Most medical schools don’t require applicants to meet
with a psychiatrist as part of their admissions process. But that’s
exactly what happened to William R. Brody in 1966 when he applied
to Harvard Medical School after finishing a master’s degree
in electrical engineering at nearby MIT.
“Even though there were a few Harvard medical faculty engaged in applying engineering to medicine, the admissions office couldn’t understand why an MIT engineer would want to ‘change careers’ and go off to medical school,” recalls Brody, now president of Johns Hopkins University. “Before they eventually admitted me, they sent me to a psychiatrist faculty member for an interview to try to figure out whether I was really suited for a career in medicine.”
How times change. In the 40 years since Harvard puzzled over Brody’s ambition to make a career of his dual interests in engineering and medicine, technological advances in diagnosis, treatment and rehabilitation have transformed the landscape of modern medicine. Medicine no longer eyes the engineers on its doorstep with suspicion. Instead it welcomes them warmly, eager for bright minds that can bridge the gap between healing and technology.
“There’s just more and more technology impacting medicine today,” explains Frank C. P. Yin, chair of the biomedical engineering department at Washington University in St. Louis and president of the Biomedical Engineering Society for 2005–06. “Medical schools are also beginning to realize that people who are trained in biomedical engineering make great decisions about how to use these technologies.”
Getting that technological background has also gotten much easier. Back in the 1960s and 1970s, when Brody was trying to put together an educational blueprint for building that bridge, combining engineering and medicine meant spending lots and lots of time in school. Between 1961 and 1977 Brody received B.S., M.S. and Ph.D. degrees in electrical engineering and did seven years of post-graduate medical training after earning his M.D. He decided to go to Stanford after the school’s dean of medicine pointed to a row of buildings 300 yards from his office and said, “Mr. Brody, there is the School of Engineering. If you come to Stanford, you can pursue graduate studies in engineering while you’re in medical school.”
These days it’s far easier for medically minded engineers to pursue a combination education. Thanks to the growing number of biomedical engineering programs, students can get the background they need in mathematics, engineering and life sciences without having to cobble together relevant courses from disparate departments that aren’t always working cooperatively.
Biomedical engineering, or BME, currently holds the title of fastest-growing
engineering discipline, according to ASEE statistics. Between 1999
and 2005, the number of undergraduate degrees awarded in biomedical
engineering grew by 137 percent, from 1,016 to 2,410. Today, more
than 14,000 students are enrolled in undergraduate BME programs.
Over the same six-year period, graduate BME degrees mushroomed as
well, growing by 135 percent for master’s degrees and 78 percent
for doctoral degrees. And while women tend to be underrepresented
in engineering, accounting for roughly 20 percent of students overall,
BME students buck that trend: Women earned 42 percent of the bachelor’s
degrees, 44 percent of the master’s degrees and 29 percent
of the Ph.D. degrees given out in BME during the 2004–05 academic
year (the most current data available).
Yin says that biomedical engineering really began to take off as
a discipline in the 1990s when the Whitaker Foundation, established
in 1976 to foster the nascent field of biomedical engineering, decided
to spend out all of its money over the course of 15 years, thereby
injecting a massive amount of cash into BME over a short period
of time, rather than pay out smaller amounts in perpetuity.
It was, essentially, a sacrificial strategy for the foundation.
But it’s hard to argue with Whitaker’s success. In 1975,
the year before the foundation was established, there were 12 biomedical
engineering departments. In 2005, the year before Whitaker shut
down, there were 75, with more on the way. All told, the foundation
has poured $710 million into biomedical engineering. Nearly 1,500
faculty members were able to establish academic careers in BME thanks
to Whitaker cash.
Money isn’t the only thing driving BME. Aging baby boomers who want to live longer, more active lives are driving the demand for sophisticated medical equipment and procedures that are BME’s bread and butter. According to the Bureau of Labor Statistics, “biomedical engineers are expected to have employment growth that is much faster than the average for all occupations through 2014.”
Yin thinks there’s another factor behind BME’s growth spurt. “The popularity of the field is that it’s a maturing discipline,” he says. “Young people are realizing that they can get a solid foundation in engineering with an education in biomedical engineering. It’s a wonderful area for them to apply their talents to. A biomedical engineer can directly improve the health and welfare of people without devoting oneself to getting an M.D.”
So what exactly does a biomedical engineer do? Lots. Loosely defined
as someone who uses engineering to solve problems in biology and
medicine, a biomedical engineer could be doing everything from trying
to make pharmaceuticals more effective to designing the next machine
for medical imaging to creating artificial skin. Biomedical engineers
have already given us pacemakers, MRIs, kidney dialysis and artificial
joints. Who knows how these engineers will change our lives in the
next 10, 20 or 30 years?
“I wanted to do this my whole life,” says Daniel Moran, a biomedical engineering professor at Washington University. As a bright kid growing up in the 1970s, Moran was a devoted fan of “The Six Million Dollar Man”— a TV show about an astronaut who is “rebuilt” with bionics after a serious crash. The show’s opening lines still resonate with him: “Gentlemen, we can rebuild him. We have the technology. We have the capability to make the world’s first bionic man. Steve Austin will be that man. We can make him better than he was. Better. Stronger. Faster.”
