AI and the Future of Healthcare: Cardiologist Dr. R. Scott Wright

[Music] hello I'm Dr Lisa Bal and you are listening to or watching radio Maine our video podcast where we explore creativity and the human Spirit we are sponsored by the Portland Art Gallery in Portland Main and today we are exploring creativity and the human spirit with a a fellow physician this is Dr R Scott Wright who is a professor of medicine and consultant in cardiology with the Mayo Clinic College of Medicine he is a fellow of the American College of Cardiology the European Society of Cardiology and the American Heart Association he is a distinguished cardiologist and Professor with the Mayo Clinic College of Medicine in Rochester Minnesota and his extensive research focuses on acute coronary syndromes dis limia type 2 diabetes and vular heart disease he's renowned for his leadership in clinical trials and database studies investigating Innovative treatments and Healthcare policies thanks for coming on today thank you Lisa pleasure to join you and wow what a great introduction uh that's really nice of you thank you we get a lot of really interesting people on radio main many of whom have main connection um this for us is a little bit of a a change because we don't often talk strictly about medicine per se um even though I am a physician and my my long-term life has been in medicine but when we think about creativity we don't often think oh medical research we don't think about creating designing and triing new medications we don't necessarily think about teaching and when I met you actually through my husband and through your ham radio connections I said this is a person that I'd really like to talk to because I think the way that I um experience medicine is very different than the way that you experience medicine and I want to learn more about that so thank you for being willing to have this conversation with me a pleasure thank you one of the things that I I know about your background and that was very interesting for me to learn was where you grew up and how it impacted your decision to work with the organization that you did and even do the work that you do now so I'm wondering if you wouldn't mind exploring that a little bit with me be happy to uh if you've read JD Vance's book hillbilly elegy you can get a great insight into my background and that of my generation who grew up in Appalachia I grew up in Eastern Kentucky and like in Vance's book where his family moved a fair amount my parents were migrants they were School teachers who went to work in Ohio because there were no jobs in Kentucky and I was born in Ohio and then after second grade my father had uh decided that he wanted to move his family back to Kentucky so we moved next door to my mother's mother in a small town near the Kentucky Tennessee border in the Appalachian Mountains and um you know it's a wonderful was a wonderful experience in many respects uh you know family was a priority uh Community was real people were kind and friendly to one another and uh everyone was poor and no one realized just how poor we were uh in I think in the 1970 US Census the county that I lived in was considered the third poorest uh but I don't think anyone felt that poor but also no one really had a lot of money I think when I look back now to some of the things that were discussed in my early High School career uh you know it's very clear that it was Appalachia and its impact so for example uh probably uh two-thirds of the students in my high school class had never been outside of the state Commonwealth of Kentucky a third to half had never left that County where we grew up in Kentucky is centered more by County than by city um and certainly a small small percent had traveled outside of the US maybe 1% or less just wasn't common or wasn't part of the cultural thing uh but I was a bright youngster and uh the school teachers really poured a lot into me which helped me you know get a great education and uh I really developed an interest in science thanks to my high school biology teacher Mrs Clark and uh and got a great background in mathematics thanks to a high school math teacher Mr louder milk and I had him for three or four classes you know we had a a dozen or half a dozen to a dozen young students who were College Bound at that time so in our senior year he uh decided to teach calculus at night so that we would understand it and be ready for it in college so while by all external appearances you know I grew up in a Community with few resources the community Spirit was rich the uh teachers really poured their heart and soul into helping students uh and if students were motivated there were plenty of opportunities to learn you know and I think compared to my own children um I there are some experiences I had that are better than anything else life can give you you know we spent a lot of time in the public library a lot of time in the school library uh our church Community was important and that's where we had a lot of our socialization uh we had a lot of common value and in many respects that also creates uh some degree of xenophobia because you think the rest of the world should be like you even in the United States right those and uh then as you become an adult and become exposed to different ideas and philosophies and things you you realize that uh U there are a variety of ways that people in this country and in this world think and act and not not all are wrong and certainly some are better than uh what you were accustomed to growing growing up and so you become U much more heterogeneous than homogeneous you know but uh I think if there are any traits that sort of typify people who leave Appalachia it's uh feeling awkward and not like they belong in any successful situations uh you're constantly wondering you know what what's going on uh we had a young man in our community who was the star basketball player in Kentucky and that's uh basketball in Kentucky is like football to Wisconsin or the Green Bay Packers you know um every high school kid playing high school basketball BB wants to play at the University of Kentucky and he actually was Mr basketball and played there but he left after two seasons and I was having