A physician who shops the world for medical technology ideas says that Israel has the four ingredients needed to rank among the world’s top medical-device “clusters,” plus one additional ingredient that’s unique: “chutzpah.”

 According to Dr. Stephen Oesterle, senior vice president for medicine and technology at Medtronic, Israelis’ attitudes and sense of urgency lead to the creation of devices and techniques that others view as dreams – or don’t even realize they want. “They come up with some ideas that are just simply outrageous, and they have the chutzpah to think, ‘We’ll just do it anyway,’” Oesterle said during a talk last fall in Minneapolisat a meeting sponsored by Knowledge at Wharton and the American-Israel Chamber of Commerce. Most medical devices come from physicians’ ideas, he noted, but Israeli engineers will try something just because the concept is interesting, and that can lead to breakthrough devices.

 For example, Technion (Israel Institute of Technology) professor Yoram Palti “thought he could put a helmet on people with glioblastoma, a lethal, malignant brain tumor.” The idea was to induce an electromagnetic field to disrupt a process of polarized proteins leading to cell division. The result is “the only thing I’ve ever seen that has an impact on glioblastoma,” Oesterle said. “[Palti] told me about this 10 years ago, and I said, ‘that’s a really nice idea.’” But Oesterle never thought it could work. From such wild ideas, however, great advances can be made, he told the audience.

 Israel has the highest density of start ups per capita in the world, Oesterle pointed out. Venture capital investments there in 2008 were 2.5 times those in the United States and 30 times greater than inEurope. In total dollars, VC investments are higher in Israel than inFrance, Germanyand the United Kingdom combined, he added.  Israel also leads the world in medical device patents per capita.

 “Things are going on in Israel that I think at some level are truly unique – different from any place in the world,” he said. “I am really aggressively working to have Medtronic have a larger footprint [there].” Medtronic, a 62-year-old developer and manufacturer of cardiac and spinal devices with $17 billion in revenue, is headquartered in suburban Minneapolis and operates in 120 nations.

 ‘Four Crucial Elements’

 During his talk, Oesterle listed Israeli technology he called “iconic”: cellular telephones, flash drives, instant messaging and Intel’s Pentium and Centrino chips. He noted that Israel, with “uncommon people doing uncommon work” in technology, is on the brink of becoming a major medical-device cluster, such as the Minneapolis-St. Paul area — home to Medtronic, St. Jude Medical and major operations of Boston Scientific.

 According to Oesterle, a cluster’s “four crucial elements” are an infrastructure of workers who know bioengineering; talent management; and risk capital. Finally, “you need culture. You can have all the money you want and all the engineering you want, but if you don’t have a culture that is entrepreneurial, where people celebrate new ideas, it doesn’t work,” he said. 

 He called Israelis “undaunted” people. “They’ve been through a lot, many of them, and they’re not going to be intimidated by a device challenge…. Additionally, “this is an optimistic bunch of people. [They] look at a problem and say: ‘Why not?’” Israel also gains from its diversity, especially waves of educated, talented immigrants from the formerUSSR, he noted.

 Another key forIsrael’s success is convergence in technology, communication, “deep miniaturization of low-power microelectronics,” and imaging and guidance. Oesterle said Medtronic is investing millions in technologies for implantable devices that can remotely manage patients with problems such as hypertension and diabetes.  Deep miniaturization means that “our next pacemaker at Medtronic, which will be released in two or three years, will be the size of an antibiotic capsule.” Imaging and guidance will enable surgery through small incisions and blood-system catheters.

 “Maybe the most exiting technology to come out ofIsrael,” he noted, is a heart valve that can be inserted through an artery, push a defective valve aside and open in its place. The idea came fromFrance about a decade ago, but “the only people who had the chutzpah to do this were in Caesarea, inIsrael…. This, to me, is one of the greatest Israeli device stories of all time.”

 Lots of money is being invested inIsrael, and “there’s lots of invention,” he said. “This place is on fire.”