Gregg Suaning, neuroscientist and medical engineer

Neuroscientist and medical engineer

Gregg SuaningGregg Suaning was born in 1963 in San Francisco, USA. He studied engineering at California State University (Chico) and received a BSc in 1986. In 1988 he received an MSc in mechanical engineering from California State University (San Jose). During 1985-87 he also worked as a mechanical engineer for Rexnord Incorporated (USA). As a member of the technical staff at Watkins-Johnson Company during 1987-1991, Suaning worked as a designer of semiconductor fabrication equipment, using chemical vapour deposition.

He moved to Australia in 1991. From 1991-92 he was a marketing systems specialist at Johnson & Johnson Medical. Following this he worked at Cochlear Limited from 1992-97 as a prosthesis designer, designing neurostimulators for the profoundly deaf and severely hearing impaired. In 1995 he became a lecturer in mechanical engineering (part time) at the Hunter Institute of Technology, Gosford, NSW, a position he still holds.

In 1996 Suaning was part of the team at Cochlear Limited that received the Australian Institute of Engineers Engineering Design Awards for Engineering Innovation, Engineering Products and Manufacturing and the Bradfield Award for engineering works of exceptional merit and community worth. In 1997 he became a research scholar in the Graduate School of Biomedical Engineering of the Department of Ophthalmology at the University of New South Wales. His PhD research project is to devise and test a vision prosthesis system (a neurostimulator) as a treatment to certain types of blindness.

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Interviewed by Ms Alison Leigh in 2001.

Contents


Inspired by parental skill and an omniscient computer

Gregg, would you say you had a conventional, suburban upbringing?

I would. I had a wonderful time as a child. I lived in a fairly leafy suburb in the eastern part of the San Francisco Bay area, with a stable family and lots of kids in the neighbourhood. I remember helping my parents build their own house – or getting in their way, more like! It was a good time and a good area to be growing up in. I went to school there and stayed around until I was about 18 and then went away to university.

When did your interest in gadgets and science start?

Very early on. My father is a tool and die maker who worked on the Danish train system before he migrated to the United States, where he worked for the Department of Defense. He is still extremely skilful. I used to take apart my toys, my little mechanical rabbits and so on, and not be able to put them back together, but he would come home – tired after a hard day's work – and do it for me. Just watching over his shoulder I learned a great deal about mechanical things, how things turn, how they work. I always sat in awe of what he could do. I remember telling my mother, 'I'll bet Dad could build a car,' because I was so impressed that he could change the oil and all that sort of thing. You always want to follow in your father's footsteps, and he was a big inspiration to me.

My real inspiration to do science began when I went to grammar school. Because I did a test which said that I was capable of more things than I realised, they put me in with a group of students who went to the University of California at Berkeley, and there we did little science-related projects like photography and growing plants. One of the rooms had very old-style computers, more or less typewriter-based, that made a dit-dit-dit-dit sound. I was sitting next to one when it started making this noise, and I saw with disbelief that it knew my name: it was saying, 'Hello, Gregg.' It told me to type something in, which eventually I did (I didn't know how to type) and then it set out my instructions and things to do on that day. From that moment I definitely wanted to be involved with these machines that knew what my name was! That entire gifted student program was a good thing for me to be involved with, and sent me in the right direction, I think.

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An interesting balance between engineering studies and a party life

Was university a rewarding time for you?

It was wonderful. The university that I went to was voted the No. 1 'party school' in the United States at the time. MTV music television was just coming out, and it got hold of the fact that (a) this was a party school and (b) the school had a festival going on – a big, fairly traditional party called Pioneer Days, which was held annually. MTV broadcast it, and so hordes of people from throughout the United States converged on our town.

University life was a little wild at times, and it was difficult to concentrate on trying to be an engineer. While everyone else was out having fun, the engineering professors were saying, 'You don't have fun when you're an engineer. You have to do this.' So it was an interesting balance. But that was the time of my life. It was really a lot of fun.

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Gaining fresh perspectives on the world

But afterwards you did 'goof off', and go travelling?

