The Future of Healthcare is…Engineering

In the view of Zahi A. Fayad, PhD, a wearable device that continuously monitors a person’s biomarkers should be embedded for life. Fayad, director of BioMedical Engineering and Imaging Institute at Mount Sinai, sees the use of data captured by wearable devices as both a gauge of someone’s current medical condition and an indicator of that patient’s medical future. An engineer and bioengineer by training, Fayad believes that the use of artificial intelligence in bioengineering can democratize health care. It is the future, he says. “Medicine in general, and most of its problems, all will be solved using engineering principles.”

Zahi A. Fayad, PhD, FAHA, FACC, FISMRM

Director, BioMedical Engineering and Imaging Institute

Lucy G. Moses Professor in Medical Imaging and Bioengineering

Vice chair for Research, Department of Radiology

Professor of Medicine, Division of (Cardiology)

Icahn School of Medicine at Mount Sinai School, New York, NY

MDT: Please discuss the genesis of the institute.

Zahi A. Fayad: Mount Sinai is a medical school and hospital system that does clinical care for inpatient and outpatient; it also trains medical students and graduate students. But we are not a university; we wanted to create access to engineering methods and principles to enrich faculty and residency programs and train the next generation of medical scientists to bring engineering principles to solve problems.

MDT: How does the institute differ from other centers of research and education?

ZF: We are embedded into the hospital system. We don't have or create artificial walls. We are in the middle of the hospital. I am surrounded by colleagues who take care of patients in the morning and then come to me in the afternoon for research. We wanted to create a discipline that is not within a traditional school but that is part of daily business. Other institutions with bioengineering research labs are usually separated from the rest of the university. Because we are naturally embedded, we can think about problems here.

MDT: Why did Mount Sinai establish the institute this way?

ZF: Silos are a physical barrier. They are also a political barrier because you are not speaking the same language. We created this environment. It is a mixed-use building. There are research wet labs, animal research labs and dry labs. We study immunology, cancer, cardiovascular, neurology research. We have imaging resources. We produce nanomaterials and are building devices and fabricating skin. All told, we have 14 faculty and more than 200 institutional review boards in progress, both central and individual.

MDT: What is the value in having an institute based on engineering principles?

ZF: As an engineer, I knew we could do work in biophysics, material science, biomechanical engineering. We picked a few areas that would be useful to us, those where we can contribute to solve health care problems.

MDT: Such as?

ZF: Can we help improve on tissue engineering by creating new materials to create the next generation of tissue, to repair and generate the body? By using engineering principles of biomanufacturing, of electronics, all of this is reparative medicine.

Our second choice is neuroengineering. We need to interact with the brain to treat disease, to discover new treatment areas, to manipulate the neurons involved with neuroinflammation; that interface of machine and brain is important to us.

Our third choice is the immune system. Not all cancers respond to immunotherapy. I think the immune system drives everything in the body. To manipulate the immune system will require new engineering principles. Covid vaccines have lipid-based nanoparticles. Science has found the best way to access the immune system via nanoparticles. We are using biocomplexity to study both the innate and adaptive immune systems.

MDT: At this point, which choice is showing the largest promise?

ZF: It is in the field of biomanipulation. Our cells are lipid based. We are taking biology and creating a new opportunity using similar compositions. We are learning from biology and reengineering the body using new materials.

MDT: Do you see a lot of value in wearables?

ZF: With these devices, we start with the design, collaborate with colleagues from different disciplines, then we tinker with the wearable and evaluate what it can do. I see a huge need for future devices.

MDT: Why?

ZF: It is one on one. There is no need for an app and something to measure it. What is powerful is continuous monitoring. Our institute is trying to improve the blurry and sporadic picture of health using a multimodality approach. Results from a doctor’s visit do not provide a sharp estimate of health. You can take blood pressure, and do something about symptoms, but a patient still needs a test for accurate results.

The body signals when something is wrong, but those signals are often ignored. If a device can monitor symptoms continuously, it will trigger alarms when something goes wrong. That device will know you better than you know yourself.

MDT: Why should engineering be in health care’s future?

ZF: Engineering is part of all industries. Medicine is behind here. We want to attract engineers and we want our clinicians to work with them. That is the goal. We feel that what we have is so good and unique that when we are ready, collaborations will develop in the private sector.

Christine Bahls is a freelance writer for medical, clinical trials, and pharma information.