S2E8 | Advances in medicine: Progress, and the promise
Pat Basu: Hi, I'm Pat Basu, president and CEO of Cancer Treatment Centers of America, and the host of Focused On Cancer. We have an incredibly exciting episode today, and I am pleased to welcome John Bardis to the show. I don't have enough adjectives to describe John; he is a leader, an innovator, an entrepreneur, just a force for good in healthcare. John served as the assistant secretary for health at the US department of Health and Human Services. He has founded nonprofits such as Hire Heroes USA, the nation's leading organization committed to training and employing US veterans. He has led some of the most impactful companies in American healthcare, and, on a fun fact, he is a champion wrestler who this year is going to be leading team USA in the Greco- Roman wrestling arena at the Tokyo Olympics, the long awaited Tokyo Olympics coming up here in the summer of 2021. So, John, I know you're an incredibly busy guy, super excited about today's show, but welcome. Thanks for joining us.
John Bardis: Well, my pleasure, Pat, it's great to be here and have some fun.
Pat Basu: Well before we get into the fun, I can't help but asking about, just briefly, the Olympics. I've been a fan for a long time, I know it's one of those things that unites us from around the world and every... Well, sort of every four years, depending on summer and winter, but this year we had to wait a year because of the pandemic, but how's it going? Everyone excited to get back in the groove there?
John Bardis: Yeah, for sure. We actually have the Olympic Greco- Roman team arriving today in this building to train for the next 11 days. So the athletes and coaches are very focused on preparation. We're getting down to the short strokes, so to speak, in terms of the details around each individual athlete, each individual Olympian's training plan, and we head out to Tokyo in mid- July, so it's coming up pretty quick. This camp will run through the 5th of July and the athlete's go home for a week and then head back to the airport, go to Tokyo and do an acclimation camp for a week and a half before we compete.
Pat Basu: Well, good luck, I know we will be watching you and the rest of team USA go for gold, and as we get into in today's show we're to talk a ton about healthcare innovation, healthcare technology. John, you've done so much in the advancement of technology during your career. I always like to ask our guests a little bit about what led you down the career path, the health technology piece, what got you interested in that in the first place and how did you get here?
John Bardis: My father was a veteran of World War II, and so he was educated by the GI Bill and came from a family of immigrants. His father immigrated from Lithuania and actually earned our family citizenship fighting in World War I as a foreign national, he was in Pershing's American Expeditionary Force, was badly wounded in battle, he stayed a year in an army hospital from the battle of Saint- Mihiel in Saint-Mihiel, France... St. Michael... And contracted the Spanish flu during his year in an army hospital, survived it, became an American citizen, and my own father was in the ROTC in high school, at Harrison High School, which no longer exists, in Chicago. And then, right out of high school, went into World War II. And one of the great benefits that American GIs received was the GI Bill, and was able to take advantage of that college education, became a captain, stayed in the army for Korea, and then a inaudible. And so he met my mother, who was, as it turns out, the last one of 11 Russian immigrant kids, and she went to Cook County School of Nursing and became a nurse, and so I grew up around healthcare and the sciences, and my parents had a big influence on what the conversations around the dinner table were and so forth. So I was very interested in healthcare because of those conversations, and when I came out of school I went to work with American hospital supply corporation, Baxter. So I worked right out of school for Baxter. And so that was my starting point, but I came by that interest through parents who talked science and healthcare at the dinner table.
Pat Basu: Wow, John, well thanks for sharing that story, and to both your grandfather's service in World War I and your father's in World War II and Korea, what an incredible path, and certainly, as you and I have discussed before, the embodiment of the American dream and so much of what has made the United States the country is today. And as we look back, as I listened to your story of the journey of your grandfather and your father, I think about this often, I would say, is it's incredible to think how much life in every way, and certainly in healthcare, has changed over the past 100 years. You mentioned that the Spanish flu, a little over a century ago, and obviously we've just been dealing with a global pandemic here in the year 2020, but keeping that aside for a moment, it really is remarkable to think about the advances in human civilization in the past hundred years and in healthcare in particular. In that time we have, I would say, found ways to truly combat most infectious diseases, we have been able to essentially replaced most organs in the human body during that time, incredible breakthroughs, some of which we'll talk about today, but as we look back over a hundred years, given your passion of both history and your track record of innovation, it's pretty remarkable, isn't it? The difference that we've seen between now and then.
