BRIDGE Linking Engin Ee Ring and Soci E T Y

Spring 2008 Health Care

The BRIDGE Linking Engin ee ring and Soci e t y

Adapting Process-Improvement Techniques in an Academic Medical Center Paul F. Levy Disruptive Innovation in Health Care: Challenges for Engineering Jerome H. Grossman Health Care as a Complex Adaptive System: Implications for Design and Management William B. Rouse The Convergence of Information, Biology, and Business: Creating an Adaptive Health Care System Christopher Meyer New Therapies: The Integration of Engineering and Biological Systems W. Mark Saltzman

Promoting the technological welfare of the nation by marshalling the knowledge and insights of eminent members of the engineering profession. The BRIDGE

National Academy of Engineering

Craig R. Barrett, Chair Charles M. Vest, President Maxine L. Savitz, Vice President W. Dale Compton, Home Secretary George Bugliarello, Foreign Secretary William L. Friend, Treasurer

Editor in Chief (interim): George Bugliarello Managing Editor: Carol R. Arenberg Production Assistant: Penelope Gibbs The Bridge (USPS 551-240) is published quarterly by the National Academy of Engineering, 2101 Constitution Avenue, N.W., Washington, DC 20418.

Periodicals postage paid at Washington, DC. Vol. 38, No. 1, Spring 2008 Postmaster: Send address changes to The Bridge, 2101 Constitution Avenue, N.W., Washington, DC 20418. Papers are presented in The Bridge on the basis of general interest and time- liness. They reflect the views of the authors and not necessarily the position of the National Academy of Engineering. The Bridge is printed on recycled paper. © 2008 by the National Academy of Sciences. All rights reserved.

A complete copy of The Bridge is available in PDF format at http://www.nae.edu/TheBridge. Some of the articles in this issue are also available as HTML documents and may contain links to related sources of information, multimedia files, or other content. The Volume 38, Number 1 • Spring 2008 BRIDGE Linking Engin ee ring and Soci e t y

Editor’s Note 3 Engineering and the Health Care Delivery System W. Dale Compton and Proctor Reid

Features 6 Adapting Process-Improvement Techniques in an Academic Medical Center Paul F. Levy Systemic changes require cooperation between those who deliver care and administrators committed to the public disclosure of outcomes. 10 Disruptive Innovation in Health Care: Challenges for Engineering Jerome H. Grossman Innovative, “disruptive” changes in the way health care is organized, paid for, and delivered may lead to a transformation of the overall health system. 17 Health Care as a Complex Adaptive System: Implications for Design and Management William B. Rouse Management of complex adaptive systems requires leadership rather than power, incentives and inhibitions rather than command and control. 26 The Convergence of Information, Biology, and Business: Creating an Adaptive Health Care System Christopher Meyer As biology becomes an information science, health care will learn from nature how to accelerate change. 33 New Therapies: The Integration of Engineering and Biological Systems W. Mark Saltzman Engineering innovation will continue to improve the quality of life and increase life expectancy.

NAE News and Notes 39 Class of 2008 Elected 43 NAE Newsmakers 43 2007 Japan-America Frontiers of Engineering Symposium

(continued on next page)

The BRIDGE

44 Call for 2008–2009 Award Nominations 45 Mirzayan Science and Technology Policy Fellows 47 A Message from NAE Vice President Maxine L. Savitz 48 List of Contributors 54 America’s Energy Future: Technology Opportunities, Risks, and Trade-offs 55 “News and Terrorism: Communicating in a Crisis” Workshops 55 China/U.S. Air Pollution Study 56 Launch of the Engineer Your Life Web Site 56 Grand Challenges for Engineering in the 21st Century 57 Calendar of Meetings and Events 57 In Memoriam

59 Publications of Interest

The National Academy of Sciences is a private, nonprofit, self- The Institute of Medicine was established in 1970 by the National perpetuating society of distinguished scholars engaged in scientific Acadmy of Sciences to secure the services of eminent members of and engineering research, dedicated to the furtherance of science and appropriate professions in the examination of policy matters pertaining technology and to their use for the general welfare. Upon the author- to the health of the public. The Institute acts under the responsibility ity of the charter granted to it by the Congress in 1863, the Academy given to the National Academy of Sciences by its congressional char- has a mandate that requires it to advise the federal government on ter to be an adviser to the federal government and, upon its own scientific and technical matters. Dr. Ralph J. Cicerone is president of the initiative, to identify issues of medical care, research, and education. National Academy of Sciences. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Academy of Engineering was established in 1964, The National Research Council was organized by the National under the charter of the National Academy of Sciences, as a parallel Academy of Sciences in 1916 to associate the broad community of organization of outstanding engineers. It is autonomous in its adminis- science and technology with the Academy’s purposes of furthering tration and in the selection of its members, sharing with the National knowledge and advising the federal government. Functioning in Academy of Sciences the responsibility for advising the federal gov- accordance with general policies determined by the Academy, the ernment. The National Academy of Engineering also sponsors engi- Council has become the principal operating agency of both the neering programs aimed at meeting national needs, encourages edu- National Academy of Sciences and the National Academy of Engi- cation and research, and recognizes the superior achievements of neering in providing services to the government, the public, and the engineers. Charles M. Vest is president of the National Academy scientific and engineering communities. The Council is administered of Engineering. jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Fall 2006 Editor’s Note

at the 2007 NAE Annual Meeting, address several of these issues.

Changing the Health Care Environment Industries, particularly large, entrenched industries, often find it difficult to change, even when they recognize that change is in their best interest. Therefore, a key driver of change is crisis, a situation that forces an industry either to change or, to put it bluntly, go under. Unlike other industries, however, health care cannot W. Dale Compton Proctor P. Reid simply go under, so it must change. Like other industries, health care must become more efficient, more respon- Engineering and the Health Care sive to patients’ (i.e., customers) needs, more flexible, safer, and of higher quality. Industries around the world Delivery System aspire to achieve the same characteristics. The suggestion that engineers join in the struggle to improve the health care system almost always Health Care as a Cottage Industry elicits surprise, even though engineers have been In a so-called cottage industry, many components actively involved in bioengineering and biomaterials of the overall system operate as independent agencies. engineering for years. In addition, publications on To an engineer, this indicates that the overall system using operations-research techniques to model hospital was not designed as a system and does not operate as a operating rooms and schedule personnel and materials system, that no single entity is in charge of the overall in various medical facilities date back more than three system, and that no cost objectives, standards of effi- decades. Today, however, the participation of engi- ciency, or safety goals have been established for the neers is more important than ever before. overall system. In addition, there is little, if any, feed- Health care delivery today is in turmoil. Despite back in terms of measuring overall operating goals. rapid advances in medical procedures and the under- As systems engineers know, you cannot optimize standing of diseases and their treatment, the efficiency, a large, complex system by optimizing its individual safety, and cost-effectiveness of the delivery of health parts, because this does not take into account inter- care have not kept pace. Improvements in the deliv- actions among the parts. Nevertheless, in the short ery of services in other industries have simply not been run, improvements in some components can be made transferred to health care. and should be encouraged. For example, systems engi- The question is why not. Here are a few of the neering principles were critical to improving clinical most obvious reasons. For one thing, the third-party operations—and quality of care—at the Mayo Clinic. reimbursement system is not conducive to a competi- Another example is described by Paul Levy, the director tive environment in which customers (i.e., patients) of Beth Israel Deaconess Medical Center, who details can seek out the most cost-effective treatment or how process-improvement techniques that have been provider. Second, health care delivery is still a “cot- used in other industries can be applied to some aspects tage industry.” Third, very little has been invested in of health care in an academic medical center. information technology. Fourth, the quality of care Moving the overall system toward optimization will delivery and benefits are difficult to quantify. Finally, require many more improvements like these, as well as the annual cost of health care is increasing by double sharing the lessons learned among providers, empower- digits. The five papers in this issue, which are based ing patients and encouraging them to take more respon- on presentations at the Symposium on Health Care as sibility for their health care decisions, ensuring that an Adaptive Enterprise: An Engineering Challenge, markets for health care services are more transparent The BRIDGE and open to new business models, and finding better Steps being taken to overcome these problems include methods of reimbursement. efforts to create a national health information infra- Jerry Grossman, director of the Harvard/Kennedy structure and a number of actions, being explored by School Health Care Delivery Program, argues in his Congress, to develop a nationwide system of electronic article that disruptive events, including revolutionary records. Several private-sector consortia, including advances in technology and business models, can be health care provider organizations, insurers, and tech- effective forces of change in the way an industry per- nology vendors, are implementing large-scale clinical forms. Disruptive innovations in the health care sec- data exchanges/repositories and personalized health tor, he says, are already driving changes in some parts record systems. But there are many barriers to achiev- of the system. ing these goals, including the exorbitant cost of these systems, especially for the 80 percent of physicians who Optimizing a Complex, Adaptive System work in groups of 10 or fewer. Bill Rouse, executive director of the Tennenbaum IT, however, involves much more than computers. Institute at Georgia Institute of Technology, focuses For example, wireless communications combined with in his paper on the complex, diffuse nature of health microelectronic sensors that can remotely sense physi- care delivery, which can only be described by a broader ologic parameters may make it possible to monitor and definition of “system.” Because of the nature of the sys- treat patients at home, thus making it possible for chron- tem in which health care operates, he says, some of the ically ill patients to visit caregivers less often. These corrective directions engineers usually pursue will not advanced IT devices and systems may also improve the work. A complex adaptive system such as health care, quality of treatment of patients in hospitals. It has been he argues, is not amenable to the controls and feedback said that these systems may someday make every hospi- forces we generally ascribe to a system. tal room an intensive care unit. Even though system tools that have been used suc- cessfully in many other industries will not suffice to Educating a New Class of Professionals solve all of the operational problems of the health care Unfortunately, most health care professionals do not system, they are the best tools we have to improve the even know what questions to ask systems engineers nor quality and efficiency of care until more powerful tools what to do with the answers, and vice versa. Most engi- for optimizing this adaptive system can be developed. neers only have contact with the health care system as For one thing, even if the performance of some parts patients, and few of them understand the constraints of the system is optimized, changing the very complex under which health care providers operate. In short, overall system will require strong, effective incentives these two groups of professionals often talk to each other and other tools for system governance rather than but seldom understand each other. system control. Chris Meyer, chief executive officer Jerry Grossman and the authors of this introduction of Monitor Networks Inc., describes an approach to experienced this firsthand as members of the NAE/Insti- change based on natural systems. He argues that the tute of Medicine study committee that published the 2005 very complex adaptive health care system requires report, Building a Better Delivery System. The committee “adaptive management.” comprised an equal number of engineers and health care professionals. Even though no significant disagreements Investing in Information Technologies arose and all of the committee members were outstand- Although many attempts have been made to increase ing professionals, we had great difficulty finding a com- the use of information technologies (IT) in health care, mon language, and thus, great difficulty writing a report overall investment in IT is the lowest of any major that could, and would, be read by both groups. industry. Thus many places still use paper records, and Based on our own experience, we recognized that only a small number of clinicians use physician order we must educate a new class of professionals, which entry systems or electronic medical records that are will require a new class of multidisciplinary research controlled by the patient. In addition, computerized and educational centers that bring together engineers systems are often incompatible, either in hardware or and health care professionals in an environment software, making communication difficult, sometimes devoted to improving health care. One goal of both even impossible. medical and engineering education must be that the Spring 2008

members of these professions learn from each other, Conclusion undertake joint research on common problems to There are abundant reasons for the problems in health develop new or modified tools, and demonstrate these care delivery. There are also abundant opportunities tools to other professionals. for working toward solving these problems. Engineers The committee members agreed that both professions may not be able to solve all of them, but the benefits of need to understand the limitations and opportunities working toward solutions can be tremendous, and the of the other. Although it will be difficult to add inter- challenges they present are enormously intellectually disciplinary material to present curricula, we dare not stimulating. Someday, the engineering profession may continue to ignore the crisis in our health care system. look back with pride on its contributions to solving this Only in the area of biomedical engineering have engi- significant social problem. neers, scientists, and medical practitioners developed a truly common language. Some of the breathtaking advances in the integration of engineering and biological systems to create new therapies for the treatment of diseases are described in the paper by Mark Saltzman, W. Dale Compton Proctor P. Reid professor of chemical and biomedical engineering at Yale University. Systemic changes require cooperation between those who deliver care and administrators committed to the public disclosure of outcomes.

Adapting Process-Improvement Techniques in an Academic Medical Center

Paul F. Levy

Academic medical centers, the crown jewels of the medical system, have a tripartite mission. First, of course, as hospitals, they are intimately involved in clinical care. At Beth Israel Deaconess Medical Center (BIDMC), for example, we take care of about 40,000 inpatients, about 50,000 emergency room patients, and about half a million ambulatory patients a year. BIDMC provides the full range of medical services, from primary care Paul F. Levy is president and CEO, through advanced imaging and diagnostics to liver transplants, bone mar- Beth Israel Deaconess Medical row transplants, and other tertiary and quaternary services. Center in Boston, Massachusetts. Research and education, the other two parts of the academic medical center’s mission, supplement and reinforce advances in and delivery of This article is based on a presentation clinical care. At BIDMC, research accounts for more than $200 million at the NAE Annual Meeting Technical of our $1.2 billion dollar budget, and clinical care and research are inte- Symposium on October 1, 2007. grated. Say, for example, a specialist in gastroenterology who is treating a patient with irritable bowel syndrome notices something about the patient’s condition that prompts her to hypothesize something about the cause of the disease. Based on that observation, she might construct a series of laboratory experiments, perhaps using mice as models, and, over time, she might learn things from these and other experiments that can be applied in the clinical setting. Over the years, this shuttling back and forth between “the laboratory bench and the bedside” informs both clinical care and research. Spring 2008

The third part of the mission is education, teach- haven’t been educated to take into account how—or ing the next generation of doctors, from undergradu- how much—the hospital or facility in which they work ate medical students (in our case from Harvard Medical affects their performance and patient care. School) to residents and fellows from around the world As the Institute of Medicine has documented, a very engaged in graduate medical education and advanced large number of people are killed or harmed in hospitals training. Nurses, dietitians, laboratory technicians, and in this country (IOM, 2000). In fact, health care does many other health care workers are also part of the edu- not meet the quality standards we expect from any other cational program. industry. Indeed, it does not meet the quality standards Academic doctors teach not only because they love to (e.g., Six Sigma) of the industries from which health- teach, but also because teaching keeps them up to date care goods and services are purchased. This is true even on the latest advances in medicine. Let’s say a bright though everyone involved in the delivery of care is young medical student is following the treatment of a well intentioned and thoughtful. Using theories and patient by a doctor who says, “This is the way we always practices of process improvement to ensure that quality care for someone with this problem.” If the student asks standards are met is simply not part of their training. why, the answer cannot be because it’s been done that And frankly, the administrators of academic hospitals way for 20 years. Students expect, and demand, more have not been thinking in a systems way either. complete, in-depth answers. This kind of give and take with students requires that doctors remain sharp and Rising Costs current in their fields. According to insurance companies in Massachusetts, Patients, whether in Boston, Seattle, Chicago, or any their annual increase in medical costs is 10 to 12 per- other city or region with a major academic medical cen- cent, as it has been for several years and is expected ter, are the beneficiaries of this marvelous agglomera- to be for years to come (e.g., Krasner, 2006). A key tion of clinical care, research, and teaching. They are driver for the increase is demographics. Baby boomers, seen by very bright people who are totally committed to now in their 50s and 60s, the age of hospitalization, taking care of them, using the most up-to-date diagnos- are being seen in hospitals for the first time (except for tics and therapies. Even patients who live in communi- women who had their babies in hospitals). At the same ties that do not have academic medical centers benefit, time, thanks to medical advances, like stents, which because advances in research and clinical care diffuse were invented and proven in academic medical cen- throughout the world, and there are doctors everywhere ters, baby boomers’ parents, who in previous genera- who have been trained in one of these centers. tions would have already died, are still alive. A person who might have died of a heart attack 15 or 20 years Cottage-Industry Care ago may now live long enough to get cancer and might Notwithstanding the marvelous features of academic remain under long-term treatment for this disease, medicine, the actual delivery of care and practice of now often a chronic condition, once again because of medicine in academic hospitals is still a cottage indus- advances developed at academic medical centers. Thus try that basically involves a one-to-one relationship insurance companies are coping with a growing number between the patient and the provider of the moment. of people entering the tertiary care system with more A good deal of what goes on in academic medicine in expensive and difficult diagnoses and treatments. the clinic is private. The cost increase of 10 to 12 percent a year compares The question is not how care providers make deci- to a 3 percent annual growth in GNP. This means that, sions. The issue is how the environment in which as Congress, state legislators, and taxpayers (who pay they work can be studied and reconfigured to eliminate for Medicare and Medicaid), as well as employers and systemic problems that lead to harmful outcomes and employees (who pay for insurance in the private sector), how doctors can be brought into that process. The experience a 3 percent increase in available income, the truth is that even these very well intentioned, bright, cost of health care goes up three or four times faster. experienced, often superb subspecialists, who justifi- I believe that academic medical centers, which have ably inspire confidence, work in a cottage industry that been at the forefront of so many medical advances, should has not had the benefit of the system-improvement also take the lead in addressing the cost issue. As anyone practices that are common in other industries. They who has experience with process improvement in other The BRIDGE industries knows, quality improvement and cost improvement go hand in hand. If you improve production processes or service processes, the delivery of those processes or services becomes generally more efficient. So how do we transfer process improvements to health care? I am not talking about global changes in the way we organize and provide health care all along the con tinuum. I am talking just about changes in a given hospital, particularly in an academic medical center.

Accountability and Change Everyone should understand that hospitals are dangerous places where mortality and morbidity occur, and academic medical centers have a responsibility to hold Figure 1 Graph showing improvement in performance of five-step VAP bundle. themselves accountable for quality and safety. I believe the best way of doing that is by publishing our data. My hypothesis is that holding ourselves accountable to the public will make our well intentioned doctors and nurses work even harder and “smarter” to improve processes and make hospital stays safer and less expensive. I noticed that some people on our staff were doing creative and interesting things related to improving quality and safety, and I decided to test the idea that publishing our clinical data would be good for our organization. I thought the transparency of clinical results would produce a kind of creative tension that, in itself, would help drive process improvement. So, a few months ago I started a blog (www.runningahospital. blogspot.com) about what is going on in our hospital. Figure 2 Graph showing improvement in ICU oral care. Here is an example about ventilator-associated pneumonia (VAP), a problem relevant to anyone who given—unless all five steps in the “bundle” and the has been or will be in an intensive care unit (ICU) or oral hygiene were done, the score was zero. The graph who will have a loved one in an ICU. A patient on shows that in the months since the ICUs began working a ventilator who contracts pneumonia has a 30 per- on reducing cases of VAP, performance of the five-step cent chance of dying, a pretty high rate of mortality. bundle, and the oral care, have risen to 100 percent. The good thing is that we know how to prevent many Note that the change was not a response to an order of these cases by taking five well documented steps, from CMS (the Medicare agency), which keeps track of including elevating the bed to 30 degrees, plus washing infections and other events and posts results a few years out the patient’s mouth every four hours to decrease the after the fact. Neither the insurance companies nor chances that bacteria growing there will enter the lungs patients nor even the hospital administrator insisted and cause pneumonia. that these things be done. In fact, it was academic phy- Keep in mind that an ICU, even though it is staffed sicians, who read journals and other publications from by one nurse for every patient, is a very demanding and around the world, who instigated the changes. After busy place and that the staff has a lot to do. To success- several of them had read the recent literature about pre- fully prevent VAP, the five steps plus oral hygiene must, venting VAP, they decided they should change the way therefore, be part of the culture, part of the routine, ICUs cared for patients. required workflow. But—and here’s the key—they then had to organize This blog posting shows the results of changes in our the 200 people who work in ICUs. Respiratory thera- ICU protocol (Figures 1 and 2). No partial credit was pists, nurses, and doctors all had to be trained to change Spring 2008

the “industrial” process, with no increase in staff and they feel proud of their efforts and motivated to move with basically no increase in resources. The doctors on to the next topic and the next opportunity for clini- went to work and made it happen. cal improvement. To the extent that results have not Many of the changes were not very complex. It yet reached the hoped-for target, publication acts as an became apparent, for example, that people do not have incentive to do better. a good sense of angles. A nurse or doctor might think Systemic change occurs as a result of an unusual the head of the bed has been raised to a 30-degree angle type of cooperation between the technical experts when it has only been raised to 20 degrees. To address who deliver care and an administration dedicated to this problem, protractors were put on the beds—the transparency of outcomes. Creative tension creates a big ones used by construction companies that are easy climate in which the only way to relieve it is to actu- to see. ally reach the goal, no matter how audacious the tar- I watched the results of the changes and started post- get. The only alternative would be to lower the target, ing them before they reached the 90 percent rate. At an unacceptable result for personal, professional, and that point, the head of this group sent an e-mail to his institutional reasons. colleagues that read something like this: “As you may I would be remiss, however, if I did not point out a have heard, Mr. Levy has a blog on which he is now symptom of the problems in academic medical centers. posting our success rates with ventilator-associated When I began posting clinical results on my blog, I pneumonia prevention. Perhaps we should take this as received many less than positive reactions from other an additional impetus to do even better, because people academic medical centers in Boston. Many were dis- out there are watching.” This message seemed to sup- dainful and convinced that publication of results was port my hypothesis that public disclosure of clinical “not good for academic medicine.” results could motivate efforts to improve processes. I hope to break down that attitude and persuade Estimates of the results of our changes in ICU care people of the value of public disclosure. From the are that 300 cases of VAP were prevented last year, traffic on my blog (more than 10,000 viewings per and 90 lives were saved. At a cost of $40,000 per case, week, including visits from medical centers all around we believe we avoided about $12 million in health the world), it now appears that people are watching. care expenses. This is a clear example of how quality I believe that social and political forces will combine improvement and cost savings can go hand in hand. to make public disclosure the norm in the future.

Motivations for Change References People in an academic setting are motivated by a IOM (Institute of Medicine). 2000. To Err Is Human: Build- combination of factors—competition, data, intellectual ing a Safer Health System. Washington, D.C.: National curiosity, and deep concern for the welfare of patients. Academies Press. They are decidedly not motivated by demands from on Krasner, J. 2006. Medical insurance hikes loom in Massachu- high, particularly from an administrator, who is not nec- setts. Boston Globe, September 10, 2006. Available online essarily an MD or even an engineer. However, when the at http://www.boston.com/news/local/articles/2006/09/10/ administrator or CEO of a hospital posts good results, medical_insurance_hikes_loom_in_mass/. Innovative, “disruptive” changes in the way health care is organized, paid for, and delivered may lead to a transformation of the overall health care system.

