Starting With Ultrasound, An Innovation Empire Is Growing In Guilford

About four years ago, a group of biomedical engineers walked out of the Guilford laboratory where they had tried and failed for four years to do something new: fit all the technology of diagnostic ultrasound on a chip.

Frustrated and defeated, they thought they would stage a coup — at least that’s how it looked to their boss, Jonathan Rothberg, whom they approached in the little, waterfront cafe next to his $100 million company, Butterfly Network.

But it wasn’t hard for Rothberg to say, “No,” when they told him it couldn’t be done, that all the technology of a device that looks inside the human body can’t be contained in a microchip.

It wasn’t hard for Rothberg because he wasn’t thinking about failure or losing money or disappointing investors. He was thinking about his goal: rebuilding ultrasound technology from the ground up, and making it smart, simple and cheap enough to place in the hands of 40 million people.

Rothberg, a scientist and serial entrepreneur, sent them out of the cafe, named Pa’s Place after his chemical engineer father, Henry, who’d built a multimillion dollar company of his own in nearby Bethany.

Not long after that, the engineers succeeded. This year, the company is starting the work of spreading its $2,000 ultrasounds, called the Butterfly iQ, beyond the hands of the well-funded few and into those who couldn’t otherwise afford it.

This month, Butterfly’s portable ultrasound device was first used in rural, resource-strapped hospitals in Kenya, where imaging intensive-care patients typically means disconnecting them from oxygen to move them through the hospital. The Butterfly iQ device connects to a smartphone and can scan everything from a fetus to tumors, broken bones, pneumonia and kidney stones, instantly uploading the images to the hospital’s cloud.

The device uses artificial intelligence as well — it learns from watching doctors perform a scan, so eventually it will be able to guide patients themselves through an ultrasound.

Rothberg, who partnered with a Brown University ultrasound team to pilot the device in the developing world, was giddy when photos from Nairobi’s Kenyatta National Hospital showed up in his Twitter feed on April 3. He typed up a joke, asking for a baby hippopotamus scan, which got him a Swahili greeting of “Jambo!” from one of the Brown emergency doctors.

“You put #butterflyIQ in our hands,” Grace Wanjiku wrote. “What can we not do? We feel quite invincible right now.”

Looking back, Rothberg says it’s no surprise that his employees proposed pivoting from the mission of Butterfly Network. The work was slow and expensive, and failure was inevitable.

“Of course you fail,” he says. “You get up. That’s the key. You get up more times than you fall down.”

“The nice thing about this not being my first rodeo, I just turned to them and said, ‘No,'” Rothberg recalls. “They said, ‘Well, there’s 50 of us,’ and I said, ‘That’s great. Now get back to work.'”

The Butterfly iQ is at least the fourth portable, handheld ultrasound device on the market. Most also connect to a smartphone and send data to the hospital’s cloud.

But Butterfly was the first to reimagine ultrasound from the ground up rather than scale down traditional ultrasound machines, which rely on the vibrations of quartz crystal transducers — essentially, tiny speakers and microphones that convert electrical energy into sound waves — to send pulses into the body.

Electronics then translate the returning pulses into pictures.

The iQ replaced those crystals with a microchip equipped with 9,000 metal transducers, each smaller than the tip of a human hair.

The creation of that chip is what took Butterfly Network $100 million and five years. But it allows the company to produce high-quality ultrasound probes for $2,000 a piece — far cheaper than similar models — with plans to lower the price in coming years.

“There’s true magic on this chip,” transducer team lead Jaime Zahorian says.

In comparison, a portable, handheld ultrasound by Canada-based Clarius Mobile Health — released in 2016 — costs $6,900 for a basic model that scans the abdomen, lungs and heart. GE declined this week to give a price range for its device, called the Vscan. And Phillips leases out its ultrasound device, for more than $3,000 a year, plus warranty. Traditional ultrasound machines cost tens of thousands of dollars.

Companies have tried to make diagnostic ultrasound more affordable before, but Rothberg said they took the wrong approach — upgrading and miniaturizing pieces of existing, bulky ultrasound machines rather than reimagining how ultrasound could work.

He thinks back to Henry Ford, who built the first first gasoline-powered horseless carriage in the 19th century. Ford didn’t try to build a mechanical, robotic horse to pull the carriage. He built the Quadricycle, the first automobile.

“When I looked at the history of [ultrasound], people had literally tried to take micro-machines and replace part of that ultrasound cart. They were literally trying to build a robotic horse,” Rothberg says. “And it’s really difficult to make a robotic horse — to this day I haven’t seen a good one, but I see lots of cars.”

