What is your hometown?
What is your official title?
Chief Medical Officer, Sequel Pharmaceuticals
Clinical Professor of Medicine, University of California San Diego
How/when did you become interested in science and medicine?
I grew up admiring Amana’s town doctor and decided to become a doctor, once I realized I couldn’t spell aeronautical engineer.
What interested you to pursue a career in medicine and medical education?
I know it sounds trite, but I really did like the idea of helping people and it looked like physicians had the perfect opportunity to use their education to do that. I chose medical education because of the mixture of teaching, research, and patient care. The faculty at Iowa and University of California San Diego were great examples for that mix.
Please highlight your major career achievements, awards, discoveries, etc.
During training I was fortunate to be elected to AOA at Iowa and obtain NIH funding to do research in the United Kingdom after my residency. Then, at the University of California San Diego, the early work I did in the development of transesophageal echocardiography and the textbook I edited on the subject were memorable aspects of my days as full-time faculty.
I’m also proud of being the lead cardiology investigator at the University of California San Diego in the three Stroke Prevention in Atrial Fibrillation (SPAF) trials funded by NIH for over a decade. They helped define the use of aspirin and warfarin in this condition. In my more recent career of drug development, obtaining FDA approval for two cardiovascular imaging agents has meant a lot to me. Probably the most meaningful achievement however was co-founding a tiny drug development company in 2003 and taking a compound through early clinical development demonstrating important findings in acute heart failure, and then having an international pharmaceutical company buy our company in 2007.
Is there a teacher, mentor or University of Iowa Carver College of Medicine faculty member who has helped shape your education?
I was sure I was headed for a career as a family physician until I had the chance to work with Dr. John Diana, Professor of Physiology at the University of Iowa. John was a great guy and he and I stayed in touch and even played golf together years later in Hawaii. I fell in love with cardiovascular physiology while working on a potential drug candidate for improving coronary blood flow. That’s when I decided to become a cardiologist. Drs. Melvin Marcus, Richard Kerber, Francois Abboud (61R-Internal Medicine), and Donald Heistad (67R-Internal Medicine) from Cardiology at the University of Iowa were great role models for me.
How or why did you choose the University of Iowa for your education and medical training?
I grew up only 20 miles from Iowa City and loved the University of Iowa but I wanted to go to undergraduate school somewhere warmer than Iowa. I went off to the University of Texas in Austin, but because I was having a little too much fun and couldn’t quite make it up in time for my 8:00 a.m. classes (I stayed up too late studying, as I now like to remember it), I decided to come back to Iowa where I remembered the winters were cold and the library ought to be the warmest place to study. I was correct and I “righted the ship” and got into the University of Iowa College of Medicine after a total of three undergraduate years. I didn’t even bother applying to other schools - I only wanted to go to Iowa. How could a kid from Iowa go to medical school anywhere else? It just wouldn’t be right.
What kind of professional opportunities or advantages has your University of Iowa medical training provided?
Being AOA from Iowa made it easy to get into any number of programs. I served on the house staff selection committee at the University of California San Diego for about ten years and I can tell you that we always ranked the University of Iowa students high if they were in the top quarter of the class.
Please describe your professional interests.
I love drug development because it involves the design of research studies but is complicated by the need to meet regulatory requirements. It’s kind of like three dimensional chess - there’s always another angle to consider. The payoff of possibly being able to treat millions of patients rather than just one at a time is pretty overwhelming. My main focus is heart failure and atrial fibrillation, the two biggest problems in cardiovascular disease.
What are some of your outside interests?
I have two wonderful kids; Jessica, who just graduated from the University of California Santa Cruz and Mark, who’s finishing his sophomore year at the University of California Los Angeles. My interest is to be a good dad and support them, but not over do it. My wife Teri (whom I love dearly) and I love golf. Well, I love golf and she likes it. If I had my way, I’d be out walking the course every day. I’m lucky to live in San Diego where that’s possible. Unfortunately, my job has me flying all over the world so I don’t get to golf as much as I’d like. I can’t forget to mention our beloved dogs Buddy and Holly. The Buddy Holly story keeps us smiling.
Do you have an insight or philosophy that guides you in your professional work?
We have a company of only nine people doing drug development. We can’t possibly know everything there is to know about what we’re doing. I have learned to find and surround myself with the best consultants. I have learned to listen closely but I have also learned when it’s time to make my own decision and go with it. I guess I could say I know when I’m the expert and when I need to get an expert. I think that’s also true in clinical medicine and in a lot of other professions as well.
Probably the key philosophy however is that I do what I love to do, and I love what I’m doing. As medical professionals, we better enjoy what we’re doing since we spend so much time doing it. I don’t like to give advice but I’d say that if someone isn’t passionate about what they do, they should find something else.
If you could change one thing about the practice or business of medicine, what would it be?
I have libertarian tendencies so I don’t like all the regulations we face. On the other hand, if suddenly there was no profit for insurance providers it wouldn’t break my heart. How did we go from self insurance (farmers, etc) 150 years ago to multi-billion dollar companies that are entirely profit driven? Imagine how costs would change if there was no profit for insurance providers.
The other area is malpractice and plaintiff’s attorneys. We’ve got to understand that there is such a thing as “bad luck”- especially in medicine. No doubt there is malpractice but there’s not nearly as much malpractice as we litigate in this country. Just look at Japan; malpractice there is non-existent but they certainly aren’t any better at practicing medicine than we are.
What is the biggest change you've experienced in medicine since you were a student?
The bedside teaching isn’t as good as it used to be when I was a student. We don’t teach the physical exam and the history as well as we used to. Some of this is clearly because of the development of diagnostic technology. As a consequence, today’s trainees and young doctors often don’t make the same personal connection with their patients. Unfortunately, some of that is also due to the fact that doctors are “on the clock” and are being evaluated on their quantity and not their quality. It’s made medicine much less personal and in some cases it may actually hurt the care that patients receive. Patient driven algorithms and treatment guidelines have their benefit but we all know there’s a lot of “art” to medicine, not just science. I currently see patients on a very limited basis and I never see patients on the schedule I’m given. I’m lucky I don’t have to make my living that way - I’m not sure I could practice full time in the current system.
What one piece of advice would you give to today's medical students?
Like I said, I don’t like to give advice since I hate to take it. I will listen to someone’s personal experience however. My experience is that I have to love what I do or keep looking until I find something that I love. There’s no harm in changing careers. I was an academic cardiologist for 12 years and I’ve been a drug developer for 12 years.
What do you see as "the future" of the medicine?
As you can imagine, I hope the innovation we’ve seen in medicine never ends. I hope to be a part of it. I’m working with a company now and we’re delivering a gene to the heart to help with the intracellular handling of calcium in patients with heart failure. I wouldn’t have bet on that as a medical student in 1978. I’m sure there will be innovations 30 years from now that I can’t imagine now.
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