a discussion last week with u two friends from my community who happened to be at Mayo Clinic site in Florida where I was working last week we were talking about him and why he why he transferred from a division one school to a division three college at the end of two years and you I never knew uh and uh my perspective was that likely it was just sort of the typical uh and what we would call today imposter syndrome I don't belong here therefore I'm leaving I want to go somewhere smaller and uh you know he's a successful adult now so he he his life has gone well but you know that's just sort of typical of of of of that background but I think in my own work now it's made me more appreciative of people their struggles you know understanding people who are less affluent who uh uh can't afford their medications or can't afford to get health care uh who can't afford an extra hotel room a night in the hotel because uh they've spent their entire budget for healthcare coming to see me uh and we need to finish their evaluation in two days instead of four days so it's I think it's provided a sensitivity and a compassion that I wouldn't have had if I'd grown up in a urban area the child of affluent individuals you know and it's made me a value and appreciate education as well and that's how I got into ham radio uh you know I don't know if Kevin your husband knows that story either but uh in seventh grade uh we had a substitute teacher so went to the school library to get some books to read so he would not assign extra homework and there was one on ham radio and I started reading about it and uh within I think uh you know a few days I'd learned moris code and I was ready to get into the Hobby and uh so I've been doing that since that year as well I'm always impressed with people who can do Morse code I know Kevin can do Morse code and he's been getting himself back up to speed but it's a whole different it's a whole different language and it's something that it's it doesn't get used as often I think in well I would assume as a cardiologist you probably don't use Morse code probably at all but it is something that's still used quite widely within the ham radio world yeah it it is thank you it is and it's used widely I think uh uh you know as a backup Communications modality now there are much better digital modes for commercial reasons and when we think digital think email think small sentences like tw Twitter uh like like tweets that you can send out that are much easier than having to decipher it you know with the with the head headphone and listening to the high-pitch sounds but there is a real parallel with Cardiology we use something called continuous wave Doppler uh to interrogate uh cardiac valves to look at gradients to look at uh pressure changes and that's just simply the same Theory as Morris code and there are many analogies between cardiac physiology and uh RF communication you know the heart is uh is a pump that has to match its output to the vascular system and it deals with impedance it deals with reactants and indu and medications that we prescribe that slow or raise the heart rate uh can change inductance and diuretics and vasodilator therapies if you're taking lartin or an Ace inhibitor or something like that uh that alters the reactant uh or the capacitance rather not the reactant but the capacitance of the body so there are lots of analogies and U when I was training in cardiology it sort of dawned on me that there were a huge amounts of parallel there and so it's helped me sort of understand how we design therapies and how we match therapies for the problems that individual patients have and I'm still working on an idea which is to try to be able to measure the coupling of the heart to the vascular system in a non-invasive way so that we can then tailor the medications for what the patient needs rather than throwing every patient throwing every medicine at every patient you know as a family physician I think that was your background if I remember correctly uh these P the patients not only have to take all of these medicines they have to deal with the side effects the nausea the the feeling of satiety and also the cost you know and uh every new medicine that comes out seems to cost between 6,000 or 12,000 a year and if you have five of those to take without insurance you suddenly can't afford to take any of them so you know I think it's behooves us in medicine to try to find therapies that fit a specific niche of a problem and use only what is needed rather than just uh blindly prescribing everything that makes a lot of sense and I I think we have gone through a phase where we were using broader Spectrum whatever it was broader Spectrum antibiotics or broader spe Spectrum blood pressure medication maybe even broader Spectrum um anti-cancer agents um but the more that we can bring them back to an individual and even I know that there's been a lot of work being done with individuals um genetics and the way that individuals metabolize things I think the better off we're going to be because when you use things that are very broad then as you've pointed out you can actually get a lot of side effects um and they may not even be the best medication for the patient but it's taken us a while I think to get to the level of technology that we've needed in order to tailor things to individual patients it sounds like this is something that you've been working on for a while yourself well it's an idea and I proposed some thoughts about how to test it many years ago and uh I've been distracted along the way with other things things including uh one of the new cholesterol medicines we'll talk about I'm sure in a few minutes but uh it's still something I hope to to work on before I finish my career um I uh I think you're exactly right that we do need to tailor medicines for individual patients we have a whole Center at Mayo Clinic in Minnesota called the center of individualized medicine and uh their goal is to combine genetic testing genomic testing uh patient prior responses and AI to sort of say what's what's optimal for you rather than uh you know are you just try everything and uh I think it's especially true with high blood pressure I'm sure