Regenerative Engineering, Racial Profiling and Healthcare Disparities

Cato T Laurencin, the father of regenerative engineering and winner of the Herbert W Nickens Award, talks launching a new field, mentorship and addressing disparities in healthcare.

Please tell us about yourself and how you got to where you are today

I work at the interface of medicine and engineering and am also someone that is very much involved in issues of social justice. I grew up in Philadelphia and became interested in medicine at a very early age, and decided I wanted to become a doctor. I started college at Princeton (NJ, USA) where I met people who were fantastic mentors in engineering. At that time, I was not quite sure how I was going to combine engineering and medicine, but I pursued chemical engineering.

When I completed college, I went on to medical school at the Harvard Medical School in Boston (MA, USA) and partway through I decided to revisit my scientific and engineering routes. I met Prof. Robert Langer who was a young assistant professor at that time and decided to join his laboratory. I subsequently took on a combined MD—PhD program combining work at Harvard with MIT (MA, USA). This program was unusual and I realized that to do a comprehensive job on both would take a long, long time!

With the support and help of Noreen Koller who was a fantastic Registrar at Harvard, I was allowed to move back and forth for my training, so I would do clinical rotations and then I would do work in the laboratory. This enabled me to complete my MD and PhD combined in 7 years, which really helped me on my journey because I became very, very used to working in both the clinical and research realms. I then began a residency in orthopedic surgery and opened my laboratory at MIT.

Since then I have been working in both areas; a common theme in all my research has been combining the principles of material science and engineering with physics and clinical medicine to allow us to be able to create new information and new science.

You have been recognized numerous times for your achievements in bioengineering. Could you tell about your work in this field?

I essentially defined what is now a new field – regenerative engineering, which is the convergence of technologies that we can utilize for the purposes for regeneration of complex tissues.

I first outlined this vision for the new field of regenerative engineering in 2012 and since then we have continued to work and expand the field. We now have a society called the Regenerative Engineering Society and our work has been successful in terms of developing new science, new technologies and new ways of thinking for the regeneration of complex tissues and organ systems. We have been fortunate to be funded by the NIH Director’s Pioneer Award and the National Science Foundation has awarded us two Emerging Frontiers in Research and Innovation awards for this new field.

You have recently been awarded the Herbert W Nickens Award by the AAMC – congratulations! Please tell us briefly about that award, why you won it, and how that makes you feel.

I was very excited and very proud to receive the Herbert Nickens Award. It’s the American Association of Medical Colleges’ highest award for social justice and equity, and it recognizes the work that I have been involved in over the past almost 40 years in the area of social justice and equity.

It recognizes my efforts to create a fairer society for all in work that has ranged from boots on the ground programs seeking to increase the numbers of Black and Brown people working in engineering, science and medicine, to larger programs such as the creation of The W. Montague Cobb National Medical Association Institute program looking at ways in which one can address disparities in health, medicine and science for Black people, to launching a new journal –the Journal of Racial and Ethnic Health Disparities – which is now the leading journal working in the space, to our new work in terms of Chairing the National Academy of Sciences, Engineering and Medicine Roundtable on Black Men and Black Women in Science, Engineering and Medicine.

I have been involved in a broad gamut of endeavors that have at their core the aim of making the USA and the world a more fair, just and equitable society.

What would you say are the main challenges still hindering equity in healthcare?

Our main challenge in terms of equity for Black people in both the USA and the world is the persistence of racism. We know that there are excess deaths each year of Black people linked to racism and we have known this for a very, very long time – this is not new news. In the 1990s, the National Medical Association had a consensus report examining racism and its effects on health and the creation of health disparities. The National Academies followed up with a study called Unequal Treatment, which examined the unequal treatment of Black people and others in the USA and found racism to be a primary reason why this is happening.

Recently, we have seen the murders of George Floyd and Breonna Taylor garner widespread media attention. This injustice translates to the medical establishment too in terms of medical care, which translates to higher mortality for Black people. That is the major challenge we have to address in terms of healthcare and something that I am very passionate about.