That's right. I guess when I got a dose of reality I became a little disillusioned with how wonderful it was going to be once I started making an income. I'd been thinking I would go out and buy my Porsche the first week, and my nice house on the hill the second week. I finished my Masters degree at a different university, in Silicon Valley, and after that I was working at a company in Santa Cruz, California, making semiconductor equipment. Although I was advancing and doing quite well there, I thought, 'If this is what it is, I might as well go and do other things. There's more to life than this.' I decided to take off and just see the world.

Going to Poland to be best man at the wedding of a friend of mine had given me the travel bug, so when I had gathered a little bit more money I took off for about two years straight, going through Africa for about six months and also through Eastern Europe when all the changes of government were taking place and Communism was falling. It was very exciting to be involved in those times – for example, to leave Romania and hear next day, as I did, that its government had toppled. Amazing times, and amazing things to see. And I guess 'goofing off' would be a good description.

What are your most lasting impressions from those days?

I guess my perspective on the world changed when I went to Russia for a short time. Everyone was interested in meeting us and seeing us, and lots of people wanted to trade things and discuss things with us. My view had always been, I guess because of my American upbringing, that Russia was the 'evil empire', but that turned around completely when I met these people and I thought, 'They're just ordinary people like everybody else and they're having a fairly tough time of it.' That was a defining time, when I realised that what you hear and what is real can be two different things.

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Marriage, Australia and the medical applications of engineering

I suppose another defining moment in your travels was meeting your future wife, an Australian. Is that why you decided to come and work in Australia?

It hadn't crossed my mind that I would ever end up here. Under the American education system you don't learn much of any country other than the United States, and basically what I knew of Australia was what I learned from Crocodile Dundee – that there was dust on the road and kangaroos everywhere. It never entered my mind that I would be doing high-technology work in Australia.

My wife, Margaret, brought me here for about a month at Christmas time, before we were married, to meet her parents. I landed in Sydney and thought, 'Hey, this is all right' – I absolutely fell in love with the place, in a 180-degree turnaround on what I had thought of it. My future in-laws treated me as one of their own, and I enjoyed that whole experience of being here. I couldn't wait to come back as soon as we were married. So there was no kicking and screaming to bring me here. It was a good time.

Tell me about how you ended up doing this PhD at University of New South Wales.

I arrived here in the middle of the last recession, and when I looked at what I was qualified to do and what was available in the Sydney Morning Herald job ads, I got a little depressed and started applying for scholarships. One, in particular, was with a foundation which works with people who have movement disorders, and I was absolutely inspired by their idea of applying neuro-stimulation to paralysed limbs. I knew this was what I wanted to do. The scholarship was to go to the United States for a year and study, and then come back and set up something at the Royal North Shore Hospital. I missed out on that, but it set my mind in the direction of applying engineering towards medicine.

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What could an eye implant do?

Let's talk now about the eye implant you are developing. Firstly, what do you hope to achieve with it?

Well, there are numerous conditions that cause blindness. Some of the more prevalent ones involve the retina itself, killing the photoreceptors – the things that are capable of receiving light and changing that into a response in the back of our head to say, 'Oh, there's light.' But if there is any nice thing about a disease, it is that this disease kills those photoreceptors only. There are basically 10 different layers of the retina. In retinitis pigmentosa and a couple of other related diseases, the nerves that are not the photoreceptor nerves basically stay alive. And when you stimulate them with electricity, they actually do whatever they used to do when you saw light. We wanted to implant some electronics (which we eventually shrunk into a silicon chip) within or around the eye, to stimulate the nerves of the retina and give some approximated vision back to some of these patients who still have the capability of seeing but no longer have the mechanism that starts it off.

But surely that won't suit people who have always been blind – none of it works.

It depends on how they went blind. The optic nerves of people with glaucoma, for example, are essentially dead. The retina itself becomes part of the optic nerve, and so those people would only be treated by a device called a cortical stimulator: a rather risky prospect in which you actually put implants in the brain to stimulate the nerves. (People who are blind don't have an awful lot to lose in eye surgery, so the risks are relatively low with stimulating the retina cells.)

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How much sight might be restored – and how can we know?

How much sight do you think you could restore? Can you give some examples of what people might be able to see?

