“The integration of ‘big data’ with artificial intelligence and immersive technologies in health care is fundamentally changing the way we will treat patients — enabling us to vastly improve and personalize care for each individual,” University of Maryland School of Medicine (UMSOM) Dean Mark Gladwin, MD, said almost exactly one year ago announcing the launch of the Institute for Health Computing (IHC). It’s an ambitious collaboration between the medical minds at the University of Maryland, Baltimore (UMB), the computing power of the University of Maryland, College Park, and the University of Maryland Medical System with the anonymized health records of 2 million unique patients each year.
But IHC is just one of the big things happening at the School of Medicine. Gladwin was interviewed by UMB President Bruce E. Jarrell, MD, FACS, Nov. 16 on Virtual Face to Face with President Bruce Jarrell.
“What's sort of the next step for this school? In terms of let's start with research growth?” Jarrell began. “Where do you see the biggest advances forward?"
“There's a need to move from under the shadow of the great pandemic,” Gladwin said, adding that during COVID-19, researchers were largely isolated, while clinicians continued their work in clinics. “So, part of it is how do we leverage all this great success of the 17 departments and 25 research centers? But how do we come together, to break down silos and to stimulate team science that that will make an even bigger difference?"
The great successes to which Gladwin referred are manifold. Two months ago, UMSOM doctors performed just the second-ever xenotransplantation of a heart into a living human patient, advancing science that might save the lives of 6,000 Americans who die each year waiting for an organ transplant and many more who need an organ, but don’t even qualify to be on the organ transplant list.
The school also received a major gift — $10 million — from the Kahlert Foundation to launch the Kahlert Institute for Addiction Medicine. Research there will focus on developing and testing novel interventions, including behavioral therapies, drugs, and innovative technologies to reduce cravings and drug use, and overcome the many complications of addiction facing Americans diagnosed with substance use disorder — there were 20 million last year.
“This is going to focus on basic science,” Gladwin explained. “How do we turn off addiction? How do we prevent addiction? How do we run clinical trials as we discover new things? And then excellent clinical care, which we now can project across the state. We have telemedicine, addiction treatment programs that serve our jails, and serve patients across the state.”
Another multidisciplinary research effort — the University of Maryland Institute for Neuroscience Discovery, or UM-MIND institute — will seek better understanding of the human brain, working to address fundamental diseases of the brain like Alzheimer's, autism, brain injury, brain inflammation, and neurodegeneration, Gladwin said, by facilitating interaction between basic and clinical scientists and enhancing collaborative research.
“We've created an institute that crosses the clinical domains of neurosurgery, neurology, psychiatry, physical therapy, and then crosses basic science domains like primary fundamental neuroscience, and then brings those groups together in this transdisciplinary institute,” Gladwin said.
“We're all seeing all these transformations,” Jarrell said. “We saw it with COVID, switching to online. There's now all of this artificial intelligence going on. What do you think is going to happen to the education of our medical students over the next couple of decades in terms of how they learn and how we teach?”
“The other thing we were seeing is sort of a transformation of the practice of medicine related to big data and related to partnerships with advanced practice providers and more interdisciplinary care,” Gladwin responded. “One of the great generational challenges we face is what I call the aging epidemic. Some people call it the gray tsunami.” Gladwin added that many predict the United States will have far fewer physicians than needed by 2050.
“So, to address that, we're going to have to change models of how we deliver care,” he explained. Physicians, he said, will need to make effective use of big data and artificial intelligence to take care of a population that we care for, and try to prevent hospitalization and disease.
“Not only do we need to now use big data and technology, but we need health science partners. We're going to work with pharmacists. We're going to work with social workers, physical therapists, we're going to work with nurse practitioners and nurses and navigators. And so, the model of patient care for panels of patients in the future is going to be teamwork, and cross-disciplinary, which is another great thing about this campus," he said.
The second half of the Face to Face program included questions from the UMB audience, most of which addressed some aspect of artificial intelligence, such as the risk of bias and increased health disparities. A common concern among researchers is a not uncommon phenomenon referred to as hallucinations.
“The AI systems, if they have the wrong data or wrong interpretations, they can strangely extrapolate or hallucinate and generate incorrect data. We think it's likely that those hallucinations are going to be augmented in minoritized patient groups or populations, again, where the data is limited. And obviously there's great risks these AI systems are going to capture biased written material, biased knowledge, and these AI systems have the significant potential for misuse and dangerous use,” Gladwin explained.
“The bias issue that I mentioned is a big concern that these AI systems learn from the data they're fed. And so, if we feed them biased data, and that can just be lack of available data, lack of a voice, that that information, the readout will be biased. So that's one of the big disparities that we're worried about. And we think we have a big opportunity to correct that disparity here through our IHC program.”
Perhaps the only question that slowed Gladwin, if only for a moment, was what most surprised him in his first year as dean. After a moment’s reflection he offered, “I feel like University of Maryland is a humble place, and people I don't think have shown off or promoted the depth and breadth of these discoveries.” Gladwin quickly mentioned the school’s success treating the most serious COVID patients with Extracorporeal Membrane Oxygenation; being one of the main sites for multiple vaccine trials that led to approvals; leading the world in exposure vaccination, where volunteers are exposed to Shigella, salmonella, and other diseases and are tested rapidly for vaccine effectiveness; advanced resources like nuclear magnetic resonance spectroscopy; an extremely wide array of grant-funded research; and much more.
“So, part of my job is to really communicate the success of the faculty and call that to people's attention.”
To watch the entire Face to Face program, click the video at the top of this page.