many of the listeners today take high blood pressure medicines but they might be shocked to learn that typically we have to prescribe three because the first one will lower blood pressure but then the body has a counterregulatory physiologic reaction to that medicine and so then you prescribe the second medicine to counter that counter reaction and then the body does a counter reaction you prescribe a third and then eventually you're able to stop the body's resistance so to speak to all these medicines and get the blood pressure to the appropriate level so if patients who are listening or any of us who are listening who take medication ever find themselves frustrated just remember you know the body is a pretty well-designed human engineering system it's designed not to have its ecosystem tilted by medication or other other things that's why it's it fends off Invaders like viruses and bacteria and it sees medicine is foreign and so you know we uh have to recognize that there will be counter responses side effects it's often called and so you have to prescribe things to to manage that or even remove that medicine if the side effect is too strong or too too harsh for the person to tolerate I appreciate the fact that you're bringing the language into um uh you're bringing it forward in a way that really anybody who's listening to this conversation should hopefully be able to understand because I think that one of the things that often happens OB obviously within primary care because we're dealing with all of the things all of the time so we're always translating back um what big names of medications mean or what different ways that the body acts um how this happens and we're always trying to bring complex ideas into something that's understandable for people who have a broad range of ways that they understand and I think that what you're describing is incredibly important um for all of us to know because sometimes when people walk into a an office whether they're seeing a nurse practitioner PA a physician um they're really relying on somebody else to kind of make a judgment on their behalf because they don't feel like they have all the information they need and it would be much better if we can bring things to a level where people understand what they're actually agreeing to so that if they start taking a medicine or if they start engaging in other types of um Therapies they know what the possibilities are for things going wrong and this I think really gives people back their ability to make their own decisions with the help of their Healthcare team um in a pretty significant way that's become increasingly important with people's um greater access to knowledge and information what do you think I fully agree with you I think uh what you just articulated much better than I could ever have done is critical I think that uh every person in training whether it's a medical student a PA or a nurse practitioner student uh really needs to be taught that uh at the end of the day we're all here to serve people to serve the patients and they are Partners they are actually in charge of their own health care they're coming to us and trusting us for advice uh and uh I always tell my patients look uh you're putting a lot of trust in me to give you advice but also to spend your money right uh and to to pick appropriate testing and to pick appropriate therapies so I like to pick uh the greatest value and testing for you you know I work at an organization where I'm salaried so I don't uh have any necessarily incentives to do things that are more expensive or less expensive uh whether it's a you know fee for service or a Managed Care type organization it's just we're salaried and we like to think that we do what's optimal for people you know I'm not uh not criticizing others but that's just a system that I've chosen to work in and I like it but also I tell patients that I really try to pick the medication that offers you the best value most of the time it's a generic medication that also has evidence that it will lower your risk of stroke or death or heart attack and that we really should get a benefit from anything we prescribe it should do more than one thing it should do more than treat the condition you have it should also give you additional prevention against other disease States because we have we live in an era now we practice in the greatest time in the history of humanity with medicine right we have all these clinical trial data and outcome studies and we have knowledge and we have lots of people globally working on things and it really behooves us to u to use therapies that are safe and effective but also add value to people uh and uh you know I try to educate and inform my patients and uh sometimes they came in they come in with a decision you know sometimes people come in and say I really want a metronic pacemaker and I'll say okay I'll let the team putting the pacemaker in know that you really want a metronic why do you want a metronic well my daughter or son works at petronic and I understand that you know and if we have a device like that they'll they'll get it but most of the time uh people uh really trust you to do that I remember I was in Chile lecturing and they asked me to come to the hospital to the ICU to see some patients and give them advice on them and one person was having a heart attack and was getting a sent and they were had done the angiogram and I was looking at the pictures with them and agreed that he needed to have an artery stented and then they stopped and there was like a 15minute discussion going on in there and I asked one of them what's going on they said oh we're offering him we're discussing the three stents that are available we have the US made stent that's this amount of money we have a second one that's this and then we have the knockoff from a third country from a country in Asia that's substantially cheaper and he's deciding which one he wants to go go with you know and uh because he was paying out of pocket for this you know and they had that discussion and I kind of helped me understand that even in a country like the us where we have lots of insurance public and private we still need to have those same discussions