Fostering Innovation—The Way Forward

World-renowned physician, inventor, and Cleveland Clinic Chief Innovations Officer, Dr. Thomas Graham spoke to PM360 just as he was excitedly gearing up for this pioneering non-profit academic medical center’s 2014 Annual Medical Innovation Summit, held in October. In this article, Dr. Graham addresses the challenges of innovation, Cleveland Clinic’s role as the leader in fostering healthcare’s next-generation solutions, the need for investment and collaboration, and the role that pharma marketers can play in helping to move innovation forward.


PM360: Dr. Graham, can you talk about the major challenges confronting healthcare innovation today and how some of these are currently being addressed?

I think that everyone involved in the healthcare industry is responsible to be proactive in recognizing today’s dramatic shift away from a volume-based system to a value-based paradigm. Essentially, we must all pursue the concept of value-based innovation—solving big problems for large populations faster, more effectively and less expensively.

But there is a perception that innovation adds cost to the medical system, which can create obstacles. That is because you can track the cost of development, but you can almost never track the “return on innovation.” In reality, innovation is probably one of the best ways we have to tackle safety issues, outcomes and access—all tied together by fiscal responsibility.

So how can this perception challenge be addressed?

We need to understand the basic infrastructure of innovation, especially as it resides on the campuses of our academic medical centers and research universities. One of the most challenging things right now is in ensuring we have the capabilities and resources to gestate creative thought.

I think when people hear the word “innovation” they think of the investment community’s interpretation, which is essentially on the back end of the process. A contemporary understanding of innovation really lies in putting ideas to work and placing metrics around the performance of innovation functions at the beginning of the idea pipeline. Through this understanding, we can serve both inventors and investors and continue to have an engine for transcendent thought that creates the solutions for next generation healthcare.

What does the infrastructure of innovation encompass?

Functions like Cleveland Clinic Innovations, the recognized leader in bringing transcendent thought to the marketplace, essentially relies on what we call the “virtuous cycle.” We have world experts working at the bedside or laboratory bench side that recognize the unmet need, then they come up with solutions.

We are strong believers that innovation happens best at the intersection of the knowledge domains. So we sought to build a global healthcare innovation alliance that brings together medical systems, universities, key industry partners and government sponsored research and technology development resources to work collaboratively on some of the biggest problems facing healthcare.

Innovation is best done in collaboration, even though it’s recognized that traditional definitions of relationships might be vendor/client, or competitor. We want to change those to partner and collaborator.

But a few things are happening right now. Due to risk, there is a movement away from interfacing with our innovation engines at both the industry and the investment community level. Investors want returns, and we are, in their minds, “too early and too risky.” But investors must understand that without the type of wellspring of creative thought found at institutions like Cleveland Clinic, there will no longer be opportunities to invest in later.

However, we do think that there’s opportunity for industry, which is almost eschewing their internal R&D capability and instead growing by acquisition. If they could better understand how innovation is done on our campuses and connect directly with innovation functions like Cleveland Clinic Innovations, the benefits will be myriad.

What might some of those benefits be?

Industry can bring their challenges, we can co-innovate, and frankly it’s a lot cheaper to get in on the “bottom floor.” That’s why we sought to build the largest aggregated intellectual property portfolio in academic healthcare. It’s so we can attract industry that wants to fill their core needs—and then wants to look to their adjacent markets.

The best possible situation is for industry to recognize that their most potent opportunity is to associate with academic medical centers and research universities on the very front lines of innovation—it’s where they will realize the greatest outcome in the short- and long-term.

And for us, this is a feel good story because we’re engaged in what we call “mission-driven innovation.” At the end of the day, we are ideating around improving and extending human life—and there’s no higher calling. So we sometimes see industry’s venture arms, as well as its philanthropic arms, coming to understand the process—and the more enlightened ones are coming on board.

I understand, too, that marketers should be involved much earlier in the innovation process.

