Brain Cancer Survivor Offers Ideas for Better Medical Packaging

Packaging engineer Michael Johnston taps into his personal experience as a patient to spread awareness of how noisy medical packaging is and how traumatic that can be.

Lisa McTigue Pierce, Executive Editor

June 10, 2023

Michael Johnston was diagnosed with a large, cancerous brain tumor when he was 13 years old. During his treatments, he would cringe when he heard medical packages being opened in the hospital because he knew pain was coming. Like Pavlov’s dogs, the reaction was visceral.

More than a decade later, he’s now telling his story to the medical industry in the hopes that packaging professionals will consider the patient’s perspective as they design new packages.

Johnston isn’t just a brain cancer survivor; he’s also a packaging engineer himself, working for medical device company MicroAire Surgical Instruments. He’s got some ideas on how to fix this issue, which starts with specific research through the Kilmer innovations in Packaging (KiiP) group.

Let’s listen in …


If you have a topic you’d like to propose for a future PACKAGING POSSIBILITIES episode, please email Lisa Pierce at [email protected].


Lisa McTigue Pierce

Hello! This is Lisa Pierce, Executive Editor of Packaging Digest, with another episode of Packaging Possibilities, a podcast that reveals what’s new and what’s next for packaging executives and engineers, designers and developers.

In this episode, I’ll be talking with Michael Johnston, a packaging engineer for medical device company MicroAire Surgical Instruments. Michael’s got an interesting perspective on medical packaging based on his personal experience in fighting brain cancer. He recently spoke at the[PACK]out conference about this — specifically how the sound of the packaging made him feel. His presentation was one of the highlights of the event.

In the hopes of reaching more packaging professionals, I invited him on this Packaging Possibilities podcast to retell his story and answer a couple questions.

Michael, hi. Thanks for taking the time to talk with us today about your highly personal experience.

Michael Johnston (guest)

Hello. Thank you so much for having me and thank you for a wonderful introduction.

Lisa McTigue Pierce

Yes. Well, I’m not kidding about it being one of the highlights of the event. But Michael, tell us your story and how the sound of the packaging made you feel.

Michael Johnston (guest)

Absolutely. So, back in 2011, I was 13 years old. And I was having headaches and a hand tremor and leg muscle spasms and a stiff neck. Up until about April 2011, I was told it was growing pains. After I lost vision in my left eye for 15 minutes and woke up one morning with my tongue that was completely numb, we were told that it might not be growing pains and that we should go to the hospital and see what was going on. And so we rushed to Children’s Hospital emergency room in St. Paul. We did a CT scan and an MRI of my torso, and we found a large cancerous brain tumor. I had two surgeries and four rounds of chemotherapy and 25 doses of proton beam radiation. And I’m happy to say that I’m 100% cancer free now.

Lisa McTigue Pierce


Michael Johnston (guest)

Thank you.

And one thing that I noticed throughout my stay at the hospital was how noisy medical packaging was, especially Tyvek pouches. Whenever I heard a pouch being handled, or especially when they were being opened, that tearing noise … I would hear that and think, “Ah oh. Pain is coming,” because I learned to associate the packaging with a poke that followed shortly afterwards.

Lisa McTigue Pierce

Sure. Makes sense.

Michael Johnston (guest)

It became my personal goal at 13 years old to enter the medical packaging industry and find a way to reduce the sound that medical packaging makes.

And right now, I don’t have the answers to that, but I’m hoping I will with it, coming shortly.

Lisa McTigue Pierce

Part of it, too, is telling your story and getting other people in the medical packaging community to help out with this.

But one of the things that I remember from your presentation is it seems like you’re a little sensitive to sound because you also said that in some cases you used music therapy at the hospital to kind of help soothe you when you know you were going through all your treatments. And I’m just wondering, do you think that the sound of packaging might have some … cause some similar negative reactions with other patients or did you think this was maybe your experience?

Michael Johnston (guest)

I definitely believe that I’m not alone. Every time I told my story to other patients about the dislike of medical packaging, I’ve gotten similar reactions, saying, yeah, we’ve gotten conditioned to expect pain as well.

And one other story that I’ve gotten from some of my friends in the hospitals were [about] pouches that were being … that held IV fluids.

When ID fluids need to be changed in the middle of the night, the nurses would unwrap the pouches and that really loud over-packaging on the ID fluids woke the patients up from a deep sleep. And then once the nurses saw that they were awake, they check their vitals. And then it was almost impossible to fall back asleep. And in the hospital, sleep is very precious. You can’t ever really get enough of it, and so anything to keep sleeping patient sleeping is critical.

