, hernia repair and hysterectomies.

In addition to selling into big Western markets, they also want to expand robot use in India, China and other emerging markets, where owning a prestigious high-tech system can be a marketing advantage for private hospitals.

Stryker is leading the charge with its MAKO robotic arm, a platform it acquired for $1.65 billion in 2013 and which has pioneered robot-assisted whole-knee operations by determining optimal positioning and then helping with bone cutting.

But it has competition from smaller rival Smith & Nephew, which last week launched a cheaper product called Navio for total knee replacements in the United States. The British group bought the company behind Navio for $275 million in 2016.

That has kicked off the battle in earnest, since both companies are now able to do total knee replacements, which represent the vast majority of knee procedures.

MAKO, which uses only Stryker’s joints and implants, costs around $1 million to install, while Navio, which does not have as many features and is not tied exclusively to Smith & Nephew’s products, is less than half the price.

Both companies believe their robots will help them capture a bigger share of an orthopedic market that has been split between four big players for more than a decade.

Indeed, Smith & Nephew Chief Executive Olivier Bohuon said it was his company’s most important strategic investment for a decade.

“We are now basically head to head with Stryker,” he said in an interview. “I do believe we are going to gain market share due to the fact we have robots, whether it’s Stryker or us.”

Cost-effectiveness question

Stryker, meanwhile, expects its MAKO system to start delivering market share gains from the end of 2017.

“As we exit this year, we expect to start to see evidence in our knee market shares,” Katherine Owen, head of strategy at Stryker, told an investment conference in June. “Our goal with MAKO on knees is to capture hundreds of basis points of market share. What that time frame looks like, we haven’t been specific about.”

Zimmer Biomet and Johnson & Johnson, the two other big players in orthopedics, are lagging in the robotics race but both have plans to enter the area in different ways.

J&J is working on surgical robotics with Verily, the life sciences arm of Google parent Alphabet, while Zimmer last year bought a majority stake in France’s Medtech, a specialist in neurosurgery.

Analysts at Morgan Stanley believe robots have the potential to disrupt a market in artificial joints that has arguably become commoditized, with no knee or hip implant emerging as supreme in recent years.

That chimes with the view of Smith & Nephew’s Bohuon, who argues that robots give his company a chance to punch above its weight, despite ranking No. 4 in reconstructive surgery.

He reckons robotics could account for 20 to 40 percent of knee operations.

Much will depend, however, on how the rival systems stack up.

Jefferies analysts said the semi-automated bone resection offered by MAKO might well win out in the long term, but Navio offers a far cheaper option and is still well ahead of anything the other two major manufacturers have today.

Orthopedic surgeon Haddad, who has experimented with both, said the machines were very different and health care systems would need to assess their cost-effectiveness in the light of clinical trial results.

“I think the clinical benefit will be pretty obvious, but whether that justifies the upfront outlay is a big question,” he said.
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Several states are seeking to join a legal challenge to a Trump administration decision to keep a widely used pesticide on the market despite studies showing it can harm children’s brains.

Led by New York, the coalition filed a motion Wednesday to intervene in a legal fight over the continued spraying of chlorpyrifos on food. Massachusetts, Maryland, Vermont, Washington, and the District of Columbia are also seeking to join the suit pending before the U.S. Court of Appeals for the Ninth Circuit in San Francisco.

The states claim that Environmental Protection Agency chief Scott Pruitt violated the law by ending his agency’s effort to ban the pesticide sold by Dow Chemical after federal scientists concluded it can interfere with the brain development of fetuses and infants. Federal law requires EPA to ensure that pesticides used on food in the United States are safe for human consumption — especially by children, who studies show are typically far more sensitive to negative effects from pesticides.

“Job No. 1 for the EPA should be protecting Americans’ well-being, especially that of our children,” said Eric Schneiderman, the attorney general of New York, in announcing the legal action. “Yet the administration is jeopardizing our kids’ health, allowing the use of a toxic pesticide for which it can’t even identify a safe level.”

The EPA said Thursday it was reviewing the lawsuit.

