3-20-25 MSC Perspectives on Medicine lecture - John Mayer

Name: 3-20-25 MSC Perspectives on Medicine lecture - John Mayer
Uploaded: 2025-03-20T18:18:21.3Z
Duration: 1 h 39 s

March 20, 2025

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00:00It's
00:02good.
00:05Okay.
00:06Hi, everyone. I think we
00:07can go ahead and get
00:08started. Thanks for joining today,
00:10and welcome to the fourth
00:11and final presentation this year
00:12that we're hosting as part
00:13of the medical student council
00:14lecture series.
00:16Today, I'm excited to introduce
00:18our last, lecture series speaker,
00:20doctor John Meyer. He is
00:21a leader in congenital cardiac
00:23surgery and cardiac research.
00:25Doctor Meyer earned his BA
00:26from Yale College and his
00:27MD from here at Yale
00:28School of Medicine before completing
00:30surgical training at, University of
00:32Minnesota.
00:33Since nineteen eighty four, he's
00:34been an important contributor over
00:35the last forty years to
00:37Boston Children's Hospital and Harvard
00:39Medical School, where he served
00:40as professor of surgery and
00:41a senior associate in cardiac
00:43surgery.
00:44With over seven thousand congenital
00:46heart surgeries performed, doctor Meyer
00:47has pioneered advancements in myocardial
00:49preservation, tissue engineering, and health
00:52policy.
00:53Beyond the operating room, he
00:54has deeply committed to surgical
00:55education, including support supporting Yale's
00:57advanced anatomy and surgical training
00:59initiatives to inspire future surgeons.
01:02Today, doctor Meyer will provide
01:04his talk titled the continuing
01:05education of an academic surgeon,
01:07and we'll have some time
01:08for questions at the end.
01:09Please welcome me in joining
01:11and please join me in
01:12welcoming doctor John Meyer.
01:18Well, thank you very much.
01:20It's a pleasure to be
01:21back.
01:24And been a long time
01:25since I graduated from medical
01:26school as you'll see in
01:28the slides. But,
01:31you know, it's a
01:32very fond
01:33part of my life's history
01:35that, time I spent here.
01:39I can't I'll tell a
01:40funny story to start with.
01:41I I now interview for
01:43the,
01:44Harvard Medical School admissions committee.
01:48And one of the students
01:49or applicants I was
01:51interviewing last year,
01:53actually was the captain of
01:56the Harvard women's field hockey
01:58team.
02:00So we get through the
02:01interview, and we're at the
02:02end, and I offer the
02:04opportunity to ask any questions.
02:06And she
02:08asked who I rooted for
02:09at the Yale Harvard game.
02:13And I told her I
02:14still had a lot of
02:14blue blood in my veins,
02:16so it was mostly,
02:18rooting for Yale. So,
02:23okay.
02:24These are my disclosures.
02:26I'm still working in the
02:28laboratory,
02:29as well as teaching at,
02:32Harvard Medical School.
02:35And these are some of
02:37the things,
02:38that we have external support
02:39from as well as art
02:41association and NIH.
02:44So
02:45my story starts in Tampa,
02:46Florida. I
02:48was, born and raised there,
02:52went to a public high
02:53school.
02:54That's the picture from the
02:55yearbook, believe it or not.
02:59You know, when I was
03:00in high school, I
03:04had a few trips to
03:05the orthopedic surgeon's office.
03:08And,
03:09my
03:11football career was somewhat limited
03:13as a consequence, but I
03:15thought this was pretty neat
03:16that it would be nice
03:18to be a
03:20physician, probably
03:21a sports medicine orthopedic surgeon.
03:24And so that's that's where
03:26this all started.
03:28So this is kind of
03:29my autobiography,
03:31and what
03:32I hope to do is
03:34by just providing a few
03:36autobiographical
03:37vignettes, if you will,
03:40give you some idea about
03:43how
03:44I have continued to educate,
03:47and how important I think
03:49it is that
03:50we educate the next generation.
03:53So
03:54I,
03:55had never seen snow until
03:57my senior year in high
03:58school when I,
03:59was
04:01encouraged by my uncle who
04:03has lived in New Jersey
04:04that I should apply to
04:05an Ivy League school.
04:07And so that's how I
04:08wound up here at Yale,
04:11for my undergraduate.
04:13My,
04:15counselor, freshman counselor, when I
04:17was there,
04:19was actually a first year
04:21Yale medical student, and his
04:23advice was
04:24you're gonna be doing science
04:26and medicine the rest of
04:27your life,
04:28do something different when you're
04:30here. So I was a
04:31history major,
04:33and did all my pre
04:35med requirements as electives.
04:38That, as you will see
04:40in subsequent slides,
04:41actually had a non trivial
04:43impact on me and my
04:45future life.
04:47So I stayed for medical
04:48school,
04:49and I think it's still
04:51the case everybody's required to
04:53do a thesis.
04:55And so
04:57I approached,
04:59one of the cardiac surgeons,
05:02Graham Hammond,
05:04who, unfortunately, has just passed
05:06away over the last few
05:07years.
05:09And
05:09he,
05:12had sort of gotten interested
05:14for some reason. I can't
05:15even remember in platelet function
05:17and thrombosis
05:18and how that was a
05:19problem in arterial
05:22and,
05:23venous systems, in particular,
05:25arterial reconstructive
05:27surgery.
05:28And so
05:30it was new knowledge that
05:31had come out about how
05:33to inhibit platelets.
05:35And so literally,
05:37the experiment I did,
05:39was,
05:40to
05:42have an arterial injury model.
05:44Did a femoral,
05:46artery injury model in dogs,
05:48pretreated
05:49some of them with
05:51aspirin, some of them with
05:52another poignantly inhibitor called diapritamole
05:54or persantin,
05:56and demonstrated that we could
05:58actually keep the vessels open
06:00if we inhibited the platelets
06:02in that arterial injury model.
06:06Actually wound up getting published
06:08in
06:09a pretty reputable journal.
06:12And that was the launch
06:13of my career,
06:15in experimental surgery. When I
06:17was in doctor Hammond's lab,
06:19he was also interested
06:20in heart valves and tissue
06:22valves in particular, trying to
06:24figure out how to make
06:25tissue valves.
06:26And
06:27as a fourth year medical
06:29student, I actually put some
06:31heart valves in dogs on
06:33bypass. So pretty,
06:36in retrospect,
06:37pretty amazing that they even
06:38let me do that. But
06:40I had good, postdoc fellows
06:42there.
06:43So from,
06:45from Yale, I went to
06:46the University of Minnesota for
06:48both my general surgery training
06:49and CT surgery training.
06:52In those days, you couldn't
06:53get to be a CT
06:54surgeon unless you had general
06:56surgery first.
06:57That's
06:58somewhat different now.