John Bardis: It really hasn't been until this past 100 years that the human race has made real progress en masse against pandemic and infectious disease, and made meaningful improvements in life expectancy. You know, life expectancy of a white male in 1900 was in his forties, and an African- American male at 1900, the average life expectancy was 31. So that data comes from the inaudible time code, which has tracked human life expectancy now for about a 120 years. And so it is fascinating, the battle that has been waged which has had an enormously positive impact on human productivity, the growth of America, for sure, and in Western civilization. We still have a lot of work to do in other parts of the world where infectious disease still is a major factor in life expectancy, but yes, wow, this hundred years, in so many ways, has been an extraordinary journey for the human race, because of public health and the advancements that have been made in therapeutics.
Pat Basu: Yeah, no question about it, it's sad, it's remarkable, and for people like you and I, who talk so often about the imperative to improve healthcare and American healthcare it is important, and I often take stock of how far we have come, as you said before, in particular in the past century. As we often think about cancer care, John, it's pretty remarkable to, as you know, in the last about 30 years, approximately from 1990 to about 2020, the death rate from cancer fell by about 30%, and that is due to some remarkable innovations in early diagnosis and precision medicine, and surgery, radiation oncology, radiology. And speaking of mRNA, there's actually a great hope that the impact of mRNA on cancer therapy is going to be big in the coming decade, even though we haven't really begun to test that yet. But do you think, John, you've had such a breadth of experience from government to non- profit to leading in the private sector and the heavy health technology work that you do now, what are some of the big technological innovations that you see on the cusp going forward? What are some of the big categories that excite you?
John Bardis: Well, one of the great privileges that I had in working in the government path was working directly with Francis Collins, inside of the NIH, and Tony Fauci, who many people now know because of his role as the head of Infectious Disease and Allergy at the National Institute of Health, so Dr. Fauci reports to Francis Collins, and both are, from my experience in working with them, are really remarkable human beings, remarkably talented, remarkably gifted, and remarkably compassionate. They love people, they have spent their entire careers finding ways to better the lives of others. Francis Collins wrote a really remarkable book based on a lot of the research and an effort that he led to sequence the human genome. And this is, as you remember, Francis was in the White House with Bill Clinton in the late 1990s, and when he announced that the human genome had been fully sequenced, and I believe that President Clinton used the term that," We now understand the language of God." And he brought this forward in the White House. Dr. Collins has continued his work in meeting the effort on understanding the impact of the human genome, in fact, he wrote just a remarkable book that I have read over and over again, and still have much to learn by absorbing more of it, it's a very intriguing, called The Language of God, and Francis sort of mixes is views on faith along with his views on science, and he comes to conclude in the book that those who are non- believers in a higher power, and those who are believers in a higher power may have more in common than they think they do. Meaning specifically that those who believe in evolution and those who believe in creation have a lot more in common, based on what he has come to learn about how the human genome operates. In 1918 there were approximately 1. 5 billion people on the Earth. Today there are over seven billion. In many ways, that's a testimony to the effort and the fact that we've had, with public health, we certainly haven't fixed every problem, but going forward, we really are in a very unique position that with, as you point out, the mRNA technology, that we can attack some of these terrible maladies that have affected mankind. I think that one of the more compelling conversations is oncology. We are on the cusp of, I think, the most exciting time in the history of human health and what it means for public health in the future, specifically auto- immunes and cancer, because of this.
Pat Basu: Yeah, I couldn't agree with you more, I mean there is almost a Cambrian explosion of innovations and breakthroughs that we see across the science and technology spectrum. I think in particular a really good focus in medical breakthroughs... The University of Illinois recently opened a medical school that really ties medicine directly to the disciplines of engineering, and I think the excitement of bringing different disciplines together to solve very, very challenging medical problems is something that you and I share. But the impact of electrical engineering in medicine, and what that can do for the central nervous system, or prosthetic limbs, mechanical engineering and its impact in bioprosthetic, and the hemodynamics of our circulatory system. Every tie- in from technology and engineering, I think, has a breakthrough that can be tied to healthcare. And as I listened to you talk, it really jogged for me the notion that how many things in medicine we can tie back again, either directly or indirectly, to big, bold bets that the United States has made, whether those were in NASA and space, where that's lead to great medical technologies and, as I often say, the earliest of telemedicine; sadly in some of our armed conflicts, where we've had great advances in trauma surgery and surgical principles in general. As we think about barriers to innovation, some of the things that worry me would be, number one, a sort of attack on data and the misinformation that we see, but also perhaps a dearth of investment from the United States in terms of some of these big areas. Do you think... Do you agree with those, and what other barriers do you see that might harness or restrict the level of innovation that we've seen in the last 50 to 70 years?