Pruitt told Congress last month his decision was based on “meaningful data and meaningful science.” Despite repeated requests, EPA has thus far not provided The Associated Press with copies of any scientific studies Pruitt consulted in determining the pesticide is safe.

Public-health advocates have been pushing for years to ban chlorpyrifos, which is commonly sprayed on citrus fruits, apples, cherries and other crops. Lawyers for Dow and the makers of two other organophosphate pesticides also asked the Trump administration “to set aside” the results of government studies showing they pose a risk to nearly every federally protected endangered species.

Last month, the American Academy of Pediatrics also urged EPA to ban chlorpyrifos. The group representing more than 66,000 pediatricians and pediatric surgeons said it is “deeply alarmed” by Pruitt’s decision to allow the pesticide’s continued use.

Dow, which sells chlorpyrifos through its subsidiary Dow AgroSciences, did not immediately comment Thursday. In the past, the company has said it helps American farmers feed the world “with full respect for human health and the environment.”

Chemical in drinking water, blood samples

Spending more than $13.6 million on lobbying in 2016, Dow has long wielded substantial political power in Washington. Dow CEO Andrew Liveris is a close adviser to President Donald Trump and the company gave $1 million for Trump’s inaugural activities.

Similar to a chemical spray developed as a weapon prior to World War II, Dow has been selling chlorpyrifos for use on farms since the 1960s. It is now among the most widely used agricultural pesticides in the United States, with about 5 million pounds sold domestically each year.

As a result, traces of the chemical are commonly found in sources of drinking water. A 2012 study at the University of California at Berkeley found that 87 percent of umbilical-cord blood samples tested from newborn babies contained detectable levels of chlorpyrifos.

Under pressure from federal regulators over safety concerns, Dow voluntarily withdrew chlorpyrifos for use as a home insecticide in 2000. EPA also placed “no-spray” buffer zones around sensitive sites, such as schools, in 2012. But a coalition of advocacy groups including the Natural Resources Defense Council and the Pesticide Action Network said those proposals don’t go far enough and filed a federal lawsuit seeking a national ban on the pesticide.

In October 2015, the Obama administration proposed banning the pesticide’s use on food. A risk assessment memo issued in November by nine EPA scientists concluded: “There is a breadth of information available on the potential adverse neurodevelopmental effects in infants and children as a result of prenatal exposure to chlorpyrifos.”
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U.S. Vice President Mike Pence pledged to usher in a “new era” of American leadership in space during a tour of the Kennedy Space Center in Florida Thursday.

“Our nation will return to the Moon, and we will put American boots on the face of Mars,” Pence told the cheering crowd of about 800 NASA employees, space experts and private contractors, but gave no specifics.

The pledge comes almost a week after President Donald Trump signed an executive order reinstating the National Space Council, which had been dormant for nearly 25 years.  He named Pence to serve as its chairman.

Once it is operational, the council will review current space policies and long-term goals for national space activity, Pence said.

“Under President Donald Trump’s leadership, we will re-orient America’s space program towards human space exploration,” Pence said. “We will return our nation to the moon, we will go to Mars and we will still go further, to places our children’s children can only imagine.”

Trump’s proposed budget, released in March, called for $19.1 billion for NASA, a 0.8 percent decrease from 2017.  It also called for NASA to abandon plans to lasso an asteroid and cut several missions to study climate change and Earth science.

Lawmakers are still hammering out their adjustments to the proposed budget, which should be decided on later this year.
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Canada is attacking its expanding opioid crisis with an unusual measure: It’s giving addicts a safe place to shoot up.

 

The government has allowed seven “safe injection sites” to open and a score of others are being considered across the country.

 

The storefront sites give addicts clean syringes, medical supervision and freedom from arrest. They don’t get help in kicking their problem unless they ask for it, but the program dramatically reduces the chance of a fatal overdose or the transmission of blood-borne diseases such as hepatitis or HIV. 

 

The effort, inspired by some in Europe, is being closely watched in the U.S., where officials are struggling to cope with a surge in overdose deaths from opioid use. Several cities say they are considering similar measures despite fears that they may encourage drug use.

