Rx: Engineering
By T.C. Brown
As co-medical director of Ohio State Sports Medicine and a team physician for the university’s Department of Intercollegiate Athletics, Dr. Thomas Best M.D. finds that engineering often provides the best remedy for health care challenges.
“I see this every day in our clinics: We deal with a lot of athletes who are constantly looking for new ways to get back to their sport more quickly and safely,” Best says.
Over the years, experts in his field have discovered that massage therapies, particularly when used after intense physical activity, help the muscles recover, says Best, who also holds a doctorate in biomedical engineering.
“I became very interested as an engineer because I started to realize there was a clinical problem, but it was largely devoid of science that helped to explain what was going on mechanistically,” Best says. “How could we translate that into more optimal care?”
To find answers, he gathered a multidisciplinary team of biologists, statisticians — and another engineer, Yi Zhao, an assistant professor of biomedical engineering and ophthalmology. They’re now working on ways to improve massage therapy from both the biological and the clinical aspects.
“When you look at the people on this project,” Zhao says, “it involves several colleges. Bringing together expertise from different perspectives was the only way to make this project possible.”
Many scientists believe we are in the midst of a revolution in terms of understanding and treating diseases, and engineers from all disciplines are helping advance these radical changes.
Ohio State is widely recognized for its engineering research work in the medical field. While the sphere of subject matter is spread all over the health care map, some analytical trends drawing particular focus have emerged, including: personalized medicine; gene mapping; tissue engineering; development of cancer-killing nano “factories”; muscular/skeleton biomechanics; bio-sensor research; and cell capture and tagging.
Richard Hart, chair of the Department of Biomedical Engineering, says many people associate engineering with medical devices, and while that is certainly true in many cases, engineering work goes much deeper.
“Engineers bring a different perspective than the life-science experts. We have a whole different tool set and a different way of approaching problems,” Hart says. “Some of it is device related, but a lot of it is a quantitative way of thinking — a way to do numerical simulations.”
Engineers bring it all, including physics, chemistry, life science, math, design and creativity, says Hart, who was recently elected secretary of the national Biomedical Engineering Society.
“It’s the coolest thing for anybody interested in a technology-oriented career,” Hart says. “You can bring all those tools to bear on problems that you can solve and make the world a better place.”
Many of those tools do lead to the development of devices. In fact, any medical device used by a physician or on the market was more than likely developed first by an engineer, says Randy Moses, the college’s associate dean for research and a professor of electrical and computer engineering.
“Engineers look at how to convert knowledge into something that becomes a diagnostic tool,” Moses says. It’s important, of course, when researchers engineer a breakthrough, but in the long run the “breakthrough” might not always hold the most value, Moses says.
“The impact of engineering on medicine isn’t the two breakthroughs in the last year, it’s the hundreds of thousands of tiny incremental advances in ways that we barely notice that make the health care system and quality of lives better,” he says. “That, to me, is what is phenomenal.”
Meeting of the minds
Many of those incremental advances, as well as the breakthroughs, come via collaboration and interdisciplinary cooperation between engineering and Ohio State’s other colleges and research centers. For instance, engineers have joint faculty, graduate students and collaborations with campus entities including:
- The Ohio State Medical Center and College of Medicine;
- Dorothy M. Davis Heart and Lung Research Institute;
- The Ohio State Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute;
- Center for Clinical and Translational Science;
- Departments of Orthopaedics and Ophthalmology;
- Ohio State Sports Medicine;
- School of Allied Medical Professions, Occupational Therapy and Physical Therapy;
- and the Colleges of Veterinary Medicine and Dentistry.
Regardless of the subject matter or discipline employed by researchers at the College of Engineering, there is one overall trend directing it all, says Hart.
“The push is to make more of an impact on patient care and human health,” Hart says. “That is translational medicine: We translate into the patient what we do in the laboratory.”
Of critical importance for making that goal a reality are the partnerships formed between engineering researchers and medical clinicians.
Best notes that Ohio State is loaded with examples of collaboration across colleges that enhance the university’s ability to compete for extramural funding and produce cutting-edge, translational research.
“Interdisciplinary research is a point of emphasis here at Ohio State,” says Best. “Engineering and medicine is a wonderful example of where collaboration has increased both the quality and quantity of science.”
Advances in science have increased its complexity, making it nearly impossible to be an expert in more than one area. And gaining financial support for research is now more challenging, limiting the number of investigators per grant, he says.
Sure, it’s cliché, but in these instances two heads — or, more likely at Ohio State, entire teams — are better than one.
“We get a better quality of science and more creative thinking from different perspectives,” Best says. “There’s an old saying, ‘If you want to go quickly, go alone. If you want to go far, go with others.’”
The collaboration of Best and Zhao on the massage therapy project is a prime example. Zhao’s background in design and fabrication was critical in the success of the study group’s obtaining pilot data to get the research funded, says Best, who is the Pomerene Chair for the Division of Sports Medicine in the Department of Family Medicine at Ohio State’s College of Medicine with faculty appointments in biomedical engineering, allied medicine and biomedical informatics.
The National Institutes of Health is funding the project, which began last year and ends in 2013, with a $1.5 million grant. Researchers are working with a rabbit model to investigate the effectiveness of different durations and pressure in massage, Zhao says.
The findings also may help satisfy insurance companies that seek a quantitative analysis of how much a patient benefits from this type of therapy.
Basically, the project is focused on developing a quantitative analysis of how massage therapy works, explains Zhao.
“Our goal is to develop instruments that can not only deliver quantitative massage actions but also determine mechanical properties of a massage during real time,” Zhao says, adding that a database can be constructed from that information.
“Then we would be able to determine which type of massage action we should use,” Zhao says. “If we can do that, the long-term goal will be to make instruments to help a physical therapist in decision making.”
