Berlin Report




A leader in biotech and medical expertise


 



All the world knows Berlin. They know it as the seat of modern Germany’s Federal Government in the iconic Reichstag building. They know it for its historical status in the Second World War and the notorious Berlin Wall that followed. They know the city for its fashion shows and film festivals. But many don’t realise that it is one of Europe’s leading centres for biotech endeavour and expertise in healthcare. Callan Emery was invited to Berlin to look at its biotech industry and healthcare facilities.

Berlin is unique in that is just one of three ‘city states’ in Federal Germany. Of the country’s 16 states only two others – Bremen and Hamburg – are city states. Throughout most of Berlin’s turbulent history it has maintained this unique, sovereign political status. The city’s iconic Brandenburg Gate used to be one of the main entrances to what was a walled city centuries ago – a point where traders were taxed before being allowed to enter the city to sell their goods. With this exceptional geo-political position comes a number of challenges. Perhaps foremost, Berlin has few natural resources and in order for the city to thrive it must rely on its intellectual prowess. It has done this successfully in the past and continues to do this today. This was clearly visible when we visited the city and spoke to the intellects behind some of city’s leading medical device, technology and biotech companies.

The city’s enormous intellectual capacity is manifest in many spheres – politics, economics and, importantly, science. This is particularly in evidence when one looks at the number and extent of scientific and biotech clusters that have grown up around this sprawling city of 3.4 million. Add to this the city’s rich cultural milieu apparent in its vibrant art, theatre, music, café culture and architecture – and it becomes clear why this a city of choice for many professionals and tourists alike.

However, modern Berlin is a relatively young city in the sense that it is only since the fall of the Berlin Wall in 1989, the consequent reunification of East and West Berlin and the relocation of the Bundestag (parliament) from Bonn to Berlin in 1999, that it has embarked on a grand redevelopment programme. This is seen not just in reconstruction of parts of the city devastated in World War 2, but also in incentives to stimulate the economy and, wherein lies our interest, the expansion of scientific capabilities and healthcare facilities.

To enhance this capability, Berlin is partnering with its neighbouring state, Brandenburg. By combining their resources and through close cooperation the ‘Berlin-Brandenburg region’ is able to promote itself as one of Europe’s leading ‘life science’ regions offering strategically networked and co-located companies doing clinical research, healthcare, translational research, biotech manufacturing and business. This strategic network provides an efficient process for maximum research output and quick conversion into innovative products.

Berlin-Brandenburg

Berlin has recently embarked on an international drive to promote the city as a centre for outstanding medical care and as a hub for innovative biotech and medical research and development. In 2007 Berlin- Brandenburg established a cluster masterplan for science and botech. It is now the fastest growing region in Germany for biotech.

Speaking to Middle East Health in Berlin, Professor Dr Günter Stock, the Masterplan Coordinator and Network spokesperson for the so-called HealthCapital Berlin-Brandenburg, explains: “With more than 85,000 people working here in science and research, the potential is enormous, especially with top research facilities such as the Max Planck institutes, Helmholtz institutes and Fraunhofer institutes, as well as the major universities and technical colleges.

“All activities that foster the strengths of the region’s healthcare cluster are integrated and coordinated under the ‘HealthCapital’ umbrella brand. Members of our network include important players from all of the healthcare branches that make the region so successful, such as universities and other educational institutions, research institutes, companies active in the fields of pharmaceuticals, biotechnology and medical technology, hospital operators, health insurers, service providers and funding institutions.”

At the heart of healthcare in Berlin is Charité University of Medicine, Berlin – one of the world’s largest teaching hospitals. Charité extends over four campuses with more than 100 clinics and institutes grouped under 17 Charité Centers. It is this institution combined with some 480 life science companies in the Berlin- Brandenburg region that has enabled this city to produce some of the world’s most innovative biotech products, such as the Berlin Heart – one of the world’s first artificial hearts; the futuristic myoelectric robot prostheses developed by Otto Bock; the truly innovative orthopaedic implants made by Merete; and the worldleading cardiac pacemakers and defibrillators manufactured by Biotronik, to name a few.

Campus Berlin-Buch

We visited the Berlin-Buch Biotech Park and Campus which is networked to the Greater Berlin cluster – the grouping of a series of biotech and biomed research parks around the city. Berlin-Buch is the city’s largest and most comprehensive biomed research complex – integrating science, medicine and healthcare. The Campus provides a unique environment for scientific exchange and research collaboration, facilitated by the close physical proximity of the research institutes, clinics and biotech companies.