Lisa McTigue Pierce

That sounds right too. I recently had a medical stay, or hospital stay, and I can attest to it’s nearly impossible to get a good night’s sleep at a hospital.

But you know, it makes me think … so for medical packaging, we’ve been hearing a lot more about the voice of the customer, VOC. And I know a lot of medical device manufacturers do this kind of research to try to get the input from this customer. But I think most of them are looking for the input … when they think about customer, I think they’re thinking of the person who uses the package or opens the package, which is really the healthcare professional — and not necessarily look at the patient as the customer. Obviously they’re the ones getting the product, but … And I’m just wondering how your experience and your mission now might change that.

Do you think the medical device manufacturers really overlook the patients?

Michael Johnston (guest)

I believe they do. At the current moment, they see that the nurses or the doctors using the devices are the end customers, but really it is the patient because they are also present in the room while packaging is being used and opened.

And I have just joined the KiiP, Kilmer innovations in Packaging, group, a part of their aseptic presentation and opening group, with this mission to get voice of customer from the patients themselves and go out into hospitals and ask patients, what do you like about medical packaging, what don’t you like about medical packaging, and see if they have any other pain points other than just the sound of the packaging being opened. Maybe it might be that they don’t like the colors of it or other … they don’t like the way it smells. Who knows?

But this the studies that we will be doing in KiiP will bring to light some of these issues that medical device manufacturers may not have known even exist.

Lisa McTigue Pierce

Right. Interesting. Oh, Michael, I’d love to hear more about those studies once you get them in the works and especially the results of them.

But so now … you have this mission. And what do you think? How should medical device manufacturers fix this problem of loud packaging and is changing the packaging the best solution?

Michael Johnston (guest)

Right now I don’t have a solution to fix the sound that medical packaging makes. I just don’t have the experience yet or the research because this would be developing new materials that may not be available on the market yet.

So I hope to come back with some answers from the research that we do at KiiP because my project has mainly two phases. Phase one, where we go out and get voice of customer from the patients. And then phase two is where we take those concerns and complaints about medical packaging and then turn them into new user needs and then develop new packaging from that.

And if we just ask the nurses or doctors to change their routine — say, open the packaging from at the far end of the room because we still have to make sure it stays sterile so you can’t open it outside of the hospital room — or ask them to play music or something as a distraction while they’re using the packaging. We can certainly ask. That doesn’t mean that they are actually going to do it.

However, changing the packaging is the absolute foolproof way of making sure that medical packaging does not cause any issues for the patients.

Lisa McTigue Pierce

Yes, good point there, Michael.

And the only other experience or example that I can call on from the sound of packaging is … a little bit more than 10 years ago when the folks at PepsiCo came out with the first compostable package for their SunChips snacks and it was so loud that it had to be taken off the market because the customers just absolutely hated it.

And they’ve made a lot of advancements in the packaging technology now. PepsiCo is using compostable packaging for their Off the Eaten Path line of products, and it’s much quieter now. It’s the typical sound of the snack food bag.

But this whole idea of the sensory aspect of packaging for customers I think is really interesting. That’s kind of like the bigger picture.

But just continuing to look at this particular example from a medical packaging point of view, I just, I wonder, do you really think that medical device manufacturers, once they realize that this might be an issue, will do something about how noisy their packaging is?

Michael Johnston (guest)

I certainly hope so. And once we have the data that proves that noise is an issue in medical packaging, we can go back to the medical device manufacturers and say this is what your customers really want and ask them to help join in the efforts to making medical packaging quieter.

Because I certainly can’t do this alone. I don’t want to do this alone. And so we could unite the entire industry together to solving this problem, I think we can create some very beneficial results.

Lisa McTigue Pierce

OK. Well, I commend you for bringing attention to this issue because a lot of people never even considered it. So thank you for doing that.

I did mention that you spoke about this at thePACKout, the recent medical packaging conference that we were both at, and I believe it was one of the high points of the event. I know there were a lot of people talking about your presentation after you gave it.

What were some of the reactions that you got there?

Michael Johnston (guest)

I got just an overwhelming sense of that everyone really seemed to enjoy what I had to say.

The one piece of feedback that I received the most was, “I had no idea that sound was an issue in medical packaging. Thank you for bringing this to light and so helping spread awareness around the industry.”