07:01And then,
07:02because when I was in
07:03medical school, there was still
07:04a doctor draft,
07:06and I had signed up
07:07for something called the Berry
07:08plan. I
07:11got to salute the flag
07:12for a few years,
07:15as a cardiothoracic
07:16surgeon. At least I had
07:17finished all my
07:19cardiothoracic
07:20and general surgery training. And
07:22where I was stationed initially,
07:24they didn't have a heart
07:25program.
07:26And,
07:29being somewhat,
07:30impetuous,
07:31I, thought it would really
07:33be a good thing to
07:34do to
07:35to try to do that
07:37so that I didn't
07:39go few years without operating
07:42on the heart.
07:44And,
07:45there's a whole story,
07:46behind that about how I
07:48managed to get that accomplished.
07:51That's probably
07:53not worth telling,
07:54but I'm happy to spend
07:56a little more time.
07:57But I did learn a
07:58lot about how the government
08:00worked,
08:01in that experience,
08:02and
08:03that also comes back,
08:05in subsequent,
08:07years.
08:08So when I finished my
08:11Air Force commitment, I
08:13was
08:14offered a position at Boston
08:16Children's and
08:18been there ever since.
08:20So since nineteen eighty four.
08:23And more recently,
08:25I've been much more involved
08:27in,
08:28the undergraduate medical school education,
08:31and we'll talk about that
08:33and when we get to
08:34it.
08:35So that's kinda the chronology
08:37of
08:38what I've
08:39done. So a little
08:41side detour here for one
08:43day a week in a
08:44bioethics fellowship,
08:46that I did relatively recently
08:48as well.
08:50So
08:51this is the career path
08:53or lack of path,
08:55and I think it is
08:57important
08:58that,
09:00one recognizes
09:01that this is not,
09:03at least for me, was
09:05never a straight line path.
09:07It was pretty important,
09:10to be able to
09:12explore new areas and new
09:14directions.
09:16And
09:17as,
09:19Gabe, mentioned, you know, I
09:21wound up getting pretty involved,
09:24in health policy type things,
09:27for our national professional society.
09:31And,
09:33I think, you know,
09:34the
09:36the history major, as you
09:38can see, you know, sort
09:40of comes back
09:42when I'm getting involved in
09:43health policy.
09:45It comes back
09:47when I got involved in
09:48an executive course at the
09:50Kennedy School of Government at
09:51Harvard.
09:52And,
09:54in a lot of ways,
09:56these,
09:58various
09:59historical things,
10:01whether it was my thesis
10:03research,
10:03originally,
10:04starting,
10:06here,
10:07or whether it was my
10:09laboratory research when I was
10:11in the lab at the
10:13University of Minnesota.
10:15All of those,
10:19experiences
10:20and undertakings,
10:22you know, really came back
10:24and put had important influences
10:27on the rest of my
10:28career.
10:29I, am quite certain I
10:32might not have
10:34pretty certain I wouldn't have
10:36necessarily wound up where I
10:37did at Boston Children's Hospital,
10:41but I'll explain a little
10:42bit more about how that
10:44happened in a minute.
10:47And all of this has
10:48led to what I'm doing
10:49now, which is being involved
10:52with the teaching in the
10:54first year curriculum at Harvard
10:56Medical School
10:58and also
10:59involved in an advanced surgical
11:01anatomy course.
11:03And
11:04that's the parallel to that
11:06is what
11:07we've been able to support
11:09here
11:10over the last few years.
11:11I'm told it's a pretty
11:13popular course,
11:14and even a few of
11:16the people who participated here
11:18are actually contributing back,
11:21as well. Pretty remarkable I
11:23would say.
11:26So lots of great experiences
11:28here. This starting this open
11:30heart surgery program at an
11:32Air Force Medical Center was
11:34among the more,
11:36remarkable as I think back
11:38on it.
11:40Sometimes it's better to be
11:41a little impertinent,
11:43to get things done, but,
11:45that that's really what happened.
11:48So let's take this apart
11:49a little bit, and let
11:50me give you a few
11:52vignettes. And I hope this
11:53will be at least somewhat
11:55demonstrative
11:56of
11:57how one gets from the
11:59starting
12:00point. You know, as
12:02a high school kid
12:04from,
12:05Florida
12:06coming to Yale,
12:08I think my class was
12:09either the first or second
12:10one where there were more
12:11high school kids than there
12:12were prep school kids,
12:14to give you a little
12:16more historical perspective.
12:20So
12:22I mentioned this,
12:23thesis that I wrote actually
12:25got published in the analysis
12:27of surgery based on those
12:28experiments that I had done,
12:31in doctor Hammond's lab,
12:34which he completely supported.
12:36You know, never you know,
12:37I guess he had funds
12:39that he could,
12:42he could,
12:43gamble with.
12:45And I would say he
12:46gambled with me, but, fortunately,
12:48this actually worked out. Actually
12:50two publications
12:51came out of that research
12:52work,
12:54but that really set the
12:55stage for me to wind
12:57up at the University of
12:58Minnesota. And so the University
12:59of Minnesota has
13:02historically
13:03been
13:04a place that has dedicated
13:06to training academic surgeons.
13:08And most of that
13:10emphasis and
13:12direction
13:13was set by doctor Longenstein.
13:15Owen Longenstein,
13:18who was the chair of
13:19the department of surgery there
13:21for quite a number of
13:22years, thirty four years.
13:26Those of you who have
13:27ever sent anything to the
13:29American College of Surgeons annual
13:30meeting,
13:31The surgical forum is known
13:33as the Wangenstein
13:34Surgical Forum,
13:36in recognition of the fact
13:38that he was so
13:40interested in having
13:42surgeons,
13:44be carrying out
13:46actually basic research.
13:49I put in here a
13:50little quote from a forward
13:52that he wrote to a
13:53book
13:55called Congenital Malformations of the
13:57Heart which sort of was
13:58written by Walt Loaheye and
14:00Danny Gore,
14:02about
14:04congenital heart disease, obviously.
14:06But,
14:08for those of you who
14:09don't know this history about
14:11heart surgery,
14:12you know, the first open
14:14heart operations
14:16for repair of anything more
14:18complicated than an atrial septal
14:20defect were carried out at
14:21the University of Minnesota.
14:24And
14:24it was the
14:27emphasis
14:28on academics, on research,
14:31on
14:31having experience in the basic
14:33science labs that were all
14:35part
14:36of the substrate that led
14:38to the ability of the
14:39group at that time
14:41to actually carry out the
14:43first successful open heart surgeries.
14:45And literally,
14:47that opened the door to
14:49all of cardiac surgery.
14:51There had been a few
14:53attempts prior to that in
14:54other places,
14:57that had sort of started
14:58and stopped because the results
15:00weren't very good.
15:02And
15:03with doctor Wongenstein's support,
15:06Walt Lulla Hai and Richard
15:07Varko were the two,
15:09senior surgeons at that point,
15:12you know, actually started all
15:13of cardiac surgery.