Disruptive Innovation in Health Care: Challenges for Engineering

Jerome H. Grossman

Seven years after the publication of two seminal reports by the Institute of Medicine, To Err Is Human (IOM, 2000) and Crossing the Quality Chasm (IOM, 2001), which documented uneven quality, dangers, and inconsisten- cies in health care delivery, a majority of the nation’s health care providers are still struggling with those same challenges. Simultaneously, a backlash against the managed-care systems of the 1980s and 1990s has led to very Jerome H. Grossman is director rapid increases in health care expenditures and consequent rapid increases in of the Harvard/Kennedy School the number of uninsured and underinsured people, both of which continue Health Care Delivery Program, John unabated. Today, there is a growing consensus that the twentieth-century model of health care is no longer sustainable. F. Kennedy School of Government, After nearly a decade of subcritical attempts in the public and private and a member of the Institute of sectors to improve the quality of health care and bring costs under control, Medicine. This article is based on a buyers’ revolt, led by businesses and insurers, combined with advances in medical and information and communication technologies (ICT), has begun his presentation on October 1, to open the closed market for health care services to new business models, as 2007, at the NAE Annual Meeting well as to new models of care delivery. Technical Symposium. Innovative, “disruptive” models of care delivery are opening the way to a new division of labor among health care providers and changes in the structure and location of care delivery. Eventually, they could catalyze a wholesale transformation of the overall health care system by accelerating the development and application of ICT tools and techniques that would Spring 2008 11

make possible the design, analysis, and governance of patients with one or more chronic conditions (Partner- new processes and systems throughout the health care ship for Solutions, 2002). system. Engineering will play a major part in supporting This fragmented care system has been sustained by this disruptive dynamic and realizing its promise. an outdated fee-for-service reimbursement model and regulatory framework that has rewarded health care pro- Understanding the Logjam viders as well as drug, device, and equipment manufac- More than 98,000 Americans die and more than turers for providing high-priced services based on new one million patients are injured each year as a result medical technologies and procedures. While this frame- of broken health care processes and system failures work has supported rapid advances in medical science (IOM, 2000; Starfield, 2000). In addition, the gulf and the development of increasingly precise diagnostic between the rapidly advancing medical knowledge base tools and therapeutic interventions, it has been indif- and the application of that knowledge to patient care ferent to, if not discouraging to, innovation directed at continues to widen. In fact, barely 50 percent of patients harnessing advances in medical knowledge and preci- in the United States receive known “best practice” sion diagnostics to improve the quality and efficiency treatment for their illnesses (Mangione-Smith et al., of health care. 2007; McGlynn et al., 2003). According to one survey, 75 percent of patients consider the health care system to be fragmented and fractured, a “nightmare” to navigate, and plagued by duplications of effort, poor communica- More than 98,000 Americans tion, conflicting advice, and tenuous links to the evolving medical evidence base (Picker Institute, 2000). die every year as a result of Poor quality is not only dangerous but also costly. David Lawrence, retired chairman and chief executive broken health care processes. officer of the Kaiser Foundation Health Plan (2005), estimates that 30 to 40 cents of every dollar spent on health care, more than a half-trillion dollars per year, is Largely because of its cottage-industry structure and spent on costs associated with “overuse, underuse, mis- dysfunctional reimbursement and regulatory framework, use, duplication, system failures, unnecessary repetition, the health care sector has woefully underinvested in poor communication, and inefficiency.” ICT—the nervous system of all information-intensive Since the late 1990s, annual health care costs have industries—to support core clinical and administrative/ risen by double digits—roughly three times the rate business operations. Health care is also underinvested of inflation—claiming an increasingly large share of in mathematical/conceptual tools and techniques for every American’s income, inflicting economic hard- designing, analyzing, and controlling a myriad of com- ships on many, and limiting access to care. By 2006, plex processes and systems. Without these tools and the nation’s uninsured population had risen to nearly technologies, most health care providers lack the capac- 47 million, about 16 percent of people under the age of ity to translate the rapidly expanding stream of diag- 65 (DeNavas-Walt et al., 2007), and it has continued nostic and therapeutic advances in medical science into to increase since then. high quality, affordable health care for all. The immediate causes of this “perfect storm” of qual- To be sure, there are isolated pockets of progress. ity and cost crises in health care are well understood. Large integrated salaried group practices with manager U.S. health care is a highly complex enterprise with ial hierarchies, such as Mayo Clinic, Kaiser Permanente, a “cottage-industry” structure (i.e., many small-scale, Intermountain Healthcare, Veterans Administration interdependent service providers that act independently (VA), and the Military Health System, are committed creating “silos” of function and expertise). This siloed to the cost-effective use of precision diagnostics and system is sorely mismatched to the nation’s overrid- therapeutics and the consistent practice of evidence- ing health challenge, namely, providing coordinated, based medicine. These groups have also invested in integrated, continuous care to more than 125 million ICT to support quality care and have even begun to use Americans who suffer from chronic disease. Seventy- systems engineering tools and techniques to improve five percent of U.S. health care dollars is spent on clinical operations. The 12 BRIDGE

However, the vast majority of groups and institu- especially at the state level. The primary force behind tions in the health care delivery system have made these changes is “disruptive innovation,” a combination little progress. The hodgepodge of individual providers, of technological advances and new business models that small group practices, clinics, academic medical cen- has the potential to transform the structure, organization, ters, community hospitals, and others continues to lag and performance of the health-care system as a whole. far behind in the efficient use of precision diagnostics and therapies, the practice of evidence-based medicine, Disruptive Innovation and the use of ICT systems and tools. For example, it is Clay Christensen, professor of business administra- estimated that only 25 percent of physicians currently tion at Harvard, introduced the theory of disruptive use some form of electronic health record and that less innovation in his book, The Innovator’s Dilemma, in than 10 percent of doctors use a “fully operational” sys- 1997. He postulated that consumers will seek out those tem.1 In the meantime, costs continue to rise, and the who can do the jobs they want done and evaluate them quality battle is, at best, at a standstill. by three simple measures: level of transparency, conve- nience of delivery, and cost that represents value. In the industries Christensen studied, consumers brought about wholesale transformations of the prevailing busi- The struggle to improve ness models by purchasing new products and services that were much more affordable and accessible than the quality of care is, at best, those that had been traditionally offered. at a standstill. Christensen argues that two conditions are necessary for disruptive innovation to increase to scale: (1) technological enablers (i.e., technologies that provide routine solutions to problems that previously required trial Breaking the Logjam and experimentation); and (2) a disruptive business Private-sector purchasers, especially large self-insured model that can profitably deliver these routine solutions organizations, convinced that the current system is to customers in affordable and convenient ways. broken and unlikely to be transformed by government The personal computer is an instructive example action, have begun to purchase health care services for of a disruptive innovation. Prior to the 1970s, only a their employees directly (i.e., not through insurers) from small number of engineers worldwide had the expertise existing or new high-value service providers, especially to design mainframes or minicomputers, which were, for wellness and preventive care, primary care, and therefore, expensive to make and market; in fact, they chronic disease management. Many large employers offer required gross profit margins of 45 to 60 percent just to fully integrated health care services for their employees cover overhead costs. In addition, users also needed from existing large multispecialty salaried group prac- expertise to operate them. The personal computer tice providers, such as Kaiser Permanente, Intermoun- disrupted this model by making computing affordable tain Healthcare, and others. At the same time, many and accessible to hundreds of millions of people. The start-up companies, backed by venture capital, are offer- technological enabler of this disruption was the micro ing high-quality, low-cost wellness care, primary care, processor, which radically simplified computer design and chronic-care services that can be delivered via the and assembly (Christensen, 1997). World Wide Web or low-cost intermediaries. Pressure on regulators to increase transparency in Technological Enablers for Disruptive 2 health-care markets and lower entry barriers to new Innovation in Health Care types of service providers is beginning to have an impact, Precision Diagnostics and Therapies Technological enablers of disruptive innovation in 1 The 2006 report of the Robert Wood Johnson Foundation, Health health care are: (1) advances in medical knowledge and Information Technology in the United States: The Information Base for Progress, provides a definition of a fully operational electronic health record: “An electronic approach to collecting, storing and manipulating patient data must be able to accomplish at least four tasks: collection of 2 A book on disruptive innovation in health care, by C. Christensen, patient health information and data, results management, order entry J. Grossman, and J. Hwang, will be published by McGraw-Hill in management, and decision support.” late 2008. Spring 2008 13

more precise medical diagnostics and therapies (includ- precision therapies or best-practice care protocols based ing drugs, devices, equipment, and procedures); and on advancing medical knowledge.. (2) advances in ICT, including Web 2.0 applications, ICT can make feasible the integration of a patient’s broadband communications, and wireless integrated health care data with a continuously advancing medical microsystems (WIMS). evidence base to provide real-time medical decision sup- Over the past half century, advances in medical port to professional care providers, as well as to patients knowledge and diagnostic technologies have greatly and their families. ICT also enables the collection, inte- increased the accuracy of diagnoses and treatments of gration, and analysis of data on the performance of the disease. If precision diagnosis is not available, treatment overall system and supports the use of many advanced is determined by “intuitive medicine” (i.e., therapeutic systems design, analysis, and governance tools and problems solved by highly trained, expensive profes- methods to improve system performance. sionals through intuitive experimentation and pattern Since 1960, efforts have been made to encourage the recognition). Intuitive medicine gives way to evidence- use of electronic records, but implementation has been based medicine when a patient’s treatment is guided by limited mostly to integrated multispecialty group prac- data showing which therapeutic interventions are, on tices. One of the most promising disruptive informa- average, most effective. tion technologies, the personal health record (PHR), If precision diagnosis is available, treatment becomes has advanced efforts to put electronic medical records in “precision medicine”—targeted therapies, includ- place throughout the health care system. Omid Mogha- ing drugs, devices, procedures, and so on, that can be dam, director of PHR programs at Intel, describes a PHR developed and routinized to address the causes rather as a record “owned and controlled by the patient that than the symptoms of an illness. Precision medical care incorporates data the patient enters, but also includes can be delivered by less highly trained, less expensive authenticated information. . . . from all of the places the care providers. So called “minute clinics,” for example, patient is involved with—insurance company, hospital, staffed by nurse practitioners using rules-based care, offer doctors’ offices, labs, and so forth” (Harvard Medical a limited range of services in shopping malls and drug- School, 2006). stores (Scott, 2006). In another case, at Intermountain Healthcare, four specialist physicians supervise the care of nearly 20,000 diabetics, mostly by family physicians, helped by nurse practitioners, specially trained techni- The personal health cians, and volunteers.3 Diagnostic technologies have already changed the record is one of the most treatment of most infectious diseases from intuitive to precision medicine. In recent years, the emergence of promising disruptive molecular diagnostics and imaging diagnostics has made information technologies. medical diagnosis and treatment even more precise. Advances in genomics and proteomics promise even greater precision, as well as personalization, of clinical diagnoses and treatments. Some companies have already adopted PHRs for their employees, and some insurers are using them to Advances in Information/Communications Technologies try to retain customers. Even Microsoft and Google The second technological enabler, advances in are competing for PHR business. The hope is that by ICT, not only supports precision medicine by enabling bringing together an individual’s medical information the development of increasingly precise techniques from all relevant sources, that individual will be in a and devices and the capture and integration of clini- better position to manage and control his or her medical data for research purposes. They also facilitate the cal care.4 Widespread use of PHRs could create an codification, continuous updating, and diffusion of

4 A good analogy is Intuit’s Quicken software, which brings together 3 Personal communication, Brent James, MD, vice president for medical financial information from many sources so an individual can manage research at Intermountain Healthcare. and control his or her own assets. See http://quicken.intuit.com. The 14 BRIDGE informed consumer base that can begin to buy health increasingly determined by the precision, consistency, services directly, rather than through third parties. and efficiency of care delivery. PHRs are diffusing very rapidly from academic environ- Rather than change the overall system, precision ments to academic-corporate-consortium partnerships, medicine was grafted onto the existing organizational and recently to the commercial world (e.g., Microsoft framework. However, because of their high overhead HealthVault).5 costs, general hospitals and physician practices have WIMS is another emerging disruptive ICT. These com- not been able to translate precision medical services binations of sensors based on microelectromechanical to higher value (i.e., low-cost, high-quality, accessible systems, microelectronics, and wireless interfaces may care) for patients. Meanwhile, the development of new provide remote, real-time monitoring, diagnosis, and business models capable of harnessing the potential of therapeutic intervention in health care (NAE, 2005). precision medicine to yield value have been stymied As the information infrastructure to support advanc- by the entrenched fee-for-service model and regulatory ing precision diagnosis and therapy improves, more framework that protect the intuitive-medicine model of kinds of precision, routinized diagnostics and thera- care from disruptive competitors. pies can be moved to locations that are convenient for Nevertheless, new forces in health-care markets have patients (e.g., from outpatient facilities to in-office or begun to open the way to disruptive business models in even in-home care) staffed by less highly trained, less both purchasing and the delivery of care. Large cor- expensive health care providers—again providing bet- porations and consortia of organizations are reconfigur- ter value. ing their conceptions of employee health care benefits. One emerging model is “direct-value purchasing” by self-insured enterprises (e.g., large employers, multi- employer union trusts [such as voluntary employee Precision medicine has been benefit associations]) from entrepreneurial, venture- backed health-service delivery companies. In this grafted onto the existing model, employers contract directly with providers to organizational framework. deliver high-value health care that matches the needs of employees and their families. The most likely companies to be self-insured have 1,000 or more employees, and estimates are that they now represent more than Disruptive Business Models for Health Care 100 million employees/consumers. Self-insured compa- At present, the sustaining business model in health nies pay insurance companies an administrative fee to care is the 60-year-old Medicare “fee-for-service” model, process claims but bear the full cost of medical care. which is controlled by special interests with political In response to these disruptive models, new care- control over the regulatory and reimbursement system. delivery models are emerging, such as Carena, a venture- Most private insurers mimic Medicare, and each state backed enterprise that provides primary care.6 Microsoft imposes further regulations. This is an inflationary, dis- has contracted directly with Carena to make home vis- torted, “third-party” model. its by family practitioners to Microsoft employees and The two prevailing institutional modes of care arrange for follow-up (e.g., prescriptions, tests, special- delivery in the United States, general hospitals and ists), as needed. Microsoft has found that, even at a very physician practices, developed more than a century high hourly rate, employee satisfaction and increased ago when the practice of medicine was focused pre- productivity more than cover the costs of the service. dominantly on the diagnosis and solution of unstruc- In addition, costs for Microsoft families are compa- tured problems by highly trained clinicians. As some rably low. Carena’s latest contract is with the state of areas of medicine, especially some aspects of primary Kentucky, another self-insured entity, in partnership and chronic care, moved toward more precise, routin- with Humana. ized diagnostics and therapies, the value of care became Other examples of “disruptive care” are delivered

5 For additional information on Microsoft HealthVault record, see http:// 6 For additional information on Carena, see the company’s website at: www.healthvault.com. http://www.carenamd.com. Spring 2008 15

by Renaissance Health, a private contractor hired by investment in ICT infrastructure, and managing policy, a union to deliver primary care, including simple blood reimbursement, and regulatory systems to support the tests and x-rays, and over-the-counter and generic pre- transformed health care system. scription drugs for $30/month for janitors in the Hous- ton area who are uninsured. Boeing has also contracted Acknowledgments with Renaissance Health to care for chronically ill I wish to express my gratitude to Elizabeth Grossman, patients. These cases are handled by small care-teams Christopher Meyer, Proctor Reid, and William Rouse located in the general clinics used by Boeing.7 for giving generously of their time and advice during the If present trends continue, disruptive business mod- preparation of this paper. els and advances in precision care and diagnostics are likely to spread to encompass a significant segment of References the market, especially for providing primary care and Christensen, C.M. 1997. The Innovator’s Dilemma. Boston, chronic care. As high-quality, reliable, safe, health care Mass.: Harvard Business School Press. services delivered effectively by less highly trained staff Christensen, C.M., J. Grossman, and J. Hwang. Forthcoming. are documented by careful, authoritative research, the Diagnosing the Disease. New York: McGraw-Hill. spread of disruptive service enterprises should acceler- DeNavas-Walt, C., B.D. Proctor, and J. Smith. 2007. Income, ate, pulled along by the diffusion of disruptive business Poverty, and Health Insurance Coverage in the United models by self-insured private, and eventually, public States: 2006. Pp. 60–233 in U.S. Census Bureau Current (state-level) organizations determined to ensure high- Population Report. Washington, D.C.: U.S. Government value health care. Printing Office. Also available online at: www.census.gov/ prod/2007pubs/p60-233.pdf. Implications for Engineering Harvard Medical School. 2006. Personally Controlled Health The dynamics of disruptive innovation in health care Record Infrastructure. Boston, Mass.: Harvard Medical present general as well as specific challenges for engi- School. Available online at: www.pchri2006.org neers. On a general level, disruptive innovation will IOM (Institute of Medicine). 2000. To Err Is Human: Build- require combining the technologies, tools, and tech- ing a Safer Health System. Edited by L.T. Kohn, J.M. Cor- niques of systems engineering with a deep understand- rigan, and M.S. Donaldson. Washington, D.C.: National ing of business processes and organization in the health Academies Press. care and services industries. As health care markets IOM. 2001. Crossing the Quality Chasm: A New Health open up to new business models, engineers can pursue System for the 21st Century. Washington, D.C.: National fruitful research on tools, techniques, and engineered Academies Press. technologies to support the design, analysis, and gover- IOM. 2004. Insuring America’s Health: Principles and Rec- nance of new delivery modes and networks. ommendations. Washington, D.C.: National Academies On a more specific level, engineers can develop, adapt, Press. and help implement the technological enablers of con- Lawrence, D. 2005. Bridging the Quality Chasm. Pp. 99–102 tinuing disruptive innovations in health care. These in Building a Better Delivery System: A New Engineering/ will include WIMS to support the remote delivery of Health Care Partnership, Part II. Washington, D.C.: high-value care (e.g., monitoring, diagnosis, and thera- National Academies Press. py); the development of decision support tools for pro- Mangione-Smith, R., A. DeCristofaro, C. Setodji, J. Keesey, fessional providers, health care purchasers, and equally D. Klein, J. Adams, M. Schuster, and E. McGlynn. 2007. important, patients and their families; the application The quality of ambulatory care delivered to children in the of bioengineering and systems engineering to accelerate United States. New England Journal of Medicine 357(15): the spread of personalized, precision medicine; and the 1549–1551. application of systems engineering tools and techniques McGlynn, E.A., S.M. Asch, J. Adams, J. Keesey, J. Hicks, A. for managing and improving the performance of com- DeCristofaro, and E.A. Kerr. 2003. The quality of health plex, interdependent processes and subsystems, guiding care delivered to adults in the United States. New England Journal of Medicine 348(26): 2635–2645. NAE (National Academy of Engineering). 2005. Building a 7 For additional information on Renaissance Health, see the company’s website at: http://www.renhealth.net/. Better Delivery System: A New Engineering/Health Care The 16 BRIDGE

Partnership. Washington, D.C.: National Academies Technology in the United States: The Information Base Press. for Progress. Available online at: http://www.rwjf.org/files/ Partnership for Solutions. 2002. Chronic Conditions: Mak- publications/other/EHRReport0609.pdf. ing the Case for Ongoing Care. Prepared for the Robert Scott, M.K. 2006. Health Care in the Express Lane: The Wood Johnson Foundation. Baltimore, Md.: Johns Hop- Emergence of Retail Clinics. Prepared for California kins University Press. Healthcare Foundation, by Mary Kate Scott. Marina del Picker Institute. 2000. Eye on Patients. A Report by the Rey, Calif.: Scott & Company. Picker Institute for the American Hospital Association. Starfield, B. 2000. Is U.S. health really the best in the world? Boston, Mass.: Picker Institute. Journal of the American Medical Association 284(4): Robert Wood Johnson Foundation. 2006. Health Information 483–485. Management of complex adaptive systems requires leadership rather than power, incentives and inhibitions rather than command and control.

Health Care as a Complex Adaptive System: Implications for Design and Management

William B. Rouse

For several years, the National Academies has been engaged in a systemic study of the quality and cost of health care in the United States (IOM, 2000, 2001; National Academy of Engineering and Institute of Medicine, 2005). Clearly, substantial improvements in the delivery of health care are needed and, many have argued, achievable, via value-based competition (e.g., Por- ter and Teisberg, 2006). Of course, it should be kept in mind that our health William B. Rouse is executive care system did not get the way it is overnight (Stevens et al., 2006). director, Tennenbaum Institute, Many studies by the National Academies and others have concluded that Georgia Institute of Technology, a major problem with the health care system is that it is not really a system. In this article, I elaborate on the differences between traditional systems and and an NAE member. This article complex adaptive systems (like health care) and the implications of those is based on a presentation at differences for system design and management. the NAE Annual Meeting Technical Complex Adaptive Systems Symposium on October 1, 2007. Many people think of systems in terms of exemplars, ranging from vehi- cles (e.g., airplanes) to process plants (e.g., utilities) to infrastructure (e.g., airports) to enterprises (e.g., Wal-Mart). In addition, they often think of improving a system by decomposing the overall system performance and management into component elements (e.g., propulsion, suspension, electronics) and subsequently recomposing it by integrating the designed solution for each element into an overall system design. The 18 BRIDGE

This approach of hierarchical decomposition (Rouse, emergent behaviors may range from valuable inno- 2003) has worked well for designing automobiles, vations to unfortunate accidents. highways, laptops, cell phones, and retail systems that • There is no single point(s) of control. System behaviors enable us to buy products from anywhere in the world are often unpredictable and uncontrollable, and no at attractive prices. The success of traditional systems one is “in charge.” Consequently, the behaviors of depends on being able to decompose and recompose the complex adaptive systems can usually be more easily elements of the system and, most important, on some- influenced than controlled. one or some entity having the authority and resources to design the system. Before elaborating on these characteristics in the context of health care, it is useful to reflect on an overall implication for systems with these characteristics. One cannot command or force such systems to comply with Hierarchical decomposition behavioral and performance dictates using any conventional means. Agents in complex adaptive systems are does not work for complex sufficiently intelligent to game the system, find “work- arounds,” and creatively identify ways to serve their adaptive systems. own interests.

The Health Care Game Not all system design and management problems Consider the large number of players, or “agents,” can be addressed through hierarchical decomposition. involved in the health care game (Table 1). It is reason- For example, decomposition may result in the loss of able to assume that each type of agent attempts to both important information about interactions among the serve its own interests and provide quality products and phenomena of interest. Another fundamental problem services to its customers. However, there are conflict- for very complex systems like health care is that no one ing interests among stakeholders, just as there are dif- is “in charge,” no one has the authority or resources to ferent definitions of quality. Thus, even assuming that design the system. Complex adaptive systems tend to all agents are well intentioned, the value provided by have these design and management limitations. the health care system is much lower than it might be, Complex adaptive systems can be defined in terms of in the sense that health outcomes may be compromised the following characteristics (Rouse, 2000): and/or the costs of delivering these outcomes may be excessive. • They are nonlinear and dynamic and do not inherently Working with the American Cancer Society, we stud- reach fixed-equilibrium points. As a result, system ied the value chain associated with disease detection behaviors may appear to be random or chaotic. (Rouse, 2000). Many people naively believe that new • They are composed of independent agents whose detection technology is the key to successful detection. behavior is based on physical, psychological, or social However, unless we address consumer awareness, con- rules rather than the demands of system dynamics. sumer education, physician education, and consumer advocacy, to name a few of the other components of the • Because agents’ needs or desires, reflected in their rules, value chain, patients may not experience the benefits are not homogeneous, their goals and behaviors are likely of new detection technologies. In general, enormous to conflict. In response to these conflicts or competi- investments in medical research will not substantially tions, agents tend to adapt to each other’s behaviors. improve health care outcomes unless they are intro- • Agents are intelligent. As they experiment and gain duced with an understanding of the overall system. experience, agents learn and change their behaviors In this context, it is useful to look more closely at accordingly. Thus overall system behavior inherently the two cells in Table 1 that include physicians. One changes over time. aspect of the overall health care value chain is the process of education and certification that provides • Adaptation and learning tend to result in self- trained, licensed physicians. Physician education and organization. Behavior patterns emerge rather than training are currently being reexamined to identify being designed into the system. The nature of Spring 2008 19

TABLE 1 Stakeholders and Interests in Health Care

Stakeholder Risk Management Prevention Detection Treatment Public e.g., buy insurance e.g., stop smoking e.g., get screened

Delivery System Cliniciansa Clinicians and providersb

Government Medicare, Medicaid, NIH, Government CDC, NIH, Government CDC, NIH, Government CDC, Congress DoD, et al. DoD, et al. DoD, et al.

Non-Profits American Cancer American Cancer American Cancer Society, American Heart Society, American Heart Society, American Heart Association, et al. Association, et al. Association, et al.

