Former Chair Ton van der Steen: ‘MD professors all have fire in their bellies’

• In 2021, nine extra Medical Delta (MD) professors were inaugurated. These professors work at at least two of the five academic institutions represented within Medical Delta (TU Delft, Erasmus MC, Erasmus University, Leiden University and LUMC). The intake brought the total number of MD professors to 22. How does such a double appointment work in practice? That is the underlying question in this miniseries of research portraits.

Prof. Ton van der Steen, Head of Biomedical Engineering at Erasmus MC remembers clearly how the Medical Delta started. “In 2006 Karel Luyben, then Dean of AS, brought six people together. Two from the LUMC, two from Erasmus MC and two from TU Delft. Luyben had seen the close cooperation between MIT and the Harvard Medical School in Boston and saw great things happening in the field of health science and technology. He believed that here in this region we have everything we need to do something like that and he suggested that we establish a similar partnership.”

It took a few years before the cooperation between technical and medical faculties got off the ground though. “We spent a couple of years meeting up and trying to understand each other and exploring the different professional cultures. And to find an answer to the question of what the focus should be. Plans were made but not much happened with them between the meetings,” remembers Van der Steen. “Then we established an office and, under the leadership of Director Menno Kok, the Medical Delta grew into a fully-fledged networking organisation in the Province of South Holland. Shortly after that we started anchoring research with double appointments for professors. To foster real cooperation among the universities, the professors need to be authorised to supervise doctoral degrees in both places.”

Launch
The time came on 12 June 2014. It was the first day of the World Cup football tournament and the first 11 Medical Delta professors with a double appointment hit the news in ‘Medical Delta elftal trapt af ’ (Medical Delta 11 launched, in Dutch). Three years later, a visitation committee concluded that the potential of the Medical Delta was even greater than was imagined. This led to Van der Steen being asked to rearrange the Medical Delta and to give science a greater role. He ultimately became the Chair of the new Medical Delta.

“I got 51 professors from the five knowledge institutions together to write a substantive programme. Medical Delta funded 20% of that programme and the rest of the funding had to be obtained from elsewhere. But that 20% allowed me to give some direction to the programme. And made it easier to obtain subsidies.” As a former Chair of the STW technology fund, Van der Steen knows exactly how research funding works.

Their substantive programme was turned into a scientific programme containing 13 subjects that were led by one technical and one clinical person and two PhD candidates and financed by Medical Delta. The initial costs, EUR 5 million, were funded by the five knowledge institutions involved: the University of Leiden, Erasmus University, TU Delft, the Leiden University Medical Centre (LUMC) and Erasmus MC. The researchers then successfully acquired external funding so that, according to Van der Steen, the total value of the Medical Delta’s research amounts to about EUR 100 million.

Misunderstood
In practice, the collaboration between a medical professional and an engineer is a lot more subtle that the interface of supply and demand. By working together, the engineer sees the issues that may arise and the medical professional learns what kind of questions to ask. Supply and demand develop simultaneously, says Van der Steen. “I experienced this myself when designing echo catheters. Before I started in 1994, I spent days being a fly on the wall in the Catheterisation Lab to see how intervention cardiologists open blocked coronary arteries with catheters and stents. This helped me understand what catheters need to do to not only be useful, but to also be usable.”

Ten years later, electrophysiology – the treatment of heart rhythm disorders by using catheters to block the electrical pathways in the heart – arrived in Rotterdam. The treatment could take up to six hours. “I had a notebook with five ways that I thought could speed up the procedure. After watching a treatment for three hours I threw that notebook away.”

It turned out that electrophysiologists and intervention cardiologists work in such different ways that you cannot use the knowledge that you get from the one for the other. “Intervention cardiologists act really fast as a speedy intervention is the important thing. Fast and acceptable is better than careful but too late. In the case of electrophysiology, it is the reverse. The medical specialist improves the electrical conductivity of the heart. It is important to be very precise. You have the time too as it is not a life and death situation. The atmosphere among these medical specialists, nurses and technicians is very different.”

Expansion
On 2 November 2021, nine Medical Delta (MD) professors were added. Van der Steen explains that a double title is complicated. “The sequencing and priority in the processes of the five knowledge institutions differ. Each candidate entails working with at least six actors. You are sometimes walking on eggs. But the very fact that these double appointments have been created shows how important the administrators of the Medical Delta consider it.”

Medical Delta sets a framework and a mission, but leaves the substance open for the researcher to fill in. This can be hard for the administrators sometimes though. Van der Steen explains that “It raises all sorts of issues. You have an extremely wide spectrum of people in terms of knowledge, character, understanding, diplomatic skills or lack of them. And that’s all fine. But every individual has fire in their bellies. This is the most important aspect that all the Medical Delta professors share.”

What about the future if there is a new group of people? “I hope and expect it to go well. It also depends on the administrative developments. But there is potential and I can point to three people who I believe would blossom as Medical Delta professors. It also depends on the initiative of the new Chair, Frank-Willem Jansen.”