and so I think Lisa your your advice is preent and it's correct and we do need to be treating the next teaching rather the Next Generation healthc care providers how to do these these tasks because patient it doesn't matter if we have the best medicine available and prescribe it if people will not stay on it and take it it does no good and uh you know we could talk about cholesterol medicine you can be on the most powerful medicine but if you're not adherent you have the same risks of bad outcomes as someone who's taking the the least effective medicine so uh you really need to be able to stay on your medicines and if you're not engaged with your healthcare provider and willing to take it you're probably not going to stay on it so you have you know we have to take the time and or have people in our team who can talk with them and help them understand the importance of that and I think it's all a partnership too between specialist and and generalist you know we none of us live in isolation and I always encourage patients to get a home physician and have a home primary physician a home specialist because most of my patients travel hours to you know thousands of miles to see me and I tell them I I can't be there if you have a heart attack you need someone locally who can treat you so don't disregard your local Healthcare team stay with them yes I agree although as a family practice doctor I I think of myself also as a specialist I just specialize in a kind of a broader range of things than um somebody who perhaps is a heart specialist as you are so I do think it is important for all the teams to be able to communicate and to work together well and one of the things I'm interested in with regard to your work is that you're doing things that are both um kind of more on the scientific research side but you really want to bring them into the the medical realm and the clinical realm and you're really trying to create value with the medicines that you've been um working on so in the most uh I guess understandable way possible could you help us understand what it is that you've been working on uh most recently and what the process has been like as far as creating um a new medication that people can use and what this is used for oh sure I'd be be happy to and please interrupt me if I go too long because uh you put a nickel in and we can give you $2 worth of output sometimes talking about these sorts of things uh in 2015 or 16 I was invited to a small meeting in London during the European Society of Cardiology that I typically attend and um some individuals that I have immense respect for who had worked in the pharmaceutical industry at Ro had transferred to a small us company at that time called the medicines company it was founded by a physician from the United Kingdom who wanted to bring disruptive therapies to the healthcare Arena and do things differently in a more affordable cost- effective and uh generally easier way so he had a small Pharma he and uh he he was living in Boston when he started the company and he had some fellow physician friends who worked with him one of them who turned out to be a ham radio Operator by the way so you know uh if any student or young person is listening to this a ham radio is a great way to boost your career it seems you know it's worked for me but anyway uh they were showing us some new data on a therapy that you could inject that would lower cholesterol 35 to 40% for 12 months if you had a single injection of it and uh we were all intrigued by that because injectable Therapies really had not uh for for cholesterol didn't exist and for most there most most problems outside of say osteoporosis just were not being utilized except with chemotherapy so they were started teaching and explaining to us that this was a new class of therapy uh based upon a discovery in 1999 by Craig melon at one of the schools in Massachusetts who discovered how viruses and and other organisms can alter the the cells and bodies of their host because they go into the cell and they alter the RNA silence silencing complex and that's a mechanism that's the body's natural way of silencing U the translation of message RNA uh so in simple terms we all have DNA the DNA can create message RNA which allows us to have proteins and other things to synthesize things in the body and so uh you you the body has used this RNA silencing complex as a way to silence the translation of things when those things need to be turned off and I think in 2005 or uh Dr melon and his team won the Nobel Prize I think in medicine for this it was a very quick thing well now fast forward to 10 more years from that Nobel Prize and now there were Therapeutics being developed using this uh by a company called alum in massachus and the medicines company had acquired the use of a drug call that they were going to call in ceran and we started looking at it and I was struck by how easy this was to take it was like a small vaccine kin to getting a flu shot that quick and uh you could lower cholesterol 35 or 40% and I immediately said to the CEO I said this is going to be disruptive and this can replace statins someday and um I said we really need to be testing this and he said yeah that's why we're here and so we were invited and there were there were four or five of us and we have worked with them uh to to help bring this medication from the concept stage the preclinical stage through phase two and phase three clinical trial testing and uh it was a approved by uh the European medicines Authority about a year before FDA approved it its approval process started coming during the pandemic which slowed down approval in the US because uh the factory producing this uh compound was in Italy and of course there was little travel during the early part of the pandemic so FDA couldn't go and look at the factory and delayed the process now it's approved in 80 countries but it's called a small interfering RNA compound it silences the translation of a protein called pcsk9 pcsk9 is probably the most important way we regulate cholesterol levels in the body even more important than what statins do blocking the enzymatic uh you know synthesis of cholesterol because by blocking pcsk9 you can reduce