Key areas of research include the study of the molecular causes of cancer, cardiovascular and neurodegenerative diseases, as well as interdisciplinary basic research to develop new drugs, patient-oriented clinical research and the commercialisation of biomedical innovation.

The 32-hectare campus has around 40 companies, research institutes – such as the Robert Rössle Clinic for Tumor Diseases and the Franz Volhard Clinic for Cardiovascular Diseases – and three highcare clinics: the Helios Clinic Berlin-Buch, the Evangelische Lungenklinik Berlin and the Rheuma Clinic Berlin-Buch.

Berlin-Buch has a long history associated with clinical research. More than a century ago the area was a former ‘hospital city’ on the outskirts of Berlin with five hospital complexes. Clinical research began here in the 1930s with the establishment of the Institute for Brain Research of the Kaiser Wilhelm Association with the affiliated neurological clinic. In the 1950s they started doing cardiovascular research here. In 1972 the different Academy research institutes at Buch merged to form the central institutes for molecular biology, for cancer research and for cardiovascular research.

With the unification of West and East Germany in 1990, the academy institutes were phased out in accordance with the unification agreement. Subsequently, the Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch was founded on the Campus in 1992. In 2000 the Leibniz Institute for Molecular Pharmacology was established.

This combination of basic research, the clinics and biotechnology make the Berlin-Buch Campus one of the leading science clusters of its kind in Germany.

Campus Berlin-Buch www.campus-berlin-buch.de


Helios Hospital Group

With 65 hospitals across Germany under its umbrella, the Helios Hospital Group is the country’s largest such organisation. The group was founded in 1994 and in 2005 Helios was acquired by multinational healthcare enterprise, Fresenius.

With 33,000 employees the Helios Hospital Group covers around 94% of all medical disciplines. In total, it treats around 2 million patients per year. Interestingly, they have introduced a number of initiatives to ensure quality control and transparency in healthcare. For example, every treatment by every doctor at every hospital is analysed to keep check on the doctor performance process. The results are compared between hospitals in the group and published annually.

We visited the Helios hospital on the Berlin-Buch Campus – Helios Klinikum Berlin Buch. The original building has been modernised to incorporate some of the latest architectural ideas in hospital design to ensure smooth, efficient patient flow, cleanliness, and comfort to enhance the patient healing process.

The hospital also has a separate section of VIP suites for international patients. The Group has a dedicated international patient department – Helios Healthcare International – to cater to international patients who choose to be treated at the hospital. The VIP suites are like smart hotel suites with personalised healthcare. Helios Healthcare International provides a full concierge service for international patients and their family members who accompany them.

Stephan Boeckle, Director international healthcare, Helios Private Hospitals, told Middle East Health: “The Middle East is our second biggest market for international patients.”

Helios Healthcare www.helios-healthcare.com


German Heart Institute Berlin

We visited the German Heart Institute Berlin (Deutsches Herzzentrum Berlin - DHZB), one of the world’s leading specialist cardiology centres. It is internationally renowned for the treatment of cardiovascular and thoracic diseases, for the implantation of mechanical circulatory support systems and for heart and lung transplantation. It is also well known for its innovative research in the fields of adult and paediatric heart surgery and cardiology.

The DHZB has 164 beds – 50 of them in intensive care units. It has 150 external beds at the associated Paulinen Hospital for postoperative care. There are four departments at the institute: Cardiothoracic and Vascular surgery; Internal Medicine – Cardiology; Congenital Heart Disease / Paediatric Cardiology; and Anaesthesiology.

The DHZB’s specialties include: Transplantation of the heart, heart/lung and lung; Mechanical Circulatory Support/Total Artificial Heart; Operations for aneurysms of the thoracic and abdominal aorta; Surgical correction of complex congenital heart disease in patients of all ages; Hybrid Surgery – such as heart valve replacement, aortic diseases, congenital heart defects. The hospital has the largest ‘artificial heart’ programme in the world with more than 1,850 patients – including 150 children – having mechanical circulatory support systems implanted.

