Martin Burns

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Moira: 00:00

Martin, welcome to the program.

Martin Burns: 00:02

Thank you very much, Maurice. A pleasure to be here.

Moira: 00:04

Now I have to tell you, I'm a little shocked to be talking about a common medical condition, which we all know about, that's caused because you're ill with something else. Something else happened to you, either an accident or, an illness, but it has nothing to do with why you ended up getting this condition. Some two and a half million Americans develop this condition every year. And here's the part that is really surprising. It's so serious.

Moira: 00:39

Sixty thousand people a year die from it. And what is it? It's bedsores, pressure sores. Now, Martin, tell us how people develop these bedsores or pressure sores. And with all the medical technology and knowledge and expertise, how is it possible that sixty thousand people could die as a result?

Martin Burns: 01:02

The prevailing logic had been that bed sores, sometimes also known as pressure injuries or pressure sores or pressure ulcers, were the result of failed nursing care. Now, what's happened in the last twelve to fifteen years? We've got found somebody to blame. And it's at this point that nurses typically reach for their pitchforks about ready to stab me with them, But don't. Not yet.

Martin Burns: 01:30

Because what we have known in the last ten to twelve years is that they are actually injuries that come from the inside out. They're not easily detectable by the naked eye. In the early stages, they're physically impossible to detect by the naked eye. And so what's happened is there's been a significant understanding now in print about pressure injuries developing invisibly. And what happens is that the damage continues until such times as you can physically either see it or you can feel it, by which time it's too late.

Martin Burns: 02:09

When it's too late, what happens is the skin breaks, and if the skin breaks, all hell breaks loose. That's where you get infections, blood infections in the form of sepsis, and then bone infections in the form of osteomyelitis. Those kill people, and that's the underlying cause, broken skin.

Moira: 02:29

Now waiting to be able to detect a pressure sore on the outside of your skin, as you say, is too late. So what has Bruin Biometrics done?

Martin Burns: 02:40

We were very fortunate to have partnered with UCLA, so the University of California Los Angeles, and specifically the schools of nursing, medicine, and then the engineering school. And what they did was they had this theory at the time that you could identify the causes of damage and the indicators of what's going on underneath the skin surface, and then you could measure them. And if you could measure them, the theory went that you could actually then intervene on a patient, treat the area that's being damaged, and thereby keeping the skin intact. That's the definition of prevention. So that was the theory.

Martin Burns: 03:25

And then what we did was we took that theory and we developed and actually delivered clinical trials that showed that the theory that was in the mind of the clinician was actually correct. So we've identified a clinical marker called subepidermal moisture. All it is, Moira, is the skin and tissue flooding with moisture like a soup of healing fluid that's designed to be able to prop up the cells locally and keep them healthy. And that's just the inflammatory response resulting in localized edema. And then you can measure it, and we used physics to measure it.

Martin Burns: 04:09

That's where the school of engineering came in. And when you measured it, even though you couldn't see it, you can treat it. And when you treat it, you end up keeping skin intact. So that journey was theoretical to begin with, is now practical, and it's actually in practice, and it works.

Moira: 04:27

This device is approved by the FDA. In fact, it has been approved in 30 countries. Now we usually say someday it may be approved, not this time. It's approved for this indication. Are we talking about a huge machine here?

Moira: 04:44

Do we have to put people inside it? What are we talking about?

Martin Burns: 04:48

It's about the size of an iPhone. It takes about two minutes to get the patient into position and less than one second for the scan. So what you should think about is actually, the original vision, Moira, was do you remember the tricorder from Star Trek? That was the original vision of can you just scan over the patient? Well, we can, but you have to actually touch the patient's skin.

Martin Burns: 05:11

One of the questions we get very frequently is where do you touch the patient's skin? And our answer is we focused on the heels and the sacral area right at the top of what's called the gluteal cleft or sort of that part of the buttocks that come right up to join with the spine. Why there? Because they account for between eighty percent and ninety percent of all pressure injury sites. What you then do is you take this particular device, you scan the anatomy, and it gives you a reading.

Martin Burns: 05:41

And the reading is either green everything's fine, move on or it's orange even if you can't see the damage, there's something compromised about the skin and tissue, treat that location. Very quick.

Moira: 05:56

And so you can treat it, but how would you treat it at that point? Is it just a reaction to inflammation? I mean, what are we talking about here?

Martin Burns: 06:06

The treatment comprises things that are already available to nurses and facilities, so we're not asking them to actually buy any new treatment products. They're using what they've already got off the shelf or what they've already got in their supply room. And those are essentially a mattress that's much more dynamic. In other words, it moves and mobilizes. Those are customary for patients who are developing pressure injuries.

