MD & DO What technical skills will be most valuable for therapy development in the next 10-20 years?

[halcyon_]

As the header says, what technical skills do you think will be most valuable for therapy development in the next 10-20 years? i.e. for treatments like immunotherapy, gene/epigenetic therapy. I’m not sure if focusing more on stats/machine learning or wet lab skills will be more useful to focus on as a med student.

---

Members don't see this ad.

 

[IM_is_cool_I_guess]

Interesting question but these are two completely different domains. In order to be a successful bench scientist, you really have to commit. Do you see your career as 80% wet lab work? Usually people already know the answer to this prior to matriculation into med school. I interviewed at some physician-scientist track residency programs, and I'd say only ~10% of the cohort was MD only (including me).

Much easier to dabble in clinical science via stats / ML.

While the vast majority of all future therapies will have their roots based in NIH-funded academic wet lab work, the major advancements of next gen therapies in genetics / biologics will be massive academic - industry collaborations headed up by giant teams of scientists / physicians.

 

[Hzreio]

The answer is whatever you’re interested in

 

[Lawpy]

As the header says, what technical skills do you think will be most valuable for therapy development in the next 10-20 years? i.e. for treatments like immunotherapy, gene/epigenetic therapy. I’m not sure if focusing more on stats/machine learning or wet lab skills will be more useful to focus on as a med student.

No but seriously, computational biology is a thing and you can do both. However basic science takes forever and not really the best use of time as a med student (unless obv MSTP)

 

[ChordaEpiphany]

Unless you're willing to go down the route of physician-scientist (and spend 4-8 years beyond your clinical training and research time in fellowship to try to secure NIH funding to start a lab), you should go for skills that you could perform without independent funding or lab space. You won't be pioneering new therapeutics as an MD without a lab. Most MDs with a tilt for translational research either go the physician-scientist route or gain some skills that act as a good foil to a PhD's drug development projects.

Technical skills aren't even the skills you actually want to do this. You want in-demand skills, like clinical insight into translational science. You won't be a better scientist than the person doing it all day, and there is no shortage of PhDs who can churn out technical work (often for $45K/year working 60 hours/week). During my tenure in the pharma startup world, I never thought to myself, "man I really wish this MD knew how to code or knew more about laboratory practices." Technical skills are cheap and (relatively) easy to come by.

So you're asking the wrong questions and maybe going down the wrong pathway. I'd instead get experience in clinical trials and leverage your knowledge of the process to then attach yourself to up and coming investigators whose projects you believe in. That might mean doing a bit of ML or advanced statistical analysis, but that's just a hurdle towards the actual in-demand skill, which is having a working knowledge of the translational process.

 

[IM_is_cool_I_guess]

Most MDs with a tilt for translational research either go the physician-scientist route or gain some skills that act as a good foil to a PhD's drug development projects.

This is a really insightful post - thanks so much for taking the time to write it. Could you speak a bit more about these skills that complement basic science work?

I'm an MD-only with a pretty extensive basic science background (some first author papers), but I'm done with basic science and want to get more into the translational - pharma sphere. I'll be a pgy-1 in July. What steps would you recommend I take? try to attach myself to trial work? Thanks again.

 

[ChordaEpiphany]

This is a really insightful post - thanks so much for taking the time to write it. Could you speak a bit more about these skills that complement basic science work?

I'm an MD-only with a pretty extensive basic science background (some first author papers), but I'm done with basic science and want to get more into the translational - pharma sphere. I'll be a pgy-1 in July. What steps would you recommend I take? try to attach myself to trial work? Thanks again.

It really depends on your eventual goals. If you're not going to be the one directly inventing new therapeutics, then you have to be in a position to pair with those who are. Academia is a good environment for this, it's not the only place it can happen, but there are a few reasons why these people tend to come from academia.

1) Pharma/therapeutics is largely switching to a "license from academic start ups" model instead of in-house research. So a lot of this development is happening in these institutions, and you're more likely to make connections there with PhDs starting companies who need your skillset.