It also has the largest heart, heart/lung transplantation programme in Germany and has transplanted more than 1,750 (180 in children) hearts; and more than 530 lung transplants (35 in children). Dr Naser Qedra, a specialist for heart surgery at DHZB, told Middle East Health that some of their mechanical circulatory support systems can serve as a bridge to transplant – in some cases for longer than a year – and that this has reduced mortality by more than 47%. He added that in older patients where a transplant is not a viable option, these devices serve as a ‘bridge to destination’ enabling some patients to live several years with this mechanical support.

“We have developed a new heart-lung machine for paediatric patients, which allows us to operate on newborns weighing as little as 1,700 grammes,” Dr Qedra said, adding that this was a unique innovation as they now do not need to wait for the child to gain wait before operating. He noted that about 6-8% of their patients came from abroad.

German Heart Institute Berlin www.dhzb.de


Vivantes

Vivantes is the largest state-owned hospital chain in Germany. It cares for 500,000 patients annually. In Berlin the group has nine hospitals, 12 nursing homes and one rehabilitation centre.

Nizar Maarouf, CEO of Vivantes International in Berlin explained that the group has more than 40 Centres of Excellence including vascular surgery, obesity surgery and endoprosthetic surgery.

“We have the second biggest obesity centre in Europe and do more than 600 obesity surgeries a year – 99% are minimally invasive,” Maarouf said. The network includes three diabetes centres, three cancer centres and two orthopaedic / endoprosthetic centres, among others.

Vivantes is involved in a number of major projects internationally, including in the Middle East, through, a fully owned subsidiary of the Vivantes Network. Vivantes International offers international healthcare consulting and management services.

Maarouf noted: “We are involved in numerous large-scale projects around the world, including a big development in Saudi Arabia – the Al Imam Academic Medical Campus in Riyadh. We are also developing a masterplan for a rehab centre in Abu Dhabi and we are currently looking at projects in Oman, Libya and Iraq.”

International patient services

The Vivantes Network also has an International Patient Services division. They operate what they call “comfort hospitals” – the Vivantes Komfort Kliniks.

“When foreign patients are looking for healthcare abroad – they want to be treated by the best doctors in the field and have the best service. Vivantes offers this,” said Maarouf. Many of the hospitals’ practising physicians and surgeons are also professors in their respective fields, he added. The International Patient Services provides a complete concierge service for visiting foreign patients and their families.

“In 2011 we had around 1,500 foreign patients,” Maarouf pointed out. He said that in the past most Arab patients preferred to visit Munich for their healthcare, but now more and more Arab patients are coming to Vivantes in Berlin following the treatment recently of a few high-profile Arab patients.

Vivantes International www.vivantes-international.com


Biotronik

Biotronik, with headquarters in Berlin, is a world leader in the development, manufacturing and commercialisation of cardiac rhythm management, ablation and vascular intervention devices. The company has R&D sites and production The Biotronik Lumax, the company’s latest implantable cardioverter-defibrillator (image not to scale) facilities in Europe and North America and markets its products in more than 100 countries around the world.

The company is most well-known for its pacemakers and implantable cardioverterdefibrillator devices, but it also produces its innovatively designed ablation catheters and diagnostic catheters as well as stent systems, balloon catheters and guidewires.

All recently developed Biotronik cardiac implants are equipped with Biotronik Home Monitoring technology. This innovation permits the automatic transmission of patients’ data to the physician and is the first and only remote monitoring system worldwide that has FDA and CE approvals to safely replace conventional in-office follow-ups by the physician. The technology also provides early detection of symptomatic and even asymptomatic cardiac events.

Biotronik www.biotronik.de


Otto Bock

We visited the Otto Bock Science Center for Medical Technology in Berlin, which is an exhibition and information centre focussing on the world of human motion. Otto Bock is one of the world’s leading producers of prostheses, wheelchairs, rehabilitation aids, orthoses and neurostimulation systems. A selection of these products were on show at the centre.

Otto Bock was established in 1919 and has always been focussed on developing innovative products for people with reduced mobility. Today it is a global player and exports its products to more than 140 countries.

Of particular interest at the exhibition was the prosthetic arm and hand which can be controlled by thought. Called the DynamicArm – this myoelectric arm prosthesis is controlled by electric muscle signals, which are generated by thought. Nerve tracts that controlled the natural arm prior to amputation are used to transmit signals from the brain to the prosthesis, allowing it to be controlled directly and intuitively. In addition, this prosthesis enables the user to feel with sensors on the artificial hand.