15:15And the mission was to
15:17train academic surgeons, and that
15:19was what attracted me to
15:20the program. That's why I
15:22went, even though by that
15:24time both Doctor. Lojai and
15:25Doctor. Wangenstein had
15:28moved on, but,
15:29doctor Wongenstein was still around
15:31actually as
15:32a Emeritus professor. But,
15:36suffice it to say, the
15:38atmosphere that had been created,
15:40was really important for training
15:42academic surgeons.
15:47So how did I get
15:48from the University of Minnesota
15:49to Boston Children's? Well,
15:52back in the lab again.
15:54This time, I worked in
15:55Ed Humphrey's lab,
15:58who was
15:59a thoracic surgeon,
16:01and who but who had
16:03a sort of basic science
16:04tilt.
16:05And so we were working
16:08on
16:09pulmonary capillary permeability and the
16:11factors that would affect how
16:13leaky the pulmonary capillaries were.
16:16And
16:18as part of that,
16:20we also
16:22took the whole graduate sequence
16:23in physiology.
16:26So I took alongside the
16:28PhD physiology students.
16:31I took renal physiology and
16:33cardiovascular
16:35and pulmonary and endocrine, and
16:38you'll see why that comes
16:39back to be, useful,
16:42at a subsequent point in
16:43a couple of slides.
16:46So
16:47all of this background here,
16:49this background with research that
16:51started here,
16:54as well as the work
16:57that we did,
16:58in the research laboratory,
17:01Doctor. Humphrey's lab.
17:03We
17:04brought a new animal model
17:07into the lab
17:08as a way to study
17:09pulmonary capillary permeability.
17:12And
17:14that led not only to
17:15some publications but obviously some
17:18reputational
17:20benefits
17:21as well.
17:22And I list here in
17:24the middle,
17:26box
17:28the,
17:29people that I worked with.
17:31So,
17:33in the congenital heart world,
17:35doctor Castaneda
17:36is,
17:37you know, one of the
17:38real,
17:40pioneers, I guess, particularly for
17:42neonatal heart surgery.
17:46And I was,
17:49exposed to him during my
17:51initial years at, the University
17:53of Minnesota, and then he
17:55left and moved to Boston
17:56Children's.
17:57And then doctor Barkow, as
17:59I mentioned earlier, was one
18:01of the first,
18:04open heart surgeons at Minnesota.
18:06Doctor Lillehei being the one
18:08who's got a lot more
18:09notoriety, but doctor Varko was
18:11really the
18:14world class technical surgeon who
18:16was involved in making that
18:18work.
18:19And then doctor Humphrey, but
18:21also the last name listed
18:23there is doctor Norwood, Bill
18:25Norwood.
18:25So Bill Norwood,
18:27who's now famous
18:29as a
18:31no longer alive,
18:32unfortunately, but neither he nor
18:34doctor Kastenade are alive. But
18:36doctor Lloyd's
18:37famous for having devised an
18:39operation for an otherwise
18:41hundred percent fatal lesion called
18:43hypoplastic
18:44left heart.
18:45So Bill was my senior
18:47resident when I was a
18:48junior resident, and so we
18:50had kept in touch.
18:52And so as I was
18:54coming out of the military
18:55and looking for a job
18:57and,
18:58you know, had written to
18:59Bill,
19:00because he at that time,
19:01he was
19:03at Boston Children's along with
19:04doctor Castaneda.
19:06And
19:09one day, I was sitting
19:10in my little air force
19:12medical office,
19:14And I got a call
19:16in the morning from doctor
19:17Norwood saying
19:19he was taking the job
19:21at the Children's Hospital of
19:22Philadelphia
19:25and was I interested in
19:26coming with him as his
19:27first fellow.
19:29And that afternoon, I got
19:30a call from doctor Castaneda
19:32saying,
19:34Bill's leaving to for Philadelphia.
19:36Are you interested in looking
19:37at
19:38considering a junior faculty job?
19:41So that's one of those
19:42days that's in the diary.
19:43Right? You know, you don't
19:45forget that kind of day.
19:47And so I
19:50looked at both positions. I
19:51thought the one in Boston
19:52was a little more secure
19:54because I wasn't going as
19:55a trainee. I was actually
19:56going on the faculty, and
19:59as they say, the rest
20:00is history. But
20:03doctor Castaneda,
20:04you know, had worked very
20:06closely
20:07with
20:08doctor Varco
20:09and doctor Humphrey when he
20:11was a junior faculty person
20:12at Minnesota.
20:14And so you can see
20:15how these connections
20:16all really make a difference.
20:22So let's change gears.
20:24So I'm here at Boston
20:26Children's,
20:27and I'm a junior faculty
20:29person. And in those days,
20:31we had
20:33to literally
20:35sign
20:35a form
20:38in order to submit a
20:39bill
20:41for the surgical services to
20:43get approved.
20:45And we had somebody who,
20:46in retrospect, was probably not
20:48very
20:50well informed or educated about
20:52this whole process.
20:55And,
20:56you know, I looked one
20:58morning when I was signing
20:59my
21:01so called HCFA, health care
21:02finance administration fifteen hundred. That's
21:04what the form was called.
21:06HCFA fifteen hundred form.
21:09And I said, well, that's
21:10not what I did.
21:11And so then
21:12I started self educating.
21:14And so I
21:16got a
21:17book
21:18that's called published by the
21:20AMA called Current Procedural Terminology,
21:22CPT book. Right?
21:24CPT.
21:25So I look in the
21:26book,
21:28and I start learning about
21:29the codes and all that
21:31stuff. Then I have to
21:32learn about the diagnosis side,
21:33which was the ICD nine
21:35codes.
21:36And
21:38after,
21:38you know, fooling around with
21:40that for a few months,
21:41I decided, well, you know,
21:43I should just take this
21:44over.
21:45So
21:46for our little practice, there
21:47were only three of us
21:48at that time,
21:51I did all the coding
21:52and billing.
21:54And so one Saturday morning,
21:56I used to do this
21:57every Saturday right after mortality
21:59morbidity conference, so I it's
22:02all fresh in my mind.
22:03I could code all the
22:04cases, and
22:05numbers stuck with me pretty
22:06easily. So
22:08one Saturday morning, I sat
22:09down and to do the
22:11coding,
22:12half the cases we had
22:13done that week, there wasn't
22:15a code for. I was
22:16having issues pointed into something
22:18else.
22:19So this is, you know,
22:20pretty mundane stuff and, you
22:22know, whatever.
22:23So I was in a
22:25little bit of a fit
22:26of peak. I wrote a
22:27letter to this AMA,
22:29and I said,
22:30there's nothing in your book
22:32that describes what we're doing.
22:35So they got a polite
22:36letter back, you know, a
22:37week later.
22:39And,
22:41they said, well, usually that's
22:42handled through your professional society.
