This week I am talking to John Martin, M.D., Chief Medical Officer, Butterfly Network, Inc. (@ButterflyNetInc) who is revolutionizing the traditional practice of medicine by adding imaging capabilities to the doctor’s tool bag earlier in the diagnosis and treatment process of patients.
John’s career started in vascular surgery where he found his ability to bring about positive change to patients’ lives limited by the inability to get to them early enough. To help bring better screening and diagnosis to patients he started a foundation to deliver free screening and education for cardiovascular disease to the community using the available tools at the time to allow earlier diagnosis and subsequent treatment to improve outcomes. John is also patient number one for this innovation which was able to bring an earlier diagnosis to a lump he found on his neck that would likely have gone undiagnosed or treated. Instead, he took the early prototype and applied it to his own neck and was able to identify metastatic cancer allowing him to get treated earlier.
We discuss the steps in innovation that took place that reduced a complex multi-system tool and put it on a chip allowing for easier and more cost-effective access, replacing the existing larger more expensive, and less accessible systems with a single multi-function chip sensor that attaches to your phone. With this technology, the potential to bring this imaging capability to the bedside and into the homes of people starts to become a reality.
Listen in to hear how this technology is bringing an inflection point in medicine that allows the use of advanced imaging capabilities at the point of care and how they are accelerating the advancement of skills necessary to make the technology useful to as many people as possible. As you will hear, this even includes patients and the potential to see these capabilities throughout the world and in communities and the home.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. John Martin. He’s the chief medical officer for butterfly. John, thanks for joining me today.
John Martin
It’s a pleasure to be with you.
Nick van Terheyden
So we’re gonna get into the details of this. But before we do, could you share a little bit of your background, and how you came to this role. And what was interesting about it that drew you to this opportunity.
John Martin
So I’m a vascular surgeon. That is my specialty and training. I was also in the early days board certified in general surgery and surgical critical care. So practicing physician and I practice in multiple, both academic and community environments throughout my career. One of the things I also was responsible for was building services, I had administrative positions and, and I was also a vice president of a large health systems physician operations of their of their of the physician operation. The other thing I did was I started a foundation 22 years ago that did community based screening, cardiovascular screening and education for the public for free. And in that incorporated the use of ultrasound to look for carotid artery disease, aortic aneurysms, peripheral vascular disease, to detect really early stage disease, I was kind of frustrated as a surgeon being on the back end of disease. And I really wanted to get on the front end. As part of that process, we discovered with one of my partners, this little company in Guilford, Connecticut that was developing some new technology that could literally transform the expense and the availability of ultrasound. So I went to a meeting with this little company called butterfly, I saw the early technology, I was blown away with what I thought the potential was. And at that moment, pivoted my career to join the company was given the opportunity to be its chief medical officer. And it’s been an amazing journey ever since. There’s a couple other ironic twists that are important that are public knowledge. Now, when we were joined the company before we had a product, took it through its final development, and then was doing the work for the FDA and literally had a little bit of a lump in my neck. And thought, Okay, well, I was going to kind of blow it off, as most physicians do about themselves. Just classically the case, but then I realized, I have an entire imaging system sitting in my hand. And I literally put the probe up against my neck and saw what was hidden under the angle of my jaw, a very large lymph node much larger than I expected, because of our technology was able to share the image quickly and essentially became patient. Number one, it was a metastatic cancer. And it was kind of a sentinel moment for me, that validated the decision that I’d made the opportunity that was here and transformed, obviously my care immediately, but was a great, I’ve now become a living example, if you will have the technology, much like we used to see those commercials with Hair Club for Men, you know, I’m not only the President, I’m a participant, well, I became one of those, which is kind of adds to the passion that I feel about this.