First center in Vancouver

 

Dozens of people a day have been coming to three new centers in Montreal, where users are given a small kit to safely inject drugs they bring with them and then an opportunity to relax for a half hour on couches listening to music, according to a 30-year-old addict who would only give his first name, Francois. The center operators denied access to the media once the center opened.

 

“They give you everything you need,” Francois said as he left a center in the gentrifying downtown neighborhood around Sainte-Catherine Street after injecting heroin. “Everyone is pretty relaxed.”

 

A single injection site opened in 2003, run by a Vancouver nonprofit organization under authorization by Health Canada. It received 214,898 visits by 8,040 individuals last year, with nurses intervening in 1,781 overdoses. It said it’s never had an overdose death.

 

Another center also has opened in that West Coast city, and in recent weeks, two more have opened in British Columbia and three in Montreal. Another is scheduled to open in Montreal soon and three in Toronto. More than a dozen other potential sites are being considered across Canada federal officials say. 

More overdoses prompt more centers

 

Health Minister Jane Philpott said the government felt compelled to add sites because of the escalating number of overdose deaths, which topped 2,400 last year. 

 

“They are absolutely known to save lives and reduce infections,” Philpott said. “We have a very significant public health issue in our country.”

 

She acknowledged they are not a complete answer to the drug problem: “This is only one in a very broad range of tools. A comprehensive approach is necessary.”

Seattle to open centers

U.S. drug overdose deaths have tripled in 15 years, reaching at least 52,000 in 2015, making it the leading cause of death for people under 50. Seattle and King County in Washington are moving forward with plans for safe injection centers and a city task force in Philadelphia has proposed some, though such measures have faced opposition.

 

John Walters, who directed the White House Office of National Drug Control Policy under President George W. Bush, said safe-injection sites merely prolong addiction and eventually lead to deaths.

 

He noted that overdose deaths have risen sharply in British Columbia despite the presence of the first safe-injection site in North America. The province had 136 deaths in April, a 97 percent increase over the same month a year earlier. There were 967 overdose deaths in British Columbia in 2016, up from 517 in 2015. And there have been 640 this year through May. 

 

“Government-sanctioned injection sites are now said by advocates to prevent overdose deaths. That clearly has not happened in British Columbia,” Walters said. 

 

Jonathan Caulkins, a drug policy expert at Carnegie Mellon University in Pittsburgh, isn’t convinced they work either but said he understands their appeal. 

“The opioid crisis is so horrible that you are desperate and willing to try anything,” he said. “There’s a part of me that says, ‘Sure, give it a shot.”’ 

​Neighbors not pleased

 

Gilles Beauregard, executive director of a Montreal safe injection site opening in September, argued that the service will help neighborhoods.

 

“At street level, we’re going to see a decrease in the number of needles lying around, and less people shooting up in parks and alleys and public toilets,” he said.

 

Not everybody living nearby agrees. Angry residents met Montreal Mayor Denis Coderre and other officials when they inaugurated the Sainte-Catherine Ease facility in late June. Chantal Beauregard, who lives in the area, said it has attracted junkies at all hours and needles now litter the ground. 

 

“It’s been one week and we’re already fed up,” she said. 

 

A new safe injection facility scheduled to open a mile east in Montreal in September is also drawing criticism 

 

“Having a supervised injection site in a school zone doesn’t make sense,” says Christelle Perrine, who has two children in a school about 200 yards (meters) from the facility.

 

A tall, broad-shouldered and extensively tattooed man who gave his name only as Benjamin was among about a dozen drug users who made their way to the Sainte-Catherine East injection site over an hour one midweek day.

 

“I’ve been waiting for something like this for years. It’s great. You don’t have junkies shooting up everywhere, leaving their needles all over the place,” the 46-year-old said after injecting cocaine. “It’s clean, the staff is great.”

 

“I understand why people who live around here aren’t happy. I have a heart and I have a brain,” he said. “My life’s ambition wasn’t to do this, but at least with this, we’re safe.” 
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Using only baker’s yeast, researchers at Columbia University have designed an inexpensive, on-the-spot test to detect major fungal pathogens. Faith Lapidus has details of the new biosensor, described in the journal Science Advances.
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