EP. 51: ON LEADING THE NATIONAL ACADEMY OF MEDICINE

WITH VICTOR DZAU

Feb 24

WITH VICTOR DZAU, MD

The president of the foremost honorific society in health and medicine shares his journey from a childhood as a refugee of the Chinese Civil War to a leader in health equity and global health.

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Episode Summary

The National Academy of Medicine (NAM) is an independent organization that provides expert evidence-based guidance on issues of health, biomedical science, and health policy. Election to the NAM is considered one of the highest honors in the fields of health and medicine, recognizing individuals who have shown exceptional professional achievement and commitment to service. In this episode, we are joined by Dr. Victor Dzau, who has been president of the NAM since 2014. He previously served as President of the Duke University Health System, Chairman of Medicine at Brigham and Women's Hospital of Harvard Medical School, and Chairman of Medicine at Stanford Health Care. As a leading scholar in cardiovascular medicine, his pioneering research laid the foundation for the development of blood pressure medications widely used today. Over the course of our conversation, Dr. Dzau discusses his challenging upbringing as a refugee of the Chinese Civil War, describes his dedication to health equity and global health; explores the work of the NAM, and passionately shares why clinicians should be more involved in public discourse.

Victor J. Dzau, MD is the President of the National Academy of Medicine. In addition, he serves as Vice Chair of the National Research Council and is Chancellor Emeritus and James B. Duke Professor of Medicine at Duke University and the past President and CEO of the Duke University Health System. Previously, Dr. Dzau was the Hersey Professor of Theory and Practice of Medicine and Chairman of Medicine at Harvard Medical School’s Brigham and Women’s Hospital, as well as Chairman of the Department of Medicine and Director of the Falk Cardiovascular Research Center at Stanford University.
Dr. Dzau has made a significant impact on health and medicine through his seminal research in cardiovascular medicine and genetics and his leadership in health innovation. His important work on the renin angiotensin system (RAS) paved the way for the contemporary understanding of RAS in cardiovascular disease and the development of RAS inhibitors as widely used, lifesaving drugs.
In his role as a leader in health, Dr. Dzau has led efforts in innovation to improve health, including the founding of the Harvard BWH Division of Global Equity, the International Partnership in Innovation in Healthcare, the Duke Translational Medicine Institute, the Duke Global Health Institute, the Duke-National University of Singapore Graduate Medical School, and the Duke Institute for Health Innovation, and recently participated in the founding of the Coalition for Epidemic Preparedness and Innovation.
Since arriving at the National Academies, Dr Dzau has emphasized leadership, innovation, and impact. He has led important initiatives such as the Global Health Risk Framework for the Future, the Human Gene Editing Initiative, Vital Directions for Health and Healthcare, and Grand Challenges in Health and Medicine. His vision is to advance science, medicine, and policy to improve health globally.
In this episode, you will hear about:
• How growing up as a refugee of the Chinese Civil War shaped Dr. Dzau’s path and practice as a physician - 2:27
• How Dr. Dzau’s became a physician-scientist - 7:06
• The circumstances that led Dr. Dzau to take on issues of global health - 11:03
• Reflections on how Dr. Dzau stays in touch with the deeper meaning of medicine - 13:05
• A discussion of the values Dr. Dzau holds in his various roles - 17:41
• The difficulties Dr. Dzau faced during his education and career and how he recovered from burnout - 20:04
• A description of the purpose and mission of the National Academy of Medicine - 28:36
• How new members are elected to the NAM - 32:26
• A survey of the current issues the NAM focuses on and how Dr. Dzau thinks about the political dimensions of his work - 36:25
• The need for medical professionals to better communicate scientific facts with the broader public - 41:25
• Advice to early-career clinicians on leadership - 45:32
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor-patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care - from doctors and nurses to patients and health care executives - those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] The National Academy of Medicine is an independent American organization that provides expert evidence based guidance on issues of health, biomedical science and health policy globally. Election to the Academy is considered one of the highest honors in the fields of health and medicine, and recognizes individuals who have shown exceptional professional achievement and commitment to service. In this episode, we are joined by Dr. Victor Dzau, who has been president of the Academy since 2014. He had previously served as president of the Duke University Health System, chairman of medicine at Brigham and Women's Hospital of Harvard Medical School, and Chairman of Medicine at Stanford Health Care. As a leader in cardiovascular medicine, his pioneering research laid the foundation for the development of blood pressure medications widely used today. Over the course of our conversation, Dr. Dzau discusses his challenging upbringing as a refugee of the Chinese Civil War; describes his dedication to health, equity, and global health; explores the work of the National Academy of Medicine; and passionately shares why clinicians should be more involved in public discourse. Dr. Dzau to kick us off, can you tell us about how your early experiences and upbringing led you to a career in medicine?