2) When looking for an MD to partner with, these start ups (and larger companies) are looking for clout (looks great on SBIR applications, scientific advisory board pages, etc...) and specific expertise. For instance, if company X is surviving on SBIR phase II money and looking for a series A for an immunotherapy application for triple-negative breast cancer, are they going to choose the breast cancer super specialist who oversees the immuno-oncology division for a big university hospital or are they going to choose the community oncologist who sees all varieties of solid tumors and even incorporates some benign hematology?

The path to this is usually carved out in fellowship, usually focusing on clinical trials but possibly focusing on basic science. This is where it gets a bit open-ended, but in general having a bit of basic science knowledge is appreciated, but having clinical/clinical trial knowledge is invaluable, especially to early-stage start ups. A lot of these professors are absolutely clueless about business and translation, especially those on their first companies. If you can gain this expertise in fellowship (and, probably most importantly, make some connections), then you will have a valuable skillset. Importantly, focus on where the industry is going. Oncology is a huge space right now, but potentially in a bubble. ID is usually an awful field for translation, but COVID has created some unprecedented opportunity that's unlikely to go away. Rheumatology, imo, is probably the most secure field and also an enormous opportunity for any translationally-focused MD right now. For one, there is a huge pipeline of autoimmune therapeutics being spun out from the immuno-oncology space. For another, it's not too competitive (so you could more easily train at a top institution and make the right connections, get involved with a few companies, etc...). The scientists might appreciate if you are fluent in their language, but it's not why they'd bring you on. No one is going to hire an MD to help build an AI/ML system or to get in the lab and synthesize some chemicals, and if they did they'd pay the MD far less than they'd make in clinical medicine.

That said, community physicians become involved with research, translation, medical devices, diagnostics, and therapeutics all the time. This all comes down to connections, personality, pursuit of opportunity, etc... You just aren't going to make these connections if you are a mostly outpatient private practice doc working from 8-5 each day. Most of the community physicians who get involved have academic ties. Sometimes larger practices will also get involved as part of their larger business plan, but that's more rare.

 

[IM_is_cool_I_guess]

Thanks again for taking the time to detail all of this out. I don't really have any connections to any translational motivated physicians at my own institution, so your thoughts have been immensely helpful.

From the sound of it, I should just focus on being a good IM resident and aim to get into a fellowship program that involves fellows in their trial work.

Oncology is a huge space right now, but potentially in a bubble.

This has also been helpful regarding onc, rheum, and ID. Any brief thoughts on other fields like GI, cards, or pulm?

 

[ChordaEpiphany]

Thanks again for taking the time to detail all of this out. I don't really have any connections to any translational motivated physicians at my own institution, so your thoughts have been immensely helpful.

From the sound of it, I should just focus on being a good IM resident and aim to get into a fellowship program that involves fellows in their trial work.

This has also been helpful regarding onc, rheum, and ID. Any brief thoughts on other fields like GI, cards, or pulm?

Honestly I have very little info on GI, cards, or pulm. It's not my space and I don't really mix with people in that space. That said, GI has a lot of overlap with rheum because of UC/Crohn's. Pulm has some overlap with ID given how hot respiratory disease is right now and also some overlap with rheum, but less so. Each have their niches, but the markets aren't nearly as big as cancer. Personally I think any medicine specialist can find a niche in the emerging autoimmune space since basically any organ can be affected by that.

Cards is an entirely different ballgame than either. Effectively no onc. The market is huge, but the research is entirely different. Innovation is progressing at a much slower pace, imho, and a lot of what's making money out there is just doing huge volume of sales. Physicians make money in industry as innovators and consultants. Once a product is established (e.g., Eloquis, Xarelto, or even dinosaurs like Lipitor) it's more about marketing/business expertise.

That said, literally any specialty can get you in the door. My ENT disclosed three conflicts of interest to me in the course of a 20 minute appointment last month. Dude's a hustler.

 

[SurfingDoctor]

Learning DNA, RNA and Chip sequencing coupled with bioinformatics.

But that is more for clinician scientists, not for clinicians only. That type of -omic driven treatments on a large scale that can be applied at the bedside and employed by the average clinician is more than a century plus away.