Anti-medical school, pro health

February 4, 2010
By Rachel Shafer, UC Berkeley College of Engineering

No offense to medical schools, but students last fall liked taking “Anti-Medical School,” a new graduate seminar at Berkeley. Why?

Medical schools teach what is known in medicine, explains BioE associate professor Steve Conolly, who helped bring the course here from UCSF. Anti-Medical School explores what is unknown and unsolved in medicine, and that’s what the course’s 70 students, mainly first- and second-year bioengineering graduate students, found compelling.

HELP FOR SENIORS: Adam Gazzaley, who studies the aging brain, wants researchers to find better tools to diagnose Alzheimer’s disease early. He presented his challenge to Berkeley bioengineering students during a recent graduate seminar entitled “Anti-Medical School." COURTESY ADAM GAZZALEY/UCSF

At each weekly lecture, a UCSF medical doctor presents a problem in need of an engineering solution in hopes of engaging the students in solving thorny, real-world clinical challenges as part of their master’s or doctorate research. “While not all the clinical challenges will become projects that satisfy all the constraints of a Ph.D., the goal is to spark new grad students’ imaginations,” explains Conolly, a member of QB3.

Course content included mechanical hearts and lungs, low back pain and affordable home-based health care, among others.

Last November, Adam Gazzaley, a QB3 neurologist and neuroscientist who specializes in the aging brain, discussed one of his field’s most pressing questions: how can we improve early detection of Alzheimer’s disease during the mild cognitive impairment phase? “We can’t stop the advance of Alzheimer’s, but if we catch it early enough, we’ll be able to slow it down with disease-modifying treatments that are on the horizon,” Gazzaley told the students.

During his lecture, Gazzaley, director of UCSF’s Neuroscience Imaging Center, reviewed current neuroimaging tools that have helped doctors both understand and diagnose the disease. As Alzheimer’s advances, the brain loses neurons and synapses (brain cells) in the memory-oriented hippocampus and other regions. Brain volume actually shrinks, so in one method, researchers use magnetic resonance imaging (MRI) studies to measure volume loss.

Another method involves taking an MRI of a patient’s brain while he or she performs a cognitive test to measure the level of neural activity, which declines significantly as disease progresses.

Finally, scientists believe abnormal biological structures called amyloid plaques and neurofibrillary tangles may play a role in killing neurons. To identify the increased presence of plaques, researchers use a substance called Pittsburgh Compound B (PiB) that binds to the amyloid and can be viewed in an imaging technique called positron emission tomography (PET).

BRAIN CELL LOSS: A healthy brain (left). As Alzheimer’s advances (right), it causes portions of the brain to shrink, enlarging the gaps between brain tissue. COURTESY ADAM GAZZALEY/UCSF

These methods, though promising, have imperfections. Mainly, they don’t catch the disease early enough, Gazzaley said, and are available to a limited number of patients. With baby boomers aging, Gazzaley hopes researchers can quickly develop a better tool. In the United States, Alzheimer’s affects 4.9 million adults over the age of 65, according to a 2007 Alzheimer’s Association report. By 2050, that number may increase to 16 million.

Omar Alhashimi is a Berkeley bioengineering doctoral student with an M.D. from the University of Wisconsin, Madison. Interested in neuroscience, he contacted Gazzaley after the lecture and now has joined Gazzaley’s lab for a rotation. “I hope to get a better sense of the field and then eventually approach it with some original ideas of my own,” he says.

Tyson Kim, a UCSF medical student and first-year bioengineer whose Ph.D. work involves regenerating blood vessels after stroke or heart attack, said the entire course helped him think about how to bridge medicine and engineering research after he graduates, highly relevant if he achieves his goal of becoming a surgeon and directing a university research lab. “It influenced how I might be able to make a professional impact on health care,” he says.

These are just the types of stories Marc Shuman wants to hear; that’s why the UCSF professor of medicine and California Institute for Quantitative Biosciences (QB3) clinical director founded the course three years ago.

“We’d like bioengineering graduate students to begin to think differently about how they approach a problem,” Shuman says. “Right now, their problem-solving is in a vacuum. Engineers invent something, then come to doctors and ask us how we can use it. The contributions would be far more significant if engineers sat down with clinicians in the beginning, found out more about their field and worked with them to solve a problem.”

Steve Conolly agrees, calling this “clinical pull” instead of “technology push.” Biomedical startups sometimes fail, Conolly says, because although they might develop smart technology, they don’t have a clear clinical goal.

With efforts like Anti-Medical School, engineers and medical doctors have the opportunity to align themselves and perhaps create an environment more conducive to startup success and improved health care.