We recently made the case for why we need to see more Black professionals working in medicine, along with science and engineering. On the medical side, Black physicians treating Black patients obviously do not exhibit the levels of unconscious bias and conscious racism that take place among white physicians and some new studies – for example in COVID-19 – have suggested that clinical outcomes are improved where Black physicians have taken care of Black patients.

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Will the COVID-19 pandemic help end systemic racism?

Dr Fola May has focused her career on health inequity research. Now, the coinciding COVID-19 pandemic and Black Lives Matter protests have highlighted pre-existing racial disparities and thrown her research into the spotlight.

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So what challenges are still faced by Black and Brown students who aspire to careers in STEM industries, such as healthcare?

Number one is that there are so many systemic racism issues. It was extreme when I was growing up – I still remember walking into a classroom at MIT and having a professor block me from coming into the door. Is it still this extreme? Probably not as blatant, but just as damaging.

As an active mentor helping address this, what are your top tips for others hoping to be good mentors?

I was very fortunate to win the Presidential Award for Excellence in Science, Math and Engineering mentorship from President Obama and the American Association for Advancement of Science Mentor Award, so mentoring is a big component of my life.

I think for mentors it is important that there is a dedication to that individual and to their long-term future. I have been fortunate to have mentorships that have been lifelong; I am still in contact with people I have mentored who are now full professors and chairs or deans. I think it is also important that the mentorship is a two-way relationship – meaning that there are expectations from both the mentor and the mentee. The mentees have to follow-up with and listen to their mentors. It is not necessarily that the person has to agree with what their mentor says, but there has to be a clear relationship in which the counsel or guidance is provided and has been well thought through. Finally, there has got to be an open dialogue about successes, setbacks and plans.

You touched earlier on studies showing the availability of Black physicians reduces unconscious bias and improves care. Do you think that a representative workforce is requisite for equitable healthcare?

Yes, I think you do need to have a representative workforce in order to be able to have equity in medicine, for a number of reasons. Number one – because, as we alluded to, when you have Black and Brown physicians, you reduce the levels of unconscious bias and racism in the system as a whole and that results in better quality of care. Number 2 is that to a great extent the under-representation of Black physicians in medicine right now is a symptom of a system that has at its roots systemic racism.

One marker for how we progress is to examine the numbers of Black people that are in medical school. We had a historic low in terms of Black men in medicine

around 2014—2015. Those numbers have rebounded a bit, but that shows that even in a world in which we talk about diversity and equity, such a phenomenon can happen. That’s why I published my piece The context of diversity. You cannot think of diversity of as an old Kumbaya general feeling. We have to look at what’s happening with specific groups and with the specific challenges that are taking place in specific groups. With Black people, especially in the USA, we know that racism plays a role in every aspect of their life.

I wrote a paper recently on racial profiling as a public health issue speaking to how racial profiling by police in America has serious health effects. This is an area that really needs to be addressed.

Finally, what have been some of your proudest moments during your career thus far?

The proud moments are too numerous to count. I am blessed and highly favored. The moments surrounding my family (meeting and falling in love with my wife, and the birth of my children probably count as the best moments). Speaking of moments, I want to share some of my philosophy. There are actually three ‘most important’ dates of your life. They are the day you are born, the day you realize your purpose in life, and the day you are truly carrying out your life on purpose. For me, starting a new field, Regenerative Engineering, taking care of patients as a surgeon, working for social justice, mentoring the next generation, all while doing the most important thing: staying connected to my family, my values and my God, collectively represent my purpose.  A life on purpose is where I am, which is the ultimate goal.

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Cato T Laurencin is well known for his extraordinary contributions to science, engineering and medicine, his academic leadership and extensive service to The USA. He is a world leader in materials science, an internationally renowned engineer, and a world-renowned practicing surgeon in the field of orthopedic surgery. He has made fundamental and seminal contributions to polymeric material science and engineering, nanotechnology including the introduction of nanotechnology into the biomaterials field, creating polymer ceramic systems for the regeneration of hard tissues and creating the first engineered systems for soft tissue regeneration in the knee in humans. For his groundbreaking work in science, he received the National Medal of Technology and Innovation, The USA’s highest honor for technological achievement. He serves as a model to us all on how to conduct groundbreaking fundamental studies, conduct applied research and make concrete advances to human health.