IEEE PULSE presents

Biomedical Innovation in 2014

Feature July/August 2014
Author: IEEE Pulse

In just a few weeks time, the EMBS will be meeting in Chicago for EMBC 2014. Each year we enjoy several days of thought-provoking discussion. In preparation, we spoke with three keynote speakers from various arenas about key developments in their fields and where the future lies. Here’s what they had to say.

Stephen N. Oesterle, M.D.

Senior Vice President for Medicine and Technology, Medtronic
Stephen N. Oesterle, M.D., joined Medtronic in 2002 as Senior Vice President for Medicine and Technology. Previously, Dr. Oesterle served as Associate Professor of Medicine at the Harvard University Medical School and as Director of Invasive Cardiology Services at Massachusetts General Hospital, Boston. A teacher and innovator in the field of cardiac catheterization, he has also developed and directed interventional cardiology programs at Good Samaritan Hospital, Los Angeles; at Georgetown University; and at Stanford University.
IEEE Pulse: What do you see as the most exciting new development in your field and why do you believe it is such?
Oesterle: In the past five years we have seen medical devices evolve as we found ways to introduce complex technologies into what were historically mechanical/electrical devices. The integration of low power micro electronics, novel power sources, IT and Communication technology, biosensors, MEMs, to mention a few, have allowed us to deeply miniaturize devices and deploy them in less invasive schemes.
IEEE Pulse: What do you see as the biggest current challenge in your field, and what is your suggestion for overcoming that challenge?
Oesterle: Generating the large body of clinical evidence that not only validates the efficacy of new devices, but more importantly, demonstrates the economic value. Such trials are large, lengthy and expensive. Venture money has fled from early stage device deals in search of more predictable data and service models. We need to find new funding models to catalyze the development of these early stage companies.
IEEE Pulse: Where do you see your field in the next 5 or 10 years? What innovations have the potential to become a “game-changer” and how?
Oesterle: Devices will still have a major role in the treatment of chronic degenerative diseases. Game changer? The pursuit of remote patient monitoring by both traditional device makers and the IT industry (Google, Apple as prime examples) will facilitate distributed health care. We should be able enhance the care of patients with heart failure, diabetes, hypertension, to name a few, through the use of implantable and wearable sensors while reducing the burden of cost.

Emery N. Brown, M.D., Ph.D.

