Death of the Stethoscope

The stethoscope is dead. Long live the stethoscope.

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Jul 14 2015, 9:00am

Image: Rosemarie Voegtil/Flickr

Where would a doctor be without his trusty stethoscope? Ever since its invention in 1816, it's been a doctor's best friend.

But the stethoscope's simplicity may have spelled its doom. The simple machine hasn't changed much in nearly 200 years, and some doctors are championing new technologies as the way of the future.

Last January, the medical journal Global Heart wrote an editorial calling the stethoscope a relic of the past.

"Certainly the stage is set for disruption; as LPs were replaced by cassettes, then CDs and mp3s, so too might the stethoscope yield to ultrasound," the editorial read, referring to portable ultrasound scanners, for example, allow doctors to see internal organs rather than only listen.

Such scanners—like the GE Vscan, touted in this CBS News segment as the future—remain prohibitively expensive for some doctors with price tags as high as $6,500, however. The most expensive stethoscopes still cost a tenth of the price of a portable ultrasound scanner.

Some innovators think it makes more sense to give the stethoscope a 21st century makeover. All the recent developments hinge upon connecting the stethoscope to the smartphone, allowing the doctor to record, store, and share heartbeats and breathing patterns.

"Doctors in developing countries are doing things with the stethoscopes that are never done in the US."

The road hasn't been smooth. Stethoscope manufacturers like 3M Littmann and Thinklabs have built tricked-out stethoscopes, but the technology was either limited (Littmann's electronic stethoscope saves up to 12 30-second heartbeat soundtracks) or costly (Thinklabs' electronic stethoscope kit is $800).

Eko Devices, a startup based in Berkeley, Calif., is perhaps the closest to bringing a new digital stethoscope to the commercial market. Priced around $200, Eko sells an adapter called the Core which attaches to any existing stethoscope. The Core amplifies sound coming from the stethoscope and records it to Eko's tablet and smartphone app via Bluetooth.

Cardiologists at University of California, San Francisco are currently trying out the Core as a clinical trial. Some doctors believe the Core and the ability to record, save and share heartbeats will educate less-experienced physicians and medical students.

"What's really exciting is it has the potential to make internists and nurse practitioners and other types of providers into cardiologists," Dr. John Chorba, the UCSF cardiologist who is leading the clinical trial, told Forbes.

The startup has received attention of nearby Silicon Valley investors in recent months. In March, Eko Devices raised $2 million from angel investors, including the founders of the music identification app Shazam.

Eko is waiting on approval from the US Food and Drug Administration, the last obstacle before a market release. The company hopes to start selling the Core later this summer.

On the opposite side of the country, MIT researchers have developed the world's first USB-powered stethoscope, with a smartphone recording app of its own. Unlike the Eko Core, the stethoscope focuses primarily on the lung and diagnosing pulmonary diseases like asthma, pneumonia, or lung cancer.

The MIT stethoscope, built with developing countries in mind, was made in collaboration with the India-based Chest Research Foundation and funded by the Indian conglomerate Tata Group. India has only a dozen facilities with advanced equipment on par with American hospitals to diagnose pulmonary diseases, according to Dr. Rich Fletcher, the lead researcher of the project.

Fletcher hopes the smartphone capability can help inexperienced doctors in rural areas make better diagnoses using the algorithms his team built to identify irregularities in breathing patterns.

Unlike Eko Devices, this stethoscope was made for research purposes, and won't be commercially sold anytime soon. Fletcher is considering starting a startup or teaming with a company which already develops digital stethoscopes, however.

If it ever hits the market, the whole kit—including the digital stethoscope, a peak flow meter to measure lung capacity and the smartphone app—can cost between $20 to $50. Considering doctors in India earn a tenth of what their American counterparts make, the stethoscope kit remains a far more financially sensible route.

There is also a certain art to expertly using a stethoscope that is dying away in the United States, Fletcher says. "Doctors in developing countries are doing things with the stethoscopes that are never done in the US because they have no alternatives," he said.

Newer generations of American doctors rely heavily on high-tech equipment, and a growing number of doctors have criticized that doctors are losing the humanistic touch in treating their patients.

But in the rest of the world where the medical technology is scarce, the stethoscope beats on strong as it has for past several generations.

"If you have a trained experienced doctor who knows his stethoscope, that's really better than any machine," Fletcher said.

Modern Medicine is a series on Motherboard about how health care and medical technology can move forward so rapidly while still being stuck in the past. Follow along here.