Then Fischell, in a collared shirt unbuttoned low, puts the Jag into action, weaving it through traffic on his way toward the University of Maryland. He has a meeting there at 2 p.m., and it looks to be an important one. The tech guys are rolling out his newest invention. And this one — a contraption he says could cure chronic pain — should be a doozy.
The life of Robert Fischell has been one of doozies. A space scientist turned inventor, Fischell has authored more than 200 patents that range from the grave to the quirky. He has invented a rechargeable pacemaker, an implantable cardiac defibrillator, a device that warns of epileptic seizures, an insertable insulin pump and a gizmo that zaps migraines before they start. He has also fashioned a bevy of penile prosthetics to cure erectile dysfunction as well as something called a “bowl for keeping cereal crispy.”
But this invention, he says, is his most ambitious yet. “Chronic pain costs the American people $600 billion every year,” Fischell says in a lilting staccato flecked with traces of his Bronx youth. “Six. Hundred. Billion. Dollars.”
Still, Fischell is not a young man. He’s 86. He’s had two surgeries for cataracts in the last six weeks. He has an artificial left knee.
Fischell, who grimaces when mortality arises in conversation, knows more days are behind him than ahead. So he keeps a frenetic pace. He clocks 10-hour days at his office. He drives his Jaguar fast. He drinks unsweetened tea by the quart. This could be his last great invention. He has to finish it soon.
It’s now 1:55 p.m. Fischell slams the Jaguar into a parking space. He hustles into the Fischell Institute for Biomedical Devices, arriving at a conference room. Fischell looks around. It’s empty. He’s early.
The language of pain
The first scientist to join him is Lex Schultheis — a man who’s ready to talk pain. Schultheis wears camouflage moccasins and an arm sling and has ruffled white hair. Some weeks back, Schultheis said, he took a bad spill while astride his unicycle and “fractured my arm into a hundred pieces.” It hurt like something else. But that, he said, was a good thing.
“There are two kinds of pain,” said Schultheis, the director of the university’s innovation initiative. “Good pain and bad pain. There’s the pain that prevents you from reinjuring yourself,” which he experienced after his unicycle accident. But then there’s “bad pain,” he said. “It’s when the repair is done and the doctors have done everything they can. It’s not serving a purpose.”
One-third of Americans know what Schultheis is talking about. We live in an era of chronic pain. It batters more people than diabetes, heart disease and cancer — combined. The answer thus far has been painkillers, and the number of opioid prescriptions have tripled in the last 15 years, according to the CDC. This, however, has been a deal with the devil. Between 1999 and 2010, the number of opioid overdoses surged from 4,000 to 16,500 amid mounting evidence suggesting that painkillers actually increase pain sensitivity.
That got Fischell thinking. What if drugs aren’t the answer? What if they communicate with nerves in the wrong language? What if it’s time for a new language?
If the body is a house, the nervous system is its electrical wiring. The network, which has millions of entry points throughout the body, communicates in electrical pulses. A finger prick shoots a series through a long axon to the spine — the pathway that all pain signals must pass — until they strike the brain. The higher the frequency of the nerve’s signal to the brain, the greater the pain.
So Fischell, now holding forth at his meeting, said the best way to calm down those nerves is to speak to them in a language they understand — electricity. The problem, of course, is that electricity kills. Wouldn’t it do more damage than good? Fischell laughed at the question like he was in on a secret joke. The answer, he said, was just around the corner.
A barrel-chested engineer named Wes Lawson materialized at the doorway. Fifteen minutes late, he wheeled in a large metallic box of blinking lights and dials. A long cord affixed to a copper coil dangled from its side.
This was Fischell’s latest invention. This device, he said, interrupts a pain neuron’s electrical signal before it reaches the brain. And the best part, Fischell said, is that it doesn’t use electricity at all. It uses magnetism.
‘A major step forward’
If there’s a moment that marked the genesis of this device, it came 15 years ago in the mountains of New York. There, ensconced inside at the Mohonk Mountain House, sat Robert Fischell with his son, a physicist, and a neurologist named Adrian Upton. They called their meeting an “innovation retreat.”
“I don’t know why it is, but the three of us could always get together and invent stuff,” said David Fischell, who holds 85 patents and helms several biomedical companies that have commercialized the family’s inventions. “So we went to this quiet spot and we literally spent five or six hours a day for two days talking about different areas where electric stimulation could help.”
No one can remember the details of who said what. But at some point, one of the three inventors brought up migraines. The brain, they reasoned, was a natural place to use electricity. “If pacemakers and electricity works for the heart, then it should work for the brain considering it’s much more electrical than the heart,” David Fischell said. But the trick was to get the electricity to the brain. So they mulled a concept in physics known as Faraday’s law of induction. The principle, which also gave rise to electromagnetic generators, holds that a pulse of magnetic energy will induce an electrical current. And that, they thought, might grant them a way into the brain.
