Professor Subrata Ghosh

Professor Subrata Ghosh

Innovation from bench to bedside

The Institute of Translational Medicine (ITM) is a world-class research institution which will progress the latest scientific advances into innovative treatments. Ian Halstead met its director, Professor Subrata Ghosh.

The strategic leaders of Birmingham’s healthcare community may be purposeful and refreshingly positive - given the challenges faced by the NHS - but they’re not usually prone to heaping accolades upon a newcomer before they’ve even reached the city.

However, when it was revealed in early 2016 that Subrata Ghosh had agreed to relocate from Canada, to become the ITM’s first director, the excitement was evident. There’d been a global search for someone to lead this £24m institution, housed snugly inside a lovingly-restored Art Deco building on the sprawling QE site, which aims to bring together clinical expertise, pioneering science and academic excellence.

Even the usually phlegmatic Professor Charlie Craddock was a-buzz to discover that the world-renowned specialist, noted for his novel therapeutic approaches, and an international specialist in inflammatory conditions, such as Crohn’s Disease and colitis, had been persuaded to come to Birmingham. As was Ghosh; a genial and charming individual, with a rare blend of professional passion, academic detachment and entrepreneurial nous.

Ghosh“I’d spent eight years as professor of medicine at the University of Calgary, and was very happy. I enjoyed doing both research and clinical care, and delivering a major centre for colitis, which I’ve been interested in for many years.

“On a professional level, I’d really enjoyed creating innovative treatments, bridging gaps in existing care, having a leadership role, and also being able to mentor young students too.

“On a personal level, my wife was also happily settled, and I have always loved skiing in the Rockies. I’d been visiting them on holiday every two years or so for a long time, and in Calgary, the mountains were just 45 minutes away.

“However, when I knew of the ITM, talked to Birmingham Health Partners, met Steve Hollis from the LEP and chatted with Charlie Craddock, it was clearly an irresistible opportunity, and a challenge I really wanted to take on.

“I’d been driving our vision for precision medicine in Calgary, and have always believed in delivering the benefits of scientific advances much more quickly to patients - what we call the ‘bench to bedside’ approach - and here was somewhere where that could be achieved.

“Having a platform, to bring innovation in drugs, diagnostics and devices forward through new and efficient collaborations really resonated with me.”

Even before the removal vans reached his Calgary home, Ghosh was already dreaming about what the ITM could deliver, and it’s a vision he shares with typical enthusiasm. “There are huge benefits to be gained from having patients, clinicians and research co-located on the same site, and we can also build on Birmingham’s very impressive record for clinical trials.

“At the same time, we also have the technology here which allows us to understand that not all drugs benefit all patients. It’s not just a case of patients suffering bad side-effects. The same drug might work for one patient, but not for someone else with the same condition.

“If we can identify the drugs which won’t work for some patients, it would have massive benefits; for patients, for clinicians and the health economy, because at the moment, millions of pounds are being wasted each year, because they’re being given to patients who receive no benefits.

“Progress for new drugs, along the ‘bench to bedside’ pathway, was always very slow, it might take ten years or longer, and patients die waiting for the right drugs, which is why Charlie came up with his concept of accelerated trials, which has been remarkably successful in tackling blood cancers.

“It’s also about bringing the right people with the right skill-sets together at the right time. For example, you might have a very bright scientist working very hard to develop a molecule which can tackle a certain disease, but he’s only working with mice, so the outcome might just be healthier mice.

“In most cases (if not all), that individual needs to be given advice and support, and to engage in wider collaborations, not least to discover if the pharmaceutical industry would be interested in this molecule.

“Even if the molecule is successfully developed, many scientists don’t find the right partner nationally or internationally, or the right company to work with. I suspect that only 20% of these molecules (at best) are ultimately used to generate better outcomes for patients.”

