Not long ago, Ge Junbo completed another "world first".
He and his team completed a high-risk coronary surgery using a new generation of interventional artificial heart, which represents a milestone for the world's smallest interventional artificial heart to officially enter the clinic.
As one of the world's most influential experts in the field of cardiology, Ge Junbo has created "China's first" and "world's first" in many cardiology fields. However, he knows that no matter how superb personal medical skills are, the number of patients that can be treated is limited after all, and only by creating an innovation ecosystem, opening up the innovation chain, and driving more people to invest in innovation and transformation can we hold more core technologies in our hands and help more patients.
Create an innovation ecosystem
In 2015, you initiated the establishment of the Cardiovascular Physician Innovation Club, and later the Innovation Academy. In addition to the daily busy surgeries and outpatient clinics, why do you attach so much importance to medical innovation?
Ge Junbo: More than 20 years ago, when I first returned from Germany to work, I found that there were very few high-end medical devices and equipment produced in China, and most of them relied on imports. In 2000, the first imported drug stent entered China, which cost more than 40,000 yuan a piece, which is a big expense for most families. I remember a hospital inviting me to a consultation, and the patient needed to fit three stents at the same time, plus balloons and other expenses, which added up to buy a Santana sedan. The patient's son told me that he was giving everything he had to save his father. On the day of the payment, he untied layer after layer of clothes, and finally pulled out a pile of money hidden in his close-fitting pocket, which still carried his body temperature. I was very touched: when will it take to wait for the price of imported brackets to be reduced? Why can't we develop our own Chinese affordable brackets?
So I talked to Liu Xuebo, my doctoral student at the time and now the director of the Department of Cardiology at Tongji Hospital, about this idea, and we decided to apply for the national 863 science and technology project and develop domestic stents. We searched for materials, researched pharmaceutical coating technology, experienced repeated failures, and finally succeeded in developing biodegradable coated coronary stents after 5 years. In 2005, including us, a total of three domestic stents were listed in China, breaking the situation of "foreign stents". At that time, some foreigners thought that our Chinese stent was not good enough, but the experimental results showed that our stent was no worse than theirs, or even better. The advent of domestic stents has also promoted a significant reduction in the cost of imported stents, and most patients no longer have to worry about the high cost of stents.
Upper view: After this domestic degradable coated coronary stent was launched, you immediately began to develop another "stent that will disappear"?
Ge Junbo: Yes, although the coating of the stent can be degraded, the stent itself is still a foreign body that has remained in the blood vessels for a long time. I thought, is it possible to completely "melt" the bracket? In 2005, my team and I began to develop scaffolds that could be completely degraded, and we started by looking for degradable materials, and gradually conducted animal testing, until we finally obtained approval for clinical trials in 2013. I gave this bracket a name called Xinsorb, Xin is the pinyin for "heart", sorb means absorption. From years of follow-up data, the patient implanted this stent after the effect is good, 5 years after the follow-up almost can not find the stent and is naturally metabolized and absorbed by the human body. This bracket has gone through a total of 15 years from development to marketing.
From the initial idea to the final application of these two stents to the final application of patients, they have roughly undergone such a process - doctors propose concepts based on clinical needs, make samples through research and experiments, engineers turn samples into products, and finally turn them into commodities through enterprises to benefit patients. The stent is only one type of medical device, and the research and development and progress of China's medical devices require a complete industrial chain.
So, on September 11, 2015, I initiated the establishment of the Cardiovascular Physician Innovation Club (CCI), and put forward the slogan: From the doctors, by the engineers, for the patients. Through this academic organization, we want to create an innovation ecosystem to promote the innovation of Chinese doctors, especially the innovation of medical devices, so that more core technologies can be in the hands of Chinese doctors.
After the establishment of this club, I felt that it was not enough, because most front-line clinical doctors still lack the awareness and ability to innovate, and they urgently need a collaborative innovation environment. Many foreign doctors have been innovating all their lives, and we Chinese doctors are no worse than them, so why not be good at innovation? So I launched an Innovation Academy and a Medical Innovation Alliance. We want to explore a way to inspire and protect innovators' enthusiasm for innovation and let them innovate without worries.
Upper view: What kind of students does this innovation academy enroll?
