I believe medicine is an art not a science. WH Auden said it was the art of wooing nature not the science of healing. We practice an artisanal craft, having become attuned to the patient’s needs and woes, using expensive complex technology to be minimally invasive. The devices and technologies we use today have been created by less than 3% of our colleagues. I know this because when I was running the annual Society of Interventional Radiology (SIR) meeting in 2010 I took the membership of the society—6,000 doctors—and cross-referenced their names with patent filings at the US and European patent offices. Of this survey, 447 people held 2,500 patents or patent filings.
I repeated this work in 2020. I have longitudinal data on a cohort of inventors over time. We built social network maps of the inventors and identified those who invented during residency, fellowship and in their staff positions. Peak creativity for most interventional radiologists occurs during their fellowship. That’s when they perfect their skills, they work with mentors, they find their voice and culture as physicians, and they are challenged by impossible cases. It’s the impossible cases, which we do not decline to attempt to fix, that result in the creation of new devices and techniques.
The focus is traditionally on new device development, intellectual property, on royalties exits and initial public offerings (IPOs). That is misplaced. Let’s be clear that invention may be a technique not a device, and it may be shared by word of mouth and example for publication without there ever being any financial reward.
I interviewed many SIR inventors, and as in other fields, I found that the driving force for most was regret. People like us lie awake at night perseverating over bad outcomes and think of ways we could have done the procedure differently. Throughout medical history this is the case. Laser Greenfield developed his vena cava filter after a patient with multiple leg fractures had died from pulmonary embolism. He lamented about this in a bar with his friend who worked in the oil and gas industry. His friend told him of a filtering system used in pipes which Greenfield applied to the inferior vena cava. Harvey Cushing developed the intraoperative anaesthesia record after a patient he was sedating with chloroform died in his arms. Andreas Grüntzig, the inventor of the coronary angioplasty balloon, and many others were driven by grief from bad outcomes to develop better devices.
What became clear from analysis of the 2020 social network maps was that key institutions played a major role in enabling trainees to express their creativity through device development. These institutions are the classic ones, the inner-city hospitals of last resort, the major training programmes across the USA and Europe. Those inevitably are the locations or cultures that have developed the supports for this creativity. They can expedite and enable our trainees to succeed in new device development. The halos of those institutions’ open doors with industry that would be regrettably shut if you were training in a smaller, less globally relevant institution.
I developed my Murphy vertebroplasty needles while a fellow at the University of Geneva working with Professor Daniel Rufenacht. He told me I was going to be the vertebroplasty person. I didn’t want to do that but when I began to do those procedures I realised how inadequate the equipment was. Daniel opened the door for me with industry which gave me access to a catalogue of tools and devices. I was able to pick and choose and create better needles, better injectors and better cements for vertebroplasty. Great mentors create those opportunities. I try to do that for my trainees today. Some are incredibly talented. That talent is like the rare earth elements in the periodic table that creates the future of interventional radiology. Talented residents and fellows need to be nurtured, enabled and opportunities created for them. That is the critical part of our role as teachers.
Kieran Murphy is vice chair and vice chief of radiology and medical imaging at the University of Toronto, in Toronto, Canada.
