President, Board of Directors Medecins Sans Frontieres U.S.A./
Doctors Without Borders
I've been a nurse for more than 30 years, and I've worked with Medecins Sans Frontieres for nearly 10 of those years. We go into the most desperate situations to provide medical relief. We can respond to just about any problem anywhere in the world within 24 hours.
For a long time, MSF, like many medical programs, had a straightforward mission: Go in, diagnose, and cure. And of course we found ourselves in situations where we couldn't "cure," because the population didn't have access to medicines, or we couldn't get access to them, or the situation was simply too overwhelming. We asked, "How do people cope with ongoing hopelessness and helplessness?" So in the early 1990s, MSF made a commitment to making mental health a strong component of our comprehensive health-care program. Usually, that comes down to building, or rebuilding, a sense of community.
Angola in 2001 was different from most missions. We couldn't start a full mental-health program because the physical and medical needs were too great. But we brought people together. We were ready to listen, not talk. At a feeding center, we played with children, drawing pictures in the dirt. There was a place for mothers to gather. Many of them didn't want to talk. Their situations were too painful. So we just sat together, pounding maize.
Back home, though, I spoke up. People don't know enough about the plight of those caught in the 27-year Angolan civil war. And health is inextricably linked to human rights. In accepting his speech for the 1999 Nobel Peace Prize, James Orbinski, then president of MSF, said it best: "We do not know if words can save lives, but we do know that silence can kill."
Founder and chief scientific officer, Nephros Therapeutics
Professor of internal medicine, University of Michigan Medical School
Ann Arbor, Michigan
They say that luck only works if you have a prepared and open mind. Back in 1992, my lab director called and said, "The cells are doing funny things. They're clumping together." We weren't looking for that. We were just looking at how cells behave in various conditions based on a clinical observation that in survivors of acute kidney failure, the kidney could heal itself. We figured that if it could heal itself, then there must be cells that had the ability to repair themselves back to full function.
It turns out the clumping meant that the cells could be regenerative. At the time, the notion that we could proliferate stem cells from an adult kidney, or any other organ for that matter, was hardly the conventional wisdom that it is today. Nobody believed us.
That day in the lab, we could have thrown out the experiment. Clumping wasn't part of our hypothesis. Instead, we investigated and hit on something big. Some of the most dramatic insights come from experiments that do not turn out as predicted.
We've been building a bio-artificial kidney for nearly a decade now. The prototype for treating acute renal failure is a foot-long cartridge filled with a billion human kidney cells. Inside, 5,000 tiny fibers house the cells, which supply vital hormones and enzymes that a dialysis machine couldn't. In kidney-replacement therapy today, the dialysis cartridges are just synthetic membranes. Ours are living. They grow. They can repair themselves.
Every step of the way, we've faced an uphill proof of concept. We went through 50 investor groups before we found two or three that were willing to bet on us. We stayed focused because we had to. It took us just $3 million to take our concept from petri dish to the first patient. That first patient, along with nine others, was treated about two years ago in a safety trial. Of the group, nine were predicted to die. Four did. If the technology is successful, it could save hundreds of thousands of patients.
President and CEO
Saving lives requires a system. The problem is not that our health-care system is broken and we need to fix it. The problem is we've never had a system.
Medicine is more complex than ever. And complexity requires systems—industrial-engineering techniques, project management, continuous improvement, all of the stuff that's done in every other industry in this country. Systems require teams. Teams require collaboration. And all of that can't happen without a common goal. Shouldn't that goal be the best patient care possible?
At the Mayo Clinic, we have a patient-centered focus. And we have a team approach to care. It's okay if a doctor isn't an expert in every disease, but we expect all of our doctors to know who are the physicians they can call in to give the patient the best advice. As a country, we need to foster more of that kind of collaboration.
One thing we can do is create a transparent environment for delivery of care. It is ridiculous that we can't have an environment where doctors and nurses, drug companies, and patients are encouraged to report misses, near misses, and accidents. And a serious commitment to transparency means tort reform of some kind. In Florida, the malpractice environment is so terrible that physicians are reluctant to write anything down when something goes wrong. Don't document. Don't pass it off. How completely backward.
I am positive that there are hundreds of hospitals around the nation making the same mistakes every day. They don't know they're all making the same mistakes, and they're not learning from one another. Internally, when there's a mistake, I can raise a fuss and do something about it. But outside of the Mayo Clinic, there isn't any mechanism for me to take action and prevent it from happening elsewhere. So basically, the business of saving lives isn't. The whole nonsystem system is killing people.
Safety engineer, Vehicle Structure and Safety Integration Center
General Motors Corp.
Seat belts, they say, save lives. And they do. It's still the single most critical message in vehicle safety. But we can save more lives if we can improve how people buckle up, and especially how kids are buckled in.
In the United States, four out of five child safety seats are used incorrectly. So one of the projects I've been working on is with an international consortium of car companies, government officials, and safety advocates on what's called LATCH (Lower Anchors and Tethers for Children). It's the new standardized child-restraint system in all new vehicles. Note the word standardized. The idea is, a harried parent can look for the same parts every time. Everything operates the same way. No more confusion.
Now did we agree on how to achieve that goal? Not on your life. Everybody had different concerns, and those concerns affected the design. In the United States, people aren't going to take an hour to put a child seat in the car if they can help it, so if it's easier to use, they're more likely to use it. In other countries, time isn't as much of an issue. Many Europeans, particularly the Germans, have laws that not only require passengers to wear seat belts but also kids to ride in the backseat until the age of 12. GM advocates that children sit in the rear seat, but in the United States, it doesn't always happen. Oftentimes, kids here ride in the front seat, so we had to take that into consideration. Meanwhile, some countries didn't even want to talk about kids who aren't properly restrained. In the end, we had two types of child seats, and we came up with a system that could work with both.
For 15 years, I've reviewed the performance of every GM vehicle sold in North America to ensure it meets crash-safety standards. That's a lot of cars. With the new child-restraint system, I'm helping to make all cars safer.
Professor of biology, MIT
Founding director, The Broad Institute
How do you save lives? You save lives through understanding. And you get understanding through the big picture. For the first time, it's becoming possible in the biological sciences to take the big picture—to see all of the components of the cell. Suddenly, biology and the business of saving lives are becoming computational.
In the 20th century, most work on disease required good luck. Today, we're making the fight against disease rational, giving medicine its periodic table of elements. If there are only 30,000 genes in the genome and something is wrong, then it has to be wrong with one of those 30,000 genes.
I don't like luck. I like a rational guarantee that if we work hard enough, we can find the cause of a disease. Now we're working on the systematic characterization of all the common variation in the human population. It turns out that there are only 10 million common genetic variants in the human population. Six years ago, we didn't know any of them. As of today, we know 5 million.
But this isn't just about the knowledge we produce. It's about the people we produce. Shaping the next generation of scientists is the greatest amplifier. David Altshuler came to MIT as a postdoc when the conventional wisdom was to focus on some gene—find one narrow problem and beat it to death. Instead, David focused on all genetic variation in the human genome. When I say we now have 5 million of the 10 million variants, it's largely due to projects that he launched. The notion that a postdoc could take on something like that is conceivable if you don't tell him it's not.
Believing in a mission is half of making it succeed. So it's the leader's obligation to believe in the mission, and to help everyone else overcome all doubts. I might say, "That's so unrealistic." But no progress is made without being unrealistic.
A version of this article appeared in the Table of Contents - April 2004 issue of Fast Company magazine.