Professor of Computational Neuroscience and Health Sciences and Technology, MIT-Harvard Division of Heath Sciences and Technology
Emery N. Brown is the Warren M. Zapol Professor of Anaesthesia at Harvard Medical School, a Professor of Computational Neuroscience at the Massachusetts Institute of Technology and a Professor of Health Sciences and Technology at the Harvard-MIT Division of Health Sciences and Technology. Brown is the Director of the Neuroscience Statistics Research Laboratory at the Massachusetts Institute of Technology, the co-director of the Harvard-MIT Division of Health Sciences and Technology and an associate director of M.I.T.’s Institute for Medical Engineering & Science. Brown also works as a doctor in the department of anesthesiology, critical care and pain medicine at Massachusetts General Hospital.
IEEE Pulse: What do you see as the most exciting new development in your field and why do you believe it is such?
Brown: I think the most exciting work in the field of anesthesiology is the current research using systems neuroscience approach to characterize the mechanisms through which anesthetic drugs produce altered states of arousal. Much work has been done in the last 30 years to define the molecular targets and receptors at which anesthetics act. However, this knowledge alone has not been sufficient to explain how anesthetics produce the major characteristics of general anesthesia, which are unconsciousness, analgesia (loss of pain sensation), amnesia (loss of memory formation) and immobility. By performing systems neuroscience experiments in which neurophysiological responses to drug administration are measured in relation to changes in behavior it is possible to define how these changes in brain state occur. In humans, this means making extensive use of electroencephalogram recordings and functional neuroimaging. In animal studies, it means using electrodes implanted in relevant brain regions to track brain activity across states of general anesthesia and sedation. As a consequence, we can now begin to make specific statements regarding how the actions of anesthetics at specific receptors, in specific brain circuits lead to the altered states of arousal mentioned above. These new insights will offer for the first time a neuroscience explanation of how anesthesia works as compared to the current pharmacological statements which merely assert that changes in behavior can be related to drug levels in the blood for intravenous agents and to drug levels in the lungs for inhaled agents.
IEEE Pulse: What do you see as the biggest current challenge in your field, and what is your suggestion for overcoming that challenge?
Brown: The biggest current challenge for researchers in our field is conducting the detailed studies to complete the characterization of how the different anesthetics act in neural circuits to produce their effects. There is not nearly the volume of research being done on this topic as is needed. However, this research is critical for understanding not only the mechanisms of the drugs, but also how they produce many of their undesirable side effects such as, neurotoxicity, post-operative delirium and post-operative cognitive dysfunction. It is also critical for understanding why patients can have awareness under general anesthesia. To overcome these challenges, it is imperative we engage more clinical researchers and basic science researchers inside and outside of anesthesiology in the study of the neuroscience of general anesthesia and sedation. Despite the fact that general anesthesia and sedation are neurophysiological phenomena they have been studied to date almost exclusively as pharmacological phenomena.
IEEE Pulse: Where do you see your field in the next 5 or 10 years? What innovations have the potential to become a “game-changer” and how?
Brown: I foresee greater investments in the study of the neuroscience of anesthesia and sedation bringing about many advances in the next 5 to 10 years. There are:

  1. more precise neurophysiologically-based approaches for monitoring the state of the brain and central nervous system under general anesthesia;
  2. the development of novel site-specific anesthetics that can be administered so as to have tight control of desired effects with little to no side effects;
  3. automated closed-loop anesthesia delivery systems for precise maintenance of brain states during general anesthesia and sedation;
  4. a deeper understanding of brain physiology in general from a prospective that is not currently being exploited; and
  5. along with the novel approaches for creating the states of general anesthesia and sedation, equally novel approaches to treating sleep disorders, curing pain, treating psychiatric disorders, such as depression, that have significant altered arousal components, and novel approaches to facilitating coma recovery.

Maryellen L. Giger

A.N. Pritzker Professor of Radiology, University of Chicago
Maryellen L. Giger is presently an A.N. Pritzker Professor of Radiology, the Committee on Medical Physics, and the College at the University of Chicago. She also serves as Vice-Chair for Basic Science Research in the Department of Radiology, University of Chicago and Director of the BSD’s Imaging Research Institute. Dr. Giger is considered one of the pioneers in the development of CAD (computer-aided diagnosis). She has authored or co-authored more than 300 scientific manuscripts (including 180 peer-reviewed journal articles), is inventor/co-inventor on approximately 25 patents, and serves as a reviewer for various national and international granting agencies, including the NIH and the U.S. Army.
IEEE Pulse: What do you see as the most exciting new development in your field and why do you believe it is such?
I believe the growth and expansion of imaging genomics to be very exciting, as researchers from computer-aided diagnosis and quantitative imaging collaborate with those in genomics to use quantitative image analysis techniques to relate computer-extracted image-based phenotypes to genomics, potentially discovering new merged signatures that serve as better predictive models.
IEEE Pulse: What do you see as the biggest current challenge in your field, and what is your suggestion for overcoming that challenge?
The biggest challenge is funding which is quite limited and more difficult to get, due to multi-disciplinary grants, which are more difficult for reviewers to review.
Where do you see your field in the next 5 or 10 years? What innovations have the potential to become a “game-changer” and how?
There are two major changes — (a) the routine use of computerized (automatic) analysis of medical images in clinical interpretations/exams and (b) the data mining of medical information that includes imaging data to advance predictive models of risk and response.
 

Related Articles