I think that a patient fitted with this is going to have to relearn how to see, just as cochlear implant patients have to relearn how to hear. And it's not going to be the way you and I see; it's not going to be 20/20 vision. Think of being at a sporting event where you can certainly see the numbers on the scoreboard, and where on some of the larger scoreboards that show pictures as well – rudimentary images, animations, that sort of thing – I guess you could make out faces if you had enough training. We may be able to get people to read; we may be able to get people to recognise at least that there is an object there, a person perhaps, movement, that sort of thing. But we are a long way off from being able to convey real images. Even so, it would be wonderful to be able to get past an obstacle without ramming into it. That is a big plus.

Light and dark perception is something that we are almost certain we are going to be able to convey. A lot of blind people suffer from horrible sleeping disorders because they lose synchrony with the 24-hour day. They don't know there is sunlight there, so they don't know when to wake up or when to go to sleep, and they shift into and out of synchronisation with us. Some of our studies have shown that the device we have is capable of at least evoking a physiological response in the brain that says, 'Yes, there is light there.' And because that is in the absence of any other light source, it has to result from our device.

So far your tests have been on sheep. How do you know what they are seeing?

The animals can't tell us what they see, but we can measure the electrical activity in their brains. When we stimulate the retina, that activity travels down the optic nerve to the centre of the brain, where it splits off and is processed in a number of ways before going to the vision centres of the brain, the visual cortex. If we can find where the visual cortex is on an animal (it's fairly well defined) we can put some recording electrodes immediately above that portion of the brain and when we stimulate it, some event is going to result if the animal is realising that it 'sees' something. And when we deliver numerous repetitive stimulations, the animal will come up with some sort of electrical pattern in its brain to tell you, ah! it sees something.

But to know what people are actually seeing – how big the light is, how bright it is, that sort of thing, which is called psychophysics – we are going to have to get some humans to tell us.

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How can an eye implant become a beneficial reality – and when?

You say the device itself is a silicon chip. How big is it?

The chip can be extremely small. We are constrained more by cost than anything else, because it was an inexpensive process we happened to make a fairly large chip, about 6 millimetres in size. Beforehand, we built a similar circuit about half a metre by half a metre that had all of the components – you can go down to Dick Smith Electronics and buy the components there. We were able to shrink that to something substantially smaller, which we could put in or around the eye region in such a way that you probably wouldn't be able to tell by looking at a person fitted with this thing that they have it.

What obstacles have to be overcome before this can be implanted in a human eye?

There are some technical things. Engineering-wise, we have to make sure that this device is sealed. If any piece of electronics – a radio, say – gets into salt water or even around salt water, eventually it will stop working. The body is made mostly of salt water, so putting electronics in the body is a very difficult problem. And the signals that this chip is able to deliver have to be able to get out from the little implanted capsule to the electrodes that stimulate the nerves. That is a particularly difficult prospect, but we are making good progress on it.

There are also some medical aspects. We have serious problems with being able to fit substantial things within the eye. I have heard the retina likened to wet tissue paper. It is extremely delicate. So we have to develop techniques of surgery. We have made some good progress, actually implanting a few devices within the eye of an animal, and it seems to be a reasonable prospect to go into longer-term tests.

Probably one of the trickiest prospects is to convey the world image in a very pixelised version. By way of analogy, although cochlear implants have been around for 10 or 15 years, there is still a huge amount of activity going on, to figure out how you get sound that goes into a microphone into something that can actually stimulate people to hear. A similar thing is going to be happening with vision.

Using the retina itself we are, in fact, at an advantage, because it is all mapped – what you see on one side is actually on the other side of your retina. So we know where we stimulate and where we see. But there is still a long way to go to stimulate what we see: does it get bigger, does it get smaller, does it hurt, that sort of thing.

What is holding up the testing in humans that you need for that?

Patients overseas have been anaesthetised on the operating table and tested. But we felt that we could not yet say, 'If we get these results, then we can actually put a implant in someone's eye.' Other studies have been extremely preliminary, and we have been reluctant to use humans for things that would not benefit anybody. We want to be ready to start implanting things for real, not just for testing.

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Staying up with the game and winning through

You have competitors around the world. Are you ahead of the game?

I think we are right up there with the game, but the others have a huge advantage over us with funding. The German government some years ago put in $A240 million or so, and I know that a group in America has just got a $US12 million grant. We started with a $5000 grant and worked up to a $15,000 grant, and then the Australian Research Council gave us about $260,000 for a period of three years. So we are definitely doing this on a shoestring. But I think we are up there with the best of them as far as the technology goes.

