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

Lisa Belisle: Hello, I'm Dr. Lisa Belisle and you are listening to or watching Radio Maine, our video podcast where we explore creativity and the human spirit. We are sponsored by the Portland Art Gallery in Portland, Maine, and today we are exploring creativity and the human spirit with a fellow physician. This is Dr. R. Scott Wright, who is a professor of medicine and consultant in cardiology with the Mayo Clinic College of Medicine. He's a fellow of the American College of Cardiology, the European Society of Cardiology, and the American Heart Association. He is a distinguished cardiologist and professor with the Mayo Clinic College of Medicine in Rochester, Minnesota. His extensive research focuses on acute coronary syndromes, dyslipidemia, type two diabetes and valvular heart disease. He's renowned for his leadership in clinical trials and database studies investigating innovative treatments and healthcare policies. Thanks for coming on today.

Scott Wright: Thank you, Lisa. Pleasure to join you. And wow, what a great introduction. That's really nice of you. Thank you.

Lisa Belisle: We get a lot of really interesting people on Radio Maine, many of whom have a Maine connection. This for us is a little bit of a change because we don't often talk strictly about medicine per se, even though I am a physician and my long-term life has been in medicine. When we think about creativity, we don't often think, oh, medical research. We don't think about creating, designing and trialing new medications. We don't necessarily think about teaching. And when I met you actually through my husband and through your ham radio connections, I said, this is a person that I'd really like to talk to because I think the way that I experience medicine is very different than the way that you experience medicine. And I want to learn more about that. So thank you for being willing to have this conversation with me.

Scott Wright: A pleasure, thank you.

Lisa Belisle: One of the things that I know about your background, and that was very interesting for me to learn, was where you grew up and how it impacted your decision to work with the organization that you did and even do the work that you do now. So I'm wondering if you wouldn't mind exploring that a little bit with me.

Scott Wright: I'd be happy to. If you've read JD Vance's book, Hillbilly Elegy, you can get a great insight into my background and that of my generation who grew up in Appalachia. I grew up in eastern Kentucky and, like in Vance's book where his family moved a fair amount, my parents were migrants. They were school teachers who went to work in Ohio because there were no jobs in Kentucky. And I was born in Ohio. Then after second grade, my father had decided that he wanted to move his family back to Kentucky. So we moved next door to my mother's mother in a small town near the Kentucky-Tennessee border in the Appalachian Mountains. And it was a wonderful experience in many respects. Family was a priority, community was real. People were kind and friendly to one another and everyone was poor. And no one realized just how poor we were.

I think in the 1970 US census, the county that I lived in was considered the third poorest, but I don't think anyone felt that poor. No one really had a lot of money. And I think when I look back now to some of the things that were discussed in my early high school career, it's very clear that it was Appalachia and its impact. So for example, probably two thirds of the students in my high school class had never been outside of the state or commonwealth of Kentucky. A third to half had never left that county where we grew up in Kentucky, which is centered more by county than by city. And certainly a small percent had traveled outside of the US, maybe 1% or less. It just wasn't common or wasn't part of the cultural thing. But I was a bright youngster and the school teachers really poured a lot into me, which helped me get a great education. And I really developed an interest in science thanks to my high school biology teacher, Mrs. Clark, and got a great background in mathematics thanks to a high school math teacher, Mr. Loudermilk. I had him for three or four classes. We had a half a dozen to a dozen young students who were college bound at that time. So in our senior year, he decided to teach calculus at night so that we would understand it and be ready for it in college.

By all external appearances, I grew up in an impoverished community with few resources. The community spirit was rich. The teachers really poured their heart and soul into helping students. And if students were motivated, there were plenty of opportunities to learn. And I think, compared to my own children, there were some experiences I had that are better than anything else life can give you. We spent a lot of time in the public library, a lot of time in the school library. Our church community was important and that's where we had a lot of our socialization. We had a lot of common values. And in many respects, that also creates some degree of xenophobia because you think the rest of the world should be like you, even in the United States. And then as you become an adult and become exposed to different ideas and philosophies and things, you realize that there are a variety of ways that people in this country and in this world think and act, and not all are wrong.

And certainly some are better than what you were accustomed to growing up. And so you become much more heterogeneous than homogeneous. But I think if there are any traits that sort of typify people who leave Appalachia, it's feeling awkward and not like they belong in any successful situations. You're constantly wondering what's going on. We had a young man in our community who was the star basketball player in Kentucky, and basketball in Kentucky is like football to Wisconsin or the Green Bay Packers. Every high school kid playing high school basketball wants to play at the University of Kentucky. And he actually was Mr. Basketball and played there, but he left after two seasons. And I was having a discussion last week with two friends from my community who happened to be at the Mayo Clinic site in Florida where I was working last week. We were talking about him and why he transferred from a division one school to a division three college at the end of two years.

