Earlier this year International Congress XVIII in Phoenix, Arizona started with a full day’s programme on angiogenesis, myogenesis and tissue engineering. Here is an overview of the keynote on the origins of innovations by the great surgical inventor, Thomas J. Fogarty. Tom Fogarty focused on identifying the translational pathways to success. His opening insight was that inventors should not think in terms of “bench to bedside” but “bedside to bench to bedside”. Basically an inventor needs to see the problems first before designing the solutions. Fogarty commented that the progress made in the last 40 years has exceeded what has been achieved in the last 200 years. He emphasized the challenge of change that clinicians face today: “Every seven years a major technology is eroded. You get trained and things change.” He cited the example of coronary artery bypass surgery where procedure volumes have declined by 40%. He cited the words of Charles Kettering that an inventor must seek to challenge the status quo: “If you have always done it that way, it is probably wrong.”
Fogarty then pointed out the difference between science and engineering. “Science is exploration of theory to prove/disprove.” The words he used to describe science were “theory, the truth, experiment, abstract and global”. “Engineering is all about innovation, technology and patients. It is the application of science for the benefit of the patient.” To describe engineering he used words including “application, utility, investigation, real, individual”. For Tom Fogarty, the inventor needs above all to imagine a better way of doing things. He quoted Albert Einstein who said: “Imagination is more important than knowledge”. He outlined how imagination differs from knowledge. “Imagination requires that you conceptualise what does not exist and knowledge requires recall of what is known.”
Fogarty then outlined the development pathway which requires funding to get from concept to bench test and a process of iteration to get through regulatory hurdles and get to the stage of a clinical implant.
Funding required for steps 1-6
1. Concept
2. Protection
3. Model
4. Engineer
5. Prototype
6. Bench test
Iteration required for steps 7-12
7. R&R (regulatory and reimbursement)
8. Cadaver test
9. Durability test
10. Animal test
11. Clinical implant
12. Outcomes analysis
Fogarty had his audience in stitches when he highlighted the antagonism of many physician colleagues towards industry. He termed this the ‘medical industrial complex’ – “Medicine is a business concerned with prevention, maintenance, and the treatment of disease states.”
According to Fogarty you need many skills to develop a new idea. “Engineers are important to development, also physicians, buyers, entrepreneurs, investors, industry, Government, institutions, patients and inventors.”
He finished by giving some tips as a successful inventor and innovator:
1. Look at the problem and see the possibilities
2. Look not as it is, but as it should be
3. Count change as a natural ally and look at a way to take advantage of change
4. See failure as part of the process of success
5. Avoid committeeism – “The medical profession is killing itself with committeeism. The ideal committee is a committee of three, two should be absent. A committee is picked from the unfit to do the unnecessary.”
6. Be willing to be an outlier and unconventional.
Tom Fogarty signed off by highlighting the importance of individualism rather than process in innovation. “For success you need a group of individuals, led by a single individual, all with a common goal and functioning as a single unit.” He called on his audience to “think young and consider the impossible, irrespective of age.”