We have an edge, though, in our ability to do things on a shoestring. In some respects, that is faster than doing things the easy way. As one example, I have a stereo (no longer functional) that I have been taking parts out of. If I were to order those things, they would have to be shipped in and that would take probably three days, whereas I can go to my stereo, clip these things out and have them there instantly, for free. Using such tricks of the trade is how we are getting through on the budget that we have.

Clearly there is considerable commercial potential for a device like yours.

There has been a lot of publicity, even on our local television, about some of the groups in other parts of the world, but I don't think anybody is ready yet. No-one is ready to go into full-blown clinical trials, for instance. But we are getting there. All of the groups around the world are going at much the same blinding speed to fix this problem. I guess some of the incentive, aside from being a scientist for whom this happens to be your life's work, is the possibility of this being another cochlear, for example – something successful that can be of benefit to mankind.

Have you had to turn yourself into a businessman?

It is just starting now. We have gone through and done the hard yards, and we are getting to the point where we have got all these little gadgets that we can show people, but what to do next is the tricky bit. This sort of thing is quite difficult for me – I enjoy sitting in my laboratory and tinkering with my electronic toys, but now I have to go out and present this to people.

I guess all scientists find it difficult to convey what they do, but it is important – unfortunately – if you want to see these things to the end. We have a list of papers that we can be very proud of and we could stop now, but in order to take it the next step we have to play the game of going out to get money and courting people to commercialise it with us. So now I have to be a bit of a businessman.

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Tenacity and versatility for successful science

What skills do scientists need besides an ability to promote their work, do you think?

They need lots of skills, but I guess the biggest one is tenacity. It is so easy to give up. Some of our experiments start at eight o'clock in the morning and go until three or four the next morning, but at about five or six o'clock at night you start to realise whether or not this is going to be a successful one. Sometimes when it gets to midnight and you are still trying and trying but nothing is happening, that is extremely discouraging. But on a number of occasions we have come away from an experiment thinking we've tried everything, there is nothing else. Then, fortunately, in the clear light of next day – in the shower, I guess, thinking about what happened – all of a sudden it is clear what to do on the next one. But it's so easy to give up. I guess that if you are a scientist and you want to see these things through to the end, you have got to be tough and take the punches.

You talked about working on a shoestring. You probably have to combine all sorts of skills to get everything done.

It's certainly tricky to do things on the cheap. It's also a challenge and sort of fun. We realise this is the situation we are in, so we are trying to make the best of it, even if we have to do crazy things like the time I had to go to a conference on a shoestring and stayed in a hotel that was absolutely infested with bedbugs.

A few times I've been asked to do things that are outside my mechanical engineering background. I recall sitting in a meeting with some people who were going to do the silicon chip for us, based on our design: it just appeared to us that yes, they were going to be able to help us, but no, that wouldn't be right now or in the near future. Then Professor Lovell, who works at the University of New South Wales with me, looked at these electrical engineers and said, 'What if Gregg did this?' I gasped in horror, thinking it was a little bit out of my field, but somehow I agreed to do it. And so I had to learn how to be a chip designer – and an electrical engineer and a physiologist and a surgeon. I guess that could be a stumbling-block for a lot of people who might be reluctant to take on these things. We have a lot of medical doctors, and some of them just want to do the medicine. But you have to also do the engineering. If you leave that to someone else, then you are relying on them to do it for you and to do it fast. So I prefer to be in there, if not doing it, at least playing a good strong role in helping it get done. It requires quite a number of skills to get through those situations.

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The personal imperatives and satisfaction of scientific work

You've got three young children, and you live on the Central Coast of New South Wales. How do you balance your family life with your academic life as a researcher?

One of the advantages of being a researcher is that a lot of us like to work in the wee hours of the morning when people are asleep – I can start work at nine o'clock at night if I want to, and work until four next morning – and then go outside and play cricket. The Central Coast is quite a distance from the university, so at our home I have a little office with a sliding glass door. The kids know when it is Dad's worktime, but also you get the occasional face pressed up against the window and something to coax you into the house to have lunch. It's a wonderful thing, a great way to be doing work. You find yourself working much longer hours than you might in a business, but I have a very tolerant wife who puts up with my nonsense and we find it a good lifestyle. As long as I have the free time to spend with the family and kids, which is something I want to do, I really wouldn't change the way I do things at the moment.

