I think tissue regeneration, and some of the work going on in spinal cord injury, for example – is suggesting that certainly animals, and hopefully someday people, who have had long-standing injuries may be able to get partial restoration of spinal cord function. I think that’s a true game-changer. I mean, until now, the idea has been that if somebody was paralyzed through a spinal cord injury, it was for life.
In fact, the work in tissue regeneration as a whole is a game-changer. Imagine that for somebody who has had a liver destroyed – because they had the misfortune of ingesting a toxin, for example; it’s not just about alcohol and hepatitis – you might be able to regenerate their liver and transplant it back into them. Or that we might be able to take a kidney from a pig, humanize it, and transplant it into somebody and take them off dialysis. I think these kinds of bioartificial approaches are going to be very, very important.
Biomedical engineer Jenni Popp with the National Institute of Standards and Technology’s prototype bioreactor for tissue engineering. The bioreactor both stimulates and evaluates engineered tissue as it grows. Tissue regeneration and bioartificial techniques hold great promise for future patients. Photo by Burrus/National Institute of Standards and Technology
In information science and connected health, we are moving from a world of Internet-connected computers to a network of cell phones and computers – and ultimately to a network that includes information from devices such as thermostats and meters. I think we’re going to be connected to that Internet. To some degree, we are now; information technology allows us to perform point-of-care research. You may have a pacemaker that allows you to examine what’s going on from a distance, or a device that helps you remember to take your medications. But I believe that the use of information science to help monitor our health and help us change our habits ourselves is going to be very, very important. The idea that an Internet-enabled refrigerator or cell phone app may be able to tell me: “Tim, you’re coming up on your 2,200 calorie limit today – you’ll want to maybe stop eating.” I think information science and connected health can make lives easier, as we grow older, so that people spend less time in nursing homes and more time in their own homes.
We pay attention to our bottom line, because we have to; Congress appropriates our money. But our health systems research is not aimed at improving the bottom line. It’s aimed at improving veteran health.
And finally, I think genomics is going to continue to expand and to change everything. I think it’s a fair statement that a very high fraction of new cancer treatments are coming as a result of understanding cancer genetics. I think that’s going to move more and more out of the realm of cancer – it’s going to move into mental health, into general internal medicine. And then when you bring that back together again with informatics solutions – because there is so much known, but none of us can know it all; I can’t look at a 3,000- or 3 million-base pair sequence and make heads or tails of it by myself. But the computer can do that. It can tell me what to do about it. And it will help us deliver better medical care … It will probably say something like, “Based on what we know about this patient and their genetic material, the treatment for the condition is drug action at the rate of Y milligrams, given three times a day with meals.” And I think that’s going to be truly amazing. We’re going to play a big role in that, because of the importance of informatics in our research program, but also in our clinical care delivery program.
It sounds as if you believe there are some things the VA health research program, because of its size and the strong connections between research and clinical care, is going to be better at than other institutions.
Yes. VA’s health systems research plays a role in helping VA be truly a learning health care system, and a laboratory for innovation that can improve the care of veterans, hopefully lead to cures for veterans, and also show others what to do. We have the opportunity to measure outcomes and make a difference.
For example, we look at not just what VA does, but what everybody has done, and ask: How much difference do wait times make? What’s going to make a difference to a clinical outcome? We all know the answer, honestly, is that for the most part, we don’t know. But having asked the question now, we’re in a position to examine the data this health care system gathers together every single day and, first of all, validate that we actually know what those wait times are. And then to look for outcomes so that we can figure out whether [we] need to make it possible for every veteran, for every purpose, to be able to walk in as you might walk into a Minute Clinic and be seen and treated immediately – which is pretty expensive. Or might it be OK for a veteran who says they’ve got issues 1, 2, and 3 to wait a week, or a month, or two months in order to see a physician?
We’re also well positioned to investigate the efficacy of connected care and telemedicine. It may be possible for a veteran to see that physician not by walking into a clinic but by essentially Skyping on their computer. Maybe as a result of this Internet of devices, they could measure blood pressure and temperature at home, send that data in and describe their conditions. And then the physician or maybe a nurse practitioner can say either: “Well, you really need to come in and do some more tests,” or “take two aspirin and if you don’t feel better in the morning, give us another call.” To a greater and greater extent, we are investing in the issue of how to move that care out of the hospital and into a person’s home. Nobody I know of – including myself – loves being a hospital patient. And so our health systems research is aimed at getting people good care, keeping them out of hospitals, treating them wherever they may be. I think this is a very important part of what we do.
Finally, I think the commitment the VA and VA research have to optimizing the health care system through the use of good science is unique, because we don’t optimize that health care system to make money. We optimize the health care system to optimize health outcomes. Every hospital system does optimization work, but they’re focusing on a bottom line: reimbursement from insurance and Medicare. We pay attention to our bottom line, because we have to; Congress appropriates our money. But our health systems research is not aimed at improving the bottom line. It’s aimed at improving veteran health. And I think that’s a unique contribution that we make, and it allows us a different approach than that of anybody else in this arena.
This interview was first published in The Year in Veterans Affairs & Military Medicine: 2014-2015 Edition.