One of the most prolific med-device entrepreneurs in history, Bill Hunter, M.D., M.Sc., has turned his voracious intelligence and energy to smart implants and through his company, Canary Medical, Inc., is doing to orthopedics what he did in cardiovascular—namely transform patient care.
Here is both Dr. Hunter’s story and the story of his new Canary Medical, Inc.—the likely technological leader in implants that can sense, compute, process and communicate—in vivo.
Dr. Hunter’s First Side Hustle
Dr. Hunter’s entrepreneurial spirit took flight when he co-founded in 1992—while still in medical school, no less—Angiotech Pharmaceuticals. Angiotech pioneered several of the most transformative technologies to treat cardiovascular disease including drug coated stents. He and his company created more than $25 billion dollars of value for investors and significantly improved the lives of tens of millions of cardiovascular disease patients.
Today, more than 30 years later, the inimitable Dr. Hunter has set his sights on orthopedics and the transformative role that smart implanted devices can play in the post-operative lives of patients—and their caregivers.
Dr. Bill Hunter: “I’m a doc by training. When I was in medical school, somewhat accidentally I ended up working on making devices bioactive. My first company was a company called Angiotech. The principle behind that was that medical devices get infected and get inflamed and pharmaceutical companies make anti-infectives and anti-inflammatories—so why don’t we put them together?”
“We made what became the TAXUS® coronary stent, the Zilver PTX peripheral stent, and paclitaxel-eluting balloons. So, what was meant to be kind of a side hustle, ended up being a company with a few thousand employees and manufacturing plants around the world. I did that for about 22 years.”
Dr. Hunter may be modest when it comes to Angiotech, but during his tenure as president and chief executive officer, Angiotech had over 1,400 employees, several thousand commercially available products, and 12 facilities in five countries. Dr. Hunter has over 200 patents and patent applications and revenues from Angiotech inventions exceeded $25 billion.
Dr. Hunter then spent seven years as president and CEO of a Canada-based specialty pharmaceutical company called Cardiome Pharmaceuticals. After growing Cardiome to a multimillion-dollar company, he founded his latest venture, Canary.
Old Dog, Same Trick
A decade ago, Dr. Hunter founded Canary. He describes it in much the same way as his first venture, simply bringing two technologies together. Dr. Hunter explained to OTW, “As I like to say, ‘old dog, same trick.’”
Dr. Bill Hunter: “Medical devices don’t communicate with the outside world and yet we have all this technology called sensors and power sources and transmission technology—yet we don’t use any of it for medical devices to self-report on function, side effects or complications or anything like that. We set about to use these technologies on medical devices to try and make them better. So very similar business models [Angiotech and Canary], very similar rationales, just kind of 25 years later using a different technology.”
“The closest surrogate to what we do in orthopedics is the pacemaker. We use a pacemaker battery as our power source. We use the telemetry that pacemakers use to transmit the data from inside out…but instead of powering leads, we power sensors. Since orthopedics is all about movement in three-space, we power sensors that are 3D gyroscopes, 3D accelerometers, step counters, things that provide movement.”
“I think what surprises most people is that the batteries are so good, and the power draw is so low, that we can pull 20 years of data off of those devices with nothing to charge, nothing to wear. That just shows you how far the pacemaker industry has come.”
While the power draw is incredibly low when compared to the pacemaker, the devices do share other similarities. Enough similarities that even during the FDA review “they had pacemaker experts on the review committee because that was the device that it most closely resembles.”
Canary + Zimmer Biomet
Dr. Hunter wasn’t finished bringing together technology with the orthopedics sensors. The sensors needed an orthopedic application.
That application was found through a partnership with Warsaw, Indiana-based Zimmer Biomet Holdings, Inc. in August 2021. Last summer, in a press release, the companies announced, “U.S. Food and Drug Administration (FDA) De Novo classification grant and authorization to market the tibial extension for Persona IQ®, the world’s first and only smart knee cleared by the FDA for total knee replacement surgery.” The companies created Persona IQ by bringing together Zimmer Biomet’s knee implant, Persona® The Personalized Knee®, and Canary’s implantable canturio™ tibial extension (te) sensor technology.
The first hospital to implant Persona IQ in October 2021 was New York’s Hospital for Special Surgery (HSS). Dr. Hunter could not say how many patients have received the implant since then. However, he could confirm that “we have a good number of patients walking around right now.”
Those patients walking around right now are providing real time data which allows their post-operative progress to be monitored.
According to Zimmer, “Persona IQ records and wirelessly transmits a wide range of gait data to a patient’s personal base station at home. The data are then securely delivered to a cloud-based platform. Surgeons can assess post-surgery recovery progress by comparing pre-operative mobility metrics captured by mymobility, with post-operative gait metrics collected by Persona IQ.”
Dr. Bill Hunter: “The device is on from seven in the morning until 10 o’clock at night, and it’s on every single day. It’s really collecting how people behave in the real world.”
“We’re partnered with the biggest knee company in the world, we’re on their bestselling product. If we end up with tens of thousands of patients, then the data scientists tell me the probability of identifying different patterns with respect to different abnormalities is fairly high. So that’s what we’re going try and do.”
Both Zimmer and Canary Medical fully expect that implanted smart technologies are just getting started. According to Zimmer Biomet’s Chairman, President, and CEO Bryan Hanson, “We now expect that Persona IQ will be the first in a broader portfolio of smart implant technologies in various orthopedic surgery applications.”
Dr. Hunter’s Vision of the Future
Around 1911, miners started taking canaries with them into the coal mines. The canaries would provide the miners with a warning about the presence of carbon monoxide. With an early warning, the miners could take action.
Canary gets its name from those birds. The company plans to use the data it gathers from the sensors to provide an early warning about problems.
What Dr. Hunter envisions for the future isn’t so different from what data has done for other industries.
Dr. Bill Hunter: “One of the data scientists was telling me a story about Boeing and how they put sensors into all the aircraft engines. And initially of course, the idea was to identify parts as soon as they broke so that they could replace them immediately. By understanding the harmonics of the engine parts, they were able to figure out when they [the parts] were going break before they actually broke so they could replace the parts before there was a catastrophic failure.”
“I think that would be ideal in medicine. If you could identify which patients are likely to have huge clinical problems before they happen, then 9 times out of 10, intervention is going to be much less invasive because you’re fixing something before it’s a medical disaster.”
During his discussion about the future, Dr. Hunter cautioned that anything he is saying about his vision of the future or how this data might be applied is simply what he hopes to accomplish. None of what he has said has been evaluated by the FDA.
Right now, Dr. Hunter told OTW, Canary Medical is gathering data like “walking speeds, stride length, cadence, distance travelled, activity.” The company can also measure range of motion and whether a patient is limping or walking normally.
Dr. Bill Hunter: “This is where the machine learning piece comes in, in terms of, okay, here’s what a normal recovery looks like. We’re going to collect somewhere around a million data points per patient per year. We’re going to have this very rich data set that says, this is normal. And then, as we have complications, we’re going to hopefully get an equally rich data set that says, this is what an infection looks like. Or this is what a contracture looks like, or this is what loosening looks like. And then, ideally with the right algorithms, there is the potential to be able to identify those complications earlier on.”
In orthopedics, early detection is key to potentially correcting problems without surgical intervention. Unlike the coal miners, patients do not presently have a canary to rely on to give them early warning about implant problems. Dr. Hunter is laying the foundation for a future where every patient will have their own canary.
Stay tuned, for sure!