22:44So, you know, the chairman
22:45of that group for your
22:48National Professional Society called the
22:49Society of Thoracic Surgeons is
22:53doctor Levitsky.
22:54Doctor Levitsky was at
22:57the Beth Israel Deaconess two
22:58blocks away from me.
23:02Next thing I know, I'm
23:03rewriting
23:04the congenital codes for the
23:06CPT book,
23:08and
23:09that all got through and
23:10was approved and everything.
23:12And about this time,
23:15two big contextual things are
23:17important.
23:18One,
23:20we had a
23:22Medicare reimbursement system that was
23:24a pretty significant departure from
23:26what it had been before.
23:29So there was legislation
23:31nineteen eighty nine
23:33that established something called the
23:34Resource Based Relative Value Scale,
23:36RBRBS.
23:38RBRBS
23:41became
23:42a whole
23:43industry unto itself.
23:45The AMA
23:47got into it and formed
23:48actually a committee
23:50that would consider
23:52codes and how they were
23:54valued
23:55so that
23:56then
23:57you would that would determine
23:59what the Medicare reimbursement was.
24:01And the important
24:03detail here is even though
24:04we weren't taking care of
24:05Medicare patients,
24:07about seventy or seventy five
24:08percent of the
24:10reimbursement by private payers
24:13was based on that RBRBS.
24:15Okay.
24:16So at the same time,
24:17we have
24:19the first or one of
24:21the
24:22more recent attempts at establishing
24:25single payer health care
24:28was affectionately or not affectionately
24:30known as Hillary Care.
24:33And,
24:34you know,
24:36I I sort of was
24:38thinking about that, seeing how
24:40that was playing out.
24:42Got a copy of the
24:43federal register, which is where
24:45they publish all of these
24:47r b relative values.
24:49None of the congenital codes
24:50had any relative values. Nobody
24:52had bothered because Medicare wasn't
24:54gonna pay for it. But
24:55if we went to single
24:57payer,
24:58we were gonna have to
24:59have values. So then it
25:01was
25:03we'll we'll figure that out.
25:05So we organized this study,
25:07got
25:09fifty congenital heart surgeons around
25:11the country to fill out
25:12surveys about
25:14how hard it is to
25:15do an ASD repair versus
25:17an aortic valve repair versus
25:20an arterial switch operation, whatever.
25:23And we got it all
25:24through
25:25this relative value update committee.
25:28So little funny stories in
25:29there as well about, you
25:31know, I was I went
25:32in with eighty codes that
25:34the this relative value update
25:36committee had to evaluate and
25:38decide whether or not they
25:39were
25:40and the staff person who
25:42was helping us with this
25:45said,
25:47we'll see you in a
25:48day or two because
25:50it takes forever even to
25:51get one code considered, and
25:53we were in and out
25:54in fifteen minutes.
25:56So
25:58why was that? Well, number
26:00one,
26:01we weren't gonna impact the
26:02Medicare
26:03budget,
26:04so
26:05nobody was worried about
26:07us taking dollars out of
26:09somebody else's pocket.
26:11And the second thing was
26:13that, actually, all the surveys
26:14had really worked out pretty
26:15well. We had pretty tight
26:17data.
26:18And all of a sudden,
26:19I was, you know, the
26:22local expert
26:23on this relative value update
26:25committee, which then led to
26:27me assuming that role for
26:28the entire STS. So all
26:31the adult cardiac and thoracic
26:32surgeons as well as the
26:34congenital
26:35surgeons.
26:37You know, and so I
26:38represented the STS for ten
26:39years at that relative value
26:41update committee.
26:43So
26:44this is sort of interesting.
26:46Right? I think as I
26:47reflect on this, you know,
26:49you have a problem. You
26:50recognize it.
26:53You start learning about it.
26:55New discipline.
26:57New nuts you know, things
26:58I'd never
26:59had any idea about before.
27:02And
27:04we actually devised a solution,
27:06and it worked.
27:08And,
27:09you know, a lot of
27:10those values that we established,
27:11you know, twenty plus years
27:13ago are the ones that
27:14are still in the book,
27:15and are guiding and governing
27:17reimbursable.
27:21So
27:23you know that led me
27:24into this whole other realm
27:26at the National Professional Society
27:28level, which is having to
27:30do with health policy in
27:31reimbursement
27:32issues.
27:35And, you know, so here,
27:37I'm gonna come back and
27:39sort of cite my history
27:40major experience that gave me
27:42the perspective to be able
27:43to do that.
27:45And the experience, obviously, is
27:47a representative
27:48to the for the society
27:50to this relative value update
27:52committee.
27:54I had another
27:55formative experience
27:57because I was
27:59invited to be part of
28:01this course
28:02that was given at the
28:03Kennedy School of Government.
28:05It was mostly inspired by
28:07one of our senior
28:08surgeons at that time, a
28:10gentleman named Jack Matloff, who
28:12was at Cedars Sinai in
28:14Los Angeles, but had done
28:16a year as a
28:17master's degree
28:19during a sabbatical.
28:21And he thought we were
28:23woefully
28:24under,
28:26represented
28:28in anything having to do
28:29with health care policy.
28:31And so the course was
28:32entitled understanding the new world
28:34of health care. It was
28:35a ten day executive course,
28:37and we learned a lot
28:38about how the government works
28:40and how it
28:41sometimes doesn't.
28:43And I would say that
28:45in addition to that,
28:49the military experience,
28:52gave me a whole
28:53unique insight, I think, into
28:56that side of the government
28:57as well
28:58and how stuff gets done
29:01at the government level.
29:03So I probably have time.
29:05I I'll tell you this
29:06story.
29:07So
29:08I'm in the military. We've
29:09got everything in place. Equipment
29:12wise, we had six
29:15anesthesia
29:16residents
29:17who had been
29:19they weren't residents. They were
29:20now, like me, coming in
29:22as part of
29:23the draft or
29:25they had had their medical
29:26school paid for
29:28in the HPSP program, but
29:29we had six fully trained
29:31cardiac anesthesiologists.
29:33We had two pumps that
29:35some of my predecessors had
29:37acquired.
29:39We had a fully equipped
29:40ICU.
29:42Why weren't we doing heart
29:44surgery?
29:45And instead, we were sending
29:47cardiac patients from our cath
29:49lab out to the private
29:51sector, which was costing,
29:53in those days, a lot
29:55of money.
29:56Nowadays, would seem trivial, but,
29:58you know, there was twenty
30:00five thousand or more per
30:01case to send that out
30:03to the private sector. So
30:04what do we do?
30:06I
30:07worked out in detail
30:10down to the suture How
30:12much it would cost us
30:13to do those cases at
30:15our hospital versus
30:17do them at
30:19a private institution,
30:21through this private insurance program
30:23called CHAMPUS in those days,
30:26now called TRICARE.