Nick van Terheyden
So first of all, you know, thanks for sharing that story, obviously, sorry to hear that. But it sounds like things have, you know, as a result of potentially the early intervention, you know, successful positive outcome, which, you know, is great news. But before we dive into where we are, for the benefit of the listeners, I think most people conceptually understand ultrasound, we see images on the media, you know, there’s essentially a an external probe, it uses a waveform technology reflection back and produces an image. And we’ve been doing that for a while. But what changed and what was significant about this, because it at the point that you joined, we weren’t able to do this in in the form that you’re currently doing it. Yeah, all
John Martin
other ultrasound systems. And it’s an incredibly powerful tool to be able to look inside the body and get information that’s important. The problem was up to date, it remained a limited resource, you know, hospitals had a few of them, the two thirds of the world has no access to medical imaging. So the expense and the complexity limited that what butterfly did brilliant scientists that are here that put ultrasound on a silicon chip, basically digitizing ultrasound, if you will. And anytime we’ve done in the history of putting stuff on a silicon chip, it’s transformed the the industry. And I get people the analogy, just think of cameras. We all we’ve had cameras forever. And people use cameras, and we bought them use them every day. But when it got digitized in that chip and got on our telephone, everybody became a photographer, and it changed the way in which photography was done. If you can think about this, now, if you put the power of imaging in the hands of every clinician now, it transforms the way you can use that information to practice medicine. And so by putting this on a silicon chip, we’ve now been able so instead of multiple probes, you can have one it covers multiple frequencies. It’s a full 2d array so it enables possible 3d imaging the power ultrasound becomes simple and practical and possible for an individual practicing clinician. And that’s really what butterflies done, which if you will shatter that ceiling of it being only restricted to a limited resource to a selected number of people that had the expertise to use it, that was the first step. The second step was understanding the importance of the user interface and software to integrate that whole process. So it had to be really easy to use. If you look at a standard ultrasound system, it’s pretty intimidating, like the cockpit of an airplane. Well, butterfly actually took it a really consumer based approach. And essentially, the way the user face is set up, if you can use your phone, you can use butterfly, it’s really simple. And we’ve also then integrated it into the electronic medical record. So that process of data flowing in into the system and being recorded becomes easy as well. So that combination of hardware and software critical, and I’ll add 1/3 Step. And that third step is unleashing the full power of artificial intelligence and incorporating into that process. Because capturing an image of ultrasound is not necessarily the easiest thing in the world, how do we make that easier, so people can have that path to competency be accelerated,
Nick van Terheyden
you know, and you bring out some really important points there. And it just reminds me going back in my career, I remember just stepping into the ultrasound suite and the challenge of just looking at the images, let alone acquiring them. That was a whole specialist skill. And one that was not an easy pathway to learn, it was, you know, relatively challenging, the imaging was not terribly good. I wasn’t ever really sure if I could see as much, although clearly at this point, we’ve improved. And it sounds like this is now at the point of really the individual that is able to do this. So when I was training your right, we had very little access. But what you’re essentially moving towards is a position where this is widely available. This is almost the same as the stethoscope in the pocket of the physician.
John Martin
Yeah, I think that’s the ultimate goal. If you think about this, and many have heard me say this, we practice medicine by doing a history and a physical, and then we pause. And whether you’re in the emergency room, a doctor’s office, it doesn’t matter where and we practice that way forever. That pause is that space? Do I know exactly? What’s wrong with you? Do I need additional tests? Is it a blood test? Is it an x ray test? Is it an ultrasound? But that pause was a critical part and that introduced delay waiting in efficiency? Listen, we all know the experience of being in an emergency room and waiting to get a test or going to see your doctor and saying, Well, I’m gonna send you off to get this we’ll schedule that. And then you’ll come back in your office is dreadful for every butterfly made possible was history, physical image. And then I got a more definitive answer to the question the power of that information to make better decisions, faster decisions, more accurate decisions, more cost effective decisions, changes that way. But the challenge is, how do we make everybody good at ultrasound? That’s the question that you ask. And some of it is we think of what we trained a technologist they went to school for three years to be good at this. And the way I answered that question is twofold. First of which I trained a technologist to be great at every aspect of their skill. So they know to be really good at ultrasound all the way to the most complex to the most simple. They get have to get perfect images every time and they have to be answer all questions, as opposed to what if I just teach you and let us learn, for example, how to get along image, just that single skill? Well, that actually is a pretty easy image to capture. And when you’re looking at congest, it’s a pretty easy one to interpret. So I break down that education into bite sized pieces. Don’t eat the whole steak with one bite, nibble at it at a time, then it becomes consumable, then I can do it. And then if I pick the right applications, I’m doing it over and over and over again, I begin to get more and more confidence in what we’re doing. And we also have to pick the right questions to ask. I don’t want to ask, what are all the things inside the abdomen? I want to know are there gallstones or not? Is there an aneurysm or not? And then I don’t have unrealistic expectations of my expertise, nor unrealistic expectations of the technology. Because these handheld devices, they’re great, but they don’t answer every question. And so I reserved the complex tests for those. So I think it’s understanding how we learn and use it today really tackles that, that concept of easy.