cholesterol 50 to 80% which is about twice what typical doses of statins will do as they're titrated up and when used in combination with statins you can have fairly profound lowering of cholesterol you could take someone with a total cholesterol of 200 and bring it down to 90 or so or 80 with both statins and these drugs so we can bring people people's cholesterols to very low values and that's important because before we all lived in urbanized centers and we were hunter gatherers our natural cholesterol levels were 80 to 100 and the LDL cholesterol or the type of cholesterol that causes plaque buildup heart attacks and strokes was in the 10 to 20 to 30 milligram per deciliter range so what we see in in urbanized areas especially in the west and frankly anywhere in the world that you live in an urbanized areas your LDL cholesterol gets up to 100 to 200 and that's when it starts having to be be deposited into the artery walls and other places because the body doesn't want that toxic stuff around so it tries to push it away to get it out of the way and that leads to disease processes that cause stroke heart attack the need for bypass surgery stance things like that so anyway the best way to lure this was through statins initially diet then then statins and now by blocking pcsk9 and there had been monoclonal antibodies to pcsk9 that were developed and tested and proven effective but they were initially priced at about 16,000 a year and almost no one could afford them then the price dropped to 7 or 8,000 a year and they still weren't being widely prescribed and so at the time we were developing the approach to testing this new compound we all insisted that while we couldn't dictate a price this had to be affordable for the average person and so to the company's credit they promised that and they also promised to bring it out in a way that most people on Medicare wouldn't have to pay excessively out of pocket for it because that's that was we felt the target population now of course we know it's it's a lot of Prem Medicare patients younger People Like Us uh who who also need it and so it works by you get an injection now we use it twice a year uh when you start on it you get an injection on day one day 90 and then every six months after that so it's a twice a year medication typically over a lifetime and it lowers cholesterol uh depending on your type of of uh condition uh between 45 and 60% and in combination with a Statin it's quite quite potent to go even lower than that so it's a very well tolerated medicine it is an injectable it has to be given either in your doctor's office or an infusion center because it's a it's a was tested and designed that way while the other the monoclonal antibodies you self inject every two weeks at home so right now we're in injectable phase of treating high cholesterol where you take a pill and then you also take an injectable and you can either take it every two weeks at home or twice a year at your doctor's office or an infusion center uh and that's kind of what we're doing uh so it's a small interfering RNA and uh I didn't think too much about it in in terms of that because it gets into the body it's delivered directly to the liver it's designed so that it's only taken up by the liver doesn't go anywhere else and then it works in the liver and then after only a single dose you get a profound effect but it wears off and that's why we go to twice a year so it's not like it's a permanent change to the body people don't have to worry that it's going to irrevocably or irreversibly alter their their their physiology it doesn't we wish it would last longer but it doesn't and that's a safety mechanism and so it's been tested and at least in the initial work that we published in a large number of patients including a publication just in May of this year uh it's profoundly safe and has very few side effects except some itchiness and redness typically at the side of the injection like almost any injectable can whether you take insulin or other diabetes medicines or you're taking woia or OIC for weight loss those can also give you some itchiness or redness at the injection site that you don't really pay attention to but fast forward to the pandemic and then suddenly any use of anything with RNA became a politically uh volatile topic right and uh how do we talk to patients about this medication which is life-changing you know in the setting of not politicizing it and either causing them to be highly in favor or highly opposed to it you know and uh so that that made it kind of tough but thankfully I think we've kind of moved beyond that a little bit in our country and so now we can continue to talk about this in a way that uh explains the science and helps them understand and it's really uh the the mechanism of of this is going to lead to discoveries for treating a lot of disease States not just heart disease you know cardiac ameloid dois is a rare condition largely in older people that has uniformly been fatal and now there is a new drug that's an injectable that was ahead of the one we brought forward that treats that and uh it's sold by I think several companies now and uh there are blood pressure medicines that have been developed and tested to lower blood pressure by blocking the conversion of angiotensinogen to Angiotensin in the liver uh liver diseases are being tested for treatment with this type of therapy because the liver it seems has a unique receptor on the surface that's been preserved over millions of years and is expressed in high amounts and it will take up a carbohydrate Moy inside the cell where you can then couple that with the medicine and deliver it right to the liver so it's targeted therapy so you know what the benefit of this is that you you target it to the organ where you need the medicine to work you don't get any systemic side effects you don't get the risks of of Target side effects typically and so we're at the precipice of a lot of new therapies coming along I know there's a lot of interest in gene therapy and Gene editing but I see this right now as a much safer alternative uh to crisper cast 9 Gene editing because it's not permanent you have to continue to take it if you get a side effect