On physician scientists and the restructuring of university medicine
Professor Daniel C. Baumgart not only works at the interface of clinic and science himself, but also actively advocates for clinical research. At our meeting, he told us what he’s researching and what developments he would like to see for physician researchers in university medicine.
Professor Baumgart, you not only work at the clinic, but are also a very dedicated researcher: where does that interest stem from?
Most people in the field of health are exceptionally motivated to help others. As a physician, you not only draw on existing knowledge in books but also develop it further. For me, the pivotal experience came at the end of my studies, when I first got to know patients with chronic inflammatory bowel diseases. The suffering of these people, who were my age at the time, moved me very much. I realized that, using the available means, we can only alleviate their symptoms and that only research promises new hope. So, the difference between me and a pure natural scientist is that I only get excited if an application is developed from a discovery.
What do you focus on in your research?
My research group focuses on chronic inflammatory bowel diseases. This involves a group of diseases in which the immune system, already at a young age, develops an overreaction to microbes with which our body normally lives in symbiosis. The disease arises because a very fundamental principle, the ability to differentiate between what is foreign to the body and what is endogenous doesn’t always work optimally in all people. At the time it developed, the immune system couldn’t yet know what our environment would be like today – so it developed a clever mechanism to nevertheless be able to decide whether something is foreign or endogenous.
BIH Clinical Fellows
2015 – 2016
Charité – Universitätsmedizin Berlin
Professor of Gastroenterology and Hepatology, Head of the University of Alberta Hospital and the Municipal Hospitals in Edmonton, Alberta, Canada
2012 – 2017
Head of the Interdisciplinary Centre for Inflammatory Bowel Diseases, Charité – Universitätsmedizin Berlin
2004 – 2017
Senior Physician at the Medical Department, Division of Hepatology and Gastroenterology (including Metabolic Diseases), Charité – Universitätsmedizin Berlin
If it’s something foreign, an immune response must be initiated. If it’s microbes with which we live in symbiosis, that response shouldn’t occur. To do this, the immune system has developed what are called “toll-like receptors”, which can compare the characteristics of different molecules. One of the hypotheses about the development of chronic inflammatory bowel diseases is that the body’s own bacteria are wrongly identified as pathogens and a chronic inflammatory response therefore occurs.
What does this misidentification mean for the patients?
The patients are enormously restricted in their personal and professional development and take up many personal and financial resources of the health system. Up to now, the therapies have been unable to combat the cause. Even gene therapy wouldn’t be enough, as the disease also has an environment component. We now understand the genetics very well and, using new methods, we’re trying to uncover the 80 per cent of missing information about the development of the disease. For that purpose, I’ve built up a large research and treatment center with about 5,000 patients. Even by international standards, that’s a large cohort. We’re developing innovative therapies, starting from the new idea and taking it all the way to a far developed product. At the same time, I’ve built up a research group in which we focus on, for example, the misidentification processes in the immune system. One specific cell type thereby plays a role – the dendritic cell. Together with the colleagues of the German Rheumatism Research Center (DRFZ) we developed a method for isolating this rare cell population from human tissues. That was our unique selling point, so to speak.
What are you researching in the project funded by the Charité Foundation?
The further development of imaging techniques plays a major role in our research. These are important for detecting precursor stages of tumors in the case of bowel diseases. These often occur when the inflammatory processes get out of control. One area which is seeing extremely rapid development is ultrasound. Until recently, you could record moving images using ultrasound, but you couldn’t examine the elastic characteristics of tissue. Today, you can not only display anatomic structures and blood flow in an ultrasound image, but also capture mechanical characteristics – for example, show whether tissue is stiff or soft. This is important for objectively describing a disease process as well as for the success of the treatment. Together with a physicist, I’ve developed elastography further with the funding from the Charité Foundation. Normally with ultrasound, you place the sonic head on the stomach, and then waves are emitted by the sonic head and are directly measured by it. In the new method, a large bass speaker that emits mechanical waves stands under the examination couch. These go through the body and the sonic head registers the changes which arise in the tissues.
You’re not only being funded yourself but are also actively involved in initiating programs for combining clinical work and research at the Charité. What inspired you to do this?
My own career was decisively shaped by a research stay in the USA. I also completed part of my medical training there. I was impressed how well organized and effective the clinical training of doctors and the collegial interaction in the USA were. I brought these impressions of American health care and scientific training back to Germany. I wanted to introduce these Anglo-American training methods here as well. As an alumnus of the BMW Foundation Herbert Quandt, responsible collegial leadership and the new generation of young scientists are very dear to my heart. That’s why I initiated and co-designed the subsidized, innovative Clinician Scientist Concept for the integrated and structured scientific clinical training of physicians, which was awarded funding through the “Off the Beaten Track” program of the Volkswagen Foundation. Meanwhile, it’s been defined as a national model program for university medicine by the Germany Research Foundation (DFG), the German Federal Ministry of Education and Research (BMBF) and the German Council of Science and Humanities (WR). However, in Germany we also need perspectives for physicians who don’t take the classic academic or clinical career path. Not all physicians who come to the Charité want to do basic research. We also need hospital managers who bring with them entrepreneurial thinking in accordance with Johanna Quandt’s ideas. Other physicians may not be working in science at all, but may be particularly talented in teaching students clinical medicine.
How do you yourself divide the work?
In my contract, as is usual in Germany, it says “doctor, scientist and university professor”. There is no percentual division. The fact that we want physician researchers, but only create the basic conditions necessary for it at the beginning of one’s career is a social contradiction. As a senior physician, you’re actually involved in sick care full time, without structured research time. This puts us at an absolute competitive disadvantage compared to other countries. From 2017, I shall be taking over the directorship of the University Clinic at the University of Alberta in Canada. In my employment contract, there’s a percentual division of clinical, research and teaching work. I’d like to have that here too. The successful Clinician Scientist Program and the options for Clinical Fellows at the Charité already represent important steps in this direction. In addition, there should be an assurance that it won’t only involve limited periods of research: instead, long-term perspectives ought to be created for physician researchers. This would enable the Charité to play a clear pioneering role in restructuring university medicine.
2017/TO and MM