Victor Dzau: [00:02:27] Yeah. So I was born in China and at a young age, five, my family and I fled China, I guess literally as refugees, to go to Hong Kong because of communism. And so my early memories, this would be post Second World War, and also, being myself, a refugee, I observed a lot of suffering. And even our early days in Hong Kong, where we lived in a single room with no bathroom, no kitchen, but our neighbors had even more suffering because we live close to a hillside and there were many people who are squatters who literally have houses made of cardboard and others, and you can imagine when it catch fire, etc. And then, of course, no really running water except one pipe, one tap for the whole kind of so-called village. So, you know, seeing illness commonly- my family had tuberculosis. My grandparents died of tuberculosis. And seeing this suffering really made me think about doing something about this and therefore becoming a physician. So that's the starting point of how I became very interested in being a doctor.
Tyler Johnson: [00:03:51] Can I just ask you Dr. Dzau - I grew up in, I openly acknowledge, much more comfortable circumstances. My family was not ever wealthy or close by the standards of the neighborhood where I lived. But we always had a house and clothes to wear and food to eat and all the rest of it. And it really wasn't until I visited Mexico when I was 19 years old and actually lived there for a few years, that I became acquainted with the degree of grinding poverty that you're describing. I'm just curious, though, that kind of poverty is so foreign to so many people who probably are listening to the podcast. I'm wondering if you could just reflect for a minute on how does the fact that that's where your roots are, that that's what your life was like for however many years starting out? How does that continue to shape the way that you see the world and the way that you practice medicine now?
Victor Dzau: [00:04:50] Tyler, I appreciate what you said and the fact that that experience will change you in a way and had an indelible impression on you. But, you know, we don't have to go that far to Mexico or to post World War Two or whatever. In our country, we have lots of poverty. And as you know, being a physician, caring for the patients, I know that many people really struggle and have lots of sufferings. I think what we need to do a lot more, particularly for our students and others, is to have them really go into community and see how people live and where they live, etc. You know, we have such a idealized situation. Sometimes you watch television and certainly the way I live, you live in others, but lots of people are struggling. I mean, we all know that in any city there are neighborhoods. I live in Durham, North Carolina, and I see poverty. And during COVID, you see a lot more. For example, students have no broadband. They couldn't even do classes. And my friends and I and many others got together to raise money to get computers, old computers, and create hotspots for people to do this. So it happens every day. We know that in a single city at different zip codes, life expectancy can be as much as 15 years difference. But let's not forget the rural areas. I bet you a lot of people have not visited them. If you grew up in the city and you have to go in rural areas. I live in North Carolina. You see there's poverty. So I think there's a need everywhere. But I thank you for raising that question.
Victor Dzau: [00:06:40] I have written, for example, in Lancet, about academic medicine, the fact that I think all students should be exposed to communities and looking at real equity issue before they even learn how to stethoscope, because I thought the stethoscope is a tool, but I think it's our values that makes a huge difference. And I'm so glad you mentioned it because obviously you have the right values.
Henry Bair: [00:07:06] Dr. Dzau, thank you for bringing that up. And we certainly know you've been involved in many initiatives addressing the needs of marginalized communities. But before all of this, before the health care leadership, you attain great achievements as a physician-scientist in cardiovascular medicine and vascular biology. Your work significantly shaped our modern understanding of how blood vessels are regulated and laid the foundation for the development of lifesaving blood pressure medications now used everywhere. Can you tell us more about your path from physician to physician-scientist and what your research was about?
Victor Dzau: [00:07:48] Well, So I said earlier I wanted to be a doctor and it took me to Canada and McGill to study medicine. So when I started studying medicine, as would be the classical academic medicine classrooms, learning about physiology and learning how to examine patients. Of course, the science of medicine became very interesting to me. I still remember my cardiovascular physiology cause I said, Oh my, this is how it works. And guess what? This is what happens when you have aortic stenosis or cardiac dilatation. So it became very obvious that science was the basis for, in fact, the understanding of medicine and the practice of medicine. So I became very intrigued by research and of course, the time I was really interested in going to United States. So I end up, as you know, at the Brigham and Women's Hospital and Mass General, and I had lots of role models who were doing research and taking care of patients, and their research translated into the management of patients. For example, Dr. Jim Braunwald, my mentor, he's kind of the godfather of cardiology, wrote the book 'The Heart.' I mean, taught me many things about how pathophysiology lead to disease and how you can intervene. His work relates to reperfusion after coronary occlusion, right, which is what we practice every day. So I became very interested in research and so I combine a career of physician-science, as you say, and I still am a physician-scientist because I believe science and research is going to help us bring better care, better diagnoses to our patients.