And I never knew, and my perspective was that likely it was just sort of the typical, what we would call today, imposter syndrome. I don't belong here, therefore I'm leaving. I want to go somewhere smaller. And he's a successful adult now, so his life has gone well. But that's just sort of typical of that background. And I think in my own work now, it's made me more appreciative of people, their struggles, understanding the people who are less affluent, who can't afford their medications or can't afford to get healthcare, who can't afford an extra hotel room a night because they'd spent their entire budget for healthcare coming to see me, and we need to finish their evaluation in two days instead of four days. So I think it's provided a sensitivity and a compassion that I wouldn't have had if I'd grown up in an urban area, the child of affluent individuals.

And it's made me value and appreciate education as well. And that's how I got into ham radio. I don't know if Kevin, your husband, knows that story either, but in seventh grade we had a substitute teacher, so I went to the school library to get some books to read so he would not assign extra homework. And there was one on ham radio and I started reading about it, and within a few days I'd learned Morse code and I was ready to get into the hobby. And so I've been doing that since that year as well.

Lisa Belisle: I'm always impressed with people who can do Morse code. I know Kevin can do Morse code and he's been getting himself back up to speed. But it's a whole different language and it's something that doesn't get used as often, well, I would assume as a cardiologist you probably don't use Morse code at all, but it is something that's still used quite widely within the ham radio world.

Scott Wright: Yeah, it is. Thank you. It is, and it's used widely, I think, as a backup communications modality. Now, there are much better digital modes for commercial reasons. And when we think digital, think email, think small sentences like Twitter, like tweets that you can send out much easier than having to decipher it with the headphone and listening to the high pitched sounds. But there is a real parallel with cardiology. We use something called continuous wave doppler to interrogate cardiac valves, to look at gradients, to look at pressure changes. And that's just simply the same theory as Morse code. And there are many analogies between cardiac physiology and RF communication. The heart is a pump that has to match its output to the vascular system, and it deals with impedance, it deals with reactance and inductance, and medications that we prescribe that slow or raise the heart rate can change inductance, and diuretics and vasodilator therapies, if you're taking losartan or an ACE inhibitor or something like that that alters the capacitance of the body.

So there are lots of analogies. And when I was training in cardiology, it sort of dawned on me that there were huge amounts of parallel there. And so it's helped me sort of understand how we design therapies and how we match therapies for the problems that individual patients have. And I'm still working on an idea, which is to try to be able to measure the coupling of the heart to the vascular system in a noninvasive way so that we can then tailor the medications for what the patient needs rather than throwing every medicine at every patient. As a family physician, I think that was your background, if I remember correctly, the patients not only have to take all of these medicines, they have to deal with the side effects, the nausea, the feeling of satiety, and also the cost. And every new medicine that comes out seems to cost between 6,000 or 12,000 a year. And if you have five of those to take without insurance, you suddenly can't afford to take any of them. So I think it behooves us in medicine to try to find therapies that fit a specific niche of a problem and use only what is needed rather than just blindly prescribing everything.

Lisa Belisle: That makes a lot of sense. And I think we have gone through a phase where we were using broader spectrum, whatever it was, broader spectrum antibiotics or a broader spectrum blood pressure medication, maybe even broader spectrum anti-cancer agents. But the more that we can bring them back to an individual, and I know that there's been a lot of work being done with individuals' genetics and the way that individuals metabolize things, I think the better off we're going to be. Because when you use things that are very broad, then as you've pointed out, you can actually get a lot of side effects and they may not even be the best medication for the patient. But it's taken us a while, I think, to get to the level of technology that we've needed in order to tailor things to individual patients. It sounds like this is something that you've been working on for a while yourself.

Scott Wright: Well, it's an idea, and I proposed thoughts about how to test it many years ago, and I've been distracted along the way with other things, including one of the new cholesterol medicines we'll talk about, I'm sure, in a few minutes, but it's still something I hope to work on before I finish my career. I think you're exactly right that we do need to tailor medicines for individual patients. We have a whole center at Mayo Clinic in Minnesota called the Center for Individualized Medicine, and their goal is to combine genetic testing, genomic testing, patient prior responses, and AI to sort of say what's optimal for you rather than just try everything. And I think it's especially true with high blood pressure. I'm sure many of the listeners today take high blood pressure medicines, but they might be shocked to learn that typically we have to prescribe three, because the first one will lower blood pressure, but then the body has a counter-regulatory physiologic reaction to that medicine.

