Strategies for University Hospitals
How do you build a successful health care science cluster in Europe?
Europe, with its often rigorous divides between research institutes and university hospitals, has fallen a long way behind power houses such as MIT/Harvard/Mass General in the generation of applied medical science. So how do you build a successful healthcare science cluster in Europe? If anyone can answer that question it is Professor Nikolaus Rajewsky. The 54-year old, jean-jacketed founder of the Berlin Institute for Medical Systems Biology (BIMSB) and of the Cell Hospital, his aim is to build somewhere in Berlin which brings together biochemists, data scientists, medical doctors and venture capitalists to find out how single cell research can transform medicine.
In theory, European university hospitals are twinned with research institutes. New science clusters with billions in revenue and budget have sprung up in London, Barcelona and Paris. Yet, in practice, numerous sources tell us that the physician in the university hospital, who is focused on the care of complex patients, is often cut off from the researcher conducting basic science in the institute. So there is often remarkably little applied innovation. And the clusters are made of sovereign bodies that are more like a diverse League of Nations than a European Union.
At the same time, potential partners such as venture capitalists, pharma and medtech are often viewed with suspicion, particularly in mainland Europe. Meanwhile, recruiting and retaining scarce data scientists in healthcare is problematic for just about every organisation. Add a plethora of competing research institutes in a city like Berlin and you can see just how fragmented life can become.
It is not helped by administrative silos. For instance, Rajewsky points out that the training of students in Berlin is often limited solely to the organisation to which they belong.
For Rajewsky, the answer is to be an enabler who breaks down these barriers, to promote a vision of what is possible and thus creates an ecosystem that brings these different groups together. Ultimately, this is based on a vision of how civil society can better function for the good of all.
So how do you do that? Here we look at the strategies he has followed.
First you need a cause. Rajewsky is a tireless advocate for single cell research. The theory is that only by understanding what is happening at the cellular level can we build preventative strategies which should enable doctors to intervene before patients even exhibit any symptoms. Or as he puts it: “Thanks to these technologies, we can analyse every single cell in a tissue for the very first time and understand when and why it gets sick.” He is convinced that in the new decade or two this will lead to improved health outcomes for all. To succeed, this calls for biochemists, physicians, data scientists to come together.
Second, you set up an institute and generate the funding. Here Rajewsky founded in 2008 a new Berlin institute, BIMSB, to study single cell biology. This is part of the Max Delbrück Center for Molecular Medicine (MDC).
Then he did two things. “Working with European colleagues, we created a European consortium called Lifetime with 150 institutions and hundreds of scientists. And then we wrote a paper: LifeTime and improving European healthcare through cell-based interceptive medicine.”
Authored by 49 prominent scientists this was published in Nature in 2019. He describes this (modestly) as “Something of an accomplishment because all the life scientists came together and agreed on the approach.” In other words, this created a manifesto for the future, with a vision of what was needed and what was possible
The second thing was, at a Berlin level, to create a new, integrated model – the Cell Hospital where scientists, data scientists and physicians can work together on real world patients.
Announced in 2020, this brings together the Berlin Institute of Health (BIH), BIMSB and the Charité University Hospital, in a joint initiative with the goal to use innovative single cell technologies to answer clinical research questions. The Cell Hospital also hopes to cooperate with private partners and other institutions in Berlin and Germany, including the Helmholtz Health Centres and the German Centres for Health Research (DZGs), as well as to create an international network.
He says it was vital that the Cell Hospital was a new body. “The art was to speak to the institutes and bring them together. To avoid rivalry it had to be a new body. It wouldn’t have worked if it had simply been under the Charité hospital administration or if it had been, say, a data science institute. What we need is a common ground where we can all come together.”
He sees the role of Cell Hospital as a bridge between biochemists, physicians and data experts. “It is super important to do this.” He says, partly because of the Lifetime venture, the Cell Hospital has attracted 26 outstanding assistant professors whose role is to start applying biochemistry science, machine learning and Crispr directly to medical problems.