Academia Business schools Basic science disciplines Technology and medical Medical schools schools

Business Employers, insurance Guidant, Medtronic, et al. Lilly, Merck, Pfizer, et al. companies, HMOs aThe category of clinicians includes physicians, nurses, and other health care professionals. bThe category of providers includes hospitals, clinics, nursing homes, and many other types of testing and treatment facilities. future physician competencies and determine the best stakeholders and interests, layered by organization, way to provide them. Some of the many stakeholders specialty, state, and so on. If this system is approached in this process are listed below: in the traditional way, decomposing the elements of the system, designing how each element should func- • Accreditation Council for Continuing Medical tion, and recomposing the overall system would be Education overwhelming. Thus we must address health care in • Accreditation Council for Graduate Medical a different way and from a different point of view—as Education a complex adaptive system.

• American Academy of Family Physicians Modeling Complexity • American Board of Medical Specialties The first consideration in designing an effective health care system is complexity. Figure 1 provides • American Medical Association a high-level view of the overall health care delivery • American Osteopathic Association (AOA) network based on recent studies of service value networks (Basole and Rouse, 2008). Note that each node • AOA Council on Postdoctoral Training in the network includes many companies and other • Council of Medical Specialty Societies types of enterprises. Assessing the complexity of networks involves defin- • Federation of State Medical Boards ing the state of the network, that is, the identity of the • Joint Commission on Accreditation of Healthcare nodes participating in any given consumer (patient) Organizations transaction. We then use information theory to cal- culate the number of binary questions that have to be • Liaison Committee on Medical Education asked to determine the state of the network. Given esti- This list is representative, but not exhaustive. In mates of the conditional probabilities of a node being addition, many functions of these organizations are involved in a transaction, complexity can be calculated state specific, so there might be 50 instances of these and expressed in terms of binary digits (bits). academies, boards, committees, and councils. Figure 1 summarizes an assessment of the complexity Even from this brief description, it is apparent that of five markets. Note that the complexity of health care the system of health care delivery involves what we is assessed to be 27 bits. This means that determin- might call networks of networks or systems of systems ing which nodes (i.e., enterprises) are involved in any that involve an enormous number of independent particular health care transaction would require on the The 20 BRIDGE

Government and Policy Makers

Health Insurance

Pharmacy

Pharmaceuticals Health Wholesalers

Health Consumers Providers Medical Equipment R&D Laboratories

Other Equipment

Figure 1 A summary of the complexity of five markets in the health care delivery network. order of 1 billion binary questions. Thus it would be The idea of consumer-directed health care, however, an enormous task to determine the state of the overall is going in the opposite direction in that it increases health care system. complexity for consumers, and possibly for clinicians. Notice the ratios of consumer complexity to total Using other markets as benchmarks, we would expect complexity in Figure 2. Even though the retail market this push to fail, or at least to have limited success. Thus is the most complex market, the consumer only has to the goal should be to increase the complexity of health address a small portion of this complexity. The retail care where it can be managed in order to reduce com- industry has been quite successful in managing the complexity for patients, their families, physicians, nurses, plexity of bringing a rich variety of products and services and other clinicians. to market without consumers having to be concerned The case for decreasing complexity for clinicians is about how this cornucopia arrives on store shelves—or supported in the analyses by Ball and Bierstock (2007), online outlets. who argue that enabling technologies should support The telecom industry has the worst ratio, as anyone both clinicians’ workflow and “thought flow.” As long who has tried to call for vendor technical support for as systems increase clinicians’ workload while providing a laptop can attest. As a consumer, you need to know them few if any benefits, the adoption of technology much more than you want to know about the hardware will continue to be difficult. and software inside your laptop. A substantial portion of innovations being pursued in this market are aimed Design Implications at significantly reducing the complexity experienced by Our studies of the complexities of markets have led consumers. We expect that those who are most suc- to two propositions for which we have found consider- cessful at reducing consumer complexity will be the able supporting evidence. Thus we now feel they can winners in this rapidly changing market. be articulated as design principles. Spring 2008 21

Consumer Total 30

15 Complexity (Bits)

0 Aerospace Automotive Retail Health Care Telecom

Figure 2 Comparative levels of complexity for five markets.

Design Principles whether they are customers, partners, collaborators, First, the nature and extent of business-to-consumer channels, competitors, or regulators. Starting with service value determines business-to-business service this model of the enterprise, the overarching strat- value, as well as the value of products and other value egy should focus on increasing complexity where it enablers. In the context of health care, the value pro- can be managed best and decreasing complexity for vided to consumers and the payment received for this end users. value determine the financial potential for all of the Designing Agile Complex Systems other players in the network. For example, if consumers do not value and will not pay for a particular test or Most mature enterprises can manage design, develop- treatment, none of the participants in this network will ment, manufacturing, and sustainment of products and be rewarded, no matter how far upstream they are from services. Few enterprises can manage economies, mar- patients and physicians. This is complicated, of course, kets, competitors, and end users. Put simply, because when third parties pay for products and services. one cannot control the state of health, education, or The second principle involves the ratio of business-to- preferences of those who seek health care, one cannot consumer complexity to total-market complexity. This assume that they will be able and willing to manage the ratio tends to decrease as markets mature. The most complexity of the system. Consequently, the design successful players in a market are those who contribute should be focused on managing complexity by provid- most to this decrease. To accomplish this, they usually ing ways of monitoring and influencing system state, have to increase business-to-business complexity, which performance, and stakeholders, as elaborated below. often increases total-market complexity. However, this This strategy for managing complexity can be facili- is done in ways that decrease the ratio of consumer com- tated by also designing an agile enterprise that can plexity to total complexity. This is the strategy that readily make decisions to redeploy resources to address health care should pursue. opportunities and problems (Rouse, 2006). Achieving As much as possible, complex systems should be agility requires trading off optimization to create the designed and not just emerge. Design should begin leanest possible enterprise while maintaining flexible with the recognition that the health care enterprise— resources that can respond to contingencies. The low- as a system—includes all stakeholder organizations, est cost health care system would be quite fragile if these The 22 BRIDGE contingencies have characteristics outside of the design Finally, value implies relevant, usable, and useful assumptions for which the system has been optimized. outcomes, which require that stakeholders under- Recent research indicates that the best way to address stand and appreciate the management philosophy of this trade-off is to use the construct of system architec- the system and its implications. In a complex adap- tures (Rouse, 2007a). tive system, a lack of understanding and/or appre- ciation tends to result in “dysfunctional” behaviors Management Implications by one or more stakeholder groups, although these Complex adaptive systems can be designed, but only behaviors may be well intended and even reason- to a certain degree. For instance, as outlined above, able according to the stakeholders’ understanding of one can design an enterprise-wide information system the ends being sought and the means appropriate to for such systems (Zammuto et al., 2007). However, achieving them. these systems cannot be designed in the same sense that a vehicle or industrial process can be designed. This is Organizational Behaviors because complex adaptive systems have strong tenden- The best way to approach the management of com- cies to learn, adapt, and self-organize. plex adaptive systems is with organizational behaviors Consequently, the task of managing complex adap- that differ from the usual behaviors, such as adopting tive systems becomes a challenge because, in effect, the a human-centered perspective that addresses the abili- system keeps redesigning itself. In fact, the construct of ties, limitations, and inclinations of all stakeholders “management” has to be viewed differently for complex (Table 2) (Rouse, 2007b). adaptive systems than for other types of systems. Con- Given that no one is in charge of a complex adaptive sider the management philosophy. Traditional systems system, the management approach should emphasize are managed to minimize cost. Health care must be leadership rather than traditional management tech- managed to maximize value. niques—influence rather than power. Because none, or very few, of the stakeholder groups in the health Value Philosophy care system are employees, command and control Recent attempts at health care reform have tended, in has to be replaced with incentives and inhibitions. effect, to pursue the lowest cost acceptable health care No one can require that stakeholders comply with for our population. In contrast, we should be pursuing organizational dictates. They must have incentives the highest value health care. Value focuses on orga- to behave appropriately. nizational outputs (or outcomes), rather than inputs. Not only are most stakeholders in health care inde- Thus we should emphasize the health states (outputs) of pendent agents, they are also beyond direct observa- patients rather than the revenues (inputs) of providers. tion. Thus one cannot manage their activities but can Value relates to the benefits of outcomes, rather than only assess the value of their outcomes. In a traditional the outcomes themselves. From this perspective, we system, one might attempt to optimize efficiency. should be very interested in productivity improvements However, the learning and adaptive characteristics attributable to wellness, rather than simply the absence of a complex adaptive system should be leveraged to of sickness. In an increas- TABLE 2 Comparison of Organizational Behaviors ingly knowledge-based economy, the intellectual Traditional System Complex Adaptive System assets embodied in people Roles Management Leadership are central to global competitiveness and economic Methods Command and control Incentives and inhibitions growth. A recent report Measurement Activities Outcomes from the Milken Institute Focus Efficiency Agility shows that the costs of lost productivity are often four Relationships Contractual Personal commitments to five times greater than Network Hierarchy Heterarchy the costs of health care Design Organizational design Self-organization (DeVol et al., 2007). Spring 2008 23

encourage agility rather than throttled by optimization system. If we were discussing the banking system, the focused on out-of-date requirements. answer would be the Federal Reserve Bank. The Fed Of course, there are contractual commitments in com- does not tell banks what to do, but it sets the prime plex systems, but because of the nature of these systems, interest rate and determines each bank’s reserve require- stakeholders can easily change allegiances, at least at the ments. Banks and investors then decide how they want end of their current contracts. Personal commitments, to adapt to any changes. which can greatly diminish the risks of such behaviors, The health care system has no overseer,1 although imply close relationships rather than arm’s-length rela- some have argued that there should be one, considering tionships among stakeholder groups and transparent the importance of the health of the country’s human organizational policies, practices, and outcomes. capital to competitiveness and economic growth. The Work is done by heterarchies, whereas permissions question is which variables an overseer might adjust. are granted and resources provided by hierarchies. To Perhaps it would adjust reimbursement rates in relation the extent that the heterarchy has to stop and ask the to the value of health outcomes. Admittedly, outcomes hierarchy for permission or resources, the efficiency and can be difficult to characterize and calibrate, and deter- effectiveness of the system is undermined. Decision- mining attribution of causes of outcomes can be difficult making authority and resources should be delegated because multiple actors are involved and outcomes only to the heterarchy with, of course, the right incentives emerge over time. Nevertheless, at the very least, we and inhibitions. should be able to characterize and assess bad outcomes Finally, as noted throughout this article, because (IOM, 2000). complex adaptive systems self-organize, no one can impose an organizational design. Even if a design were imposed, it would inevitably be morphed by stakeholders as they learn and adapt to changing conditions. In that Because complex adaptive case, the organization that management would think it was running would not really exist. To the extent that systems self-organize, everyone agrees to pretend that it still exists, or ever no one can impose an existed, value will be undermined. organizational design. Information Systems Based on the organizational behaviors for complex adaptive systems described above, information to over- More controversially, an oversight organization see the system should include the following elements: might adjust tax rates so that (risk-adjusted) high-value providers would pay lower taxes, perhaps reflecting the • Measurements and projections of system state in economic benefits of high-value health care. I know terms of current and projected value flows, as well as this idea is controversial because I have presented it to current and projected problems. various groups of thought leaders in health care. Beyond • Measurements and projections of system performance the philosophical objection to using the tax system to in terms of current and projected value, costs, and improve the public good, the most frequent criticism metrics (e.g., value divided by cost), as well as current is that providers cannot fully affect health outcomes and projected options for contingencies. because patient behaviors are also essential to success. However, this is also true of markets of all kinds. The • Observations of system stakeholders in terms of enterprises that succeed are the ones that convince the involvement and performance of each stake- and incentivize consumer behaviors that co-create holder group.

• Capabilities for measurement, modeling, and display 1 Some have argued that the Centers for Medicare and Medicaid Ser- of system state, including agile “What If?” experimen- vices (CMS), an element of the U.S. Department of Health and Human Services, plays a dominant role in setting reimbursement levels for tation and adaptation. patients enrolled in these programs via the Medicare Payment Advisory Commission. However, CMS does not oversee the whole health care The question arises about who would be looking at system or address the overall health outcomes and economic impacts and using the information for the whole health care discussed in this article. The 24 BRIDGE high-value outcomes. Success for the health care approaches 100 percent, many things would certainly model depends on providers seeing themselves as change, and health care might be rationed at that point. ensuring high-value outcomes, rather than being However, by acting long before we reach such a crisis reimbursed for the costs of their services. point, we can engineer much better solutions to providing high-value health care. Conclusions Systems engineering for health care can operate on The models and analyses discussed in this article can multiple time scales. Several of the ambitious ideas out- be summarized in just two words—information and lined here will take several years, or more, to be fully incentives. Substantial improvement in the system of realized. However, in the process of pursuing these health care in the United States will require that stake- ideas, we will gain in understanding, which will inevi- holders have easy access to information on the state and tably result in our identifying much low-hanging fruit, performance of the whole system, or any subsystem, as that is, short-term opportunities that can be pursued well as information on best practices at all levels. This much faster than the overarching vision. These short- information would be used to assess current and emerg- term pursuits will undoubtedly improve the health care ing situations in this complex adaptive system, which system, even as we work on the long-term vision to would lead to adjustments of incentives and inhibitions transform the overall system. to motivate stakeholders to change their behaviors to We need to analyze and design the systemic nature continually increase value. of health care delivery and not continue to let it evolve In general, incentives are essential to complex adap- and see whether one idea or another works. Complex tive systems. Outcomes, as well as activities, must be adaptive systems require sophisticated and sometimes incentivized. Payments to providers should reflect subtle analyses and designs, which will no doubt require the (risk-adjusted) value of the outcomes achieved experts in a wide range of disciplines beyond engineer- regardless of the cost incurred to achieve them. Poorly ing. However, a strong competency for analysis and informed and/or out-of-date practices should be disin- design of complex adaptive systems will serve us well. centivized. High-performing providers should reap substantial rewards, and poorly performing providers will Acknowledgements go out of business. In this way, the average performance I am indebted to Marion Ball, Kenneth Boff, Dale level will continually rise. Compton, Jerome Grossman, John Paul, and Stephen Wellness, which contributes to productivity, should Schoenbaum for their comments and suggestions on also be incentivized. Building on the recent report of drafts of this article. the Milken Institute (DeVol et al., 2007), an economic model could be developed of the relationship between References wellness and productivity to provide a basis for determin- Aspinall, M.G., and R.G. Hamermesh. 2007. Realizing ing how much should be invested in public awareness and the promise of personalized medicine. Harvard Business education. The model would also be a basis for designing Review 85(10): 108–117. tax incentives for employers who offer wellness programs Ball, M.J., and S. Bierstock. 2007. Clinician use of enabling and whose employees participate in them. technology. Journal of Healthcare Information Manage- These are “big” ideas that need much refinement, ment 21(3): 68–71. analysis, and debate, and we must keep in mind the Basole, R., and W.B. Rouse. 2008. Complexity of service inertial power of the status quo. A few years ago, The value networks: conceptualization and empirical investiga- Economist (2004) published a long survey article on tion. IBM Systems Journal 47(1): 53–70. health care financing, which admonished would-be DeVol, R., A. Bedroussian, A. Charuworn, A. Chatterjee, reformers to remember that every health care dollar I. Kim, S. Kim, and K. Klowden. 2007. An Unhealthy saved is somebody’s income. Aspinall and Hamermesh America: The Economic Burden of Chronic Disease. Santa (2007) reinforced that idea in a recent assessment of the Monica, Calif.: Milken Institute. promise of personalized health care. Economist. 2004. Survey of Healthcare Finance. July 15. Thus we clearly need incentives for key stakeholders IOM (Institute of Medicine). 2000. To Err Is Human: Build- to change. One incentive might be a crisis. For exam- ing a Safer Health System. Washington, D.C.: National ple, when the percentage of GDP devoted to health care Academies Press. Spring 2008 25

IOM. 2001. Crossing the Quality Chasm: A New Health Rouse, W.B. 2006. Agile Information Systems for Agile System for the 21st Century. Washington, D.C.: National Decision Making. Chapter 2 in Agile Information Sys- Academies Press. tems, edited by K.C. Desouza. New York: Butterworh- National Academy of Engineering and Institute of Medi- Heinemann. cine. 2005. Building a Better Delivery System: A New Rouse, W.B. 2007a. Complex engineered, organizational and Engineering/Health Care Partnership. Washington, D.C.: natural systems: issues underlying the complexity of systems National Academies Press. and fundamental research needed to address these issues. Porter, M.E., and E.O. Teisberg. 2006. Redefining Health Systems Engineering 10(3): 260–271. Care: Creating Value-Based Competition on Results. Bos- Rouse, W.B. 2007b. People and Organizations: Explorations ton, Mass.: Harvard Business School Press. of Human-Centered Design. New York: John Wiley and Rouse, W.B. 2000. Managing complexity: disease control as Sons. a complex adaptive system. Information • Knowledge • Stevens, R.A., C.E. Rosenberg, and L.R. Burns, eds. 2006. Systems Management 2(2): 143–165. History and Health Policy in the United States. New Rouse, W.B. 2003. Engineering complex systems: implica- Brunswick, N.J.: Rutgers University Press. tions for research in systems engineering. IEEE Transac- Zammuto, R.F., T.L. Griffith, A. Majchrzak, D.J. Dough- tions on Systems, Man, and Cybernetics—Part C 33(2): erty, and S. Faraj. 2007. Information technology and the 154–156. changing fabric of organization. Organization Science 18(5): 749–762. As biology becomes an information science, health care will learn from nature how to accelerate change.

The Convergence of Information, Biology, and Business: Creating an Adaptive Health Care System

Christopher Meyer

The world of health care lies between the realms of medical science, which continues to deliver new treatments and information at an accelerating rate, and of policy, which is conservative by design to protect patients’ safety. Other organizations and businesses have been adapting to changing environments much more quickly than health care, but as biology and information sciences converge, the health care system could use similar techniques to Christopher Meyer is chief executive improve the quality of care. of Monitor Networks. This article Adaptive Enterprises is based on his presentation at Since the days of Henry Ford, traditional businesses have prized stabil- the NAE Annual Meeting Technical ity, efficiency, and predictability. A traditional businessperson looking at Symposium on October 1, 2007. the two graphs in Figure 1 might prefer the one on the left because of its stability and narrow range of variation. However, these graphs depict the heart rates of two individuals. The person on the right is healthy; the person on the left died eight days later. One might think a healthy heart would beat at a stable, predictable rate and that a diseased heart would have an erratic and changeable heartbeat. In fact, a healthy heart takes inputs from the body about the concentration of oxygen and sugar in the bloodstream and other conditions and then adapts—that is, it “makes a decision” about what to do. A heartbeat as constant as a metronome is a sign of disease. Spring 2008 27

Which Process is Healthier? to processes by which popu- lations of organisms evolve 140 140 in response to changing 130 130 environmental pressures. minute) 120 120 How does nature do it, and

er how can managers adopt 110 110

s p nature’s techniques? 100 100 In It’s Alive, Stan Davis beat 90 90 and I created a simplified e ( 80 80 model of evolution as the at outcome of six principles

t R 70 70 and then translated those 60 60 0 300 600 900 0 300 600 900

Hear principles into business terms Time (seconds) Time (seconds) (Meyer and Davis, 2003):

Heart Eight Days Healthy Heart • Self-organization. Any Before Cardiac Death group of “decision-making units” capable of link- FIGURE 1 Two cardiograms showing (left) an unhealthy heartbeat and (right) a healthy heartbeat. ing to each other, be they molecules, software This analogy holds true for business. In 2006, Ford routines, or people, is likely to organize autono- had to close a plant near Atlanta that had produced mously to create something more complex. In nature, the company’s line of Ford Taurus and Mercury Sable 92 chemical elements organized themselves into sedans, essentially identical cars. Although the plant our planet. In business, farmers have been forming was one of the most productive on the continent, it was weekly village markets for centuries (Kauffman, 1993). not adaptable. • Recombination. Biology remixes the recipes for spe- In the same year, Honda constructed a plant that cies by combining the genetic recipes of parents. This could produce both Civics and Elements, two quite remixing, or recombining, is the source of almost all different models. The capital efficiency lost from innovation in nature. In business, the Wright broth- investing in adaptability was small compared with the ers created something completely new by combining robustness gained from being able to follow the market. the capabilities of the airfoil, the bicycle wheel, and Asian manufacturers like Honda understand that bet- the internal combustion engine. ting on correctly anticipating the market in an environment of constant change is bound to be expensive • Selective Pressure. The environment determines in the long run. the likelihood of passing along genes to the next gen- But these trade-offs are becoming increasingly old- eration. A specific innovation, whether in the rain fashioned, because robustness and efficiency are not forest or the marketplace, may or may not confer an necessarily mutually exclusive. Information-intensive advantage. However, in a rapidly changing environ- approaches, such as mass customization and digital opti- ment, a higher rate of innovation improves the odds mization and control, can eliminate the inefficiencies of of a species finding a successful adaptation. variation, and real-time feedback loops and learning systems can update the way businesses work as circumstances • Adaptation. Over time, with cycles of recombina- change. In some industries, however, particularly health tion and selection of the fittest, the abilities of a spe- care, management approaches have not kept pace. cies evolve. • Coevolution. Species share the environment. As Learning from Nature Kauffman says, “When the frog evolves a sticky In the words of Stuart Kauffman (1993), a physician tongue, flies get Teflon feet.” and complexity theorist, “Nature’s been [adapting] for 3.8 billion years. Maybe we should pay attention to • Emergence. From looking at the periodic table, one how it does [this].” In the biosphere, adaptation refers would not predict that life would emerge from these The 28 BRIDGE

diverse elements. However, interactions among self- and controlling change to building an organization that organization, recombination, selection, adaptation, senses external change and responds appropriately, like and coevolution lead to a connected ecology, or, in a healthy heart. We refer to this as the shift to “adaptive business, an economy made up of markets. Inter management.” dependencies among interactions make it impossible The six principles of evolution outlined above can be to predict which outcome will emerge. For instance, translated into six practical business principles, which we cannot predict how a rain forest will change as we call “memes for managing” (Table 1). In the follow- the climate changes, or how capitalism will evolve ing sections we describe the business application of two as energy becomes scarce. memes: (1) “recombine” and (2) “sense and respond, learn and adapt.” “General Evolution”: Applying Biology to Business “Recombine” at John Deere Adaptation is embedded in biological systems, but John Deere uses techniques of directed evolu- the general theory can be applied to other kinds of tion—the intentional recombination and selection complex systems, including social systems like business. techniques used to create thoroughbreds and show When companies interact with one another they cre- dogs—to schedule operations in a highly complex ate new economic opportunities and capabilities. Busi- factory in Moline, Illinois. The factory makes seed ness capabilities are like genes, and we can think of the planters, the large machines farmers tow behind trac- economy as a set of capabilities turning each other on tors to sow seeds. and off the same way a genetic regulatory network turns Manufacturing planters is challenging because the gene expression on and off. many kinds of seeds, tractors, soils, and climate gen- For a business to thrive in a volatile, evolving envi- erate 1.6 million configurations, most of which are ronment, it must apply the lessons learned from bio- produced in low volumes. Thus Deere could not build logical evolution. Managers must shift from predicting a truly automated-transfer assembly-line factory. As

TABLE 1 Memes for Managing

Name Definition Business Example Application to Health Care Self-organize Manage your organization from the bottom Southwest Airlines cargo- Hippocratic oath, up. Influence the rules that affect individual routing simulator rule-based HMOs choices rather than the overall behavior of the organization.

Recombine Proliferating connections make Genetic algorithms to Gene shuffling recombination—of software code, product schedule John Deere attributes, people, and markets—easier. Turn factory production your business into an open system to capture the value and innovation of diversity.

Sense and respond, Equip your business to sense changes in Honeywell Adaptive Partners HealthCare learn and adapt real time and to respond immediately, Intelligent Recovery physician order-entry accurately, and appropriately. Then learn Thermostat system from that experience and incorporate the new information into your repertoire of responses.