Nick van Terheyden
So let’s go back to your analogy of the digital photography, and you know it, I’m trying to recall how long it took. But we introduced these cameras. I think I know the iPhone wasn’t the first or maybe it was but it didn’t sort of rapidly take off. But at this point, it’s an integral part. And I know there’s a large number of professional photographers who are saying well You have diminished the capacity of people by reducing the quality of photography. But is that true in medicine as well? Are we dumbing down the clinician so that they stopped doing the other things? And, you know, this becomes a skill set that replaces other things that are as important do you think?
John Martin
Well, I think the interesting part of this is that we’ve been having this debate, since the invention of the CT scan, for instance, it’s you know, you don’t need a physical exam, you just get a CT. And and I had the pleasure of, for instance, being in the fourth year of my residency being sent to Australia. And that was kind of the old English system where physical examination was a dominant skill. And when I looked at and compared my training in the United States and my training in Australia, there was a difference. Their physical examination skills were better. And I certainly my old school professors with a stethoscope are better than I am. I know they are. I think the importance is understanding how do we combine those two skills to leverage the power of the new and not over diminished the power of the other? And I think the way it is, is to understand that a good physical examination guide you to What image do I want to get? What question do I want to ask? How do I actually get to the right thing, because the physical examination is still critically important. And I think the way I think about it, history skill to develop physical exam skill to develop, image skill to develop, allows you to maintain the To Do I believe that we’re going to create tools that probably diminish our physical examination skills, probably. But at the end of the day, maybe this gain offsets a little bit of this loss. So the collective together, they’re better.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. John Martin, he’s the Chief Medical Officer for butterfly, we were just talking about the innovation that’s come the change to essentially medical education. I love your sort of analogy around imaging and the digital imaging. And in fact, you know, if you look back, we started out and a lot of it was pretty poor. But look at what people have managed to do with that newfound image capability. It becomes integral. I mean, we take pictures of everything, not all of them are great. But the reality is it sort of changed our way of approaching the world in general. I mean, I now take pictures of things to remind me, it gives me additional information. And I think your concept of building this in is is essential. But as I look at my own daughter’s medical education, I don’t know that she’s seen much. I mean, I think the was certainly in some of the clinical experiences. But are we giving them enough? And is it sufficient to get them to that point where we start to really accelerate the process and move that imaging to an earlier point in the diagnostic process?
John Martin
You know, we’re, we’re, I think if you if you looked at healthcare and say, Is it a tortoise or is it a hare? I think it’s pretty easy to answer that question. We don’t change well, in healthcare. And you know, you’re an experienced physician, I’ve done really well my whole career without that newfangled technology I don’t need and true confessions, which is I’m embarrassed to tell this story. When I I used ultrasound a lot as a vascular surgeon, but I didn’t use it to put in a central line. Why do I need ultrasound for a central line, I’m a vascular surgeon, I know where the blood vessels are. I was kind of an arrogant jerk, really, at the beginning. But then somebody convinced me use it once I was like, Whoa, that was an idiot. This is so much better, so much safer, so much easier. And so we’ve got to make that transition. And a big focus of butterfly is at the Medical Education residency level. Because as the kids learn, and they come out, they’re better doctors, and better equipped than we were when we got out there, we may trade off our clinical skills with one another. But that skill sets really important. And in medicine, it’s really interesting. We have a whole breed of people who love being innovators, and will be out there and they will push us there’s no question. But human behavior is such that we don’t necessarily value gain. As much as we fear loss. What happens in all these tipping points is, it’s not well, I don’t want to be the innovator out there. That’s not my style. But as soon as I feel like I’m behind, and I’m not practicing the right quality of healthcare, I’m running as fast as my little feet can carry me to get up to speed with my colleagues. And so we’re you can see this curve start to turn up toward the we’re gonna get to this tipping point, you’re you talk about the central lines that sometimes your daughter put in, it is now a standard of care to use ultrasound. That kind of just happened and that people started using it. They saw it was better caught on we learned. Now it’s a standard that’s going to happen in the rest of these areas. Too many medical schools are incorporating as part of their training residency programs that are demanding that’s going to be part of it. The next thing it’s going to happen is and I’ll use one example the chest X ray, lung Ultra Sound has been known for 10 years to be better than chest X ray for a whole lot of conditions. Yet the standard inside hospitals is still using chest X ray that is going to change, it’s going to because ultrasounds more efficient is more effective, it’s more accurate, we just got to get there. And I can tell you how my compliments to you is because it’s programs like this and people listening and hearing what’s going on everywhere else than they understand, oh, I need to get in there because the world’s going and I need to hurry up and catch up.
