Can start-ups finish up?

n this issue of Circulation: Cardiovascular Quality and Outcomes, Xu et al present findings from a search of US patents related to bare-metal coronary stents in an effort to gain insight on how medical device innovation starts and how policies in the United States might help to promote more innovation. 1 Of the 245 patents identified by their search strategy for the years 1984 to 1994, the authors report that the most frequently cited stent patents (their measure of patent importance to innovation headlined by the Palmaz and Gianturco patents) were from individual physician inventors working in academic medical centers and their small private companies. They also report a temporal trend that shows, in later years, more patents were granted to public companies. They concluded that policies aimed at supporting these entities might enhance and accelerate innovation because early innovation, in this case, was spurred by individual inventors with their small companies. It is true that individual practitioners struggling with the challenges of everyday practice are an important source of new-device concepts that can possibly solve an unmet clinical need. However, the journey of successful innovation to maximized impact on public health requires that these early ideas (such as the original stiff, boxcar like tubular stent of Palmaz or the poorly scaffolding clam shell stent of Gianturco) need significant refinement through subsequent innovation (such as the later, industry-based Lau patent of the Multilink stent that enabled broad application to the coronary circulation). Innovation may begin with practicing physicians, but the ultimate benefit of a technology to society depends on continued innovation throughout product development and iterative refinement as contributed by companies with greater financial resources and a larger workforce of engineering and scientific talent. The hypothesis that the most cited patents may represent the most influential ones (eg, producing the most clinically and commercially successful devices) may not always be the case, as evidenced in the current study by the fact that many of the top 10-cited patents never became a clinical stent. 1 Such a hypothesis would require some technical analysis of the various designs and how they might have contributed to the successful development of clinical science, the treatment of patients, further innovation, and, ultimately, success in the marketplace. The use of the assignee and its classification according to type in the study is also complex. For example, the nature of the actual inventors, regardless of whether they …