you stop if you get a side effect from Gene editing you live with it the rest of your life you know whether it's an off Target effect like a cancer or your hair changes color or something you know whatever it could be we don't know what it will be because the gene therapies haven't been approved yet and are just being tested but I think this is the next phase so my my dream is that we can go from taking pills 365 days a year or several times a day to getting some injectables that are infrequent that make compliance and adherence much better and easier for people you know I think all of us who take medications and I certainly do on a daily basis forget to take them Ally uh you're traveling you run out you can't get your refills back in time somebody doesn't deliver them to you you know through mail order on time so you're kind of stuck and uh you know with cholesterol medicine if you miss it for a few weeks your risk for heart attack goes up and so the benefit of this too is that it keeps your cholesterol down it may it may not be at 50% down because the drug is wearing off and it may be only at 40 but it's some reduction and it protects you until you can get the refill of the other medicine or get back for your injection so that's that's kind of where we are I think that's that's the future that's where Healthcare is heading and I'm pretty excited about it I think 10 to 15 years from now maybe we can come back on radio Main and talk about the 25 or 30 disease states that are being treated by this I'm optimistic the diabetes and maybe rheumatoid arthritis I'm just going to just think creatively if I may this is not any inside knowledge I have because I don't uh lots of disease States maybe aler of colitis or Crohn's can be treated with things like this it would be wonderful to just develop new therapies that are really problematic for people and uh you know help uh and there's another another lipid problem called elevation of lipoprotein a which is a specific lipid elevation disorder in a percentage of the population that has no therapy and there are two or three drugs being developed now that are small injectable RNA Inhibitors and they'll be out in testing and likely before FDA in a couple of years and we may have those available so it's a pretty exciting time in medicine to be practicing and a really exciting time to be a patient uh if people are really happy with how glp1 drugs have helped weight loss I think they're going to be even more delighted to see chronic disease states that have been here to for a fatal become much less fatal and it's all part of helping to restore health and improve quality of life for people which is why we all went into medicine one of the things that I'm reflecting on as you're talking is the fact that there have been really dramatic advances within the relatively short period of time that you and I have been practicing and I mean relative relative to like the history of medicine just overall because I know that you have you have more than more than one decade into your uh Health Care career and certainly I do as well but it's been a fairly short period of time even from I think the earliest that we began prescribing Statin and even understanding that cholesterol was an issue and even moving past this idea that we're just trying to get the clumps of fat out of your blood to understanding that actually this is an inflammatory process that we're working with so I I'm I'm continually Amazed by how much we've been able to learn by bringing clinical and bench research together so that we can kind of keep iterating on what we know and moving into the next um phase even as you're talking I'm thinking about my uncle who actually does have um cardiac amitosis and it's basically a miracle that he did receive he was in the trial he does have this injectable and his life essentially could have been over if they hadn't made this available to him and it's just by virtue of having been born when he was and being alive when he is and um and it really does give me as a physician hope for the future that we are continuing to look at things creatively within our field oh I agree you know uh Statin were a by byproduct Discovery right they were being developed as an antifungal or antibiotic by the Japanese and they didn't work but someone discovered they lowered cholesterol so that led to a lot of testing and Discovery and then uh after Brown and Goldstein published their seminal work on the biosynthesis of cholesterol and ultimately received the Nobel Prize in medicine the pieces started being put together so I think I look at it this way I I like you I I feel very fortunate or blessed or lucky to be at this phase in life and to see this you know my own grandmother died of heart disease when I was uh 18 uh which had a profound impact on me uh my grand parents my grandfather on my father's side also died of a heart attack uh uh you know heart disease used to be so fatal now it doesn't have to be so fatal it can be um a condition you live with rather than you die from but I think there are two things that have also contributed maybe more to to the discoveries we have one is the fact that we uh fund a lot of creative science through federal grants state grants nonprofit work like American Heart Association the Alzheimer's groups to let scientists just try to discover things and then there's sort of an open free market in a sense globally of all these ideas so that people can see research and they can then built upon they can stand on the shoulders of one another you know and make discoveries and there really are No geopolitical Boundaries about biomedical research uh one of the things I really enjoy about attending International conferences that I can meet people from countries for example like Iran that I would never be able to travel to and talk with them about medicine and Healthcare and see what they're doing and learn from them and they can learn from me and uh recently been doing some talks via zoom into Kazakhstan and uh that would be a very difficult place to travel to and maybe someday I'll go but it's much you know I can share my knowledge they can share their discoveries they submitted a paper to our Journal at Mayo