Ge Junbo: We recruit students once a year, most of whom are front-line clinical doctors, as well as engineers, founders of pharmaceutical-related companies and investors in the medical field. Students must pass an interview before they can be admitted. After the Innovation Institute gained a certain popularity, people came to me one after another to say hello and want to come here to study. Our criteria are clear, if you come in to study just to meet some contacts and expand your "circle of friends", then this starting point is wrong.
This year, the eighth phase of the Innovation Academy has begun, and nearly 500 students have graduated before, some of them have developed catheters, some balloons, some stents, and there are many innovative varieties, solving many "stuck neck" problems. Some students have also established their own start-ups and started their own businesses in Shenzhen, Suzhou, Hangzhou, Beijing and other places.
Ge Junbo is an academician of the Chinese Academy of Sciences, a member of the Standing Committee of the National Committee of the Chinese People's Political Consultative Conference, and a vice chairman of the Central Committee of the Jiusan Society. He is currently the director and professor of the Department of Cardiology of Zhongshan Hospital affiliated to Fudan University.
Not only books, not only superiors, retain a copy of innocence
As the dean of the Innovation Academy of the Cardiovascular Physician Innovation Club, what would you tell the students?
Ge Junbo: In the first class, I will tell the students the stories of "deviant" innovations in the history of medicine. In addition to inheriting existing knowledge to save lives and help the wounded, doctors also undertake the mission of medical innovation and medical progress. In this process, doctors should respect the most essential needs of patients, including physical and psychological needs, and avoid building behind closed doors while changing medical technologies and concepts, and cooperate with various specialties for collaborative innovation. More importantly, to respect the power of science and respect medical ethics, at no time can human beings act as "creators".
In addition to the first lesson, I will also give them an analysis of where the clinical needs are, where the pain points of innovation transformation are, and how to turn a sample into a product. The Innovation Academy will invite well-known cardiovascular doctors at home and abroad, chief technology officers of enterprises, experts in intellectual property and other fields to explain to the participants the path and principles of medical innovation, screening and evaluation of clinical needs, medical-engineering integration, intellectual property protection, registration regulations, medical innovation models, etc., involving the whole chain of innovation transformation.
Shangguan: What seemingly "deviant" innovations in the history of medicine have promoted the development of human medicine?
Ge Junbo: Let's say laparoscopic techniques. The first doctor to perform laparoscopic appendicitis surgery that year was fired from the hospital. At the time, the vast majority of surgeons believed that laparoscopic surgery with a few small holes in the body was sensational, even contrary. Today, laparoscopic surgery has benefited countless patients and is very common.
Also, more than 40 years ago, doctors believed that stomach ulcers were the main cause of stomach cancer, and stomach ulcers were mainly caused by excessive stomach acid. Warren, a pathologist abroad, discovered a bacterium that he believed was closely related to gastritis and stomach ulcers, but almost everyone thought it was impossible.
Warren and his partner, Dr. Marshall, did not abandon research on the bacterium. Marshall used Campylobacter isolation technology to culture biopsy specimens, and 34 consecutive biopsy specimens were cultured without finding bacteria, and Marshall was very disappointed. While cultivating the 35th specimen, it happened to coincide with the Easter holiday, and instead of waiting to observe the results of the culture, as usual, he went home for the holidays. A few days later, when Marshall returned to the lab, he was surprised to find that the bacteria he had been waiting for had finally been cultured.
He published his findings in the prestigious journal The Lancet, but many people still didn't believe him. Marshall decided to try the "poison" by first proving that his stomach was healthy through a gastroscope, and then drinking the bacteria. His peers and even his family thought he was stupid. Two weeks later, he developed symptoms such as hiccups and stomach pain, and was diagnosed with gastritis. He did another biopsy and grew the bacteria. Warren and Marshall then conducted a detailed study of 100 patients with stomach problems. Marshall has since named the bacterium Helicobacter pylori. The discovery of Helicobacter pylori has greatly increased the probability of radical treatment of gastritis, gastric ulcer and other patients, and may nip gastric cancer in the bud. In 2005, Warren shared the Nobel Prize in Physiology or Medicine with Marshall.
It can be seen that medical innovation is a painful, anxious but happy process, sometimes questionable and full of risks.
