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Second, is the lack of a mutual professional trust. Because their training involves such emphasis on medical responsibility for the patient, the medical profession is unsually conservative in accepting the intervention of other professions into its operations. Also, the engineer is trained to place great confidence in the reliability of nature's laws, and to distrust the intuitive human opinions characteristic of the uncertain situations of clinical medicine.

Third is the difficulty that comes from a dichotomy within the medical profession itself—the difference in interests between medical research and clinical medicine. In dealing with medical research, the engineer can assist in the design of experiments, biological subsystem models, and in providing instrumentation. In clinical medicine, the primary interests are in systems for patient care, in diagnostic data analysis, and in artificial patient aids. The medical researcher's orientation toward science (as contrasted with the clinician's orientation to the patient) makes it somewhat easier for the engineer to deal with the researcher. The medical scientist and researcher of today is sophisticated, aggressive, and is already using all manner of technical aid and talent. However, the clinically oriented medical investigators who direct their work to the solution of well-recognized problems (auto crash injuries, leukemia, heart failure and so on) need engineering and applied science collaboration to a degree which is not generally available to them today.

Fourth, is the lack of strong Government encouragement for the involvement of the engineer in health problems. For example, the National Institutes of Health will generally not approve a project unless a medical researcher or clinician is a principal or coprincipal investigator. Further, the present review committees are so heavily weighted toward basic medicíne that an engineering-oriented project is not apt to receive much status.

Fifth, is the inadequacy of facilities and services in both medical and engineering institutions for undertaking new and large programs. In most medical schools, for example, physiological and medical laboratories are already overloaded with medical school and clinical work. A similar situation exists in most engineering schools. In addition to facilities for research, a corresponding shortage of supporting technicians also exists.


Assuming these difficulties, what should be done to achieve maximum application of technology to medicine? I suggest that the first step is the establishment of such interaction as a goal of national importance. In simplest terms, this means providing funds for its accomplishment commensurate with its potential national benefits.

The proper administration of such a program can, of course, be vital to its success. Because acceptance by the medical profession is essential, the program may produce public benefits most quickly if it were placed under the cognizance of the Department of Health, Education, and Welfare. Further, if the goal warrants support and emphasis it should be directed by a “man with a mission”—perhaps a deputy assistant secretary for engineering-medicine.

Within HEW, the National Institutes of Health are probably most qualified to insure integration with, and acceptance by, the medical profession of engineering-medicine projects.


In view of the potential importance of this field, I would suggest that there be created a National Institute of Engineering Medicine under the cognizance of NIH. Such an institute would help insure equal representation by engineers and applied scientists with life scientists and clinicians in the allocation of funds. The principle of parallel and equal participation by engineering and medicine must be publicly emphasized. Without such a recognized role, the most creative engineers and applied scientists will not be motivated to leave their present fields and work in engineering-medicine.

In terms of a specific operating approach, I suggest the large institutional grant. Such grants should be provided to those universities which have existing major medical and engineering schools prepared to commit themselves to a joint administration of the grant. Under such terms, responsibility for the achievement of the general program goals can be decentralized to the campus, and to the university laboratories where the work will be accomplished. Such an allocation of responsibility to the individual university would achieve the necessary managerial relationships between responsibility, authority, and knowledge of day-to-day performance. By permitting local selection and direction of the individual investigator's activities, it should be possible to produce on each campus a cohesive task force approach from the many specialist groups in both the engineering and medical schools.

A further advantage of the institutional grant would be the assumption by a professional administrative staff of the managerial load of fulfilling Government regulations. The present administrative requirements of financial accountability, operational forms and reports have grown to be a serious burden on the time of individual researchers. An institutional operation on the campus should result in an increase of research productivity of the professional personnel.

An additional advantage of such an institutional grant to a university would lie in the improved selection of personnel responsible for major projects. It is very difficult to determine from a written proposal the ability of individuals to actually perform the task in a sophisticated manner. Local visibility and knowledge can generally pierce the artificial image created by a good paper presentation. A secondary benefit would be the stimulation of young talented researchers who cannot yet command a grant by virtue of their accomplishments and prestige. The support of such new talent must be an essential part of any long-range program, and the institutional grant should provide fellowships, both predoctoral and postdoctoral, for engineers and applied scientists to work in medicine, and vice versa.

The institutional grant although renewed annually, should have at least a 5-year duration to permit reasonable project planning and task completion. The grant funds should cover the total program costs, including costs of the principal investigators, staff assistance, appropriate portions of expanded facilities, all overhead costs, and the cost of pre- and post-doctoral fellowships. Except for the costs allocable to the teaching function, the university should not be required to cost share. In a research and development program as heavily weighted toward public service as this would be, the university should not be required to be a financial partner of the Government.

The size of an institutional grant in engineering medicine would be determined not only by national benefit but also by the ability of the receiving university to efficiently use and administer the grant.

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A university with large engineering and medical schools could readily handle a starting grant of about $2 million to initiate a program in engineering medicine and could subsequently operate at a level of about $5 million per year with high productivity. Such a sum would permit sufficient activity in engineering medicine for group stimulation by interested coworkers, and for required supporting services. At the same time, it is sufficiently small to permit the involvement of the regular faculty of the university without disturbing normal operations.