Seed, select, and Test many diverse options and reinforce the Public beta software Evidence-based medicine amplify winners. Experiment, don’t plan. releases; Sun’s Java Fund

Live at the edge The rate of environmental change demands Google, Amazon Dr. Peter Pronovost’s of chaos internal instability for survival. Disrupt the checklists to prevent line static elements in your organization. infections in ICUs

Monetize molecules The next wave of innovation is in the Hybridized plants, Drug discovery intersection of molecular science and nanotechnology technology. Spring 2008 29

a result, workers wheeled planters through the aisles As the seasons change, the effect of the learned manually, and, depending on the particular configura- behavior also changes, for example because the room tions of the planters, they often bumped into each other loses heat faster in colder weather. Because the thermo- and impeded each other’s progress. Despite the use of stat keeps learning, its behavior adapts to these seasonal standard optimization techniques, such as linear pro- shifts. It not only senses and responds, but also learns gramming, throughput was poor. from the results of its actions and adapts to match its Finally, Bill Fulkerson, a Deere engineer, proposed a performance to the shifting environment. nonlinear approach—genetic algorithms. Given the set Recombination and SRLA together can lead to a of planters the factory wanted to build the next day, the new phase of economic evolution enabled by the con- system created a few random sequences for producing vergence of information and business. BMW recently them. The schedules were expressed digitally—each ran an ad showing a car’s wheels screaming and spinning one a string of zeros and ones, just as the instructions on an icy road. The driver hits a button and talks to the for creating an organism are expressed in a string of Gs, concierge, who quickly finds a solution to the driver’s Ts, As, and Cs. dilemma. The BMW downloads a patch to its traction- Deere engineers then applied the principle of selec- control system, and off goes the car with new behavioral tion to the schedules, evaluating each one with a com- rules onboard. puter simulator that assigned it a “fitness” score based on its simulated throughput. The winning sequences were then “put out to stud,” that is, a genetic algorithm recombined parts of the best schedules to create a new Nature’s methods generation of schedules. can outperform Every night, 40,000 new schedules ran simulated races, and the winning plan was used for the real-life engineering methods. production on the factory floor the next day. The genetically engineered schedules were about 15 percent more efficient than the schedules Deere had designed However, the new code could have evolved with- based on traditional linear methods. out human intervention. The antilock brake system The lesson from Deere’s recombinant strategy is that (ABS), which knows when a wheel is spinning, could nature’s approach to adaptation can outperform previ- have transferred the telemetry to a central information ous engineering methods. By using genetic algorithms, system. Even if the exact configuration of weather con- Deere literally translated the recombination of DNA to dition, climate, load, tire design, and road surface had recombinant code in another domain. never been seen before, BMW could have used a genetic algorithm to invent a new software solution by using “Sense and Respond, Learn and Adapt” at a simulator to evaluate the problem (as at Deere) and Honeywell and BMW send the “winner” to the traction-control system. The meme “sense and respond, learn and adapt” So far we have “sense” (the ABS system), “respond” (SRLA) has two feedback loops, one short term and (telemetry), and “learn” (recombination via a genetic one longer term. The thermostat in your home has one algorithm and the installation of new code in the brak- of these loops, a real-time sense-and-respond feedback ing system). What about “adapt”? BMW could take system that senses the temperature in the room and note of the success of the new software and update the responds by turning on the furnace when it drops below ABS not just in one BMW but throughout its fleet. a designated level. In this way the “species” would evolve, or adapt, in By comparison, the Honeywell Adaptive Intelligent response to the experiences of individual “organisms” Recovery Thermostat has higher consciousness. It to their environment. observes the effect of its actions on a room, and if it Businesses that install and exploit these feedback loops, overshoots the mark one day, perhaps because of the and have the capacity for innovation to adapt to them, high thermal mass of the radiators, it remembers and can create the capacity to respond to changing environ- turns off the heat earlier the next day. That’s the “learn” ments, not through studies, surveys, and redesigns, but part of SRLA. through a continuous evolutionary process. The 30 BRIDGE

Applying Biology to the Business of Health Care sense and respond, and learn and adapt as a collective In the words of Jerry Grossman, former head of the response. Scientists can simulate, for instance, a fully New England Medical Center, “Health care has been functioning human heart. Researchers at UCLA have locked in irons since the end of World War II.” While studied computer models of a heart to determine how most of the business world has become more adapt- drugs could be targeted more directly to the turbulent able, shortened its product life cycles, increased process breakup of heart waves during sudden cardiac arrest innovations, and increased the rates of job and CEO (Xie et al., 2004). The Food and Drug Administration turnover, health care, like the heart of the sick man in now accepts the results of similar heart simulations as Figure 1, has been too stable for too long. part of filings for drug licenses. Keep in mind, however, that health care’s reluc- Researchers have also used computer simulations to tance to embrace change is based on valid arguments. reduce wait times at a hospital in Canada. Managers Experimentation—and innovation always begins with were able to model, in the virtual world, the effect of experimentation—can be dangerous. Like an industrial adding a walk-in clinic for people with minor injuries factory floor of the 1930s filled with dangerous tech- and adding more physicians at peak times. They then nologies such as molten steel and explosive chemicals, put what they had learned from the simulation into hospital environments can be dangerous places, and practice (Blake and Carter, 1996). mistakes can be fatal. Innovation is not a good thing if Nature can even be reengineered as biological sys- people die when it leads to an unexpected result. The tems are translated into information and information medical meme for health care management, “First, Do is translated into biology. As Richard Dawkins (2003) No Harm,” is conservative for good reason. says, “Genetics today is pure information technology. Industry has increased its pace of change in the past This, precisely, is why an antifreeze gene can be copied two decades by embracing information technologies. from an arctic fish and pasted into a tomato.” Real-time sensing, algorithmic control systems, and The ultimate form of experimentation is the emerg- simulation, for example, have expanded the perfor- ing field of “synthetic biology,” radical techniques for mance envelope of all sorts of businesses. making the genetic engineering of an organism work as routinely as the design of a new computer chip. One goal of synthetic biology is to design and build engineered biological systems that “manipulate information, construct materials, process chemicals, produce energy, Innovation begins with provide food, and help maintain or enhance human experimentation, which can health and our environment,” according to Drew Endy, a biologist at the Massachusetts Institute of Technology be dangerous, especially in (Endy, 2005). Unlike genetic engineering, which moves genes health care. one at a time between species to create a new molecular entity, the goal of synthetic biology is to assemble genes from different organisms to create new metabolic Today, with the convergence of biology and informa- pathways, and even new organisms. In the long run, tion, health care is poised to follow suit, but the industry this might involve rewriting genetic code altogether is still trying to operate in two places at once—a capi- to build organisms that are beyond the capabilities of tal-intensive, dangerous, cost-imperative world and, natural biology. simultaneously, the area of convergence of medical sci- Experimentation in silico simulates existing systems. ence and information technology, which is accelerating But synthetic biology is creating a new platform for change and compelling adaptation. Crossing the divide investigating biological possibilities. Modeling the will require a new kind of experimentation. heart and modeling the hospital emergency room are Medical researchers today can run experiments in akin to Sir Isaac Newton watching an apple fall and silico, with computer simulations, rather than in vivo, discovering gravity. Synthetic biology is analogous to through clinical trials. In this way they can begin to Einstein’s theory of general relativity, which attempts understand how complex biological systems recombine, to explain all of space and time. Spring 2008 31

The Adaptive Imperative for Health Care Navigating through the increasing turbulence will An example of the adaptive imperative in health require adaptive leadership, rather than a command- care is the Partners HealthCare physician order-entry and-control approach. Ultimately, an adaptive mind- (POE) system, which is already being used by the set will be necessary for health care executives to meet flagship hospitals in the Partners chain, Brigham and the increasing demands and for health care as a whole Women’s and Massachusetts General in Boston (Dav- to compete with new species and shape the industry’s enport and Glaser, 2002). The Partners system uses rapidly evolving transformation. The intensive use of physicians’ experiences and outcomes to continually simulation and other less hi-tech information tools— adapt and change the rules disseminated to physicians such as checklists—will be essential to ensuring that the in the network. evolution proceeds safely (Gawande, 2007). To order a drug or a procedure or a test, a doctor must As John Maynard Keynes wrote in The General put the order into the POE system, which then looks at Theory of Employment, Interest and Money (1936), the patient’s information—the other drugs being taken “The difficulty lies, not in the new ideas, but in and other important circumstances—and asks the doc- escaping from the old ones, which ramify, for those tor, “Did you know your patient is taking this drug, brought up as most of us have been, into every corner which is incompatible with what you just asked for?” of our minds.” Or it says, “Do you know that our board of cardiolo- References gists thinks that the new drug Avastatin is better than Lipitor?” The system doesn’t tell doctors what to do, Blake, J.T., and M.W. Carter. 1996. An analysis of emergency but it gives them the latest knowledge, which can then room wait time issues via computer simulation. INFOR change their decisions. 34(4): 263–279. Available online at http://findarticles.com/ At the back end, the POE system collects information p/articles/mi_qa3661/is_199611/ai_n8748764/pg_1. about patient outcomes, enabling the board of cardiolo- Davenport, T.H., and J. Glaser. 2002. Just-in-time deliv- gists to review them and revise their recommendations ery comes to knowledge management. Harvard Business accordingly. Once they make a revision, every doctor in Review 80(7): 107–111. the network will see the revised rule the next time he or Dawkins, R. 2003. A Devil’s Chaplain: Reflections on Hope, she logs in—just like the BMWs mentioned above. Lies, Science, and Love. Boston, Mass.: Houghton Mifflin. When Partners experts determined that a new drug The Economist. 2006. Life 2.0: synthetic biology. The Econ- was helpful for heart problems and then made that infor- omist 380 (8493): 76. mation automatically available to doctors prescribing Endy, D. 2005. Foundations for engineering biology. Nature treatment, orders for that drug increased from 12 percent 438(7067): 449–453. Available online at http://www.nature. to 81 percent. As a result of the POE system, Partners com/nature/journal/v438/n7067/full/nature04342.html. has saved money because doctors are prescribing cheaper Gawande, A. 2007. The checklist. The New Yorker, Decem- and more effective drugs and treatments, and hospital ber 10, 2007. Available online at http://www.newyorker. stays are shorter. In addition, adverse drug interactions com/reporting/2007/12/10/071210fa_fact_gawande/. have been reduced by 17 percent, saving about $10 mil- Gibbs, W.W. 2004. Synthetic life. Scientific American, lion annually (Market Wire, 2002). April 26, 2004. Available online at http://www.sciam.com/ article.cfm?id=0009FCA4-1A8F-1085-94F483414B7F0000 Conclusion &print=true. The health care delivery field has been an isolated Hall, S.S. 2007. TR 35: David Berry. Technology Review, ecology, and an ecology that is sheltered for too long September/October 2007. Available online at http:// becomes vulnerable to predators from the outside. New www.technologyreview.com/tr35/Profile.aspx?Cand= interloper species are already arriving, in the form of T&TRID=603. innovative companies like Steve Case’s Revolution Kauffman, S. 1993. The Origins of Order: Self-Organization Health and walk-in clinics at CVS and Wal-Mart and Selection in Evolution. New York: Oxford University stores, to destabilize the health care ecology and disrupt Press. established business models We don’t yet know if those Keynes, J.M. 1936. The General Theory of Employment, species will be invasive, like kudzu, or will be ill-suited Interest and Money. London, U.K.: Macmillan Cambridge to the environment and die out. University Press. The 32 BRIDGE

Market Wire. 2002. Partners HealthCare Goes Live with Xie, F., Z. Qu, J. Yang, A. Baher, J.N. Weiss, and A. Garfinkel. Web-Based Physician Order Entry System Built on Inter- 2004. A simulation study of the effects of cardiac anatomy Systems’ CACHE. November 2002. Available online in ventricular fibrillation. Journal of Clinical Investigations at http://findarticles.com/p/articles/mi_pwwi/is_200211/ai_ 113(5): 686–693. Available online at http://www.pubmed- mark02048422. central.nih.gov/articlerender.fcgi?&pubmedid=14991066. Meyer, C., and S. Davis. 2003. It’s Alive: The Coming Con- vergence of Information, Biology, and Business. New York: Crown Business. Engineering innovation will continue to improve the quality of life and increase life expectancy.

New Therapies: The Integration of Engineering and Biological Systems

W. Mark Saltzman

In the twentieth century, overall life expectancy increased by 30 years (Fig- ure 1), and young people today can expect to live longer, healthier, more active lives than their great-grandparents, grandparents, and parents. Dra- matic changes in the practice of medicine have affected the life of almost every American. Couples can test for pregnancy at home; new vaccines are available for hepatitis B and chicken pox; inexpensive contact lenses provide clear W. Mark Saltzman is Goizueta vision; artificial hips enable recipients to walk and run; magnetic resonance Foundation Professor of Chemical is routinely used for high-resolution imaging of the brain; and many diabetics and Biomedical Engineering and now use small, reliable pumps that administer insulin continuously. Much of this progress has resulted from work by engineers, who have been chair, Department of Biomedical chiefly responsible for the mass production of vaccines, the design of replace- Engineering, Yale University. This ment joints, the creation of new techniques for safe imaging inside the human article is based on a presentation at body, and other life-extending and life-improving technologies. In the twenty- first century, engineering innovations will surely continue to improve the the NAE Annual Meeting Technical quality of life and increase life expectancy. For example, patients may soon Symposium on October 1, 2007. be able to live at home while undergoing high-dose chemotherapy. Some new technologies will create challenges for our health care system, such as questions about how to pay for expensive new treatments, while others will make therapies safer and cheaper. We can reasonably hope that new technologies will contribute to better, more equitable health care in the United States and elsewhere, encouraged, perhaps, by incentives for The 34 BRIDGE

they arouse only weak immune and inflammatory responses. It is not yet possible to predict which polymer structures will be biocompatible, but several classes have been identified. Some of these are hydrophobic and stable, such as poly(ethylene-co-vinyl acetate) and silicon, which are useful in some medical applications because they do not change over the lifetime of the patient. Other polymers are water soluble, such as poly(ethylene glycol). Still others, such as poly(lactide- co-glycolide), degrade slowly with time after exposure to the biological environment. The latter are most useful for delivering drugs because they can be implanted, deliver their drugs, and eventually disappear after the treatment is complete. Advances in medical materials have also led to new ways of administering drugs. Transdermal patches, polymer devices applied to the skin that slowly deliver drugs into the bloodstream, have been available for several decades. They offer alternative, arguably bet- FIGURE 1 Human life expectancy has increased dramatically in the past 200 years. ter, approaches for treating heart disease, preventing unwanted pregnancies, encouraging people to quit the development of technologies that make medical smoking, and so on. In addition, new systems for treat- care available to large numbers of people. In this brief ing cancer, such as the Gliadel® system for brain cancer review, I describe engineering technologies for medi- (described below), are based on principles that have cine that are expected to become routine in the next implications for future technologies. 50 years. Polymer/Drug Composites New Materials One biomedical engineering technology that is now The last few decades have been exciting for biomedi- used routinely involves embedding drug molecules cal engineers, as tremendous advances have been made into polymer materials to fashion drug-delivery sys- in biology. The discovery of the structure of DNA in the tems. When a drug/polymer composite is implanted or 1950s was rapidly translated into new kinds of therapies, injected into a patient, it provides a long-term source new treatments for disease, and new ways of diagnosing of the drug inside the body. Materials that release low- disease. For example, gene therapy, which was used in molecular-weight drugs can be produced readily; thus humans for the first time several decades ago, has led to materials that release proteins, and even gene therapy drugs designs based on biological principles. vectors, can be designed to work for long periods of One new opportunity made possible by advances in time after implantation. The duration and rate of drug human biology is the integration of biological features release depend on properties that have been engineered into materials traditionally used in medicine. In the into the composite. past, most of these materials were developed from syn- Synthetic polymers also offer significant advantages thetic inert materials, such as metals, plastics, ceramics, for a variety of other medical applications. For exam- and composites. New medical materials with integrated ple, polymer-coated metal wires are used in a variety of biological functions are a major step forward. For exam- medical settings, from pacemaker leads to microwires ple, engineers have developed advanced materials that for recording signals in the brain. Many reliable, simple can provide the long-term release of drugs to a local methods, which were developed for coating wires with a disease site (Saltzman, 2001, 2004). thin layer of polymer material, can be used to coat wires Polymers are also now safe and reliable medical tools, with polymer/drug composites (Figure 2). A polymer/ many of which can be safely implanted in the body. drug-coated wire inserted into the brain, for example, These materials are referred to as biocompatible because can release a drug continuously and locally. Spring 2008 35

FIGURE 2 Scanning electron microscopy images of (a) an uncoated microelectrode; (b) a dexamethasone-polymer coated microelectrode; (c) the controlled release of dexamethasone from microwires with coatings of 10 (triangle), 30 (square), or 50 percent (circle) dexamethasone coatings. All coatings were produced from dexamethasone in poly(ethylene-co-vinyl acetate). Source: Lo, Laubach, and Saltzman, unpublished data.

Wires can be produced with coatings that release to function biologically. In this case, the function drugs that perform a variety of functions. For example, is provided by a drug, which is released in a pattern the local release of steroids could prevent the formation controlled by the device engineer. In other cases, the of scar tissue around the surface of a microelectrode, biological function might be provided by the material potentially extending its lifetime. This is one example itself. For example, the surface chemistry of the mate- of adding a biological property to a device that is already rial might include elements that interact directly with being used to produce a new device that lasts longer or cells in the tissue, or cells might be implanted with the is less likely to cause medical complications. material (the latter is discussed below). The best known product of this sort is the drug-eluting stent, a device placed in an artery to open it mechani- Local Drug Delivery cally and increase the size of the lumen. Stents are used Biodegradable polymer/drug composites have also led in patients with arteries that have narrowed to the point to new approaches to medical therapy. For example, that blood flow is not adequate to satisfy the tissue (e.g., Gliadel®, a degradable polymer wafer, can be loaded a coronary artery on the surface of the heart). Stents with high concentrations of a highly active, potent provide an alternative to open-heart surgery for many chemotherapy drug and placed at a site near a tumor, patients, because they can be inserted without surgery where it can deliver the drug directly to the tumor cells. using well tolerated intravascular techniques. The first clinical application of Gliadel was for brain A normal metal stent often evokes a tissue response cancer, which had been difficult to treat with existing in the blood vessel called restenosis, the regrowth of techniques. With Gliadel, surgeons resect the tumor reactive tissue around the stented area, which can and place the polymer/drug wafers into the surgical- lead to re-narrowing of the vessel. Drug-eluting stents resection cavity. The patient leaves the operating (metal stents coated with drug/polymers, similar to the room with ongoing high-dose chemotherapy, delivered coating on the wire shown in Figure 2) slowly release not throughout the body where it can cause unwanted an anti-stenosis drug into the region of the vessel where side effects, but directly to the tumor site where it has the stent is placed. The drug acts on cells in that area maximum effectiveness with low toxicity. to prevent the reformation of scars, thereby greatly When the technique was first tested in animals with extending the life of the stent. experimentally induced brain cancer, a significant Drug-eluting stents are not only interesting devices proportion of the test animals were cured when the that provide new options for patients with life- material was designed properly. Clinical studies then threatening disease, they are also harbingers of a showed that patients who received polymers embedded change in approach. Whereas previous implanted with drugs had higher survival rates than patients who materials were predominantly made of materials that received placebo polymers that had not been embedded are known to be inert, new materials are designed with drugs. The 36 BRIDGE

Significantly, there were long-term survivors of this enabling deeper penetration of the drug into the tissue. very serious disease—many more long-term survivors Experiments showed that this prediction was correct than one would expect without therapy (Sawyer et al., (Fleming et al., 2004). Subsequently, this drug/polymer 2007). In addition, because Gliadel® is an engineered conjugate was engineered, based on conventional engi- system that can be produced reliably and in large quanti- neering analysis, to possess properties that would carry it ties, and because it augments a treatment already being farther throughout the central nervous system. used, the added cost for this benefit could potentially As new technologies are more widely used they might be low. reveal opportunities for improvement, as this example illustrates. In this case, the availability of local drug- Mathematical Models delivery systems created an opportunity to rethink the Mathematical modeling, a valuable tool in the way drugs are designed. Drugs created to be adminis- design of new materials, provides information that tered by the old paradigm, mainly orally, are not always would be difficult, and expensive, to get any other the best candidates for new modes of drug delivery. way. Engineering analysis—the development of mathe matical models to describe a phenomenon—requires Nanotechnology writing differential equations, which can often be a Nanotechnology will have a dramatic impact on the fairly straightforward process (Fleming and Saltzman, engineering of materials for new therapies. With nano- 2002). These models can be critical to understand- technology, small particles, less than 100 nm in diam- ing how implanted drug-delivery systems work. In the eter, can be synthesized for drug delivery, imaging, or case of Gliadel, the models were able to answer difficult diagnosis. Fahmy et al. (2005) and Peer et al. (2007) questions, such as where the drug molecules go when have described some potential advantages of nano released directly into brain tissue, how long they last, particles in medical applications. and how far they penetrate into the tissue. Nanoparticles provide a new way of thinking about Models also provide a mechanism for testing changes the administration of drugs. With these tiny particles in engineered systems. They can suggest ways of engi- it may be possible to design a vehicle that will carry a neering drugs—even drugs that are not yet available or drug safely into a cell and only then release it. Cur- have not yet been synthesized—with properties suited for rent methods of drug administration rely on flooding particular kinds of therapy. For example, models that we the body or tissue site with a drug in hopes that an ade- developed in the early 1990s suggested that certain kinds quate number of molecules reach the intracellular site of drug molecules would be best suited for local deliv- of action. Drug-loaded nanoparticles promise therapies ery in the brain. The ideal molecule was water-soluble, that are more efficient, more selective, and safer because highly diffusible, yet unable to permeate easily through they will have fewer side effects. capillary walls (Saltzman and Radomsky, 1991). One advantage of nanoparticles as drug carriers is One version of that ideal molecule was produced by that the delivery system does not have to be implanted, coupling a synthetic polymer, poly(ethylene glycol), which requires a surgical procedure. These tiny par- with drug molecules at each end of the linear polymer ticles can be introduced into the body in many ways, chain (Figure 3). Models suggested that this design such as injection or inhalation. In addition, some cells would penetrate much better through brain tissue, thus internalize nanoscale particles. If these particles are loaded with drugs, such as chemotherapy drugs, they could deliver high doses into the cell interior. Polymer The first major challenge in engineering nano particles is to produce them with high drug content, Drug which would enable the administration of a small Biodegradable Spacer quantity of particles containing a sufficient quantity of drug molecules for the desired period of release. If this FIGURE 3 Design of conjugates optimized for local delivery. Drug molecules cova- can be achieved, the result would be a totally synthetic, lently attached to water-soluble polymers will penetrate farther from the implant virus-sized particle loaded with active agents. If prop- source than free drugs because they are diffusible but are slowly eliminated from erly engineered, the drug molecules would be released the local site. in a controlled pattern (Figure 4). Spring 2008 37 e a b

releas Burst release Linear release drug of mass

0 10 20 30

Cumulative Time (days)

FIGURE 4 Nanoparticles for the controlled release of drugs. (a) A scanning electron micrograph shows nanoparticles formed from poly(lactide-co-glycolide), a biodegradable polymer. Scale bar = 1 micron. (b) Drug molecules are slowly released from the nanoparticles after introduction to a water-rich environment. Although linear release is usually desirable, many nanoparticle formulations release a substantial fraction of their drug load in an initial burst.