Medicine is sometimes full of uncertainty, but this uncertainty can be the driving force of innovation.
Ge Junbo: Exactly. In 2005, I performed interventional surgery on a patient at Zhongshan Hospital who completely blocked two main blood vessels on the left side of his heart, which is known in the industry as "the last bastion of coronary heart disease". At that time, the operation was broadcast live via satellite to the most influential academic conference in the world, allowing top doctors from all over the world to "watch" together. During the operation, I tried repeatedly, but the guidewire could not pass through the blood vessels in a positive direction, and I was a little anxious, thinking that this was an international live broadcast, and I couldn't disgrace the Chinese doctors. At that time, I had a whim, using a microcatheter to enter from the collateral circulation, and the microcatheter actually went backwards to the occluded position, and finally opened the occluded blood vessel.
When I was in college, my teacher told us that the collateral circulation is not a blood vessel, it is a channel composed of endothelial cells, which will break when touched, and I never thought that the microduct could go through the collateral circulation to the occluded position. Later, this technique was named "reverse guide silk technology" and has now become one of the three major conventional surgical methods in the world.
Medicine is a rigorous science, but it does not mean that all theories and techniques are static. Students should respect their teachers, but I also don't want my students to think that everything I say is right, otherwise medicine will not improve. I believe that students should be encouraged to go beyond books and superiors, but only to truth, and to retain a sense of innocence. Naivety is the most important element of innovation. The naïve mentality is the curiosity of the unknown, the curiosity of "habituation", not bound by traditional theories, and constantly asking questions, in order to have the motivation to innovate.
Ge Junbo has long been committed to promoting the innovation and transformation of major cardiovascular disease diagnosis and treatment technology in mainland China, and has carried out fruitful research in coronary intraluminal imaging diagnosis, technological innovation in complex interventional diagnosis and treatment, research and development of new devices and establishment of cardiovascular critical care system.
There must be both an atmosphere of innovation and an atmosphere of transformation
Medical innovation should be based on clinical needs, ultimately serve the clinic, and stand the test of practice. Are there some cases of innovation for the sake of innovation?
Ge Junbo: There is indeed such a situation. In recent years, the country's attention to innovation transformation, especially medical innovation transformation, is unprecedented, and the number of patent transformation in the country's top three hospitals has shown an increasing trend. However, although some medical personnel have applied for innovation patents, the results have not been transformed in the end. This kind of untransformed, long-term "lying still" patent is called "zombie patent".
In order to advocate innovation and transformation, in 2022, the Medical Innovation Alliance launched the first "China Medical Innovation Transformation Ranking", which calculated the total number of patent applications and the transformation of patents in more than 1,000 hospitals in China, and listed the corresponding sub-lists through 8 indicators. This year, the second ranking was released in Qingdao, and we gave this list a name called "Langya Hui", and added two new sub-lists: the list of the fastest improvement and the list of conversion amount. Hospitals across the country are very concerned about the release of this list.
Above: What are the main reasons why patents have not been transformed for a long time?
Ge Junbo: First of all, the original intention of innovation. True innovation is not based on results, and everything that goes for results is not called innovation. The original intention of innovation should be based on clinical needs, not innovation for innovation, not just for the promotion of professional titles.
In addition, an idea first goes through the "0 to 1" proof-of-concept and early project incubation stage, then goes through the "1 to 10" product verification stage, and finally enters the transformation stage, which is the "10 to 100" stage. The first two stages mainly rely on the close cooperation of front-line doctors and engineers, while the "from 10 to 100" process requires the role of enterprises, which is related to the business environment of each place and city.
As far as the current innovation transformation achievements of our Innovation Institute are concerned, half of the innovation transformation has been achieved in the Greater Bay Area, in addition to Jiangsu, Zhejiang and other places, and not many have been transformed in Shanghai. Shanghai has a strong atmosphere of innovation, but it needs a better atmosphere of transformation.
Shangguan: You just mentioned that you want to explore a way to protect the enthusiasm of innovators for innovation and let them innovate without worries. In practice, what are the main worries of innovators?
Ge Junbo: I have expressed the view many times: innovation is not only the innovation of the innovator himself, but the innovation of the whole society. If we want to take more core technologies into our own hands, we must encourage original innovation and let innovators work without distractions. At present, the definition of the attribution of innovation achievements is one of the confusions of innovators, and the identification and protection mechanism of transformation achievements needs to be improved.