Diagnostic researchers had already used this technology — called transcranial magnetic stimulation — to poke and prod the brain with bursts of electricity. But no one, David Fischell said, had used it to treat the brain.
So Upton, back at his office in Ontario at McMaster University, fired a pulse of magnetic energy into the skull of a patient who complained of migraine pain and an aura. The patient’s aura then shifted shape and size. This suggested something big: Electricity could affect the neurons behind the migraine. “The overall principle is very straight forward,” Upton said. “Migraines are like epilepsy in that there is an electrical spreading in the brain, and if you can interrupt that spreading, you could stop the migraine.”
In 2000, the three inventors filed an application for a patent. It detailed a portable device that presses against the skull and shoots magnetic energy into the brain, expunging a migraine before it starts. One study published in Neurology called such technology a “major step forward” in chronic migraine treatment. Another study in Neurological Research found that 50 out of 51 migraine patients reported a 50 percent reduction in headache frequency after one week of treatment. The Journal of Neurological Sciences said it “ameliorates chronic migraine” in one part of the brain.
Still, 13 years passed before the Food and Drug Administration approved Fischell’s device. In those 13 years, a lot of life happened. Fischell started a department of biomedical engineering at the University of Maryland. He criticized the FDA at a Congressional hearing for what he called its sluggish pace in approving patents for consumer use. And his wife of 54 years died of leukemia.
It crushed Fischell. For a man who has hung a sign that says “nothing is impossible” in his office, he couldn’t accept his own helplessness. “I couldn’t save her,” said Fischell, who watched his wife’s deterioration in daily doctor visits. “I’m an inventor. I invent things. But I couldn’t come up with anything that could save her.”
A little more than a year after her death, Fischell married his former secretary, which surprised his three children. “It seemed a little fast,” son Tim Fischell said. “But he is not someone who does well alone. He is not someone who would be OK alone, but he and his [new wife, Susan] had known each other and now are very devoted.”
And it was this relationship that inspired Fischell’s greatest pursuit yet: his quest, at 84, to eliminate chronic pain.
‘Inventing is a blessing and a curse’
Fischell lives inside a cavernous ranch-style home tucked among trees on an estate he calls “Willow Oaks.” He rarely leaves it. He holds meetings there when he can. He takes meals at the nearby Crossroads Pub. He hangs out with neighbors. One such gathering came in December of 2013 when one neighbor, a woman in her seventies, was dying of cancer.
“She’s telling my wife how severe the pain is in her feet from two years of chemotherapy,” Fischell said. “There are 10 million Americans with severe foot pain. And my Suzie, who doesn’t even have a college degree said, ‘Well, why don’t we use Bob’s migraine device to erase your foot pain?’ And I said, ‘What the hell are you talking about?’ A migraine is a migraine. This is foot pain.” But the suggestion nonetheless stayed with him. Possibilities sloshed around in his mind that whole night. He wondered: Could the same principles that govern the migraine invention do the same for chronic pain?
Fresh research suggesting receptors in the meninges produce migraines has emboldened Fischell’s hypothesis. If electrical currents can disrupt pain receptors in the meninges, it might do the same for other parts of the body. So Fischell has spent weeks drawing. He has drawn a boot-shaped contraption that someone can slide their foot into to receive a jolt of electromagnetic energy. He has drawn a shoulder harness that targets the rotator cuff. He has drawn a belt festooned with a giant copper coil that someone with back pain can wear. He gave his technicians weeks to forge 10 prototypes that he can use in a clinical trial beginning in September to test his hypothesis.
Everything’s moving fast — but is it too fast? Fischell’s career, after all, was forged in space laboratories at a time when astronauts were shooting off to the moon and everything seemed possible. That optimism has informed his decisions in innovation. And while it has driven him farther than most, it has also misguided him at times. (It’s unclear, for instance, who will need a cereal bowl that ensures crispy corn flakes.)
“Folks who don’t know him that well may be suspicious of his optimism,” Schultheis said. “He’ll tell you that this will cure all pain. And while he’s not unrealistic, there are projects that he works on that aren’t successful.”
Fellow inventor Upton agrees: “This isn’t something that’s going to happen over night as some sort of miracle. That’s not realistic. But there’s no question that the type of stimulators he’s working on now help pain, no question.”
But Fischell’s not interested in talking about things that can’t happen. He’s not interested in discussing his age, or his mortality. He’s not interested in considering what he’ll do when the work stops.
As he departs his meeting on a recent Tuesday and climbs into his Jaguar, he says he’s interested in getting back home to his office. There’s so much work to do. There’s no time to waste.
“Inventing is a blessing and a curse,” he said. “But it’s fun, too. It’s a game. But the stakes of this game couldn’t be graver.”
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