SXSW 2016
The week of March 6, 2016
tdd-tricorder

The yearslong quest to make the ‘Star Trek’ tricorder a reality

By Chris Stokel-Walker

On a late May day in 2014, Jonathan O’Halloran stood on the stage of Thinking Digital, a technology conference held in the northeast of England. While most attendees wore business casual shirts with slacks or smart dresses, O’Halloran was dressed in worn jeans and a raglan tee emblazoned with a biohazard logo. Pacing the stage, his forehead lightly covered in a sheen of sweat, he introduced himself to the audience, a baby-faced presenter with his shaggy black fringe pushed up in a small peak at the top of his forehead. He carried a water bottle in his hand as he spoke, his presentation punctuated with little hesitations and tics.

He explained how he’d begun his career as a fruit fly geneticist—only to recoil at the thought of a life in a lab coat, writing impenetrable papers that’d go unread. He moved into pathology labs at private hospitals, running allergy and immunology tests.  

Nervously he flicked through a slide deck, stumbling over his words. “This is me, in my garage,” he said, gesturing to the screen behind him: his younger self, beer in hand, wearing a straw hat, an England national soccer shirt, and a smile. In the picture, he had a laptop, a clipboard, and some vials in a pink plastic box scattered before him; he stood in front of a central heating boiler and two cinder block walls.

O’Halloran explained that he he’d been “dealt a really bad genetic hand”: He is color-blind, dyslexic, suffers from gastroesophageal reflux, and frequently falls ill. He wanted to know himself. He wanted to learn why he had these illnesses, and that meant reading his genetic sequence.  But the standard medical tests he ran in hospital labs, while revealing, took too long and required too much complicated, expensive machinery.

“It was during this time working in my garage that I started to look at technologies to reduce the timeline for tests,” he said, his voice an odd mid-Atlantic agglomeration of British overenunciation and American uptalk. He laid out an audacious plan—over the next 15 minutes on stage, then over pints of beer in a nearby pub—to make real a sci-fi dream from the era of the original Star Trek. What he wanted, he told his growing audience, was a handheld device that could be used by anyone, anywhere, to quickly and simply conduct the kind of DNA testing that would help O’Halloran understand and treat his own ailments—and hundreds of others. He wanted to put the power of a laboratory in his hand and the brain of a diagnostic doctor in his device.

Jonathan O’Halloran wanted to build a tricorder.

Jonathan O'Halloran at the Centre For Life, Newcastle. (Photograph provided by QuantuMDx.)
Jonathan O'Halloran at the Centre For Life, Newcastle. (Photo via QuantuMDx)

“Trying to explain a handheld DNA test in the background of everything that’s out there at the moment—the requirement for a whole laboratory and lots of equipment—is very tricky,” O’Halloran says. Eighteen months after his Thinking Digital presentation, he’s in the offices of his company, QuantuMDx, based in a medical research building in Newcastle, England. Without the pressure of performing to an audience of several hundred people, his voice is different; the nervous, restrained monotone has become more expressive. His eyes smile. A boundless enthusiasm makes him seem much younger than his 39 years.

No matter his enthusiasm, though, explaining his project means delving into complicated genetic science, so he reaches for the sci-fi metaphor. Calling his work a tricorder “provides a great analogy of what we’re trying to do; we’re trying to get to a point where we can do in-field diagnosis.” He wants to take the medical lab to the patient, instead of the other way around.

He reaches onto a window ledge and picks up a chunky white device and places it on the table. About nine inches long, it looks like a speedboat mated with an iPhone: a sunken touchscreen with a clickable button underneath tapers off to a curved prow. This is his invention, the Q-POC prototype as it stands right now, in late October 2015.

It acts a bit like a superpowered genetic Game Boy. There’s a graphical user interface and a touchscreen on the base unit; cartridges inserted into it can analyze a sample as small as a pinprick of blood in 15 minutes. Each plug-and-play cartridge carries out a different task and displays the results onscreen. This can include a diagnosis—is the patient testing positive for malaria?—and how to treat it: For example, this type of malaria is resistant to one drug, so prescribe the other. The Q-POC has three goals: test and treat illnesses at speed, at scale, and with accuracy.