30:28So I ran that up
30:30FIFO at,
30:31within the Air Force chain
30:32of command,
30:34and they said,
30:35you know, you're in the
30:37same pot of money as
30:38the guys that are buying
30:39the jet fuel and the
30:41bullets for the machine guns
30:43and stuff like that.
30:44Can't do it.
30:47So I'm pretty discouraged.
30:49I take some temporary duty,
30:52wind up going to the
30:53Armed Forces Institute of Pathology
30:55in Washington because they had
30:56a heart collection,
30:58got to know the surgeons
30:59at Walter Reed.
31:02They were short.
31:04So they decided
31:06they were gonna trade.
31:08So they offered to trade
31:09an army thoracic
31:11non cardiac surgeon
31:13to the air force,
31:15come to be stationed in
31:16Mississippi where I was stationed,
31:18and then I would go
31:19to Washington.
31:22And the air force said,
31:26sorry. We need this Meyer
31:27guy here. You know? He's
31:28gonna start an open heart
31:30program
31:31after they just turned it
31:32down.
31:33So I got unhappy,
31:36as you might imagine,
31:37and happened to have a
31:39relative
31:42who was in Washington, and
31:44I really didn't quite appreciate
31:46everything that, he had done.
31:50And I sent him everything.
31:52He's I called him up.
31:53I sent him everything. He
31:54said,
31:55let me show this to
31:56a few people I know.
31:59Ten days later, I get
32:01a call
32:03from the office of the
32:04chairman of the Senate Armed
32:05Services Committee
32:11who, the staff person
32:13asked me to sort of
32:14go over a few of
32:15the details, verify the story.
32:17Yep. Okay.
32:21He said, well, as a
32:22taxpayer, that sort of pisses
32:23me off that you could
32:24do it for a fifth
32:25of the cost. Right? So
32:28six weeks later, my immediate
32:29superior officer was in my
32:31office asking me how soon
32:32I could be ready to
32:33go.
32:38Sometimes you can't plan this
32:39stuff out. It just happens.
32:42But it turned out, I
32:43found out subsequently,
32:45that my
32:46cousin by marriage had actually
32:49run
32:50Howard Baker's campaign for president
32:52when he was running for
32:54president in nineteen eighty,
32:56and you couldn't have picked
32:57a more connected
32:59person.
33:01So
33:03you never know, but you
33:04have to keep trying.
33:07This is actually a picture
33:08from that first Kennedy School
33:10course.
33:11There are seven people in
33:12that picture that were presidents
33:15of either the Society of
33:16Thoracic Surgeon or the American
33:18Association for Thoracic Surgery.
33:24So what about the science?
33:25You know, was I just
33:26fooling around in public policy
33:27and stuff all that time?
33:29Well, I would say I
33:31would give you two examples
33:32of things that occupied a
33:34lot of my
33:35academic,
33:37traditional academic
33:39work.
33:40One was in this realm
33:42of myocardial protection, and the
33:44question was
33:47common assumption in those earlier
33:49years that somehow neonates
33:51were there. Myocardium was more
33:54vulnerable
33:55to ischemia reperfusion
33:57than an adult
34:00who was having a heart
34:01operation.
34:02And so
34:04we
34:05I had a fellow who
34:07came to the lab who
34:08made the observation that the
34:10way that the patients were
34:13reperfused
34:14in our operating rooms were
34:16quite different after a period
34:18of ischemia, were quite different
34:20than from his home institution.
34:22And so we pursued that
34:25and found out that
34:28the pressure conditions
34:30under which you reperfuse the
34:32heart after a period of
34:33myocardial ischemia
34:35are pretty critical,
34:37at least especially for neonatal
34:39hearts. So we had a
34:40neonatal lamb model. That's what
34:42we did. We
34:44took the heart,
34:46subjected it to ischemia,
34:49cold ischemia
34:50as you would if you
34:51were having
34:52a cardiac operation, and then
34:55reperfused it and altered just
34:57the reperfusion
34:58conditions.
34:59And what we found out
35:00was there was pretty strong
35:02evidence there
35:03that there was endothelial
35:05injury
35:07that was occurring during that
35:08reperfusion period
35:10and that you could mitigate
35:12that
35:13with a variety
35:15of pharmacologic
35:16and other,
35:19means
35:20in addition to just controlling
35:21reperfusion,
35:23pressures.
35:25And
35:26we ultimately,
35:28determined,
35:30through some,
35:31endothelial function studies using
35:34acetylcholine
35:35as a coronary vasodilator
35:37that only works
35:39if you have an intact
35:40endothelium.
35:41You know what that in
35:42fact the endothelium was a
35:43really big part of this.
35:46That led to a lot
35:47of publications,
35:48but from a clinical standpoint,
35:50what did we learn? We
35:52learned that
35:53a variety of these medications
35:55would work, would help at
35:58least in isolated lamb hearts.
36:00And so
36:02what was available readily right
36:03off the shelf was nitroglycerin.
36:05And so every patient that
36:07I operated on
36:08after that got nitroglycerin
36:10during the initial reperfusion period
36:12after a period of myocardial
36:14ischemia.
36:16So that was all in
36:17the context of this emerging
36:19knowledge about endothelial function. It
36:21wasn't just a lining cell,
36:23it had all sorts of
36:24functional
36:25impact, including release of
36:28both relaxing
36:29and,
36:31constrictive
36:31factors.
36:34And what we also found
36:35out was that
36:38this was a collaborative
36:40effort.
36:42And it involved,
36:43you know, people from different
36:45backgrounds, different disciplines.
36:47We
36:47started investigating
36:49in,
36:50neutrophil,
36:51endothelial
36:52interactions,
36:54which were critical to, this
36:56whole endothelial injury and reperfusion,
37:01injury that that occurs.
37:04So that was
37:06the majority of the early
37:07work.
37:08And then
37:09in the last twenty five
37:11plus years, we've been trying
37:13to solve another problem,
37:15which is the problem of
37:18being able to accomplish
37:20a
37:21complete
37:22physiologic
37:22repair
37:24in a baby.
37:26But if that baby was
37:28lacking
37:29a pulmonary artery or pulmonary
37:30valve or both or whatever,
37:33that would,
37:36that you could
37:37find a conduit.
37:38Typically, now what's used are
37:40homographs.
37:41But,
37:42in the early days, people
37:43were using prosthetic
37:45graphs,
37:46but they don't grow. They're
37:48not alive.
37:49And so
37:50our last many years of
37:53work,
37:54have been directed at trying
37:56to address this problem by
37:57creating a living structure. So
37:59both valve and conduit wall,
38:02would be the, you know,
38:04the ultimate goal.
38:06But
38:07the hypothesis
38:08is that if we have
38:09something that's alive,
38:11it will grow just like
38:13your normal valve does,
38:15and your normal artery.
38:18I wanna emphasize again the
38:20importance of these multidisciplinary
38:23collaborations.