I think I achieved that goal, at least for now.

Lisa McTigue Pierce

Yes, I think you did.

One final question that I have for you. You’re packaging engineer at a medical device company. What are you doing to help design packages that maybe give the patient, specifically the patient, the most positive experience?

Michael Johnston (guest)

Well, right now the devices that I work with are all, mostly, used in operating room settings, so the patients are usually put under and don’t, aren’t awake to experience the packaging.

But if I was doing bedside packaging or at-home care, I would look at different materials that you might not use, sticking primarily more to thermoformed trays because those give off a little bit less sound than a crinkly pouch.

Lisa McTigue Pierce

OK. That’s great.

Michael, just one last comment on my end. Going back to the example of the SunChips compostable package … ah, go ahead.

Michael Johnston (guest)

I have another story with sound in medical packaging. One example that I was made aware of when I joined KiiP was that urology patients that need to self-catheterize … sometimes they need to use a catheter in a public bathroom. And hearing a loud crinkly pouch is not something that you usually hear in the men’s room. And so they become very self-conscious and embarrassed that they need to use their medical devices even though it’s helping to save their lives. They don’t really … they have an aversion to using the medical packaging.

So making packaging quieter will also help, not just prevent classical conditioning to expect pain, but also reduce embarrassment from using medical devices.

Lisa McTigue Pierce

Yes, the whole discretion aspect of it, too. Excellent example. Thank you, Michael, for bringing that out.

One last comment that I wanted to make. I don’t know if it’ll help or not … but going back to the SunChips example … one of the things that they did to alleviate some of the noise was to look at the adhesive, the cohesive, that they were using in the flexible film structure to quiet it down a little bit. So I don’t know if the adhesives that they use for sealing those pouches might help or not, but I thought I would just throw it out there and, you know, see what you thought, what other people thought.

Michael Johnston (guest)

Absolutely. One of my original ideas to make medical packaging quieter, I mentioned this during my presentation, was when I was a student at UW Stout, I wanted to completely get rid of Tyvek because I thought it was too loud and too crinkly. Now I know that probably wouldn’t be allowed since we have …  Tyvek is very beneficial. We just can’t completely wipe it from the industry …

Lisa McTigue Pierce

And a lot of medical packages are using Tyvek. So yes, that would be hard to get away.

Michael Johnston (guest)

That’s a little bit of an unrealistic goal that for now. But now that I know a little bit more about medical packaging, one thing that I’m going to be looking at in my group in KiiP are new coatings for Tyvek.

So we have the CR27 and the BB2000 coatings for Tyvek. Maybe there’s a different coating that still has the same seal strength when you seal the lids, but doesn’t peel quite as loud. Now, we can apply all over the Tyvek to reduce the amount of crinkly noise that it makes.

Lisa McTigue Pierce

Sure. Yes.

And again, maybe look at some of the other industries out there, because the food industry, I’m thinking specifically of the easy-peel pouches that they have for, like, lunch meat. They work very hard on getting the secure seal and yet easy-peel as well.

So you know, a lot of different markets are looking at some of the same issues and packaging engineers work in all of these markets. So maybe look a little bit beyond the medical market. You might find some good ideas elsewhere.

Michael Johnston (guest)

Also, at Stout, the cafeteria would package cookies and muffins and distribute them around campus in like the stores every day. And those had a very loud, crinkly pouch on them. But it was made out of polylactic acid, which is compostable.

Lisa McTigue Pierce

Yes, but that was that was the same material that they used for the SunChips bag that was too loud. So it’s definitely material specific.

Ooo … You know what? You just … right on the nose there, Michael. It’s very material specific.

So … what you’ve just kind of like proposed … The idea is, if a material could be too loud, then a material could be soft as well, or not loud. Quieter.

Michael Johnston (guest)


Lisa McTigue Pierce

Good job. OK, excellent.

Thank you so much. Really appreciated your time and talking about this. And hope we can get some more people interested in helping you with your mission.

Michael Johnston (guest)

Thank you. It was my pleasure coming on. And thank you for allowing me to tell my story.

About the Author(s)

Lisa McTigue Pierce

Executive Editor, Packaging Digest

Lisa McTigue Pierce is Executive Editor of Packaging Digest. She’s been a packaging media journalist since 1982 and tracks emerging trends, new technologies, and best practices across a spectrum of markets for the publication’s global community. Reach her at [email protected] or 630-272-1774.

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