Clinic the Mayo Clinic proceedings we've accepted it because they've developed a nationwide lipid lipid program lipid Clinic program that's quite an quite uh I don't know excellent it's just you know novel that they've trained everyone nationally and uh they have made available uh therapies for people who have conditions and uh the world will learn from that and so you know unlike the geopolitical boundaries that our politicians create we actually have a free flowing exchange of ideas I know everyone is frustrated with the covid pandemic and they feel like it wasn't managed well here where there or wherever and all of that but really I I think uh covid was a time that the global medical community came together uh you know the courageous physicians in China who reported it out unsure about what they were doing uh the courageous people in Italy who shared what was going on the courageous physicians in New York who shared what was going on and put their lives on the line to treat it early so that all of us could learn globally then when it went to the southern hemisphere they did the same uh and uh lots of therapies including diagnostic testing uh you know convalescent plasma monoclonals vaccines uh even um the more recent oral therapies have all been tested globally and it accelerated the discovery of new treatments and uh I think Co really demonstrated to the world how quickly we could respond I kind of have a rule of thumb about pandemics my first rule of thumb is that the next pandemic cannot occur during a presidential election year because I think that slowed down the uh scientific work and it distracted the population and it created a lot of angst fear uncertainty and doubt among people about whether masking helped whether it didn't help whether vaccines worked or didn't work and uh I mean you know I didn't really need a clinical trial to show me that masking worked when I could see people with active covid and our practice because I was seeing consultations in the emergency department and not catching it uh and yet I was able to help them it gave me confidence as a healthc care provider that I could safely work in this illness and not be dying from it a few weeks later helping those who had it and uh the same with the convalescent plasma you know I got I was so lucky in pandemic Lisa to be asked by the Food and Drug Administration in Mayo Clinic to help lead the world's largest Co study which was the US convalescent plasma study with friends and colleagues at May Clinic Michael Joiner Delisa Fairweather Ricky Carter where we treated 105,000 people across the United States in sort of a pragmatic clinical trial and then published it in the New England Journal in January of 2021 showing a reduction in mortality a reduction in hospitalization and Improvement uh and then it led to an emergency use authorization uh in August of 2020 uh by FDA uh for the use and then until better therapies came along you know it was all we had and now it's used in largely imuno comp comis patients where the current treatments uh are not working but convalescent plasma still does offer some benefit but it also set the stage scientifically for why vaccines would work and why monoclonals would work and yet watching this happen globally I just marveled at how wonderful it was to be in a profession where we could cross Geographic boundaries we could have conferences globally share ideas and information and just help one another do better you know and so there's a little competition in medicine but a lot of collaboration because at the end of the day we're all helping one another and we realize that the therapies and discoveries we bring forward as well as the things that we discover that don't work ultimately will help our family our friends our neighbors and ourselves and so I think in medicine it's if if you're listening to this and you're interested in a career in medicine go for it uh because it's it's a very diverse and Broad field you could be a specialist like Lisa a specialist like me or you can do something entirely different but you have a chance to put your skills and talents to work and you'll never be bored and you'll have a whole host of people who are grateful and are appreciative of what you do and they trust you and there are very few professions where we get the trust uh and that trust comes with a big uh a big commitment though you have to you have to never violate that trust and some people in the medical profession do and thankfully they get caught and we take them out but uh most of us just toil anonymously you know you're kind to promote what I've done and to give me this opportunity to talk about but there are two or three thousand Physicians like me at Mayo Clinic who are just as talented just as good doing just as neat of stuff we just happened to meet through ham radio and you heard of my story and uh but you know there are so many silent unsung heroes in in medicine who do this every day so let me just say that if you go into your primary care provider next week just tell them give them a thanks for what they do because you know I don't know about you Lisa but I live in a home where no one knows what time I'm coming home every day from work because I don't even know what time the day will end uh you know I had some dinner plans stively for tonight that I've canceled because I see the day is going to go long and I don't know what time it will end and uh my wife is patient and our children have grown up being patient you know uh understanding that uh but the end of the day you know I feel very fortunate that I was admitted to medical school had a chance to train at Mayo Clinic and then to practice there and be part of a group of people who really do want to serve Humanity Dr May has a saying that we quote often from his early days in the 1900s which is that the needs of the patients are the only needs to be considered and anytime you get your your North Star gets tilted you come back to that right that we're here to serve humanity and you know my personal needs my personal needs for publishing This research finding or that that's secondary to what's best for the person that I'm serving and treating very well said and I know that people who