Don Ganem: Where is the medicine in biomedical research?

“Academic biomedical science has a much narrower bandwidth than it perceives. And most medicine lies outside that domain,” Don Ganem, MD, Global Head of Infectious Disease Research and VP of the Novartis Institutes for Biomedical Research, said on Tuesday, November 29 during his talk in QB3’s Quadrant industry speaker series.

Ganem is not bashing UCSF or other academic centers. He is pointing out a huge blind spot of academic science that needs to be addressed if translational research is to fulfill its promise in the clinic.

Ganem himself spent the first 30 years of his career as an academic physician-scientist at UCSF. He even directed the Biomedical Sciences graduate program here. But transitioning to a leadership role at Novartis last year broadened his perspective of how to effectively approach biomedical research.

At Novartis, Ganem has to consider aspects of biomedical science beyond the scope of target molecules and pathways in the lab. Compound formulation, toxicology, pharmacokinetics and other complications arise when developing compounds for use in living organisms. Many of these critical issues are left unstudied by academic scientists. As an example Ganem cites the fact that only five academic researchers study bacterial efflux and permeability issues, which account for most drug resistance. The entire field of microbiology is focused on the wrong problem if the goal is to develop a new generation of effective antibiotics, Ganem says.

Perhaps even more importantly, academic science is out of touch with the needs of the medical community. One of the first questions that Novartis considers in initiating a project is ‘what is the medical need?’ Ganem, who was an acting physician until December 2010, uses his experience in treating patients to identify these needs and appropriately direct projects to fill them.

This clinical perspective is strikingly absent from academia. Top-tier publications like Cell and Nature Medicine pride themselves on covering cutting-edge biomedical science, but not a single physician has served on either editorial board in the last 10 years, according to Ganem. How can a group of scientists determine what is cutting-edge in medicine without any input from the medical community? He calls these publications a “collection of party tricks, like how to turn a cell blue.”

Even in elite medical schools like UCSF, the study of clinical disease is an enrichment activity, rather than a core necessity, Ganem says. He found that his interest in clinical medicine was not shared by most of his colleagues at UCSF, who tended to phase out their clinical practice in favor of studying molecular mechanisms in the lab.

Attempts to blend medicine with academic research have fallen flat, Ganem says: “The UCSF Biomedical Science program has lapsed back into a fairly traditional graduate program.” He is disappointed in the narrow scope of coursework, despite the breadth of information availableGanem declares the fact that anyone can get a PhD in biomedical sciences without learning about immunology or medicine is a crime.

Without exposure to clinical medicine, biomedical researchers focuse on diseases with high visibility in the media and scientific publications, rather than the true medical needs of practitioners and patients. Ganem cites hospital acquired infections and kidney disease as examples that don’t get much press or attention in academia, but are common and often lethal problems in the clinic. A whole world of medicine exists outside of “big-ticket” items like cancer, and these needs are not being met by academic biomedical research, he says.