And so then you prescribe the second medicine to counter that counter-reaction, and then the body does a counter-reaction, you prescribe a third, and then eventually you're able to stop the body's resistance, so to speak, to all these medicines and get the blood pressure to the appropriate level. So if patients who are listening, or any of us who are listening who take medication, ever find themselves frustrated, just remember the body is a pretty well designed human engineering system. It's designed not to have its ecosystem tilted by medication or other things. That's why it fends off invaders like viruses and bacteria, and it sees medicine as foreign. And so we have to recognize that there will be counter-responses, side effects, it's often called. And so you have to prescribe things to manage that or even remove that medicine if the side effect is too strong or too harsh for the person to tolerate.

Lisa Belisle: I appreciate the fact that you're bringing the language forward in a way that really anybody who's listening to this conversation should hopefully be able to understand. Because I think that one of the things that often happens, obviously within primary care, because we're dealing with all of the things all of the time, so we're always translating back what big names of medications mean or what different ways that the body acts, how this happens. And we're always trying to bring complex ideas into something that's understandable for people who have a broad range of ways that they understand. And I think that what you are describing is incredibly important for all of us to know, because sometimes when people walk into an office, whether they're seeing a nurse practitioner, a physician, they're really relying on somebody else to make a judgment on their behalf because they don't feel like they have all the information they need. And it would be much better if we can bring things to a level where people understand what they're actually agreeing to, so that if they start taking a medicine or if they start engaging in other types of therapies, they know what the possibilities are for things going wrong. And this, I think, really gives people back their ability to make their own decisions with the help of their healthcare team in a pretty significant way. That's become increasingly important with people's greater access to knowledge and information. What do you think?

Scott Wright: I fully agree with you. I think what you've just articulated much better than I could ever have done is critical. I think that every person in training, whether it's a medical student, a PA or a nurse practitioner student, really needs to be taught that at the end of the day, we're all here to serve people, to serve the patients, and they are partners. They are actually in charge of their own healthcare. They're coming to us and trusting us for advice. And I always tell my patients, look, you're putting a lot of trust in me to give you advice, but also to spend your money and to pick appropriate testing and to pick appropriate therapies. So I like to pick the greatest value in testing for you. I work at an organization where I'm salaried, so I don't have any necessarily incentives to do things that are more expensive or less expensive, whether it's a fee for service or a managed care type organization.

It's just we're salaried, and we like to think that we do what's optimal for people. I'm not criticizing others, but that's just a system that I've chosen to work in and I like it. But also I tell patients that I really try to pick the medication that offers you the best value. Most of the time it's a generic medication that also has evidence that it will lower your risk of stroke or death or heart attack, and that we really should get a benefit from anything we prescribe. It should do more than one thing. It should be more than treat the condition you have. It should also give you additional prevention against other disease states. Because we live in an era now, we practice in the greatest time in the history of humanity with medicine. We have all these clinical trial data and outcome studies, and we have knowledge and we have lots of people globally working on things.

And it really behooves us to use therapies that are safe and effective, but also add value to people. And I try to educate and inform my patients, and sometimes they come in with a decision. Sometimes people come in and say, I really want a Medtronic pacemaker. And I'll say, okay, I'll let the team putting the pacemaker in know that you really want a Medtronic. Why do you want a Medtronic? Well, my daughter or son works at Medtronic and I understand that if we have a device like that, they'll get it. But most of the time people really trust you to do that. I remember I was in Chile lecturing and they asked me to come to the hospital, to the ICU, to see some patients and give them advice. And one person was having a heart attack and was getting a stent, and they had done the angiogram and I was looking at the pictures with them and agreed that he needed to have an artery opened, and they stopped and there was a 15 minute discussion going on in there, and I asked one of them, what's going on?

They said, oh, we're discussing the three stents that are available. We have the US made stent, that's this amount of money. We have a second one that's this, and then we have the knockoff, a third from a country in Asia that's substantially cheaper. And he's deciding which one he wants to go with because he was paying out of pocket for this. And they had that discussion. And it kind of helped me understand that even in a country like the US where we have lots of insurance, public and private, we still need to have those same discussions. And so I think, Lisa, your advice is prescient and it's correct. And we do need to be teaching the next generation of healthcare providers how to do these tasks, because it doesn't matter if we have the best medicine available and prescribe it, if people will not stay on it and take it, it does no good.

