Designing Drugs

Making medicine for pediatric malaria victims is one of my projects. Our team must design the medicine in order to save lives.

Some problem background. Malaria sickens about 250,000,000 people and outright kills close to 1,000,000 every year. Most deaths are pregnant women or children under the age of five. For every child killed, the disease cripples or mentally impairs perhaps another ten kids. There's no immunity -- victims may suffer malaria multiple times yearly -- and vaccines have been "five years away" for the last fifty years.

We in the U.S. have forgotten malaria was once a scourge here too. We eradicated malaria in the 1950s and 1960s. We killed it with fire, poured oil on swamps, and sprayed entire cities with DDT. Mosquito-borne infections were such a big problem that my home town's mosquito control district existed until 1998.

Bed nets, insecticides, quarantines, abatement programs all work. But when infected, people need treatment to kill the Plasmodium sp. parasites swimming through their veins and laying eggs in their livers and blood cells. Let me restate: there is no immunity to malaria. Victims get it again and again and again every year. Exhausted victims just ... die.

Part of the problem is availability of treatment. Distribution and logistics in malaria-infested regions that are typically remote and rural are sketchy at best, and suppliers contend with black markets, thuggery, and graft.

For young children who can get medicine, its poor usability often bars effective treatment. The medications are giant pills meant for adults. They're meant to be taken in sequence over three days. The come with complex instructions, often in tiny print and in English. Parents and caregivers must break up pills and hope the dosing works for their kids. Too little, and the children remain sick while the parasites start becoming resistant.

The Real Problem

Packaging and package design are critical. We've one answer, depicted on the BioSUNATE™ site and below. Here are some of the design constraints:

• Packaged drugs must survive the tropics. Heat and humidity degrade the product. In the pharma business, this is known as stability. A minimum two year shelf life is desirable.
• The patient must take the full three-day course or it won't kill the parasites. This one's hard. In countries where it's possible to buy a single Tylenol™ from a pharmacist, multi-course treatments get broken apart and sold as individual doses, or patients keep some medicine "for later" instead of taking the full required course.
• Illiterates must be able to use it. The package must convey the dose-to-patient match. Overdoses are as harmful as underdoses. Children, especially young children, are most often mis-dosed.
• Ethnic and tribal divisions are rife. One people will refuse to take medicine which depicts another people on the box or label. It's not prejudice, it's identification: "Oh, this medicine is for Yorubas, not Igbos."
• The consumer price must be low. Therapies run US$3-8 in countries where this represents between two days and two weeks wages. This forces the manufacturing price under a dollar.
• It tastes bad. Really bad. Bitter as poison. Infants and toddlers will spit it out and hence fail to get the full dose.

These problems omit the rest of the issues with setting up a business, finding buyers and suppliers. Fun.

Fixing the Design

We're looking for other solutions, too. The packet design has some flaws: it's easy to split up for resale (three packets are required to complete the course). The taste mask for the active ingredients is bulky. The medicine must be mixed with food or drink and some patients are too sick to eat.

We are also considering development of a melt-in-the mouth medicated strip. Children may take it more readily than having to swallow something.

There's more about what we're doing at CURE Pharmaceutical's BioSUNATE™ site. Ideas are welcome; funding for the project is even more welcome. If you can help with either, contact us at info@curepharmaceutical.com.

"Good design" doesn't mean texting your BFF faster or getting the latest game from the app store. "Good design" in this problem means gravely sick kids get the right drug course comprising the right doses of active compound. "Good design" here means a child lives.


References

WHO Malaria Home Page

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Goldilocks and the Share Bears

Working together on shared information has been goal of the software industry since ... forever. How hard can that be?

Very. The easiest way to share information is simply to give it to someone.  Consider three models:

• Collaboration suites (SharePoint or Groove) or earlier portals (Plumtree)
• FTP sites
• Plain Old File Servers and their WAN cousins (DropBox, SkyDrive)

Sharepoint/portal porridge is too hot. They're great for building corporate departmental sites to contain and control information. They are, however, highly interactive, require developers and administrators to set up and manage, and have an overwhelming number of layout and design options. It's hard to simply put and find stuff with all the interface noise and clutter. Without a design and set-up, they're inert.

FTP porridge is too cold. Users must look whether files are new or old, and working with info means pulling files down to the local desktop. MS Windows can set up an FTP server as a folder in the file system, making it look like a local file set, but files on the servers don't behave the same way as true local files, access times notwithstanding. FTP is close, but clunky.

POFSes pretty much win. DropBox porridge is juuuuuust right. Set up is trivial, accounts are generous (how do these guys make money?), and files sync across dozens and dozens of machines among self, family, and friends, automagically, in the background. That's why DropBox, after several years in business, is finally getting traction in the consumer geek press this summer.

POFSes, done right, just work. They work the way people expect "sharing files" to work. No fancy interface like Groove (which did the same magic file sync), no setting up torrents, no DAV exposed, no "file sharing" monkeying around. Open the folder, work on the file, close the folder. Everyone else sees the same stuff. Just like on a LAN or your own computer.


The Real Problem

People have spent nearly 30 years in WIMP GUIs shuffling info around inside folder/file hierarchies. That's nearly 30 years of unlearning to do.

