On physician scientists and the restructuring of university medicine

What does this misidentification mean for the patients?

The patients are enormously restricted in their personal and professional development and take up many personal and financial resources of the health system. Up to now, the therapies have been unable to combat the cause. Even gene therapy wouldn’t be enough, as the disease also has an environment component. We now understand the genetics very well and, using new methods, we’re trying to uncover the 80 per cent of missing information about the development of the disease. For that purpose, I’ve built up a large research and treatment center with about 5,000 patients. Even by international standards, that’s a large cohort. We’re developing innovative therapies, starting from the new idea and taking it all the way to a far developed product. At the same time, I’ve built up a research group in which we focus on, for example, the misidentification processes in the immune system. One specific cell type thereby plays a role – the dendritic cell. Together with the colleagues of the German Rheumatism Research Center (DRFZ) we developed a method for isolating this rare cell population from human tissues. That was our unique selling point, so to speak.

What are you researching in the project funded by the Charité Foundation?

The further development of imaging techniques plays a major role in our research. These are important for detecting precursor stages of tumors in the case of bowel diseases. These often occur when the inflammatory processes get out of control. One area which is seeing extremely rapid development is ultrasound. Until recently, you could record moving images using ultrasound, but you couldn’t examine the elastic characteristics of tissue. Today, you can not only display anatomic structures and blood flow in an ultrasound image, but also capture mechanical characteristics – for example, show whether tissue is stiff or soft. This is important for objectively describing a disease process as well as for the success of the treatment. Together with a physicist, I’ve developed elastography further with the funding from the Charité Foundation. Normally with ultrasound, you place the sonic head on the stomach, and then waves are emitted by the sonic head and are directly measured by it. In the new method, a large bass speaker that emits mechanical waves stands under the examination couch. These go through the body and the sonic head registers the changes which arise in the tissues.

You’re not only being funded yourself but are also actively involved in initiating programs for combining clinical work and research at the Charité. What inspired you to do this? 

My own career was decisively shaped by a research stay in the USA. I also completed part of my medical training there. I was impressed how well organized and effective the clinical training of doctors and the collegial interaction in the USA were. I brought these impressions of American health care and scientific training back to Germany. I wanted to introduce these Anglo-American training methods here as well. As an alumnus of the BMW Foundation Herbert Quandt, responsible collegial leadership and the new generation of young scientists are very dear to my heart. That’s why I initiated and co-designed the subsidized, innovative Clinician Scientist Concept for the integrated and structured scientific clinical training of physicians, which was awarded funding through the “Off the Beaten Track” program of the Volkswagen Foundation. Meanwhile, it’s been defined as a national model program for university medicine by the Germany Research Foundation (DFG), the German Federal Ministry of Education and Research (BMBF) and the German Council of Science and Humanities (WR). However, in Germany we also need perspectives for physicians who don’t take the classic academic or clinical career path. Not all physicians who come to the Charité want to do basic research. We also need hospital managers who bring with them entrepreneurial thinking in accordance with Johanna Quandt’s ideas. Other physicians may not be working in science at all, but may be particularly talented in teaching students clinical medicine.

How do you yourself divide the work?

In my contract, as is usual in Germany, it says “doctor, scientist and university professor”. There is no percentual division. The fact that we want physician researchers, but only create the basic conditions necessary for it at the beginning of one’s career is a social contradiction. As a senior physician, you’re actually involved in sick care full time, without structured research time. This puts us at an absolute competitive disadvantage compared to other countries. From 2017, I shall be taking over the directorship of the University Clinic at the University of Alberta in Canada. In my employment contract, there’s a percentual division of clinical, research and teaching work. I’d like to have that here too. The successful Clinician Scientist Program and the options for Clinical Fellows at the Charité already represent important steps in this direction. In addition, there should be an assurance that it won’t only involve limited periods of research: instead, long-term perspectives ought to be created for physician researchers. This would enable the Charité to play a clear pioneering role in restructuring university medicine. 

2017 / TO and MM