Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Stewart Goldman, Chair of the Department of Child Health and Senior Vice President of Research at Phoenix Children’s and the University of Arizona College of Medicine–Phoenix

Transcript

Dr. Stewart Goldman, Chair of the Department of Child Health and Senior Vice President of Research at Phoenix Children’s and the University of Arizona College of Medicine–Phoenix · Becker’s Healthcare -- Pediatric Leadership Podcast

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  Welcome to Becker's Healthcare podcast. I'm Mariah Taylor,
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  assistant editor, and I'm thrilled to be interviewing
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  Stuart Goldman, chair of the department of children
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  health and senior vice president of research at
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  Phoenix Children's and the University of Arizona College
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  of Medicine Phoenix on the podcast today. Doctor
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  Goldman, thank you so much for being here.
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  I'm so excited to dive more into the
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  pediatric
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  pediatric research you're doing and everything that that
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  has produced.
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  But before we get into my questions, I
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  would just love to take a second for
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  you to introduce yourself and tell us a
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  bit about your background.
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  Well, thank you. I'm also really excited to
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  be here and to really talk about not
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  only the wonderful things that are happening at
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  Phoenix Children's and the University of Arizona,
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  but in pediatric research in general.
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  I am a pediatric hematologist
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  oncologist
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  who for the last
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  35 years has practiced pediatric neuro oncology. I've
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  become a brain tumor specialist.
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  And I was originally at the University of
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  Chicago where I trained and stayed on as
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  Faulk Brain Tumor Center,
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  ultimately becoming the division head of Hematology
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  Oncology,
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  Neuro Oncology and Stem Cell Transplantation,
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  the longest division name ever created.
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  And then in April of 2021,
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  I moved to Phoenix Children's Hospital in the
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  University of Arizona
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  where I'm here to really witness
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  firsthand
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  the growth of an academic powerhouse
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  and
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  an institution that gives the best care to
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  children throughout the state and our region.
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  That's amazing.
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  You have such a deep background in pediatric
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  research. And so I'm wondering what are some
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  of the current gaps in pediatric research within
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  health systems?
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  Well, I really think that we're in a
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  critical time for the future
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  of pediatric
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  research.
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  And when you think about
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  some of the amazing things that have happened
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  due to notable
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  pediatric scientific achievements,
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  for example,
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  it was pediatricians
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  that developed the Haemophilus influenza
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  Type B
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  treatments
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  and gave us eradication of that invasive disease
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  in many, many ways.
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  It was pediatric
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  pediatricians and researchers who developed
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  and eliminated
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  phenylketonuria
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  in congenital hypothyroidism by doing congenital screening. It's
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  thyroidism by doing congenital screening.
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  It's pediatricians that help reduce the risk of
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  sudden infant death with back to sleep and
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  safe to sleep.
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  It's pediatricians
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  banding together
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  to treat rare diseases for my beloved children's
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  oncology group where we now have more than
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  90%
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  of kids with average risk leukemia
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  surviving and being cured.
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  And not to even mention the changes we've
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  made in life expectancy
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  with children and adolescents with cystic fibrosis,
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  sickle cell disease
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  and not to mention how we've decreased the
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  risk of transmission of HIV from mothers to
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  infants to now less than 1% of birth,
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  all through the really
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  intensive work of pediatric researchers.
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  But
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  I said this was a critical time because
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  right now, if you look over the last
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  few decades, less and less
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  physician scientists are going into the pediatric research
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  field.
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  And that's really multifactorial
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  from the lack of funding to support folks
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  to the lack of time and mentoring. In
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  fact, here at Phoenix Children's and the University,
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  we've developed
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  a cohorts
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  of
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  young,
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  scientists who are just finished their training to
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  be mentored in research
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  of clinical,
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  translational
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  and how to develop that research career because
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  it is becoming so and so difficult.
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  And really another issue is the partnership between
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  hospitals and academia. And that's one of the
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  things that really made me feel lucky to
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  be here at Phoenix Children's is this great
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  partnership we have between the university
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  and the hospital system.
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  So there are some real, real changes here
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  that are worrisome.
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  In fact,
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  I know
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  just to mention the fellowship match for the
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  20 5, 20 6 year just happened this
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  last week
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  and actually
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  3 37
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  spots were unfilled, that's 36%
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  of the programs. And if you think
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  about
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  specifics
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  like Peds GI,
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  31% of the programs went unfilled,
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  there was 99 positions filled, 23%
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  23 until that's almost 19%
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  nationally.
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  HemOnc even more
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  concerning nationally,
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  31
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  of the
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  77 programs did not fill and 21
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  0.6 percent of the national positions
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  went unfilled. And I'm very concerned as I
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  think many of
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  the physician leaders about the future of our
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  academic
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  and research
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  due to these trends.
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  Absolutely.
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  What do you think systems can do to
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  create a strategy that brings in more of
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  those senior and junior investigators to their communities?
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  And how can they get buy in from
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  the C suite leaders?
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  Well, I think
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  we should never forget that
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  I reject that the C suite is different
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  than your practicing physician,
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  different than your academic institutions. We're all really
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  here for one thing and that's to improve
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  the lives of the children that we are
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  so honored to serve,
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  children we have served in the past and
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  those will serve in the future. And so
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  I think we're
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  really all trying to get to the same
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  place. There are competing interests, of course, right?
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  We need to make sure that
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  institutions stay financially sound.
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  As in my old institution, I heard many,
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  many times no margin, no mission.
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  But one of the things we can do
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  is
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  we need to advance clinical excellence and innovation