This is done by creating what he calls “a new group leader model”, a marriage between assistant professors in basic science and individual clinical directors in the hospital. “The physicians in the hospital could see the quality of researchers and so they are eager to work with them. We have a much closer relationship than is normal.”
It is, he thinks, very important that the Cell Hospital is an actual place, with an identity and a face of its own. “Networking can achieve something, but people need to feel there is a place or an organisation to which they belong and which is their home where they go to collaborate.” This he says is also important for innovation partners such as venture capitalists or tech companies. “It is a space where IP can be shared.”
And it is also important to have a place where the general public can come and learn more.
To enable commercial engagement, the Cell Hospital has gone out and asked potential commercial partners for proposals on projects they would like to back. “We’ve just had our first open call and we got 38 proposals, all with a potential corporate partner involved. These have now been reviewed by 40 international experts and they felt that more than half were viable and should be funded. They were really impressed by the quality.”
The next step is to apply to the ministry for state funding for some of these ventures as well as external funding. “The long-term goal is to create a community where venture capitalists and other investors can see that something is cooking and see how they can get involved.”
He is interesting on the malaise Germany has faced. He thinks this goes beyond the rigid siloes that exist between institutes, university hospitals and general hospitals.
“At one level this goes back to a lack of civic society. This and a lot of science talent was wiped out by the catastrophe of the Third Reich and then the east-west divide. These things are still there in the suspicion so many Germans have of capitalist models in pharma and medtech. Research funding in Germany tends to be from the taxpayer. The disadvantage is that it is difficult to move fast and to make decisions which are decoupled from political decisions.”
Another reaction to the past in West Germany was to divide power leading to a highly complex world which further slows decision-making.
He also sees a need to challenge wider German society on its distrust of science. “Only 75% of the population is fully vaccinated. That is considerably lower than surrounding countries.”
Much, he thinks, can be learnt from the USA. He spent nearly a decade on the East Coast, where venture capital is an intrinsic part of the model. But he says that US culture is now spinning out in Europe with a generational shift in thinking among research scientists. “A decade or two decades ago, they were often only interested in scientific papers and had little desire to become involved in debates about patents or intellectual property. That has now changed totally. The new generation we are recruiting ask about these things at interview. Their heroes are not scientists, but tech entrepreneurs like Steve Jobs!”
One of the major strengths of the Boston hub was the development some 20 years ago of independent PhD programmes that allowed physicians after medical training to do a PhD in basic sciences. This means Boston has many individuals who can manage everything from the science bench to the patient bedside. Such animals are much rarer in Europe. Rajewsky says Germany now has “a pretty strong clinician scientist programme” but agrees that independent PhDs remain “much less common” than in the States.
He is being watched from the other side of the pond. Prof Philip Sharp of MIT who sits on the advisory board of the Cell Hospital thinks that what he has achieved in such a short time is ”nothing short of miraculous”.
So what lessons can we draw?
Rajewsky has followed a series of separate and intentional strategies:
He has been able to clearly and simply describe a cause which politicians, payors and policymakers can get behind. This has led to a stream of funding.
From the bottom up, he has created new institutes which he defines as places and homes for research.
He has been able to build a Europe-wide association and create a common cause there as well.
All this created an excitement and awareness of possibilities that saw physicians at Charité really engage with the science researchers.
And, from the top down, he has engaged with the outside world: investors, pharma and medtech and brought their ideas on projects to the new institution.
So how does the man himself think it is going?
He says: “There is a feeling in Berlin of these different worlds coming together and moving together. The development of an exciting long-term friendship. People in Europe and even in the USA are noticing that something is really happening in Berlin. It is happening at a speed that I have not experienced in my time anywhere.”
But then he catches himself and adds: “I just don’t want to say things that may sound super-boosterish.”
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