So what is driving you to work so hard, to be so tenacious, to keep on with these projects?

I guess we all want to make our mark in the world and leave something behind. Having made my mark biologically with my three kids, I guess in that respect my job is finished. I still need to raise the children, but if it is our purpose in life to go on and make our mark, this work is hopefully going to be my mark and I will get some good papers out of it. Sometimes you are tempted to write papers on things where you could probably build up the results you give, making them look a lot better than they actually are, but some of the influences I have around me are preventing me from doing that. I will wait until I have the best results to present.

When you were travelling in the Third World you would have seen a lot of people afflicted by blindness. Is it an exciting prospect, to be able to make people see?

Definitely. Although I don't speak French, I travelled in the back of a truck through the Central African Republic. Médecins Sans Frontières, the Doctors Without Borders, were working in a town far ahead of where we were travelling, and along the way I noticed people with Coke-bottle glasses. They had all had cataracts, and the Doctors Without Borders had actually operated on them – at no cost, nothing. They were just there to do this nice thing for these people, and so people who were blind one day could see the next, all of a sudden. When I met some of these doctors in the next town that we went to, they asked, 'Well, what is your purpose here?' I felt a little embarrassed, because I was just there to look and they were there to do. I carry that with me: 'Well, are you here to do this?'

You asked me about commercial success. All things have a possibility of commercial success but the odds are well and truly against you. It would be a wonderful thing if we could do this, though. Even if we got nothing for it, I would be ecstatic.

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Great expectations and opportunities

Do you think you would have made it this far if you had stayed in America?

To be honest, no. Australia and America are both free countries where you can express yourself and do things, but I have the impression that whereas America has a lot of inertia behind it, Australia is still very dynamic and able to move quickly in certain things, unhindered by inertia. My original university's reputation as a 'party school' is a stigma that you carry with you in America, and to get funding over there would be extremely difficult, if not impossible, for someone with my background. In Australia it doesn't matter where you come from, what you do – the person counts more. Here, what is important in getting grants and being taken seriously is my ability and my potential to do something, rather than my past. The funding isn't so great, but it is wonderful here to be given a chance.

Where do you think you will be in 10 years' time, and where do you think the device will be?

Ah, that's a tricky one. When I first started working on this, I read the literature from all of the groups that had ever worked on it, and those that are working on it. And all of them along the way from probably the 1950s have said, 'Within five years we'll have something.' I started this four years ago, so on those predictions I should have something in a year's time. But on those predictions we should already have had something in 1959, in 1964. There are a lot of things preventing this from happening. All are technology-related, all are overcomeable, but someone has to actually go through and fix these problems.

It can be done in 10 years, but we are getting to the point where we need money. It is not a matter of how smart you are; some of these things – chip fabrication, for example – are just extremely expensive to do. So some of the groups that are much better funded than we are might get to a point where we can't compete with them any more. I believe someone will have a device within five to 10 years. There will be people with eye implants. How well it works, how beneficial it is, I can't really tell you. But I would be very surprised if in 10 years there wasn't something on the market that could help people who are blinded by these conditions.

Where will I be within 10 years? I want to enter academia, but I also want to be involved in this project. I noticed that some of the researchers with the cochlear implant, although they were able to be involved, seemed to find themselves fairly frustrated by being pushed towards marketing and business instead of the raw science of it all. So I want to be involved in both of those aspects of it. I'll probably be happier in academia, doing the continued research on this.

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'Go for it': getting the priorities straight

What advice would you give to young people who think they want to be scientists but are worried about the prospects?

I'd say, 'Don't be worried.' The happiest people I know went in the direction their heart told them to go, rather than the way the money told them to go. I remember consciously saying to myself, I guess when I started travelling, that from then on I would never make a decision based solely on money. That would have to be the second priority.

This is a rewarding field to be in. You can make a huge difference to humanity. You can make your mark in the world, write your publications, have the lifestyle that you want. I would say, 'Do it. If you don't like it, you're well able to do other things with those qualifications. So go for it.'

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