Martin Burns: 06:32

Heel boots, offloading with pressure, literally offloading the pressure from the anatomy. So think about, in some instances, Maura, I'm not joking, we've got nurses that are putting blankets underneath the patient's calf muscles to float the heels just to be able to take the pressure off for a period of time. And then you end up with more sophisticated interventions like multi layer dressings, those big dressings that have got foam in them. They're extraordinary and they protect the skin. So it's a combination of those things.

Martin Burns: 07:08

What we found in our clinical studies is that some interventions work better than others, and so that's now coming out. You can see, ah, for that particular patient type, do this, and then for this other particular patient type, do these other things.

Moira: 07:22

Now during COVID, we suddenly had all these patients showing up in hospitals, and we had to measure their oxygen levels because they might need intubation. And then we didn't have enough ventilators to go around, so decisions had to be made. And it was at this time we discovered that the measuring devices for people of color well, the darker their skin, the more inaccurate the reading. Now once that was discovered, well, things changed and fast. So here you are, Bruin biometrics, looking at skin.

Moira: 07:58

Does it matter the color of the person?

Martin Burns: 08:00

So Bates Jensen, the the individual who invented this, said something actually just last week on this exact topic, And her comment was, the device doesn't see skin color. In other words, it's irrelevant. So unlike devices that require light to penetrate the skin that's what SpO2 is. You when you put that little clip on the end of your finger? It's using near infrared light to be able to penetrate the skin.

Martin Burns: 08:29

This technology instead uses what's called capacitance, and I can explain that as much as we want, but just know that it's a principle of physics. That changes with the amount of fluid in the skin and tissue. The electrical value that we display goes up with more fluid. It goes down with less. It's pretty fundamental.

Martin Burns: 08:51

And what happens is it's not affected by skin color at all. So what this does then is is level what was previously a deeply inequitable playing field, and it's leveled that now.

Moira: 09:04

Now there's been some real progress in adopting this technology. I know the VA hospitals, the Veterans Administration hospitals have them. I know a number of very reputable or prestigious, I should say, medical systems have taken them up to study them in their acute care. I know several long term medical systems have adopted them, but it's not everywhere yet, right?

Martin Burns: 09:29

It's not everywhere yet. You're quite right, though, that the level of uptake has really increased a lot in the last year, and we are pleased, as you say, to have very prestigious organizations using it as they're now their routine standard of care. It's just how they deal with their patients. I want the test to be everywhere. Every at risk patient ought to be scanned to see, is my tissue compromised or is it not?

Martin Burns: 10:00

Now, we're actively working to make sure that we get the device everywhere, we get the test everywhere. That's quite complicated in the sense that newness in medical care is often seen as being a medical error. So you have to develop a sufficient amount of medical evidence, get the guidelines to be updated, so clinical practice guidelines to be updated, and it to be generally accepted. We have done all of those things. So you're quite right.

Martin Burns: 10:30

You're actually now talking to a company that's developed technology that's actually further along than might be customary for people that are listening to the podcast because we're so far along. But what we're wanting to make sure now is to make sure that every single patient, particularly dark skin tone patients, benefit from this today.

Moira: 10:51

When I think about anyone recovering from a pressure injury like this, if you've known anyone, it's very painful, and it's constant care. You know, just to be able to avoid that is a very good call.

Martin Burns: 11:06

Let me add some color to that, Maura. I totally agree with you. So a person who develops a stage four pressure injury, stage four is where the bone can actually be seen. It's exposed. First of all, their experience of life quality drops off considerably.

Martin Burns: 11:23

So there's a huge amount and I don't know why this is true, actually, but there's a huge amount of shame. Part of it is that the wound is actually extremely uncomfortable. It's painful, as you say. It also smells, and it requires an awful lot of attention to be able to try to get it to heal. The level of attention is, on average, only half of those wounds will recover.

Martin Burns: 11:48

And the recovery journey for those that do requires are you ready for this? Two thirty six changes of dressings over the course of the recovery for that wound. Two thirty six. And so what happens is you end up with nurses specialized nurses having to go into that patient's home, clean, remove surgically any tissue that's dead, cleanse the wound, replace the dressing, and then they keep doing that until it recovers. That is a monstrous amount of time.

Martin Burns: 12:22

It's a huge amount of waste, and it's an awful lot of unnecessary patient suffering. I say unnecessary because following the procedure that we've been talking about is three times safer than the alternative old standard of care. In other words, this is a preventable condition that does not need to be occurring.

Moira: 12:43

Now I mentioned earlier that you are approved at this point in 30 countries. And, of course, this interview will go all over the world. Can you name some of the countries that it's in at this point?

