Updated: Sep 29, 2019
In the past, we’ve seen things like bioelectronic medicine defined as the nexus between the molecular target, the signal or neural pathway, and the device – or even more broadly the combination of molecular medicine, neuroscience, and engineering. To Dr. Eric Grigsby, the ultimate trifecta lies at the intersection of patient care, discovery, and innovation. This may seem like a simplistic goal; isn’t everyone in the field trying to bring the basic science through to the patient population – at least at some level? But how many people in our field are active in all three pursuits? I recently had the chance to sit down with Dr. Grigsby and talk with him about how he got his start, what drives him, and how he plans to make a difference.
I always enjoy hearing stories about how couples meet, when people found their best friend, and how someone discovers his professional calling in life. As a bit of a wanderer myself, I’m envious of people who had an early calling to their career choice; I feel that is frequently the case among people in neurotech. I was surprised to learn that that was not the case with Dr. Grigsby. “I wish I was one of those people that had a very clear career path since they were four years old saying ‘I just want to be a doctor my whole life.’ I didn’t. I went to college and I was a biology and economics major so I had already completed all of the med school prerequisites. But, I thought I would be a park ranger or something really important at the time – that was in the 70’s,” said Grigsby.
“But I was a science guy, I was about a year out of college when I decided that medicine was probably a great idea,” Grigsby said, as if admission to medical school were no more of a challenge than getting a job at the local movie theatre. At the time, the MCATs were administered annually. His brief hesitation meant some time off between college at Brown University and medical school at Boston University. Initially, Dr. Grigsby had sought a career in general surgery at the Mayo Clinic in Rochester, Minnesota. He and his wife both had career and family aspirations that were in opposition to the lifestyle and time demands of a general surgeon and so he completed his residency in anesthesiology and pain medicine. “The (surgery) program, as it should be, was tough in those days,” he said. “It taught me a lot of stuff that I didn’t think about at the time, but it didn’t fit with my budding family ambition – my wife is a professional and we knew we wanted a big family and she wouldn’t tolerate me not being involved – and I wanted to be involved. But, it was clear that this was a co-parenting deal and a co-professional support deal; general surgery – at least the way it was defined at the time and at a top flight surgery training program, was not going to fit that very well.”
Dr. Grigsby’s shift to anesthesiology not only changed his career path away from surgery but toward what would become the field of pain medicine. “The anesthesiology piece for me was great because it was deep in neuroanatomy – neurophysiology, neuro is king in anesthesiology,” he said. “Well, neuro and cardiac, but cardiac didn’t excite me much.” Dr. Grigsby finished his anesthesiology training at Mayo in 1988, several years before pain became an official specialty in 1994.
“Pain in those days – pain patients were considered lazy, crazy, or addicted. Maybe they just needed a better surgeon. We poorly understood that pain could even be a disease or condition, and we sure poorly understood what the neuropathological foundation of that was,” said Grigsby. “We still don’t understand as much as we need to today – but we understood zero back then.”
It was also at Mayo where Dr. Grigsby would have another pivotal moment through the person of Dr. Sten Lindahl who went on to join the Nobel Prize Committee in addition to being a world-leading scientist in his own right. “Dr. Lindahl got me thinking about discovery – not innovation as I define it today – but he got me thinking about what it takes to discover stuff and to make a difference,” he explained. This connection with Lindahl and others would have a profound effect on Dr. Grigsby’s desire to be an innovator as well as a clinician, but more on that in a moment. I wanted to know how a young man from modest Tennessee roots get through an Ivy League program, nonchalantly takes on medical school, lands a job at one of the most prestigious research and clinical institutions in the United States, and ends up in Napa, California. The answer was simple: a very important woman was involved.
“My wife grew up here in Northern California and we met in Boston,” said Grigsby. “Part of the gig was that if she went to Minnesota with me and braved the conservative midwest – the cold was nothing – having grown up in Marin County in Northern California – it was two different worlds,” he continued. “So once we got married and had our first baby and those sorts of things, we got looking out here. So the getting here was easy – I just followed my wife.”
With his experience at Mayo at the leading edge of pain medicine, Dr. Grigsby found his break-out position in Northern California at UC Davis where he started the pain center in 1989. From Davis he moved about an hour west to Napa and opened the Napa Pain Institute in 1992. Now called “Neurovations,”the center is home to over 60 professionals servicing patients in Northern California and Hawaii.
“I already knew that that field of pain was something special. There was a special opportunity in this field to take care of patients that were underserved,” Grigsby said. “Now you have to get kinda deep into my own background. I grew up poor, I would say very poor, and my mom and dad more so. My dad grew up in a log cabin with no running water, no electricity – so weekends at my Grandma’s house were her cooking on a wood stove and walking to the spring to get water and all that stuff. But then I went to prep school and I had all these strange worlds. I was definitely a friend of the underdog from early, early on, because I was an underdog. I was the kid from the wrong side of town in a prep school… a kid from Tennessee in an Ivy League College. So I’ve always had a soft spot for the underdog and all of our patients in pain have been disrespected in some way; I don’t think that overstates the case. You know they’ve been disrespected in the sense that they were dismissed. As a typical story they were sitting in an exam room with a doctor looking at the MRI and the doctor says ‘You know ma’am your MRI looks good.’”
