Latest / Success Story with Scott Clary / Brian L. Strom - Chancellor of Rutgers Biomedical and Health Sciences | Shaping the Future of Global Health

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Brian L. Strom - Chancellor of Rutgers Biomedical and Health Sciences | Shaping the Future of Global Health · Success Story with Scott Clary

• 0:00
  In my career as a primary care doc, much of what I did, you did not need a physician's training to do.
• 0:05
  Today, we're honored to welcome Dr. Brian L. Strom, a true pioneer in the field of pharmacopodemiology,
• 0:10
  and one of the leading minds in biomedical research.
• 0:13
  As the inaugural chancellor of Rutgers biomedical and health sciences and executive vice president for health affairs at Rutgers University,
• 0:20
  Dr. Strom has redefined healthcare systems.
• 0:23
  People do bed behavior, they get sick, they come in, they treat it for the sickness,
• 0:27
  they sent back out where they do the bed behavior again.
• 0:29
  You're not focusing on keeping people healthy and focusing on treating them when they're sick.
• 0:33
  We don't need as many MRI machines, we don't need as many CT scans, we need people to think more.
• 0:38
  With over 650 papers written, 15 books published, and more than 275 groundbreaking research projects under his leadership,
• 0:45
  these contributions have earned him international recognition from shaping the future of healthcare
• 0:49
  to tackling global health challenges, get ready for this extraordinary conversation.
• 0:57
  Welcome to success story, I'm your host, Scott Clary.
• 1:00
  The success story podcast is part of the HubSpot podcast network.
• 1:04
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• 1:12
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• 2:16
  Brian, I'm super excited.
• 2:21
  I'm really glad you decided to join and come on.
• 2:26
  This has been a long time in the making, actually.
• 2:29
  I'm glad we finally got a chance to sit down and record together.
• 2:32
  But I want to kick this off.
• 2:34
  I want people to get to know you a little bit better.
• 2:37
  I usually ask this question at the end, but I thought it'd be a fun question to actually ask at the beginning.
• 2:41
  So if you could go back in time after your entire career and your incredible career
• 2:46
  and you could tell your younger self one piece of advice, what do you think that piece of advice would be?
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  Do you enjoy it?
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  And it's actually the piece of advice I give to a lot of young people now.
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  In medicine people tend to look at the next job and say that's the division chief above them,
• 3:05
  the department chair above them, whatever.
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  That's where I need to go.
• 3:07
  That's where I need to go.
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  And my advice to them and my advice to my young self would be the same.
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  Get in touch with what you want and what you enjoy and then do that.
• 3:15
  Because that's just going to be good at.
• 3:17
  That's what you're going to enjoy most.
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  It was only a few years ago that one of the young kids here at Rutgers made up a Wikipedia page for me.
• 3:26
  And it wasn't until they did that that I saw that every position I've ever had.
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  I have been founding or inaugural of whatever it is.
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  I have never moved into an existing position that created them all along the way.
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  And that would be my advice to people.
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  Don't do what you think you should do.
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  Do what you get in touch with what you enjoy and do what you want to do.
• 3:49
  That's so fascinating.
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  That's such an entrepreneurial personality that would do that.
• 3:55
  So you're telling me, so you over your whole career, you made the positions that you walked into.
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  Everyone.
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  Which I didn't realize until just a few years ago.
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  And it's interesting to comment about how to entrepreneurial.
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  My father is a small businessman in New York.
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  He parented that at two brothers.
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  He parenthetically tried one older one.
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  He tried to get each of the three of us to join his business by overpaying us for a summer.
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  We all hated it.
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  None of us went into it.
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  But I grew up with the business sets.
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  And now I often say I wish my father could see it now.
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  And now I run a $2.3 billion business.
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  And it's very entrepreneurial.
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  When I walked in, this place was a disaster.
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  We were very, very deep in the red.
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  And now we're the only part of the university that's in the black.
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  We're spinning off in large margins.
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  And can't say profits, but contribution margins.
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  Each year, it hours is an entrepreneurial world in healthcare.
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  And it's a, yes.
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  So it's a teaching.
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  And I never thought of myself as an entrepreneur until you just asked them.
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  No, you definitely are.
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  I think that, listen, if somebody is entrepreneurial and I actually love what you said
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  about advice to your younger self and medical students and not just doing what they think they have to do next.
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  Because the lessons that we learn in one field parallel everything else in life,
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  it's so interesting.
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  So many people feel like they need to jump into entrepreneurship because it's cool.
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  And they don't want to build within a company.
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  They don't want to find ways to be innovative within a company.
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  If you look at some of Nvidia's employees, I mean, they've made a lot of money.
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  Being very entrepreneurial, innovative within a company.
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  And they didn't have to have the risk of starting their own thing or all the stress or all the struggle.
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  They just built within a company.
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  So I think that maybe not always having to follow the course that you think is laid out or the quote-unquote right way.
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  I think that's actually a really, really great lesson.
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  I actually appreciate that a lot.
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  When you were starting it, it's like, so maybe walk me through.
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  Your background, you got paid.
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  Your dad tried to bribe you to work in his family business.
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  Let's just say, call his mate a spade.
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  Yes.
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  Yes.
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  So what was the best?
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  Why didn't you like it?
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  Why was it not aligned?
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  Where did you find yourself as a young Brian?
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  He was a landlord in New York and running rent control buildings.
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  And I just felt it was boring.
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  It was an interesting.
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  He did everything himself.
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  He didn't have any employees and any assistants.
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  It just wasn't the kind of world I want that I live in.
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  But when you think about medicine, so there's so many pathways to medicine,
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  how did you take your own advice and not follow the route that everyone else took?
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  You know, I went to I went to college in the 60s.
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  I landed in the 60s.
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  It was V&M.
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  Our, the buzz word of a generation was relevance.
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  And, and, and so, so, you know, I started out in college.
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  I have majoring in math, major in physics.
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  Decided it wasn't relevant.
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  Wanted something more concrete and more human oriented switched to psychology, though.
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  In those days, it wasn't a rigorous science.
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  It is now, but it was a bit of wasn't that.
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  And ultimately stumbled into a field, like about physics and biochemistry,
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  which, which in college where I was, we were one of the first,
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  I was one of the first majors in that interdisciplinary field.
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  But I stumbled into it as something that that sort of covered was biological.
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  A science was rigorous, so covered, covered the bases and decided,
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  to go into medicine to apply science to be able to help people.
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  But also, it was, also, I was interested in politics.
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  And I was interested in policy from that point of view.
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  And I knew from the beginning I wanted to do research that was policy related.
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  So, so I combined that in medicine, but went into medicine in an unusual,
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  a little bit unusual way.
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  You know, when you started in medical school, you know, you're taught,
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  you know, you use this drug for this purpose.
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  Well, what's the basis of that?
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  Well, you look a textbook of refers as references.
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  You look back, what does it refer to other textbooks?
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  What does that refer to other textbooks?
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  There was no basis for a lot of what medicine did.
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  The still isn't.
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  Medicine is as much an art as it is a science.
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  And training in medicine is really an apprenticeship.
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  Have you ever been to colonial Williamsburg?
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  Medicine and pharmacy with the same profession in those days?
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  When you worked in the pharmacy like a plumber, like a carpenter,
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  for endless years being treated like dirt until you get your certification,
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  and then you get advanced and you do that to other people.
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  Well, pharmacy split from that became a more academic field.
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  Medicine still does internships and residencies,
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  and has very much the same kind of training.
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  We are learning from the professor rather than look at what makes sense scientifically.
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  And so I wanted to contribute to the science,
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  but also science that was policy related.
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  So medical school, I spent the summer working at,
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  I found a program in our school of public health.
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  I found a faculty member in a medical school who was on the state legislature.
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  I went to him and I said,
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  what can I do research wise that would help you policy wise in terms of,
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  and he had just passed a law called anti substitution law.
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  It was the first such law passed in the US.
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  All 50 states have those now.
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  It's a law that says if you prescribe a drug by brand name,
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  the pharmacy has to dispense that brand name, not a generic equivalent.
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  And he said, why don't you study the impact of that,
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  which is what I did and published a number of papers from it.
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  Got me interested in drugs that are pharmaceuticals to be clear.
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  And again, applying rigorous scientific methods to be able to study
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  the effects of pharmaceuticals,
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  and a field that ultimately became the,
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  so back into a field that we then called drug epidemiology,
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  we ultimately called renamed it pharmacoepathy biology,
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  because people's comment was, oh, drug epidemiology.
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  You study heroin.
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  No, not exactly.
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  Yeah, prescription drugs.
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  And sort of it was really sort of a scientific trying to use the methods of epidemiology,
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  which no one knew what that was pre-pandemic.
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  We used to work on the t-shirts going, no, I'm not a skin doctor.
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  Now people know what epidemiology is.
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  But using the methods of epidemiology to study the effects of drugs
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  in large numbers of people, typically adverse reactions,
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  because normally when a drug is approved in the market,
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  you know it's effective in 500 to 3000 patients that study,
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  which that's all it takes to do that.
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  And what it means is if it causes rare adverse effects,
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  even if it's very serious,
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  drug can be killing people,
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  you won't know about it before it's marketed.
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  And so not until it gets into the market,
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  and you can study large numbers of people,
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  do you end up knowing what a drug real effects are?
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  Well, that's how, I was going to say that's very, that is to hear that.
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  That's very scary, but your goal in life was to obviously affect
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  policy and not just affect policy, but I guess I want to understand,
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  when you look at that process as a young person going into medicine,
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  I understand that you do want to affect policy for the right reasons,
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  and you want to understand how some of the scientific choices
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  or some of the drugs that are created are actually potentially interpreted
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  or allowed through public policy and government,
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  and given out to the people.
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  But when you see that process, you just described,
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  what's the red flag or what's the concern from your perspective
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  that a young Brian was trying to change or trying to improve
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  or trying to optimize,
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  because the way that you just mentioned that,
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  that sounds very scary,
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  to the average person saying only 3,000 people were tested,
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  and we only know the effects after it goes to market.
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  What does this mean for me?
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  And it should be scary.
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  And one of the lines I often use in press is,
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  all drugs are poised.
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  By definition, we are giving them to interfere
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  with the body's normal system.
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  They will be poisons, they will do her.
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  It's just they also do good.
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  And so you make an unequal decision that the benefit is worth the her.