Why not have an early look at what’s coming? Why not be a futurist? Why not be proactive rather than reactive? And so my admonition to marketers is this: You’re not going to have anything to market if we don’t have the resources and capabilities to move things forward.

The whole innovation process is accelerated if we better understand not only what we can create, but also what we can sell. I believe if the marketplace can tell us earlier what the unmet needs are, and we can ideate around them, we’re going to be that much more effective in creating what is needed.

Every once in a while you’re going to have opportunistic innovation, a “eureka” moment. But I like the “strategic innovation” approach, when someone says, “The market is demanding this. Patients or clients need it. Why don’t you put your heads together around this issue and we’ll sprinkle some resources on it and bring it forward.” That is going to be the new model of innovation.

Coming Soon: 2015’s Top 10 Medical Innovations

Each year, Cleveland Clinic holds its Annual Medical Innovation Summit, drawing thousands of attendees from around the world, and announces the Top 10 Medical Innovations destined to provide better healthcare in the following year. Here’s what to look forward to in 2015:

1. Mobile Stroke Treatment Unit

Faster, effective stroke treatment can be achieved via the Mobile Stroke Unit. It allows high-tech ambulances to work with in-hospital stroke neurologists who interpret symptoms via broadband video link, while an onboard paramedic, critical care nurse and CT technologist perform neurological evaluation and administer t-PA.

2. Dengue Fever Vaccine

The first vaccine for mosquito-borne dengue fever—affecting 50 to 100 million people globally each year—was developed, tested and is expected to go to regulatory groups in 2015, with commercialization expected later that year.

3. Cost-effective, Fast, Painless Blood-Testing

Needles and vials may become passé due to a new blood collection/testing system that uses a drop of blood drawn painlessly from the fingertip and delivers test results within hours. Cost is estimated at 10% of the traditional Medicare reimbursement.

4. PCSK9 Inhibitors for Cholesterol Reduction

Patients intolerant to the statins used to reduce cholesterol will have options. Several PCSK9 inhibitors, or injectable cholesterol lowering drugs, are in development. The first PCSK9, which reduces cholesterol to lowest levels ever achieved, should receive FDA approval in 2015.

5.  Antibody-Drug Conjugates

The only treatment for some cancers, chemotherapy, destroys cancer cells, but also harms healthy cells. A new approach to advanced cancer treatment selectively delivers cytotoxic agents to destroy tumor cells while avoiding healthy tissue.

6. Immune Checkpoint Inhibitors

Difficult to treat, cancer kills about eight million people annually. But immune checkpoint inhibitors may make significantly more progress against advanced cancer. Combined with chemotherapy and radiation treatment, the inhibitors strengthen the immune system and offer long-term remissions for patients with metastatic melanoma.

7. Leadless Cardiac Pacemaker

For more than 50 years, cardiac pacemakers have consisted of a pulse generator and a thin wire, or lead, inserted through the vein to keep the heart beating steadily. But leads can break, and in 2% of cases, become infection sites. Soon, wireless vitamin-sized pacemakers may be implanted directly into the heart. The procedure requires no surgery, eliminates malfunction complications and removes restrictions on patients’ daily activities.

8. New Drugs for Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) scars the lungs’ air sacs and complicates breathing for nearly 80,000 American adults. But the FDA approved two new experimental drugs, pirfenidone and nintedanib, that slow the disease progression—typically lethal within three to five years. No prior IPF treatment existed.

9.  Single-Dose Intra-Operative Radiation Therapy for Breast Cancer

Detecting breast cancer early often leads to a cure. For most patients, a lumpectomy followed by radiation therapy reduces recurrence. Intra-operative radiation therapy focuses radiation on the tumor during surgery as a single-dose and has proven effective as whole breast radiation.

10. New Heart Failure Drug

Angiotensin-receptor neprilysin inhibitor, or ARNI, was granted FDA “fast-track status” due to its impressive survival advantage over ACE inhibitor enalapril, the “gold standard” heart failure treatment. The unique drug compound represents a paradigm shift in heart failure therapy.


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