For anything engineering related, JH is better than Penn and Columbia. For BME specifically, it’s a no brainer that JH is on a different level. You are probably too wrapped up with the prestige factor (as are many other kids in hs). JH is just as respected as the these 2 ivys. I’d argue that if everything else is equal, med school admissions people will be more impressed with a 3.9 gpa from JH than from penn or Columbia (due to more grade deflation). However, if you wanna impress your fellow students, friends, your relatives, and layperson right now, then go to penn or Columbia. It might have more of the “wow” factor that seem important to you. Having said all this, I’d go with the sb bsmd option over these other schools.