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  When you look in,
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  parathetically, natural products,
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  herbals, whatever,
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  they've never been proven to do good.
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  So if they're doing harm,
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  there's no positive trade-off.
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  But in terms of pharmaceuticals,
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  we know they will do good.
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  We don't know what their harms are when they market it.
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  It's appropriate to be scary.
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  What I've said to my patients through all the years,
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  when they come to me with an ad for a new drug
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  or whatever,
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  you know, do you want to prescribe this to me?
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  If you see those drugs on TV,
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  those are exactly the ones you don't want to use.
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  Because they don't get know what their effects are.
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  And if it really was compelling,
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  that it was dramatic,
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  we'd better than other things,
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  and we'd better prescribe it to you already.
• 13:24
  Besides that,
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  let's let the world experiment on other people
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  and find out what the real effects of the drugs are.
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  And so the answer is,
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  as a young Brian,
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  as a current Brian,
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  doing studies,
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  we want to find out what the real effects of the drugs are,
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  and the ones that are hurting more people
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  than they're helping remove them from the market.
• 13:42
  Most cases that's not the case,
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  there's a balance,
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  but in order to make that balance as a patient,
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  as a doctor,
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  to make those trade-offs,
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  you need to have the full data,
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  and the full in understanding of what the effects of the products are.
• 13:57
  And we don't have that at the time of marketing.
• 14:00
  That's okay.
• 14:01
  It's not a flaw in the marketing process,
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  because to go from 3000 patients to 30,000 patients
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  to 300,000 patients,
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  we would delay access to good drugs
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  and keep them off the market financially
• 14:14
  for a decade or two decades
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  when people could benefit from them.
• 14:18
  That makes sense.
• 14:19
  So it's always a risk,
• 14:20
  but there is always a risk.
• 14:24
  That's basically the net takeaway,
• 14:26
  and you just have to be aware that
• 14:28
  whatever you see on TV,
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  that lists out a thousand side effects
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  after they play the commercial,
• 14:35
  maybe that's not something to jump into immediately,
• 14:39
  but the point is to talk to your doctor.
• 14:40
  That's really the takeaway.
• 14:42
  But when you spoke about impacting policy,
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  are there policies that have changed over your career?
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  You've had a long career in this
• 14:52
  that are a net positive
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  or a net negative for that process?
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  What is something that you are happy to change?
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  What is something that you aren't happy that changed?
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  And then what is something that you still wish would change?
• 15:03
  Interesting. Wait a minute.
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  So what are things that I'm happy to change?
• 15:07
  There's only a number of drugs,
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  I give you two examples.
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  One is a drug called turtle.
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  We studied the effects of it,
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  but it's an Advil-like drug.
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  It almost came off the market.
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  It didn't come off the market
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  because of our studies showing its benefits.
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  So we showed it that it's relative safety,
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  relative to other products.
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  An example of something which was wrong
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  was a drug of the same class.
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  Zomax, great marketing,
• 15:41
  been the name of the drug.
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  It's a mip racket.
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  It's another Advil-like drug.
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  It was the first drug marketed as an analgesic.
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  It's the first drug of the class market as an analgesic.
• 15:50
  As an analgesic, you would expect
• 15:52
  it might have a problem with serious allergic reactions.
• 15:55
  Ultimately, it did have a problem with serious allergic reactions.
• 15:59
  That removed from the market.
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  We did a study showing it was no different than other drugs used
• 16:04
  in that same way,
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  but they had destroyed their market in the process.
• 16:09
  Another example,
• 16:12
  not drug-based for 50 years.
• 16:16
  The American Heart Association,
• 16:17
  the American Dental Association,
• 16:19
  recommended that people with heart valve abnormalities,
• 16:23
  which include stop to 10% of the population
• 16:26
  if they're going to network,
• 16:28
  have taken antibiotics before the dental work.
• 16:31
  So we were exposing 10% of the population
• 16:34
  to antibiotics twice a year, typically,
• 16:36
  with allergic reactions with antibiotic resistance
• 16:40
  that caused without any evidence that it made sense.
• 16:43
  The evidence was animal data.
• 16:45
  It was data that you have blood.
• 16:48
  You have bacteria in your bloodstream.
• 16:50
  When you have dental procedure,
• 16:52
  which you do,
• 16:53
  but you have bacteria in your bloodstream
• 16:55
  every time you have bowel movement or brush your teeth.
• 16:58
  Was dental work any worse than any others?
• 17:02
  In fact, ultimately,
• 17:04
  we did a study that showed it was.
• 17:08
  And it got confirmed by people in the Netherlands.
• 17:10
  And all the recommendations changed.
• 17:12
  This was now, at this point, probably,
• 17:14
  20 years ago.
• 17:15
  All the recommendations of getting dental work
• 17:17
  every time you have had getting antibiotics
• 17:19
  any time you had dental work has disappeared.
• 17:22
  As part of that,
• 17:24
  based on our data,
• 17:26
  what do I wish would change that hasn't happened?
• 17:29
  Is it better or be?
• 17:30
  Yeah, like a policy,
• 17:31
  a policy or something that you still want to affect.
• 17:33
  Yeah, herbals would be,
• 17:36
  herbals, herbals,
• 17:37
  it would be a perfect example.
• 17:38
  So I'll give you one that did have, again, policy-wise,
• 17:40
  did have a good effect and didn't have a good effect.
• 17:43
  When the statins were coming off patent,
• 17:47
  the drug companies wanted to make them over the counter.
• 17:50
  You know,
• 17:52
  to benefit from it coming off patent.
• 17:55
  I very deliberately wrote a letter to the editor
• 17:58
  in New England Journal carefully timed
• 18:00
  to get in the way of that happening,
• 18:02
  and it's exceeded.
• 18:03
  I mean, they don't make no sense as an other counter drug.
• 18:06
  You need to measure liver functioning,
• 18:07
  you need to measure cholesterol.
• 18:09
  It's not what an over-the-counter drug is about,
• 18:11
  we went with a patient,
• 18:13
  can judge the effects of the drug themselves.
• 18:15
  Country is the herbals.
• 18:17
  Herbals have never been proven to be shown
• 18:20
  to be effective for anything.
• 18:22
  They undoubtedly have harm,
• 18:24
  like any other chemical,
• 18:26
  and yet they're an extremely widely used product
• 18:30
  that people say,
• 18:32
  well, I take it and it makes me feel good.
• 18:34
  Well, they had nothing to do with the other.
• 18:36
  When do you take a medicine?
• 18:38
  You take a medicine when you're feeling worst.
• 18:40
  You take whatever it is.
• 18:42
  You feel better.
• 18:43
  It's the statisticians call it regression to the mean.
• 18:45
  The spontaneous return to normal
• 18:47
  will fool both you and the doctor
• 18:49
  into thinking it did some good.
• 18:51
  And so it's a,
• 18:53
  that's how our blood destroyed with herbals.
• 18:55
  Maybe some of them are effective?
• 18:58
  If that was the case,
• 19:00
  they would be drugs not herbals.
• 19:01
  And we would know that.
• 19:02
  So the policy I wish would change
• 19:04
  is herbals should be regulated like drugs
• 19:07
  and required to have data on efficacy
• 19:10
  in order to be on the market.
• 19:12
  Hey guys, Scott here.
• 19:14
  I just wanted to take a quick moment
• 19:16
  to say a heartfelt thanks to every single one of you.
• 19:19
  Six years of this show
• 19:20
  and it's really all because of you.
• 19:22
  Your listens, your support, your shares,
• 19:24
  it will keep this thing going.
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  When I started, I had no idea how big this would get,
• 19:28
  how many lives we touch.
• 19:30
  The stories we share, the lessons that we learn together,
• 19:33
  it's truly humbling.
• 19:34
  And I believe that we're building something
• 19:36
  really special here.
• 19:37
  A community where no one has to reinvent the wheel.
• 19:40
  We're all in this together, learning and growing.
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  And here's my ask.
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• 20:14
  just spread the word.
• 20:16
  I'm eternally grateful for each and every one of you.
• 20:19
  Let's keep learning, let's keep growing
• 20:21
  and let's keep making this world a little bit better together.
• 20:24
  All right, let's get back to the show.
• 20:26
  It actually seems just very, very anecdotally
• 20:29
  without the data to back it up.
• 20:31
  Just through a casual conversations,
• 20:33
  it seems like more people are trying herbals
• 20:37
  and Eastern medicine.
• 20:39
  And all of these things that don't seem to be Western.
• 20:43
  And it's so interesting because I think there's cultures
• 20:46
  that seem to default to Eastern medicine
• 20:50
  or herbal medicine.
• 20:51
  I mean, I'll give you an example.
• 20:53
  Growing up, I didn't, it was just, it was just regular drugs.
• 20:57
  I don't even know how to describe it.
• 20:58
  It's just like, it's like Western medicine
• 21:00
  and doctors and prescriptions and antibiotics and anything else.
• 21:03
  And then, so, so my, my, my better half.
• 21:06
  She, she's, she's a couple different things.
• 21:08
  But her, her mother is Jewish, Israeli.
• 21:12
  And her dad is Russian.
• 21:15
  And she has tried so many different herbal things
• 21:19
  to get better.
• 21:20
  And when she's sick, the default is herbal this
• 21:24
  or herbal that or try that.
• 21:25
  And there was like a, like a Chinese doctor
• 21:29
  that she went to go see one time.
• 21:31
  I'm like, I don't understand.
• 21:32
  Any of this isn't from my, my world
• 21:34
  or what I knew growing up.
• 21:35
  So I feel like, and maybe just because I have proximity to it.
• 21:39
  But I also hear it in conversations.
• 21:42
  Not a complete lack of trust in Western medicine.
• 21:47
  But some lack of trust in Western medicine.
• 21:50
  And I'm so curious why you think that's happening.
• 21:54
  And if I'm incorrect in that,
• 21:56
  you could tell me that too.
• 21:57
  But I felt that in conversations.
• 21:59
  I, I think you are correct in that assumption widely used.
• 22:04
  And the herbal's non-typical treatment is entrusted
• 22:10
  or taken widely.
• 22:12
  And people instead take herbals and other things.
• 22:14
  And it does come a lot from lack of trust.
• 22:17
  Part of it is that given where health care has,
• 22:21
  has come.
• 22:22
  And that was a, it is evolved.
• 22:24
  Physicians don't spend much time with patients.