A second challenge is to make the nanoparticles One of the most difficult problems in tissue engi- smart so they know where to go in the body, which cells neering has been the reliable production of functional to enter, and when to release the drugs. One way to blood vessels to transport nutrients and waste in and out achieve this is to mimic an attribute of viruses by adding of the newly formed tissue. One promising technique ligands, or recognition molecules, to the surface of the involves using cultured human endothelial cells, usu- particles. In this way, it may be possible to make drug ally derived from umbilical veins. In the most promis- carriers that are much smaller than a cell but capable of ing examples of blood vessel formation, these cells were delivering large doses of drug directly to the cell’s inter- genetically engineered to express proteins that improve nal machinery. Antibodies, antibody fragments, and their survival and encourage their transformation into mimics are the most common reagents used as recogni- functional blood vessels (Enis et al., 2005; Schechner tion elements. et al., 2003). Polymer nanoparticles are a potential new tool of To create new regions of vascularized tissue, the nanotechnology. Others are nanoparticles assembled genetically engineered cells are first suspended in a from lipids (liposomes), polymer micelles (colloidal par- polymer gel, which is then transplanted to a tissue site. ticles self-assembled from amphiphilic polymers), and Within a few weeks, a robust network of new, functional dendritic polymers. blood vessels forms the three-dimensional space once occupied by the implanted gel. The cell-loaded poly- Tissue Engineering mer gel is a smart material. When implanted into a site All the cells in our bodies are surrounded by a matrix— in the body that lacks sufficient blood flow, it induces called the extracellular matrix—that contains elements, the formation of new blood vessels in that region. often networks of fibers, with typical diameters of 10 to Based on this example, one can envision dozens of 100 nm. Engineers have developed artificial matrices new ways to treat disease. The cell-loaded patch could composed of natural or synthetic polymers that can be applied to tissues that have become ischemic to cre- serve as scaffolds for the transplantation of cells into the ate new pathways for blood flow and the delivery of body. The purpose of this aspect of biomedical engi- oxygen. Alternatively, the patch could be loaded with neering, called tissue engineering, is to develop meth- multiple cell types provided in response to the specific ods of repairing tissues or organs damaged by disease or needs of the patient. For example, with a patch con- trauma. A few pioneering efforts are already being tested taining endothelial cells and beta cells—the cells in the in patients, such as engineered skin equivalents to repair pancreas that secrete insulin in response to glucose—a wounds and chondrocyte implantation to repair articular vascularized region of tissue that functions like an cartilage defects. These studies have shown that novel endocrine pancreas might be produced after transplan- tissue-replacement strategies will work in certain cases. tation. Protein-loaded delivery systems might be used The 38 BRIDGE to accelerate or direct the process of tissue formation, Academy of Sciences of the U.S.A. 102(2): 425–430. to facilitate the integration of the tissue, or to suppress Fahmy, T.M., P.M. Fong, A. Goyal, and W.M. Saltzman. 2005. unwanted local immune reactions. Targeted nanoparticles for drug delivery. Materials Today These are just a few examples of new kinds of therapy (Nano Today) 8(8)(Supplement 1): 18–26. using tissue engineering that might be available in the Fleming, A.B., and W.M. Saltzman. 2002. Pharmacokinet- next 10 years. The development of each new therapy will ics of the carmustine implant. Clinical Pharmacokinetics involve overcoming significant engineering and medi- 41(6): 403–419. cal challenges, but progress is certain. One can imagine Fleming, A.B., K. Haverstick, and W.M. Saltzman. 2004. using engineering principles that are fairly easy to define, In vitro cytotoxicity and in vivo distribution after direct perhaps even easy to manufacture, to produce complex delivery of PEG-camptothecin conjugates to the rat brain. transplantable materials built from component parts that Bioconjugate Chemistry 15(6): 1364–1375. are biologically safe. Tissue engineering will change the Peer, D., J.M. Karp, S. Hong, O.C. Farokhzad, R. Margalit, way health care is delivered to certain patients. and R. Langer. 2007. Nanocarriers as an emerging platform for cancer therapy. Nature Nanotechnology 2(12): Summary 751–760. Engineering and new technologies improved the Saltzman, W.M. 2001. Drug Delivery: Engineering Principles quality of life and extended life expectancy during the for Drug Therapy. New York: Oxford University Press. twentieth century. New technology—including safer Saltzman, W.M. 2004. Tissue Engineering: Engineering Prin- biomaterials, nanoscale drug-delivery systems, and cell- ciples for the Design of Replacement Organs and Tissues. based therapies like tissue engineering—will build on New York: Oxford University Press. these advances in the twenty-first century. The impacts Saltzman, W.M., and M.L. Radomsky. 1991. Drugs released of emerging technologies on health care delivery and from polymers: diffusion and elimination in brain tissue. health care costs are difficult to predict, but they are Chemical Engineering Science 46(10): 2429–2444. sure to be profound. Sawyer, A.J., J.M. Piepmeier, and W.M. Saltzman. 2007. New methods for direct delivery of chemotherapy for treat- References ing brain tumors. Yale Journal of Biology and Medicine Enis, D.R., B.R. Shepherd, Y. Wang, A. Qasim, C.M. Sha- 79(3-4): 141–152. nahan, P.L. Weissberg, M. Kashgarian, J.S. Pober, and Schechner, J.S., S.K. Crane, F. Wang, A.M. Szeglin, G. J.S. Schechner. 2005. Induction, differentiation, and Tellides, M.I. Lorber, A.L.M. Bothwell, and J.S. Pober. remodeling of blood vessels after transplantation of Bcl-2- 2003. Engraftment of a vascularized human skin equiva- transduced endothelial cells. Proceedings of the National lent. FASEB Journal 17(15): 2250–2256. Spring 2008 39

NAE News and Notes Class of 2008 Elected

In February, NAE elected 65 new Technology, Cambridge. For contri- U.S. Naval Postgraduate School, members and 9 new foreign associ- butions to data flow and multi-thread Monterey, California. For contri- ates, bringing the number of U.S. computing and the development of butions to large-scale optimization members to 2,227 and the number tools for the high-level synthesis theory and its military and indus- of foreign associates to 194. Elec- of hardware. trial applications. tion to NAE, one of the highest pro- Dennis N. Assanis, Jon R. and Howard J. Bruschi, executive fessional distinctions accorded to an Beverly S. Holt Professor of Engi- consultant, Westinghouse Electric engineer, honors those who have neering, University of Michigan, Company, Pittsburgh, Pennsylvania. made outstanding contributions to Ann Arbor. For scientific contribu- For leadership in the design, devel- “engineering research, practice, or tions to improving fuel economy and opment, and licensing of the pas- education, including . . . significant reducing emissions of internal com- sively safe Westinghouse reactors, contributions to the engineering lit- bustion engines, and for promoting the AP600 and AP1000. erature” and to “new and develop- automotive engineering education. Gary S. Calabrese, former vice ing fields of technology, . . . major Wanda M. Austin, president and president and chief technology advancements in traditional fields chief executive officer, Aerospace officer, Rohm and Haas Company, of engineering, or . . . innovative Corporation, Los Angeles, Cali- North Andover, Massachusetts. For approaches to engineering educa- fornia. For leadership in the engi- the development of advanced election.” A list of newly elected mem- neering and integration of national tronic materials and processes for bers and foreign associates follows, space intelligence systems. semiconductor device manufacture. with primary affiliations at the time Ray Henry Baughman, Rob- Mau-Chung Frank Chang, pro- of election and brief descriptions of ert A. Welch Professor of Chem- fessor, Electrical Engineering Depart- principal accomplishments. istry and director of the Alan G. ment, University of California, Los MacDiarmid NanoTech Institute, Angeles. For the development and New Members University of Texas at Dallas. For commercialization of GaAs power Bernard Amadei, professor of civil pioneering novel applications of amplifiers and integrated circuits. engineering, University of Colorado, conjugated polymers and related Stephen Z.D. Cheng, dean, Boulder. For the creation of Engi- nanomaterials. College of Polymer Science and neers Without Borders, leadership in Pallab K. Bhattacharya, Charles Polymer Engineering, University sustainable development education, M. Vest Distinguished University of Akron, Akron, Ohio. For the and research on geomechanics. Professor of Electrical Engineering development of materials for liquid Robert C. Armstrong, Chev- and Computer Science, Univer- crystal displays and the elucidation ron Professor of Chemical Engi- sity of Michigan, Ann Arbor. For of structure-property relationships neering, Massachusetts Institute of contributions to quantum-dot opto- in polymeric materials. Technology, Cambridge. For con- electronic devices and integrated Peter A. Cundall, principal and ducting outstanding research on optoelectronics. senior consultant, Itasca Consulting non-Newtonian fluid mechanics, Paul N. Blumberg, independent Group Inc., Minneapolis, Minne coauthoring landmark textbooks, consultant, Southfield, Michigan. sota. For advancing the understand- and providing leadership in chemi- For the synthesis of automotive- ing of rock-deformation and failure cal engineering education. system models that has led to more processes and the development of Arvind, Charles W. and Jennifer effective control of emissions and innovative computational proce- C. Johnson Professor, Department improvements in fuel economy. dures in rock mechanics. of Computer Science and Engi- Gerald G. Brown, distinguished Robert H. Dodds Jr., profes- neering, Massachusetts Institute of professor of operations research, sor and department head, M.T. The 40 BRIDGE

Geoffrey Yeh Chair of Civil Engi- Gary Stephen Grest, Distin- Engineering, University of California, neering, Department of Civil guished Member of the Technical Berkeley. For outstanding contribu- and Environmental Engineering, Staff, Sandia National Laborato- tions to the understanding of catalyst University of Illinois, Urbana. ries, Albuquerque, New Mexico. structure-function relationships, the For contributions in nonlinear For development of large-scale development of novel catalysts, and fracture mechanics and applica- simulations for improved under- leadership in the field of catalysis. tions to practice in nuclear power standing of metals, polymers, and Jon M. Kleinberg, professor of and space systems. particulate matter. computer science, Cornell Univer- Cynthia Dwork, senior research- Barbara J. Grosz, interim dean, sity, Ithaca, New York. For con- er, Microsoft Research, Mountain Radcliffe Institute for Advanced tributions to the understanding of View, California. For fundamen- Study, and Higgins Professor of Nat- the structure and behavior of the tal contributions to distributed ural Sciences, School of Engineer- World Wide Web and other com- algorithms and the security of ing and Applied Sciences, Harvard plex networks. cryptosystems. University, Cambridge, Massachu- Anthony David Kurtz, chairman David A. Dzombak, Walter J. setts. For pioneering research in and chief scientist, Kulite Semicon- Blenko Sr. Professor of Environmen- natural language communication ductor Products, Leonia, New Jersey. tal Engineering, Carnegie Mellon between humans and computers and For the conception, development, University, Pittsburgh, Pennsylva- its application to human-computer and commercialization of the silicon nia. For the development of models interaction. semiconductor pressure transducer. used in evaluating chemical behav- Donald J. Haderle, president, Burn-Jeng Lin, senior director, ior in water quality engineering and Haderle Consulting LLC, Los Gatos, Nanopatterning Technology, Tai- environmental remediation. California. For contributions to the wan Semiconductor Manufacturing Anthony E. Fiorato, chairman, management of high-performance Company Ltd., Taiwan, Republic of CTLGroup, Skokie, Illinois. For relational databases and leadership China. For technical innovations research on improved concrete in founding the relational database- and leadership in the development materials and construction, devel- management industry. of lithography for semiconductor opment of tests and standards, and J. Michael Harrison, Adams manufacturing. technical leadership. Distinguished Professor of Manage- Thomas Anthony Lipo, direc- Thomas J. Fogarty, president, ment, Stanford University, Stanford, tor, Wisconsin Power Electronics Fogarty Engineering, Portola Valley, California. For fundamental contri- Research Center, University of California. For invention of the bal- butions to stochastic networks and Wisconsin, Madison. For contri- loon catheter and devices that have financial engineering. butions to the design and develop- revolutionized vascular surgery, and John L. Hudson, Wills Johnson ment of variable-speed drives and for creating companies to commer- Professor, Department of Chemical motor controls. cialize these inventions. Engineering, University of Virginia, Alexis C. Livanos, president, James D. Foley, professor, Col- Charlottesville. For advances in Northrop Grumman Space Technol- lege of Computing, and Stephen the understanding and engineer- ogy, Redondo Beach, California. For Fleming Chair in Telecommunica- ing of complex dynamic chemical- contributions to the development and tions, Georgia Institute of Tech- reaction systems. insertion of advanced semiconductor nology, Atlanta. For contributions Michael W. Hunkapiller, general technology for commercial and gov- to the establishment of the fields partner, Alloy Ventures Inc., Palo ernment space systems. of computer graphics and human- Alto, California. For the invention Michael J. Lockett, corporate fel- computer interaction. and commercialization of DNA and low, Praxair Inc., Tonawanda, New Lee-Lueng Fu, senior project sci- protein sequencers and DNA syn- York. For contributions to the the entist, Jet Propulsion Laboratory, thesizers that have revolutionized ory and practice of distillation. Pasadena, California. For contribu- comparative genetics and the map- David G. Luenberger, profes- tions to the development of satellite ping of the human genome. sor, Department of Management altimetry and applications in ocean- Enrique Iglesia, Chancellor Pro- Science and Engineering, Stanford ography, geodesy, and climatology. fessor, Department of Chemical University, Stanford, California. Spring 2008 41

For contributions to control theory, for academic affairs, University of computer sciences, University of optimization algorithms, and eco- Southern California, Los Angeles. Wisconsin, Madison. For funda- nomic dynamics. For contributions to the development mental contributions to the theory Stephen Malkin, Distinguished and diverse applications of adaptive of nonlinear optimization and to Professor, Department of Mechani- signal processing, and for leadership military planning. cal and Industrial Engineering, Uni- in engineering education. Vladimir Rokhlin, professor of versity of Massachusetts, Amherst. Malcolm R. O’Neill, indepen- computer science and mathematics, For pioneering research in and the dent consultant, Vienna, Virginia. Yale University, New Haven, Con- implementation of grinding-system For exceptional leadership and necticut. For the development of simulation and optimization. innovative management of national fast multipole algorithms and their W. Allen Marr Jr., president and missile-defense programs and other application to electromagnetic and chief executive officer, Geocomp high-profile military-technology acoustic scattering. Corporation, Boxborough, Massa- capabilities. Thomas P. Russell, professor, chusetts. For innovative applications Prabhakar Raghavan, senior Polymer Science and Engineering of numerical methods, risk analysis, vice president and head, Yahoo! Department, University of Massa- advanced laboratory techniques, and Research, Santa Clara, California. chusetts, Amherst. For contribu- field instrumentation to geotech- For significant contributions to tions to the processing of thin-block nical engineering and construction. algorithms and the structure of the copolymer films to achieve well- John C. Martin, president and World Wide Web. organized nanostructures. chief executive officer, Gilead Sci- Yahya Rahmat-Samii, Northrop Robert F. Sawyer, Class of ences Inc., Foster City, California. Grumman Professor, Department 1935 Professor of Energy Emeritus, For the invention, development, of Electrical Engineering, Uni- Department of Mechanical Engi- and commercialization of anti-viral versity of California, Los Angeles. neering, University of California, medicines, especially treatments for For contributions to the design Berkeley. For pioneering work in HIV/AIDS. and measurement of reflector and reducing energy consumption and James A. Miller, Distinguished handheld-device antennas. improving the environment, and for Member of the Technical Staff, Marc Raibert, president, Boston contributions to our understanding Sandia National Laboratories, Dynamics Inc., Waltham, Massa- of air pollution. Livermore, California. For research chusetts. For biomechanically moti James A. Sethian, vice chair for on the theory and modeling of com- vated analysis, synthesis, control, and undergraduate affairs and professor, bustion chemistry that has led to application of multilegged robots. Department of Mathematics, Uni- universally applied codes for com- Bhakta B. Rath, head of Materi- versity of California, Berkeley. For bustion modeling. als Science and Component Tech- the development of efficient meth- David L. Mills, professor, Electri- nology Directorate and associate ods of tracking moving interfaces. cal and Computer Engineering and director of research, Naval Research Paul H. Siegel, director, Center Computer and Information Scienc- Laboratory, Washington, D.C. For for Magnetic Recording Research, es, University of Delaware, Newark. leadership in advancing materials and CMRR Endowed Chair, For contributions to Internet time- research and technology to support Department of Electrical and Com- keeping and the development of the national security. puter Engineering, University of Network Time Protocol. Rebecca Rae Richards-Kortum, California, San Diego, La Jolla. For Shree K. Nayar, T.C. Chang Stanley C. Moore Professor and the invention and development of Professor of Computer Science, chair, Department of Bioengineer- advanced coding techniques for Columbia University, New York, ing, Rice University, Houston. For digital recording systems. New York. For the development of research on the diagnosis and treat- R. Paul Singh, professor, Biologi- computational cameras and physics- ment of cancer in women, and for cal and Agricultural Engineering based models for computer vision leadership in bioengineering educa- Department, University of Califor- and computer graphics. tion and global health initiatives. nia, Davis. For innovation and lead- Chrysostomos L. (Max) Nikias, Stephen M. Robinson, profes- ership in food engineering research provost and senior vice president sor of industrial engineering and and education. The 42 BRIDGE

Kumares C. Sinha, Olson Andrew M. Weiner, Scifres Dis- Biomolecular Engineering, Univers Distinguished Professor of Civil tinguished Professor of Electrical ity of Melbourne, Victoria, Australia. Engineering, Purdue University, and Computer Engineering, Purdue For contributions to mineral-water West Lafayette, Indiana. For con- University, West Lafayette, Indiana. interfacial phenomena, their appli- tributions to the advancement For contributions to the develop- cation to mineral processing, and of highway infrastructure engineer- ment of femtosecond optical-pulse leadership in industry-government- ing and management and to the shaping technology. academic cooperation. education of transportation profes- William W-G. Yeh, Distinguished Akihisa Inoue, president, Tohoku sionals worldwide. Professor and chair, Department of University, Sendai, Japan. For out- Richard L. Sites, software engi- Civil and Environmental Engineer- standing achievements and inter- neer, Google Inc., Mountain View, ing, University of California, Los national leadership in the design of California. For leadership in using Angeles. For the development of advanced bulk metallic glasses and rigorous cost and benefit analyses in methodologies for optimizing the other metastable materials. processor designs, and leadership in management of water resources, Alexander I. Leontiev, professor, the development of binary transla- and for inverse methods of estimat- Department of Thermogasdynamics tion technology. ing subsurface parameters. and Gas Turbine Engines, Moscow Frans Spaepen, John C. and Helen Roe-Hoan Yoon, Nicholas T. State Technical University, Mos- F. Franklin Professor of Applied Camicia Professor, Department of cow, Russia. For contributions to Physics, School of Engineering and Mining and Minerals Engineering, the fundamental understanding of Applied Sciences, Harvard Univer- Virginia Polytechnic Institute and convective heat transfer, and for sity, Cambridge, Massachusetts. For State University, Blacksburg. For furthering international scientific contributions to the understanding advancing the surface chemistry of cooperation. of structures of melts, amorphous mineral systems and developing new Arthur John Robin Gorell Mil- metals, and semiconductors. mineral processing technology and ner, Emeritus Professor, University Zhigang Suo, Allen E. and flotation kinetic models. of Cambridge, Cambridge, United Marilyn M. Puckett Professor of Yannis C. Yortsos, dean, Viterbi Kingdom. For fundamental con- Mechanics and Materials, School of School of Engineering, University tributions to computer science, Engineering and Applied Sciences, of Southern California, Los Ange- including the development of LCF, Harvard University, Cambridge, les. For fundamental advances in ML, CCS, and the pi-calculus. Massachusetts. For fundamental fluid flow, transport, and reactions Ekkehard Ramm, professor, and applied contributions to the in porous media applied to the Institute for Structural Mechanics, thermomechanical performance of recovery of subsurface resources. University of Stuttgart, Stuttgart, electronic material systems, actua- Germany. For contributions to the tor materials, and composites. New Foreign Associates finite element analysis of plates and David A. Tirrell, Ross McCollum- Isamu Akasaki, professor, Meijo shells and leadership in computa- William H. Corcoran Professor University, Nagoya, Japan. For con- tional mechanics. and chair, Division of Chemistry tributions to the development of Rutger Anthony van Santen, and Chemical Engineering, Cali- nitride-based semiconductor mate- professor, Department of Chemical fornia Institute of Technology, rials and optoelectronic devices. Engineering and Chemistry, Eind- Pasadena. For pioneering contri- Ann P. Dowling, professor and hoven University of Technology, butions to bioengineered materials head of the division, Department Eindhoven, Netherlands. For pio- and the synthesis of novel artificial of Engineering, University of Cam- neering work on the fundamentals proteins. bridge, Cambridge, United King- of reaction mechanisms in heteroge- David R. Walt, Robinson Profes- dom. For advances in acoustics and neous catalysis. sor of Chemistry, Tufts University, unsteady flow, and for leadership Tadashi Watanabe, project leader, Medford, Massachusetts. For the in collaborative research between RIKEN, Tokyo, Japan. For contri- development of revolutionary sen- industry and universities. butions to the design and develop- sors that can simultaneously image Thomas W. Healy, professorial ment of vector architectures for and perform biochemical analyses. fellow, Department of Chemical and supercomputers. Spring 2008 43

NAE Newsmakers

Zdenek P. Bazant, McCormick John Junkins, George J. Eppright the plenary session of the seminar Institute Professor and W.P. Murphy Distinguished Professor of Aero- held in San Antonio, Texas. Dr. Professor of Civil Engineering and space Engineering, Texas A&M Singhal was honored for outstand- Materials Science at Northwest- University, was honored by the ing leadership and innovation in ern University, has been elected a UCLA Henry Samueli School of the promotion and overall advance- foreign member of the Accademia Engineering and Applied Science. ment of fuel cell technology. Nazionale dei Lincei (Italian Dr. Junkins received the 2007 Wm. A. Wulf, University Profes- National Academy) in Rome; the Alumni Achievement in Academia sor and AT&T Professor of Engi- academy, of which Galileo was a Award in recognition of his out- neering and Applied Sciences, member, was founded by the pope standing contributions to engineer- Department of Computer Science, in 1603. Dr. Bazant is a member ing research and education. University of Virginia, and former of four other national academies— Subhash Singhal, Battelle Fel- NAE president, is the first foreign National Academy of Sciences, low and director, Fuel Cells, Pacific corresponding member of the Ven- National Academy of Engineering, Northwest National Laboratory, ezuela Academy of Engineering. Austrian Academy of Sciences, and received the 2007 Fuel Cell Semi- Czech Engineering Academy. nar and Exposition Award during

2007 Japan-America Frontiers of Engineering Symposium

speakers described their cutting- edge research in these areas, such as voice-based, continuous control of electromechanical devices; recent advances in electrode materials in lithium-ion batteries; simulation of advanced rockets; recent advances in the environmental control of data centers; and the engineering of human arteries from “off-the- shelf” biomaterials. In the dinner speech on the first evening, Dr. Stan Williams, HP Senior Fellow and founding director of the HP Quantum Science Speaker Jennifer Elisseeff from Johns Hopkins University describes the engineering of human arteries. Research Group, described a new architecture for computing called The seventh Japan-America Fron- Engineering Academy of Japan (part- “memristance.” On the following tiers of Engineering (JAFOE) Sym- ners in the JAFOE program) and the afternoon, all of the participants posium was held on November 5, National Science Foundation. had an opportunity to describe 6, and 7, 2007, at HP Labs in Palo The five topics addressed at the their technical work or research Alto, California. Approximately 2007 meeting were: human-computer during a lively poster session, and 60 engineers, 30 from each country, interaction, battery technologies, on the second day, everyone was attended the meeting, along with rocketry/aerospace, next-generation treated to tours of four HP labs: a representatives of the Japan Science data centers, and materials for data center and other labs dealing and Technology Corporation and the medicine. Japanese and American with nanoprint lithography; digital The 44 BRIDGE commercial printing; and Pluribus, a Engineering at the Massachusetts meetings (Indo-U.S. FOE), JAFOE technology that combines multiple, Institute of Technology, who will meetings bring together outstand- inexpensive projectors to create a co-chair the 2008 JAFOE Sympo- ing engineers (ages 35 to 45) from scalable “superprojector.” sium on November 17, 18, and 19 industry, academe, and govern- Glenn H. Fredrickson, Mit- in Tsukuba, Japan. The topics for ment to share their experiences subishi Professor of Materials and that meeting will be advances in and describe exciting new develop- Chemical Engineering and direc- automation for biotechnology in ments, techniques, and approaches tor of the Mitsubishi Chemical health, natural language processing, at the forefront of many areas of Center for Advanced Materials at alternative energy, and sensors. engineering. The meeting also the University of California, Santa Funding for the 2007 JAFOE facilitates contacts and collabora- Barbara, and Kohei Itoh, professor Symposium was provided by the tion among the next generation of in the Department of Applied Phys- Japan Science and Technology engineering leaders. ics and Physico-Informatics at Keio Agency, National Science Foun- For more information about the University, cochaired the organiz- dation, Armstrong Endowment symposium series or to nominate an ing committee and the symposium. for Young Engineers, and National outstanding engineer to participate Dr. Fredrickson, who completed Academy of Engineering Fund. in a future FOE meeting, contact his second term as U.S. cochair NAE has hosted JAFOE meet- Janet Hunziker in the NAE Pro- for JAFOE, will be succeeded by ings since 2000. Like the U.S.FOE gram Office at (202) 334-1571 or by Dr. Arup Chakraborty, Robert meetings, German-American meet- e-mail at [email protected]. T. Haslam Professor of Chemical ings (GAFOE), and India-U.S.