Victor Dzau: [00:09:38] That's really what happened. So then I followed a very standard career of being a physician-scientist. I became a division chief because I did good work in vascular biology. And then, as you know, I came to Stanford and became chief of cardiology and head of cardiovascular research. Then I became chair of medicine at Stanford before it's called back to Boston to succeed my mentor, Jim Brown, as chair of medicine. But you know, what's really important in this journey is what I think you're -that is you, Henry, and you Tyler- you think about a lot, which is at the end of the day, what are we trying to do? We're trying to bring better health to people, to population, whether they're patients or they whether they are not patients yet, but the population. So because of my background in China and Hong Kong, I never, that never left my mind. So when I have a chance to do science and feel very gratified, as you mentioned, vascular biology, ACE inhibitor, a lot of work I did. Now the drugs that lead to, you know, improving lives and saving lives, I feel very gratified. But that never left me understanding that at the end of the day, we are about helping people and supporting people's health.
Henry Bair: [00:11:03] Next, can you tell us more about how you got involved with health equity and global health?
Victor Dzau: [00:11:10] Along the way, as I became more and more, shall we say, administration and leadership, it became very obvious to me that I should do more. And as chair DuPont Medicine and then later on, the CEO of the health system at Duke in Durham. Many people it's a very diverse community, 50% are non-white and many people really required health, and in fact, I was a big employer of Durham and the health system. Became obvious to me I need to be engaged in the community and help them beyond just giving care, but looking at what can we do about social determinants, what can you do about many education, you name it. So I got very active in this, became much broader in my thinking about what we need to do to help to improve population health and hence the whole concept of community, population, health and many others. Finally, because of my background and growing up globally, when I went back to the Brigham from Stanford and met Paul Farmer and Jim Kim, they were two of my faculty member and people say, "You got to meet them." I said. "Oh, yeah." So when I realized what they're doing is they're doing such wonderful things globally. It took very little convincing that that's what we ought to be doing as well. Kind of. Tyler, your observation. So then I hooked up with them. I helped them, supported them, create a division for them. And of course, I became very active in global health. So I think if you talk about career, I bet you all of you going to end up in different ways, not necessarily my pathway, but your always to follow your passion, to do what you believe is the right thing to do to improve health and society.
Tyler Johnson: [00:13:05] Doctors. One thing I want to reflect on, one of the aspects of your career that's so unusual is that as I hear you summarize it, it's had at least four phases. So there's the phase of being an individual doctor to a patient sitting in front of you. Then there's the medical science, the research aspect, then there's the administrative and leadership aspect, and then there is the global health aspect. But one question that I want to thread that I want to follow through all four of those facets that I think is really relevant to what we talk about on this podcast. One of the reasons that we establish the podcast is because everybody is aware in medicine that there is an epidemic of burnout. And clearly we always want to make sure to acknowledge that many drivers of that epidemic are systemic factors that are beyond the reach of any individual physician. And that's a whole separate discussion that we could have some other time. But Henry and I also have a thesis, which is that we also believe that as doctors, we've lost touch with the things that make medicine meaningful. We've lost the ability to sort of stay connected to the most important roots that brought almost all of us into medicine. And I believe that the question of how to do that is equally important across all four aspects of your career, right? Because whether you're talking about the very busy workaday schedule of seeing patients a lot or whether you're talking about sustaining interest over research questions that you may have to investigate over decades, or whether you're talking about all of the busyness of being an administrator and all the things that are involved in leadership, or whether you're talking about the same questions in global health. All four of those aspects of your career have to involve you staying in touch with the deeper reasons for being there, because otherwise it just becomes a bunch of stuff to do, right? So logistically, how do you do that? Like day to day? How do you stay in touch with the deeper meaning?