And we could talk about cholesterol medicine. You can be on the most powerful medicine, but if you're not adherent, you have the same risks of bad outcomes as someone who's taking the least effective medicine. So you really need to be able to stay on your medicines. And if you're not engaged with your healthcare provider and willing to take it, you're probably not going to stay on it. So we have to take the time, and or have people in our team who can talk with them and help them understand the importance of that. And I think it's all a partnership too, between specialist and generalist. None of us live in isolation. And I always encourage patients to get a home physician, have a home primary physician, a home specialist, because most of my patients travel hours to thousands of miles to see me and I tell them, I can't be there. If you have a heart attack, you need someone locally who can treat you. So don't disregard your local healthcare team. Stay with them.

Lisa Belisle: Yes, I agree. Although as a family practice doctor, I think of myself also as a specialist. I just specialize in a kind of broader range of things than somebody who perhaps is a heart specialist as you are. So I do think it is important for all the teams to be able to communicate and to work together well. And one of the things I'm interested in with regard to your work is that you are doing things that are both kind of more on the scientific research side, but you really want to bring them into the medical realm and the clinical realm, and you're really trying to create value with the medicines that you've been working on. So in the most, I guess, understandable way possible, could you help us understand what it is that you've been working on most recently and what the process has been like as far as creating a new medication that people can use and what this is used for?

Scott Wright: Oh, sure. I'd be happy to, and please interrupt me if I go too long because you put a nickel in and we can give you $2 worth of output sometimes talking about these sorts of things. In 2015 or 16, I was invited to a small meeting in London during the European Society of Cardiology that I typically attend, and some individuals that I have immense respect for who had worked in the pharmaceutical industry at Roche had transferred to a small US company at that time called the Medicines Company. It was founded by a physician from the United Kingdom who wanted to bring disruptive therapies to the healthcare arena and do things differently in a more affordable, cost-effective and generally easier way. So he had a small pharma and he was living in Boston when he started the company, and he had some fellow physician friends who worked with him, one of them who turned out to be a ham radio operator, by the way.

So if any student or young person is listening to this, ham radio is a great way to boost your career, it seems. It's worked for me. But anyway, they were showing us some new data on a therapy that you could inject that would lower cholesterol 35% to 40% for 12 months if you had a single injection of it. And we were all intrigued by that because injectable therapies for cholesterol didn't exist, and for most problems outside of, say, osteoporosis, just were not being utilized except with chemotherapy. So they started teaching and explaining to us that this was a new class of therapy based upon a discovery in 1999 by Craig Mello at one of the schools in Massachusetts, who discovered how viruses and other organisms can alter the cells and bodies of their hosts because they go into the cell and they alter the RNA silencing complex. And that's a mechanism that's the body's natural way of silencing the translation of message RNA. So in simple terms, we all have DNA, the DNA can create a message RNA, which allows us to have proteins and other things to synthesize things in the body.

The body has used this RNA silencing complex as a way to silence the translation of things when those things need to be turned off. I think in 2005 or 2006, Dr. Mello and his team won the Nobel Prize, I think in medicine, for this. It was a very quick thing. Well, now fast forward 10 more years from that Nobel Prize, and now there were therapeutics being developed using this by a company called Alnylam in Massachusetts, and the Medicines Company had acquired the use of a drug that they were going to call Leqvio. And we started looking at it, and I was struck by how easy this was to take. It was like a small vaccine akin to getting a flu shot, that quick, and you could lower cholesterol 35% or 40%. And I immediately said to the CEO, I said, this is going to be disruptive and this can replace statins someday.

And I said, we really need to be testing this. And he said, yeah, that's why we're here. And so we were invited, and there were four or five of us, and we have worked with them to help bring this medication from the concept stage, the preclinical stage, through phase two and phase three clinical trial testing. And it was approved by the European Medicines Authority about a year before FDA approved it. Its approval process started coming during the pandemic, which slowed down approval in the US because the factory producing this compound was in Italy. And of course there was little travel during the early part of the pandemic. So FDA couldn't go and look at the factory and delayed the process. Now it's approved in 80 countries, but it's called a small interfering RNA compound. It silences the translation of a protein called PCSK9. PCSK9 is probably the most important way we regulate cholesterol levels in the body, even more important than what statins do, blocking the enzymatic synthesis of cholesterol, because by blocking PCSK9, you can reduce cholesterol 50% to 80%, which is about twice what typical doses of statins will do as they're titrated up.