Dr. Grigsby continued to summarize his motivation for addressing the needs of this underserved, unrecognized population. “Disrespect has always been my hot button and my wife will tell you it hasn’t always been very pretty. I always felt like I kinda got the pain patient. I grew up in the part of town where people didn’t have good access to a doctor. You couldn’t just call up and say ‘Hey, John. I know you’re an orthopedist and you focus on elbows but I got this shoulder thing going on, can you come over and take a look and I’ll give ya a glass of wine for your trouble.’ That just always seemed like the coolest thing to me. But people in my part of town didn’t have anything like that. It was a whole different world – and maybe more so in the stratified South of the 60s. You develop your world view in those early days; I sure did. And so the patients, when I came in contact with a group of patients that I thought were underserved and misunderstood and disrespected – well that was my game! I was in for that.”
But the innovation piece would creep up again and again. From his first interactions with Dr. Lindahl and learning to look for opportunities to serve, Dr. Grigsby continued to address the clinical needs of his patients and to work to develop new ways improve patient outcomes. “Part of taking care of these patients over the years you realize that we just don’t know anything. Which means that we don’t have any tools that are useful,” said Grigsby. “We have a few more tools now, but we still don’t know how to measure pain, how to interpret it, we’re at such an infancy of development and there’s so much that we need to do – so that’s compelling – that’s the opportunity. The fun of it has been the collaboration. The truth is patient care is a pretty solitary adventure.”
Beyond the need for innovation, Dr. Grigsby also had a driving need to collaborate. “I had 25 scheduled appointments a day for about 28 years and each of them was in a room with two people in it – me and my patient. There was collaboration for sure, there’s collaboration with the patient and the care team and other physicians and sometimes administrators. I’d be lying if I said that all collaboration is meaningful – it’s competitive in many ways, it’s collaborating with mostly people who are not always your peers on the clinical side of things. You’re the most well trained, and providing the clinical leadership when you’re the physician and sometimes it’s nice to collaborate with people who are more well trained than you, or are smarter than you, or with more experience,” Grigsby expounded. “As physicians we rarely, if ever get that opportunity. So for me, the idea that I could contribute to an area that I don’t know very well and that there are people who are far more experienced and are smarter than I am, that’s great. That’s the nature of mentorship. The old story is true – If you’re the smartest guy in the room, you’re in the wrong room. Truly.
“But the collaboration piece in business, the way I would define it – not as a money-making venture, but as a production project, a mission to achieve – something that one person can’t do alone – that’s really the nature of business in my mind- doing something as a group with resources and leadership that one person can’t do by themselves – and healthcare, medtech, neurotech innovation is an example of that. It’s a really rich environment.”
So how does one make innovation accessible and collaboration desirable? Well, put on a conference, of course. “Dr. Elliot Krames and I got together six or seven years ago and thought ‘Hey let’s do a meeting,’ and usually you make those kinds of statements after a couple of glasses of wine – because there’s no fun in the meeting business from a financial perspective,” Grigsby said. Neuromodulation: The Science has been a really great community builder and it’s introduced a lot of great scientists from all around the world. We have folks from Asia, Europe and the US and we just wanted people that are doing the smartest work in neurotech and the foundational science that could get to the innovation piece and the pre-clinical and clinical piece pretty quickly or had some real relevance to the clinical development pathway. We just wanted those people there. They’re doing the real fundamental work on the mechanisms of action.”
One of the primary objectives of the past conferences has been to bring the neurotech research group together in a way that allows them to let their guard down. Although the conference has previously been hosted in Orlando, San Francisco, and Cleveland, the October conference will be held in Napa, California’s premier Wine Country. “It allows folks to get in the back of the room or head out for a glass of wine here in Napa and say ‘hey, let’s think about this…’ and you just don’t know how those conversations are going to speed up the scientific process and bring that innovation to the patient’s bedside,” said Grigsby.
For 2019, Neuromodulation: The Science has partnered with NYC Neuromodulation to bring attention to innovations in both invasive and non-invasive neurotechnologies. I have attended two of the past three conferences and was impressed by the scientific rigor at each. I asked the doctor what he was most excited about for the 2019 meeting. “I think there are a bunch of things that are pretty awesome this year. One is that we’ve partnered with Marom Bikson. First, Marom is a really exciting scientist on his own and second, he’s highly connected and a well respected advocate for minimally invasive bioelectronic medicine,” he said.
“Marom has been a really great guy to work with – he brings a lot of energy. And, as you would expect from a scientist, he’s a very disciplined thinker, he keeps us in a straight line, his network has been great. We’re going to have most of the world’s experts on minimally invasive neuromodulation, direct current, magnetic, and transcranial stimulation devices. Being around Marom helps you appreciate the smart folks.”
Having attended my fair share of neurotech conferences (more than my fair share if you consider that I’m neither a scientist nor an engineer,) it is not lost on me that many conferences lack diversity among the presenters. I’d like to encourage you to review the very first session on the conference’s agenda: Dr. Marom Bikson will be moderating a panel comprised entirely of (incredible) women including Sarah Laszlo, Cristin Welle, Cynthia Chestek, and Maryam Shanechi. Additionally, field-leading female researchers and entrepreneurs have strong representation throughout the entire agenda.
“It’s simple, if you keep in mind the end point; nobody addresses the needs of a population of people like somebody from that population,” said Grigsby.
“In science I think we have a chance to be clean on that one. As a population, our world is 51% women, so it would be dumb to have exclusively male scientists trying to solve the problem. Our biases are intrinsic and unrecognized. I get it, I’m a white guy. I get that I can’t see and I’m never going to be able to see exactly what is relevant to all of the people I worked with in Malawi when we set up a palliative care organization down there. But I can partner with people who really get it and help stimulate them and help lead them and find resources and direction and people. We can include them so that we get to the end point that is relevant to the population that we’re aiming at. It would be dumb not to include everyone. It’s a fact that people like to be around people that are like them. That’s a fundamental piece of human nature. In science we have the opportunity and the obligation to not just hang around people like us but to find different ways that we’re like each other.”