Victor Dzau: [00:15:17] I will say that you're spot on, Tyler. I think what gets us out of bed every day and do our job every day and day after day, year after year, is the purpose why we're doing this. The fundamental value that we have. And I think everybody needs to remember why we went into medicine. And really, what is our core value in doing what we do. That's key. And, you know, here my career is really have evolved my career over time, but never really drifted away from why I want to do this. As you contribute in so different, different ways. Now, you know, of course, I'm so much older than you are, so I have a richness in my life in terms of having enough years to be able to do different things. You guys are still much younger. You're really doing -look at this podcast- You are doing what you love to do and you're making a difference. I think that's an important to remember why are you doing it, and that the passion you can bring with you to what you're doing and the feeling that you're making a difference, that's really important. Because there's no single map that you can take to go from point A to point Z.
Victor Dzau: [00:16:33] It's actually yourself pursuing what you love to do most, but staying true to your values and your principles. And I think you figure it out. As you can say, this is the best way to use my time. This is a better way to use my time. I'm going to do more than one thing. Particularly when you are further along as I am. You have more flexibility to more things, right? Earlier, you can have to establish a career. So, you know, when I was growing up, my teachers I'm talking medical school now say focus, focus, focus. You know, you really got to do one thing well. And I think that's very good advice. But lots of young people like you are multitaskers, and I encourage you to do that as long as you well, what you do if you do five things well, great. If you do three things poorly, then do one really well. Right. So I think I come back to your question. Why do we do what we do? I still argue that you got to remember why you in medicine and what the purpose in your life is. And I think that's critically important.
Henry Bair: [00:17:41] So you've gone from Harvard to Stanford to Duke. And of course, now you are at the National Academy of Medicine. I'm wondering, as you go from place to place and take on these leadership roles. Are your values and your mission at the top of your mind. And if so, what are those values that you bring into these roles?
Victor Dzau: [00:18:05] Well, they're certainly top of my mind in what I do today. Why? I mean, naturally medicine is top of mind is to make a difference and really to improve health for everyone. I'd say along the way, those core principle has to be there for everyone. And when you have tough days, you have to take a step back and say, "Why am I doing this?" And I'm sure you've asked yourself in tough days, why am I doing this? You say, Oh my God, is it worth doing this? But if you truly believe you're doing it because you went into medicine for the purpose of making a difference, then I think you realize, as I was brought up, that there are bumps along the road. Sometimes things are really tough, but you're going to have to stay with it and overcome those things. Kind of persistence, learning from your failures and celebrating your success. So I would say not every moment of my day to ask answer your question. I have to say this, but I think it's back in my mind why I'm doing this. But when times are tough, it's really important to remember and ask that question. You know, it's hard to talk about burnout. I have experienced burnout when I was an intern, and this is too long a story to tell, but you have a chance. I gave a commencement speech at Boston University that talks about this to undergraduate students. You know, because COVID has caused a lot of burnout, despite even the medical profession, but even elsewhere. But I think recognizing burnout is important and we all experience this, but overcoming it and then being able to take the best out of this and help others is important. I think we do a lot of work and burnout at the National Academy of Medicine because I recognize something on this issue is and we can talk about that if you like to.
Tyler Johnson: [00:20:04] Doctors Dzau, can I ask a question. I know that especially this is still true when I look at the CV of someone as senior as you. But it was even more true when I was a medical student. I remember I would look at accomplished physicians or academics or whatever and just think, Oh, there's no way in the world. Because when you look at the CV, it appears to just be an unbroken string of successes, right? It's just success, success, success, success, success, success. And yet a moment ago, when Henry asked you to reflect on the way that the deeper meaning is important to you, one of the things that you said was precisely that it's important when things are not going well, when you are feeling burned out, when you would be tempted to maybe walk away or whatever, to shatter the myth of the idea that your career has just been one unbroken string of successes with no real hardships, could you talk a little bit about a time that was really, really tough and how you got through that anyway?
Victor Dzau: [00:21:04] Well, there were many times, particularly in the early part of my career for sure. So I started by saying, Why did I leave Hong Kong? I want to be a doctor. Hong Kong at the time in the sixties, had one medical school that admitted about 70 students. I didn't get in. And so it was difficult as it was. I had to hop on the plane and to start again to try to make sure that I would be able to get admitted to medical school. That was obviously, you can imagine, age 18, never left Asia, trying to start a whole new life with cultural differences was not easy. So that's the first failure. Second, I actually didn't say and I will say this to you, I got an internship from McGill in New York Hospital. And that year of internship was when I got burned out. My wife was really sick. She was a mental hospital several times. And those days we were told, you can't leave the ICU. That's your primary responsibility. My wife was four floors above me in the hospital and I couldn't see her. And through a number of other reasons, I said, I'm not going to do this. And so I told my program director, I'm doing something else, but this is where my upbringing was good. But I didn't quit. This was back in February or March. I didn't quit. I said, I'm not coming back. I'm going to do something else.
