Discussing anecdotes, advances and breakthroughs, the directors of EPFL and CHUV met with us to talk about why they want their institutions to work closely together.
“We met in the early 1990s. Even back then, we discussed how doctors could benefit from working with engineers.”
The sun is finally shining at the Swiss Federal Institute of Technology in Lausanne (EPFL), after remaining in hiding for several long weeks. But no one is out basking in the sun on this campus. While students are nailed to their chairs to squeeze in some last-minute study time before their exams, the administrative and teaching staff whittle away at the standard mountain of paperwork that goes with the end of the academic year.
We have agreed to meet in the CE building where the management staff is. Patrick Aebischer greets us with the director of CHUV, Pierre-François Leyvraz. What immediately strikes the observer is how well the two men get on. They’ve known each other for more than 20 years and share the same viewpoint – and concerns – about the issues affecting health care. And their friendship began the very first time they met. “I remember it perfectly,” says Patrick Aebischer. “It was in the early 1990s, and I’d only recently returned from the United States. Pierre-François came to see me to talk about setting up his biomechanics lab at EPFL, and all the potential benefits medicine stood to gain from collaborating with the world of engineering.”
Dr. Leyvraz had sensed this far from the Lausanne University Hospital. Actually, it was thousands of kilometres away, in the middle of New York City. “When I saw the first Macintosh for sale at Macy’s in the early 1980s, I realised that from then on technology could transform medicine, that we were going to go from a static to a dynamic approach. When I came back to Switzerland, I immediately went to see the chief of my service. I wanted to meet the professors from EPFL to turn that idea into a reality. It was totally new, and I was lucky to have a boss who was won over. And gave me full freedom. He essentially just told me, ‘Figure it out’,”
“People won’t talk about healthy or sick, but about managing health”
the director of CHUV says with a smile. “I had to convince people and, more importantly, find a common language with the engineers. They weren’t enthusiastic about my idea at first, until I gave them a practical example, the challenge of developing knee implants.”
Bridging the gap
A little more than 30 years ago, seeing a doctor walk down Rue du Bugnon to go to any school other than the school of medicine was an extremely rare, if not extraordinary, sight. “These days, seeing biologists, physicians and engineers working together seems unquestionably obvious,” Patrick Aebischer says. “With the bridges we’ve built, science is no longer perceived as a set of blocks, but as a whole, an integrated system which requires creating
several profiles. That’s why I developed life sciences at EPFL. The idea was obviously not to compete with the Faculty of Biology and Medicine. Actually, biology has continued to attract people, while our department is the second most popular speciality here. Promoting this mix means we’re also promoting the development of innovative new projects. An engineer who spends six months at a clinical department won’t become a doctor, but will more clearly understand the health care environment and its needs.”
And neither of them is trying to say that all doctors should trade in their stethoscopes for 3D printers. “What’s most important is that everyone can talk to each other,” says Pierre-François Leyvraz. “That kind of open communication is vital for our university centre. A radiologist or orthopaedic doctor who wants to do research must have a dual profile, like Professors Meuli and Jolles (see p. 18 and 20). But that kind of background is rare. We simply want to facilitate the flow of people and knowledge in this new environment. Again, we’re only talking about 10% to 15% of the medical profession. We’ll always need practitioners. But even they will have to get used to new tools. They don’t need to know how it works, just how to use it!”
A new education paradigm
Artificial intelligence, personalised medicine, robotics, and so on. Behind all the thousands of promises are revolutions that are just beginning to happen. Who – doctor or computer – will be giving the diagnosis? Where will patient data go? “We’re only in the early stages,” says Patrick Aebischer. “Technology is everywhere. Telemedicine, for example, exists even in developing countries.” And where does the patient fit in? “When patients are surrounded by a growing number of increasingly specialised professionals, a new type of profile – let’s call them integrators – will be essential for monitoring patients throughout their course of care and maintaining an overview of the care given,” says Pierre-François Leyvraz. His counterpart from the Lausanne Institute of Technology agrees. “Health care providers, biologists, engineers and doctors will team up. But we haven’t yet defined the common denominator. Career changes will probably be more frequent. Doctors will no longer be able to do what’s common nowadays, simply finish their degree and move on.”
"A little more than 30 years ago, seeing a doctor walk down rue du Bugnon to go to any school other than the school of medicine was an extremely rare sight."
During his visit to the EPFL campus, Google CEO Eric Schmidt made no secret about the tech giant’s ambitions in health care. Huge resources are moving technology forward much faster than governments. Pierre-François Leyvraz and Patrick Aebischer believe we need to act fast. “Soon, we probably won’t be able to treat cancer without genomics,” says Pierre-François Leyvraz. “Techniques continue to advance faster than mindsets. How can we currently imagine what the social, legal and ethical issues will be when our progress in genomics will transform 750,000 citizens of the Canton of Vaud into 750,000 future patients? Or we might still be able to visit our great-great-grandparents who’ve been retired for 60 years and are still living off an inheritance. People won’t talk about healthy or sick, but about managing health.”
“We’ll always need teachers”
Lines have been blurred. And scientists have only been defining this world in the past few years, during which medicine has undergone more changes than it has in centuries. However, despite this progress, we should not give in to the temptation to completely rethink the way we train doctors. “Let it be clear. Technology will never be the easy road to the best career,” says Pierre-François Leyvraz. “I’ve always fought so that clinicians could become professors, because it is important not to spread oneself too thin. Surgeons should first remain surgeons. But they have to learn how to do their job in the best way possible. We need – and will always need – teachers, like César Roux was in his day.”
Throughout the discussion, the same words keep coming up: organisation into systems, need for an overview, etc. “The MOOCS we offer are wonderful knowledge integrators,” says Patrick Aebischer. “But for students to know where to go, we’ll have to define new types of teachers so that they can piece the entire image back together.”
As the interview comes to a close, we naturally asked both professors what field they would choose if they were to begin their studies in 2016. “I would become an organ player. It’s a passion I’ve had since I was a young kid,” the director of CHUV says jokingly. “Actually, I didn’t realise I wanted to become a doctor until my first internship. Today I’d make the same choice, but with a more solid base in biology.” And Patrick Aebischer is clear about his choice. “I’d be a student at EPFL in life sciences to approach medicine from a technological point of view. I didn’t have that revelation until late in life! However, I have to admit that my experience as a doctor is invaluable. Having so much responsibility every day, without ever being able to rest on your laurels was the best management school you can imagine!” Now more than ever, humility remains the safest bet for the future of medicine. ⁄
Patrick Aebischer completed his education in medicine and neuroscience in the 1980s in French-speaking Switzerland. After spending several years in the United States and then at CHUV, he became President of EPFL in March 2000.
Pierre-François Leyvraz has been the general director of CHUV since 2008. Prior to that, he headed the Orthopaedic Hospital in French-speaking Switzerland and was chief of the Service of Orthopaedic Surgery and Musculoskeletal Traumatology at the Orthopaedic Hospital and at CHUV.
Both men agree that Health Valley should not become arrogant or pretentious. “We can’t be the best at everything,” Patrick Aebischer says. “We don’t have the resources of giants like Harvard University to make huge investments. We have to focus on our strengths. Fortunately, our leading areas of expertise are concentrated in biology, medicine and technology within a small
radius, like in Zurich.”
Pierre-François Leyvraz is also optimistic about the future. “I’m amazed at the change in mindset
in the region over the past 30 years. The northern shore of Lake Geneva has found its potential and its pride. And that has attracted fresh talent. Additionally, with political stability and numerous investors, the region offers the ideal biotope!”