A device like O’Halloran’s tricorder could recognize and diagnose many ailments almost immediately—that’s the hope, anyway.

He rolls the device over in his hands, explaining that it’s the sixth generation, with each generation having about 12 minor iterations. By the time it’s ready to launch by the end of 2016, he estimates they’ll be on mark 10. Handmade in Singapore, this version costs around €80 ($88 U.S.) to make, which “clearly isn’t going to work financially.” So they’ll keep tweaking, bringing the costs down, making it easier to manufacture at scale.

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O’Halloran hopes his device can help combat contagious diseases by quickly getting patients the right diagnosis and the right treatment. Tests that currently take days could be performed in minutes, meaning one less trip to the doctor—which can have remarkable effects on public health. For example, from March through September of this year, a gonorrhea strain resistant to the standard-issue antibiotic treatment spread through the north of England. Doctors correctly diagnosed gonorrhea infections and prescribed the typical antibiotic while waiting for more specific test results.

But O’Halloran says more than two-thirds of patients don’t return for those types of results. Other estimates vary, but the problem is large enough that the World Health Organization lists “point-of-care diagnostic tests for STIs [sexually transmitted infections]” as an important tool in fighting STIs worldwide. A device like O’Halloran’s tricorder could recognize and diagnose the resistant strain almost immediately—that’s the hope, anyway. In the recent case of the “super gonorrhea” outbreak, patients who never returned for their results may not have realized they had an antibiotic-resistant infection; they were left taking ineffective medication. “They just accept the clinical diagnosis and get given the first line therapy,” says O’Halloran. “This is why we need to get better at identifying the pathogens and the drug-resistant base: so we can provide the right therapy at the right time.”

He also points to the recent Ebola outbreak in West Africa. Beginning in early 2014 and just recently declared as having run its course, it has killed more than 11,314 people; the World Health Organization called it the largest such epidemic in history. For a time, around 1,000 new cases each week were discovered. O’Halloran believes that by cutting the time between in-field diagnosis and treatment (including with the experimental drug ZMapp), even a deadly virus like Ebola could be curbed.

Jonathan O'Halloran at the Centre For Life, Newcastle.
Jonathan O'Halloran at the Centre For Life, Newcastle. (Photo by Chris Stokel-Walker)

In one of QuantuMDx’s laboratories, a two-minute walk from its offices, O’Halloran becomes animated, shuffling quickly back and forth, oblivious to the stunning view of sun-streaked Victorian city-center architecture outside his window as he demonstrates the various pieces of kit that make up the Q-POC’s different iterations.

He first turns to a large box a couple of feet wide, under which sit a series of bottles. It’s an early version of the device, which breaks open and splits up DNA from a sample. From there, using a process called polymerase chain reaction (PCR), it multiplies the sample like a molecular photocopier. That copying creates enough DNA to subsequently carry out genetic testing for specific ailments or immunities to drugs. Traditionally PCR has been done in labs with big clunky machines: “For the rest of the world, it’s two hours,” he explains. Here, it takes three minutes.

“Everybody thought I was the mad professor, just hanging out and playing. I don’t think anybody took me seriously at first.”

Next, he shows the second stage of miniaturizing the technology: a smaller cuboid with curved edges, looking uncannily like a mini refrigerator. Lifting the lid reveals two sections: the first, a series of multicolored wires encased in acrylic. Above it, the second section has three cassettes holding the sample, bolted in with small metal screws. Close the lid, push a button, and wait 15 minutes, and you have a result for a pathology test. (Pathology tests use small samples provided by patients to help diagnose illnesses, track the progression of diseases, or simply check up on a person’s general health.)

In his lab, surrounded by thousands of dollars’ worth of specialized apparatuses, and with around 35 scientists working in laboratories in England and Singapore, O’Halloran has come a long way—in space and time—from long nights spent tinkering in his garage. “It’s just a bit different,” he says, with characteristic understatement.