And when used in combination with statins, you can have fairly profound lowering of cholesterol. You can take someone with a total cholesterol of 200 and bring it down to 90 or so, or 80, with both statins and these drugs. So we can bring people's cholesterols to very low values. And that's important because before we all lived in urbanized centers and we were hunter gatherers, our natural cholesterol levels were 80 to 100. And the LDL cholesterol, or the type of cholesterol that causes plaque buildup and heart attacks and strokes, was in the 10 to 20 to 30 milligram per deciliter range. So what we see in urbanized areas, especially in the west, and frankly anywhere in the world that you live in urbanized areas, is your LDL cholesterol gets up to 100 to 200, and that's when it starts having to be deposited into the artery walls and other places because the body doesn't want that toxic stuff around.

So it tries to push it away to get it out of the way. And that leads to disease processes that cause stroke, heart attack, the need for bypass surgery, stents, things like that. So anyway, the best way to lower this was through statins, initially diet, then statins, and now by blocking PCSK9. And there had been monoclonal antibodies to PCSK9 that were developed and tested and proven effective, but they were initially priced at about 16,000 a year and almost no one could afford them. Then the price dropped to seven or 8,000 a year, and they still weren't being widely prescribed. And so at the time we were developing the approach to testing this new compound, we all insisted that while we couldn't dictate a price, this had to be affordable for the average person. And so to the company's credit, they promised that, and then they also promised to bring it out in a way that most people on Medicare wouldn't have to pay excessively out of pocket for it because we felt the target population.

Now, of course, we know it's a lot of pre-Medicare patients, younger people like us who also need it. And so it works by, you get an injection. Now we use it twice a year. When you start on it, you get an injection on day one, day 90, and then every six months after that. So it's a twice a year medication, typically over a lifetime, and it lowers cholesterol, depending on your type of condition, between 45% and 60% in combination with a statin. It's quite potent to go even lower than that. So it's a very well tolerated medicine. It is an injectable. It has to be given either in your doctor's office or an infusion center because it was tested and designed that way, while the monoclonal antibodies, you self-inject every two weeks at home. So right now we're an injectable phase of treating high cholesterol where you take a pill and then you also take an injectable, and you can either take it every two weeks at home or twice a year at your doctor's office or an infusion center.

And that's kind of what we're doing. So it's a small interfering RNA. And in terms of that, because it gets into the body, it's delivered directly to the liver, it's designed so that it's only taken up by the liver, it doesn't go anywhere else, and then it works in the liver, and then after only a single dose, you get a profound effect. But it wears off, and that's why we go to twice a year. So it's not like it's a permanent change to the body. People don't have to worry that it's going to irrevocably or irreversibly alter their physiology. It doesn't. We wish it would last longer, but it doesn't. And that's a safety mechanism. And so it's been tested, and at least in the initial work that we published in a large number of patients, including a publication just in May of this year, it's profoundly safe and has very few side effects except some itchiness and redness, typically at the side of the injection, like almost any injectable can, whether you take insulin or other diabetes medicines, or you're taking Wegovy or Ozempic for weight loss. Those can also give you some itchiness or redness at the injection site that you don't really pay attention to.

But fast forward to the pandemic, and then suddenly any use of anything with RNA became a politically volatile topic. And how do we talk to patients about this medication, which is life changing, in the setting of not politicizing it and either causing them to be highly in favor or highly opposed to it? And so that made it kind of tough. But thankfully I think we've kind of moved beyond that a little bit in our country. And so now we can continue to talk about this in a way that explains the science and helps them understand. And it's really the mechanism of this is going to lead to discoveries for treating a lot of disease states, not just heart disease. Cardiac amyloidosis is a rare condition, largely in older people, that has uniformly been fatal. And now there is a new drug that's an injectable that was ahead of the one we brought forward that treats that, and it's sold by I think several companies now.

And then there are blood pressure medicines that have been developed and tested to lower blood pressure by blocking the conversion of angiotensinogen to angiotensin in the liver. Liver diseases are being tested for treatment with this type of therapy because the liver, it seems, has a unique receptor on the surface that's been preserved over millions of years and is expressed in high amounts, and it will take up a carbohydrate moiety inside the cell where you can then couple that with the medicine and deliver it right to the liver. So it's targeted therapy. So the benefit of this is that you target it to the organ where you need the medicine to work. You don't get any systemic side effects. You don't get the risks of off-target side effects typically. And so we're at the precipice of a lot of new therapies coming along. I know there's a lot of interest in gene therapy and gene editing, but I see this right now as a much safer alternative to CRISPR Cas9 gene editing because it's not permanent.