• 22:26
  And as, as health care has more and more become a business,
• 22:30
  rather than sort of the solo practitioner doctor
• 22:34
  who comes to your house and whatever,
• 22:36
  you know, trust people as much.
• 22:39
  And again, if you talk to most patients,
• 22:41
  they'll all say, health care is terrible.
• 22:43
  It's that my doctor, he's great.
• 22:46
  And, you know, people who have a primary care doctor
• 22:49
  and then biased, I'm a primary care doctor.
• 22:51
  But people have a primary care doctor.
• 22:52
  Typically, we'll trust their primary care doctor.
• 22:55
  But he, it's a, but more and more as medicine has become corporate.
• 23:00
  And as health care has become much more expensive
• 23:02
  and hasn't become corporate,
• 23:04
  the times people spend,
• 23:06
  docks spend with patients is less and less.
• 23:09
  More of that is in front of a computer screen.
• 23:11
  And so the doctor is interacting with the computer rather than the patient.
• 23:14
  There's much less trust.
• 23:16
  And part of what alternative health care providers do is
• 23:20
  they spend more time with patients in part because they're cheaper.
• 23:24
  So if you're going to make extra number of dollars per hour
• 23:28
  that whatever that clinical specialty is, you know,
• 23:31
  if you're a surgeon, they want you in the operating room.
• 23:33
  If you're an anesthesiologist, they want you in the operating room
• 23:35
  to give me anesthesia,
• 23:36
  not spending a lot of time talking to patients.
• 23:39
  And I think it has definitely hurt the trust of medicine.
• 23:43
  I think the other thing that has hurt ironically was years ago
• 23:46
  when the people came out with the 80-hour week,
• 23:49
  which probably doesn't mean anything to you,
• 23:51
  but the expanding to your audience.
• 23:54
  There was a,
• 23:57
  there were people who clearly were hurt and they hit the press
• 24:00
  because the doctors taking care of them were too tired.
• 24:04
  And so they put in place a rule for residency.
• 24:07
  We talked before about treating your trainees like,
• 24:10
  like Dura does endless slaves as residents,
• 24:13
  that you're not allowed to work more than 80 hours a week.
• 24:16
  Now, the way the word resident comes from is people
• 24:20
  they lived in the hospital.
• 24:21
  They were resident in the hospital.
• 24:23
  They were also about a house staff.
• 24:24
  Because again, they lived in the hospital accordingly.
• 24:28
  It was a commitment to your patient that was inherent
• 24:31
  in becoming a physician.
• 24:33
  The nature of professional ethics was your patient comes first.
• 24:38
  And you stay in the hospital until your patients come in well.
• 24:41
  You do whatever is needed.
• 24:43
  The 80-hour week of the rule imposed because of fear that people were too tired,
• 24:48
  made doctors into shipwriters.
• 24:51
  That at the end of your 80 hours you have to leave
• 24:54
  or the program is penalized in accreditation.
• 24:59
  It's changed the character of medicine and our trainees completely with that.
• 25:05
  And I think there's a big loss to physicians in terms of self-worth.
• 25:13
  But it's also a big loss in terms of patient care.
• 25:16
  But I think the corporatization of medicine has been a big part of it as well.
• 25:21
  Do you feel like there's an eat, not an easy but even any solution to that?
• 25:28
  Because I mean, that's not a great path that everybody's going down.
• 25:31
  If they don't trust and now you have this profit machine,
• 25:35
  not just profit machine, you have, okay, respecting the wellness,
• 25:41
  physical mental of the residents.
• 25:43
  I understand where that comes into play.
• 25:45
  But when you're talking about surgeons are in the operating room.
• 25:48
  Anesthesiologists are in the operating room.
• 25:50
  There's a dollar value attached to every hour of a medical professional.
• 25:53
  There's this, there's this industrial complex that's driving this behavior.
• 25:58
  Very hard to beat an industrial complex.
• 26:00
  So how do you, how do you create trust or space for medical practitioners,
• 26:07
  medical providers to have that time with the patient so they can restore the trust?
• 26:13
  That seems to be the X factor that has to be solved for.
• 26:16
  It certainly is one issue, no question, no question.
• 26:19
  I think one way is we need to make it make better use of other professions.
• 26:24
  You don't need a doctor to do everything.
• 26:26
  So in my career as a primary care doc, much of what I did,
• 26:29
  you did not need a physician's training to do.
• 26:32
  Why did I do it?
• 26:33
  Because physicians could build for it.
• 26:35
  What we now know, nurse practitioners, physician's assistance,
• 26:39
  can often do it better and cheaper and more routine tasks.
• 26:45
  And so by, and one of the advantages we have in Rutgers health,
• 26:48
  is all of those schools are under us under one roof.
• 26:52
  So if we need more practice, nurse practitioners, we train them.
• 26:55
  If we need more PAs, we train them.
• 26:57
  And as the world moves to more population health,
• 27:01
  going forward and we move away from fee to service accordingly,
• 27:06
  because we're bankrupting the country and healthcare and yet don't have good outcomes.
• 27:11
  One of the solutions is we need to think more population-based
• 27:14
  and we need to make better use of other professionals
• 27:18
  who can actually do a better and cheaper job of it
• 27:21
  and save the physicians who are the most expensive
• 27:23
  than the things that you really need the physicians time for.
• 27:26
  And you know, it's, I think your health has sort of done this
• 27:30
  using more time from psychologists and social workers
• 27:33
  and saving the physicians to write the prescriptions.
• 27:36
  And in which case, it's not as satisfying to the physicians
• 27:39
  that they don't have the relationships with the patients.
• 27:42
  But you know, there's no one silver bullet here,
• 27:45
  but I think we've become two health care,
• 27:47
  it's become too much of a big corporate entity.
• 27:49
  Focusing non-ernd health is really to come sick care, not healthcare.
• 27:53
  It's really been, you know, people do bad behavior, they get sick,
• 27:59
  they come in, they treat it for the sickness,
• 28:01
  they sent back out where they do the bad behavior again,
• 28:04
  whether it's smoking or drinking or whatever it is,
• 28:06
  they're doing too much of, you know,
• 28:08
  you're not focusing on keeping people healthy,
• 28:10
  you're focusing on only treating them when they're sick.
• 28:15
  And that's because the current incentive system,
• 28:17
  that's what it is.
• 28:19
  And that's what is changing as we move to more to population now.
• 28:25
  It is because, you know, we're bankrupting the country,
• 28:30
  we're approaching 20% of the gross national product.
• 28:32
  And yet we have bad outcomes.
• 28:34
  The countries that spend half as much as we have,
• 28:37
  have better clinical outcomes than we do,
• 28:40
  because we focus, you know, we don't need as many MRI machines.
• 28:44
  We don't need as many CT scans, we don't need as much surgery,
• 28:47
  we don't need as much testing, we need people to think more.
• 28:50
  But our, the health care system,
• 28:52
  classically, doesn't pay people to think,
• 28:54
  it pays people to do.
• 28:56
  Surgeons are paid a lot,
• 28:58
  our Medicare docs have paid much more.
• 29:00
  Pediatricians, neurologists,
• 29:02
  psychiatrists are all paid much less than surgeons
• 29:05
  or other higher paid specialties.
• 29:08
  And we're in this cycle where,
• 29:11
  where if you want to maintain salaries, income,
• 29:16
  we need them to spend all the time in the operating room
• 29:19
  and spending less time with patients going forward.
• 29:21
  So it's not one solution.
• 29:23
  I think the closest to one solution is really population out.
• 29:26
  It's really sort of moving to a,
• 29:29
  a patient per month basis for reimbursement,
• 29:33
  where suddenly the risk of the providers,
• 29:38
  you know, instead of being paid to do too much,
• 29:41
  you're taking the risk of patient gets sick.
• 29:44
  Yeah, I understand.
• 29:46
  So now the incentives are aligned.
• 29:48
  Now the incentives are aligned.
• 29:49
  Yeah.
• 29:50
  But now the incentives are aligned in the wrong direction.
• 29:52
  Now the incentives are aligned to do too little.
• 29:55
  If you pay per month,
• 29:57
  it also changes the character
• 29:59
  because individual docs can't,
• 30:01
  or individual hospital,
• 30:03
  can't possibly afford that one transplant patient
• 30:06
  would bankrupt you.
• 30:07
  So the docs come together,
• 30:09
  the hospitals come together,
• 30:10
  everything is all coming together
• 30:12
  and that's what's happening,
• 30:13
  what is happening,
• 30:14
  and healthcare is the consolidation.
• 30:16
  Accordingly, in order to deal with that,
• 30:18
  you also in order to prevent under treatment,
• 30:21
  you need a huge data infrastructure.
• 30:23
  You need to be able to say,
• 30:25
  as everyone has gotten,
• 30:26
  that COVID vaccine got in their COVID vaccine,
• 30:28
  as everyone has gotten,
• 30:29
  who has a high blood pressure,
• 30:31
  are they getting treated?
• 30:32
  Are they at high cholesterol?
• 30:33
  Are they being treated?
• 30:34
  You need a huge data infrastructure to do that.
• 30:37
  And again, that requires a mass,
• 30:39
  a scale,
• 30:40
  to be able to put that together
• 30:42
  and afford to do that.
• 30:44
  And so what you're saying,
• 30:45
  seeing, of course, the country is,
• 30:46
  is this enormous consolidation,
• 30:48
  as we move,
• 30:50
  we're in this funny and between now,
• 30:52
  moving from a fee-for-service system
• 30:54
  to a population system,
• 30:55
  and the health systems
• 30:57
  have a very hard time in different speeds
• 31:00
  in different localities.
• 31:02
  If you move too slowly,
• 31:04
  you'll go bankrupt.
• 31:05
  If you move too fast,
• 31:06
  you'll go bankrupt.
• 31:07
  Because right now,
• 31:08
  in many places,
• 31:09
  when the embarrassment,
• 31:10
  it's still primarily fee-for-service.
• 31:12
  So if you move too much toward prevention,
• 31:14
  well, you know,
• 31:16
  you keep people out of a hospital,
• 31:18
  the hospitals go bankrupt.
• 31:21
  But we don't need anywhere
• 31:22
  near the number of hospitals we have,
• 31:24
  if we actually focused on keeping people healthy,
• 31:26
  rather than waiting for them to get sick
• 31:29
  and treat them when they get sick.
• 31:31
  So they're twisted and send a system.
