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The White Rhinoceros


Matthew Howard
Matthew Howard

The 2009 Wilfred G. Bigelow Lecture, given by Matthew Howard III, Professor and Head of the Department of Neurosurgery, Iowa State University examined the current status and challenges facing Academic Surgery. Dr. Howard compared the contemporary surgeon-scientist to the white rhinoceros, one of the first creatures to capture the public imagination as an endangered species. He highlighted data by Rangel et al demonstrating that compared to their colleagues, surgeons simply are not applying for NIH grants and when they do apply, they are not getting funded Fig 1. Whether it be the white rhino or the surgeon scientist, Dr. Howard argued that we need to gain knowledge of the animal and its environment, determine the causes of impending extinction and formulate a rescue plan.

The challenges facing surgeon scientists today include the apparent cognitive dissonance between surgical practice and scientific surgical investigation. There is a fundamental difference between the mental discipline necessary to run a busy clinical service and the creativity and free-thinking associated with the process of discovery. Wilfred Bigelow and Matthew Howard brilliantly illustrate how this tension can be resolved. Dr Howard also reminded us of the problem created by the strong financial incentives related to the remuneration of surgical productivity both for the hospital/institution as well as the individual surgeon, especially in the face of the mounting debt of contemporary medical trainees. Basic or clinical research, although intellectually satisfying, is often performed at the expense of the bottom line.

The arguments for surgical research are clear. Surgical practice and outcomes continue to improve as a direct consequence of surgical investigations. Without the efforts of Drs. Bigelow and Howard, we would not have the insights to manipulate body temperatures intraoperatively nor to position leads accurately in beating hearts in a minimally-invasive manner. Surgeon-scientist Howard holds over 25 patents, six NIH grants totaling over $5 million. He is the Editor-in-Chief of Clinical Neurosurgery and is the Director of the Human Brain Research Laboratory, University of Iowa.

The lecture mandate is to link the fields of cardiac surgery/ cardiology with the mind/brain. Indeed, throughout his career, Dr. Howard has seamlessly crossed disciplines from neurosurgery to cardiac surgery to physics and engineering. The biotech company that he established, Stereotaxis (http://www.stereotaxis.com), is just one


multidisciplinary example. His initial inspiration was the lack of a controlled method to guide probes in the brain. This line of investigation led to the development of a magnetic navigation technology coupled with fluoroscopic imaging to guide lead placement for electrophysiological procedures such as cardiac resynchronization therapy.

Graph NIH grants
Graph NIH grants
Fig 1. Number and success rate of N1H grants. K's are grant categories. Rangel et al. (1)

Part of the solution to the challenge of rescuing our endangered species is for surgical departments to recruit leadership with research expertise and to encourage and mentor young surgeon scientists. Dr. Howard correctly identified the Department of Surgery, University of Toronto, as a "game preserve" for surgical scientists. This is a tribute to our leadership that has strongly supported academic pursuits of both staff surgeons and trainees for over four decades. The challenge will be to continue to nurture such endeavors.

The format of the talk was simple and informal, but to this young trainee, the message was clear-it was a call to arms for engagement in academia. Dr. Howard is, in the words of Dr. Christopher Caldarone, a triple threat: a first-class surgeon, an accomplished scientist and proven leader. To trainees aspiring to make a contribution as a clinician scientist, his words and demonstrated success are inspiring.. Indeed this lecture was profoundly memorable as we strategize our own balance between clinical practice and discovery. We thank Dr. Howard for a thought-provoking and entertaining lecture.

Bobby Yanagawa
Cardiac Surgery Resident

(1) Rangel SJ, et al. Recent trends in the funding and utilization of NIH career development awards by surgical faculty. Surgery, 2004; 136:232-239.

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