Diferenciación

Academic research in medical technology (or biomedical engineering that we use synonymously) is a relatively young discipline in Sweden dating back to the 1940s/50s, when more focused research began to emerge in

63 _{P25075 – Maintained health with functional food (Bibehållen hälsa med funktionella}

some places. Today, as we saw in Chapter 4 medtech research, broadly defined, is carried out at many universities and departments/centers. In this section, the history of medtech (or biomedical engineering) research in Sweden will be described shortly as a background to the current situation (as described in Chapter 4) and, more importantly, to the effect analysis. From an international perspective, medical technology as a research field began to appear in the 1940s. There were for example clinical physiologists or other physicians within the faculties of medicine who were interested in technology and began to develop new techniques and instruments, which they needed primarily for their own medical research (rather than for treatment or diagnosis of patients). At the same time, technical research dealing specifically with the development of new methods, apparatuses and other types of products to be used in healthcare began to appear at some universities of technology. Commonly, research groups with such a focus emerged within departments of electrical engineering (where medical technology became one of several application fields – typically one of the smaller). Sweden, which already in those days had an internationally well- reputed medical research and where large resources were invested in the creation of an advanced and publicly funded healthcare system, became at an early stage one of the leading countries in Europe also in medtech research. In the beginning of the 1950s, three pioneering research groups began to develop, namely, at the Karolinska Institutet (KI), Lund University and Chalmers University of Technology.

Before describing these developments, it is worth mentioning that Sweden as one of the first countries in the world established in 1956 a Society for Medical Engineering and Medical Physics (Svensk förening för Medicinsk Teknik och Fysik, MTF). In 1967, it arranged the World Congress in Biomedical Engineering, which is seen as an early milestone in the development of medical technology in Sweden.64

At KI, Sweden’s largest medical school, the initiative to start up medtech research was taken by Bertil Jacobson, a physician and clinical physiologist who had a strong interest in technology and in developing new products for healthcare. In the early 1960s, thanks to his efforts in this field he got a personal professorship in medical technology and built up a small research group (4-5 people). However, the main focus was on product development, rather than building up an expanding research group and establishing a post graduate program. Among other accomplishments, Bertil Jacobson came up

64 _{MTF has today about 1,000 members, most of whom work with clinical engineering at}

hospitals. The main tasks of the clinical engineers are procurement, service and maintenance of medtech equipment, but they may also take part in R&D projects.

with a number of X-ray inventions made in collaboration with radiologists.65 The group was later on moved from the main campus in Solna to the new campus in Huddinge, in the southern part of the Stockholm region. After Bertil Jacobson’s retirement in 1992 Håkan Elmqvist took over as professor and head of the current Division of Medical Engineering (a position he had until he retired in 2008). Interestingly, he came from Siemens in Germany where he had had a senior management position in the medical business. Despite being a pioneer within Swedish medtech research, the division has remained relatively small over the years and has produced only a limited number of PhDs. However, a close collaboration has been established with KTH’s School of Technology and Health, and since early 2000s they form a joint research environment in the southern part of Stockholm.

In parallel to the activities at KI, Lund Institute of Technology (i.e. the Faculty of Engineering within Lund University) emerged as another Swedish pioneer in medtech research. The key figure here was physics professor Hellmuth Hertz, who is behind several breakthrough discoveries and inventions, especially regarding ink-jet technology and medical applications of ultrasound. Starting in the early 1950s, and in close

collaboration with clinical researchers in Lund, he developed methods to use ultrasound for medical diagnostics – methods that have been widely used worldwide and contributed to build a new branch of industry. Attempts to get the technology commercialized by Swedish industry failed, due to lack of interest from the firms concerned. So unfortunately, the industrial effects of this pioneering research did not benefit Sweden, but were instead

materialized in other countries. In 1963, the Department of Electrical Measurements was established, and Hellmuth Hertz began to build up a strong research group in the area. After his retirement in 1986, the

environment-building work was continued by his successor Professor Kjell Lindström – with good help from a small group of senior researchers who had chosen to stay at the department after having completed their PhD. As a complement to the ultrasound research, which has remained a core activity, the department has since then expanded into other research fields, in particular microsystems engineering, nano-biotechnology (incl. lab-on-a- chip), proteomics, and neural interfaces. Within the current Division of Electrical Measurements there are some 20 researchers working in the medical field.

Also in the 1950s, Chalmers University of Technology began to build up research in applied electronics with a focus on medical applications. It all

65 _{An important contribution of Bertil Jacobson was a text book on biomedical engineering}

that has become widely used in Sweden, and still is many years after the first edition. The book has been translated into English and is used also abroad.

started with Professor Henry Wallman, an American mathematician from MIT who had been recruited by Chalmers. For personal reasons he became interested in medical technology and started pioneering research on X-ray television. He also began to build up a research group and broadened the research to cover other technologies and applications. Signal processing at an early stage became a core area. The second half of the 1970s and the first half of the 1980s can be characterized as a flourishing time from a medtech point of view. The Department of Applied Electronics had two full

professors (Robert Magnusson and Torsten Olsson) and practically all research was focused on bioengineering. A tradition of close collaboration with clinicians at the nearby Sahlgrenska University Hospital was

established.

Despite internationally well-recognized research and interesting results produced by the Chalmers researchers commercialization was rare. It was difficult to get established medtech firms to take over the knowledge and inventions and bring them to the market. It was against that background that Chalmers established the foundation Medicin & Teknik in 1985. The main idea was to further develop and prepare commercially interesting projects for exploitation by established firms or start-up companies. Besides a number of successful consulting projects for firms, the main outcome of Medicin & Teknik’s activities is the founding in 1991 of a company called Svenska Telemedicin System. It was six years later acquired by Ortivus Medical and is the origin for one of this company’s present core businesses. There are a few other companies which over the years have spun off from the department, with or without support from Medicin & Teknik.