• 31:33
  So I mean, maybe use,
• 31:35
  maybe use Rutgers as an example,
• 31:38
  what are you doing to,
• 31:41
  when you talk about keeping people healthy?
• 31:43
  Yes, agreed.
• 31:44
  I've never gotten work-out advice
• 31:47
  or nutrition advice
• 31:49
  from my doctor ever.
• 31:50
  And I'm not even American.
• 31:51
  I'm Canadian.
• 31:52
  And so already,
• 31:53
  I don't have to worry about paying
• 31:54
  for too much compared to coming down here.
• 31:56
  And I've actually found that,
• 31:57
  ironically,
• 31:59
  for the past year,
• 32:00
  I've paid more in insurance
• 32:02
  than I've ever built.
• 32:03
  So like,
• 32:04
  it seems like I could just
• 32:05
  pay every time I go into the doctor
• 32:07
  and I'd still spend less money.
• 32:09
  I think I spend about 12 grand
• 32:11
  in insurance over the last calendar year.
• 32:13
  I did not have,
• 32:14
  I'm 34,
• 32:15
  I'd not have 12 grand worth
• 32:16
  of things happen to me,
• 32:17
  God forbid,
• 32:18
  if we had a pregnancy,
• 32:20
  God willing,
• 32:21
  that'll happen very soon.
• 32:22
  Maybe there's a couple of points in my life.
• 32:24
  Or if I could hit by a car,
• 32:25
  again,
• 32:26
  God forbid.
• 32:27
  But anyways,
• 32:28
  the point is,
• 32:29
  it's a very interesting system.
• 32:30
  And it doesn't quite make a lot of sense.
• 32:31
  And it's so funny,
• 32:32
  because even when I speak
• 32:33
  to my friends down here,
• 32:35
  they also don't understand it,
• 32:36
  even though they've been,
• 32:37
  they've been American
• 32:38
  their whole lives.
• 32:39
  They still get confused
• 32:40
  by the whole insurance system.
• 32:41
  But that's besides the point.
• 32:43
  In any system,
• 32:46
  I've been a part of.
• 32:48
  There's never really been a focus on prevention
• 32:50
  or wellness.
• 32:51
  So at Rutgers,
• 32:52
  I was bringing back to my question.
• 32:54
  What are you doing
• 32:55
  to sort of prime doctors
• 32:58
  for this concept of
• 33:00
  wellness prevention,
• 33:02
  focusing on,
• 33:04
  on true health,
• 33:06
  not just fixing sickness,
• 33:09
  as like a,
• 33:11
  sickness is like a lagging indicator,
• 33:13
  at the end of the day,
• 33:14
  but a doctor should be doing it.
• 33:15
  Absolutely.
• 33:16
  So let me give partial answer,
• 33:19
  a few partial answers to that,
• 33:21
  because we certainly haven't solved the problem.
• 33:23
  And so,
• 33:24
  one is,
• 33:26
  you know, I've been here
• 33:27
  now 11 years.
• 33:28
  When I walked in,
• 33:30
  every New Jersey was all filled
• 33:32
  with one disease and two disease.
• 33:33
  The docs will separate,
• 33:34
  the hospitals will separate.
• 33:35
  In the interim 11 years,
• 33:37
  there's been an enormous consolidation.
• 33:39
  In our part of Rutgers,
• 33:41
  maybe Rutgers Health,
• 33:42
  I walked in,
• 33:43
  we had two separate nursing schools.
• 33:44
  We have two separate medical schools.
• 33:45
  We're now merging the two medical schools,
• 33:47
  bringing scale,
• 33:48
  and in terms of bringing them.
• 33:50
  You don't need to duplicate everything everywhere.
• 33:53
  We're training more physician's assistance.
• 33:55
  We're training more nurse practitioners.
• 33:57
  We're focusing a lot more on the well-being of the docs,
• 34:01
  also, as part of that.
• 34:03
  But they're still trained as physicians.
• 34:05
  Their job is to treat people who are sick.
• 34:07
  We don't necessarily need one of each separately
• 34:10
  in New Brunswick and separately in Newark.
• 34:12
  If we can hire one person because it's one school,
• 34:15
  we'll practice half time in one and half time in the other,
• 34:18
  treating people with the less common diseases between them.
• 34:22
  And so we're combining,
• 34:24
  we're bringing things to scale.
• 34:26
  But the other is as we develop our,
• 34:29
  as we're merging the medical school,
• 34:30
  we're developing the two medical schools now.
• 34:33
  Robert, we found some medical school in New Brunswick
• 34:36
  and New Jersey Medical School in Newark.
• 34:38
  We're merging them into the Rutgers School of Medicine.
• 34:40
  We are choosing as a theme for the entire school health equity.
• 34:45
  So this will be when it's accredited in a couple of years,
• 34:48
  combining with the schools.
• 34:50
  The second largest medical school in the country.
• 34:52
  And the entire focus is good band health equity.
• 34:54
  They were dealing with populations in Newark, New Brunswick.
• 34:58
  With the people who get sick and have the biggest problems
• 35:03
  who need the health issues,
• 35:05
  they're not people like you and me,
• 35:07
  who are going to be exercising on our own.
• 35:09
  And I assume you don't smoke.
• 35:10
  I don't, you know,
• 35:11
  but you know,
• 35:12
  you take a look to take care of the people
• 35:14
  who suffer the most of the underprivileged,
• 35:17
  who are barely making it.
• 35:19
  And how do you,
• 35:21
  and they're the ones who are going to be more likely to be hit
• 35:24
  by a car or a shot or otherwise.
• 35:26
  But they're also the ones have high cholesterol
• 35:28
  that nobody picked up,
• 35:29
  but a high blood pressure is that nobody picked up.
• 35:31
  So we are running,
• 35:33
  the simple thing is we do things like,
• 35:35
  like having our medical students and PA students
• 35:39
  and other nursing students and others.
• 35:42
  So they learn in the process,
• 35:44
  go out and screen populations,
• 35:46
  run campaigns in the populations
• 35:48
  in the community,
• 35:49
  have your blood pressure checked.
• 35:50
  Have you have, you know,
• 35:52
  for easy to teach somebody to measure blood pressure,
• 35:54
  the blood pressure is elevated,
• 35:55
  you then refer them for care.
• 35:57
  The students are learning prevention.
• 36:00
  And at the same time,
• 36:01
  the patients are getting intervened
• 36:03
  on to the degree they need it.
• 36:05
  From a medical school point of view,
• 36:08
  our whole,
• 36:09
  our plan is the entire medical school,
• 36:11
  new medical school,
• 36:12
  have merged with the two old medical schools,
• 36:14
  is going to focus on health equity as a team.
• 36:17
  So everyone from top to bottom
• 36:19
  is going to get the medical students,
• 36:21
  the secretaries and the clerks who see patients,
• 36:25
  they want to be treating patients right,
• 36:27
  whether the patients are underprivileged or not,
• 36:29
  they shouldn't be treated any differently accordingly.
• 36:32
  And just, just have a general,
• 36:34
  but also staffing appropriately.
• 36:36
  So, so, you don't need a physician
• 36:39
  to do a non-physical work as part of that.
• 36:42
  So, so this is a process and experiment.
• 36:44
  Again, we will be the first medical school
• 36:46
  in the country to do anything like this.
• 36:48
  And, and as the second biggest medical school
• 36:51
  in the country,
• 36:52
  hopefully a model that others can copy
• 36:54
  from that because health equity is such a focus.
• 36:57
  You know, in New Jersey is perhaps
• 36:59
  the one or two most diverse states in the country.
• 37:02
  Kind of, we have 20% of people in the state of foreign board.
• 37:06
  And, and I, you know,
• 37:08
  a lot from South Asia,
• 37:09
  a lot from, from Latin America,
• 37:11
  there's a huge population from Baja,
• 37:13
  Mexico, here in New Brunswick,
• 37:15
  huge, huge populations from Brazil
• 37:17
  and other countries in Newark,
• 37:19
  huge African American populations
• 37:21
  and, of course, the state.
• 37:23
  We are a very wealthy state,
• 37:25
  but also a very underprivileged state.
• 37:28
  And, you know, the other piece of that is,
• 37:30
  is wanting to generate the scholarship money
• 37:32
  to be able to support.
• 37:34
  Right now, somebody who comes from one of those backgrounds,
• 37:36
  no matter how poor they,
• 37:38
  no matter how motivated they are,
• 37:40
  no matter how smart they are,
• 37:41
  can't afford to go to medical school.
• 37:43
  Our medical students graduate with a debt of $200,000.
• 37:46
  We have students who have a debt of $400,000.
• 37:49
  You know, attract people into medicine
• 37:52
  who come from poor backgrounds.
• 37:54
  If that's the case.
• 37:55
  And so, they won't go back into those communities.
• 37:57
  If that's not the backgrounds, they come from.
• 38:00
  They're also less likely to go
• 38:02
  into lower paid specialties.
• 38:04
  They kind of want to become surgeons or otherwise,
• 38:06
  so they make more money.
• 38:07
  And they're also less likely to stay in New Jersey,
• 38:10
  which is an expensive state.
• 38:11
  Uh, limit.
• 38:12
  So wanting to mobilize the resources
• 38:14
  to be able to attract people students
• 38:17
  from those populations
• 38:18
  as part of what we want to do,
• 38:20
  and wanting to have the entire school
• 38:23
  going, going forward, focusing on,
• 38:25
  on top health equity is a focus.
• 38:27
  You know, way, you know,
• 38:28
  and another different example,
• 38:30
  we have, um,
• 38:31
  one of the things Rutgers has is the lots of students.
• 38:33
  We have 70,000 students.
• 38:35
  Um, and we, we have a program,
• 38:37
  um, where we, um,
• 38:39
  uh, we have our undergrads
• 38:42
  get very involved in service learning
• 38:44
  across the state.
• 38:45
  What, what's that?
• 38:46
  Yeah.
• 38:47
  We are, as a student,
• 38:48
  you're doing a course,
• 38:49
  which is really providing service.
• 38:51
  So, so the example from a health,
• 38:53
  like his health point of view,
• 38:54
  we, um, is we have students
• 38:56
  and we've had hundreds and hundreds
• 38:58
  who have applied to us now.
• 38:59
  So far, we've only been able to do it
• 39:00
  with about 40 from a financial point of view.
• 39:03
  We have, we have,
• 39:04
  the students mostly come from New Jersey.
