Ultrasound foundation speeds medical advances

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UVA neurosurgeon Neal Kassell has given up the OR in favor of working to advance a surgical technology he says could be the most important medical device development since the invention of the scalpel—and he’s building a new research funding model in the process. Photo courtesy of UVA Medical Center. UVA neurosurgeon Neal Kassell has given up the OR in favor of working to advance a surgical technology he says could be the most important medical device development since the invention of the scalpel—and he’s building a new research funding model in the process. Photo courtesy of UVA Medical Center.

Seven years ago this month, Dr. Neal Kassell had an epiphany.

The UVA neurosurgeon was struggling with the challenge of treating certain brain tumors too deep for the knife and too big for targeted radiation. At the same time, he was researching how to use sound waves to measure blood flow in the brain.

During a drive home from the hospital one night, a solution came to him.

“I had this ‘Aha!’ moment where I said, ‘I bet we can use ultrasound in some way to treat these brain tumors,’” said Kassell, now 66. “I thought I had a Nobel Prize-winning idea.”

Turns out he might have—it just wasn’t his Nobel Prize-winning idea. But he didn’t let go of it.

Physicians have been exploring focused ultrasound as a non-invasive surgical tool for decades. Treatments involve pinpointing a trouble spot in the body with concentrated sound waves that can superheat a tiny area only a centimeter across and burn away tissue.

So far, the only FDA-approved use is for the treatment of benign uterine tumors, but in the last decade, research has indicated focused ultrasound’s potential as a tool to operate elsewhere in the body—including the brain. Kassell believes the applications are almost limitless. But the wheels of conventional medical device development turned far too slowly for the Porsche-driving doctor, so he built his own model to fund research. More than half a decade and $20 million later, he can point to results.

He’s driven by a simple philosophy: Identify the bottlenecks holding back advancements, and find the funds to loosen them up.

When it comes to moving medicine forward, said Kassell, “the distance between where we are today and where we need to be can be closed simply by the brute force application of money.”

Kassell became something of a rockstar in his field after he was recruited to UVA from the University of Iowa in 1984. He specialized in very tricky procedures on aneurysms and hard-to-reach tumors. John-Boy Walton actor Richard Thomas even played him in a 2001 TV movie about a famous surgery he performed on a boy with a brain tumor.

But even as helped build a world-class program at UVA, he was preoccupied with the things he couldn’t fix.

“You don’t log or think about the successes in general,” he said. “What really stays in your mind are the failures.”

Following his ultrasound eureka moment, he invited the leading therapeutic ultrasound device manufacturer to give a presentation in Charlottesville, and started pitching the idea of a UVA-based therapy center to donors.

Kassell is not, he said, “a naturally born supplicant.” But he moved in powerful circles. He served on the board of directors of the Virginia National Bank and several nonprofits, and knew people with deep pockets. And he had a compelling pitch. Researchers are confident that focused ultrasound could be a safe way to destroy tumors anywhere in the body, increase the effectiveness of radiation and drugs, treat symptoms of Parkinson’s Disease, and much more.

Two weeks after he started shopping around the idea of a research center, he secured his first half-million-dollar pledge from Berkshire Hathaway hedge fund manager Ted Weschler, and Kassell started thinking beyond the University.

“It became apparent that we could do this on a much broader, more global scale, while continuing to nurture UVA,” he said. He created the Charlottesville-based Focused Ultrasound Foundation (FUSF) in October of 2006 with the idea that it could warehouse funds that would be used to drive ultrasound research all over the world.

Kassell still oversees surgical residents and visits patients, but these days, he’s swapped out the OR for a conference room in an office park off Barracks Road. Clad in scrubs and with one loafered foot propped on the table in front of him, he explained one recent morning why he’s out to change not just surgery, but medical research itself.

Medical advances—drugs, devices—are expensive and time-consuming to develop, said Kassell. Academic institutions have the know-how, but current funding mechanisms encourage researcher self-preservation over rapid development. He experienced it firsthand: Why go for a three-year grant when you can instead aim for the prestige and security of seven years of funding from the NIH for the same project?

“There’s an incentive to drag it out,” he said. “That was my life.”

His organization leverages private money to fund regular workshops that bring together far-flung experts, and the grants the FUSF offers come with strict milestone requirements. Kassell said the approach causes indigestion among some who are wary that collaboration could mean losing competitive footholds. And that’s fine, he said. They can look elsewhere for funding.

“Our feeling is, wonderful, let somebody steal your idea if they’re going to find a way to use it faster to treat the patient,” he said.

Of the $20 million the FUSF has spent on research since its founding, 30 percent has come from device manufacturers and 70 percent from philanthropists whose only return on investment is patient outcome. What they’ve created, Kassell said, is a nexus where academia, industry, and the private donor world pool resources and get a swift kick in the direction of progress. He brushes off questions about the model’s sustainability.

“We’re priming the pump,” he said. “Success for this foundation is when we go out of business.”

It seems unlikely that will happen soon. The FUSF has funded nearly two dozen studies on the use of ultrasound for everything from burning away breast tumors to melting body fat, and more research is on the horizon. Some of the most promising work is happening close to home.

UVA neurosurgeon Jeff Elias completed a pilot study earlier this year that tested ultrasound’s ability to treat essential tremor—unexplained and often debilitating shaking of the hands and body. Physicians know how to treat it: with tiny brain lesions created during procedures where the patient stays awake throughout. It’s a fix Elias thought could be achieved with ultrasound, and so far, it appears he was right. Fifteen patients were strapped into a device that looked like a giant shower cap and inserted into an MRI machine, Elias said, and for three hours, doctors carefully targeted problem areas of their brains with soundwaves. The results were on par with far more invasive procedures, he said.

It was the first time anyone had tried to treat tremor symptoms with ultrasound. “It was exciting to plow new territory,” said Elias. “Everyone here is invigorated.” A bigger, randomized study designed to prove efficacy in treating Parkinson’s patients with tremor is now in the works—with funding from the FUSF.

When he talks about what’s next for his foundation, Kassell’s excitement is evident —he points to swelling numbers of researchers at a regular ultrasound symposium he’s helped organize in Bethesda, and the international group of engineers that recently crowded Darden’s conference center for a workshop on improving the technology.

But his impatience shows, too. He has his foot on the gas, but he wants the work to move faster.

“It takes decades before a major technology—diagnostic or therapeutic—becomes mainstream,” he said. “If you can shave one year off that process, you’ve reduced death and suffering for countless people.”

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