Over the years, as a member of the National Committee of the Chinese People's Political Consultative Conference, I have been calling for innovators to make it clear that once their results are transformed into products, what is due remuneration and which are not, and cannot step on the red line of the law.
In the past, cardiologists often encountered the problem of cardiac catheterization being ejected because the pressure was too high to insert into the heart. In 1967, while on vacation by the sea, Dr. Gantz saw a sailboat drifting back to the harbor along the ocean current and suddenly had an inspiration. He thought, if you put a balloon in the heart catheter and inflate it, won't it be able to drift into the heart in the direction of blood flow? Through a series of experiments, he invented the famous floating catheter technique, marking the dawn of the era of hemodynamic monitoring. This technology has benefited many patients around the world, and the companies that use it will pay the doctor a certain royalty, and he will enjoy the fruits of innovation.
I believe that doctors and researchers who trudge on the road to innovation are motivated by a sense of social responsibility to make humanity better. This sense of responsibility and enthusiasm is very valuable, and only with the effective protection of the law can we truly stimulate the enthusiasm of innovators to innovate.
从元空空到"心universe"
Lookup: Are the Innovation Club and Innovation Academy only for innovation in the cardiovascular field? Will it expand into other areas in the future?
Ge Junbo: We are ready to include innovations in the field of cerebrovascular. In recent years, there have been more and more stroke and diabetes patients. Why are doctors working hard, hospitals working hard, but more and more patients? In fact, stroke is also a vascular disease. If the blood clot blocks the cerebral blood vessels, the brain will die; If the blood clot blocks the blood vessels in the heart, the heart muscle dies. So what causes so many people to get vascular disease? Mainly smoking, alcohol and other bad lifestyle habits caused by high blood pressure, high blood lipids, high blood sugar increasing, these diseases will cause vascular problems. So we put forward a concept of "panvascular", prepared to establish a panvascular innovation center, and invited brain interventional experts to join us to carry out innovation in the field of panvascular.
Shangguan: Artificial intelligence and the metaverse are hot topics at present, what changes will these emerging technology trends bring to medical innovation?
Ge Junbo: The metaverse is a concept proposed by Stephenson in Snow Crash in 1992, which was originally translated as "metaverse", and he described a virtual world parallel to the real world, which has all the forms of the real world. Simply put, everything and everyone in the real world is digitally projected into the cloud world.
Can the metaverse be applied to the diagnosis and treatment of cardiovascular diseases and become a "heart universe"? I think the answer is yes. In the future, we can enter a new era of cardiovascular disease diagnosis and treatment through 3D heart animation and AR glasses, wearable devices, real-time medical education space, virtual hospitals and virtual consultation rooms.
The medical metaverse consists of five major technical elements: artificial intelligence, extended reality, blockchain, 5G communication, and digital twins. How will the medical metaverse of the future work? Assuming that Lao Wang is diagnosed with high blood pressure and hypercholesterolemia, doctors will recommend that he sign up for a special health app to characterize his digital twin patients. The digital twin technology will bring together all of Lao Wang's digital health data and interact with artificial intelligence to monitor his panvascular health. Artificial intelligence compares Lao Wang's data with other people's health data, and in this way, the digital twin patient model can simulate and predict Lao Wang's health in the next 5 or 10 years, as well as the treatment that may be needed next, and take preventive measures before the condition worsens. AI can also provide Wang and his doctors with targeted prevention or follow-up recommendations.
Shangguan: How long do you think these future technologies will be applied?
Ge Junbo: I don't think it will be long. We're currently doing research on digital twins and already have a certain amount of data. In the past, doctors relied on looking and hearing, but now they diagnose diseases through individual examinations, but this can only gain a primary understanding of the disease, and it is inevitable that there will be misdiagnosis and missed diagnosis. In the future, doctors will be able to integrate various factors of patients and make more accurate treatments with the help of big data. With the help of the above technology, we can truly treat the patient as a whole, rather than a headache and a foot pain.
(Intern Wang Miao also contributed to this article)
Editor-in-chief: Gong Danyun Source: Provided by interviewee
Source: Author: Chen Junjun