You have to continue to take it. If you get a side effect, you stop. If you get a side effect from gene editing, you live with it the rest of your life, whether it's an off-target effect like a cancer or your hair changes color or something, whatever it could be. We don't know what it will be because the gene therapies haven't been approved yet and are just being tested. But I think this is the next phase. So my dream is that we can go from taking pills 365 days a year or several times a day to getting some injectables that are infrequent that make compliance and adherence much better and easier for people. I think all of us who take medications, I certainly do on a daily basis, forget to take them occasionally. You're traveling, you run out, you can't get your refills back in time.

Somebody doesn't deliver them to you through mail order on time, so you're kind of stuck. And with cholesterol medicine, if you miss it for a few weeks, your risk for heart attack goes up. And so the benefit of this too is that it keeps your cholesterol down. It may not be at 50% down because the drug is wearing off and it may be only at 40%, but it's some reduction and it protects you until you can get the refill of the other medicine or get back for your injection. So that's kind of where we are. I think that's the future. That's where healthcare is heading and I'm pretty excited about it. I think 10 to 15 years from now, maybe we can come back on Radio Maine and talk about the 25 or 30 disease states that are being treated by this. I'm optimistic that diabetes and maybe rheumatoid arthritis, I'm just going to think creatively if I may, this is not any inside knowledge I have because I don't, lots of disease states, maybe ulcerative colitis or Crohn's can be treated with things like this.

It would be wonderful to just develop new therapies that are really problematic for people and help. And there's another lipid problem called elevation of lipoprotein A, which is a specific lipid elevation disorder in a percentage of the population that has no therapy. And there are two or three drugs being developed now that are small injectable RNA inhibitors, and they'll be out in testing and likely before FDA in a couple of years, and we may have those available. So it's a pretty exciting time in medicine to be practicing, a really exciting time to be a patient. If people are really happy with how GLP-1 drugs have helped weight loss, I think they're going to be even more delighted to see chronic disease states that have been heretofore fatal become much less fatal. And it's all part of helping to restore health and improve quality of life for people, which is why we all went into medicine.

Lisa Belisle: One of the things that I am reflecting on as you are talking is the fact that there have been really dramatic advances within the relatively short period of time that you and I have been practicing. And I mean relative to the history of medicine, just overall, because I know that you have more than one decade into your healthcare career, and certainly I do as well, but it's been a fairly short period of time, even from I think the earliest that we began prescribing statins and even understanding that cholesterol was an issue, and even moving past this idea that we're just trying to get the clumps of fat out of your blood to understanding that actually this is an inflammatory process that we're working with. So I'm continually amazed by how much we've been able to learn by bringing clinical and bench research together so that we can kind of keep iterating on what we know and moving into the next phase. Even as you're talking, I'm thinking about my uncle who actually does have cardiac amyloidosis, and it's basically a miracle that he did receive. He was in the trial, he does have this injectable, and his life essentially could have been over if they hadn't made this available to him. And it's just by virtue of having been born when he was and being alive when he is. And it really does give me, as a physician, hope for the future that we are continuing to look at things creatively within our field.

Scott Wright: Oh, I agree. Statins were a byproduct discovery, right? They were being developed as an antifungal or antibiotic by the Japanese, and they didn't work, but someone discovered they lowered cholesterol. So that led to a lot of testing and discovery. And then after Brown and Goldstein published their seminal work on this biosynthesis of cholesterol and ultimately received the Nobel Prize in medicine, the pieces started being put together. So I think I look at it this way. I, like you, feel very fortunate or blessed or lucky to be at this phase in life and to see this. My own grandmother died of heart disease when I was 18, which had a profound impact on me. My grandfather on my father's side also died of a heart attack. Heart disease used to be so fatal. Now it doesn't have to be so fatal. It can be a condition you live with rather than you die from.

But I think there are two things that have also contributed maybe more to the discoveries we have. One is the fact that we fund a lot of creative science through federal grants, state grants, nonprofit work like American Heart Association, the Alzheimer's groups, to let scientists just try to discover things. And then there's sort of an open free market in a sense, globally, of all these ideas so that people can see research and they can then build upon it, they can stand on the shoulders of one another and make discoveries. And there really are no geopolitical boundaries about biomedical research. One of the things I really enjoy about attending international conferences is that I can meet people from countries, for example, like Iran, that I would never be able to travel to, and talk with them about medicine and healthcare and see what they're doing and learn from them.

And they can learn from me. I've recently been doing some talks via Zoom to Kazakhstan, and that would be a very difficult place to travel to. And maybe someday I'll go, but it's much, I can share my knowledge, they can share their discoveries. They submitted a paper to our journal at Mayo Clinic, the Mayo Clinic Proceedings. We've accepted it because they've developed a nationwide lipid clinic program that's quite, I don't know, excellent. It's just novel that they've trained everyone nationally and they have made available therapies for people who have conditions, and the world will learn from that. And so unlike the geopolitical boundaries that our politicians create, we actually have a free flowing exchange of ideas. I know everyone is frustrated with the Covid pandemic and they feel like it wasn't managed well here or there or wherever and all of that.