Call for 2008–2009 Award Nominations

Traditionally, NAE has awarded and academia. The Founders and programs have contributed to the five prizes (Founders Award, Arthur Bueche awards are presented each quality of the engineering work- M. Bueche Award, Charles Stark fall at the NAE Annual Meeting. force. The focus is on innovations Draper Prize, Fritz J. and Dolores H. Recipients receive gold medallions, in curricular design, teaching meth- Russ Prize, and Bernard M. Gordon hand-lettered certificates, and ods, and technology-enabled learn- Prize) for outstanding achievements $2,500 cash prizes. ing. The Gordon Prize is shared in engineering. We invite you to The Charles Stark Draper Prize equally between the recipient(s) and help continue that tradition by is awarded annually for innova- the institution. The Draper, Russ, nominating outstanding individuals tion and reduction to practice of and Gordon prizes, which include for the 2008–2009 awards. an advancement in engineering or $500,000 cash awards, gold medal- technology that contributes to the lions, and hand-lettered certificates, NAE Awards welfare and freedom of humanity. are presented during National Engi- The Founders Award is presented The biennial Fritz J. and Dolores neers Week at the NAE Annual to an NAE member or foreign asso- H. Russ Prize is awarded in recogni- Awards Dinner. Nominators of the ciate whose professional, education of an engineering achievement winning recipients are also invited tional, or personal achievements that has contributed to the advance- to attend. and accomplishments exemplify the ment of the human condition. Cur- ideals and principles of NAE. The rently focused on bioengineering, To Submit a Nomination recipient of the Arthur M. Bueche the Russ Prize encourages collabo- Nominations for the 2008 Found- Award is an engineer who has been rations between engineers and the ers and Bueche awards and the 2009 actively involved in determining medical and biological disciplines. Draper and Gordon prizes will be U.S. science and technology pol- The Bernard M. Gordon Prize for accepted through April 4, 2008. icy, promoting U.S. technological Innovation in Engineering and A list of previous recipients can be development, and improving rela- Technology Education is given found on our web site (www.nae. tions among industry, government, annually to honor educators whose edu/awards). Members and foreign Spring 2008 45

associates have received nomina- [email protected]. Nomination mate- Engineering, 500 Fifth Street, N.W. tion materials by mail. Nonmem- rials can also be downloaded from (#1048), Washington, DC 20001, bers may obtain materials from the our web site (www.nae.edu/awards). or faxed to (202) 334-2290. NAE Awards Office by calling (202) Nominations should be mailed to 334-1628 or sending an e-mail to NAE Awards, National Academy of

Mirzayan Science and Technology Policy Fellows

Jessica Buono Ana Ferreras Shelby Perkins

Rafi Soulé Michael Tomlinson Greta Zornes We are happy to introduce six Since moving to Washington, quality of military health care, par- new Mirzayan Science and Tech- D.C., Jessica has conducted research ticularly for patients with traumatic nology Policy Fellows who joined on issues in health policy ranging brain injuries. Her goals are to learn NAE in January. from traumatic brain injury to dia- to write efficiently about policy as Jessica Buono is currently pur- betes. As a Mirzayan fellow she it relates to health and scientific suing a master’s in public health hopes to learn more about the policy research and to communicate effec- in epidemiology at George Wash- behind the science in her studies. tively about science to raise the level ington University. She received She is working with the Committee of public understanding. a B.S. in behavioral neuroscience on Women in Science, Engineer- from Lehigh University, where her ing, and Medicine of the Policy and Ana M. Ferreras is currently research was focused on specialized Global Affairs Division on projects completing her Ph.D. in industrial properties of neurons in the brain involving women in science and engineering (IE) at the University and their functional relationships in interdisciplinary health careers. In of Central Florida (UCF). For her both biology and psychology. Jessica addition, she is conducting research doctoral research, she is developing plans to pursue a career in health in the NAE Program Office for a a company-success index model to research at the National Institutes study on using systems engineering assess and predict organizational per- of Health. tools and techniques to improve the formance based on critical factors, The 46 BRIDGE such as profit, productivity, efficiency, budgetary issues concerning the governmental risk-management quality, employee morale, safety, and U.S. nuclear weapons complex. systems and international systems- ergonomics. She holds an M.S. In 2006, Shelby traveled to Ant- management projects. At CASEE, in engineering management from arctica, where she was inspired to she is looking into the impediments the Florida Institute of Technology expand her study of environmental and enablers of student transfers and a B.S. in electrical engineering policy to include human impacts from community colleges to bacca- from UCF. Along with her doctoral on the environment. She plans laureate engineering programs at lib- research, Ana has assisted in the to continue to diversify her career eral arts colleges. She enjoys playing reengineering of the undergraduate experience in handling policy issues Scrabble and tennis, reading, travel- IE curriculum at UCF, taught courses related to science and technology. ing, and debating current issues. on quality engineering, and writ- During her Mirzayan Fellowship, ten proposals for the development Shelby is working with Rachelle Michael Tomlinson earned his of educational programs consistent Hollander, director of the Center Ph.D. in chemical and biomolecu- with the skills identified in the Engi- on Engineering, Ethics, and Soci- lar engineering from North Caro- neer of 2020 reports. While at NAE, ety. Shelby works with an advisory lina State University in 2005. His Ana is working at CASEE on using group to develop studies of ethical postgraduate research was focused the World Wide Web as a platform and societal issues associated with on modifying surfaces with end- for delivering and assessing innova- emerging technologies and collec- tethered macromolecules, also tive content for engineering faculty tive professional responsibility. known as polymer brushes. Specifi- and students. cally, he developed combinatorial Ana holds a Six-Sigma Black Rafi Soulé, a graduate student methods for quick verification of Belt and enjoys certifying other at George Washington University, previous brush theory and investiga- students working to improve pro- expects to complete her M.S. in sys- tion of the morphological character- cesses and systems for community tems engineering/project manage- istics of multiblock brush surfaces. nonprofit organizations and government in May 2008. Her graduate During his postgraduate years, ment agencies. Her career goal is to research involves the development Michael served on the leadership improve the quality of engineering of policies for fighting the spread of committee for the Self Knowledge education in academic institutions the Ebola virus in central Africa. Symposium, a nonprofit student to help the United States maintain She has also worked on using systems organization that promotes “authen- its leadership role. In her free time, engineering tools for the require- tic living.” After graduation, he she enjoys making pottery, attend- ments of the U.S. “VIP Gunfire joined the PolyFilm Network (an ing theater performances, designing Protection System,” particularly for EU-funded Marie Curie Research clothes, traveling, dancing, snorkel- the deployment and testing of the Training Network); based at the ing, and reading. shield system University of Sheffield in England, Rafi also has a B.S. in finance he conducted research on pH- Shelby Perkins completed her from the State University of New responsive polyelectrolyte brushes, J.D. and master’s degree in environ- York in Plattsburgh and an A.S. specifically using neutron reflec- mental law at Vermont Law School. in business administration and tometry to study interfaces between After becoming a member of the New management from Clinton Com- reversibly adhesive polyelectrolyte Mexico Bar, she practiced nuclear munity College. Throughout her surfaces. During his three years in waste law as an attorney for the U.S. studies, Rafi has been interested Europe, he met people from around Department of Energy (DOE), where in the intersection between micro- the world and spent his leisure her work was focused mostly on the business and macroeconomic fac- time hiking through historical and preparation of the natural-systems tors in international markets and natural sites. His passions include portions of DOE’s Yucca Mountain systems development and integra- teaching, learning, and traveling. construction permit application tion. She has been a member of Michael’s project at CASEE is to the Nuclear Regulatory Com- Phi Theta Kappa, an international to review the literature on linkages mission. In addition, she worked honors society, since 2003. between asserted and actual faculty on environmental, regulatory, and Rafi’s career goal is to work on instructional behavior. This work is Spring 2008 47

related to two projects supported by She received her M.S. in environ- ing consultant with CH2M HILL. the National Science Foundation— mental engineering from Manhattan Her goal is to work on international the development of an assessment College in 2000, where her research water/wastewater/water reuse issues, of student and faculty engagement was on biofilm formation in drink- particularly policies and programs in engineering education and the ing water systems. Her undergradu- that affect water and wastewater development of metrics of instruc- ate studies in environmental science management. Greta is active in tional scholarship. at the University of Oklahoma Engineers Without Borders and is included a year at the University of currently involved in a project in the Greta Zornes recently completed Dundee, Scotland. community of Amayo, Nicaragua. her Ph.D. in environmental health Greta has completed internships During her Mirzayan fellowship, sciences at Tulane University in New with the World Health Organiza- Greta is working with the Diversity Orleans. Her doctoral research was tion in India and with the Socio- in the Engineering Workforce Pro- on the status and potential of water Economic Union in Russia; she is gram supporting the EngineerGirl! reuse in Hyderabad and Delhi, India. currently employed as an engineer- and “Engineer Your Life” web sites.

A Message from NAE Vice President Maxine L. Savitz

America’s Energy Future: Technol- received support from several foun- ogy Opportunities, Risks, and Trade dations and government agencies. offs, an academies-wide project to In addition to our leadership in explore the role of energy in long- the America’s Energy Future project, term U.S. economic vitality, national NAE continues to seek and receive security, and environmental quality. funding for other initiatives. To The purpose of the project is to pro- honor past NAE president Wm. A. vide a sound, factual basis to inform Wulf, members, friends, foundations, policy decisions that will affect us and corporations have contributed locally and nationally and impact $6.3 million to the Wulf Initiative. Maxine L. Savitz the global community. On March 13 The purpose of the initiative is to and 14, the academies sponsored help ensure that current academy Private philanthropy enables the National Academies Summit on leaders have the resources they need the National Academies to bring America’s Energy Future. The sum- to lead the academy into the future. together experts to address multi mit was attended by leading thinkers On behalf of the NAE Council, dimensional questions that underlie from the private sector, universities, I wish to thank all of our members our country’s most urgent concerns. and government agencies with differ- and the organizations, corporations, One example is the privately funded ent points of view on energy issues. foundations, government sponsors, 2005 report Rising Above the Gath- The engagement of NAE’s cor- and friends of NAE who have pro- ering Storm, which influenced the porate partners, which include Dow vided generous support for NAE America COMPETES Act. Dona- Chemical Company, GE Energy, programs. Their donations enable tions by members, and support from General Motors, and Intel, has been us to address proactively issues that foundations and corporations, make critical to launching the America’s are critical to the technological wel- it possible for us to produce critical Energy Future project. The NAE fare of our nation. studies like this in the absence of Development Committee was instru- government funding. mental in securing funding from As questions regarding our these partners, each of which has Maxine L. Savitz nation’s energy future mount, NAE committed $300,000 to the project. NAE Vice President has assumed the leadership role for We are very fortunate to have also The 48 BRIDGE

National Sydney Brenner Whitney and Betty Shep and Carol Ruth Fletcher and Peg Byrom MacMillan Shepherd Academy of James McConnell Clark William W. McGuire Melvin I. Simon Engineering Dale and Jeanne Compton Burton and DeeDee Georges C. St. Laurent Jr. Roman W. DeSanctis McMurtry Charlotte and Morry 2007 Private Contributions Robert W. Deutsch Richard and Ronay Tanenbaum The National Academy George and Maggie Eads Menschel Ted Turner of Engineering gratefully Richard Evans Dane and Mary Louise Leslie L. Vadasz acknowledges the following Harvey V. Fineberg and Miller Roy and Diana Vagelos members and friends who Mary E. Wilson Mrs. G. William Miller John C. Whitehead made charitable contributions Tobie and Dan Fink George and Cynthia Wm. A. Wulf during 2007. Their collec- George and Ann Fisher Mitchell Alejandro Zaffaroni tive, private philanthropy Harold K. and Betty A. Ambrose K. Monell Golden Bridge Society helps to advance NAE’s ser- Forsen Gordon and Betty Moore of the National Acad- vice and impact as advisor to William L. and Mary Kay Joe and Glenna Moore emy of Engineering our nation. Friend David and Lindsay Eugene Garfield, Ph.D. Morgenthaler The Golden Bridge Society Einstein Society William H. Gates III Richard M. Morrow recognizes the generosity In recognition of members T.H. Geballe Philip Needleman of NAE members who and friends who have made Nan and Chuck Geschke Gerda K. Nelson have made cumulative lifetime contributions of William T. Golden* Ralph S. O’Connor contributions of $20,000 $100,000 or more to the Corey S. Goodman Peter O’Donnell Jr. to $99,999. Bernard M. Gordon Kenneth H. Olsen National Academies. Andreas Acrivos David Grainger Doris Pankow William F. Allen Jr. Anonymous Jerome H. and Barbara N. Jack S. Parker Gene M. Amdahl John Abelson Grossman Shela and Kumar Patel William A. Anders Bruce and Betty Alberts Corbin Gwaltney Percy Pollard Bishnu S. Atal Rose-Marie and Jack R. Margaret A. Hamburg and Robert A. Pritzker William F. Ballhaus Jr. Anderson Peter F. Brown Dr. and Mrs. Allen E. William F. Banholzer John and Lise Armstrong William M. Haney III Puckett Paul Baran Richard C. and Rita Michael and Sheila Held Ann and Michael Ramage Thomas D. Barrow Atkinson Jane Hirsh Simon Ramo Roy H. Beaton* Norman R. Augustine M. Blakeman Ingle Carol and David Richards Franklin H. Blecher William F. Ballhaus Sr. Robert L. and Anne K. Anne and Walt Robb Erich Bloch Craig and Barbara Barrett James Henry M. Rowan Barry W. Boehm Jordan and Rhoda Baruch Anita K. Jones George Rowe Lewis M. Branscomb Warren L. Batts Thomas V. Jones Jack W. and Valerie Rowe George Bugliarello Stephen D. Bechtel Jr. Trevor O. Jones Mrs. Joseph E. Rowe William Cavanaugh III Kenneth E. Behring Kenneth A. Jonsson Mrs. Fritz J. Russ* Robert A. Charpie C. Gordon Bell Yuet W. Kan William J. Rutter Joseph V. Charyk Elwyn and Jennifer Fred Kavli Stephen and Anne Ryan John M. Cioffi Berlekamp Cindy and Jeong Kim Jillian Sackler A. James Clark Diane and Norman Mrs. Olga Kirchmayer Henry and Susan Samueli Stephen H. Crandall Bernstein Frederick A. Klingenstein Bernard G. and Rhoda Malcolm R. Currie Mrs. Elkan R. Blout Daniel E. Koshland Jr.* Sarnat Lance A. Davis Harry E. Bovay Jr. William W. Lang Wendy and Eric Schmidt Ruth M. Davis David G. Bradley Gerald and Doris Laubach Sara Lee and Axel Schupf Donald L. Bren

*Deceased *Deceased *Deceased Spring 2008 49

Gerald P. Dinneen Simon Ostrach John and Lise Armstrong Zack T. Pate E. Linn Draper Jr. Lawrence T. Papay Norman R. Augustine Daniel W. Pettengill Mildred S. Dresselhaus Zack T. Pate Stanley Baum Frank and Billie Press Robert J. Eaton Donald E. Petersen Stephen D. Bechtel Jr. Simon Ramo Thomas E. Everhart Dennis J. Picard Clyde J. Behney Allen F. Rhodes* Samuel C. Florman George B. Rathmann Paul Berg Alexander Rich Kenneth F. Foltby Charles Eli Reed* Franklin H. Blecher Frederic M. Richards Robert C. Forney George A. Roberts Daniel Branton Henry W. Riecken Donald N. Frey Brian H. Rowe* Robert and Lillian Brent Richard J. and Bonnie B. Richard L. Garwin Maxine L. Savitz Morrel H. Cohen Robbins Louis V. Gerstner Jr. Warren G. Schlinger Colleen Conway-Welch James F. Roth Martin E. Glicksman Roland W. Schmitt Ellis B. Cowling Sheila A. Ryan Joseph W. Goodman Robert C. Seamans Jr. Barbara J. Culliton Myriam P. Sarachik William E. Gordon Robert F. Sproull Ruth M. Davis Paul R. Schimmel Robert W. Gore Arnold F. Stancell Robert A. Derzon Stuart F. Schlossman James N. Gray Chauncey Starr* Peter N. Devreotes Rudi Schmid* Paul E. Gray Raymond S. Stata Paul M. Doty Kenneth I. Shine Delon Hampton H. Guyford Stever Mildred S. Dresselhaus Robert Louis Sinsheimer Martin C. Hemsworth Stanley D. Stookey Ernest L. Eliel Dale F. Stein Robert J. Hermann Peter B. Teets Gerard W. Elverum Jr. John A. Swets David and Susan Hodges Daniel M. Tellep Emanuel Epstein Esther S. Takeuchi Edward E. Hood Jr. Leo J. Thomas William K. Estes Paul Talalay Irwin M. Jacobs Gary and Diane Tooker Richard Evans Ivan M. Viest Robert E. Kahn Charles M. Vest Robert C. Forney Willis H. Ware Thomas Kailath Ivan M. Viest Paul H. Gilbert Robert H. Wertheim Dr. and Mrs. Paul G. Andrew J. Viterbi Martin E. Glicksman John Archibald Wheeler Kaminski Willis H. Ware George Gloeckler Wm. A. Wulf James N. Krebs Johannes and Julia Michael and Sheila Held Charles Yanofsky Kent Kresa Weertman Richard B. Johnston Jr. Michael Zubkoff John W. Landis Robert H. Wertheim Anita K. Jones David M. Lederman Albert R. C. Westwood Jerome Kagan Catalyst Society Frank T. and Bonnie Robert M. White Samuel Karlin In recognition of NAE Berger Leighton Sheila E. Widnall John W. Landis members and friends who Johanna M.H. Levelt John J. Wise Norma M. Lang contributed $10,000 Sengers Edward Woll William W. Lang or more to the National Norman N. Li A. Thomas Young Jane Menken Academies in 2007. Frank W. Luerssen G. Lewis and Ingrid Meyer NAE Members Kenneth G. McKay Heritage Society Gordon and Betty Moore John L. Moll In recognition of members Arno G. Motulsky Anonymous Van C. Mow and friends who have Van C. Mow John A. Armstrong George E. Mueller contributed to the future Guido Munch Bishnu S. Atal Dale and Marge Myers of the National Academies Mary O. Mundinger Norman R. Augustine Cynthia S. and Norman through life income, Gerda K. Nelson William F. Ballhaus Jr. A. Nadel bequests, and other estate Norman F. Ness William F. Banholzer John Neerhout Jr. and planned gifts. Ronald P. Nordgren Paul Baran Robert M. Nerem Gilbert S. Omenn Craig R. Barrett Andreas Acrivos Ronald P. Nordgren Dr. and Mrs. Bradford Jordan J. Baruch Gene M. Amdahl Franklin M. Orr Jr. Parkinson Stephen D. Bechtel Jr.