• 39:06
  And, um, some of the undergrads,
• 39:08
  especially come from poor areas.
• 39:10
  We're, as a summer job
• 39:12
  that, that get course credit
• 39:13
  and they'll get paid
• 39:14
  to go back to their community.
• 39:16
  And screen for blood pressure,
• 39:18
  screen for diabetes,
• 39:20
  screen.
• 39:21
  So you educating the students,
• 39:22
  you're educating the parents.
• 39:23
  And the meantime,
• 39:24
  you're educating the community.
• 39:25
  They, these, you know,
• 39:26
  students get,
• 39:27
  is going to get credit for it.
• 39:28
  It, as well as getting,
• 39:30
  getting paid for it again.
• 39:31
  So, you know, service learning
• 39:32
  so that it's helping the community
• 39:34
  while at the same time they're doing it.
• 39:36
  And one of the things I'd love to do,
• 39:37
  um,
• 39:38
  we haven't worked this out yet,
• 39:39
  is randomly assigned
• 39:40
  to different counties in New Jersey.
• 39:42
  So that students in different counties
• 39:44
  would do different intervention.
• 39:45
  They go back home over the summer
• 39:47
  and one county would focus on,
• 39:49
  stop smoking.
• 39:50
  One county would focus on,
• 39:52
  treat cholesterol,
• 39:53
  one would focus on,
• 39:54
  on treat hypertension.
• 39:55
  And then you'd have easy metrics.
• 39:57
  You've randomly assigned them
• 39:58
  across the different counties.
• 40:00
  Um,
• 40:01
  all of them should benefit.
• 40:03
  But you look at,
• 40:04
  as this county has county access
• 40:06
  smoking,
• 40:07
  improved more than county Y,
• 40:09
  where county Y,
• 40:10
  Y's blood pressure
• 40:11
  has improved more than county X.
• 40:12
  And so we could study
• 40:13
  the actual clinical benefit,
• 40:15
  health benefit of this,
• 40:17
  this kind of intervention.
• 40:18
  Um,
• 40:19
  but,
• 40:20
  but either way,
• 40:21
  it educates our large number of students
• 40:23
  and students who,
• 40:24
  hopefully,
• 40:25
  dismal,
• 40:26
  personally, will go back
• 40:27
  into those communities.
• 40:28
  I just want to take a second
• 40:29
  to thank the sponsor
• 40:30
  of today's episode, HubSpot.
• 40:31
  Now, HubSpot has an incredible
• 40:33
  podcast network.
• 40:34
  Success stories part of it.
• 40:35
  And if you like success story,
• 40:36
  you're going to love other podcasts
• 40:38
  in their network.
• 40:39
  One of my favorites is,
• 40:40
  I digress,
• 40:41
  is hosted by Troy Sandage.
• 40:42
  What Troy does exceptionally well
• 40:44
  is in under 30 minutes,
• 40:46
  he helps eliminate complexity,
• 40:48
  complications,
• 40:49
  confusion in your business.
• 40:50
  He talks about frameworks,
• 40:51
  strategies that really work
• 40:53
  to help you achieve,
• 40:54
  scalable,
• 40:55
  and sustainable success.
• 40:56
  So you need to go listen to
• 40:57
  I digress,
• 40:58
  one of the most useful
• 40:59
  podcasts for entrepreneurs
• 41:00
  and founders,
• 41:01
  part of the HubSpot podcast network,
• 41:03
  wherever you get your podcasts.
• 41:05
  I love that.
• 41:06
  I think that's very smart.
• 41:07
  I didn't realize that
• 41:08
  common sense is in common.
• 41:11
  And it seems like
• 41:12
  that's such a smart,
• 41:14
  a smart program,
• 41:15
  but I didn't realize that that,
• 41:16
  and what Rutgers is doing is,
• 41:18
  is that novel,
• 41:19
  and no one else is doing it.
• 41:20
  Because if I just objectively
• 41:21
  take a step back and look at,
• 41:23
  like a problem that I would see,
• 41:25
  so a lot of health problems
• 41:27
  are disproportionately affecting
• 41:30
  a different socio-economic
• 41:32
  class of individuals.
• 41:33
  And then it almost turns into
• 41:35
  this negative flywheel,
• 41:37
  because now you have this class
• 41:39
  that's overburdening
• 41:41
  the local health care system,
• 41:43
  which already doesn't have
• 41:44
  the resources to deal with it,
• 41:46
  which is then going to cause
• 41:47
  even more issues
• 41:48
  for that particular class,
• 41:50
  or that segment of the population.
• 41:52
  And it just seems like,
• 41:54
  there's no positive outcome
• 41:56
  in this scenario the way.
• 41:58
  And this is probably
• 41:59
  how the U.S. is
• 42:01
  literally right now
• 42:02
  in 2024.
• 42:03
  This is how it is.
• 42:04
  That's exactly correct.
• 42:05
  There was a great description.
• 42:06
  We refer to it as
• 42:07
  the social determinants of health,
• 42:08
  and the social determinants of health
• 42:10
  are probably much more important
• 42:12
  than anything we do clinically.
• 42:14
  And so by trying to intervene,
• 42:17
  one of our hospitals in New York
• 42:19
  has just built housing
• 42:21
  for some of its,
• 42:22
  it's a state hospital,
• 42:23
  it's the only state hospital.
• 42:24
  It just built the housing
• 42:25
  for some of its poor patients,
• 42:27
  where in sick patients
• 42:29
  they have a nurse who lives
• 42:30
  in the housing.
• 42:31
  The people don't have to
• 42:32
  go to the emergency room
• 42:33
  and they can just go to the nurse.
• 42:34
  But instead of being homeless,
• 42:38
  they're living in nice housing.
• 42:41
  So intervening on the social determinants of health
• 42:44
  and recognizing the importance
• 42:46
  of the social determinants of health
• 42:48
  is a key part of what we want to do
• 42:49
  in the medical school,
• 42:50
  new medical school going forward
• 42:51
  as we focus on health equity.
• 42:53
  That it's not just
• 42:54
  the highest tech care
• 42:55
  and the most expensive care.
• 42:57
  But it's really,
• 42:58
  if you want to have pot intervention
• 42:59
  that affects larger number of people,
• 43:02
  you need to affect them
• 43:04
  where they live
• 43:05
  and intervene on things
• 43:06
  and again,
• 43:07
  it's often not the dark.
• 43:08
  The dark is
• 43:09
  time is too expensive,
• 43:10
  the too well-trained,
• 43:11
  it's not an efficient way
• 43:12
  of doing it.
• 43:13
  But rather we should have
• 43:14
  used things like community health workers
• 43:16
  who we hire from the community,
• 43:18
  train them,
• 43:19
  they go back into the community
• 43:20
  in order to try to intervene
• 43:22
  on some of these issues.
• 43:23
  COVID pretends
• 43:24
  at all home so, so loud and clear
• 43:27
  because it was the underprivileged
• 43:29
  communities that were suffering
• 43:30
  the most,
• 43:31
  dying the most,
• 43:32
  and yet weren't getting vaccinated
• 43:33
  because they didn't trust health care.
• 43:36
  And...
• 43:37
  That's such a sick,
• 43:38
  that's such a sick,
• 43:39
  like twisted,
• 43:41
  truth,
• 43:42
  like so,
• 43:43
  they're dying them
• 43:44
  because you would look
• 43:45
  and you'd see the charts
• 43:46
  and the graphs
• 43:47
  and just lower
• 43:49
  socio-economic populations,
• 43:51
  they were just getting
• 43:52
  demolished by COVID.
• 43:53
  But I didn't realize
• 43:54
  I didn't realize
• 43:55
  that they also didn't want
• 43:56
  to get vaccinated
• 43:57
  because of lack of trust.
• 43:58
  Exactly.
• 43:59
  They didn't think that
• 44:00
  it's a self-fulfilling prophecy
• 44:01
  to a degree.
• 44:02
  100%
• 44:03
  And so, you know,
• 44:04
  and no Newark, for example,
• 44:05
  we tried our,
• 44:06
  the dean of the medical school
• 44:08
  in Newark,
• 44:09
  is African-American.
• 44:10
  He's been there forever.
• 44:11
  He's got close ties
• 44:12
  in all the churches
• 44:13
  throughout the city,
• 44:14
  using him and some
• 44:15
  of our senior African-American
• 44:16
  faculty
• 44:17
  to go out into the community
• 44:18
  to try to educate the community.
• 44:19
  You know, I gave
• 44:21
  a podcast with the mayor,
• 44:23
  again, talking about COVID,
• 44:25
  talking about the vaccine
• 44:26
  and the importance of vaccines,
• 44:27
  trying to educate
• 44:28
  the community
• 44:29
  who immediately resisted it.
• 44:30
  They immediately
• 44:31
  didn't want to do it
• 44:32
  because of lack of trust.
• 44:34
  And, of course,
• 44:35
  our political environment
• 44:36
  didn't help that.
• 44:37
  The national political environment.
• 44:39
  Not in the jerseys.
• 44:41
  But it's a, it's a,
• 44:43
  it's a,
• 44:45
  our hardest hit communities
• 44:48
  of the ones that suffer most.
• 44:50
  And we,
• 44:51
  our focus in, again,
• 44:54
  we teach pedagogically
• 44:56
  by social deterrents of health.
• 44:58
  But we want our new medical school
• 44:59
  to have that as,
• 45:01
  a health equity
• 45:02
  and the importance
• 45:03
  of social deterrents of health,
• 45:04
  running from top to bottom,
• 45:06
  be the focus of the schools.
• 45:08
  One thing that I thought
• 45:10
  was very interesting,
• 45:11
  when we were prepping,
• 45:12
  I was looking at a couple
• 45:13
  of different things to speak to you about,
• 45:15
  and one thing that came up
• 45:16
  was research priorities.
• 45:18
  Because that's a,
• 45:19
  I mean, this is,
• 45:20
  this is probably what you deal
• 45:21
  with every single day.
• 45:22
  So you have health challenges facing New Jersey,
• 45:24
  you have health challenges facing,
• 45:26
  all of the US, right?
• 45:28
  But you have to figure out
• 45:29
  what areas to prioritize.
• 45:31
  But there's influence,
• 45:32
  and there's money,
• 45:33
  and there's people
• 45:34
  that want some things
• 45:35
  studied,
• 45:36
  and there's people
• 45:37
  that don't care about other things.
