Doctor in the Class
Plastic surgeon Joseph Rosen wants to fix health care. Teaching engineering students is part of his plan.
By Lee Michaelides
Photographs by John Sherman
Joseph Rosen, Professor of Surgery at Dartmouth Medical School and Adjunct Professor of Engineering at Thayer, likes to say that to see into the future you have to look at the past. To understand where Joe Rosen is heading today let’s look back to where he was in 2001.
That was the year Rosen got his 15 minutes of fame in a really big way. A Harper’s profile had dubbed him “Dr. Daedalus” because he predicted that surgeons in the not-so distant future would be building wings for humans. If Twitter, Facebook, YouTube and blogs existed back then, the story would have gone viral instantly. As it was, the story made the rounds for weeks in old media such as the Washington Post and England’s Guardian. All the coverage caused no small amount of eye rolling, snickers, and condemnation by medical ethicists. A fellow plastic surgeon was quoted as saying Rosen should be “ashamed.”
Most people, it seems, missed Rosen’s real message: “Plastic surgeons solve problems that don’t have solutions.”
ROSEN WAS THEN AND STILL IS A PROVOCATIVE THINKER who has expanded the boundaries of his surgical specialty and medicine in general by looking at the world around him and asking “why.”
Why must a patient travel hundreds of miles to consult a specialist?
Why can’t a robot controlled by an off-site doctor do a surgical procedure?
Why can’t we reform health care?
These are not just rhetorical questions. Rosen seeks out the people who want and need to move beyond the confines of conventional wisdom: experts in defense, bio-terrorism, global health, disaster relief, high technology, and academic medicine. As a section director of Emerging Technologies Assessment at Dartmouth’s Institute for Security, Technology, and Society, as a member on the Bio-terrorism Working Group of the IEEE-USA Medical Technology Policy Committee, and as a consultant at the Institute for Defense Analysis in Washington, Rosen pulls together people with various pieces of critical technical, medical, and organizational knowledge. Thayer professor Peter Robbie ’69, who has worked with Rosen since the early 1970s, describes him as an “instigator and a connector.”
Rosen also is a teacher. Despite a full clinical schedule at Dartmouth-Hitchcock Medical Center (DHMC), he has been changing out of his scrubs and heading into Thayer classrooms ever since 1991. These days he co-teaches two courses with Robbie: ENGS 5: Healthcare and Biotechnology in the 21st Century and ENGS 13: Virtual Medicine and Cybercare. Both courses challenge engineering students to think big about what is possible in medicine today — and what might be possible tomorrow.
Rosen brings in his extensive network of experts to talk to students directly about problems and needs on the front lines of health care. Among recent guest lecturers: the director of the Laboratory of Tissue Engineering and Organ Fabrication at Massachusetts General Hospital, the prosthetic programs manager at Defense Advanced Research Projects Agency (DARPA), and the chief technology officer for SimQuest, a firm that’s developing training simulators for surgery and combat casualty care. “The goal of the classes is to stimulate student interest and thought by bringing in what is leading in the field — and then getting them hooked,” says Robbie.
Rosen sees his teaching at Thayer as a means of reaching students who will be in positions of influence in national health policy in the coming decades. He wants them to come up with the new ways of thinking. As he says on the ENGS 13 home page: Do you want a new health-care system? Invent one.
ROSEN HIMSELF IS A MEMBER OF A 10-MEMBER NATIONAL TEAM that is inventing a distributed network-based health-care system called Cybercare that would take the place of our current hospital-centered system.
“Why do we have hospitals?” asks Rosen while sitting in his office at DHMC. “Hospitals were an outgrowth of the Civil War,” he says, answering his own question. “New arms technologies inflicted massive casualties, and assembling medical teams near the battlefield to treat them became a necessity.”
The Cybercare team argues that times have changed. “In our model, medical care is delivered locally in neighborhoods and individual homes, using computer technologies like telemedicine, to link patients and primary care providers to tertiary medical providers,” the team states in the November 2008 issue of IEEE Engineering in Medicine and Biology Magazine. “This decentralization could reduce costs enough to provide all citizens with medical insurance coverage; it would benefit patients and providers; and as a dual use system, it would better protect the country’s resources and citizens in an event of biological terror or natural disasters.”
Technology is already decentralizing some aspects of health care. For example, some U.S. hospitals now employ doctors in India to read X-rays taken at night rather than waiting until their own radiologists arrive in the morning. Robotic surgery is also gaining a toehold. Two decades ago Rosen and virtual reality expert Jason Lanier pioneered the idea of telesurgery — a doctor in one location operating on a patient somewhere else, perhaps on a battlefield or in a village on the other side of the world. At the time the technology wasn’t powerful enough for actual surgery, but the concept itself was proven to be viable. Today doctors are using robotic systems for laparoscopic surgery, and robotics experts predict that in the not-too-distant future, “smart-stretchers” will enable a single person to run two operating rooms, a task that today requires a staff of six.
According to Rosen, Cybercare will reduce hospitalizations because an array of networked devices will electronically monitor a patient’s condition from home. If Cybercare were in place during a swine flu pandemic, for example, patients could be diagnosed in a local doctor’s office, where their entire medical histories are available online, and treated and monitored at home in a portable quarantine unit. In the Cybercare scenario, there would be far fewer hospitals than exist today, and they would only offer specialized services like transplants, oncology, and highly technical electronic scanning.
The inertia of the current health-care system, not the lack of technology, will be Cybercare’s biggest obstacle. If you think the current debate about public versus private health insurance is loud, imagine the outcry of special interests against a decentralized health-care system that proposes to close hospitals. Rosen and the rest of the Cybercare team recognize that the path to the future won’t be easy. That’s why they open their IEEE article by looking back and quoting Machiavelli:
“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order.”
— Lee Michaelides is the managing editor of Dartmouth Alumni Magazine and a contributing editor at Dartmouth Engineer.
For more photos, visit our Engineering in Medicine set on Flickr.