Doctor's invention sprang from patient need

When Warren Smith, MD, a family physician from Boulder City, Nev., is not seeing patients, he can usually be found at his other job, a testament to how physician ingenuity can turn patient frustrations into successful businesses.

Dr. Smith said several times in his life he has heard stories from patients that kept him up at night as he tried to think of a way to help the person whose story he heard. The story he heard in 1997 from a 19-year-old patient was the story that never left him and resulted in a successful side business.

Dr. Smith's other role is owner and founder of the American Biffy Co., which produces a bidet that can be attached to a toilet. In 2007, American Biffy -- biffy is British slang for toilet -- sold more than $350,000 in bidet products and is on target to double that amount this year.

Dr. Smith said he has no intentions of leaving his practice anytime soon. But, in an "unexpected twist of fate, Biffy will provide the means for me to retire when I am ready."

Dr. Smith isn't the first physician to turn patient frustration into a marketable product. But going from tinkerer to business owner doesn't happen easily, experts say.

Frank Jackson, MD, a retired gastroenterologist from Camp Hill, Pa., said the ones who are successful are generally those who stick to what they know, which is why many physician inventions are specialty-specific.

Dr. Jackson holds several patents on products in the endoscopy field. He said many doctors make the mistake of not testing the market before moving ahead with an idea to which they've grown emotionally attached.

"Whenever you come up with an idea for a product, you have to think of what the market will pay for it, and that's where a lot of inventors get into trouble," he said.

Birth of the Biffy

The 19-year-old patient who led to Dr. Smith's second career was born with phocomelia syndrome, a rare birth defect that causes deformity in the upper limbs.

At a routine office visit in 1997, Dr. Smith asked the patient and his mother how the teen accomplished daily activities, including cleaning himself after bathroom use. The patient's mother said she had to wipe her son each time after he went to the bathroom, and if she wasn't around, he had to ask friends for help.

Dr. Smith couldn't stop thinking about the indignation the boy must have felt every day. "Sometimes someone tells you something, and it haunts you," he said.

Always somewhat of a tinkerer, Dr. Smith hit his home workshop and started creating what became the first Biffy Bidet, an automated bidet system that attaches to the rim of the toilet and doesn't require full dexterity to use.

The prototype was made with a plastic bug sprayer that Dr. Smith molded to fit on the rim of the toilet by warming the plastic bottle with a blow dryer. The part of the contraption that did the work was a spray wand attached to the bottle. It was operated with applied pressure to the valve on the bottle, which required no hand to operate.

The next step was to create a bracket that would swing back and forth so that "the Biffy comes to you and not the other way around," he said.

It took him several hours and many soaked ceilings to get the angle just right before he implemented the plan with acrylic pieces that were a little more sophisticated than the bug sprayer.

Then he showed the device to his patient.

"I expected him to jump up and down in excitement," Dr. Smith said, "But I think he was more in shock."

Dr. Smith later realized that the contraption could be beneficial not only for patients with limited dexterity but also for patients with hemorrhoids, new mothers and a host of others with varying conditions.

Over the next few years, Dr. Smith made a few more copies for patients he thought might benefit from it. As word spread, demand increased to a point that it was taking too long to construct the contraption by hand. The doctor called in a mold maker and had a few thousand Biffys made.

"The demand quickly outstripped our ability, even then, to stay up with them," Dr. Smith said.

In 2000, the American Biffy Co. was born.

Solving problems

Many physician inventions start out like Dr. Smith's Biffy.

For Glen House, MD, a Colorado Springs, Colo., internist who specializes in spinal cord injury, his invention was intended to make his own life easier and ended up having an impact on his patients, as well.

Dr. House, a quadriplegic at the age of 20 after he injured his spinal cord skiing, said he quickly realized there had to be a better way for people like him to catheterize themselves because the old catheterization systems "were engineered for procedures, not people."

He invented the C3 iCath, a catheter that made it possible for patients without full dexterity to catheterize themselves.

Dr. House said the device not only improved the lives of patients but also made things easier for nurses because it cut the procedure time down from 10 minutes to one. The device was also more sterile than previous methods.

Success in the marketplace

If a product doesn't have good market potential though, inventing and gaining patents could be an expensive hobby.

Patent law attorney David Gornish, with the Philadelphia law firm of Caesar, Rivise, Bernstein, Cohen & Pokotilow, said it generally costs between $7,000 and $10,000 to go through the patent application process.

Retired gastroenterologist Dr. Jackson said not all of his inventions justified that cost.

One example is the "moon pants" he invented. They were shorts with a trap door in the rear for patients undergoing an endoscopy. The product was well-received, but he was only able to charge about $2 a pair for them.

He still sells the product, but it's not a moneymaker, Dr. Jackson said.

Sometimes it takes refining your own product, or redefining your target market, in order to make a product more commercially successful, as was the case for the Biffy.

Dr. Smith said the Biffy mold was changed at least three times to make it better. One way it was improved was a redesign that allowed the system to shut off automatically.

Each change made the product more expensive to make, so the price had to be adjusted. When he started, Dr. Smith was selling the Biffy for about $69. It now sells for $99. Add-on products, such as a water warmer, have also been introduced.

Even though the Biffy was initially intended for medical use, Dr. Smith said the general public has now become the target audience.

One reason is recent environmental efforts that have made more people conscious about the amount of paper products they use.

Another reason is the trickle effect from the European market, where bidets -- normally, separate from the toilet -- have been common for many years.

Americans are now realizing "it's sexy and its better to be clean," Dr. Smith said.