*Deceased *Deceased The 50 BRIDGE

C. Gordon Bell Friends Ronald P. Nordgren Steven B. Sample Harry E. Bovay, Jr. Rose-Marie and Jack R. Dennis J. Picard Jerry Sanders Lewis M. Branscomb Anderson Simon Ramo Donald R. Scifres George Bugliarello Barbara M. Barrett Leo J. Thomas Robert C. Seamans Jr. John M. Cioffi James McConnell Clark Gary and Diane Tooker Richard J. Stegemeier A. James Clark David Grainger Willis H. Ware H. Guyford Stever W. Dale and Jeanne Jerome H. Grossman William L. Wearly Kenneth E. Stinson Compton Jill Howell Kramer Adrian Zaccaria Joseph F. Traub Lance Davis John F. McDonnell Andrew J. Viterbi Friends Robert W. Deutsch George P. Mitchell Daniel I.C. Wang Gerald P. Dinneen Joe F. Moore Warren L. Batts Johannes and Julia Robert J. Eaton Darla Mueller Wiley N. Caldwell Weertman Thomas E. Everhart Peter O’Donnell Jr. Eugene Garfield Albert R.C. Westwood Daniel J. Fink Dolores H. Russ* Jane Hirsh Edward Woll William L. Friend Sara Lee Schupf William F. Kieschnick Friends Elsa M. Garmire Georges C. St. Laurent Jr. Neil R. Rolde William H. Gates III Harvey S. Sadow Kristine L. Bueche Charles M. Geschke Rosette Society Challenge Society Charter Society Paul E. Gray In recognition of NAE Kenneth F. Holtby members and friends who In recognition of NAE In recognition of NAE Anita K. Jones contributed $5,000 to members and friends who members and friends who Thomas V. Jones $9,999 to the National contributed $2,500 to contributed $1,000 to Trevor O. Jones Academies in 2007. $4,999 to the National $2,499 to the National Dr. and Mrs. Paul G. Academies in 2007. Academies in 2007. Kaminski NAE Members NAE Members NAE Members Jeong H. Kim Thomas D. Barrow Kent Kresa Forest Baskett III Rodney C. Adkins Andreas Acrivos Norman N. Li Elwyn R. Berlekamp Anonymous William G. Agnew Dane A. Miller Samuel W. Bodman David K. Barton Edward C. Aldridge Gordon E. Moore Barry W. Boehm Vinton G. Cerf Clarence R. Allen George E. Mueller Joseph V. Charyk G. Wayne Clough Frances E. Allen Franklin M. Orr Jr. Malcolm R. Currie Stephen H. Crandall Lew Allen Jr. Lawrence T. Papay Ruth M. Davis Ruth A. David Minoru S. Araki Jack S. Parker Thomas V. Falkie Howard Frank Neil A. Armstrong Michael P. Ramage Samuel C. Florman Wesley L. Harris Wm. H. Arnold Walter L. Robb John O. Hallquist Juris Hartmanis Irving L. Ashkenas Henry M. Rowan Leah H. Jamieson George N. Hatsopoulos Thomas W. Asmus Jonathan J. Rubinstein Robert E. Kahn Chenming Hu Ken Austin Henry Samueli Thomas Kailath John and Wilma Arthur B. Baggeroer Maxine L. Savitz Brian W. Kernighan Kassakian Clyde and Jeanette Baker Warren G. Schlinger Leonard Kleinrock James F. Lardner Frank S. Barnes Robert F. Sproull Gerald D. Laubach Edward D. Lazowska James B. Bassingthwaighte Peter B. Teets David M. Lederman John Neerhout Jr. Wallace B. Behnke Charles M. Vest James C. McGroddy William J. Perry Philip A. Bernstein Raymond Viskanta Richard M. Morrow John W. Poduska Sr. Wilson V. Binger Robert H. Wertheim C. Dan Mote Jr. Raj Reddy R. Byron Bird Wm. A. Wulf Cynthia S. and Norman Ronald L. Rivest Franklin H. Blecher John A. Young A. Nadel George A. Roberts Donald J. Blickwede

*Deceased Spring 2008 51

David B. Bogy Robert C. Forney J. Ross Macdonald Brian H. Rowe* Rudolph Bonaparte Gordon E. Forward Thomas S. Maddock William B. Russel Seth Bonder Eli Fromm Frederick J. Mancheski Andrew P. Sage H. Kent Bowen Louis V. Gerstner Jr. Craig Marks Vinod K. Sahney Corale L. Brierley Alexander F. Giacco Edward A. Mason Harvey W. Schadler James A. Brierley Paul H. Gilbert James F. Mathis Ronald V. Schmidt Alan C. Brown Eduardo D. Glandt Robert D. Maurer CAPT Willard F. Searle Jr. Andrew Brown George J. Gleghorn Bramlette McClelland Daniel P. Siewiorek Harold Brown Arthur L. Goldstein Sanford N. McDonnell John B. Slaughter James R. Burnett Mary L. Good Robin K. McGuire Ernest T. Smerdon Jeffrey P. Buzen Joseph W. Goodman Brockway McMillan Alvy R. Smith Federico Capasso William E. Gordon Kishor C. Mehta Bob Spinrad Robert P. Caren Hermann K. Gummel Richard A. Meserve Joel S. Spira Francois J. Castaing Elias P. Gyftopoulos James J. Mikulski William E. Splinter Corbett Caudill Edward E. Hagenlocker William F. Miller Arnold F. Stancell A. Ray Chamberlain Delon Hampton James K. Mitchell Raymond S. Stata Chau-Chyun Chen Douglass C. Harvey Benjamin F. Montoya Gunter Stein Nai Y. Chen Kenneth E. Haughton Duncan T. Moore Thomas G. Stephens Shu and Kuang-Chung John L. Hennessy John R. Moore* Henry E. Stone Chien David G. Hoag John W. Morris Stanley D. Stookey Sunlin Chou David and Susan Hodges Van C. Mow Ronald D. Sugar Uma Chowdhry Charles O. Holliday Dale and Marge Myers John E. Swearingen* Richard M. Christensen Edward E. Hood Jr. Albert Narath George J. Tamaro Philip R. Clark Leroy Hood Venkatesh Narayanamurti Morris and Charlotte Wesley A. Clark Mary Jane Irwin Robert M. Nerem Tanenbaum Aaron Cohen Shirley A. Jackson Dr. and Mrs. Bradford Man-Chung Tang Joseph M. Colucci George W. Jeffs Parkinson Matthew V. Tirrell Harry M. Conger Donald L. Johnson C. Kumar N. Patel Paul E. Torgersen Esther M. Conwell G. Frank Joklik Neil E. Paton John W. Townsend Jr. Gary L. Cowger M. Frans Kaashoek H. W. Paxton James A. Trainham III John and Norma Crawford C. Judson King Thomas K. Perkins Hardy W. Trolander Natalie W. Crawford Edwin E. Kintner Donald E. Petersen Harold J. Vinegar Charles R. Cushing James L. Kirtley Henry Petroski Thomas H. Vonder Haar Glen T. Daigger Albert S. Kobayashi Frank E. Pickering Robert H. Wagoner Lee L. Davenport Robert M. Koerner William P. Pierskalla Jasper A. Welch Jr. Carl de Boor Lester C. Krogh William F. Powers Willis S. White Jr. Raymond F. Decker Ernest S. Kuh Donald E. Procknow Robert H. Widmer Thomas B. Deen Doris Kuhlmann-Wilsdorf Edwin P. Przybylowicz John J. Wise Daniel W. Dobberpuhl Charles C. Ladd George B. Rathmann Eugene Wong Nicholas M. Donofrio Richard T. Lahey Jr. Buddy D. Ratner Edgar S. Woolard Jr. James J. Duderstadt William W. Lang Joseph B. Reagan Margaret H. Wright Edsel D. Dunford Alan Lawley Kenneth L. Reifsnider Richard N. Wright Robert C. Earlougher Jr. Fred J. Leonberger Richard J. and Bonnie B. Israel J. Wygnanski Farouk El-Baz Frederick F. Ling Robbins William D. Young Lawrence B. Evans Jack E. Little Bernard I. Robertson Abe M. Zarem Edward A. Feigenbaum J. David Lowell Alton D. Romig Edith M. Flanigen Richard H. Lyon Anatol Roshko Friends G. David Forney Jr. John B. MacChesney Gerald F. Ross Evelyn S. Jones

*Deceased *Deceased The 52 BRIDGE

Other Individual Anil K. Chopra Fred N. Finn Angel G. Jordan Donors Richard C. Chu Essex E. Finney Jr. Aravind K. Joshi In recognition of NAE John L. Cleasby Abdel-Aziz A. Fouad Biing-Hwang Juang members and friends who Louis F. Coffin Jr. Charles A. Fowler Eugenia Kalnay contributed up to $999 to the Richard A. Conway Gerard F. Fox Ivan P. Kaminow National Academies in 2007. George E. Cooper Judson C. French Melvin F. Kanninen Fernando J. Corbato Ivan T. Frisch Raphael Katzen NAE Members Ross B. Corotis Shun Chong Fung Lawrence L. Kazmerski H. Norman Abramson Dale R. Corson Elmer L. Gaden Howard H. Kehrl Jan D. Achenbach Edgar M. Cortright Theodore V. Galambos Riki Kobayashi Mihran S. Agbabian Eugene E. Covert Ronald L. Geer Max A. Kohler Paul A. Allaire Douglass D. Crombie John H. Gibbons William J. Koros Charles A. Amann David E. Crow Elmer G. Gilbert James N. Krebs John E. Anderson James Q. Crowe Earnest F. Gloyna James L. Lammie John L. Anderson Lawrence B. Curtis Solomon W. Golomb David A. Landgrebe Anonymous David E. Daniel Thomas E. Graedel Robert C. Lanphier III Frances H. Arnold Paul D. Dapkus Serge Gratch* Louis J. Lanzerotti R. Lyndon Arscott Edward E. David Jr. William A. Gross Chung K. Law James R. Asay L. Berkley Davis Jerrier A. Haddad Margaret A. LeMone Arthur Ashkin Delbert E. Day Carl W. Hall Johanna M.H. Levelt David Atlas F.P. de Mello Carol K. Hall Sengers Donald W. Bahr Morton M. Denn William J. Hall Marc Levenson W.O. Baker* Robert C. DeVries Donald L. Hammond Mark J. Levin John W. Batchelor Frederick H. Dill Thomas L. Hampton Herbert S. Levinson Robert F. Bauer Ralph L. Disney Robert C. Hansen Salomon Levy Howard and Alice Baum John E. Dolan Stephen E. Harris Paul A. Libby Zdenek P. Bazant Albert A. Dorman Howard R. Hart Jr. Frances S. Ligler Robert Ray Beebe Irwin Dorros Julius J. Harwood Barbara H. Liskov Georges Belfort Earl H. Dowell Ira G. Hedrick Verne L. Lynn Leo L. Beranek E. Linn Draper Jr. Alan J. Heeger Malcolm MacKinnon III James R. Biard Floyd Dunn George H. Heilmeier Christopher L. Magee Alfred Blumstein Peter S. Eagleson Adam Heller Subhash Mahajan F.P. Boer Lewis S. Edelheit Martin Hellman Robert C. Marini Geoffrey Boothroyd Helen T. Edwards Robert W. Hellwarth Hans Mark George H. Born Charles Elachi Arthur H. Heuer James J. Markowsky Lillian C. Borrone Bruce R. Ellingwood George J. Hirasaki David K. Matlock P. L. Thibaut Brian Joel S. Engel John P. Hirth Hudson Matlock Peter R. Bridenbaugh F. Erdogan William C. Hittinger William McGuire Frederick P. Brooks Jr. John V. Evans Thom J. Hodgson Kenneth G. McKay Norman H. Brooks James R. Fair Lester A. Hoel Ross E. McKinney Jack E. Buffington Robert M. Fano David C. Hogg Robert M. McMeeking L. Gary Byrd James A. Fay John R. Howell Alan L. McWhorter James D. Callen Joseph Feinstein Thomas P. Hughes Eugene S. Meieran John M. Campbell Sr. Robert E. Fenton Izzat M. Idriss David Middleton E. Dean Carlson Michael J. Fetkovich Sheldon E. Isakoff Angelo Miele Douglas M. Chapin A.J. Field Paul C. Jennings Joan L. Mitchell Vernon L. Chartier Morris E. Fine James O. Jirsa Richard K. Moore W. Peter Cherry Bruce A. Finlayson Marshall G. Jones A.S. Morse

*Deceased *Deceased Spring 2008 53

Joel Moses Geert W. Schmid- Warren M. Washington Louis W. Cabot E. P. Muntz Schoenbein John T. Watson Wiley N. Caldwell Earll M. Murman William R. Schowalter Robert J. Weimer M. Blouke Carus Haydn H. Murray Frank J. Schuh Sheldon Weinbaum Ralph J. Cicerone Peter Murray Lyle H. Schwartz John J. Wetzel II James McConnell Clark Thomas J. Murrin Mischa Schwartz John R. Whinnery Michael T. Clegg Albert F. Myers Hratch G. Semerjian Marvin H. White W. Dale Compton Gerald Nadler Robert J. Serafin Robert M. White Nancy E. Conrad Devaraysamudram R. F. Stan Settles Robert V. Whitman Charles R. Denham Nagaraj Maurice E. Shank Ward O. Winer Ralph C. Derrickson Stuart O. Nelson Don W. Shaw Jack K. Wolf Charles W. Duncan Jr. Joseph H. Newman Freeman D. Shepherd M. Gordon and Elaine Harvey V. Fineberg Wesley L. Nyborg Thomas B. Sheridan Wolman William L. Friend James G. O’Connor Neil G. Siegel David A. Woolhiser Raymond E. Galvin Daniel A. Okun* Arnold H. Silver Loring A. Wyllie Jr. Eugene Garfield Robert M. Oliver Jack M. Sipress Eli Yablonovitch Jack M. Gill Charles R. O’Melia Elias Snitzer Laurence R. Young Ronald L. Graham Robert S. O’Neil J. Edward Snyder* Ben T. Zinn Jerome H. Grossman Alan V. Oppenheim Soroosh Sorooshian Norman Hackerman* Elaine S. Oran Alfred Z. Spector Friends Samuel F. Heffner Jr. John K. Ousterhout Edgar A. Starke Jr. Jeffrey A. Chandler Jane Hirsh David H. Pai Francis M. Staszesky Frances P. Elliott M. Blakeman Ingle Athanassios Z. Dale F. Stein Rosemary Gratch Christopher Ireland Panagiotopoulos Dean E. Stephan James and Carole Young Scott A. Jones Frank L. Parker Gregory Stephanopoulos William F. Kieschnick Louis C. Parrillo Beno Sternlicht Presidents’ Circle William I. Koch Robert J. Patton Kenneth H. Stokoe II Donors from the private Jill Howell Kramer P. Hunter Peckham Richard G. Strauch sector whose contributions Gerald D. Laubach Alan W. Pense Gerald B. Stringfellow are dedicated to promoting Robert H. Malott Julia M. Phillips James M. Symons greater awareness of science Davis Masten Karl S. Pister R. Bruce Thompson and technology in our society John F. McDonnell Priya Prasad James M. Tien and a better understanding Burton J. McMurtry Ronald F. Probstein William F. Tinney of the work of the National Charles H. McTier Eugene M. Rasmusson Charles H. Townes Academies. George P. Mitchell Robert H. Rediker Charles E. Treanor Joe F. Moore Jack R. Anderson Charles Eli Reed* Alvin W. Trivelpiece Darla Mueller Barbara M. Barrett Cordell Reed Richard H. Truly Patricia S. Nettleship Craig R. Barrett Eli Reshotko Stephen W. Tsai Peter O’Donnell Jr. Thomas D. Barrow John R. Rice Howard S. Turner Jack S. Parker Ernest A. Bates Jerome G. Rivard Moshe Y. Vardi Frank Press Warren L. Batts Robert K. Roney Anestis S. Veletsos Peter H. Raven Donald R. Beall Arye Rosen Walter G. Vincenti John S. Reed Berkley Bedell Ken Rosen John Vithayathil Charles W. Robinson Diane Bernstein Allen S. Russell Irv Waaland Neil R. Rolde Jo Ivey Boufford B. Don Russell Steven J. Wallach Stephen J. Ryan E. Cabell Brand Miss Jean E. Sammet C. Michael Walton Harvey S. Sadow John I. Brauman Peter W. Sauer Rong-Yu Wan Maxine L. Savitz George Bugliarello Thorndike Saville Jr. Darsh T. Wasan Barbara A. Schaal Malin Burnham

*Deceased *Deceased *Deceased The 54 BRIDGE

Sara Lee Schupf S.D. Bechtel Jr. Georgia Institute of Northrop Grumman H.R. Shepherd Foundation Technology Corporation Susan E. Siegel Bell Family Foundation Geosynthetic Institute Ohio University Georges C. St. Laurent Jr. Cummins Business Google The David and Lucile Judy Swanson Services The Grainger Foundation Packard Foundation Charles M. Vest C.R. Cushing & Co. The Grossman Family Parametric Technology Robert H. Waterman Cytec Industries Inc. Foundation Corporation Susan E. Whitehead Dow Chemical Company Hewlett-Packard PJM Interconnection Margaret S. Wilson Foundation Company Southwest Research Wm. A. Wulf The Charles Stark Draper Indo-US Science and Institute Carole S. Young Laboratory Technology Forum The Teagle Foundation James F. Young DuPont Company Ingersoll-Rand Company TIAA-CREF ExxonMobil Foundation Intel Corporation UGS Corp. Corporations, FJC W.M. Keck Foundation United Engineering Foundations, and GE Energy Lockheed Martin Foundation Other Organizations GE Foundation Corporation Watermark Estate Anonymous General Motors Lutron Foundation Management Services Bechtel Group Corporation Merrill Lynch & Company WGBH Educational Microsoft Corporation Foundation

America’s Energy Future: Technology Opportunities, Risks, and Trade-offs

NAE took the lead in initiating create a sense of urgency about After discussions with leaders and and funding a major new inter- America’s energy future and the experts from across the spectrum, academy study on America’s energy government policies that affect it. including very senior representa- future, a critical factor in the vital- Although a number of stud- tives of industry, academia, and ity of the U.S. economy, national ies have been published in recent government and members and staff security, environmental quality, years exploring technology options of all of the academies partners, the and quality of life. The rising global for energy, their conclusions often National Academies initiated the demand for energy from continued conflict, reflecting disagreements America’s Energy Future (AEF) proj- population and economic growth, about the potential of these tech ect to inform the national debate. especially in developing countries; nologies, particularly biomass The study will provide authoritative the vulnerabilities of energy sup- energy, renewable electric power- estimates of current and potential plies to political instabilities and generating technologies, nuclear contributions of existing and new terrorism; limited energy resources, power, and advanced coal tech- energy technologies to meet both especially oil; growing global con- nologies. The nation sorely needs supply and demand, as well as asso- cerns about emissions of greenhouse an up-to-date, credible analysis ciated impacts and projected costs. gases from the burning of fossil of technology options, costs, and The study will anchor a portfolio of fuels, which currently supply most impacts as a basis for making sen- follow-on studies at the academies of the world’s energy; questions sible decisions about our energy and elsewhere related to energy about the adequacy of investments future that take into account research and development, strategic in the infrastructure and technolo- competing national priorities and energy technologies, policy analysis, gies necessary to develop alternate interests, such as (1) reducing and related subjects. energy sources; and concerns about dependence on imported oil; (2) As part of the project, the acade- the large-scale deployment of some ensuring that abundant, affordable mies hosted the National Academies alternate energy sources, such as energy is available; and (3) reduc- Summit on America’s Energy Future nuclear power, have combined to ing emissions of carbon dioxide. on March 13 and 14 to stimulate Spring 2008 55

discussion among experts with dif- Petroleum Council, Council on separate reports on three classes of ferent points of view. Leaders in Foreign Relations, National Com- technologies—energy efficiency, energy policy from government, mission on Energy Policy, the Inter alternative transportation fuels, and research institutions, and the pri- academy Council, and others. renewable electric power generating vate sector addressed three major The 25 members of the AEF study technologies—about which there themes—energy security, energy committee are experts on all aspects are considerable uncertainties and and the economy, and energy and of the issues and represent all of disagreements. The final report is the environment. Their presenta- the major interested parties. Three expected to be published by the end tions included overviews of recent independent panels have been of 2008. major studies by the National organized to investigate and publish

“News and Terrorism: Communicating in a Crisis” Workshops

NAE began a new series of “News At each workshop, local reporters, workshop attendees break into small and Terrorism: Communicating in government officials, and engineers groups where they analyze the han- a Crisis” interactive workshops in and scientists participate in a ter- dling of events and discuss how they January 2008. On January 17, the rorism or disaster scenario exercise can improve their preparation for first event of the new series was focused specifically on their region. terrorist events or disasters. held in Charlotte, North Caro- Because large organizations will be For more details or information lina, and additional workshops are significant sources of information for on future workshops, please e-mail being planned around the country their employees, the current series of Randy Atkins at . throughout the year. The NAE workshops also includes representa- As part of the project, the National Program Office produces these tives of the private sector. As sce- Academies has produced fact sheets workshops in collaboration with narios unfold, panelists from each on biological, chemical, nuclear, and the Radio and Television News community enact their particular radiological attacks. Fact sheets are Directors Foundation and the U.S. roles, bringing to light concerns and available in PDF format at .

China/U.S. Air Pollution Study

A joint study by NAE and the burgeoning vehicle fleet. In addition, leaves the implementation of these Policy on Global Affairs Division China’s energy decisions will have policies largely to local leaders. of the National Research Coun- regional and global implications. In 2007, a committee of Chinese cil (NRC) is the latest phase of an China’s most secure form of energy and U.S. experts, led by Dr. John ongoing project with the Chinese is indigenous coal, which provides Watson, a researcher on air quality Academies of Science and Engineer- much of the power for its electricity, at the University of Nevada Des- ing. As the number of economic, urban heating, and cooking. How- ert Research Institute, completed a scientific, and technical issues com- ever, air pollution from burning coal consensus study on the energy and mon to China and the United States has had severe detrimental effects on air pollution challenges facing both increases, exchanges of information public health and the nation’s biota countries. The report details the sit- are becoming increasingly important and water resources. Economists have uation in four cities—Los Angeles, to both countries. A case in point is determined that air pollution has Pittsburgh, Dalian, and Huainan. China’s current efforts to secure also slowed the growth of China’s A prepublication version released energy concessions from countries GDP. In recent energy and air- in September 2007 received wide- around the world to ensure its quality policies, China acknowledges spread press coverage in China and supply of transportation fuel for a the effects of pollution from coal, but the United States. The final report The 56 BRIDGE was released in January 2008 (the in Beijing, Huainan, and Tianjin. technology transfer, and recommend Chinese translation is expected in During the meetings, the U.S. and priorities for future collaborations February 2008). Chinese academies agreed, in prin- on cost reductions, efficiency In November, delegates from the ciple, to conduct a follow-on study improvement, grid connectivity, and U.S. committee traveled to China on wind, solar, and biomass energy. energy storage. to attend joint workshops and dis- Building on an ongoing NRC Proctor Reid, director of the NAE cuss the findings and recommen- project, America’s Energy Future, Program Office, and Derek Vollmer, dations. Mayors, environmental the proposed follow-on study would senior program associate, Policy managers, and researchers repre- provide an assessment of resource and Government Affairs Divi- senting both national and local potential in China, explore near-term sion, participated in the November interests participated in discussions market opportunities for inter-country workshops.

Launch of the Engineer Your Life Web Site

On February 20, NAE hosted they chose to pursue engineer- Engineer Your Life™ is a produc- the official launch of Engineer ing careers. The site also provides tion of WGBH Educational Foun- Your Life (http://www.engineer descriptions of 11 fields of engi- dation and NAE in partnership yourlife.org), a web site that encour- neering, a wide range of engineer- with the Extraordinary Women ages high school girls with the ing projects, information about Engineers Coalition. The Engineer necessary academic background starting salaries and resources, and Your Life web site is part of NAE’s to enroll in undergraduate engi- videos of young engineers describ- ongoing commitment to diversify- neering programs. The web site ing their careers. A third section ing the engineering workforce. The is part of a nationwide effort to provides information about how to new site complements material on inform high school girls, and the prepare for a college engineering other NAE web sites, such as Engi- adults in their lives, about the program, including which classes neerGirl! (http://www.engineergirl. professional and personal aspects to take in high school; descriptions org), a site designed specifically for of engineering. of the personal experiences of engi- girls in middle school. Engineer Your Life provides a neering students; and information Major funding for the Engineer forum where high school girls can about choosing an engineering pro- Your Life project is provided by the “meet” young women engineers and gram. In addition, the site provides National Science Foundation and learn about their careers. Twelve resources and training on advising Northrop Grumman Foundation. women tell inspiring stories about students about engineering careers Additional funding is provided working in communities to solve for parents, counselors, teachers, by Stephen D. Bechtel Jr. and the real problems and explain why and other educators United Engineering Foundation.

Grand Challenges for Engineering in the 21st Century

In 2006, the National Science William J. Perry, can be found at but to identify what we need to do Foundation asked NAE to convene www.engineeringchallenges.org. Early to help people everywhere and to an international group of leading last year, the committee invited NAE keep our planet healthy. The over- thinkers for the purpose of devel- members, engineering societies, and all goal is to increase public aware- oping a list of grand challenges for the worldwide public to contribute ness and stimulate discussion about engineering in the 21st century. ideas. So far, people in more than global challenges and how they can Information about the 18-member 40 countries have responded. be addressed through engineering. blue-ribbon committee, chaired by The goal of the Grand Challenges These discussions might ultimately former U.S. Secretary of Defense Project is not to make predictions inspire policy makers to recognize Spring 2008 57

the importance of engineering in (www.engineeringchallenges.org), The committee believes the addressing these major issues. where the public can vote on which 14 challenges should be realisti- On February 15, 2008, the com- items should be included in the final cally addressable by the end of mittee announced its conclusions at list of 14 challenges. The commit- this century, at the latest, and that a news conference at the American tee has not ranked the challenges, overcoming any one of them would Association for the Advancement and findings are not meant to be dramatically improve life on Earth. of Science annual meeting and comprehensive or specific about on the Grand Challenges website particular approaches.

Calendar of Meetings and Events

March 1–31 Annual election of officers April 23 NAE Regional Meeting May 6–7 NRC Governing Board Meeting and councillors Arizona State University, May 8–9 NAE Council Meeting April 2 NAE Regional Meeting Tempe, Arizona Annapolis, Maryland California Institute of April 24–27 german-American Frontiers of June 12 NRC Governing Board Meeting Technology, Pasadena, Engineering Symposium California Beckman Center, Irvine, June 20 NAE/NAEF Audit Committee Meeting April 9 governing Board Executive California Committee Meeting May 1 NAE Regional Meeting All meetings are held in the Academies building, April 10 NAE Regional Meeting IBM, Yorktown Heights, Washington, D.C., unless otherwise noted. For University of Wisconsin, New York information about regional meetings, please contact Madison, Wisconsin May 5–6 NAE Convocation of Professional Sonja Atkinson at [email protected] or phone (202) Engineering Societies 334-3677.