• 45:39
  So how do you balance
• 45:41
  all the influence,
• 45:42
  all the initiatives?
• 45:44
  I mean, who,
• 45:45
  maybe even like,
• 45:46
  lay it out.
• 45:47
  Who does influence
• 45:48
  what you research
• 45:49
  and what you don't research
• 45:50
  if it's not just
• 45:51
  you and your team?
• 45:53
  Yeah.
• 45:54
  So directly,
• 45:55
  it's not me and my team,
• 45:56
  because we're an academic center.
• 45:57
  People,
• 45:58
  faculty have the,
• 45:59
  the freedom to do what they want,
• 46:00
  to study what they want.
• 46:01
  So,
• 46:02
  so pardon the influences,
• 46:04
  funding,
• 46:05
  NIH decides its priorities,
• 46:06
  and,
• 46:07
  and so on.
• 46:08
  But the,
• 46:09
  the biggest way we influence it is
• 46:11
  who we recruit,
• 46:12
  and who we hire.
• 46:13
  And recruiting people
• 46:14
  who see this as a priority.
• 46:15
  We have a faculty member, for example,
• 46:17
  who's a superstar,
• 46:18
  who's a very interesting
• 46:20
  community oriented research,
• 46:21
  and,
• 46:22
  in COVID,
• 46:23
  she was folks spending her time
• 46:24
  and community engaged research,
• 46:25
  trying to say,
• 46:26
  how do we get the community
• 46:27
  more engaged?
• 46:28
  How do we get them,
• 46:29
  wanting to get vaccinated,
• 46:30
  wanting to be,
• 46:31
  be treated properly?
• 46:33
  And by,
• 46:34
  by recruiting the correct people,
• 46:36
  you,
• 46:37
  you,
• 46:38
  you change the focus.
• 46:39
  Now again,
• 46:40
  the school will never be
• 46:42
  prestidious,
• 46:43
  if it's also not doing the high
• 46:44
  tech stuff,
• 46:45
  and the transplants,
• 46:46
  as well.
• 46:47
  But, but by making sure
• 46:48
  we recruit people
• 46:49
  who, who are,
• 46:50
  have a focus
• 46:51
  on social determinants,
• 46:52
  and one of the things
• 46:53
  that was striking,
• 46:54
  coming here,
• 46:55
  I mean, when I did my
• 46:56
  first strategic plan,
• 46:57
  now, you know,
• 46:58
  I've been here 11 years,
• 46:59
  I mean, I,
• 47:00
  first strategic plan,
• 47:01
  so 10 years ago,
• 47:02
  9 to 10 years ago,
• 47:03
  50% of our faculty
• 47:05
  had community engagement,
• 47:07
  as, as their primary focus.
• 47:09
  Striking,
• 47:10
  that, that,
• 47:11
  there was that high,
• 47:12
  again,
• 47:13
  with the State University
• 47:14
  of New Jersey,
• 47:15
  and,
• 47:16
  and the,
• 47:17
  our faculty really care
• 47:18
  about this kind of thing.
• 47:19
  And,
• 47:20
  and yet,
• 47:21
  not many of them
• 47:22
  were researchers
• 47:23
  doing research
• 47:24
  and,
• 47:25
  there were clinicians
• 47:26
  or otherwise.
• 47:27
  So, another way
• 47:28
  to deal with that,
• 47:29
  is to take some of these people
• 47:30
  who are really talented
• 47:31
  and really care about this,
• 47:32
  and train them.
• 47:33
  So, I,
• 47:34
  I'll give you an anecdotal example.
• 47:36
  One of my,
• 47:37
  my mentees, now,
• 47:38
  came from a,
• 47:39
  very poor background
• 47:41
  and,
• 47:42
  and,
• 47:43
  south Jersey.
• 47:44
  Um,
• 47:45
  Pell Grant,
• 47:46
  you know,
• 47:47
  drugs, alcohol,
• 47:48
  in this family,
• 47:49
  um,
• 47:50
  uh,
• 47:51
  Tony was going to be
• 47:52
  a professional baseball player,
• 47:53
  and,
• 47:54
  but in,
• 47:55
  in the high school,
• 47:56
  in Georgia's own,
• 47:57
  didn't realize it could be
• 47:58
  a,
• 47:59
  it was a picture.
• 48:00
  Didn't realize it could
• 48:01
  be repaired.
• 48:02
  Um,
• 48:03
  depressed,
• 48:04
  dropped out of high school,
• 48:05
  um,
• 48:06
  they got into a lot of trouble
• 48:07
  with the law,
• 48:08
  uh,
• 48:09
  in the meantime.
• 48:10
  And New Jersey,
• 48:11
  very much to its credit,
• 48:12
  this is long before,
• 48:13
  I was here,
• 48:14
  involved,
• 48:15
  obviously,
• 48:16
  time,
• 48:17
  my credit.
• 48:18
  And,
• 48:19
  um,
• 48:20
  uh,
• 48:21
  said to him,
• 48:22
  he did,
• 48:23
  and he was a total
• 48:24
  change of his
• 48:25
  life.
• 48:26
  He,
• 48:27
  went back to high school,
• 48:28
  did really well,
• 48:29
  went to communion college,
• 48:30
  did so well,
• 48:31
  that Cornell gave him
• 48:32
  full scholarship.
• 48:33
  Wow.
• 48:34
  After the last two years,
• 48:35
  Cornell,
• 48:36
  went to medical
• 48:37
  school after that,
• 48:38
  became a trauma
• 48:39
  surgeon,
• 48:40
  uh,
• 48:41
  was a star trauma
• 48:42
  surgeon,
• 48:43
  and a faculty member
• 48:44
  with us,
• 48:45
  ninety-nine percent
• 48:46
  clinical.
• 48:47
  And then his father,
• 48:48
  who was a contractor,
• 48:49
  fell off a roof
• 48:50
  and broke his neck.
• 48:51
  And he's a student,
• 48:51
  prevent,
• 48:52
  that,
• 48:53
  and that prevention
• 48:54
  was more powerful.
• 48:55
  So on the side,
• 48:56
  he ended up, um,
• 48:57
  going to a school of
• 48:58
  public health
• 48:59
  and getting a master of
• 49:00
  public health.
• 49:01
  Um,
• 49:02
  and then decided
• 49:03
  public health focuses on
• 49:04
  interpreting research
• 49:05
  from a policy point of view.
• 49:06
  He wanted to do the research.
• 49:08
  Instead people pointed him,
• 49:10
  Brian,
• 49:11
  if you want to,
• 49:12
  his, his mentor,
• 49:13
  his trauma surgery,
• 49:14
  mentor said,
• 49:15
  you go out and learn to do
• 49:16
  research,
• 49:17
  talk to Brian,
• 49:18
  um,
• 49:19
  referred him to me,
• 49:20
  to do research, he's gotten multiple NIH grants, but he cares enormously about underprivileged
• 49:26
  populations and changing things. So we can direct people's research through training.
• 49:32
  If they care correctly, we can direct research through who we recruit into the field.
• 49:38
  We can't tell them what to do, because back in the beginning. So do you not get a lot of pressure
• 49:44
  from pharmaceutical companies as well to do research on uncertain drugs? And how do you balance that
• 49:52
  out when a huge pharmaceutical company is asking you to do research, because they're trying to
• 49:56
  get to an end result versus you as an institution wanting to make sure that the research is
• 50:00
  independent and sound. Yeah, the pressure to do controversy, absolutely. I'm
• 50:08
  happy to do them as long as we have control and independence. Exactly. You're talking about
• 50:13
  we will never accept a grant without the ability to freely publish it regardless of the result.
• 50:21
  So if they come to us to do a study, they are taking the risk that no matter what the result is,
• 50:28
  it's going to get public because it's completely true. Does that like I mean without naming?
• 50:32
  That makes. Does that upset some of the people that come to you? Oh yeah, they won't fund us.
• 50:38
  There's companies that won't fund us. Really? Like names if people would know would not fund you
• 50:43
  because they're worried about OGs. That's not good. But there are other organizations,
• 50:46
  contract research organizations that they go to and set where they can control the results.
• 50:52
  And there are certainly companies, IEI, do a lot of consulting for drug companies myself,
• 50:58
  as well. And they're good. And I always make clear to them up front. Is this consulting or
• 51:03
  is this economic? If it's consulting, they can keep it private, but it can never be able to publish.
• 51:08
  And often they come to me and give them advice to help them design a study or whatever,
• 51:12
  and they say, we'll publish that in the interest now because you didn't take the risk upfront
• 51:17
  of being transparent about it. So real academic freedom and transparency is critically important
• 51:24
  to all the major academic centers in the country. And is the difference between contract research
• 51:28
  organizations and academic centers? And then the net effect is their companies that won't
• 51:34
  won't help us do the research. But what it means is when we publish it has more credibility.
• 51:40
  And is that something that, I mean, if I'm an average American, I'm looking for a drug to solve
• 51:47
  X problem. Just last thought on this point, what are the things that I should think about,
• 51:55
  or look into, or even ask my doctor, or even understand if my doctor is being incentivized to
• 52:04
  push me one way versus the other? compound question with it is a compound question. I know I'm sorry.
• 52:12
  I know, but great said question. To start with your last one, conflict of interest of your doctor
• 52:16
  is something absolutely to be sensitive to. And there are field like orthopedic surgery or cardiology
• 52:21
  with it where there are more, there are more often conflicts because they've developed a new toy
• 52:30
  or a new hip or a new knee. And they only want to use theirs and the hospital pays you pay three
• 52:35
  year insurance. And that drives up costs, but there's clearly conflict ventures and no question
• 52:40
  there. So ask your doctor about conflicts of interest of them making recommendations like that.
• 52:45
  I think more broadly, physicians don't have the time or the expertise to read, to critically
• 52:51
  appraise the literature in detail. That's what, as a clinical epidemiologist, that's my specialty.
