Chapter 22: Medical Education, Radiology Researchers, and The Future of Radiology Research (in the Healthcare Economy)

Chapter 22: Medical Education, Radiology Researchers, and The Future of Radiology Research (in the Healthcare Economy)

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Description

Dr. Podoloff speaks broadly of advances in radiology research.

He first states that conservatism in medical education is the major reason that medicine does not advance rapidly. He talks about the qualities that an innovative researcher must have, reflecting on his own curiosity.

He makes final comments on how radiology’s shift in focus from form to function will give rise to entirely different kinds of inquiry in the future. He notes that the biggest influence on research will be changes in the healthcare systems. He talks about healthcare costs and policy.

Identifier

PodoloffD_03_20150604_C22

Publication Date

6-4-2015

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; The Researcher; Overview; Definitions, Explanations, Translations; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; On Research and Researchers; Character, Values, Beliefs, Talents; Personal Background; Inspirations to Practice Science/Medicine; Fiscal Realities in Healthcare; The Healthcare Industry

Transcript

Tacey A. Rosolowski, PhD:

Are you speaking specifically about the spin lab or in general?

Donald A. Podoloff, MD:

In any endeavor where you’re looking at something that’s going to happen in the future, you never know. The other big thing is multimodality imaging, PET/CT, and now PET/MR. And those are areas that we’re going to be exploring over the next five to ten years to see if there are additional pieces of information that we can get from PET/MR that are not available to us with PET/CT. And there’s some competition within this. For instance we now have dual energy CTs. And there comes a question can dual energy CT do a lot of the things that MR can do. So within their own house there are competing and complementary elements in the types of imaging we do.

Tacey A. Rosolowski, PhD:

I’m thinking about how dramatic or how confusing, how exciting it can be for a researcher who’s been educated in a field that has a perspective at a particular time, as your generation educated with radiology that is about form, to be going through this huge change in the field to suddenly it’s a different entity.

Donald A. Podoloff, MD:

Yeah, it has its—the implications about what you’re talking about have to do with what sort of a person goes into radiology, and what is the training of that individual like as we move from anatomy to function. It’s like in the early days before chemotherapy and before radiation, cancer was a surgical disease. And it really didn’t become a nonsurgical disease until after the Second World War when we recognized some of the nitrogen mustards that were being used had potential cell killing. And then the development of radiation oncology—although it wasn’t called that at that time, it was called radiation therapy, it’s now called radiation oncology—came along. So now you had the ability to not only cut stuff out but you could also burn it out and you could poison it out. And what we’re learning now is there’s a kinder gentler way to perhaps do that in looking at signal pathways and blockers and unblockers of chemical events. The most obvious example of that and the first was Gleevec, a very specific chemical reaction is blocked, and leukemia gets cured, a particular type of leukemia. And then after a while because cancers aren’t stupid they figure a way around it, much like bugs do around antibiotics.

Tacey A. Rosolowski, PhD:

Right, right. I’m thinking too—

Donald A. Podoloff, MD:

And we’re in a position now where we can begin to start to think about can I image that event.

Tacey A. Rosolowski, PhD:

That’s—yeah, very exciting.

Donald A. Podoloff, MD:

And that is very exciting.

Tacey A. Rosolowski, PhD:

Does it take a kind of resilience though as an individual? Because sometimes it’s hard to overcome that initial training. It shapes how you think, it shapes how you see things, shapes how you problem-solve.

Donald A. Podoloff, MD:

The training that we give to our physicians is the major cause of medicine not advancing. When I was in medical school there was an article published in the New England Journal of Medicine I think it was that said that the average life span of a fact that you learn in medical school is 5.2 years.

Tacey A. Rosolowski, PhD:

That’s really scary. (laughter)

Donald A. Podoloff, MD:

If you think about it it’s intriguing because it should teach you don’t accept anything, because it may not be true in five years. In fact there’s a high likelihood that it won’t be. I think we’ve talked about this philosophically before.

Tacey A. Rosolowski, PhD:

We have, yeah.

Donald A. Podoloff, MD:

Two hundred years from now I believe that we will look back on chemotherapy and radiation therapy and surgery the same way our doctors today look at bloodletting. Everybody in the world that I know of told Jim Allison that he couldn’t do what he did because it wouldn’t work. I believe I’ve heard John Mendelsohn say the same thing. He was told that his theory about antibodies was ridiculous and wasn’t going to work. Well, it did work. But you need people. Freireich is like that too. People who will say, “Well, that’s what you say, but I’m going to go do it anyhow.”

Tacey A. Rosolowski, PhD:

It seems like it takes a particular kind of resilience and maybe constant intellectual curiosity to—

Donald A. Podoloff, MD:

That’s one thing. It also takes some life experiences.

Tacey A. Rosolowski, PhD:

What kind of life experiences? I’ve never heard anybody say that before.

Donald A. Podoloff, MD:

Well, I don’t know if you read the article about J Freireich in the paper.

Tacey A. Rosolowski, PhD:

No, I haven’t seen that.

