Few physicians here in the Discovery District would disagree with the assessment that their involvement in the commercialization of health technologies remains sparse, if not non-existent. Most physicians are likely happy with this arrangement. They would argue that commercialization presents too many conflicts of interest, especially in light of recent reports of ghost-writing peer-reviewed articles by pharmaceutical companies and fraudulent research funded by medical device companies (see this article). Some would go as far as to suggest that physicians should not be involved at all in the medical innovation process.
However, as I recently argued in commentaries published in Nature and Science it is important to recognize why physician involvement that leads to the need to manage conflict of interest is so critical to advancing medical innovation.
Physician involvement can accelerate the development and uptake of high-impact technologies, especially for niche areas such as pediatric surgery or global health diagnostics that are typically neglected by the medical device industry. Stanford Medical School has a long history of such “physician-driven medical innovation” and, through its BioDesign innovation program, brings together graduate students from medicine, engineering and business to systematically generate novel biomedical innovations. The program has served not just as a training exercise for would-be innovators, but has generated about a dozen start-up companies that have treated over 10,000 patients. In 2008, Stanford University partnered with the Indian Institute of Medicine in Delhi to create a BioDesign India, which leverages the large number of Indian diaspora in the Silicon Valley area for growing the local Indian biomedical device industry. Stanford also has a textbook forthcoming in late 2009 on the BioDesign innovation method.
The process centres on deploying interdisciplinary teams of residents, engineers and entrepreneurs into clinical settings to identify needs, develop potential solutions to those needs and eventually prototype and create business plans, research strategies or project plans. A specialty is chosen outside the area of the residents’ expertise to avoid preconceptions of how to do things.
As one of Stanford’s eminent innovators, Thomas Fogarty, inventor of the embolectomy balloon catheter says: “Innovators tend to go out and ask doctors what they want, rather than observe what they need.” Who better to observe than physicians themselves? Philosophically, the programs are grounded in the idea that entrepreneurship can be taught and innovation itself is not the exclusive domain of rare talents or serendipity. In the last two years, several medical schools in the United States and abroad have begun to adopt such “physician-driven innovation” programs. Most notably, our neighbors at the University of Michigan, Ann Arbor, created a program in 2008. As a state university of comparable size, Michigan’s adoption shows that physician-driven innovation programs are likely not merely an artifact of $12 billion dollar endowment coupled with Silicon Valley.
In the next three years, almost $60 million in medical device-related or prototyping facilities at Sunnybrook Health Sciences Centre, University Health Network and Toronto Rehabilitation Institute will be created. Combined with several proof-of-concept funds that have been launched by the Ontario government and other organizations, this creates a tremendous opportunity for Toronto to seize leadership in the biomedical device industry through the creation of a physician-driven innovation program. A physician-driven innovation program would serve as a unifying platform that through its “halo effect” of trained innovators and would infuse the Toronto region with new entrepreneurial activity in the biomedical device space, and bring attention to the industry.
With the upcoming creation of a Centre for Global Health Innovation at the Faculty of Engineering similar to MIT’s D-Lab and Northwestern’s CIGHT to train “global engineers” and existing world-class expertise for commercialization in low-resource settings at the McLaughlin-Rotman Centre for Global Health (a MaRS tenant), Toronto could easily leverage these strengths for high-profile partnerships in emerging markets similar to BioDesign India. Imagine sending teams with students from the University of Toronto and University of Stellenbosch in South Africa along with frontline physicians at Medicins sans Frontieres to create new HIV/AIDS diagnostics. Over the past few months, high-level administrative talks have been underway, primarily led by Dr. Kieran Murphy, the Faculty of Medicine’s recently hired Director of Medical Imaging, formerly Director of Interventional Neuroradiology at John Hopkins University.
As these ideas develop, I encourage the local biomedical community here in Toronto to discuss and support these initiatives from the ground up. Physicians do, in fact, have a vital role to play in biomedical innovation. If we can harness their energies and influence here in Toronto, we could surely help to accelerate the commercialization process from lab to market, or the even loftier goal: from lab to village.