Professor Kieran Murphy's Art of Medicine

“Since I was a kid I have been inventing. When I was in the boy scouts I was always coming up with crazy things to do with tents, geodesic-hydro structures, things like that. Some kids can dance, some kids can play music. It’s the same kind of creative energy. The question is how it is managed, controlled or expressed. Having some way to express that energy is a privilege.”

A lucky thing perhaps then, that Professor Murphy chose to study medicine, allowing him to utilise this creative spark for the benefit of patients since his graduation from RCSI in 1986. “I can’t sing, I can’t dance, but I can invent medical devices. Most of that comes from need. We see something that upsets us and we want to make sure it never happens again. I think most of us who invent do it for that reason. Or we want to solve the problem for that patient. I can’t say no if someone asks me something. Then I lie awake at two in the morning thinking ‘why did I say yes?!’”

It’s at this point that Prof. Murphy's talent for applying a creative solution to a medical problem will come to the fore. “Then you have to invent something, whether it be a technique or a procedure or a way of access, like going through the umbilical artery to get into a baby’s brain, or a different access route into the head, like retrograde jugular to get into the transverse sinus, or transoral to get into C2. So, I’ve come up with many ddifferent routes or devices to do things safely. I have about 81 patents on different things.”

In many cases these patents are the end point on a journey that can be years, sometimes decades in the making. “Sometimes we see things that are unfixable no matter what we do. That regret results in a desire to find a solution that persists for years. Like, one of my devices I’ve worked on for 19 years. When you’re driven by something like that motivation, that can sustain you beyond any financial benefit. And that’s part of our responsibility, it’s the art of medicine.”

Inspired by the experiences of a family member, a recent invention of his is poised to have a very timely global impact. “My mother-in-law came home from a cancer hospital with a list of medications not to take prior to her radiation therapy for breast cancer. And they were all antioxidants. So, I thought that if that works for a gray of radiation, then this could work for a millisievert, and I developed an antioxidant complex, Halo, with FDA approval and Health Canada approval. And the investment arm of the State Department in the US has invested in that company. I shipped 20,000 pills to the Ukrainian army around the Zaporizhzhia power plant, lest the Russians blow up the power plant and they sustain radiation injury. It could help buy them more time to escape. That’s the definition of translational medicine. You follow through, you develop and you deliver it. Now we’re looking at stockpiling globally.”

Another project on Prof. Murphy’s drawing board originated in a problem even closer to home. “There’s something I’m working on for rib fractures. I broke a rib in a race car, and it hurt like hell. I was thinking ‘do I tell my wife?’ in which case she might kill me. In the end, I told her, she didn’t kill me, but we have no way of treating rib fractures. As a result, I’m working on a device that applies cryoablation to the intercostal nerve to decrease rib fracture pain while the rib heals. It’s just specifically for that indication. Its thermo-electric, it doesn’t use liquid cryogen so it’s safer.”

Clearly timing is all-important when it comes to innovation, but so too is determination, especially if the invention in question is entirely novel or revolutionary. “A lot of inventions are like humour, you make the funny comment in the moment, at the time when it’s appropriate, but then you have to persuade everyone else you’re right. Now, if you go along pre-existing belief lines, then that’s easy. And even better if there is a reimbursement code. But if it’s never been done before and it doesn’t align with people’s medical faith, then it takes years and years and years. And you have to persuade insurance companies to pay for it. And that takes a long time.”

In writing his recent book, The Essence of Invention: Medicine and the Joy of Creativity, Prof. Murphy discovered a further character trait common to many maverick physician-inventors, which he himself shares. “There are examples in this book of physicians who experimented on themselves and then were ultimately found to be right. For example, Peter Markus wanted to develop safer life jackets for RAF pilots in the Second World War. Because they were leaping out of planes at 20,000 feet, passing out from hypoxia, landing in the English Channel, they would then drown by floating face forward. He had himself intubated and ventilated and thrown in a swimming pool until he had the right design whereby he floated on his back.”

He goes on. “The physician who came up with the infection diagnosis and treatment for gastric ulcers, Barry Marshall, nearly lost his licence in Australia for suggesting that they could be caused by infection. He experimented on himself, drank a broth of h-pylori and gave himself an infection. And then he couldn’t get his papers accepted or presented. And then he won a Nobel Prize.” In developing his Halo antioxidant complex, Prof. Murphy followed the examples of Markus and Marshall, and took on the role of chief clinical trial subject. “I tested my antioxidant on myself by drawing my blood, radiating my blood, taking the pills, radiating my blood, and doing this until I got the right formulation.”

Looking ahead, enabling greater access to high-quality medical education could be the next challenge that Prof. Murphy takes on. “I think AI and the world of rapid access to online content enables us to think for the first time in maybe a hundred years about restructuring medical education, embracing AI rather than being fearful of it.”

He goes on to explain his thinking. “There are 5,200 med schools in the world all creating their own individual content. People brighter than me are wasting thousands of hours creating their content to teach, but somebody else has done it already. We could have huge impact at RCSI by sharing our content. If somebody digitalised, say, the anatomy lectures here, which are exquisite, and say if University of New South Wales has phenomenal digital pathology lectures, then why don’t we trade, why don’t we barter that, why don’t we create a platform for bartering medical education with people? Then using the World Bank classification of wealth, decide who gets it for free. And if you’re below a certain threshold, we say ‘We’re going to help you. Don’t worry about creating all that content. Here are our lectures, here are our slides, here’s our content for you to give to your students, and we’ll help you maintain quality. You can focus on the teaching and the patient care, rather than the content creation.’ That would have a huge global impact.” You heard it here first!

Prof. Murphy currently treats approximately 600 spinal patients each year at Toronto Western Hospital, alongside his work in healthcare innovation. However, his path to and through RCSI was not straightforward. “I had a really hard time getting into medical school. I went to Terenure College but didn’t particularly enjoy my time there and ended up repeating my Leaving. I didn’t put much faith in my ability to enter medical school but I vividly remember Mr Grace giving me an opportunity to do an interview.”

His early years at RCSI were challenging. “I found the first few years difficult because you have to remember a lot, and I’m a bit dyslexic so that made it more difficult. But in third year I won a medal for medicine in surgery. It was the first thing I won intellectually, and it was so important to me. I went back to Michael Horgan – because he ran the Exam Office – I went back couple of times that day asking, ‘did I really win that?’”

That vote of confidence over 40 years ago left a lasting impact. It’s something he keeps in mind in his role as a mentor to medical graduates – the importance of giving someone a chance, of sharing knowledge and experience, all of which could help a future star on their way to greatness. “Mentorship appeals to my sense of fairness. Many young graduates don’t get good guidance, they don’t know how to navigate the system. It’s important to share your own experiences to help people at the start of their career, like ‘don’t go there, they’re not nice. Those people are kind, go there.’ And helping them to understand that it’s more about the type of people you work with than the halo of the institution you work in. All these kids are talented but if it starts off badly often they’ll never get a chance to recover. We need to manage that piece really well to make sure their talent is nurtured. Talent is the rare earth element that makes the world go around.”

The 2024 RCSI Alumni Awards is kindly supported by FRS Recruitment, an award-winning healthcare recruitment agency that works with healthcare professionals seeking career opportunities in organisations throughout Ireland.