ActiGate neuroimplant

Other innovative products the company produces include the ActiGate neuroimplant to help rehabilitate stroke patients suffering from weak foot dorsiflexion. This is a completely new type of therapy. The ActiGait neurostimulator reactivates fully or partially paralysed muscles via the corresponding intact nerve. The movement impulse is transmitted by a small electronic chip that can be implanted into a small incision in the skin of the thigh in a day surgery procedure or during stationary care. A cable leads to the nervus peronaeus communis above the hollow of the knee and connects to it using an especially developed cuff electrode. After this contact point, the natural signal transmission path is used. The muscle receives the impulse telling it to contract, and raises the foot. The implanted chip is supplied with energy by an external control unit worn on the belt. A pressure sensor worn under the foot supplies the control unit with information regarding the gait phase. The data are evaluated by the control unit and muscle stimulation is matched to the gait pattern. The goals of stimulation are to expand the activity radius, improve independence, maintain or reestablish the personal activity level of the patient, reduce spasticity, and maintain joint mobility.

C-Leg

In 2011 Otto Bock launched a new version of the C-Leg prosthesis system based on their experiences and in close cooperation with customers and technicians. The new, technologically advanced C-Leg offers reliability and safety, combined with new functionality to meet the individual needs of the user. The knee joint is controlled by a complex sensor system, which permits adaptation to various walking speeds. Stability even in uncertain situations, walking slow or fast, negotiating slopes and walking down stairs step-over-step. The functions of the joint are also individually adaptable to the needs of the wearer. The C-Leg has optimised swing phase control, enhanced stumble recovery and a higher weight limit up to 136 kg are just some of the innovations, according to Otto Bock. The company says the new C-Leg is ideal for anyone with high stability and reliability requirements in everyday life, and provides extensive mobility and freedom.

Otto Bock Science Center for Medical Technology
www.sciencecenter-medicaltechnology.com

Otto Bock www.ottobock.com


Foreign interest

So what can Berlin offer the Middle East? The key here is knowledge. The city has specialist knowledge and experience in abundance. They can offer help and cooperation with specific competencies, whether it be scientific clustering, the development of masterplans for greenfields healthcare infrastructure, or specialist knowledge sharing of the latest innovations in cardiology or oncology, for example. This city has the expertise. In the field of international patient travel, Berlin has several facilities offering world-class and highly specialised treatment with executive style service to cater to those who can afford and want the best healthcare in the world. The Berlin Heart Institute is truly one of the world’s leading cardiac treatment centres and the Helios and Vivantes hospitals have 5-star hotellike patient rooms for foreign patients seeking specialist treatment abroad. And for family members accompanying patients, Berlin is a tourist haven with magnificent museums, theatre, art, architecture, dining and shopping.

Etihad airline has recently partnered with Air Berlin to provide more frequent direct flights between the UAE and Berlin.

 

Biotronik innovations

ProMRI – The Biotronik ProMRI series is the industry’s broadest portfolio of MRconditional approved cardiac devices and leads. It gives patients access to
MRI scanning under certain conditions.

Closed Loop Stimulation – Closed Loop Stimulation (CLS) is a unique physiologic rate-adaptive technology, which is integrated into the natural cardiovascular control system. It determines the appropriate heart rate based on intra-cardiac impedance measurements. These measurements reflect changes of the cardiac contraction dynamics based on information coming from the Autonomic Nervous System. CLS provides the most advanced physiological rate regulation on the market and is the only one to adapt the pacing rate effectively for both physical and mental activities. During periods of mental excitement or stress, the technology is designed to optimise cardiovascular flow.

DX Atrial Sensing
– DX Atrial Sensing is capable of detecting a new onset of atrial fibrillation with only a single-chamber ICD, providing extended diagnostic capabilities and protection.

New technology

Drug-Eluting Absorbable Metal Scaffold (DREAMS)
– Biotronik offers the world’s only drug-eluting absorbable metal scaffolding for temporary vessel support after angioplasty. It is similar to a conventional stent, however, nothing foreign remains in the vessel following the absorption. Absorbable metal scaffolds also allow long-term restoration of vasoreactivity and vessel remodelling in less than 1 year. The DREAMS device is under investigational use in the BIOSOLVE studies.


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ate of upload: 24th Mar 2012

 

                                  
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