Martin Burns: 12:55

The US and Canada are our primary markets. Then outside of that, we're in The United Kingdom, and I have a story about that. Ireland, Australia, New Zealand, Hong Kong, Singapore, UAE, Qatar, Saudi Arabia. I could keep going. Germany, France.

Martin Burns: 13:13

Yep.

Moira: 13:14

You're in a lot of places. So okay. Tell us your UK story.

Martin Burns: 13:18

Yes. So The UK was one of our very early places to go to. There's a whole bunch of reasons for that, but mostly related to the regulatory environment. But one of our users there is an organization called Mari Curie. So Mari Curie provides hospice care, end of life care, for cancer patients, hence the Maricuri name.

Martin Burns: 13:42

The lead nurse at Maricuri rejected the idea that was generally accepted in wound care that patients who are end of life will inevitably develop bedsores. She said, no, no, no, no. My patients have lived well, and I want them to die well. And dying with a bedsore doesn't count. So she went against her nursing colleagues, used the device and this test, and has managed to reduce the incidence of broken skin ulcers on her patients by over seventy percent compared to without it.

Martin Burns: 14:18

Now this is for end of life patients with very frail papery like skin, and she has refuted she's actually proven that end of life pressure ulcers do not need to happen. So her patients are now dying with the grace that she wants them to have. I personally take enormous amounts of pride out of that because that's really forgive me for being so teenager about it, but it's really cool.

Moira: 14:42

We'll allow that. Cool. We'll allow that here. Now you can always look up at any point in time what are the most serious medical conditions for what causes death in The United States or anywhere in the world. And I looked everywhere.

Moira: 14:58

None of them mentioned pressure ulcers or pressure injuries or bedsores. And yet in The United States alone, we're talking sixty thousand people die from them as I mentioned earlier. What's going on there?

Martin Burns: 15:13

So that number of

Moira: 15:14

Yeah. That that's a very official question. What's going on there? Yeah.

Martin Burns: 15:19

Yeah. What's going on there? So I'll make two comments about this. So the first one is that the sixty thousand number comes from a group called the Joint Commission, And the Joint Commission's in Chicago, and they measure performance essentially of health systems in the delivery of care. And this was a report that came out in 2012.

Martin Burns: 15:42

Now, you take that 60,000 number and you look at the top 10 list that the CDC produces, the Centers for Disease Control, and you won't see bedsores on there because they don't formally measure it. But if you were to map the sixty thousand to that list, bedsores would be, depending on the year, number seven or number eight in the list of leading causes of mortality in The United States. The one that is immediately in front, number six, and the one that's immediately behind, number eight, are both cancers. Now, unlike cancer, we know what causes this. We know how to treat it.

Martin Burns: 16:23

We know how to prevent them, and therefore we know how to reduce the incidence of deaths. And it's already being done in leading institutions all across The US. So if this were cancer, can you imagine the size of the army of people that would be fighting to be able to prevent these on scale? It would be massive. This type of discussion helps with that objective very meaningfully.

Martin Burns: 16:51

So the second point, Maura, was just related to this broader topic of what's actually preventing prevention. Now, I'm a systems guy, and I studied health systems with Professor Nancy Levison from MIT. She's the world's leading expert on this particular topic. And when you study her work and you apply it to this particular area, what you find out is the sort of four stages to this. One, you have to have insights as to why this is happening, and you've put a light on that already.

Martin Burns: 17:24

It's biology. It's not magic. Then you have to have it in practice. And again, there it's about making sure that you have the test in practice, that it's available, that people know how to use it, and they know what to do with the numbers once they get them. And then you have to have nurses actually trained.

Martin Burns: 17:44

There are 4,100,000 nurses in this country, most of whom get three hours of wound care training as part of their education. What we're doing is educating the 4,100,000 about how you prevent bed sores. Then there are all of these carrots and sticks, and you can think about that as payments for prevention, penalties for when it's not achieved, and then protocols and policies that enforce all of that. We're working with CMS, which is the Centers for Medicare and Medicaid. It's the biggest payer for health costs in the country.

Martin Burns: 18:21

And we're asking them to make sure this is covered and reimbursed, paid for, so that acute care, long term care, skilled nursing care can get paid for doing this procedure in the same way they're paid for, I don't know, blood oxygen levels or blood pressure on admission. And when you combine those four elements, what you end up with is achievement of prevention everywhere across the country for all patients.

Moira: 18:51

Well, Martin, this has been terrific, and I think it really motivates me and the people listening that if someone around them has this condition, call it bedsores, pressure injuries, and the like, whatever, they can spring into action. So I thank you very much, and I hope you come back and see us again.

Martin Burns: 19:11

Laura, what a treat. Thank you very much.