Moran isn’t giving anyone arms with the strength of bulldozers or eyeballs equipped with night vision and zoom features, but he is working toward his childhood dream of using technology to mend people with serious injuries. Moran’s latest efforts could prove to be even more impressive than anything the TV writers dreamed up for Steve Austin.
Working in collaboration with neurosurgeon Eric C. Leuthardt, Moran is developing technology that enables people to move objects on a computer screen using only their minds. No joystick. No keyboard. No motion sensors. Just the electrical signals from their brains. In their most recent experiment, Moran and his coworkers were able to get a 14-year-old boy to play the classic arcade game “Space Invaders” with nothing but his imagination.
The teenager was undergoing treatment for epilepsy, which involves surgically placing an electronic grid directly onto the surface of the brain. The patient stays in the hospital for about a week so doctors can monitor the grid for signals in the brain that pinpoint the focus areas of seizures, with the aim of removing that area.
“When patients are undergoing the seizure monitoring, they’re in bed all the time,” Moran says. It can get pretty boring, and that can be a problem because the inactive patients tend to have few seizures, making it more difficult to locate the area of the brain responsible for the seizures.
Moran’s group hit upon a way to help the teen pass the time and also get valuable information at the same time. They were able to interface the monitoring system with the “Space Invaders” software, which they then programmed so that when the teenager made certain movements, those motions would initiate movement in the video game.
Moving his tongue would move the video game’s laser cannon. Wiggling his fingers would make the cannon shoot. Next, they asked the teen to think about those movements, but to not really do them. It wasn’t long before the teenager was playing the game just by thinking about it.
Of course, the goal isn’t to get people to throw out their handheld controllers and play video games with their brains. Rather, Moran thinks the technology could someday help quadriplegics and people with degenerative muscle diseases interface with computers and control wheelchairs with just their minds.
It might even lead to a new generation of smart prosthetics that can be controlled just by thinking about it—not that different from the way people move the limbs they were born with. Shades of “The Six Million Dollar Man” indeed.
Listening for Cancer’s Early Warning
John Viator has an ear for skin cancer. Literally. Viator, a biomedical
engineering professor at the University of Missouri, Columbia, fashioned
the listening device out of a laser, special microphones and a computer
interface. And while the setup doesn’t look much like an ear—Viator
calls it a photoacoustic detection system—he thinks it can
help doctors “listen in” on deadly melanoma cells as
they spread throughout the bloodstream.
Although melanoma is the rarest type of skin cancer, it is also
the most deadly, accounting for nearly 74 percent of skin cancer-related
deaths in the United States last year, according to estimates from
the American Cancer Society. Melanoma’s lethality arises from
the fact that the cancer often goes undetected. It frequently looks
like an innocuous mole, and by the time a patient realizes the discolored
bump is something more serious, its cancerous cells have often metastasized—broken
away from the original tumor and spread to other parts of the body.
Viator hopes to catch these metastasized melanoma cells early on, when chemotherapy has a better chance of killing them, thereby giving patients a better chance of survival. “Specifically, we’re looking at circulating tumor cells in the bloodstream,” he explains. Viator and his research team shoot a laser at a sample of blood. The laser light heats up the melanin in any melanoma cells that may be hanging around, forcing it to expand. As the melanin quickly cools down, it makes a unique cracking sound—inaudible to human ears—by creating ultrasonic waves. Viator records these noises with special microphones.
Since melanoma cells are the only cells in the bloodstream that carry melanin, the technique is excellent at detecting the disease specifically. Viator says the technique is so sensitive that he can find melanoma with only 10 cancer cells present. Doctors could use the technique to see if a patient’s melanoma has metastasized, to judge how efficiently chemotherapy is working for someone with melanoma and to look out for the disease in people whose genes put them at a higher risk for developing it.
The technique is cheaper and easier than what doctors currently use to track melanoma, and it gives a quantitative measure of how many melanoma cells have made it into the bloodstream. “The most complicated part is drawing blood. The whole procedure should take 20 minutes,” Viator says. He’s already gotten a lot of interest from patients and is setting up a pilot study.
Viator became interested in the problem almost two years ago, when Paul Dale, the university’s chief of surgical oncology, made a visit to the engineering department. “He said there are lots of problems in medicine that we really need engineers to tackle,” Viator recalls.
It was a call that spoke to precisely what got Viator interested in BME in the first place. “The appeal of biomedical engineering was that it gave me the ability to make people’s lives better,” he says. “What could be better than being able to do what you love—engineering, physics and math—and be able to apply it to something that is as rewarding as healing people?”
Ending Pharmaceutical Heartbreak
For pharmaceutical companies, the antihistamine Seldane is a textbook example of what you don’t want in a new drug. Seldane hit the market as the first nondrowsy allergy medication in 1985. It was a stunning success, quickly becoming one of the top 10 most-prescribed drugs. But the U.S. Food and Drug Administration started to get some alarming reports about the drug. By 1997, when it was pulled from the market, Seldane had been identified as the cause of serious cardiac problems in 83 people. Fifteen of those people died.
