Continued: Pacemaker keeps the beat going on

Young Earl Bakken liked to build stuff.

Stuff like the Kiss-O-Meter he built to tempt the girls and intrigue the boys. Then there was a robot that smoked cigarettes, inhaling with "lungs" made of hot-water bottles. A gun-shaped taser he fashioned shot 20,000 volts of electricity and "scared the bullies away,'' declared Bakken.

Saturday afternoon Frankenstein matinees at the Heights Theatre in Columbia Heights sparked the notion in young Bakken that electricity brought life to the unliving.

Years later, after he had an engineering degree from the University of Minnesota, Bakken's urge to tinker, his fascination with electricity and his scientific know-how would collide, quite literally, with a bolt from the blue.

What happened next would put Minnesota on the map as a hotbed of medical technology innovation. Half a century later, a company that started in Bakken's garage -- Medtronic Inc. -- posts $12.3 billion in annual sales and has emerged a leader in a $5 billion market for devices that pace and stimulate irregularly beating hearts.

The kid who built the Kiss-O-Meter would end up saving millions of lives.

That's why this week, Bakken, now 83, will become the first person in the 120-year history of the University of Minnesota Medical School to be given an honorary M.D. for his contribution to medicine.

But first, back to that dark and stormy night that changed cardiac care forever.

The brain storm

A storm blew in, lightning struck and the Twin Cities was plunged into darkness that would become known as "Black Thursday," a major electricity blackout on Halloween 1957.

Over at the University of Minnesota hospital, the power went out and University of Minnesota heart surgeon C. Walton Lillehei, famed as the pioneering father of open-heart surgery, was helpless to save a young patient.

The child was connected to the best cardiac technology of the day -- a bulky tabletop pacemaker powered by an AC circuit plugged into a wall socket. "They would have to run extension cords down the hall, and drop an extension cord down the elevator to keep the AC power going,'' Bakken recalled in a recent interview.

The child died.

Bakken recalls a traumatized Lillehei approaching him the next day with an urgent request: "He said, 'Earl, isn't there some way we can have a battery back-up on these pacemakers to keep them running during a power failure?' I said, 'Sure.'"

Bakken already was a familiar figure in Twin Cities hospitals, having co-founded Medtronic, then a fledgling medical equipment company. The Norwegian and Dutch engineer retreated to his garage in Northeast Minneapolis to tinker.

Within a month, he cobbled together the world's first external battery-powered pacemaker.

The first pacemaker Bakken concocted involved "a whole cart full of equipment'' powered by a rechargeable car battery. Unsatisfied, Bakken remembered plans in Popular Mechanics magazine for an electronic metronome using a two-transistor circuit. "I thought with those clicks of electricity on a metronome, I could plagiarize that circuit and make a pacemaker out of it.''

He took the prototype to Lillehei, and it worked on its first "patient" -- a dog. Bakken figured it needed fine-tuning. But a day later, "I went over to the university and here he had this pacemaker wrapped to a child. That was quite an emotional moment in my life to see a child being kept alive by something we had made with our own hands."

A year later, a St. Paul surgeon fitted an elderly man with an external pacemaker. This raised the possibility that the new-fangled device could be used in an aging population, and not just in hospitals -- in a sense creating a business market for the device.

By 1960, Medtronic licensed battery technology for the first implantable pacemaker, a disc roughly the size of a hockey puck that sold for $375.

The business boom

Today, silver-dollar sized pacemakers sell for about $8,000.

Bakken's little gizmo not only saved lives, but also created the landscape for medical technology businesses in Minnesota.

In his garage 50 years ago, Bakken couldn't have predicted that the small metal box would be the catalyst for Medtronic to emerge as the largest medical technology company in the world.

Nor could he have fathomed that the device's core technology of electrical stimulation would later treat a diverse slate of diseases and conditions beyond heart disease -- ranging from Parkinson's disease to chronic pain to epilepsy. Or that it would make Minnesota a magnet for medical technology companies, with Medtronic's arch competitors -- St. Jude Medical Inc. and major operations of Boston Scientific Corp. -- nearby.

"In some ways, you could say that little box was the nucleus of the medical device industry in Minnesota,'' said David Rhees, executive director of the Bakken, a Minneapolis electricity museum. Local med-tech observers estimate that Medtronic alumni have spawned between 150 and 350 start-ups (estimates vary widely).

The technology continued to advance as competitors cropped up -- including Little Canada-based St. Jude and CPI (later Guidant Corp., now part of Boston Scientific). Pacemakers now are smaller and last longer; their connecting wires are implanted inside the body, and the devices are used to treat different kinds of heart problems.

In ensuing decades, the core technology of Bakken's pacemaker also enabled invention of a more sophisticated cousin, the implantable cardioverter defibrillator, or ICD. The device looks similar to a pacemaker and paces the heart like a pacemaker, but it also shocks the heart if it detects an irregular rhythm.

The multibillion ICD industry, although sluggish in recent years because of a series of safety recalls, has deep roots in Minnesota; all three players (Medtronic, St. Jude and Boston Scientific) are based or have major Minnesota operations that employ about 8,500 people.

"It all goes back to the combination of an inventor and the health-care personnel at the U of M,'' said Thomas Gunderson, a longtime med-tech analyst at Piper Jaffray & Co. "But it was also the right product at the right time that took advantage of what was about to become the micro-electronics industry. Everything got smaller over the past 50 years."

In the past decade, perhaps the most-promising iteration of Bakken's invention emerged. Spurts of low-voltage electricity from pacemaker-like devices were approved to treat movement disorders and chronic pain.

Medtronic initially seized this market with devices that zap the brain or the spinal cord -- its neuro business now makes up 10 percent of overall revenue with $1.2 billion in sales. St. Jude and Boston Scientific also have neurostimulation units, thanks to large acquisitions. Smaller companies, both public and private, are crowding into the space.

Today, these devices have been approved by regulators to treat depression, epilepsy and urinary incontinence, among other diseases. And in the future, they could treat traumatic brain injuries, bulimia, obesity, migraines and obsessive compulsive disorder, providing therapy beyond drugs and alternatives to severely ill patients who are fast running out of treatment options.

Not everyone responds to electrical therapy, and generally, the first-line of treatment should be drugs or behavioral or psychiatric therapy, if appropriate, said Dr. Ali Rezai, a leading neurosurgeon at the Cleveland Clinic.

Still, Rezai and others believe the next generation of pacemaker technology could be bigger than the cardiac market and the impact on patients far more profound, especially as the nation's baby boomers age.

"It's a new frontier,'' he said.

But looking back over the decades, Bakken still marvels at the original device, the one the started it all. "It's such a strange device," he said, "that has so much life to it.''

Janet Moore • 612-673-7752