Nick van Terheyden
Yeah. And to be clear, I’ll add one other additional item. It’s also safer because we don’t need any more radiation. And albeit it’s a very small minor amount, but still it keeps stacking up. So the opportunity to diminish that I think is extremely important. I like the concept of loss aversion. I mean, that’s a psychological profile that is well understood. It’s been utilized in many, many areas. So if we think about loss aversion in the healthcare space, I mean, that’s a great way of doing it. So what we have to have is a broader access to it, more people doing it, you see it? And I’ll be honest, I mean, I think back to putting central lines in and, you know, there was an awful lot of hits on this. And I’m sure there’s still is with ultrasound guided. But I think at this point, it’s got to be reduced from a patient standpoint. So I think huge progress added to the curriculum, and incorporated as a standard of care. But how do we broaden that out? Because at this point, I mean, it’s not cheap. Let’s be clear. Can we get that? Or maybe it is? I mean, is it? I’m sure it’s cost effective, because you’re improving the speed to diagnosis. So you’re saving money saving time, and obviously from a patient satisfaction. But can we get to the point where it’s broadly accessible throughout the world?
John Martin
I do believe so. And for a number of different reasons, one of which is because butterflies there now, I mean, you know, we were putting 1000 probes into Sub Saharan Africa with applications so that maternal fetal health is going to be changed forever. You know, it’s up on the Space Station, it’s on the sidelines of major sports franchises. It’s on ambulances, it’s on helicopters. It’s in the frontlines of battlefields now. So it is everywhere. And so this infiltration is occurring. And we’re going to see this tipping point because, you know, one of the other interesting things, it’s so rare, that actually new technology can lower the cost of care. That’s really rare. Most of the time, we add expenses, and we try to justify it. But great study that was done, where the hospitals used ultrasound routinely inside, it reduced the need of chest X rays by 87%. That’s cost reduction right there. It reduced the need for CTS and echoes dramatically. And so you’re exactly right, better diagnosis more accurate. And then you use more efficient use of those complex, expensive machines. Because that’s a different animal, we’re going to still need them. But let’s use them selectively only one we do, and answer the simple questions here. I don’t need a complex machine to tell whether or not you have a name, I can answer that question right at the bedside fast instantly. And as a matter of fact, we’re going to answer that in an ambulance, which is terrific, because now the hospital is going to be ready when I get there, you’re gonna get better care survival is going to improve.
Nick van Terheyden
Yeah, so it’s interesting, you’re talking about, you know, even pushing this down to other modalities or other clinical professionals, you know, in the community, I think of, you know, we have a D devices that have been pushed out with automation. I don’t know that that goes to this point. But I’ve seen, you know, the reduction in cost. And I think of you know, scoping. And I purchased, it was fractional in terms of cost, a fiber optic device that would attach to my phone that I could scope in, not to people to be clear, but you know, I obviously had that as a concept. So we’ll see this essentially pushed out to further groups. Where do you see this is going you’ve you’ve obviously, this has been a long journey, but you must be excited about the potential for the future.
John Martin
Oh, I could listen, I, you brought up defibrillator a great example. Listen, this is a device that delivers an electric charge, that if it lands on the wrong part of the cycle, it kills you. It doesn’t save you, it kills you yet. And when we first started, you had to have advanced training only in the hospital by exercise, but use it. Now it’s in every gym, hospital, church is everywhere. Because we can drive with new technology, simplicity and accuracy and safety. That same pathway is happening with this. And so we’ve started clinical trials with patients scanning themselves for the management of their diseases in the home. And so that’s coming yes, you’re going to see a day where for selected conditions, I pull out my butterfly, I’m going to scan myself I’m going to manage my heart failure at home And I’m going to reduce the amount of times I gotta go to the emergency room, go to the hospital and be admitted. I think that is a reality. And there are a number of key conditions that are there.