Back then he’d beg, borrow, and steal equipment from his old supervisors at the University of Sussex. Even his wife and friends were often bemused with the way he’d lock himself away to tinker on the project. “Everybody thought I was the mad professor, just hanging out and playing,” he admits. “I don’t think anybody took me seriously at first.”

Indeed, O’Halloran faced a lot of bemused looks. He and his business partner had their proposition: Give us money and we’ll build a handheld device, usable by untrained technicians, that can analyze DNA from a sample of blood or spittle and suggest a treatment plan—within minutes. “Most people thought—and were really happy to tell me—it was impossible to test a sample in a molecular diagnostic DNA test,” which analyses DNA to diagnose infectious diseases, O’Halloran says. “And,” he adds, “most people said it was even more impossible to put it into a handheld device.” Even he admits it still sounds a bit like science fiction.

He had to go 9,000 miles from home to find a friendly audience. A biotech fund backed by the South African government offered to invest in QuantuMDx; O’Halloran’s idea held special appeal in a country with higher-than-average levels of typhoid and malaria infections, and where sexually transmitted diseases are rife (nearly one in five 15- to 49-year-olds in South Africa are infected with HIV).

So it was that in in the late 2000s O’Halloran found himself in the Tygerberg hospital outside Cape Town, South Africa. “Even if there are the trained staff available,” which wasn’t always a given, O’Halloran explains, “there isn’t always electricity in the field in townships. And if you don’t provide a diagnosis to these patients then and there, you’re not going to see them again.”

His vision wasn’t simply about managing epidemics—he wanted to show that a Q-POC could change lives in places lacking basic healthcare. He wants to provide a simple all-in-one diagnostic tool for people without regular medical service, who need the most rapid diagnosis and advice on treatment. “The most important goal,” he says, “is simplicity.”

Q-POC prototype, October 2015. (Photo by Chris Stokel-Walker)
Q-POC prototype, October 2015. (Photograph by Chris Stokel-Walker

After two years of development in South Africa, the funding ran out. O’Halloran arrived in a cold corner of northeast England, in Newcastle, and he’s been there for four and a half years, working within a burgeoning startup scene and a world-renowned biomedical research hub.

And he’s never stopped—not when he’s been quizzed by skeptical investors, nor on the three occasions when funding dried up, leaving QuantuMDx hours from bankruptcy. He remembers returning from Cape Town feeling buoyed by his progress, only to feel stymied on his return to the U.K., where he couldn’t find funding to take the Q-POC to the next stage.

“When you have such a vision that you believe can save so many people’s lives, it’s truly frustrating to come up against barriers all the time,” he says. “But that’s real life.”

At the last moment an investor stepped in. “He came in and saved the day,” O’Halloran says. “He’s also a South African.”

Asked what he would have done had QuantuMDx ever run out of money and been forced to close, O’Halloran can’t quite parse the question. He pauses, scratches his head, and looks quizzically into the middle distance. He smiles. “I haven’t a clue,” he says. “It has never crossed my mind.”

“When you have such a vision that you believe can save so many people’s lives, it’s truly frustrating to come up against barriers all the time. But that’s real life.”

O’Halloran believes his technology can change the face of healthcare. He believes medicine could be different; he sees a future where the centralized laboratories in which he began his career complement in-community or at-home triage tests using devices like the Q-POC. Rather than sending samples off to a pathology department for testing, the Q-POC would provide the opportunity to do that that testing remotely and quickly. Answers will come in minutes, rather than hours or days.

His vision of the future has been a long time coming, and he hopes to have devices launched by the end of 2016.  “It’s eight years from ideation to where we are now,” he says. “It’ll be 10 years in total by the time we get it out, which is just about right in terms of bringing in a disruptive new technology.” Ten years, he figures, is long enough to wait to change the world.

 

This story originally appeared in the Nov. 1, 2015 issue of the Kernel.

Illustration by Bruno Moraes