“This is really a biomechanics project, but biomechanics on a biological level,” Zhao adds.
Before any hands-on work actually began on the project, time was taken to assemble the proper team: Best; Zhao; Sudha Agarwal, a molecular biologist from the College of Dentistry; the College of Medicine’s Denis Christian Guttridge, an expert in molecular and cellular biochemistry, and Xiaoli Zhang, a research scientist at the Center for Biostatistics; and David Jarjoura, director of the Center for Biostatistics and a research professor in the College of Public Health.
Collaboration across disciplines is critical to the success of an investigation, says Peter Katona, a professor of electrical and computer engineering at George Mason University and the former president of the Whitaker Foundation, which at the time supported interdisciplinary medical research but now is the Whitaker International Fellows and Scholars Program focused on strengthening international collaborations in biomedical engineering.
“Technology is absolutely everywhere in medicine, so it is very good to have people who can understand the uses and needs of medicine so that they may develop technology in such a way to be more helpful in the care of patients,” Katona explains. “Also, because engineers have understanding of the uses of technology, they can help contribute to containing the costs of health care.”
Broader focus, better solutions
Indeed, cost containment, technology and other health care challenges are among the factors attracting students to the field of biomedical engineering these days, says Moses, the engineering college’s associate dean for research.
Responding to biomedical engineering’s strong resurgence in interest in recent years, Ohio State now has a Department of Biomedical Engineering with new undergraduate programs. Students are flocking in.
“We have a more diverse group of undergraduate students interested in a more diverse set of problems,” Moses says. “Students of this generation have, in general, an increased interest in solving the world’s problems, and they see health care and medicine as having problems that need solving.”
That interest stretches across the College of Engineering’s programs and is prompting research in a wide variety of areas, including medical imaging, improving the lives of the disabled, development of new drugs and water management and quality.
The general trend is to look at broader problems, Moses says, but individual focus, like personalized medicine, also is gaining a lot of attention.
“If we understand something about you (as a patient) in particular, then we can develop a better approach to treatment,” Moses says. “The traditional approach was to understand the human bell curve and come up with treatments. Now the view is more to measure and treat individual traits.”
Along those lines, Stuart L. Cooper, chair of the William G. Lowrie Department of Chemical and Biomolecular Engineering, and colleagues are working on a cell-capturing technique that could be used in diagnostics for vascular health.
“We are trying to quantify in a patient’s blood the concentration of a form of stem cell, the endothelial progenitor cell. This cell can reprogram itself into an endothelial cell and proliferate to line our blood vessels. The progenitor cells also may be a marker of a disease state.” Cooper says. “The progenitor cells are present in extremely low concentrations — only a couple of them in a milliliter of blood. By contrast, there are millions of white blood cells in a similar volume. So there is a significant challenge in capturing them.”
Funded with $1.3 million from the National Institutes of Health, Cooper’s team is in the middle of the project. The development of a cell-capturing device involves the use of specific low-molecular-weight peptides that bind avidly to the cells as well as the use of magnetic bead cell separation technology developed by Jeff Chalmers, professor of chemical and biomolecular engineering. Their medical college colleague is Nic Moldovan, research associate professor of cardiovascular medicine, in the Davis Heart and Lung Institute.
“We expect a number of other applications of this research beyond that of correlation of progenitor cell concentration with various disease states,” Cooper adds. “An important one is to apply the capture technology to materials used for the fabrication of synthetic blood vessels. If a few progenitor cells can be attracted to the surface of these artificial blood vessels, the expectation is that they will proliferate and evolve into a well adherent ‘natural’ blood vessel lining.”
The right prescription
To strengthen communication between engineers and the medical field, the Department of Biomedical Engineering in 2008 initiated the annual College of Engineering/College of Medicine Translational Research Symposium.
“We’re trying to get clinicians to talk about their problems — not just successes, but failures too,” says Hart. “We have engineers there to present some methods and techniques in hopes of sparking additional collaborations.”
Symposium topics have addressed cardiac issues, cancer, and cell-based therapies and regenerative medicine.
“Engineers are good at problem-solving, but they need to know what the problem is. Clinicians know what the problem is but may not be equipped to solve it,” Hart says, explaining the significance of collaboration between the two disciplines.
The territory is wide open for fundamental research in the health care field, says Cooper.
“There will be new drugs, and new companies will be started,” Cooper says. “Treatment will be more effective, but the big challenge is the economics of it all.”
For instance, in the realm of personalized medicine, if drugs become more specific for each individual, that raises the question of how a drug company can still make money, Cooper says.
“If they can sell only $10 million of a drug for a very small population and not sell billions of dollars of Lipitor, for example, there is a challenge to all of that,” he says.
Other developments may look like they come straight from the imaginations of science-fiction writers, says Moses.
“It wouldn’t surprise me if in a few years people have something embedded in their cell phones that takes medical information,” he says. “We’ll see more and more things like smart pills that deliver medicine and that constantly monitor the levels of medicine in the body.”
Tissue engineering also will be a big field of research, says Hart. Doctors already can grow large amounts of skin for burn patients. Cartilage and then bone will likely follow, says Hart.
“A lot of the early work was developing mechanical replacements, like a metal knee or hip, for parts of the body that didn’t work,” Hart says. “Now, the emphasis is on growing these kinds of things and implanting more natural tissue.”
These are the types of projects in the medical and health care fields that engineers love to tackle. Not only does the work solve problems, it can also help reduce costs.
“Engineers are always interested in having efficient, high-quality systems to address whatever the problem is, and they can help bend that curve to make things more affordable,” Hart says. “So, if you can improve quality at the same time you lower costs and make it more available to more people, those are the things engineers are good at.”
T.C. Brown is a freelance multimedia producer, writer and editor in Columbus.
