October 27, 2017
The entrepreneur who helped ignite a revolution in DNA sequencing is setting his sights on a new disruption: reimagining the ultrasound scans that are a standard way for doctors to take pictures of what is going on inside the human body.
Usually, ultrasound scans are done with a machine big enough that it needs to be transported on a cart, with multiple attachments that must be switched out depending what part of the body a doctor wants to look at. But the iQ, a new machine from a startup called Butterfly Network, is a 300-gram, hand-held device with no attachments to swap that hooks up easily to an iPhone. The iQ seems to deliver clear images. Three outside doctors who’ve used the machine were impressed. It’s also simple to use. I used it myself to view my carotid artery. Today, Butterfly is announcing that it is launching the machine with 13 different device clearances from the Food and Drug Administration.
Part of what is astounding is the price. Some handheld ultrasound devices can cost $8,000; for a full capability machine, physicians say, a hospital would spend at least $20,000, and, frequently as much as $100,000 for a high-end unit. The Butterfly Network IQ will cost just under $2,000, a price point at which it’s conceivable that every doctor in an emergency room could carry an ultrasound device. The device is not intended for consumers, at least not at first.
“In the 20th century, you had one machine, one operator, and the patient came up to the machine in a suite,” says David Bahner, an emergency medicine physician who has gotten to try the iQ. “In the 21st century, you have one machine, multiple operators, and the machine goes to the patient’s bedside. So if this would take it even further. One device, with one person, and you can take it wherever you go. It’s pretty exciting.”
The new device is the brainchild of Jonathan Rothberg, 54, a longtime biotechnology entrepreneur. “This is the birth of an industry,” Rothberg says. (He says stuff like that.)
Rothberg founded his first company, Curagen, in his basement in 1991, at one point it notched a $1.5 billion deal with Bayer before the 1990s-era bubble in genetics stocks burst. While still at Curagen he started 454 Life Sciences, the first “next generation” DNA sequencing company. 454 was purchased by Roche for $140 million in 2007. In 2010, Rothberg started another DNA sequencing firm, Ion Torrent, which was eventually sold to Life Technologies for $725 million and is now part of Thermo Fisher.
He has said he was inspired to work on decoding DNA when his infant son Noah, who is now 18, was ill. The inspiration for the ultrasound device was also personal. Rothberg’s daughter, who is now in college, suffers from a disease called tuberosclerosis (TSC), which leads patients to develop tumors throughout their bodies. While his daughter was receiving an ultrasound scan, he wondered why the equipment needed to be so unwieldy.
Rothberg started Butterfly after seeing a talk by MIT physicist Max Tegmark, who becoming fascinated by artificial intelligence. They decided to start a company together, but Rothberg demanded one of Tegmark’s smartest students: Nevada Sanchez, a co-founder of the company who was honored on Forbes 30 Under 30 in 2015. The company raised more than $100 million, $20 million of it Rothberg’s own money. Rothberg says it has spent about half that sum.
Existing ultrasound devices, including those made by General Electric, Philips, and Fujifilm, use piezoelectric crystals to use sound waves to create images of what is going on inside the body. Rothberg’s solution is to replace these with a silicon chip. This is what makes the device far cheaper to manufacture. The new design also allows a single sensor to replace the multiple wands that are used on traditional ultrasound devices.
The fact that a single device can replace all those others is one of the main selling points of the new machine. “The fact that you would be able to have one probe that is able to give you all the data of all of the scans you’d want, it’s a big thing,” says Renee Dversdal, director of point of care ultrasound at OHSU in Portland, Oregon, who has seen a demonstration of the machine. She says she has no financial conflicts of interest.
“The quality of the image was really pretty exceptional from what we were seeing and I was excited to see that in a portable variety of machine,” adds Kevin Piro, director of internal medicine ultrasound education at OHSU. (Also no conflicts.) Eric Topol, the Scripps cardiologist and personalized medicine expert, said on Twitter that he had tried out an earlier version of the device, and was unimpresed.
John J. Kendall, ultrasound director at Denver Health Medical Center, is serving on a medical advisory board for Butterfly; he is being paid for his time. He says he has conducted a study comparing the new device to older machines, and that the quality is similar. Another selling point is that the artificial intelligence being packaged with the machine should, over time, make it possible for less-and-less skilled medical professionals to take and read ultrasound images. “It’s one of those projects that is going to absolutely change medicine and change how we practice,” says Kendall. “It’s so impactful.”
From a business perspective, it’s a tough prospect. The global market for ultrasound devices was $5.8 billion in 2013, according to an estimate from consultancy IHS Markit. If Butterfly’s machines replaced all of them, it could cut the dollar size of that market to a tenth of its current size. In order to succeed, Butterfly will need to not only challenge incumbents, it will need to dramatically expand the use of ultrasound imaging. Rothberg says that’s exactly what he wants to do. He watched the DNA sequencing revolution be taken over by a rival, Illumina, at his previous companies and never managed to win it back.
“We would like to change the world with ultrasound on chip,” Rothberg says. He looks over at his son, Noah, who inspired his DNA sequencers and has come along to demo the new device at Forbes. “We'd like to own it this time, right, Noah?”
Noah’s reply has the simple confidence of a teenager – or maybe his dad. “Yeah.”
Butterfly says the iQ will ship in 2018.