Globe 100 Innovators | Medicine

The word doctor

Dr. Atul Gawande is the top innovator in medicine

Dr. Atul Gawande Dr. Atul Gawande (Illustration by Joel Kimmel for The Boston Globe)
May 22, 2011

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1. Dr. Atul Gawande, Brigham and Women’s Hospital, Dana-Farber Dr. Atul Gawande, surgeon and writer, is as celebrated for his New Yorker articles on health care policy as he is for his work at Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and the Harvard School of Public Health. His 2009 book, “The Checklist Manifesto,’’ helped popularize a simple technique being used by doctors to reduce medical errors.

Now Gawande, 45, who was cited by Globe 100 judges for influencing the national health care debate and for his moves to reduce deaths and complications from surgery, is working on a new set of emergency checklists that can be used in childbirth and in operating rooms.

Gawande said he is interested in the kind of “systems innovation’’ that until recently has been unheralded in the health care world.

“It’s a different kind of innovation,’’ he said. “There’s innovation from the discovery of drugs and medical devices. But these are innovations making it possible for people to deliver health care in the right place at the right time and without wasting resources.’’

Despite the standoff over the US health care overhaul, Gawande said he remains confident health care will improve. “We all have to be determined to make it better,’’ he said, “because the only alternative is rationing, and that would be Dickensian. We’re either up for the challenge, or we’ll decline.’’

– Robert Weisman

2. Dr. Daniel Haber, director, Massachusetts General Hospital Cancer Center Daniel Haber made headlines a few years ago for discovering means for treating liver cancer in patients with specific genetic profiles. That development affected a small number of patients immediately, but also opened up a new direction in the battle against the so-called emperor of maladies.

Recently, Haber helped invent a device that can detect tiny cells in the blood that originate from tumors, effectively allowing doctors to use a blood test to search for tumors. It's an understatement to say the device is sensitive. It can detect a single tumor cell among the one billion cells in a teaspoon of blood, he said.

The device is in the prototype phase and for now, is complicated to operate. But eventually, Haber hopes it can be an inexpensive, easy-to-use tool with little more than an "on" button.

Once the machine is perfected, he added, the real work begins. "The Holy Grail," Haber said, "is understanding the nasty cells that travel in the blood and finding a way to target them."

– John Dyer

3. Dr. John Frangioni, co-director, Center for Molecular Imaging, Beth Israel Deaconess Medical Center John Frangioni, professor of medicine at Harvard University, hopes to give surgeons around the world a little inside knowledge.

Frangioni developed FLARE, or Fluorescence-Assisted Resection and Exploration, a system that uses a near-infrared light — invisible to the naked eye — to allows surgeons to see about a quarter of an inch beneath solid tissue. Doctors inject a special compound into patients, then can peer within their organs using the near-infrared light.

The benefits to surgeons are legion, said Frangioni, 47.

"Surgery hasn't changed fundamentally in 150 years," he said. "The imaging system surgeons use most often around the world is their eyes and brains."

FLARE could give doctors in rural areas or developing countries a significant leg up in diagnosing and treating injuries, said Frangioni. To make sure the technology reaches hospitals as quickly as possible, he's set up the nonprofit FLARE Foundation to distribute the system, rather than choosing to sell it commercially once clinical trials are completed.

"I'm not going to feel like I've done anything worthy," Frangioni said, "until I get the technology to the patient."

– John Dyer

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