Nick van Terheyden
Wow, that’s really exciting. So you’ve essentially starting a principle of putting this into patients hands, which, for me feels like a very complex piece of technology to enable that, how can you? I mean, what’s the process to go about this? I can’t imagine a patient I mean, I struggle with it. So having a patient go through that, what are you doing to enable that, that allows for this to be a productive experience?
John Martin
Well, I think it boils down, first of all, pick the right applications where it actually makes sense. And where you have kind of a safety margin of, you know, is this something that’s actually practical to do? The second thing is, does it actually do something to really help and make a big difference? So is it worth the effort to do it? And can it really impact care in a meaningful way? And then the third thing is, is it a big enough problem, actually, to actually do this? Because it really matters to a large scope of people. Because yes, this is an adventure, you’re one of the key conditions is congestive heart failure. And one of the interesting things about that is, when you’re congested or full, you develop this artifact in the lung called B lines. And what’s great is a lot of ultrasounds actually really easy to do. B lines, you can actually automatically count them. And actually you can treat it with a diuretic and you the B lines disappear. So it’s kind of set up perfect to be one of those conditions where management makes sense with ultrasound. The second thing that we had to find out was does it actually mean if you use ultrasound can you reduce Edy visits and hospitalizations. And now there’s great data, that that actually is the case. Then the third thing you say is Well, patients can they actually do this. So we did a study out at UCLA, and they brought in 48 patients, and they watched a five minute video, and were handed a butterfly. And they scanned themselves, over 80% of them could get good enough images to actually interpret after a five minute video. And so that was great evidence to us that this is actually we’re on the right track. And if you look at heart failure, one of the biggest health problems around the world and so great opportunity to better care, save money better for dogs better for patients. And so I think it’s the combination, right application, right technology, and then the user interface and the walkthrough, you got to use those tools that you can develop to make it simple to do. That’s just the beginning. And there’ll be many others that will be just like that.
Nick van Terheyden
So I mean, this is an exciting future. It’s been fun to watch the progression of medicine, you know, we have this historical concept history, physical examination, you’ve changed the process and brought forward imaging. Do you see this conceptually as even coming further forward? I mean, at this point, you’re talking about potentially having these devices accessible, you know, is this and you know, maybe thinking of the applications I can’t think specifically but maybe there are opportunities for this. Perhaps not in the home but in central places where you go, Wow, this would be a great place we can truly change and impact Pryor as you did in Your practice to try and get to the cardiovascular impact earlier. Yeah. And
John Martin
I think it’s all about, you know, being responsible and the way in which you do this, being respectful of the the power of misinformation in the practice of medicine. And I think if you do both of those is there listen, I think about it this way. And it may be overstating, but I don’t believe so. In the history of medicine, there have been antibiotics, there have been vaccines that have gone around the globe. But it literally stops there. And for the first time, now, we have the power of imaging that could span the globe, from the far reaches of Africa, to the most advanced health systems in the world, they’re going to have the same device and using it in the same way that’s never happened in healthcare, certainly for the last 100 years, because there’s not portable X ray machines running around. They’re just not, but cell phones are there. Now butterfly is there. And I think that’s the change. And I think, as we’ve made this kind of change, it only opens our minds to what is possible. There are ways in which we use this we haven’t even dreamed of yet that are coming. And do we go into a CVS, we put our arm inside a blood pressure machine to see what our blood pressure is that happens today? Is there a respectful way in which you use a butterfly the same way? Probably, but we’re not there yet. But probably because the power of imaging information, a window into the body to see what’s wrong with me, if done appropriately and safely, is just too important to not push the envelope to see where we can go.
Nick van Terheyden
Exciting times. And I think as I play on that I’m thinking about the cooperative aspect to that where maybe I’m doing it, and I’m doing it with remote support somebody guiding and also the image analysis that can be taken. You can pass those images through tremendous scope to sort of really expand this change the way that we practice medicine, push it further out into the community and preventative. These are exciting times It must be great to be at that company. Unfortunately, as we do every week we’ve run out of time just remains for me to thank you for joining me on the show. It’s always a pleasure. Thanks, John.
John Martin
I’ve really been excited to be part of this and share this story. I think being a part of watching healthcare Evolve is a really exciting, exciting thing to actually do. And I would encourage everyone get on board the bus because the bus is going