John Bardis: You know, it's very interesting set of subjects that you sort of touch on there, Pat. You know, as a starting point what I would say is my observation, from working inside the CDC and running the cyber operations as well, of all the IT operations at HHS, is that America to me is an indispensable force for good in the world. We talked a little bit about mRNA technology, but the use of those kinds of remarkable breakthroughs and intellectual insight in science have had a very positive effect on the world. inaudible. I'll give you an example of that. Back when the Ebola crisis hit in Africa, we, as you know, in America, already had a good bit of experience with boots on the ground, from a commission, core, and public health perspective in Africa with HIV. Under the Bush administration, we started a program called PEPFAR, and PEPFAR was a collaboration between USAID in the state department, HHS, the NIH, and the CDC. And that was a direct response of probably the wealthiest and most powerful nation in the world to wipe out HIV and the spread of it in Africa, and the PEPFAR program under the Bush administration and led by Dr. Deborah Birx, who later became ambassador to South Africa before she returned to coordinate the COVID- 19 pandemic response, ultimately provided antivirals to over 15 million Sub- Saharan Africans, and still does every day. It's something that America doesn't get credit for, it doesn't get discussed very often in the public press, but that's the public health response that America has been involved in for a long period of time, and we had real success in stemming the advance and growth of HIV in Sub- Saharan Africa. We had a similar set of actions when Ebola hit, I think it was Sierra Leone, it's America who put the Commissioned Corps on the ground in hazmat suits and buried the dead and built the hospitals and began to care for those who were sick. But also, again, what's not often discussed is we would use handheld technology and the breadth of technology that we have in the federal government, but specifically HHS, is pretty remarkable, right? We cut Medicare checks with inaudible, which prints our checks, and that's nearly a 70 year old program for managing large chunks of information, and something that very few organizations use today, since it's very long outdated. And at the same time, we have handheld technology that can unravel the DNA and sequence it and send that information back to the United States, from which we, through DARPA, developed an Ebola vaccine within... I believe that Ebola vaccine was built in 24 days, which is an amazing thing, right? We did the same thing with Zika. So I think that the United States, from an economic and from a science and from a public service perspective, has continued to be a remarkable force for good, when it comes to the health of the world. And those are two pretty meaningful examples of that.
Pat Basu: Absolutely. Those are terrific examples. And, as you've mentioned some of those really powerful examples, it jogs, for me, this notion that as much as we talk about technological advances in terms of Moore's Law and the doubling of computer processing speed, it's pretty remarkable. I mean, sometimes I think people overlooked the advances... You referenced 1998 with sequencing the human genome, the rate of, well, the costs and the ability to sequence a human genome has dropped... Has increased, rather, faster than even Moore's Law has progressed. And so I think there's been a lot of opportunities. If you look at everything from tele- health to value- based care to other things that have... We're not done yet, but increased access, decreased wait times, and begun to increase safety, that's something in the past decade that's given me a lot of hope. Other examples, or areas that you've seen in terms of process innovation in healthcare?
John Bardis: We have built a system that was designed to respond to the changes that we saw in human life expectancy, right? So going back a little bit, Medicare was really a direct response to a successful effort to improve the lives and life expectancy of the average American. So we've talked a little bit about that life expectancy issue, all the way back to the 1900 timeframe, by the time Medicare itself came around, the life expectancy, due to things like penicillin and innovations and antibiotics and public health and vaccinations... You talked a minute, I think, about vaccinations and the need... I remember as a kid getting smallpox vaccines and mumps and measles, vaccine and boosters because of the viral morphing of all of those pathogens, and we are now eliminating childhood diseases that were killing kids. The mortality rate for children in New York city at the turn of the last century was about 20%. So if you had 10 children, there was a fair chance that two of your children didn't make it through childhood because of infectious disease. So we've made these just remarkable improvements in life, and then Medicare, inaudible 65, is response to an aging population. And we had built a system of care in the United States, while not perfect, is designed to provide services to both the poor through Medicaid, the elderly through Medicare, and the working folks through private insurance. And in addition to that, we have a program called CHIP, which is our children's healthcare program in the United States, where every child, regardless of where they are from economically or the economic capabilities of their family, have access to the finest network of children's hospitals in the United States. And so reducing childhood mortality rates has also been a key factor in productivity, but all of this also has been wrapped in process improvement. And then, back to your point, there's much more to do, right? The electronic medical record, while an important piece of information for Americans to have to carry throughout their healthcare for life and process, is essentially a medical passport of information that can be used to effectively help each individual manage the care as well as their caregiver. But, if you look at the process today, right, we've taken the best and the brightest of our students, in the form of our medical doctors nationwide, and if you watch a doctor do rounds on floors in US hospitals today, of that hour per- round, about 15 to 20 minutes is used directly in front of the patient. The rest of the time that 40 to 45 minutes of the additional time in an hour is used for documentation, which I think is a problem. I think we've taken the best and the brightest of our students in the form of our medical doctors and our nurses and our lab technicians, and we have overburdened the process of documentation, to the point of where I think we've eliminated some of that face- to- face diagnostic interface time and patient relation time that would benefit the patient more. So I think while we've made real improvements, and a great example of that is the da Vinci robot, right? Robotic surgery is just so precise that you can microsurgically cut around very, very small nerve structures and not damage the patient in a way that a more manual human interaction might, those are just examples of the innovation that have come along, along with, we've talked about, the human genome and other therapeutics. So I'm very bullish on the future when it comes to the science, therapeutic and process improvement. Not to overburden the question, but we in America have some other challenges around our healthcare system, and that is it's too expensive, right, and you have a cost challenge and something that this generation and the next generation are going to have to manage.