But really I think Covid was a time that the global medical community came together, the courageous physicians in China who reported it out, unsure about what they were doing, the courageous people in Italy who shared what was going on, the courageous physicians in New York who shared what was going on and put their lives on the line to treat it early so that all of us could learn globally. And then when it went to the Southern hemisphere, they did the same, and lots of therapies including diagnostic testing, convalescent plasma, monoclonals, vaccines, even the more recent oral therapies have all been tested globally. And it accelerated the discovery of new treatments. And I think Covid really demonstrated to the world how quickly we could respond. I kind of have a rule of thumb about pandemics. My first rule of thumb is that the next pandemic cannot occur during a presidential election year because I think that slowed down the scientific work and it distracted the population and it created a lot of angst, fear, uncertainty, and doubt among people about whether masking helped, whether it didn't help, whether vaccines worked or didn't work.

And I mean, I didn't really need a clinical trial to show me that masking worked when I could see people with active Covid in our practice because I was seeing consultations in the emergency department and not catching it, and yet I was able to help them. It gave me confidence as a healthcare provider that I could safely work in this illness and not be dying from it a few weeks later, helping those who had it. And the same with the convalescent plasma. I was so lucky in the pandemic, Lisa, to be asked by the Food and Drug Administration and Mayo Clinic to help lead the world's largest Covid study, which was the US Convalescent Plasma study, with friends and colleagues at Mayo Clinic, Michael Joyner, Lisa Fairweather, Ricky Carter, where we treated 105,000 people across the United States in sort of a pragmatic clinical trial. And then published it in the New England Journal in January of 2021, showing a reduction in mortality, reduction in hospitalization and improvement.

And then it led to an emergency use authorization in August of 2020 by FDA for the use. And then until better therapies came along, it was all we had. And now it's used in largely immunocompromised patients where the current treatments are not working, but convalescent plasma still does offer some benefit. But it also set the stage scientifically for why vaccines would work and why monoclonals would work. And yet watching this happen globally, I just marveled at how wonderful it was to be in a profession where we could cross geographic boundaries. We could have conferences globally, share ideas and information, and just help one another do better. And so there's a little competition in medicine, but a lot of collaboration, because at the end of the day, we're all helping one another. And we realize that the therapies and discoveries we bring forward, as well as the things that we discover that don't work, ultimately will help our family, our friends, our neighbors, and ourselves.

And so I think in medicine, if you're listening to this and you're interested in a career in medicine, go for it, because it's a very diverse and broad field. You can be a specialist like Lisa, a specialist like me, or you can do something entirely different, but you have a chance to put your skills and talents to work and you'll never be bored. And you'll have a whole host of people who are grateful and are appreciative of what you do, and they trust you. And there are very few professions where we get the trust. And that trust comes with a big commitment, though. You have to never violate that trust. And some people in the medical profession do, and thankfully they get caught and we take them out, but most of us just toil anonymously. You're kind to promote what I've done and to give me this opportunity to talk about it.

But there are two or 3000 physicians like me at Mayo Clinic who are just as talented, just as good, doing just as neat. But we just happened to meet through ham radio, and you heard of my story, but there are so many silent unsung heroes in medicine who do this every day. So let me just say that if you go into your primary care provider next week, just tell them, give them a thanks for what they do. Because I don't know about you, Lisa, but I live in a home where no one knows what time I'm coming home every day from work because I don't even know what time the day will end. I had some dinner plans for tonight that I've canceled because I see the day's going to go long and I don't know what time it will end. And my wife is patient, and our children have grown up being patient, understanding that.

But at the end of the day, I feel very fortunate that I was admitted to medical school, had a chance to train at Mayo Clinic, and then to practice there and be part of a group of people who really do want to serve humanity. Dr. Mayo has a saying that we quote often from his early days in the 1900s, which is that the needs of the patients are the only needs to be considered. And anytime your north star gets tilted, you come back to that, right? That we're here to serve humanity, and my personal needs, my personal needs for publishing this research finding or that, that's secondary to what's best for the person that I'm serving and treating.