Donald A. Podoloff, MD:

It was in the Chronicle a couple weeks ago. I learned, I didn’t know this about him. But apparently he was on his own very very early on as a kid. And part of how he grew up was a survival mechanism. And that’s part of the reason I suspect that he is as innovative as he was. I know somebody outside of medicine, he’s a good friend of mine, who came home one night and his mother, who was his only parent, left him a note, said she was out. So at fifteen years old, he had to live for himself. He’s now a multimillionaire in real estate. David has a very interesting way of looking at life, as you might imagine. So I think life experiences shape. They fashion you to do what you do. Why do you become a doctor or an engineer?

Tacey A. Rosolowski, PhD:

What are some life experiences that gave you that resilience? Or the ability to keep up, change thought patterns?

Donald A. Podoloff, MD:

I was very curious and always have been. I loved chemistry as a kid. And I used to have a chemical thing in my house. I remember my parents used to take me, my dad used to take me down to Winn Chemistry at Twenty-third Street and Seventh Avenue in New York City. It was an old apothecary. And I used to make stuff. That led to the science. And I got interested in medicine at a very early age. My parents tell me that I told them I wanted to be a doctor when I was five years old. I don’t remember that. But I knew—as early as I have memory, I knew that I was going to be a doctor. I had an uncle who was a doctor but I wasn’t very close to him.

Tacey A. Rosolowski, PhD:

Yeah, you talked about in our first session actually how early you had discovered that. And I remember you mentioning your chemistry sets too. But it’s an interesting question where does someone get that independence of thought. There’s so much pressure to conform, to do things the way that they’ve been done and that’s presented to you as well, you’re learning your field, when actually it can be an exercise in conformity that can last way longer than is useful.

Donald A. Podoloff, MD:

Well, there’s a certain amount of conformity that you have to do to get through medical school. I mean if you walk in a medical school and decide well, I really don’t need to do biochemistry or anatomy, you’re not going to get very far. And a lot of medical education used to be rote memory. The people who had the best memories became the best doctors. Well, that doesn’t necessarily mean that you’re a creative thinker, it just means you have a good memory.

Tacey A. Rosolowski, PhD:

Right. Yeah, creativity is key. Is there anything else that you wanted to tell me about next technological advances? We talked about the spin lab and QIAC.

Donald A. Podoloff, MD:

It all gets down to this form moving to function or with function. It’s a complementary thing. That’s why we develop these multimodality imaging devices, because one element does anatomy and the other does some kind of function. That’s relatively new, I mean it’s ten, fifteen years old. I suspect in the future we’ll see optical imaging or acoustic imaging paired up with some other kind of imaging. If I knew I would be very rich because I would be making the next great machine. That’s not where I am.

Tacey A. Rosolowski, PhD:

Not where you are, yeah. Well, a related question of future and general perspectives. I was wondering about your comments on changes in health care delivery. There’s a lot of conversations about that, and a huge impact on the institution and of course the nation in general.

Donald A. Podoloff, MD:

Allegedly. I mean we’re still doing pretty well. We still function largely like a fee-for-service organization. The great majority of MD Anderson’s money doesn’t come from philanthropy or from grants, it comes from us seeing patients and generating revenue. That’s been true for the whole twenty-nine years I’ve been here. There’s more discounting than there used to be. But we seem to be doing all right and growing. So it hasn’t negatively affected us. There are changes that are inevitable based on the fact that the cost of medicine in the United States is now perceived as being out of control with respect to the benefit that it creates. So just last night there was an article on the news I think because ASCO is running about drugs that cost $100,000 a year to keep people alive. The people who are looking into the future think something is going to happen about that. It may. But I don’t think—I subscribe very heartily to the Yogi Berra theory of history, which is predictions are very difficult, especially about the future.

Tacey A. Rosolowski, PhD:

(laughter) Now you said—the phrasing I think you used was there’s a perception that medicine has gotten—

Donald A. Podoloff, MD:

So you picked up on that.

Tacey A. Rosolowski, PhD:

I did. (laughter) I listen to language for a living. So tell me more about that.

Donald A. Podoloff, MD:

Why it’s not a reality? Because I don’t necessarily see a scientific experiment that shows that to be true. I see a lot of anecdotes. I don’t know that it’s more expensive than it should be. I do know that it’s not reasonable to assume that it can be the total gross national product of the United States. It can’t be that much. So it’s got to be something less than that. The question is how much. Well, depends on who you’re talking about. If it’s my wife, probably it can get pretty close to that figure. If it’s you, probably not so much.

Tacey A. Rosolowski, PhD:

(laughter) True. Personal bias and personal connections make a lot of difference, they do.

Donald A. Podoloff, MD:

Exactly. And it’s the difference between health care delivery and health care policy. It is probably not appropriate for people over the age of seventy to get mammograms. My wife is going to get a mammogram. So that’s the difference between health care delivery and health care policy.

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Chapter 22: Medical Education, Radiology Researchers, and The Future of Radiology Research (in the Healthcare Economy)

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