Medicine’s Own Thomas Edison

Dr. Thomas Fogarty fashioned his first important invention in 1961 out of a surgical catheter and the finger of a latex glove, tied together with a fly-fisherman’s knot. The idea was to punch the catheter through an arterial blood clot, inflate the latex with a saline solution behind the clot and then use the balloon-like contrivance to draw out the blockage through a tiny incision in the skin.

The procedure represented a huge advantage over conventional practice, which required a surgeon to rip open a patient’s blood vessel in search of the blockage. Nevertheless, the medical establishment resisted the innovation.

“The concept of noninvasive surgery simply wasn’t there at the time,” Fogarty told me this week at his Portola Valley, Calif., office. This observation launched him on an extended discussion of the medical profession’s habitual aversion to new technologies.

“Physicians are taught to do what is safe. That represents the standard of practice. If you deviate from that, you’re an outlier, subject to criticism by your peers and to lawsuits. There’s an incentive not to be innovative.”

If he sounds as though he’s replaying the numerous battles of a lifelong war, that’s not surprising. The effort needed to establish the Fogarty embolectomy balloon catheter as the professional standard still rankles: “The first article we wrote on the clinical experience of the balloon catheter was turned down by every major surgical journal, because it was viewed as inappropriate and dangerous,” he recalls.

Today, at 69, Fogarty holds more than 100 patents on surgical instruments and devices, many of which he feels took longer than was necessary to win general acceptance. In 2000 he was awarded the $500,000 Lemelson-MIT Prize, one of the most prestigious honors for inventors and innovators, and the following year he was inducted into the National Inventors Hall of Fame.

Through his investment firm, Three Arch Partners, he has spun off or backed nearly 50 companies pursuing medical technologies ranging from aortic stents (to treat weaknesses in vessel walls) to health-care software. Meanwhile, he serves as a professor of vascular surgery at Stanford Medical School and consults as a physician. There’s also the Thomas Fogarty Winery & Vineyards in Woodside, Calif., on the ridge overlooking the heart of Silicon Valley.

Yet Fogarty remains concerned about the difficulty of infusing new technologies into standard medical practice. To a certain extent he blames the system of medical pedagogy: “As a student you’re required to assimilate so much knowledge in so short a time that you can’t take the time to question a basic premise,” he says. “We don’t spend enough time teaching people how to think rather than what to think.”

But he also believes the enormous investment embedded in one’s medical education and in establishing a practice naturally makes physicians conservative. “Innovation both creates and destroys,” he says. “It’s human nature to protect your turf.”

The subject has been on his mind lately, thanks to the efforts of Sleep Solutions Inc., a company he’s backing, to promote a new way to diagnose sleep apnea. Apnea is a sleep-deprivation syndrome associated with an elevated rate of vehicular and industrial accidents, as well as stroke and heart failure, among its sufferers.

The company, Fogarty says, has developed an alternative to standard diagnostic practice, which generally requires patients to sleep under observation at a hospital sleep center for as much as $5,000 a night. Instead, Sleep Solutions devised a system of simple monitors that patients attach at home and wear overnight, producing data that can be downloaded and analyzed by the company.

Sleep Solutions maintains that its system is as accurate as clinical observation, at a third of the cost, and is much more convenient for the patient. But adoption has been slow.

“When you look at why it’s not adopted,” Fogarty says, warming to his point, “it’s because of self-interest. Sleep centers are profit centers, and there aren’t many of those left in hospitals.”

I first heard Fogarty’s name at a meeting of the Band of Angels, a Silicon Valley group of private venture investors that counts him among its members. It was clear at the time that, wealthy and accomplished as the group was -- most members are successful entrepreneurs or retired executives of major tech companies -- Fogarty occupied a special place in their esteem, and not only because he throws an annual reception for them at the winery that ranks as a high point of their social season.

It was the esteem they reserve for people who have the ability to invent something on their own, not only as part of an engineering team at a major company. I almost felt as if Fogarty, to the Band of Angels, was the closest thing to Thomas Edison.

When I got around to meeting him in person, he turned out to be a thoughtful and voluble man with a folksy manner and a faint drawl that still betrays his Cincinnati origins. He’s direct and reserved in speech, like someone accustomed to addressing groups of intelligent students without talking down, although on occasion he’ll digress passionately about some perverse or stupid policy or habit, whether it’s the way people blame rising medical costs on new technologies or the over-conservatism of venture capitalists. Then he’ll launch into a brief, fervent digression before returning to the main thread. (“We’re off track,” he chuckled to me at one point in our conversation. “What was the question that led to this diatribe?”)

One thing that marks Fogarty as an inveterate tinker (his predilection for inventing goes back to his childhood of designing soapbox derby racers and model airplanes for neighborhood pals) is his determination to keep practicing medicine as a way to tap into problems awaiting solutions.

“It’s only by being part of medical community that I can observe what the problems are,” he says. “Simply by going on rounds or to conferences, you hear the issues we’re trying to deal with and you can also calculate their frequency.”

A few years ago, for example, Fogarty turned his attention to the general ineffectiveness of closed-chest massage as a resuscitation procedure for victims of cardiac arrest.

“It wasn’t an isolated observation, but a series of observations,” he says. One was of “the mayhem surrounding a cardiac arrest in a hospital.” Another was of what happened the day he helped resuscitate a stricken runner on a local jogging path, only to have him die on the way to the hospital.

“What transpired was inefficient closed-chest massage,” he recalls. “That’s a problem. I started looking at how often this problem occurs, and came to the conclusion that we don’t do closed-chest massage well, even under optimum circumstances.”

On reaching his office, Fogarty laid the issue before a team of engineers he employs at Fogarty Engineering; eventually it came up with an electronically powered 18-pound backboard that fits under the victim and is connected to a strap around his or her chest. The strap contracts the chest, producing a compression up to 80 times a minute, a rate that would quickly exhaust a human provider of CPR. Marketed by a Sunnyvale, Calif., start-up called Revivant Corp., the device will shortly be test-marketed in San Francisco and San Jose.

“This will cause a major paradigm shift in the way we resuscitate,” Fogarty says confidently. “It’s so simple, it’s hard to believe that nobody thought of it before.”

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Golden State appears every Monday and Thursday. Michael Hiltzik can be reached at golden.state@latimes.com.