Lisa Belisle: Very well said. And I know that people who listen regularly to Radio Maine, this is a little bit of an offshoot. We were talking about creativity in a very different way, but I do completely agree with you that the ability to shine a light really on how we in medicine are addressing things creatively in the many ways that you just mentioned. Also, through incorporation of AI, which you and I didn't even get into this time. So we might have to get back together to talk about AI, but I do think it is important to maintain a sense of gratitude and hope, because we are mostly hearing stories right now about how hard it is to be a doctor, a nurse practitioner, a PA, a nurse. Absolutely, it is absolutely true. There is no invalidating that. And also, we still need to take care. We still need to work with patients to enable them to care for themselves and our communities. So I agree with you that there needs to be a way to have a balanced view of the work that we do in medicine and healthcare. And I'm hoping that by bringing your story to at least our Radio Maine audience, people can feel a sense that there are lots of different ways of contributing, and there are lots of different ways of being creative in this space. So I really appreciate your willingness to take time out of your day to talk with me today.

Scott Wright: Oh, thank you. You're more than welcome. And we do work long hours, you and I and all the healthcare providers. And in the late nineties, I was at a meeting discussing some cholesterol therapies with a group of physicians globally and developed a friendship with a physician from Leiden, Netherlands, who's now a distinguished chair of cardiology and just a really accomplished scientist there. And he told me, he said, we've got to discover ways to prevent heart attacks. He said, I'm getting really tired of getting up in the middle of the night to treat heart attacks. We figure out a way to prevent them. And I said, I'm with you. So in many respects, this creativity that we have comes out of seeing problems that we would like to solve, to also help our own workloads get better and help people live longer. And my compassion goes out to all those in healthcare who are working hard, who are facing burnout and who are facing moral injury, the moral injury of having a full hospital and having to turn away someone who might be dying without being in the hospital.

These are real issues. And really, I would urge all the listeners to talk with their healthcare providers and their elected officials about how we can improve this. It's not just a financial thing. It's actually providing resources and helping have the necessary numbers of hospital beds and staffing. And those are discussions that need to be had at a higher level. And I would love to talk about AI sometime. We are doing some really cool things with AI, and I'll leave it with a teaser if I may. Every patient I see now at Mayo Clinic, I pull up their electrocardiogram and I read it, and then I click a link that takes it to the Mayo Clinic AI dashboard, and I can screen them at that moment using AI for hypertrophic cardiomyopathy, low heart function, poor heart function, or low ejection fraction. I get their heart age, it tells me their sex.

Now, why is that important? Well, if you've had a heart transplant, the sex of the heart will change from the donor to the recipient over about six months. So we can see that transition. It's kind of interesting. I think it was done as an internal validation tool, but it's still there. We screen for cardiac amyloidosis, we screen for aortic stenosis, and then some other things as well. And it's really a cool tool, and I think the technology will soon be extended to smartphones where you can then access that. So AI is not something to be feared. It's really something that will help us to make all of us smarter and better doctors and to help patients become better and more savvy patients. It's sort of like, if you've flown on a flight from the United States to anywhere in the world, your pilots use autopilot a lot. It keeps the ride smoother, safer, helps them to be able to monitor the complex systems they're managing besides having to hang onto the yoke and the rudder and manage that plane.

The autopilot does it. And I wouldn't want to travel abroad on a plane without autopilot. And that's what AI will do with healthcare. It'll make us better doctors, smarter. It's like cruise control too, keeps us safe. My car has adaptive cruise control, so if someone starts slowing in front of me, my car slows down before I maybe realize they've slowed down. And sometimes it'll stop automatically if someone pulls right in front of me and I don't even see them, and it's stopping before I recognize it. So like airbags, like seat belts, AI will make medicine safer. So we don't need to be afraid of it. We can embrace it, we'll put limits on it, but maybe I'll even introduce you to some real experts in AI from my own organization that can talk better about it than even I can. But I certainly use it every day, and it's great to join you and to be able to share my story and to share with you as well as your listeners. And my congratulations to you on your podcast and what you're doing, because it's just another thing, another example, that you're really promoting good mental health to a community now by having podcasts like this about creativity, and I think that's really neat. So thank you.

Lisa Belisle: Thank you, Scott. I've been speaking with Dr. R. Scott Wright, who is the professor of medicine and consultant in cardiology with the Mayo Clinic College of Medicine, fellow of the American College of Cardiology, European Society of Cardiology, and the American Heart Association. And really the list of things that you do goes on and on. So I appreciate your willingness to come in and take time out of your very busy day to have this wonderful conversation about creativity and how it's manifest in the medical and clinical world. I'm Dr. Lisa Belisle. You have been listening to or watching our video podcast, Radio Maine, where we explore creativity and the human spirit. We are sponsored by the Portland Art Gallery in Portland, Maine. Thank you so much for coming on, Dr. Wright.