A recent Forbes article from David Shaywitz, MD/PhD, discussed a highly interactive translational research innovation symposium at Duke University put together by Dr. David Epstein at the Duke Eye Center and Chancellor Victor Dzau. The program featured both University faculty and invited external speakers. Shaywitz described the symposium based on four key themes.
Theme 1: Driving science into application remains difficult but desirable
Shaywitz noted that many participants were eager to push science into the clinic, from PhD chemists and biologists to internists and surgeons (and, of course, ophthalmologists). A vigorous entrepreneurial spirit was apparent, a determination to do something outside the usual academic practice. To achieve this goal, he identified three necessary basics: culture, coordination, and capital.
He noted that culture really matters – and academic leaders can play a vital role by either passionately encouraging and supporting entrepreneurship (Susan Desmond-Hellmann and Tom Byers stand out in my mind here), or offering only tepid lip service. Arguably the most valuable aspect of culture are the presence of positive examples, faculty members and students who’ve actually done this – developed a product, started a company, pushed an innovation into the clinic and changed medical practice. This also suggests an opportunity to initiate a virtuous cycle – once you have a nucleus of entrepreneurs, a critical mass, the excitement can spread virally.
Shaywitz noted that coordination is important because forming a company or developing a technology for licensing, tends to be complex, and (in the case of start-ups) typically involves far more work than the participants had originally anticipated. It’s also clear that while there may not be a formula for innovation, there are discrete structural activities that can be done in an environment to support, nurture, guide and sustain innovation, as several faculty members from Duke’s Fuqua School of Business emphasized.
Some learning is inevitably didactic (learning the rules of road), but most is experiential, and a crucial element seems to involve learning how to work as team, to transform the germ of an idea into something concrete. The best learning, clearly, is real world experience; seeing and solving the real-world challenges experienced as you try to transform an idea into an actual (often commercial) product or service likely represents the most useful training of all.
Finally, he noted that capital plays a vitally important role in driving innovation, and the availability of capital can be transformative – just as the lack of same can be a problem.
Theme 2: Think differently
Shaywitz noted several examples from this meeting, which suggested that there are actually approaches to deliberately think about problems in slightly different ways. Dean Nancy Andrews, for example, presented interesting social science data highlighting the value of diversity in innovation; it turns out that heterogeneous teams tend to solve difficult problems more effectively and apparently more creatively than teams with less diversity. This ties in nicely with the suggestion that breakthroughs tend to occur at the intersection of disciplines.
Keynote speaker and legendary MIT bioengineer Robert Langer emphasized the value of multi-discipline collaboration as well; such interactions have been a defining characteristic of his career, and also the foundation, beginning with his decision to pursue his post-doc not in a chemical engineering division, but rather in the lab of a pediatric surgeon, the late Judah Folkman.
The emphasis on unexpected ideas tied in very well with a second point Dean Andrews also made, about the unique value of students on entrepreneurial teams; not only do they tend to be energetic, of course, but they are also relatively naïve, and can ask the fundamental, vital questions overlooked by those with more experience.
The idea of thinking differently was a key message for Shaywitz’s talk and a significant theme of the talk given by Geoff Duyk, a physician-scientist by training, and currently managing director of TPG’s in-house biotech VC fund; not surprisingly, Duyk is a big believer in the concept of intellectual “cross-training.”
Both Duyk and Shaywitz highlighted the need to look beyond the traditional model of early stage innovation (pathway -> target -> drug), and consider other types of innovation that could improve health – including innovation in devices, services, processes, and care delivery. Of particular interest, Duyk highlighted the unique healthcare needs and opportunities associated with countries in Central and South America, as well as Asia, providing an often underappreciated global perspective, and an important reminder of the value of thinking outside the border as well as the box.
Theme three: Pharmascolds still have academics running scared.
Despite enjoying the discussion of innovation, Shaywitz was “struck” by the fear that university researchers and clinicians had from the attacks on physician-industry collaboration led by the pharmascolds. An anxiety that took many forms. Junior faculty were concerned that working with industry in any way might jeopardize their relationship with the National Institutes of Health (NIH), and introduce a prohibitive array of complications and requirements into their already busy lives.
Many people emphasized the need to be completely transparent and open; there was unanimous agreement here. The problem, rather, was the seemingly excessive and gratuitously onerous requirements associated with this transparency, a level of micromanagement (one might argue nanomanagement) that was perceived at times to be absurdly heavy-handed, and more likely to inhibit university/industry collaboration than enhance it.
There was also a strong sense that partnering with industry is still viewed in many academic circles as collaborating with the enemy, a relationship that threatens to stigmatize the researcher – a disgraceful phenomenon. In Shaywitz’s view: we should be celebrating, not castigating, the researchers who seek to drive their science into practice, not just into papers and prestige.
Several senior faculty members strongly believed that the media had their crosshairs fixed squarely on academics who work with industry, and any academic leader who tried forcefully to defend or support these relationships was likely to be taken down. Shaywitz noted that a number of academic leaders at a range of institutions have highlighted the perceived ferocity of the pharmascold attacks, as well as the courage of the rare academic leaders – such as Desmond-Hellmann – willing to stand up and forcefully make the case that driving science into application (a) is core to a research university’s public mission, and (b) can be powerfully facilitated through well-structured collaborations with industry. (See here as well.)
Theme four: Role of the champion and the opportunity to make a difference
Shaywitz said that the two highlights of the symposium were the first talk of the day by Langer, and the last talk of the day, by Y.T. Chen. Each seminar highlighted the tremendous impact of an impassioned innovator.
Langer’s talk discussed the arc of his career, including the initial challenges he faced as he struggled to get a new technology patented. He also highlighted the excitement and many challenges of developing new products and forming new companies, the success of which depends not only on brilliant and uncommonly creative individuals but also “exceptional persistence, and a lot of gritty work.”
Chen’s talk, to close the symposium, “offered a poignant and modestly-presented reminder of why translation is so essential.” Chen, a physician-scientist (pediatric geneticist), developed the first treatment for Pompe Disease after being motivated by the searing experience of a patient’s memorial service. Following the development of a enzymatic replacement strategy by Chen – and its subsequent development and commercialization by industry (Synpac, later Genzyme, now Sanofi) – many children with this disease have a significantly improved chance of living a much better – in some cases, relatively normal – life, especially if treatment is initiated very early.
This example caused Shaywitz to think about this “model of innovation, this narrative of the intrepid, determined physician-scientist successfully shepherding a discovery from the lab into the clinic.” He said, “It’s a compelling vision – it’s what I had in mind when I decided to pursue an MD/PhD, and I know it’s what many of my colleagues were thinking as well.”
However, he noted his concern that this model is now the exception, not the rule. He noted that more often, progress may involve a number of discrete, and often disjointed advances, that over time are integrated into a more complete picture, and ultimately give rise to novel therapies. Ultimately, Shaywitz hoped that we can “continue to highlight the accomplishments of clinical champions like Y. T. Chen, like Judah Folkman, like Peter Pronovost (incidentally a nice example of a champion pursuing systems innovation)” because these individuals “offer an inspirational reminder of the power of what can be achieved with a focused mind, a committed heart, and little bit of luck.”