• 52:57
  But I think when you talk about prescription drugs, people should feel comfortable because you
• 53:02
  have FDA regulation. FDA goes through it in painstaking detail. It actually gets the actual data
• 53:07
  from the company and reanalyzes it. So if FDA gets a different answer than the company,
• 53:12
  God, you know, if the real data showed this, the FDA regulation will eat it. If it's FDA approved,
• 53:20
  it means it works. And it means it's as safe as we know, subject to the kind of things we talked
• 53:25
  about before and into the limited samples. If it's not FDA approved, like herbals going back to
• 53:30
  that conversation, we're like, like herbals and so on, then it's, it's cavity entered. You, you
• 53:35
  cannot know. And the doctor's not going to know. And nobody's going to know because science doesn't
• 53:39
  know in most cases, because the studies haven't been done. And so it's a, you know, we have a system
• 53:47
  of a learning intermediate area. There's what the lawyers call it with the patient goes to a doctor.
• 53:54
  You know, if somebody has an adverse reaction, they typically don't sue the
• 54:00
  doc. They sue the company, which is a deeper club. But it's why the company you talked about the
• 54:05
  ads with all those adverse reactions, all those adverse reactions are basically the company's legal
• 54:09
  friends. Well, I told them. And it was in my advertisement. So the patients should have read it.
• 54:15
  But we really haven't learned it in to mirror a intermediary process where where the companies
• 54:20
  provide the doc information of the docs, the docs make the judgments for the patients. And then the
• 54:24
  docsist should should have the the ideally the expertise to do it. But that's where FDA comes in.
• 54:32
  Goes back to my comment about why statins are not over the counter-drug because they're both
• 54:37
  both to measure their efficacy and their safety and their adverse reactions. You need
• 54:43
  position expertise and access to laboratories to be able to do it. When you looked at
• 54:49
  emerging some of the the two largest medical institutions, I mean, this is very difficult to do. It
• 54:54
  was very complex. Talk to me about some lessons learned, maybe even from like a leadership perspective,
• 55:02
  the you had to the you had to figure out when you're doing this when you're doing this merger.
• 55:09
  Yeah, so it's I mean, again, to clarify, they weren't the largest to begin with, but they will be
• 55:14
  the largest would say, okay, once merge. Yeah, it's been a real education. Yeah, as as people
• 55:21
  have said to me, when I came from Pennsylvania, New Jersey is not one state, it's three.
• 55:27
  Yes, it's small, but South Jersey, Central Jersey, North Jersey are very different,
• 55:32
  their rivals in different cultures. And here I'm I proposed now happening, merging medical
• 55:39
  school from the central part of the state and the northern part of the state, merging together.
• 55:43
  Those two together, by the way, I've certainly 5% of the population of the state.
• 55:46
  But it's it's a it became a little bit of a political football. It became a lot of rival,
• 55:54
  a lot of rivalries. It's like having two children in each thinks the other is the favorite.
• 56:01
  And why are you doing this? You're doing it to benefit them. You know, the people in Newark,
• 56:04
  because the university is based in New Brunswick, the people in Newark were afraid we were abandoning
• 56:09
  Newark. And the process that it was New Brunswick taking over Newark. And which is anything,
• 56:15
  but it's actually the opposite effect, but it's a it's a it's a
• 56:24
  as much as I tried, including people and talking to people and talking to faculty and so on,
• 56:28
  it it I couldn't do enough because it generated a backlash of people opposing it.
• 56:37
  Now that now I did a much better job of educating our governing board because
• 56:44
  they unanimously voted for it. Now that our two deans are working on the merger,
• 56:49
  they've had very, very wide engagement. Hundreds of faculty, students, staff are involved.
• 56:55
  And the opposition is melted away. And so it's a
• 57:00
  there was a lot of fear of we're going to abandon so and so. My comp plan is going to change to
• 57:05
  their comp plan. My salary is going to go down. I mean, there was an enormous misinformation
• 57:10
  out there. And as much as I did spend time trying to address it in retrospect, it obviously
• 57:16
  wasn't enough. But now that we're in that process and the two deans are in the process of doing it,
• 57:23
  it's a you know, the faculty's into school didn't even know each other. They didn't know each other
• 57:29
  as a curriculum. They didn't know each other processes. They're both training docs. You know,
• 57:33
  they got together and they said, Oh, you're much more similar to us than we thought.
• 57:36
  Yeah, you're both training physicians. It's ironic how this is a little micro example of
• 57:42
  the world at large, but I'll leave that. I'll leave that be. Yeah. And it's a bit, but with a lot
• 57:48
  of resistance that admit a lot of in the process, which again has since melted away. And the irony
• 57:54
  with the concern about about the abandoning Newark, the wrong concern about abandoning Newark,
• 58:03
  we're in the process of building a new big new research building in New Brunswick, which will have
• 58:07
  a lot of space for laboratories and space for spin-off companies as well, incubated space for
• 58:14
  companies that part of it. So the labs at the medical school, which will also be moving into
• 58:21
  New Brunswick, uh, can spin-off companies accordingly. The building in the medical school building in
• 58:27
  Newark is old and dilapidated. We had renovation plans for that too, but it's easier to build a new
• 58:32
  building. And the governor was more interested in that, um, and then the, uh, then old building,
• 58:38
  then renovated old building. But part of what we've had found out since in looking planning for
• 58:44
  the accreditation of the new combined medical school is the students on the two campuses need a
• 58:49
  comparable experience. And so it accelerated the renovation in Newark. So rather than us
• 58:56
  abandoning Newark, the fact that we're combining the two schools has actually led to, it's
• 59:01
  talbing Newark and accelerating that renovation. So, and we're certainly not abandoning it. I mean,
• 59:07
  the best medical schools give students an experience in community hospital, private hospital,
• 59:13
  and safety in the hospital. We had them split. And it makes much more sense from a student
• 59:18
  point of view to have both options in the same school. So people can be educated in all of them
• 59:23
  that the expertise in the two schools is different. The scale of the two schools, um, again,
• 59:29
  they're both sort of comparable, but together we will have a scale, you know, both of our cities
• 59:34
  are not that big to be able to be able to have enough people with uncommon diseases to keep
• 59:41
  a physician busy. Having one physician who can practice in both places makes much more sense.
• 59:48
  Without that, people have to go to New York or Philadelphia for care of the rare conditions.
• 59:53
  People who socio-economically can afford that, it's inconvenient, but they can do it,
• 59:58
  that the poor can't. And so again, from a health equity point of view, it means we can better
• 1:00:03
  meet the needs of the community, because we can meet the needs in New Jersey, which
• 1:00:08
  parenthetically ends up being much cheaper also, because it's not out of network
• 1:00:14
  engineering, um, and meet the needs of the local communities and meet them locally.
• 1:00:19
  You know, my cancer center director likes to say cancer doesn't travel well.
• 1:00:24
  If you're in chemotherapy or radiation therapy, and we are going every day for treatment,
• 1:00:28
  you don't want to be going back and forth, of course, to the river, and have course bridges to
• 1:00:31
  be able to get that kind of care, delivering it locally is much better for the people of the
• 1:00:37
  state of New Jersey. So it's better for education, it gives a larger scale for research,
• 1:00:42
  and it's most of what's better for the people of the state, because we can treat
• 1:00:47
  uncommon diseases that people would have to go to New York or New York or Philadelphia.
• 1:00:53
  New York or Philadelphia, to get that treatment, which again, is it inconvenient for people to
• 1:00:59
  can't? So I mean, like really, but what I'm hearing is like the future of health care,
• 1:01:04
  and this is what you're doing in New Jersey, but this can be a model that you can replicate
• 1:01:10
  in other states, you can replicate it anywhere really. It's all about interdisciplinary
• 1:01:16
  collaboration. That's really it. And it's so strange that that's not the case right now.
• 1:01:22
  Yeah, interdisciplinary and interprofessional. So certainly it's not the case now,
• 1:01:27
  and you've got the surgeons, you've got the internist, you've got the cardiologist, you've got
• 1:01:30
  the each is separate, each is separate silo, because each has separate regulation and separate
• 1:01:36
  licensing responsibilities. And it doesn't even make rational sense that a cardiologist,
• 1:01:42
  that's a subspecialty of internal medicine. Cardiac surgery is a subspecialty of surgery.
• 1:01:48
  Cardiologist has a lot more in common with a cardiac surgeon than they do with an endocrinologist
• 1:01:53
  who's treating thyroid problems or whatever, but that's not the way medicine is organized,
• 1:01:59
  and it's not historically, it's not been interprofessional, where you don't reach to nurses and
• 1:02:04
  physicians assistants and so on to give care, because it's all been physician care only. And so
• 1:02:10
  the consolidation gives the opportunity to be able to do that and to be able to pay more attention
• 1:02:16
  in the process to the whole equity. You know, people like physicians assistants and nurse practitioners
• 1:02:20
  are much better at focusing on health equity, spending more time with patients, spending on health
• 1:02:26
  and staying healthy, giving counseling to people accordingly. Physicians are too busy to be able
• 1:02:31
  to do that. You need a system that really combines them all and really, you know, we have the
• 1:02:38
  advantage of rough years, and I said this publicly many times, we're developing the health care
• 1:02:45
  system of the future because it's all in the one roof. And yeah, we produce the physicians,
• 1:02:51
  we produce the nurses, we produce physicians assistants, we produce the physical therapists,
• 1:02:55
  the occupational therapists, whatever it is, everything. We can change the numbers as need be
• 1:03:00
  in order in order to do it. And I need to grant experiment to try to help improve a very
• 1:03:07
  inefficient and not very effective US health care system using New Jersey as the laboratory.
• 1:03:15
  I was going to say, I mean, it is an experiment, but just to echo your point, I don't think
• 1:03:20
  the existing is a great, is working very well. I don't think it's working very well.
• 1:03:26
  If you look, I mean, if you look at other countries, nobody looks at the US as the epitome of health care.
• 1:03:33
  I mean, you know that and else to this, we spend much more money and we have worse outcomes.
• 1:03:38
  Yeah. Yeah, at part of it, again, how many people show up at a safety and a hospital in Newark,
• 1:03:44
  when the first care they get when they're pregnant is showing up and they burn through in labor.
• 1:03:52
  And I think about the problems in the offspring and the costs that involved and the trouble
• 1:03:59
  that could have been prevented if they had been treated beforehand and seen beforehand.
• 1:04:03
  But instead, we're focusing on the transplants and the high end things and we have to do that too.
• 1:04:08
  The US is really good at that and spends too much of its money on that.
• 1:04:12
  Yeah, but I mean, that's, I mean, we also have to take care of the rest of the population as well.
• 1:04:18
  That's also very important.
• 1:04:20
  Ideally, keep them out of transplants.