Linköping Institute of Technology (i.e. the Faculty of Engineering within Linköping University) is home of one of the largest medtech research and educational environment in Sweden, that is, the Department of Biomedical Engineering with at present some 35 researchers (incl. PhD students). This department was established in 1972 in connection to the founding of Linköping Institute of Technology. In the preceding planning process, and based upon an idea put forward by an industry representative, it had been decided that biomedical engineering should become a core activity of the new Institute. Such an investment in creating a large academic unit specializing in medical technology was at the time perceived to be in line with international trends. Professor Bertil Jacobson from KI, who had been engaged as councilor, had come up with a unique proposal – today

described by many as brilliant – to locate the department to the university hospital, instead of to the main campus where the other technical

departments had their facilities. With hindsight, this choice became very important for the development of the department, since it enabled the medtech researchers to have daily contacts with the physicians at the

hospital. Thus, from the very beginning the research was carried out in proximity to the clinical environment, which facilitated cooperation with clinicians and testing of new methods and products under real-world conditions. The fact that Åke Öberg, the first professor of the department, also became head of the clinical engineering department at the university hospital also contributed to make Linköping a pioneer in integrating technology and medicine. Even in an international perspective this kind of strong linkage between technical research and practical healthcare was rare. Linköping Institute of Technology soon became Sweden’s largest educator of clinical engineers to be employed by the healthcare sector and the industry as well. The expanding research at the department, initially funded mainly through General University Funds66 also resulted in a large number of PhD theses (in total 65 up till today). Later on in this chapter we will describe in more detail how this department has evolved over time. From the late 1970s and onwards, a large number of other research environments with different fields of specialization have emerged in

different parts of the country. At Lund Institute of Technology, for example, medtech-oriented research groups of considerable size have been

established also within the Department of Electrical and Information Technology and at Lund Laser Center. In addition, a separate Biomedical Engineering Group has been formed within the Faculty of Medicine. In Linköping, technical research focusing on medical applications has been established, inter alia, within the Department of Physics, Chemistry and Biology and the Department of Systems Technology. At Umeå University, which has a strong research tradition in medicine and biosciences, a Center for Biomedical Engineering and Physics was established in 2000. This center is now, since a couple of years, run jointly with Luleå University of Technology. In Gothenburg, strong research groups working on

biomaterials have been built both at Chalmers and the University of Gothenburg. The latter has in fact a long tradition in this field thanks to Professor Per-Ingvar Brånemark’s pioneering research on osseointegration of titanium implants (starting already in the 1950s).

Besides the emergence of new medtech-oriented research groups at the older universities, some of the younger ones have more recently entered the field, typically by recruiting key persons from other universities. This includes Luleå University of Technology, University College of Borås, Mälardalen University and Örebro University.

66 _{This is what in Swedish is usually called ”fakultetsmedel” (the latest government bill on}

research and innovation, from Fall 2008, uses the expression “Direkta anslag till

lärosäten”). This is research money granted to the universities by the government as ”block funding”, as opposed to direct funding of specific projects.

As will be further discussed below, during the 1980s and 90s STU and its successor Nutek (from 1991) became the dominant external financiers of medtech research in Sweden. Through its medtech and other relevant programs STU/Nutek helped many existing research environments to expand as well as to build up new research groups (some of which had not worked much on biomedical engineering before).

From the beginning, leading professors mainly from the large medtech research environments had a dominant influence on STU/Nutek’s medtech programs. But in 1993, Nutek decided to take in company representatives in the steering groups. An effect of the increasing influence from industry was that the research projects in many cases became more interdisciplinary. As described by a previous Nutek project officer the companies often made other priorities than the academics. This led to the bringing in of researchers who did not come from the traditional medtech environments. These “non- traditional” medtech researchers added new competencies, technologies and perspectives that sometimes could be used to strengthen existing projects run within the classical research environments.

Another initiative taken by Nutek in 1993 was to organize annual medtech conferences. They substituted previous separate meetings arranged by each program. These national conferences were broadened also by inviting companies and by dealing with EU projects. A further broadening took place after a few years when the conferences also included the new Nutek- funded competence centers and researchers who received grants from the Foundation for Strategic Research. These conferences were highly

appreciated both by academics and company representatives. They became an important meeting place and enabled new contacts to be established both among researchers and between academia and industry. These medtech conferences were run until around 2000. After the formation of VINNOVA no such meeting activities directed specifically at medical technology have taken place.

It is beyond the purpose of this study to describe in detail how the medtech research landscape in Sweden has evolved over time. But this short

historical account, and the examples given, will hopefully help the reader to get a feeling for the historical context in which the effect analysis has been carried out. How the present situation looks like was presented in Chapter 4. We saw there that the field of medtech research is increasingly more

difficult to define and delimit. The reason is the increasing convergence of different technologies, meaning for example that traditional medical

technologies are often combined with modern biotechnology as well as with micro and nano technologies. This means that an increasing number of research groups claim to be active in the field, and by consequence compete for grants dedicated to medical technology/biomedical engineering.

It seems that the broadening of the medtech discipline, spurred by scientific and technological developments as well as STU/Nutek/VINNOVA’s actions, has not been appreciated by all researchers representing the classical medical technology. It has meant increasing competition for research grants. Others are more positive and emphasize the need for renewal of the medtech research.

5.3.2 Funding of medtech research in Sweden: a short note on