Seldane, doctors now know, caused certain patients to develop Long QT Syndrome, a malfunction in the heart’s electrical signaling system named for a split-second lengthening in the time it takes the cardiac muscle to contract and release. The delay can cause the heart to beat out of control or, in some cases, stop altogether.
A genetic defect causes Long QT Syndrome in between 10 and 15 percent of the population. It’s usually to blame when an otherwise healthy child dies, usually while exercising, for no apparent reason. Today more than 30 commonly prescribed drugs carry a very small risk of inducing Long QT Syndrome in people without the genetic defect. More than 70 others are suspected of doing the same.
Considering that it costs about $900 million to get a new drug on the market, pharmaceutical companies would like to learn sooner, rather than later, if their investment is going to turn into a liability. Jean Philippe Couderc, a professor of both biomedical engineering and medicine at New York’s University of Rochester Medical Center and founder of iCardiac Technologies, is developing software that will help pharmaceutical companies do just that.
“The magic words today are ‘translational research,’ making sure that your research is reaching the patient,” Couderc says. He specializes in using digital signal processing to get information from electrical signals in the body. Couderc hopes to use his software to pick up on the small changes in the heart’s electrical system that indicate Long QT Syndrome or other types of cardiac toxicity are developing.
“We have developed a set of electrocardiographic tools to do quantitative analysis of signals coming from the heart,” Couderc explains. Those tools, he continues, can help them determine the warning signs of cardiac toxicity with greater precision and long before the changes are significant enough to pose a threat to the patient. He recently secured a $1 million grant from the National Institutes of Health to validate the software containing a massive data set from FDA’s past clinical trials.
Ultimately, Couderc thinks that drug companies will be able to use the software to pick up on the warning signs of cardiac toxicity much earlier in the approval process. It could even identify people who are at an increased risk of developing drug-induced Long QT Syndrome, so they can avoid potentially dangerous medications altogether.
House Calls for the New Millennium
In the future, it may not be our family doctor, or our friends, or even our family who are the first to notice when our memory starts to slip. If Tamara Hayes’ research is any indication, the first warnings that our health is flagging will come from our houses.
“I really do imagine a time when, rather than running off to a clinic to see what’s wrong with me my doctor can get all my health information from data gathered by my house,” says Hayes, a biomedical engineering professor at Oregon Health & Science University. In fact, she continues, the doctor can get better information because the house is a purely objective observer. It doesn’t play hooky, and it doesn’t try to appear healthier than it is.
Hayes’ research involves gathering data from different types of sensors placed throughout a person’s home. The information, she and her colleagues hope, will help ferret out behavioral changes that indicate the early stages of dementia and Alzheimer’s. “The technologies themselves are pretty simple,” Hayes explains. Her monitoring toolkit includes motion sensors, contact sensors, computer keyboard sensors and mouse movement sensors.
Hayes makes her patients play video games so she can see if they’re progressing or if they’re relearning the game’s tasks over and over. There’s even an electronic medicine box that records when people take their medicine. According to Hayes, people who have early memory loss were four times more likely to forget to take their medicine. That’s a problem if the medicine is supposed to halt memory loss in the first place.
People don’t usually realize when they are in the early stages of diseases such as Alzheimer’s or dementia. If they experience any memory loss, they chalk it up to general forgetfulness or they just forget that they’re forgetting. Because doctors see a patient only a few times a year, they often don’t notice the signs until the disease has progressed to more advanced stages. This means patients get treated later when medications are less effective.
Because it’s constantly monitoring a subject, Hayes’ sensor system could pick up on early behavioral changes most doctors miss. She recently completed a study in which she used sensor data to compare the behavior of otherwise healthy seniors to those in the early stages of dementia. The underlying concept is that everyone has a pattern of behavior that’s normal for them, Hayes explains. “When that pattern changes, it could be indicative of a medical problem.” In this study, she found people with dementia tend to move around more and have a more variable routine than their healthy counterparts.
Hayes just started a more comprehensive sensor-monitoring study that will gather data from 300 people over the age of 75 for three years. During the course of the experiment, a substantial portion of the subjects will develop dementia or Alzheimer’s. Hayes thinks that with the data she and her colleagues gather, they will be able to pick up on the more subtle behavioral changes that underlie larger health problems. “We’ll be able to say, ‘This is the indicator. We didn’t realize it at the time, but now we know,’” she explains.
If the home monitoring sounds Big Brotherish to you, you’re not alone. Hayes says she sometimes encounters that attitude from her younger students and colleagues, due in large part to the fact that younger folks don’t usually need this kind of scrutiny … yet. “Older people don’t feel that way,” she notes. “I never have problems recruiting volunteers. They say they’ll try anything that can keep them in their homes—and out of nursing homes—longer.”
Bethany Halford is a freelance writer based in Baltimore.