Pat Basu: Absolutely. You know, your point on physician process, I think you have agreement from me and probably about 800, 000 other doctors, where there are just some unbelievable statistics around, that doctors are only having eight minutes to spend in front of a patient, and as you said before, the amount of time actually delivered in care delivery or doing what a doctor was trained to do, versus the administrative and documentation burdens that have really playing the system are epic. Cost is clearly a mega, mega emergency issue in American healthcare, and another one that obviously has popped up as an issue of disparities; gender disparities, ethnic disparities, but really just a wide standard deviation, if you will, across healthcare. And, so often in the past, healthcare was spoke of in sort of monolithic terms, and we talk about life expectancy in terms of a number, but there's wide variation by a variety of factors. One of the things that gives me optimism though, is something that you work on very directly, is data and analytics. And it's been around technologically for, 20- plus years, our ability, John, now, to really segment, to identify and stratify populations that are at risk and even individuals that are at risk, so we can target better processes and better therapies to them. And I know you do a lot of work in that area, but I think that's going to be an area of great advancement in the decade ahead where we can use data and analytics to precisely pinpoint not just genes and not just medicines, but people in need of a specific type of therapy versus somebody else. Would you agree?
John Bardis: Oh yeah. Well, I think you kind of have to be, right? I mean, as we know, progress and everything doesn't happen in a straight line and we clearly, in this country, while, in my view, the best idea in the world has ever seen around government and even life improvement, the American democracy is the best example, it is highly imperfect, it still has major shortcomings overcome. And those tend to play themselves out more dramatically in the social and economic disparity category, right? So when you look at our poorer populations, those who are on a lower socioeconomic rung financially, often times those populations, through education and lack of resource, who continue to struggle with their health methods. While we've made efforts to make improvements there, we've come to realize that the health system, as we know it today, has some holes in it as it relates to those access points. And I think perhaps the most compelling example of that has been how the system is constructed financially. It is a cost- plus system that remains largely a cost- plus system. We hear the terms used quite frequently, value- based care versus cost and fee- for- service based care, but when you have poor people who are struggling financially, trying to get care in a model that, in a sense, care that is on a fee- for- service basis, it's those programs like Medicare specifically, and even Medicaid specifically, who pay less, which add a direct restriction on the poor and those socio- economically stressed classes. It prevents them from getting the care that they would need because the incentive of the system is to create a cost that you can then charge up for, and so poorer populations don't afford that to a system which is incentived in that manner. And so, as a result of that, a lot of that burden for the population the poor and the underserved in our country, falls on Medicaid, when you know as well, Pat, most practices in this country, most health systems in this country, don't seek to serve the Medicaid population, which is a large reason why we've got a lot of public hospitals, for example, Cook County in Chicago, or here in Atlanta, Grady, or down in Miami, Jackson, or in Los Angeles, LA County. While those were attempts to rectify this disparity, it doesn't get the job done fully. So I do think the fee- for- service model further separates the poor and the underserved from access, and I think it's something that inaudible we have to come to grips with and deal with.