• 1:04:22
  The point is they don't need kidney transplants if we treated their blood pressure right,
• 1:04:27
  and the kidneys never went bad to begin with.
• 1:04:30
  It's very interesting and I don't want to go down this rabbit hole,
• 1:04:33
  but it's very interesting how I find that out of all the topics that are discussed in the
• 1:04:38
  political arena, health care is not prominent.
• 1:04:43
  It's very interesting how that's never addressed.
• 1:04:46
  And it's just sad, I think, because it has to be.
• 1:04:47
  But it's good that you're addressing it other ways.
• 1:04:49
  That's it.
• 1:04:50
  It had been in the past and Obamacare was a major compromise,
• 1:04:55
  but a major advance toward that.
• 1:04:57
  And then then prior president tried to undo that over and over and over again, unsuccessfully.
• 1:05:03
  So it's sort of the one party can't undo it and the other party has succeeded in going as far as,
• 1:05:09
  you know, what we really, my personal view, what we really should have is at least a public option,
• 1:05:16
  and maybe not worse to it.
• 1:05:18
  The most efficient health care in the US, by far, no is Medicare for the elderly.
• 1:05:25
  We don't have the huge bureaucracy.
• 1:05:27
  We spend 20, 25% of our health care dollars on dealing with this huge bureaucracy.
• 1:05:33
  And so if everybody was offered, even young people,
• 1:05:38
  or for Medicare as an option, for example, it would make much more sense.
• 1:05:46
  Well, I think I wish somebody would focus on them.
• 1:05:49
  That's the yes.
• 1:05:52
  Okay, so one I want one thought on what you're excited about for the future of health care
• 1:06:01
  or medical research.
• 1:06:02
  And then also one thought that you're excited about on just the future of health care or medical care.
• 1:06:10
  Interesting.
• 1:06:10
  So let me respond this way.
• 1:06:13
  Well, my refrain since I've gotten here, the first and last slide of every talk I give,
• 1:06:19
  different pictures, but to build one of the best economic health centers in the country within
• 1:06:22
  Amazon one.
• 1:06:24
  And the tagline of the Amazon one is integrating one of the things I've done my entire career,
• 1:06:30
  has been to take different fields in my personal career.
• 1:06:33
  I bridge across multiple separate fields.
• 1:06:35
  That one of the difficult decisions I had when I first arrived was which school do I take
• 1:06:39
  my tenure in because of the multiple options.
• 1:06:42
  So I think the nature of health care is we need scale and we need teamwork and we need people
• 1:06:47
  being able to work together in a way that they don't now, they work in silos that don't focus
• 1:06:54
  on the patients, they focus on themselves and their professions rather than the best serve
• 1:07:01
  servicing the patients.
• 1:07:02
  And I think we're building a model for that and the medical school will be building a model
• 1:07:08
  particularly one that focuses on health equity trying to keep people healthy rather than just
• 1:07:14
  waiting for them to be sick.
• 1:07:16
  Research wise, I think certainly researching figuring out how to do that is going to be a key
• 1:07:22
  question. I think completely different. This is completely different is what's the role of
• 1:07:27
  artificial intelligence in health care. We talked about doctor patient relationships.
• 1:07:34
  Computerization of electronic records has had many advantages of the disadvantages.
• 1:07:39
  One of the disadvantages has been getting in the way of doctor patient relations.
• 1:07:42
  As we move to AI, how do we make sure there aren't mistakes made and people getting the wrong
• 1:07:48
  thing because of AI and how do we make sure it doesn't get in the way of the doctor patient
• 1:07:52
  relationship? Much of what, again, I'm a general internist, there's no data behind what I've
• 1:07:58
  about to say, but an anecdote that sort of rings very true, that is a general internist,
• 1:08:04
  you know, 5% of your patients are going to die no matter what you do, 5% are going to get better
• 1:08:08
  in the matter. 5% you're going to change that course. The other 90% are going to get better
• 1:08:16
  in a matter of what you do. It's regressing to the mean that they come to you when they're
• 1:08:19
  worst, they're going to spontaneously get better. They feel better because of the physician laying
• 1:08:25
  on the hands of the physician relationship and having the time with the doc and interacting,
• 1:08:31
  how do you protect that in the face of scale, corporatization, the need for efficiency?
• 1:08:42
  Those are major research questions in terms of how do you design a healthcare system that's
• 1:08:46
  optimal and how does AI help that? Where is AI going to help that? They're going to hurt the
• 1:08:51
  health. If AI gets in the way of the doctor-related physician, doctor provider, not just doctor,
• 1:08:57
  relationship, then AI is going to be harmful. If AI allows you to be more flexible,
• 1:09:03
  I had more efficient. So, for example, we've developed now an AI program. When some of the
• 1:09:09
  hospitalized, you summarize the hospitalization with COVID-Distart summary. It takes a lot of work
• 1:09:14
  for the doctor to put that together. Everyone was answered and I paid for it, but it's an appropriate
• 1:09:19
  part of important in care. We've now developed an AI program that will present to the doctor
• 1:09:26
  based on scanning the electronic medical record. It just starts summary that summarizes it.
• 1:09:32
  Doctors start out to read and edit it somewhat, but so far it looks like it's working really well.
• 1:09:36
  We'll save a ton of work and let people get much more efficient. That won't get in the way
• 1:09:40
  of the doctor-patient relationship. That'll save time. That reduces the cost. How do you use
• 1:09:46
  the AI in order to be able to improve the efficiency of the healthcare? And increase the time where you
• 1:09:51
  can have those human-to-human interactions, basically. Absolutely. What would be one piece of
• 1:10:00
  advice that you've received from one of your mentors or one of your peers over your career
• 1:10:06
  that's really influenced how you work? Here, but the patient first,
• 1:10:11
  patient has to come first. I mean, how that's the theme? Yeah. Healthcare is designed around the
• 1:10:16
  doc. Sometimes this fights should be designed around the nurse, should it be around now? It
• 1:10:21
  should be around the patient. It should be what makes most patients. We are building a new cancer
• 1:10:26
  center. We are the all-in-one building. A patient with cancer doesn't have to go. When
• 1:10:32
  end of a complex for radiation therapy in a different end of the complex for chemotherapy,
• 1:10:35
  the different end of the complex for blood testing, I mean, those silos are how healthcare
• 1:10:43
  is now organized. And there are lots of different ways, even in our construction and our
• 1:10:48
  architecture, that we can change that by being more patient-centric. I love that. We wanted to
• 1:10:54
  a lot. What do we not go into that is sort of on your mind right now, something that you'd like
• 1:11:00
  to leave the audience with. You're not sure. We did cover a lot. You don't need an answer,
• 1:11:05
  by the way, for this one. I'm just giving you the floor. There's no right answer for this.
• 1:11:10
  We went into a lot. I really appreciate it. I'm glad I'm glad we sort of covered
• 1:11:14
  as a wide range. I mean, chatting with you is fascinating. I probably talked to you for hours,
• 1:11:20
  but I want to keep it within the confines of what we've spoken about today. A fun question that I
• 1:11:28
  thought of, if you look at historical medical figures that are innovative, that have changed the
• 1:11:37
  way that we do things, who is one that you most associate with? Who is one historical medical
• 1:11:44
  figure that you wish you could collaborate with them today? Interesting question.
• 1:11:52
  Crop. William Olser. As a disciple, sort of, and I'll describe what I mean by that,
• 1:12:04
  a temp tumulti, telep tumulti, F Hopkins, around the medical school. They focused on the patient.
• 1:12:09
  They focused on clinical skills, not just technology. Tumulti was my advisor in
• 1:12:16
  medical school, and I had this talk that he gave, you know, something was books on the wall,
• 1:12:23
  and I quoted on every graduation speech about the power of being a physician and the importance
• 1:12:30
  of being a physician and the ability through your personality and the laying on of hands and having
• 1:12:36
  a conversation to make the to cure people and to make the dying feel better as they die,
• 1:12:43
  and the enormous power in that. And yet, tumulti didn't even know how to read nakedgy.
• 1:12:50
  He was the ultimate physician's physician. When you didn't know what was wrong,
• 1:12:54
  you presented, we had what we call tumulti rounds. You presented the case to him,
• 1:12:58
  he'd go through a detailed discussion, it's a differential diagnosis of what may be wrong,
• 1:13:02
  what may be right, and you know, why ultimately he thinks it's in this disease.
• 1:13:06
  Someone was in a hospital for two weeks doing the testing, and it always proved him right.
• 1:13:11
  That's so funny. I mean, clinically enormously skilled, not tied to just technology.
• 1:13:17
  I mean, we here, I mean, don't come along. Our modern medical technology is fantastic,
• 1:13:22
  but we sometimes lose sight of the personal aspects in the meantime.
• 1:13:27
  I love that. Right, I appreciate you a lot. If people want to learn more about what you're doing,
• 1:13:34
  connect with you, where do they go? I mean, you can send people anywhere. I'll put a whole bunch
• 1:13:39
  of links in the show notes as well, but where should people go to explore?
• 1:13:43
  Yeah, so one is, I mean, where's Chris Holtz? What we're doing in Breaker's Health
• 1:13:48
  websites is probably, and if people want to connect directly, I have a chancellor email address.
• 1:13:52
  Let me, I mean, I don't know what it is often. And that's fine.
• 1:13:59
  And I can, here it is, a chancellor at rbhs.ruchkers.edu.
• 1:14:05
  So it's a chance at rbhs.ruchkers.edu biomedical and health sciences.
• 1:14:10
  We've changed our name to ruchkers health because it's a better name, but, but our legal name is
• 1:14:14
  still rbhs.edu. And it's a, you know, one of the sort of bottom line messages is that this
• 1:14:22
  is a very exciting time in medicine. It's a very exciting time in my life in terms of being able to,
• 1:14:28
  to, you know, I've always been a change agent. I came here with knowing that that, and in fact,
• 1:14:35
  you know, my job, the chancellor job, was created when UMDNJ, University of Medicine,
• 1:14:40
  in Dentistry of New Jersey, was merged into ruchkers. Every time the presidency of UMDNJ became
• 1:14:46
  available, I was asked to look at it and I refused even to look. But when this job became available,
• 1:14:51
  merged into ruchkers, I saw the potential for the kind of change that I could drive on a statewide
• 1:14:57
  basis and we're doing it. We got a long way to go, but it's just sort of very proud of what we've
• 1:15:04
  been able to accomplish and what we will accomplish in the future.