38:27Bioengineering,
38:28I had a great collaborator,
38:30you know, for
38:32twenty
38:33probably of those years as
38:34a bioengineer.
38:37We got involved with people
38:39who had expertise in matrix
38:41biology and cell biology.
38:43And more recently,
38:44we
38:45are collaborating with people who
38:47know
38:48a lot about proteomics,
38:51and as you saw in
38:52this
38:53disclosures,
38:54we've
38:55also gotten involved with some
38:57biotechnology
38:58companies who are trying to
38:59carry some of these ideas
39:01forward,
39:02into clinical,
39:04application
39:05and approval.
39:08So
39:11one last,
39:13vignette here is,
39:15the
39:16work that I've been involved
39:18in,
39:19in the last probably ten
39:20years or so about
39:23outcomes,
39:24in congenital heart surgery.
39:27And the context is that
39:29probably twenty years ago or
39:31more,
39:32an effort was started at
39:34the Society of Thoracic Surgeons
39:35to create a database
39:37that would collect all the
39:38cases that were being done,
39:40a lot of information
39:41about that, and then try
39:43to figure out,
39:44you know, how we could
39:46use that to get better.
39:48I think we got off
39:50track, or,
39:52leadership at that time got
39:53off track
39:55because not only do we
39:56create a
39:57mortality risk model,
39:59but it got into the
40:01public arena.
40:03And I think that's
40:04probably
40:05not such a good idea,
40:07and we could maybe discuss
40:09that further in the discussion
40:11time.
40:12But what was happening is
40:14two things.
40:15People started paying attention because
40:17this was showing up in
40:18US News and World Report,
40:20and it was,
40:23an a real incentive
40:25to game the system, if
40:26you will,
40:27up code, do whatever.
40:31And, also, I think it
40:33led to a lot of
40:34questions about how well the
40:36model worked. Was it really
40:38credible?
40:39Was it accurate?
40:40Or and how much was
40:42this getting off track?
40:47There was
40:49a real,
40:50movement among congenital heart surgeons
40:52around the country to bail
40:54out,
40:55which would, I think, have
40:56been a tragedy. And so
40:58I kind of got pulled
40:59into this,
41:01and asked to take over
41:02this effort. And as part
41:04of that,
41:06solving this problem,
41:08we developed
41:10some new concepts
41:11about how you define patient
41:13cohorts.
41:14And in particular,
41:16all the cohorting had been
41:18done based on the name
41:20the type of operation
41:22without considering a number of
41:24other things.
41:25And one that sort of
41:27jumped out at me and
41:28which we then explored,
41:31was to cohort both by
41:33diagnosis and procedure.
41:35And you may say, well,
41:37for many cases
41:39that
41:39diagnosis is on one diagnosis,
41:41one operation,
41:43you know, that's not a
41:43big deal. But
41:45for many, particularly of the
41:47more
41:48high risk and palliative
41:51operations,
41:52you can actually have a
41:53whole series of diagnoses
41:55that could lead you to
41:56that same operative intervention.
41:59And if that happens,
42:02does the outcome
42:03vary by diagnosis?
42:05And the answer is absolutely,
42:07which in some ways is
42:09sort of intuitively obvious, but
42:10we had never done that.
42:13I had to learn a
42:14lot about statistics,
42:15And, fortunately, I had really
42:17powerful collaborators,
42:19one of whom is one
42:21of the statistical editors for
42:22the New England Journal.
42:24Nice to be in the
42:26local environment.
42:28And,
42:29you know, I
42:31still don't claim any expertise,
42:33but at least I can
42:35talk the language a little
42:36bit. And I understand about
42:38Bayesian edited regression trees and
42:40less so. And,
42:42you know, this has subsequently
42:43led to
42:45NIH funding
42:46and, you know, at least
42:47four papers already published and
42:49several more in the works.
42:52And
42:53we've already
42:56accomplished
42:57changing at least some of
42:58the ways that STS
43:00has been running this risk
43:02model mortality risk algorithm.
43:05And by the way, I
43:06will take personal credit for
43:08getting rid of the star
43:09system,
43:10you know, like rating restaurants.
43:11You know, we had one
43:12star, two star, three star
43:14programs.
43:15I got rid of that,
43:17as part of
43:18the time when I was
43:20leading this effort.
43:21So now we're trying to
43:23lead from behind and
43:24develop new science and
43:26bringing,
43:29bringing, this,
43:31what to what I hope
43:32is both a more credible
43:33and a more,
43:35accurate,
43:36way of establishing
43:37risk.
43:41So what am I doing
43:42now? I'm still going to
43:44work.
43:45I'm would characterize
43:47my
43:48time now is my give
43:50back time.
43:51Part of the reason I'm
43:52here.
43:53Part of the reason that
43:54I'm teaching,
43:56at the first year students
43:57at the medical school.
44:00I've continued
44:01to,
44:02teach,
44:04our residents and fellows as
44:05I have all the way
44:06along during my time in
44:08Boston.
44:09I
44:11think, you know, even this
44:12has required some new learning.
44:14You know, I have had
44:15to learn some new vocabulary,
44:18because the way is things
44:20are taught at HMS
44:22are,
44:23you know, we use this
44:24technique called case based collaborative
44:26learning.
44:27There's a lot of emphasis
44:28on interleaving,
44:30and
44:31in this case based learning,
44:33we
44:34frequently
44:36present the students with difficulties
44:38and ask them to work
44:39their way through it.
44:41Some
44:41been characterized as
44:43desirable
44:45difficulties
44:45in learning, which is important
44:48for making it stick.
44:50There's actually a book called
44:51Making It Stick.
44:53But in
44:55more both learning opportunities
44:57as well as a way
44:58to give back.
45:00So did all you know
45:02how did this all come
45:03about? Was I just you
45:04know sort of
45:06you know
45:08jumping around from one thing
45:09to another. I I have
45:11to confess that one of
45:13the more important
45:14little
45:15turning points in my career
45:17was this article
45:20that one of my pediatric
45:22cardiology
45:23associates gave me
45:25called Open Season. And Robert
45:27Sapolsky
45:29was
45:29is a neuroscience
45:31professor at Stanford,
45:34who is really a renaissance
45:35kinda guy. I mean, he's
45:36written about a lot of
45:38stuff in a lot of
45:39different,
45:41things, but a lot of
45:42it has to do with
45:44human and human
45:46motivations
45:46and psychology
45:47and things like that.
45:49And I'll just give you
45:50a few things that I
45:52learned from that article that
45:54really influenced me.
45:57You know, there was a
45:58lot of conventional wisdom,
46:00up to that point that,
46:02you know, great creative minds
46:03were less likely to generate
46:05anything new,
46:06over time. You know, they
46:08had their flesh in their
46:09twenties and thirties, and and
46:11that was it. And, you
46:13know, two notable examples were
46:15Einstein, who could never apparently
46:17get his head quite around
46:18quantum mechanics,
46:20and,
46:22Mierski was a leading cell
46:24biology person who never accepted
46:26the idea that DNA was
46:28a molecule of heredity.
