"We focus on the social embedment of innovations"

Interview Antoinette de Bont

In the field of health care, as in several other fields, Erasmus University Rotterdam collaborates with the Erasmus Medical Centre (Erasmus MC) and Delft University of Technology (TU Delft). Prof. Antoinette de Bont is a professor of sociology of innovations in health care at the Erasmus School of Health Policy & Management (ESHPM). In association with programme director Prof. Richard Goossens, who is a professor of physical ergonomics at TU Delft, she is closely involved in the Health & Medical Technology section of this collaborative partnership.

In this context, does ‘convergence’ simply mean an intense collaboration with TU Delft?

“No, there’s more to it than that, because we’ve collaborated on a lot for a while now. We’re already offering interdisciplinary initiatives. What we are seeking to do now is to challenge academics to use each other’s methods in a new context. I’ll give you a nice example: the development of artificial organs for the testing of new medicines. This involves cooperation between academics involved in the life sciences and in physics, and they encounter new challenges. They really have to exchange methods, and conduct research in new contexts, in order to do this.
Let me give you another example. During the coronavirus crisis we had to create models to determine how many patients we were expecting and how many beds we would need at the IC unit. Epidemiologists use different modelling methods than economists. What happens when you mix or combine their techniques or variables? That goes beyond having different parties conduct different parts of a study. 
Erasmus MC conducts basic research and clinical trials, TU Delft provides the technical knowhow, while we focus on the social embedment of innovations, from the first germ of an idea to knowledge commercialisation.”

And what role does Erasmus University, in particular, play in the Health & Medical Technology programme?

“We focus on what can be done for society by using certain new techniques. For instance, artificial intelligence can help us prevent medical issues. But prevention is a broad concept; it doesn’t refer to health only, but to all sorts of correlated things. Perhaps the creation of new jobs will go a longer way in preventing medical issues than asking whether we’re all taking 10,000 steps each day. What this means is that the prevention of medical issues is a societal issue. So how do we make preventive artificial intelligence inclusive, thus allowing everyone to use it, rather than just the happy few? How do we make it socially legitimate, so that the people or the government won’t mind paying for it?”

“How do we make preventive artificial intelligence inclusive, thus allowing everyone to use it, rather than just the happy few? How do we make it socially legitimate, so that the people or the government won’t mind paying for it?”

What is your answer to that question? How do you plan to go about it?

“We’d like to take our cue from societal issues or things people are concerned about – for instance, social inequality in the healthcare system. Or the kinds of worries people have when a pandemic occurs. We’ll take our cue from actual needs. What kinds of societal issues are we seeing, what kinds of situations need to be resolved, and for whom will we be doing it?
Rotterdam is a great place to ask such questions. When it comes to people’s health, this city is home to some huge disparities. People living on one side of the city will live seven years longer than people living on the other side. Naturally, our objective is to make sure that everyone is healthy, or has a chance to get healthy.”

Can you give us a specific example of the kind of work that needs to be done?

“When a new technology is discovered, it must be produced, and someone has to pay for that. In our healthcare system, we are dealing with rights, an inspectorate, healthcare institutions and a National Health Care Institute, and we’re also dealing with companies, such as KPN or Philips. EUR has solid relations both with its social partners and with businesses. If TU Delft develops a new technique, such as folding cells for artificial organs, we will determine what is needed to realise this technique. We check whether the new method is socially acceptable, and what kind of information institutes such as the National Health Care Institute need to be able to determine that the method has been proven to be effective, or safe. We also look at new ways to evaluate medical technology, in association with the Health Care Institute.”

Technology alone won’t solve all issues, right?

“The main challenge we are facing is that we all know how hard it is to lead a healthy life. An app that tells you to be a good boy or girl is not going to change that. The solutions are a lot more complicated than that, which is exactly why we need so many different types of scientists to get involved. We need an understanding of behaviour, of health, but also of what a city’s neighbourhoods are like, what architecture is like. We must prevent research from being conducted without reference to other types of research.
We seek to establish a type of health care that is proactive. We’re already quite able to use data to predict whether someone will fall ill, but can we actually prevent medical issues from arising? I think we have two distinct tasks that need performing. One is the development of new technology. This is what TU Delft will be doing. The other is changing the healthcare system, which is what Erasmus MC and EUR will be doing together. We can ensure that the new discoveries fit into the social system, that the Inspectorate approves them, and that the costs are covered by insurers.”

“I’m involved in the development of the Consultation Room 2030. What will doctors’ surgeries look like in the future? The first question to be answered is: where will such consultation rooms even be?”

What specific project are you involved in?

“I myself am involved in the development of the Consultation Room 2030. What will doctors’ surgeries look like in the future? The first question to be answered is: where will such consultation rooms even be? Will it be your own bathroom? Or will your phone serve as your consultation room? And how can we improve the consultation process? For instance, by installing walls that inhale and exhale. If we’re surrounded by walls that breathe slowly, we will breathe more slowly ourselves, which will calm us. People at TU Delft are coming up with ideas like that. Another important question that needs answering: are there any ways to enter a conversation between a doctor and a patient in a patient’s electronic health record automatically, without the doctor having to type anything? That would reduce doctors’ workload. There’s an American company that is willing to try and create this technology for us in a doctor’s surgery. I also find it interesting to analyse this situation from the perspective of my own discipline: who will be present in such a doctor’s surgery? Will there be a nurse, or will there also be a technician who will analyse data?
Let me give you another example: the way in which patients are diagnosed. We know certain types of care haven’t been provided lately because of the coronavirus crisis. This is quite problematic in certain types of care – say, skin cancer. Skin cancer has an annual growth rate of 6 per cent, and we don’t have enough dermatologists to inspect everyone. Can we automate this type of diagnosis, thus allowing people to self-diagnose at home? But just as importantly, we need to ask questions such as: is self-diagnosis of cancer socially acceptable? Do patients wish to diagnose themselves? Do GPs want them to? Do organisations want them to? And if it’s effective, will insurers cover the costs? We intend to answer all these questions.”

Is this taking you into unfamiliar territory?

“On the one hand, it isn’t. We’ve been doing this for years. The TU Delft technologies we just discussed have been in development for years. And EUR has focused for years on how to improve the healthcare system. We have proper foundations. What we seek to do is to bring all these foundations closer together, so as to be able to solve societal issues. That’s the main goal.”

Professor