I suggest that the usual NIH practice of channeling institutional grants through medical schools should not be followed in this program. In order to insure a coequal role for engineers and applied scientists in this program, such institutional grants should be given to a joint project administration of both the engineering and medical schools. This will establish the “joint contractor” approach to the engineering medicine program rather than the usual “prime-sub” relationship. Such equal status for technology will be essential for the program's

May I summarize my key points. First, the application of modern engineering techniques to medicine is essential to meet our long-term public health obligations. Second, the program can be undertaken by the universities as a combined task of their engineering and medical schools. Third, the program's values are evident, the cost is modest in relation to the need, and, I respectfully suggest, the time to act is

I appreciate this opportunity to appear before you. Thank you for your interest.

Senator HARRIS. Thank you for a very helpful paper and one which makes very specific points and recommendations.

What is being done, do you think, in medical schools and engineering schools insofar as thinking along these lines?

Dr. STARR. There is a large body of activity generally dispersed throughout the country and dispersed in the medical and engineering schools. But most of it is in small projects and most of it does not form a cohesive whole. It does not provide what I would call the "task force” approach, that furnishes the answers which can be applied throughout the country in medical practice.

The biggest emphasis has not been on clinical medicine. It has been on medical research. I am sure the National Institutes of Health has a fairly extensive program, if one were to add it all up. Yet, in the specific area of engineering technology, if one looks at the budget which they have submitted to Congress, engineering as such, receives very limited treatment.

I have a copy here of the recognition of that particular area, if I can find supporting papers.

In the appendix to the budget for fiscal year 1968, page 446, there is a discussion of the National Institutes of Health program, and on page 447, there is an item called "Engineering Development.” It says:

Funds for this program, new in 1967, will be used to plan for a centralized medical engineering development component. This effort will be directed toward applying engineering and technological innovation to biomedical problems in such areas as the development of artificial organs, synthetic materials, and the automation of clinical and laboratory measurements.

These funds, I am sure, are only to initiate the planning of such a program; $348,000 is itemized for 1967 and an equivalent sum for

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1968. These funds presumably could lead to a National Institute of Engineering Medicine such as I have suggested. The absence, however, of a cohesive, planned attack on medical problems by engineering is evident by the fact that the National Institutes of Health itself wishes to institute the planning of such a program.

Senator HARRIS. Right. I appreciate very much that suggestion, because it is an area in which we have had a good deal of interest, starting with our conference in Oklahoma last October. As I have said earlier in these hearings, I suppose the word that we heard more in that conference than any other was "interdisciplinary."

Dr. STARR. Yes.

Senator HARRIS. I said earlier, too, that it seems to me this may be the “interdisciplinary age.” We seem to be returning to the days of Thomas Jefferson, or even earlier to the days of Leonardo da Vinci. It is almost impossible to segregate one body of knowledge or one discipline without touching upon so many others. I think that is true in the social sciences as well as in the bioengineering field.

I think you have made some very good suggestions about how we might solve one problem: that is, the low prestige of the engineering half of bioengineering. I think there has been some resistance to date which has resulted in lower status that engineers are afforded on projects with physicians and other basic scientists. I think that this subcommittee will want to consider very seriously including as part of our recommendations in our report the very specific suggestion you have made, and also, the documentation of the areas of progress in this field, which, I think, is very good. We have been admonished by at least one witness that one of our responsibilities might be to comnence an inventory of needs in the whole biomedical field. We have made a start, and I think you have certainly assisted us in your statement in the field of bioengineering.

I do not really have any further questions. I will say that I am pleased by your testimony, which I think will be very helpful.

Do you have anything you want to add?

Dr. Starr. No, sir. I think I have said my piece in my testimony. I will be happy to answer any questions at any time, but I think I have said what I need to say now.

Senator HARRIS. What is happening in your own engineering college in this field?

Dr. STARR. Because of these needs we have specifically started a study between our medical school and our engineering school, and a brain institute which we have on the campus, to set up a coordinated program which will try to produce a much greater impact of engineering in medicine. The key element is one I have emphasized ; that is, the one of coequal recognition. Very good engineers and applied scientists want and need the same recognition that good clinical and medical researchers need. They have important programs of their own and they are not going to give up these programs if they are good unless they feel something else is very important and recognized.

Senator HARRIS. I think you have made some very good points in the first part of your statement about the differences in outlook which do not have anything to do with the good intentions of the people

involved, but nevertheless make it difficult for them to see things on a basis which will allow for

Dr. STARR. In answer to your question we are trying on our campus to set up a joint program and joint effort which will give the engineers and the applied scientists this kind of recognition in the medical school itself.

Senator HARRIS. How did you come personally to make such an inventory of needs in biomedical engineering? How did you come to be interested in such a study?

Dr. STARR. We had started this study before your committee request came to me. I had felt that this was important in the discussions that I have been privy to in the National Academy of Engineering.

This area has been brought up by many thoughtful people as an area where an engineer should play a national role. So when your committee request came in, it gave me an opportunity to focus the information I had. In that sense, it was very helpful and very constructive to me.

Senator HARRIS. We, of course, had known of your general background and interest, and that is why we wanted to hear what you had to say. I can say that it is very helpful to us to have such concrete recommendations upon which to base our work in this subcommittee.

Dr. STARR. Thank you.
Senator HARRIS. Thank you very much.
The subcommittee will stand in recess until 10 a.m. tomorrow.

(Whereupon, at 4:35 p.m., the subcommittee recessed to reconvene at 10 a.m., Friday, March 2, 1967.)

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