POFSes also map onto the physical sense of place. The language used to describe actions is place-oriented: "I put the file [over] there"; "she stuck it in this folder here"; "where did you save the sales report?" The notion of place is hard-wired into humans' physical selves.  Even Hansel in "Zoolander" gets it: "The Files are in the Computer."

Chopping information in weblets or interposing app/applets further confuses place with action. Applets add needless extra steps: the resource must first be found, then asked to divulge information. Sticking extra software or processes into the task mix is valuable when that software add control over detail, such as when sharing a calendar. Extra pages, links, access methods, etc, are annoying when the shared items are will understood and their normal operation is familiar, e.g. "open this PDF brochure."


Fixing the Design

Work with what people know. That's one of the basic tenants of good design, along with "don't reinvent the wheel". Trite, but true.

Follow the principle of least surprise. There are no surprises when sharing files in Dropbox. FTP shares as folder extensions have a nasty surprise: opening the file in the folder can cause the file handle to go stale. Saving the file returns a user-surly message which is unhelpful for resolving the problem. It's a message never seen when using "plain old files" on the computer.

Where problems do occur, help fix them. Dropbox users will have problems with conflicting edits. Dropbox doesn't try to resolve conflicts automatically. The system nicely labels conflicted files with the name of the person whose write caused the collision, so folks can call each other to work it out. This model works because conflicts are relatively rare, fewer than 2% of the accesses by my tests.

Drop-dead installation is the icing on the cake. Setting up an FTP or shared portal requires fiddling with logins and credentials on both ends, more with complex controls for permissions and access guards to secured areas. Dropbox pushes this responsbility out and uses a simplified UNIX-like sharing model: me, my friends, everyone else. Easy and done.


References


Groove Virtual Office

Setting up FTP folders on MS Windows

Dropbox review: File synching for your Mom at Techwizbackup

Newer:

• DropBox review in Network World
• DropBox for mobile at InfoWorld

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Design Fetish and Function Failure

The most devastating comment Don Norman makes about over-design in The Psychology of Everyday Things is that a design is so good "it must have won an award."  The meaning, in context, is that the product looks great but is unusable — it's broken as designed.

Apple and Steve Jobs make a fetish of design.  Their industrial design tradition stresses beauty and  function, especially for casual users and folks who just "want it to work" like my 80-year-old dad.  Kudos.

Apple's new iPhone 4 is a triumph of design over function.  Its slender glass and stainless-steel case has wowed reviewers and fans from the beginning. It's sleek and chic and oh-so-unique.

Apparently it doesn't work very well, too.  The new iPhone dropped communications during Apple's World-Wide Developer's Conference, frustrating even demo-god Mr. Jobs. The problem was blamed on too many wireless signals in the room.

Today (24 June) the phone is being shown to lose signal when merely held "incorrectly":



The problem appears to mystify Apple fans and computer geeks alike.  How did Apple let this one get by?


The Real Problem

My son showed me the above video.  Inspecting the lower-left hand corner of the iPhone 4's case reveals the problem.  When held left-handed, the ball of the thumb covers up a small gap in the stainless-steel band that girds the unit.  This band is Apple's touted integrated antenna.

I'm a software-and-systems guy, not an electrical engineer, but I messed around with radios as a kid.  To anyone who's played with radios, the problem is immediately obvious: touching the gap bridges the antenna.

Antennae work by having a hunk of wire stick one or more ends out.  The free end lets the signal jump from the wire into space, which is why radio antennae are depicted as at right.  Even the goofy tech in Star Wars gets it: recall the antennae that festoon Cloud City's underside in "The Empire Strikes Back".  Their fundamental design saves Luke from plummeting to his death.

Antennae have worked like this since they were first invented by Heinrich Herz in 1888.  On the new iPhone, the user's hand placement appears to couple what look like two antennae on the case, turning them into a closed circuit.  No antenna, no radio signal, and the stylish, sexy iPhone 4 becomes a smaller, less-capable iSlab.


Fixing the Design

If bought already, put a piece of Scotch Tape over the antenna gaps on the case. Wait for someone to make a silicon rubber band that covers the iPhone's antenna/edge. It'll probably retail for $17.95.

Test with people who hold the product in alternate hands.

Put an electrical engineer who has radio experience on the product design team. Steve should be sure his engineer can say "no", then he should listen to him.


References

• Steve Jobs has problems demonstrating the iPhone at WWDC, June 2010, BusinessInsider
• Beautiful and sleek iPhone 4 impresses the design world, The Design Blog
• Radio Antenna (Wikipaedia)
• Cloud City (Wookieepedia)

Addendum

30 June 2010 - Apple reportedly is hiring antenna engineers.

2 July 2010 - Apple Admits iPhone 4 Signal Issue, Blames it on Incorrect Signal Display. But Will Software Fix It?

14 July 2010 - Wall Street Journal reports Apple's engineers knew of the problem a year ago, but Steve Jobs forced the design.

14 January 2011 - Computerworld says Apple has redesigned the antenna for Verizon's upcoming roll-out of iPhone service.

9 February 2011 - Geek.com reports the newly redesigned antenna on the iPhone 4 suffers from "death grip" too.

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