MicroscopeThere’s a smidgeon of professional frustration in his remarks, and Ghosh confesses that he thinks Britain’s healthcare economy needs a good dose of entrepreneurial culture - to be found most visibly in North America. “Everyone understands the major challenges around healthcare provision in the US and Canada, but that doesn’t mean other countries can’t learn from them. In Calgary, for instance, my oldest faculty members were in their 80s, but they were still productive and still thinking like entrepreneurs.”

“The more we can encourage academics, researchers, clinicians and everyone else in the healthcare community together, and at the early stage of projects, the more can be achieved.”

Birmingham-based Glenn Howells Architects took on the painstaking task of converting and refurbishing the QE Hospital building, built in the 1930s, into a home fit for the ITM in a digital era, and Ghosh has been impressed by their vision and the quality of their work. “We have six floors here, and lots of space for people from different disciplines to mix and meet has been built in, which is perfect because such inter-location is a huge driver of innovation. However, we can’t rely on random meetings, because while one chance encounter might work, nine more may never happen.

“We want to do things differently here, and we want do to things better, so we deliberately encourage disruptive ideas and debate, about drugs, devices, new approaches or technology. Everything has to be about delivering better outcomes for patients, and no-one should lose sight of that goal.

“I’ve always been a supporter of brain-storming, which nowadays appears to be called ‘swarming’, so we bring lots of people to the area behind our cafe, which was designed for such sessions, and throw challenges at them.

“They might be researchers, clinicians, bio-engineers… anyone in the healthcare community, and we ask them to think and interact in new ways. Doctors, in particular, are often surprised and impressed to discover what other people do.

“We are also seeing people from industry here in growing numbers; to help people here develop their ideas, and to ask people here to help them develop their ideas. Big Data is crucial, so we can understand potential opportunities and also understand how treatments can be effective on patients in very large numbers.

“Digital technology is equally important, and we’re bringing forward the concept of virtual clinics, so patients don’t have to travel for hours to be assessed, and specialists from different disciplines can interact with each other and the patient from remote locations.

“University Hospitals Birmingham NHS Foundation Trust (UHB) has been identified as a centre of digital excellence, and for innovations in healthcare IT, and you can see the expertise in healthcare informatics.

“It’s one of the best examples of how all the elements of healthcare can interact for the benefit of patients, if the systems and the structure are in place.”

Understandably, patients have embraced the rationale for the ITM’s creation, and the ‘can do’ mindset of Ghosh and his colleagues, because it offers them hope.  “Almost every patient we speak to has a challenging disease, whether it is cancer, colitis, arthritis or another serious illness, and you feel a real sense of optimism from them. Patients love to come here, because they know innovations are happening here which may be able to treat their condition.

Ghosh 2“We search for people with specific conditions, and contact them to see if they’d become involved in novel forms of treatment - which are proactive, not reactive - and almost all volunteer to take part in research trials.

“We do early-stage tests of new drugs, to see if they will deliver better and earlier results than existing drugs, and at this stage, pharma companies get involved, often through the Trials Acceleration Programme.

“We’ve been generally successful in winning grants from the pharmaceuticals industry, because of our expertise at clinical trials and because we genuinely believe in collaborations between the NHS and the drug manufacturers.

“The Wellcome Trust gave UHB £13m over five years, the Biomedical Research Centre provided more than £12m over the same period, and Cancer Research UK recently granted another £7m, and all this vital funding came here because of the ITM’s existence.

”The entrepreneurial culture isn’t generally found in hospitals, or in the wider economy, but we can only make scientific advances if we have the finance available, to employ like-minded people, with the right skill-set and experience, and to acquire the very expensive equipment we need.

“I know that some people in the NHS, and in the wider health community, look at business with a degree of caution, and even with distrust, but that’s a mindset I’ve been eager to change since my first day.

“Just one of the machines here costs £500,000, and I have never seen anything ‘wrong’ with entrepreneurs benefiting from bright ideas and innovations which provide clear benefits to patients. To me, everything we do has to be for patients, and we always need to remember that common purpose.”