listen regularly to radio main this is a little bit of a an offshoot we're talking about creativity in a in a very different way but I do completely agree with you that the ability to shine a light really on how we in medicine are addressing things creatively in the many ways that you just mentioned also through incorporation of AI which you didn't you and I didn't even get into this time so we might have to get back together to talk about AI um but I do think it's it is important to maintain a sense of gratitude and Hope because we are mostly hearing stories right now about how hard it is to be a doctor a nurse practitioner a PA a nurse absolutely it is absolutely true there is no invalidating that and also we still need to take care we still need to work with patients to enable them to care for themselves and our communities so I I agree with you that there needs to be a way to have a balanced view of the work that we do in medicine and Healthcare and I'm hoping that by by bringing your story to at least our radio main audience people can feel a sense that there are lots of different ways of contributing and there are lots of different ways of being creative in the space so I I really appreciate your willingness to take time out of your day to talk with me today oh you thank you you're you're more than welcome and you know we do work long hours you and I and all the healthc Care Providers and the late 90s I was at a at a meeting discussing some cholesterol therapies with a group of Physicians globally and developed a friendship with a physician from lien Netherlands who's now distinguished chair of Cardiology and just a really accomplished scientist there and he told me he said we've got to discover ways to prevent heart attacks he said I'm getting really tired of getting up in the middle of the night to treat heart attacks can we figure out a way to prevent them and I said I'm with you so in many respects this creativity that we have comes out of seeing problems that we would like to solve to also help our own workloads get better and uh help people live longer uh yeah and my my compassion goes out to all those in healthcare uh who are working hard who are facing burnout and who are facing moral injury you know the moral injury of having a full hospital and having to turn away someone who might be dying without being in the hospital these are real issues and really I'd urge all the listeners to talk with their health care providers and their elected officials about how we can improve this you know it's not just a financial thing it's actually uh providing resources and helping have the necessary numbers of hospital beds and Staffing and uh those are discussions that need to be had at a higher level and would love to talk about AI sometime we are doing some really cool things with AI and I'll leave it with a teaser if I may every patient I see now at Mayo Clinic I pull up their electroc cardiogram and I read it and then I click a link that takes it to the Mayo Clinic AI dashboard and I can screen them at that moment using AI for hypertrophic cardiomyopathy low heart function function poor heart function or low ejection fraction I get their heart age it tells me their sex now why is that important well if you've had a heart transplant uh the sex of the heart will change from the donor to the recipient over about six months so we can see that transition it's kind of interesting uh but I think it was done as an internal validation tool but it's still there we screen for cardiac ameloid dois uh we screen for aortic stenosis and then some other things as well and it's really a really cool tool and I think the technology will soon be extended to smartphones where you can then access that so AI is not something to be feared it's really something that will help us to make all of us smarter and better doctors and to help patients become better and more Savvy patients it sort of like if you've flown on a flight from the United States to anywhere in the world your Pilots use autopilot a lot keeps the ride smoother safer helps them to be able to monitor the the complex systems they're managing besides having to hang on to the Yoke and the rudder and manage that plane the autopilot does it and I wouldn't want to travel abroad on a plane without autopilot that's what AI will do with Healthcare it'll make us better doctors smarter it's like cruise control too keep us safe my car has adaptive cruise control so someone starts slowing in front of me my car slows down before I maybe realize they've slowed down and sometimes it'll stop automatically if someone pulls right in front of me and I don't even see them and it's stopping before I recognize it so like airbags like seat belts like that AI will make medicine safer so we don't need to be afraid of it can embrace it we'll put we'll put limits on it but uh you know maybe maybe I'll even uh introduce you to some real experts in AI from my own organization that can talk better about it than even I can but I certainly use it every day and uh it's great to join you and to to to be able to share my story and to share with you as well as your listeners and my congratulations to you on your podcast and what you're doing because uh you know it's just another thing another example that you're really promoting good mental health uh to a community Now by having podcasts like this about creativity and uh I think that's really neat so thank you thank you Scott I've been speaking with Dr R Scott Wright who is the professor of medicine and consultant in cardiology with the Mayo Clinic College of Medicine fellow of the American College of Cardiology European Society of Cardiology Cardiology and the American Heart Association and really the the list of things that you do goes on and on so I appreciate your willingness to come in and uh take time out of your a very busy day to have this wonderful conversation about creativity and how it's manifest in the medical and clinical world I'm Dr Lisa balile you have been listening to or watching our video podcast Radio main where we explore creativity and the human Spirit we are sponsored by the Portland Art Gallery in Portland Main thank you so much for coming on Dr Wright [Music]