"A huge opportunity has been seized"
Blake Wilson, co-inventor of the cochlear implant and translational medicine researcher at Duke for more than three decades, talks about the new MEDx program
What’s your experience been like at Duke when it comes to collaborations between the engineering and medical schools?
I’ve been fortunate enough to be involved with both schools in the development of the cochlear implant. When I started as a researcher at Research Triangle Institute, shortly after graduating from Duke as an electrical engineer, there was no effective treatment for deafness or severe losses in hearing.
Our initial work in the early ‘80s required a clinical collaborator, and at the time there were only three centers in the United States that had any sort of clinical program for cochlear implants, and those centers were all in California. Thus, we initiated what proved to be a wonderful collaboration with the University of California at San Francisco. In the collaboration we developed software and hardware for tests with recipients of cochlear implants and the tests were conducted at UCSF by us and our colleagues there. At least until Duke stepped in.
Joe Farmer, who was an otologic surgeon at Duke, offered to initiate a clinical program here so that Duke could support our work and help deaf patients. That portended the spectacular support I’ve experienced at Duke for the past three and a half decades, and it paved the way for the remediation of hearing loss. Of course there have been a high number of collaborations between engineering and medicine at Duke, and those efforts have produced stunning improvements in healthcare. For one example among the many, the work by Warren Grill and his counterparts in neurology and neurosurgery at Duke have transformed care for Parkinson’s disease with deep brain stimulation.
What would you say contributes the most to Duke’s ability to nurture these sorts of collaborations?
Duke is just such a special place, with world-renowned experts in engineering, all of the medical school, genomic medicine, neuroscience…and when all of these powers can be brought together, remarkable things happen. But it requires coordination and initiative.
That’s what Dr. Farmer had with me. We were given a generous equipment grant and space was made available in the Baker House at Duke for a laboratory where we studied cochlear implant patients for 10 years. It was that kind of partnership and that kind of generosity that made this thing happen. Today, nearly all users of cochlear implants can talk on the telephone, which is a long trip indeed from total or nearly-total deafness and a long trip from where we started, when we were thrilled when an implant subject could understand even one single-syllable word out of 50.
Actually, the effort at Duke was one of the first collaborative efforts between engineers and physicians in the field of remediation of hearing loss. And that partnership produced key breakthroughs that enabled high levels of speech reception for the great majority of today’s users of cochlear implants. In retrospect, our work together was one of the first examples of what is now called translational medicine or translational research, which was highly encouraged here at Duke. It didn’t have those names back then, but now it’s the vogue and so important!
So Duke was a big proponent of translating discoveries to clinics even back in the ‘80s?
Duke was way ahead of the curve. I benefitted immensely from being at Duke. Wonderful people took me under their broad wings and taught me engineering, how to write, and auditory physiology and neuroscience. To this day I don’t know why, but I could not be more grateful.
It’s not enough for a drug manufacturer or a device manufacturer to read papers to be able to implement a new approach well. A program of active technology transfer is essential, so that persons at the companies can fully understand the advance and how best to use it. In these programs, everyone works together to make sure the drug or the device can be manufactured well and efficiently. Those elements must be in place for making the advances available to high numbers of patients and not just to research subjects. It’s a very close collaboration.
And Duke also focuses on making advanced medical technologies affordable in low- and middle-income countries. One example is low-cost but still highly effective cochlear implants, which we and others are working to produce and provide. There are many other examples, like the great work by BME’s Bob Malkin and his colleagues, who are developing low-cost devices for widespread applications in those countries, especially low-income countries.
How does the marriage between engineering and clinical research at Duke compare today?
It’s even better now than when I and my coworkers started more than three decades ago. There have been world-changing advances at the intersection of engineering and neuroscience here at Duke, for example. My own research is carrying on in that grand tradition and there are discussions under way to increase the funding for, and the profile of, that intersection even farther.
And of course the initiation of the MEDx program makes such collaborations all the more feasible. It encourages people from different disciplines to talk and to describe the problems they’re working on to other brilliant people, who then say, “Aha! Did you think of this or that?” Or to say, “Aha! Maybe we can work together on this particular aspect.”
That’s the background of the MEDx program as I understand it. You may find someone in mathematics who is working on chaos theory, for example, who could give valuable insights into different types of processing in the brain. Without MEDx and without these interactions facilitated and encouraged, these chance meetings might not occur and indeed probably would not occur.
So from my selfish perspective, I have succeeded in persuading brilliant people at Duke to think about the problems of hearing loss as opposed to the hundreds of other things they can think about. I’m sure they’re thinking about multiple things, of course. But hearing loss is on the list, and that’s made a huge difference in my work and to hearing impaired persons worldwide.
What other opportunities in this vein do you see today at Duke?
I think a huge opportunity has been seized with MEDx. The whole purpose of the program is to bring people together who have different types of expertise.
A key factor in this endeavor is the leadership at Duke. Larry Carin, the vice provost for research, Sally Kornbluth, the provost, and the deans of the medical and engineering schools have all been great and highly effective proponents of these interactions. So it’s not only the physical resources we have here at Duke, it’s the incredible intellectual resources that make surprising things happen. MEDx has spectacular leadership and that’s so important, and I think everyone will be very pleased with the program as it moves forward.
Any closing thoughts?
Duke is an open place. It is not a siloed or cloistered place. People are alert to opportunities and can recognize when something is unusual. And they act on it. For me, the wonderful interactions continue and there hasn’t been a time when I haven’t been invigorated by them.
In some places, engineering is engineering and medicine is medicine, and they don’t intersect. That’s forgoing a major opportunity. MEDx will help raise the profile of the intersection at Duke even farther, and that will no doubt help in garnering further deserved recognitions and additional funding from outside sources.
The track records of our medical school and engineering school are awe inspiring. To bring the schools together even more resolutely is such a good idea.