Innovation: It’s Academic
Can academic medical centers like Cedars-Sinai do better at shepherding innovations that help patients? Our surgeon in chief thinks so.
Illustration: Serge Bloch
There is no question that new drugs, devices, and other treatment paradigms have greatly improved medical care over the past 20 years. That said, the pace of innovation in medicine and biology does not compare favorably to the transformative changes in such industries as computing and telecommunications. It took Apple just a few years to develop the first iPhone from initial idea to becoming market-ready. By contrast, on average it takes 12 years for a new drug to make it from the laboratory to the medicine cabinet, undergoing numerous rounds of preclinical testing and the prescriptive clinical trials.
Given medicine’s high stakes, why does it take so long to implement change? There are known challenges in regulation (getting treatments approved for use) and reimbursement (getting that use paid for). Still, I would argue that a substantial fraction of the difficulties in developing new ideas are within our control. I am referencing the hurdles and sometimes outright barriers imposed by our modern universities and academic medical centers. These institutions have an extraordinary critical mass of bright and committed clinicians and researchers. But too often they get disillusioned by the bureaucracy of approvals and restrictions inherent in bringing inventions to completion and human use.
There is a clear need to liberate this intellectual capital and leverage the many advantages held by academic medical centers,
with their access to large numbers of patients with both simple and complex illnesses that range in incidence from common to rare. The birth and maturation of new ideas are easily nurtured in academic settings where we share space, patients, and research projects. Given these intrinsic advantages, how can we correct the impediments to new inventions and facilitate their introduction to treat patients and lessen their suffering?
One of the best ways to foster innovation is to connect people with different expertise and perspectives.
This can be facilitated by offering a special category of pilot funding focused on multidisciplinary collaborations. The funding should require a “big hairy idea” with clear implications for helping diagnose or treat a disease. While feasibility will remain important, the highest priority should be potential impact and originality rather than reams of preliminary data. The pool of money need not be large.
Once an idea has progressed to a device prototype or functional version of an app, it is critical to provide the inventors access to a wide range of mentors. Interactions with these experts will refine the product, test the business plan, or even repurpose the discovery to a more important problem (aka “pivoting”).
Every potential innovation requires beta testing—where hospitals and physicians are willing to study the product in a clinical environment. These trials need to be appropriately regulated and safe for patients, but the degree of safety must be considered in the context of the desperation of the situation. If no effective therapy is available for a life-threatening illness, why wouldn’t a greater degree of risk be acceptable than for a less critical problem? That said, these are often very difficult ethical choices and must never be trivialized.
Cedars-Sinai is actively addressing all of these issues to encourage medical innovation, both within and outside our institution. Through our Technology Transfer Office, we routinely foster development of intellectual property generated by our faculty. This effort, particularly over the last decade, has provided substantial revenue that is reinvested into bolstering future research.
We also have established an on-site accelerator in a partnership with Techstars, an internationally recognized startup incubator. Every 10 months, out of more than 500 applications, 10 companies are selected. The program takes place over a three-month period during which the companies have access to Cedars-Sinai physicians, nurses, staff, and administrators as well as other experts in business, law, and entrepreneurship from across Southern California. Perhaps the most important advantage of residence in this accelerator is the access to our hospital and the connections that exist between Cedars-Sinai and other top institutions across the country. The thirst for innovation and the need for serious capital and large databases to test new drugs and devices is leading to more cooperation and fewer restrictions among academic medical centers. Most mentored companies have been able to place their products in multiple sites, gain valuable insights and exposure, and garner additional investment. An impressive 93 percent of the 27 Cedars-Sinai-incubated companies are still active and have raised a median of $2.6 million to invest in future achievements.
With proper nurturing, the creative environment within academic medical centers is blossoming. We need to cooperate even more in our public advocacy for rational regulation and reimbursement. For the health of our current and future patients, it is at least as vital that we thoughtfully adapt our institutional cultures to make innovation in healthcare a valued academic pursuit.
Under his leadership, National Institutes of Health (NIH) funding to the Department of Surgery has increased dramatically to more than $10 million annually, placing it among the country’s top 10 NIH-funded surgery departments.