46:31What,
46:32doctor Sapolsky,
46:35pointed out is that, actually,
46:37brain aging does not necessarily
46:39involve massive neuron loss,
46:42and that the aging brain
46:44can actually make new neurons
46:45and form new connections.
46:47And one of the surest
46:48ways to make that happen
46:52is to place the organism,
46:54whether it's an experimental animal
46:55or
46:56Homo sapiens,
46:57in a stimulating
46:59environment.
47:00And he relates this
47:03ability to continue to have
47:05creative output
47:06and openness to novelty
47:09is best predicted
47:11by one's time and discipline.
47:13And I took this to
47:14heart. And as you can
47:16see, I've been in more
47:17than one discipline
47:19during the course of my
47:20academic career.
47:22I've had to learn a
47:23lot of new stuff.
47:26Had to learn about engineering.
47:27What engineering did I learn
47:29about when I was a
47:30history major? Not much.
47:32I had to learn about
47:34public policy, and I had
47:35to learn about this whole
47:37relative value system.
47:39And I've had to learn,
47:41about
47:42endothelial biology
47:44and endothelial
47:45cell function,
47:47you know, and how that
47:48relates back
47:50to what we do clinically.
47:53So this was really a
47:55important article.
47:57It's first published in the
47:58New Yorker and then published
48:00as part of
48:01a multiple,
48:03multiple,
48:04thoughts from this author,
48:07that was published in a
48:08book called Monkey Love, which,
48:12you might infer
48:13from the title,
48:15had to do with how
48:17we are, in many ways,
48:18still functioning as animals.
48:22So takeaways
48:23from this,
48:26I I guess my advice
48:27would be to beware the
48:29straight line,
48:31notion of a career.
48:33Recognize
48:34that
48:35working hard always works.
48:39But, also,
48:40one has to
48:42remember that
48:44it's important to try new
48:45things, and that's the
48:48whole Sapolsky
48:49message.
48:50Look for problems to solve.
48:53Be willing to cross disciplines.
48:57I think, you know, we
48:59sometimes get in our silos,
49:00and I think that is
49:02not good for making progress.
49:06Always think about if you
49:08don't know much about something,
49:09find somebody who does. I
49:11happen to be fortunate enough
49:13to live in a
49:15very rich intellectual environment.
49:18I can always find somebody
49:20who knows a heck of
49:21a lot more about a
49:22topic than I do,
49:23and seek them out, and
49:25find out, and learn from
49:27them. And you have to
49:28learn
49:29how to talk their talk,
49:30how to learn their vocabulary,
49:32but also
49:33learn how they think about
49:35problems.
49:35Because that cross disciplinary approach
49:38really enriches
49:39one's ability to make progress.
49:42And I think this is
49:44an important thing.
49:47So keep learning.
49:49And I would say particularly
49:50from this perspective as a
49:51no hair, gray hair guy
49:53that, you know, it's important
49:55to give back whenever you
49:57can.
49:58So thanks very much. I'm
50:00happy to
50:01have a discussion about any
50:03of or all of these
50:04points, and thank you very
50:05much for having me.
50:16All right. Thanks, Doctor. Meyer.
50:17It was great to hear
50:18about your,
50:19interdisciplinary
50:20career and see how a
50:21lot of it came together.
50:22We have about nine minutes
50:24for questions, so I can
50:25pass the mic around so
50:26we get it on the
50:26recording as well if if
50:27anyone has any.
50:34Hi, doctor Meyer. Thank you
50:35so much for your talk.
50:36It seems like you've been
50:37involved in a lot of
50:38different arenas throughout your career.
50:40And I'm curious how at
50:41each time point you kind
50:43of made the decision about
50:44how to balance your time.
50:45Obviously, it's impossible to be
50:47good at everything all the
50:48time.
50:49And so was that a
50:50role of mentors who, you
50:51know,
50:52helped guide you toward things,
50:53or was that kind of
50:54intellectual curiosity? And would love
50:56to hear a little bit
50:57more about that. I I
50:58think probably most of it
50:59was curiosity and recognizing a
51:01problem and then going after
51:02it.
51:03It's kind of a surgical
51:05approach, I suppose, one might
51:06argue.
51:08It's,
51:10you know, I I had
51:11a very
51:12supportive environment,
51:14certainly,
51:16where,
51:17you know, I could take
51:20three days, four times a
51:21week to go to a
51:22relative value update committee meeting,
51:24or I could
51:26take a week or ten
51:27days and go to the
51:28Kennedy School, or,
51:30you know, have time to
51:31work in the lab.
51:33You know, when we worked
51:35in the operating room, we
51:36worked hard. We did
51:38lots of cases.
51:40So
51:42and and but I would
51:43say the other thing, and
51:44I didn't emphasize it, at
51:46all and should have, is
51:48that,
51:49you know, the intellectual environment
51:51here is not just within
51:52the Department of Surgery. It's
51:54within the whole program. And
51:55so I think more and
51:56more now across the country,
51:58there
51:58are congenital heart programs that
52:01involve cardiologists
52:02and surgeons and anesthesiologists
52:04and intensive care docs
52:08and nursing and
52:10respiratory therapy and the perfusionist.
52:12I mean, it's a team
52:13sport.
52:15So
52:17I will have to say
52:18one other thing that I
52:20think is critical.
52:22I happen to be fortunate
52:24enough to marry a an
52:26extraordinarily
52:27supportive
52:28spouse,
52:30who
52:31when I couldn't show up
52:32for something because I was
52:33stuck in the operating room
52:35or off at one of
52:36these meetings or whatever.
52:38You know, she just picked
52:39up the ball and and
52:40carried it.
52:42So
52:43it would I would be
52:44very remiss not to,
52:46emphasize that point.
52:49I
52:50I think, you know, have
52:51we been down some blind
52:53alleys?
52:54Absolutely.
52:55Certainly,
52:57one might argue we don't
52:58have anything clinically ready to
53:00go in the tissue engineering
53:01space, but, you know, that
53:04we we remain optimistic.
53:06And the fact that we've
53:07got some
53:08companies now involved and interested
53:11suggests that
53:12maybe there's a future.
53:16But I I think,
53:18I I've been fortunate enough,
53:21to be able to
53:22go where my interest took
53:24me.
53:26And
53:27I don't think it's worked
53:28out too bad.
53:40Thanks. So for anybody who
53:42doesn't know me, I'm Peter
53:43Gruber. I'm a pediatric heart
53:44surgeon here at Yale.
53:46And if it wasn't obvious
53:47from doctor Mayer's, presentation and
53:49what he's accomplished so far,
53:51he's an absolute legend in
53:53the field of cardiac surgery,
53:54let alone pediatric cardiac surgery,
53:56and his contributions are really
53:58incalculable
53:59in many different areas. So
54:01thank you, doctor Mayer.