In the next 18 months, Rothberg said, he would like to sell more than a quarter of a million devices. His teams are also working to build other forms of ultrasound, including a wearable patch and a pill that could image cancer from within the body. In the next 10 years, he wants imaging to be ubiquitous — as common as thermometers in home medicine cabinets.

He also envisions the devices replacing the stethoscope, with nurses imaging lungs rather than listening to them, and imaging hearts rather than measuring blood pressure. And with ultrasound being used as an early diagnostic tool for regular aches and pains, it could catch diseases more quickly, leading to faster treatments and better outcomes.

That was the case for cardiologist John Martin, Butterfly Network’s own chief medical officer. He made headlines in 2015 after he used the device to scan a tender spot on his neck and found a large mass — metastatic throat cancer.

Martin says he’s not sure if he would have visited a doctor before the cancer spread beyond treatment. As is, he still underwent a more than five-hour surgery and radiation.

“There really isn’t a single disease state in which time doesn’t impact how well you do,” Martin says. “There’s a lot of waiting in medicine, and the more we tackle that problem of waiting and get to treatment sooner, the better everyone’s going to be.”

Rothberg has been trying to conquer that concept of time for decades.

He’s best known for creating a microchip technology that revolutionized the slow, arduous process of reading DNA. It was a breakthrough inspired by Rothberg’s desire to help his son, Noah, who had difficulty breathing as an infant.

Years later, Rothberg turned his attention to ultrasound because he wanted to find a treatment for his daughter’s kidney tumors, caused by a genetic disorder called tuberous sclerosis complex. The need to give her a window into her body — and to eventually turn ultrasound into a device that erases tumors — drove the creation of Butterfly Network.

Martin says it wasn’t until his cancer diagnosis that the company’s goals became personal to him.

“The driver was, ‘The people that I love need this,’ and expanded, ‘The people in the world need this,'” Martin says.

Rothberg’s business pursuits began in 1991 as a graduate student at Yale. He was inspired to enter the corporate world by his parents, who grew their tile and stone installation business into a three-generation family company that now has a 1,500-person workforce and 35 manufacturing locations worldwide.

Rothberg, studying molecular biology, founded CuraGen to develop cancer therapies.

One of his proposed treatments for metastatic breast cancer is still one of the most advanced in Celldex Therapeutics’ pipeline nine years after Rothberg sold the business for $94.5 million.

CuraGen also spawned the high-speed DNA sequencing invention through a business unit called 454 Life Sciences, which sold to Roche in 2007 for $155 million. That breakthrough earned Rothberg the highest presidential honor for technology — the National Medal of Technology and Innovation — in 2016 and enabled the fields of genomics medicine and personalized health care to grow like never before.

Also in 2007, just before the financial collapse, Rothberg sold a social networking company for investors, called Clarifi, to Standard and Poor’s.

His biggest public sale came in 2010, when Rothberg sold his second genomics company, Ion Torrent, to Life Technologies for $725million.

“We only do things no one else is doing, and we only do things people say can’t be done,” Rothberg says. “Then we put together a group that doesn’t know better, and we get it done.”

On a recent Friday, Rothberg bounced from station to station in the Butterfly Network lab, sparing a few minutes at each to get updates, ask questions and make calls. In one corner of the lab sits a wooden crate marked “Moet and Chandon,” a remnant from the team’s celebration of its FDA approval in October 2017.

In a room of white lab coats, Rothberg wears a black hoodie embroidered with a tiger, a gift from his kids. Later that afternoon, he’ll share a limo with two of his oldest and head for Cold Spring Harbor, N.Y., to host a birthday party.

James Watson, the co-discoverer of the DNA double helix, is turning 90.

Just 10 years ago, Rothberg was part of a team that sequenced Watson’s personal genome, all 6 billion base pairs of DNA. It was the first time that scientists had sequenced an individual human genome.

Rothberg says his 18-year-old son, Noah, likes Watson, who told the teen to “go for the gold” because there’s fewer people going for the hardest problems.

Rothberg is more specific when he gives his kids advice, especially Noah, who says he’d like to start a hedge fund.

The serial entrepreneur thinks his son, a Yale freshman, is joking, as freshmen often do. But he wants to be sure that his five kids reap the right lessons from the innovation empire he’s still building in a little corner of the Long Island Sound.

“You’re supposed to build things in this world,” Rothberg tells him. “There are makers and there are users. You have to be a maker.”

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