In Memoriam

Steven F. Clifford, 64, Gene H. Golub, 75, Fletcher Donald R. Herriott, 79, Senior Research Scientist Emeri- Jones Professor of Computer Sci- retired head, Lithographic Systems tus, University of Colorado, died on ence, Computer Science Depart- Department, AT&T Bell Laborato- September 18, 2007. Dr. Clifford ment, Stanford University, died on ries, died on November 8, 2007. Mr. was elected to NAE in 1997 “for November 16, 2007. Dr. Golub was Herriott was elected to NAE in 1982 contributions to the understand- elected to NAE in 1990 “for con- “for the invention of the helium- ing of electromagnetic and acoustic tributions in developing and ana- neon laser, and inventions and propagation in random media, lead- lyzing robust and stable numerical development of lithographic systems ing to the development of new sens- algorithms used in solving complex for integrated circuit fabrication.” ing techniques.” engineering problems.” David N. Kennedy, 71, con- C. Allin Cornell, 69, Profes- Serge Gratch, 86, Professor sulting engineer, died on Decem- sor Emeritus, Department of Civil Emeritus, Kettering University, died ber 23, 2007. Mr. Kennedy was and Environmental Engineering, on December 4, 2007. Dr. Gratch elected to NAE in 1998 “for plan- Stanford University, died on Decem- was elected to NAE in 1983 “for ning and management of water ber 14, 2007. Dr. Cornell was elected contributions to the thermodynamic resources.” to NAE in 1981 “for the develop- properties of gases, development of ment of practical methods for appli- successful automotive exhaust con- Herbert J.C. Kouts, 88, cation of probability to structural trol systems, and utilization of alter- retired board member, Defense and earthquake engineering.” native fuels.” Nuclear Facilities Safety Board, The 58 BRIDGE died January 7, 2008. Dr. Kouts was Courtland D. Perkins, 95, Technologies, died on November 29, elected to NAE in 1978 “for con- past president, National Academy 2007. Dr. Slepian was elected to tributions in nuclear engineering, of Engineering, died on January 6, NAE in 1976 “for contributions especially physical principles and 2008. Dr. Perkins was elected to to the elucidation of fundamental safety of nuclear power reactors and NAE in 1969 “for leadership in the limits that apply to the processes of nuclear materials safeguards.” fields of airplane stability and con- communications, signal detection, trol and airplane dynamics.” and data extraction.” John H. McElroy, 76, Dean of Engineering Emeritus, Univer- Charles Eli Reed, 94, retired J. Edward Snyder Jr., 83, sity of Texas at Arlington, died on senior vice president, General Elec- retired oceanographer, U.S. Navy, September 14, 2007. Dr. McElroy tric Company, died on November 16, died on November 4, 2007. Rear was elected to NAE in 1998 “for 2007. Dr. Reed was elected to Adm. Snyder was elected to NAE in the development and applications NAE in 1969 “for his engineer- 1979 “for contributions to the Polar- of laser technology to space-based ing accomplishments in blending is missile reentry systems and to the geodesy, atmospheric science, and scientific, technological, and com- National Oceanographic Program.” communications.” mercial elements to the production of man-made diamonds, new sili- Peter Staudhammer, 73, Daniel A. Okun, 90, Kenan cones, commercialization of oxida- retired vice president, Science and Professor of Environmental Engi- tive technology in the form of lexan Technology, TRW Inc., died on neering Emeritus, University of polycarbonates and the plant design January 14, 2008. Dr. Staudhammer North Carolina, died on Decem- and process developments accompa- was elected to NAE in 1996 “for ber 10, 2007. Dr. Okun was elected nying these new materials.” engineering achievements in space to NAE in 1973 “for innovative systems, plasma and microwave contributions to sanitary engineer- David Slepian, 84, retired processes, remote sensing, instru- ing and to teaching and research.” head, Mathematical Studies Depart- mentation, and their application to ment, Bell Laboratories, Lucent commercial systems.” Spring 2008 59

Publications of Interest

The following reports have been Dr. Henrique (Rico) Malvar, manag- increasing production of corn-based published recently by the National ing director of Microsoft Research, is ethanol in the United States and Academy of Engineering or the also included. Appendixes provide prospects for the next genera- National Research Council. Unless information about contributors, the tion of biofuels have raised con- otherwise noted, all publications are symposium program, summaries of cerns about the impact on water for sale (prepaid) from the National break-out sessions, and a list of par- resources. This report, based in part Academies Press (NAP), 500 Fifth ticipants. This is the thirteenth vol- on a colloquium held in 2007, con- Street, N.W., Lockbox 285, Wash- ume in the USFOE series. cludes that water quality could be ington, DC 20055. For more infor- NAE member Julia M. Phil- considerably compromised as the mation or to place an order, contact lips, director, Physical, Chemical, result of soil erosion and increases NAP online at or by phone at (888) 624-8373. National Laboratories, chaired the cides. Water supplies could also (Note: Prices quoted are subject to symposium organizing committee. be overstressed by requirements for change without notice. Online orders Paper, $46.00. growing biofuel crops and supplying receive a 20 percent discount. Please water to ethanol-processing plants, add $4.50 for shipping and handling for Energy Futures and Urban Air Pollution: especially in areas where water sup- the first book and $0.95 for each addi- Challenges for China and the United plies are already stressed. “Cellu tional book. Add applicable sales tax States. This bilateral report sum- losic ethanol” is expected to have or GST if you live in CA, DC, FL, marizes current trends in combating less impact on water quality but MD, MO, TX, or Canada.) air pollution in urban areas, profiles cannot yet be produced on a com- two U.S. and two Chinese cities, and mercial scale. The study commit- Frontiers of Engineering: Reports on recommends measures to help both tee concludes that a policy bridge Leading-Edge Engineering from the 2007 countries improve urban air qual- may be necessary to encourage the Symposium. U.S. Frontiers of Engi- ity. The study committee, formed development of new technologies, neering (USFOE) symposia bring by the National Research Council the use of best agricultural prac- together 100 outstanding engineers and National Academy of Engi- tices, and the development of crops (ages 30 to 45) to exchange infor- neering in cooperation with the for fuel production that require less mation about leading-edge tech- Chinese Academy of Sciences and water and fertilizer. nologies in a range of engineering Chinese Academy of Engineering, NAE members on the commit- fields. The 2007 symposium cov- concludes that China can learn spe- tee were Jerald L. Schnoor (chair), ered the engineering of trustworthy cific lessons from the successes and Allen S. Henry Chair Professor, computer systems, control of protein failures of U.S. efforts. The overarch- Department of Civil and Environ- conformations, biotechnology for ing conclusion, however, is that both mental Engineering, University of fuels and chemicals, the modulation countries must improve energy effi- Iowa, and Edward A. Hiler, Ellison and simulation of human behavior, ciency in power generation, transpor- Chair in International Floriculture, and safe water technologies. Papers tation, and other economic sectors. retired, Texas A&M University. in this volume describe leading- NAE member Glen T. Daigger, Paper, $18.00. edge research on disparate tools in senior vice president and chief tech- software security, decoding of the nology officer, CH2M Hill Inc., was Condensed-Matter and Materials Phys- “mechanome,” corn-based materi- a member of the study committee. ics: The Science of the World around Us. als, modeling of human cultural Paper, $76.25. The development of the transistor, behavior, water treatment by UV integrated circuit, liquid-crystal irradiation, and many other top- Water Implications of Biofuels Produc- display, and even the DVD player ics. A speech by dinner speaker tion in the United States. Rapidly can be traced back to fundamental The 60 BRIDGE research in the field of condensed- systems, and the market of inter- members of the study committee. matter and materials physics bank funds; and the effects of sys- Paper, $38.00. (CMMP). Although the United temic risk on trade. States has been a leader in CMMP, NAE member Elisabeth Paté- Approaches for Evaluating the NRC Res- that status is now in jeopardy. This Cornell, Burt and Deedee McMurty ident Research Associateship Program report, part of the Physics 2010 Professor, and chair, Management at NIST. The National Research decadal survey project, assesses the Science and Engineering, Stanford Council Resident Research Asso- present status of the United States; University, was a member of the ciateship Program at the National suggests directions for the 21st cen- conference oversight committee. Institute of Standards and Tech- tury; identifies scientific challenges Paper, $31.00. nology (NIST) provides two-year for American researchers in the appointments for outstanding sci- areas of energy demand, the phys- Plasma Science: Advancing Knowledge in entists and engineers. This report ics of life, information technology, the National Interest. The U.S. Depart- includes descriptions of program nanotechnology, complex phenom- ment of Energy, National Science applicants and awardees and offers ena, and behavior far from equilib- Foundation, and National Aero- suggestions for an in-depth assess- rium; and recommends allocation nautics and Space Administration ment of career outcomes. Prelimi- priorities for federal funds. asked for an assessment (as part of nary investigation indicates that NAE members Mildred S. Dres- Physics 2010, a decadal survey) outreach efforts have attracted selhaus, Institute Professor of Elec- and outlook for plasma science and more qualified applicants than trical Engineering and Physics, engineering for the next several NIST can accommodate, the pool Massachusetts Institute of Technol- years. The study reviews progress in of applicants is becoming increas- ogy, and William J. Spencer, Chair- plasma research, identifies the most ingly diverse, and many Research man Emeritus, SEMATECH, were promising and important scientific Associates go on to permanent cochairs of the study committee. opportunities, evaluates prospects positions at NIST. The assessing Paper, $52.00. for new applications of plasmas, committee suggests that the agency and offers guidance for realizing conduct a thorough evaluation of New Directions for Understanding Sys- these opportunities. The study the program, including outreach temic Risk. The vulnerabilities of committee adopted a “demand- to potential applicants, individuals the financial system to systemic side” perspective to emphasize how who decline awards, the program’s events have long been critical issues plasma research can contribute to impact on the careers of awardees, for central bankers and research- meeting national goals, such as and the benefits of the program to ers. Recent world events and the the development of fusion energy, NIST and the larger scientific and growing complexity of the financial improving economic competitive- engineering community. system suggest that older models of ness, and reinforcing stewardship NAE member Isaac C. Sanchez, countering systemic shock might of the nuclear weapons stockpile. William J. Murray Endowed Chair not be able to address future distur- The report covers low-temperature in Engineering, Department of bances. To assess these concerns, plasma science and engineering, Chemical Engineering, University the Federal Reserve Bank of New plasma physics at high energy den- of Texas, Austin, chaired the study York and the National Research sity, plasma science of magnetic committee. Paper, $39.50. Council cosponsored a confer- fusion, space and astrophysical science to bring together engineers, ence, and basic plasma science. Technical Input on the National Insti- scientists, economists, and experts NAE members James D. Callen, tutes of Health’s Draft Supplementary in financial markets to discuss sys- Donald W. Kerst Professor Emeritus Risk Assessments and Site Suitability temic risk in a variety of fields. The of Engineering Physics and Physics, Analyses for the National Emerging conference discussions addressed: University of Wisconsin, Madison, Infectious Diseases Laboratory, Boston tools used in ecology and engineer- and Erich P. Ippen, Elihu Thomson University: A Letter Report. The state ing to study systemic collapses; Professor of Electrical Engineering of Massachusetts requested that the trends in research on systemic and professor of physics, Massachu- National Research Council (NRC) risk in the economy, payment setts Institute of Technology, were evaluate a draft supplemental risk Spring 2008 61

assessment prepared by the National Engineering, University of South- and Alexander MacLachlan, retired Institutes of Health (see http://www. ern California, was a member of senior vice president, research nems.nih.gov/aspects/nat_resources/ the study committee. Hardcover, and development, E.I. du Pont de programs/nepa2.cfm) for a proposed $59.00 Nemours & Co., were members biocontainment laboratory at Bos- of the study committee. Paper, ton University. The risk assessment Countering the Threat of Improvised $15.00. is intended to provide a scientific Explosive Devices: Basic Research basis for an environmental impact Opportunities, Abbreviated Version. Proceedings of a Workshop on Statistics report requested by the state. The Attacks in London, Madrid, Bali, on Networks. Knowing how complex NRC committee concludes that the Oklahoma City, and elsewhere have networks in biological, physical, and draft assessment does not adequately demonstrated that improvised explo- social systems operate is critical to develop worst-case scenarios or pro- sive devices (IEDs) are weapons of a general understanding of network vide comparisons with alternative choice for terrorists. Scientists and behavior. Each of these disciplines sites in case of the release and spread engineers have developed tech- has developed its own statisti- of a pathogen. A more acceptable nologies to counter individual IED cal theories for inferring network analysis would include agents that attacks, but events in Iraq and else- data. To improve overall under- are readily transmissible and would where have shown that IEDs remain standing, the National Research demonstrate that the models used effective weapons of asymmetric war- Council sponsored a workshop to take into account biological com- fare. The Office of Naval Research bring together researchers who deal plexities, reflect what is known asked the National Research Coun- with network data in these vari- about outbreaks of disease, and take cil to examine the current state of ous contexts. This report—which into account population density. knowledge and practice in the pre- is available only on CD—includes NAE member John F. Ahearne, vention, detection, and mitigation of the texts of 18 workshop presenta- director, Ethics Program, Sigma Xi the effects of IEDs and to recommend tions focused on five major areas of Center, Sigma Xi, The Scientific areas for research for mitigating their research: network models, dynamic Research Society, chaired the study effectiveness. The recommendations networks, data and measurement of committee. Free PDF. in this study include identifying the networks, robustness and fragility most important and most vulnerable of networks, and visualization and Human-System Integration in the Sys- elements in the chain of events lead- scalability of networks. tem Development Process: A New Look. ing up to an IED attack, determin- NAE members on the study com- This report focuses on how human ing how resources can be controlled mittee were Thomas M. Cover, capabilities can be integrated into to prevent the construction of Kwoh-Ting Li Professor of Engi- system design using an incremental IEDs, using new analytical meth- neering and professor of electrical model of systems engineering that ods and data modeling to predict engineering and statistics, Stanford continually assesses risks, including the behavior of insurgents/terror- University, and Michael Lesk, pro- risks associated with human partici- ists, improving the understanding of fessor, Rutgers, The State University pation, at each phase of develop- social divisions in societies, improv- of New Jersey. CD, $90.50. ment. Chapters focus on methods ing surveillance capabilities, and of describing human capacities and improving IED detection. Prospective Evaluation of Applied En- limitations; needs, tasks, and work NAE member John L. Ander- ergy Research and Development at DOE environments; and methods of char- son, provost and university vice (Phase Two). Since the passage of acterizing and evaluating designs. president, Case Western Reserve the Government Performance and As systems become more complex University, chaired the study com- Results Act and other mandates, and the focus shifts from the design mittee. NAE members Edward federal agencies have been required and operation of individual systems H. Kaplan, William N. & Marie to measure their performance. to systems of systems, new methods A. Beach Professor of Manage- At the request of Congress, the and approaches will be necessary. ment Sciences, professor of public National Research Council has NAE member Barry W. Boehm, health, and professor of engineer- undertaken a series of studies to pro- TRW Professor of Software ing, Yale School of Management, vide quantitative evaluations of the The 62 BRIDGE effectiveness of research and devel- management, an analysis of the increased dramatically, and a great opment (R&D) on applied energy forces affecting federal facilities deal of research has been done on at the U.S. Department of Energy. asset management, an assessment possible biological or human health This third report in the series pro- of the core competencies neces- effects resulting from their use. The vides the results of an assessment sary, a comprehensive strategy for U.S. Food and Drug Administra- (based on a benefits-evaluation workforce development, and rec- tion asked the National Research methodology developed in the sec- ommendations for implementing Council to organize a workshop to ond study) to evaluate six R&D that strategy. identify research needs and gaps in programs: carbon sequestration, NAE members on the study com- knowledge in the areas of dosimetry integrated gasification combined- mittee were David J. Nash (chair), and exposure, epidemiology, human cycle technology, natural gas explo- president, BE&K Government laboratory studies, mechanisms, ration and production, distributed Group, and Richard L. Tucker, and animal and cell biology. The energy resources, light-duty vehicle Joe C. Walter Jr. Chair in Engineer- workshop did not include the evalu- technology, and chemical indus- ing Emeritus, University of Texas. ation of health effects or provide trial technologies. The report also Paper, $29.00. recommendations for how identi- includes explanations of improve- fied research needs should be met. ments in the methodology, such The Role of Theory in Advancing 21st Research needs identified at the as the addition of indicators of Century Biology: Catalyzing Transfor- workshop include: (1) characteriza- environmental and security ben- mative Research. Theoretical and tion of exposures in juveniles, chil- efits, and refinements of the evalu- conceptual frameworks inform every dren, fetuses, and pregnant women to ation process based on case studies. step of biological research, including wireless devices and radio frequency Finally, an appendix to the report which experiments are undertaken, base station antennas; and (2) evalu- provides a detailed analysis of each which techniques and technologies ation of the effect of devices based of the six programs. are developed, and how data are on newer technologies (e.g., texting, NAE members on the study interpreted. At the request of the web surfing). committee were Maxine L. Savitz National Science Foundation, this NAE member Frank S. Barnes, (chair), retired general manager, report by a committee of experts Distinguished Professor, Depart- Technology/Partnerships, Honey- examines the question of whether ment of Electrical and Computer well Inc., and Wesley L. Harris, more emphasis on theory would Engineering, University of Colo- department head and Charles Stark advance biological research. The rado at Boulder, chaired the study Draper Professor, of Aeronautics and committee concludes that, although committee. Paper, $21.00. Astronautics, Massachusetts Insti- theory is already inextricably tute of Technology. Paper, $50.50. involved, explicitly stating that Manpower and Personnel Needs for a theory has equal status with other Transformed Naval Force. Advances Core Competencies for Federal Facili- aspects of biological research could in science and technology will be ties Asset Management through 2020: catalyze transformative research that critical to efforts by the U.S. Depart- Transformational Strategies. In the might lead to creative, dynamic, and ment of Defense (DOD) to trans- face of shrinking budgets, an aging innovative advances in our under- form the armed services to meet workforce, and rising costs, the U.S. standing of life. future military challenges. Changes government must find new ways to NAE member Leroy E. Hood, resulting from new technologies manage federal facilities and infra- president, Institute for Systems have already highlighted the need structure. This fourth study by Biology, was a member of the study for changes in personnel policies. the Federal Facilities Council of the committee. Paper, $45.00. To assist the Navy in defining these National Research Council focuses changes, the National Research on the people and skills necessary Identification of Research Needs Relat- Council was asked to review the to managing federal facilities in ing to Potential Biological or Adverse military manpower and personnel the next decade and beyond. The Health Effects of Wireless Communica- policies and studies currently under- report includes a description of the tion Devices. In recent years the use of way at DOD and to develop a strat- current environment for facilities wireless communication devices has egy for the Navy’s future manpower Spring 2008 63

and personnel needs. This report are divided into four areas repre- and suggests that efforts to collect provides an introduction to current senting specific aspects of systems and analyze data to support it be personnel policies and concerns; an of public health preparedness: increased. assessment of demographic, techno- (1) making training more effective NAE members on the study com- logical, and other aspects of future and useful; (2) improving time- mittee were Thomas E. Graedel, personnel needs and availability; ly emergency communications; Professor of Industrial Ecology, Yale summaries and assessments of pre- (3) creating and maintaining sus- University; Terence P. McNulty, vious studies; a discussion of the tainable response systems; and president, T.P. McNulty and Asso- need for research on implementing (4) generating criteria and metrics ciates Inc.; and Brij M. Moudgil, changes in personnel policy; and an for determining effectiveness. Distinguished Professor and direc- analysis of obstacles to and strategies NAE member Richard C. Larson, tor, Particle Engineering Research for transforming the naval force. Mitsui Professor, Department of Center, University of Florida. Paper, NAE members Barry M. Horo Civil and Environmental Engineer- $42.00. witz, professor of systems engi- ing, Engineering Systems Division, neering, University of Virginia, Massachusetts Institute of Technol- Pre-Milestone A and Early-Phase Sys- and John B. Mooney Jr., J. Brad ogy, was a member of the study com- tems Engineering: A Retrospective Mooney Associates Ltd. and U.S. mittee. Free PDF. Review and Benefits for Future Air Navy retired, were members of the Force Acquisition. The ability of the study committee. Paper, $39.50. Minerals, Critical Minerals, and the U.S. U.S. military to field new weapons Economy. Minerals are part of virtu- systems quickly and to contain costs Research Priorities in Emergency Pre- ally every product we use; common has declined significantly. There paredness and Response for Public Health examples include copper in electri- are many reasons for this, includ- Systems: A Letter Report. The pas- cal wiring and titanium in airplane ing increased complexity of the sage of the Pandemic and All Haz- frames and paint pigments. Infor- weapons systems, funding instabil- ards Preparedness Act (PAHPA) mation Age products also contain ity, increased bureaucracy, and more (Public Law 109 417, 2006, 101 minerals, such as tantalum in cell diverse user requirements. However, et seq.) created an immediate phones and indium in liquid-crystal many people are now convinced need to define research priorities displays. For some critical minerals, that better systems engineering for the Centers for Public Health such as the platinum group metals could help shorten development Preparedness (CPHP) at schools used to make catalytic converters in times. To investigate this idea, the of public health. The Institute cars, there are no substitutes. Thus U.S. Air Force asked the National of Medicine (IOM) formed an ad restrictions on the supply of a criti- Research Council to examine the hoc committee, conducted a fast- cal mineral could significantly affect effectiveness of using systems engi- track study, and issued this report, certain sectors of the economy, as neering to address the causes of which defines near-term research well as consumers. Mineral sup- program failure, especially during priorities for emergency prepared- plies can be threatened by sudden pre-milestone A and early phases ness and response in public health increases in demand, increased dif- of an acquisition program. This systems. These priorities will be ficulty in extracting the mineral, or report provides an assessment of the used by the Coordinating Office the exhaustion of natural ores. The relationship between systems engi- for Terrorism Preparedness and most vulnerable minerals are those neering and program outcome; an Emergency Response to develop that are extracted from a limited assessment of the systems engineer- a research agenda and announce- number of mines or by a few mining workforce; and an analysis of ments of funding for research ing companies or are found in only systems engineering functions and projects. The study committee’s a few places. Baseline information guidelines, including a definition priorities are based on information on minerals is currently collected at of minimum systems engineering presented at a public meeting and the federal level, but no methodol- processes necessary during project workshop, as well as the expert ogy has been developed to identify development. judgments of committee members. potentially critical minerals. This NAE member Paul G. Kaminski, The research areas recommended report develops such a methodology chairman and CEO, Technovation The 64 BRIDGE

Inc., chaired the study committee. nonregulatory measures authorized quality in the Mississippi. Specifi- Other NAE members on the com- under the Clean Water Act have cally, EPA should establish a data- mittee were Natalie W. Crawford, reduced a good deal of pollution in sharing system and work with states senior fellow, RAND Corporation; the Mississippi River from “point to establish and enforce water- Robert A. Fuhrman, retired vice sources,” such as industrial facili- quality standards. In addition, states chairman, president, and chief oper- ties and water-treatment plants. must be more proactive and must ating officer, Lockheed Corporation; However, pollution caused by urban participate in cooperative water- and Wesley L. Harris, department and agricultural runoff and other quality programs. head and Charles Stark Draper Pro- “non-point sources” have proven to NAE member Jerald L. Schnoor, fessor of Aeronautics and Astro- be more difficult to control. This Allen S. Henry Chair Professor, nautics, Massachusetts Institute of report concludes that the Environ- Department of Civil and Environ- Technology. Paper, $36.00. mental Protection Agency (EPA) mental Engineering, University of must provide stronger leadership Iowa, was a member of the study Mississippi River Water Quality and the to ensure that the 10 states along committee. Paper, $56.00. Clean Water Act: Progress, Challenges, the river coordinate their efforts and Opportunities. Regulatory and in monitoring and assessing water

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