54:03I just wanted to quickly
54:05follow-up on something you just
54:06said, and that is how
54:07do you know when to
54:08quit?
54:09Right? Because those are all
54:11great things you've achieved, but
54:12I bet there's a whole
54:13barrel of stuff that you
54:14said, you know what? We're
54:14not gonna finish this.
54:17Well, I I I'm gonna
54:19quote something I came across,
54:21I think, when I was
54:22when I was in high
54:23school,
54:24which
54:25is something to the effect.
54:27I won't get the quote
54:28exactly right.
54:30But nothing's really fun. Not
54:32nothing's really work
54:34unless you'd rather be doing
54:35something else.
54:37And so,
54:38you know, as long as
54:40my health holds and my
54:42interest remain high, I,
54:45you know, I I'm don't
54:46see any reason not to
54:47keep working.
54:49And,
54:50it's
54:52been a great place to
54:53work.
54:54You know, a great and
54:55supportive
54:56environment.
54:59I I feel like as
55:00long as I'm making a
55:01contribution,
55:02and I always
55:04make it as clear as
55:05I can that if somebody
55:06feels I'm not making a
55:07contribution anymore, just tell me
55:09and then, you know, I'll
55:10hang it up. I'll go
55:11do something else. But,
55:14I think as long as
55:15one is able to do
55:17that,
55:18and as long as you
55:20are making a contribution and
55:22you're still
55:23thinking and working and trying
55:25to solve problems,
55:26I I don't see any
55:28reason not to keep going.
55:30I wanna just clarify my
55:32my question briefly. We certainly
55:33don't ever want you to
55:34quit.
55:36I was actually referring to
55:38all those experiments that you
55:39could do forever and ever
55:41that will never work. And
55:42then you gotta say to
55:43yourself, you know what? It's
55:44time to move on. Yeah.
55:46And you've been in lots
55:47of different areas, and, certainly,
55:48you need to make
55:50those,
55:51decisions at some point.
55:52Yeah. I I'll tell you.
55:54I think the reason that
55:55we
55:56kind of
55:57stop
55:58pursuing the myocardial preservation stuff
56:01is
56:01the clinical problem had become
56:03much less of an issue.
56:05We really had figured out,
56:06I think, how to
56:08be able to preserve the
56:10heart for
56:11relatively longer periods of time
56:12that would allow us to
56:13get more complicated operations done.
56:17And we were sort of
56:18at the you know, I
56:19was at a block roadblock.
56:22You know, there were only
56:23so many new drugs to
56:24try during reperfusion and things
56:25like that.
56:28And I didn't have a
56:29good collaborator
56:30that would really help me
56:31dig down inside, you know,
56:33cell biology and that sort
56:35of thing. And so for
56:37those reasons,
56:39as well as,
56:43the fact that there was
56:44this other possibility
56:46and, you know, with the
56:47tissue engineering stuff
56:49that,
56:50I thought, you know, maybe
56:52we should pivot a little
56:53bit and go not a
56:55little bit, a lot.
56:57And,
56:58you know, there's a little
56:59serendipity
57:00story here that I think
57:01is also important. You can
57:04see there have been a
57:05few serendipity things that have
57:07affected my life.
57:09But
57:10this one was I
57:12actually was sitting down at
57:14lunch
57:15with when there was a
57:16doctor's dining room. There isn't
57:18anymore, but there used to
57:19be one at Boston Children's.
57:20And one of my colleagues
57:22was trying to figure out
57:23how to grow a liver
57:25because he was running the
57:26liver transplant program, and they
57:28had too many kids who
57:29weren't surviving to the point
57:31of getting a liver transplant.
57:34So
57:35he was telling me he
57:36had sort of gotten started
57:37in this tissue engineering field
57:39and
57:41was trying to grow a
57:42liver. I
57:44looked at him. I said,
57:45boy, that's really gotta be
57:46hard. That's what a complicated
57:48structure.
57:49Why don't we do something
57:50simple like make a heart
57:52valve?
57:53Right? Better be naive than
57:55informed sometimes.
57:56And literally,
57:58that we got one fellow
58:00from his lab, one fellow
58:01from my lab
58:03who
58:04started working on this.
58:06And, you know, we've we've
58:08made a lot of progress.
58:09We learned a lot. We
58:10learned a lot about basic
58:11valve biology, basic valve mechanics.
58:15You know, why if you
58:16put a piece of pericardium
58:17in in place of an
58:19aortic valve leaflet,
58:21it isn't gonna
58:22work because
58:24the,
58:26biomechanical
58:27characteristics aren't right. It's a
58:28dead piece of tissue. It's,
58:30you know, it's just
58:31all those things. But, you
58:32know, you one would never
58:34have had those insights without
58:36having had all that background
58:38and trying to figure out
58:39valve biology and what does
58:41an interstitial cell do and
58:42what does an endothelial cell
58:44do, etcetera.
58:45So,
58:47you know, these
58:49what you learn in different
58:51ways can come back and
58:53influence
58:54things in the future pretty
58:55positively.
58:57And I think that's,
58:58you know, that's one of
58:59the benefits of doing research.
59:01You know, it's not always,
59:02well, I wanna
59:03cure that cancer, so I
59:05know that I have
59:07these steps that I have
59:08to do. You know? We're
59:09learning stuff about valve biology,
59:11and maybe some point we're
59:13gonna get to the having
59:14a better valve substitute. But,
59:17you know, along the way,
59:19that valve biology has helped
59:20us understand how things work
59:22or don't work in the
59:23operating room. And so
59:25when we're trying to repair
59:27a diseased valve.
59:29So you never can quite
59:31always
59:32make a straight line,
59:33and I if there's no
59:35other message in this whole
59:36discussion, it's
59:38don't don't fall into the
59:39straight line. At least that
59:41would be my advice.
59:46Any other last minute questions?
59:50Alright. Now we can thank
59:51doctor Meyer.
01:00:03Good. Thank you. Thanks for
01:00:05coming.
01:00:06You're coming. Really good talk.
01:00:07Oh, okay. Great. Good.
01:00:09Okay.
01:00:11Very good. Yes. Alright. I'm
01:00:13gonna sit and have some
01:00:14lunch, and then I'm gonna
01:00:15go get on the train.
01:00:16What time is your shift
01:00:17at?
01:00:18I've got a reservation. I
01:00:19don't know. Four o'clock, but
01:00:20I'll probably see if I
01:00:21can get earlier one. So
01:00:23it's
01:00:24one o'clock out there. I
01:00:26think it might be one
01:00:26at two, but I didn't
01:00:27wanna cut it too close.
01:00:28So Yeah.
01:00:29Yeah.
01:00:31If I go, I guess.
01:00:34Oh, yes. Thanks.
01:00:35Oh, there you go.