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  through the recruitment of these physician researchers and
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  surgeon scientists.
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  And I think that that speaks not just
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  to us as scientists, but to our C
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  suite because
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  bringing in these people
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  leads to more collaboration
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  and innovation
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  and helps to attract the very best physicians
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  in health systems. And
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  in my own institution, we've had
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  tremendous buy in from our CEO
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  who wants to make sure that we're doing
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  this in a rigorous fashion to really return
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  benefit to our patients and our community
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  by bringing in really good researchers and training
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  and
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  retaining
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  physician scientists for the future.
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  I can't speak enough about the importance of
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  mentoring so that not only do we make
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  this investment
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  in teaching our young folks how be physician
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  scientists, but then encouraging them to retain
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  this skill
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  and to go on forward even fighting with
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  all the lack of federal funding
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  that is so difficult for us.
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  Absolutely.
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  Now it seems that your system is kind
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  of at the top of things when it
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  comes to pediatric research. So I'd love to
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  know what are some of the advancements that
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  you've seen at Phoenix Children's Research Institution,
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  and what has changed or what has that
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  done to change patient outcomes or care?
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  Well, I think we can talk about
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  things where
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  we have an immediate impact
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  and where we have an impact that's going
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  to change for generations
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  to come. You know, we've really
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  between the collaboration
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  between Phoenix Children's and with the support of
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  our C suite that you just mentioned
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  and the academic
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  our partner, the University of Arizona and the
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  Dean, we developed what's called the Phoenix Children's
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  Research Institute at the University of Arizona,
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  capitalizing
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  on making sure that we combine our partnerships
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  between a university institution and a strong children's
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  health system.
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  And that's really allowed us to recruit some
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  of the top scientists from around the country.
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  And I'll just mention 2 things just briefly
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  that those top scientists are doing. You know,
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  Doctor. Kalinichenko
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  in the American Journal of Respiratory and Critical
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  Care Medicine last year published a really seminal
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  paper
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  where he was able to take
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  a mouse's
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  genes and put them into a blastocyte and
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  then actually grow
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  a mouse's lung in a rat. And when
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  you think about that, that's going to lead
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  down the line growing children's lungs in an
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  animal model so that we can have proper
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  transplantation
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  for those premature children who have their lungs
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  affected by the necessary treatments to keep them
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  alive when they're young or children who had
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  other conditions that hurt their lungs.
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  Another one of our recruits, Doctor. Callan,
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  just published in the last year an exciting
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  paper I believe in EMBO
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  and this really showed that we always think
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  that
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  cancer cells spread because they we want to
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  block those blood vessels and starve the tumor
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  cells. But we found through some mechanisms like
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  FOXF1 that maybe
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  what we want to do is increase the
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  blood flow to those tumor cells to stop
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  metastatic potential. And this has really been shown
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  in her model for
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  lung cancers
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  and childhood tumors that metastasize
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  to the lungs. These are
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  findings in an animal models that are going
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  to down the line change the future.
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  But we're currently doing real time research that's
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  changing the lives of children from Doctor. Sitzman
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  and his craniofacial
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  team who are really making
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  tremendous changes in the care of kids with
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  cleft lip and palate,
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  helping them to get good nutrition early on
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  and have adequate feeding.
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  You know, I can go on and on.
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  Doctor. Kreuer and his work
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  with kids with different types of movement disorders
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  and cerebral palsy and looking at individual genetic
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  causes and how we need to treat them
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  differently and find answers.
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  So there's so much going on. You know,
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  I'd love to brag and tell you that
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  we have over 700
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  studies in different areas, almost 150 I'm currently
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  accruing from the spectrum of cancer to kidney
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  disease to development
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  to avoiding
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  social behavioral problems. And so
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  the array of what we're doing is really
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  exciting. And I have to tell you, even
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  though
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  I'm at the farther end of my career,
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  I've never been more excited about the future
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  of research
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  and what pediatricians will do to change the
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  world.
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  I love that. So, let's talk about the
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  future. What's coming up next in pediatric
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  research?
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  Well, you know, that's
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  one of the really difficult questions because
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  when you think you know the answer, you
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  might be closing your eyes to some new
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  fields. But I do see
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  understanding
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  individual
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  differences,
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  you know. Why is it that
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  2 kids, the same weight,
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  the same age,
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  the same height,
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  one takes
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  25 milligrams of Benadryl and it's the appropriate
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  dose, let's say, and falls fast asleep and
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  the other ones running around like they're on
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  fire because we have different
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  pharmacogenomic,
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  pharmacodynamic,
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  pharmacokinetic
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  differences.
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  And so this leaves us this whole idea
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  of precision medicine or what I really like
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  to call individualized medicine.
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  Understanding
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  our genetic makeup and how we interact with
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  the world and how we can best individualize
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  the therapy to give the best outcomes with
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  the least amount of toxicities.
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  And we need to do that for so
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  many diseases.
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  And there's so many things that we can
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  do to impact the world. So I see
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  the difference with genomics,
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  precision medicine
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  and really excitement over some of the changes
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  we can do for behavioral health to affect
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  our health of our children and families.
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  Amazing.
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  Well, thank you so much for sharing some
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  of what you're doing over there in Phoenix
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  and for all of your expertise and your
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  hard work for patients.
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  It's been absolutely a pleasure talking with you
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  on the podcast today.
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  Thank you so much.