Subscribe to one of our feeds
Print
In 1967, the two institutions set up a joint committee on engineering and living systems to consider the desirability and feasibility of establishing a joint program. Three years later, that program was launched with a fairly simple concept: physicians in training would be exposed to serious work in medical engineering and medical physics, and physical scientists and engineers in training would be initiated into clinical medicine through classwork and clinical rotations alongside medical students. The program offered an M.D., M.D./Ph.D., as well as Ph.D.’s in medical engineering and medical physics. Over time, additional programs were established in biological informatics, even bioastronautics. In 2002, HST established a Biomedical Enterprise Program in conjunction with MIT’s Sloan School of Management.
Like-minded institutions established more recently, such as Cal(IT)2 and QB3, a partnership among the University of California, Berkeley, the University of California, San Francisco School of Medicine, and University of California, Santa Cruz, focus more on the mathematical, informational, and electronic end of the spectrum of convergent disciplines. At HST, however, the intellectual anchor has always been the tangible reality of the patient-clinician bedside interaction, and the day-to-day constraints and opportunities of that exchange.
Since its inception, HST has graduated 1,267 students, 75 percent of whom now hold faculty positions at 70 institutions in the United States. Notable alumni range from former FDA Commissioner Dr. Mark McClellan, who, through the program, received his medical degree from Harvard and Ph.D. in Economics from MIT, to Dr. Peter Diamandis, who received his medical degree on top of an MIT undergraduate degree in aerospace engineering. Diamandis then went on to found and direct Zero Gravity Corporation, which offers the experience of weightlessness to the general public through 90-minute sub-orbital flights. Other companies launched by alumni include Cambridge Heart, NeuroMetrix, and Apex Surgical. Among HST’s 64 current faculty, the average number of patents is 11 each.
“One of the big problems in the whole of the life sciences is the very Balkanized way in which not only the basic research and development gets done, but essentially the way the industry follows that same model,” says Pisano. “Everybody does a little piece, which they inherit from the academic world.” Pisano and Gray both note that traditional departmental structures in academia maintain a “guild-based” reward system that, in effect, imposes disincentives for pursuing objectives outside one’s narrowly circumscribed discipline. Assistant professors of internal medicine, for instance, would not necessarily gain credit toward tenure for research and publication in chemistry or engineering.
The business world has worked to overcome intellectual fragmentation by finding people to mind the big picture, Pisano says. “In computers,” he notes, “there are lots of people who worry about components, but there are also people who are called architects, who worry about integration,” he says. That is also the case in aerospace, automobiles, semiconductors, and in software. “These architects are not necessarily experts in each of the little pieces, but they really understand the interactions.”
For its part, HST has attempted to create the kinds of “systems architects” in biomedicine who could bring all the moving pieces together in healthcare innovation. To do so, HST requires that Ph.D. candidates in engineering or applied mathematics take basic science courses at Harvard Medical School. They then go through three preceptorships, which are six-week rotations at Harvard-affiliated hospitals. But they do not merely observe. They engage, just as if they were training to become physicians, in learning such basic aspects of clinical practice as taking a patient’s medical history and administering a physical exam.
“You can’t escape the power of it,” says HST’s Erez Lieberman, a Ph.D. candidate from New York City. And the benefit for an engineer is particularly profound, as Lieberman explains, because within the context of biomedical innovation, solving any given problem is actually secondary to knowing what questions to take on. “The hard thing is problem choice,” he says. “One of the most powerful pieces of myself as a researcher is to be able to sit in the driver’s seat and say that this is really the problem that is going to have a big impact.”
What are the things that doctors know that the engineer needs to know in order to communicate with them? What is the cycle that a patient goes through in a hospital? Who is paying, and at what point does cost become a barrier to care? “These are the raw facts on the ground,” says Lieberman. “Once you’re familiar with them, they inform your judgment about what is most clinically relevant.”
.gif)