Pat Basu: Absolutely. Well, I'm going to have to have you back on on a show to discuss some of the policy solutions and policy implications, which I think are many, to continue the race towards building a better health care system as part of a more perfect union. John, as we begin to kind of wrap up here, I wanted to kind of end where I began, which is, we traced back over the last hundred years, you showed the personal journey of your grandfather and your father, and I referenced this look back and how I often think about future children and grandchildren, and what will healthcare look like going the opposite direction 50 years, a hundred years in the future. Paint, if you will, what might be some visions of what we might expect? You're truly one of the best innovators and entrepreneurs that I know in healthcare; paint a vision of 50 years from now, maybe a hundred years from now, what do you see as the great advances in healthcare and what will it look like?
John Bardis: Yeah, great question. Well, first of all, I really don't know, but I'll have to shot, but I think we have a great possibility of eliminating... I don't think I'll see it, I think you'll have a chance to see it, Pat, I think your kids will see it. I think we'll eliminate most cancers, I think we're going to eliminate the auto- immunes, I think the entire health delivery system will change as a result of it. There is a real case to be made for not just these advancements, but the equal sharing of these advancements throughout the world. It is a good and positive thing that America and those of like- minded philosophies throughout the world, in Western Europe, et cetera, that these great technologies are spread, right? If you look at it, the last generation... These things don't move at the same time or at a pace that maybe we would want, but when you think about the polio vaccine, you look at elimination of all of these infectious diseases that have happened over the last hundred years, they have moved the needle northbound in terms of life improvement for the rest of the world. And I think, going forward, that the effect of this allows people to be more productive, live better lives, and hopefully with solutions that fit the cultures and expectations of the people, hopefully free people, in the countries who are benefiting from these advancements. So America is, I believe, really at the tip of the spear of this type of innovation. The concept of innovation, in my view, has the idea behind it of wide improvement, not just for Americans, in our case, but the rest of the world, and that creates a more stable and safer, a better future for all of our children. So I, for one, I'm extremely bullish on the future because of these innovations and what it can do for the rest of the world, and I think it's incredibly important that America retain and maintain its leading position in terms of the advancement of these sciences because our track record is very straightforward. We underwrite it and we finance it, and then we often make it available to the rest of the world at costs which are fractional to the state, compared to what this nation pays for it. And that, in and of itself, has been a challenge for the country, right? As we look at it today, America is approximately 4. 5% of the earth's population. We will spend well over$4 trillion this year, and five years from today, more than$ 6 trillion on healthcare, if American healthcare was a country, today it would be the fourth largest economy in the world. American healthcare expenditures are larger than it's our GDP of Germany, four times larger than the entire GDP of Russia, and so we spend more money per capita than any other nation on earth by far on healthcare. I think that's something that we often think we have to solve for, but in the meantime, leveraging off the innovation that is underwritten literally by federal grants all the way through our major teaching institutions to improve human life, and that become commodities available to the general population, I think it's a system that has proven to be exceptionally effective in improving human life. And so I, for one, am extremely optimistic about what's to come. And I also think that we have to be watchful, and vigilant, even, on on our cost of inaudible.
Pat Basu: Well, John, I really share your optimism. You know, a few threads that you hit on very, very eloquently that the notion of America is an indispensable force for good, the combination, the milieu, of a free society that encourages not only entrepreneurs and innovators such as yourselves, but undergirds them with a nation that has consistently taken big, bold bets to really provide that foundation. Whether it be NIH, DARPA, a myriad of other foundations that have really led to that infrastructure, and absolutely what a note to end on. I do share your opinion and I am absolutely confident that in our lifetime, we will see the remarkable change in the trajectory of diseases, including infectious diseases, all the way to absolutely stopping the plague that we call cancer. And it's because of incredible leaders and innovators like you that we're going to get there. So, John, I know how busy you are, but really, really enjoyed having you on the show, I know the audience did as well. Thank you for taking the time, and once again, we'll talk soon and good luck leading Team USA in Tokyo.
Gene-editing tools that make the body smarter in fighting cancer. Robots that help surgeons more precisely excise a tumor. Screening technologies that can spot lung tumors the size of a grain of rice. This gee-whiz age of innovation and technological genius looks a lot different than the horse-and-buggy era of the early 1900s when today’s everyday essentials like anesthesia and antiseptic surgeries were only beginning to catch on. And there are even more groundbreaking opportunities on the horizon. On today’s episode of Focus on Cancer, our host, Pat Basu, MD, MBA, President & CEO of Cancer Treatment Centers of America® (CTCA), welcomes entrepreneur and technology-sector leader John Bardis to map out the progress, and the promise, of technological advances—yesterday, today and tomorrow.