Victor Dzau: [00:22:44] Because my feeling of responsibility is that I can't let other people down. I can't just walk away. So I stuck with the program to the end and then tried to find something else. So that's the second thing. So I won't go through the long, circuitous route. I end up being a pathology resident at the Brigham. And then I realize I want to take care of patients. So I call the program director, Say I'd like to come back. He say they don't have a slot for you. You quit. So then I was really saying, What am I going to do? And I decided I'll take a chance and apply to the medical residency at the Brigham. And this is when Dr. Braunwald just came as a new chair. I met the program director, Marcia Wolf, and I said, my wife said to me, look, you love it so much. I will work and go and volunteer to work for nothing. And I want to say I will work for nothing. And they say, Well, we can't do that because we have caps, we have liability. So I said, What am I going to do? Right now, the good news is, along the way, there were lots of people who gave me a helping hand. In pathology I met people who said, okay, this is a pretty young, bright young guy. We vouch for you. And so despite all this vouching, there's no slot. I said, Oh my God, what am I going to do? Then I got a call to say, Oh, someone just decided not to come back to the residency. We got a slot open for you. That's the history.
Victor Dzau: [00:24:24] Right. And then to be coming in to an Ivy League program of this amazing guys who are my colleagues and some women. And it was very intimidating. And I would want to go through my first few years as a resident. That was really difficult, you know, to come from that. You know, by that time it was only about one six, seven years from, you know, from Hong Kong. Right? So there were lots of things along the way, that was not easy. But I think the thing I learned is, as you said, learn from your failures. And really in many ways, you know, don't just give up. And the other thing I've learned, of course, is people. You would say, boy, you're lucky, because somewhere along the line things worked out. I tell you, it's because people say, I'm going to help you. And that's why I really believe that our job is to look for people, anyone like yourself and others to help. Because that helping hand that believe in me, to enable me to be able to do what I want to do is so important. I mean, that's what we call mentorship, right? And so many other aspects of it. So I think people are so important in your life.
Tyler Johnson: [00:25:46] So I just want to draw out the fact because a lot of our listeners, from what we gather, are younger even than us, right? They're pre-medical students. Medical students or very young trainees. I just think it's really important to highlight the fact that here we're talking to the president of the National Academy of Medicine, and he did not get into medical school his first time, had to move to a foreign country and then left internship or residency after his internship because the internship was so unreasonably hard, which I just say that because it really does- I know that as a young trainee, everybody has imposter syndrome and thinks that everybody else doesn't, right? They're convinced that they're the only one who doesn't fit and everybody else is smarter and nobody else is having a hard time and whatever. So just the next time you young listener are thinking that you can think back to this interview and know that in fact you are not the only one who is struggling in your medical training.
Victor Dzau: [00:26:40] Well, you know, I would say that don't struggle by yourself, really. I think supportive environment is so important. Whether you have a loved one's, you know, your spouse, your family, your friends, and certainly in the workplace, I have found that particularly workplace in my own experience has been really important to have your peers and colleagues understand you and support you and to have your supervisor support you. This is where coming back to your question, Tyler, about burnout, I think that as you said, you know, we've learned some time ago it's not "individual, suck it up and learn how to do this;" it's the environment that supports you. Here's what I'm very proud of National Academy of Medicine, because everybody knows the Institute of Medicine, IOM, which is where we are, we were and now we call NAM, wrote a report "To Err is Human" to say those medical errors are not individual errors. It's a system error. Right. And look at what you're doing today when you go to the O.R., when you're checking your patients. Everybody is really vigilant about checking and make sure there's no errors. The system issue, the same goes for burnout and distress for the trainees and for doctors. We need to create a system environment to support them. We need to create a system that listens to them and help them do their work and reduce the unnecessary workload, all that stuff. And as I was saying, the National Academy of Medicine have taken this on a big way. We've been working on this six, seven years. We just released a national plan along with Surgeon General, to look at what are the things that we all need to do to really stem this tide, particularly because of COVID and before COVID.
Henry Bair: [00:28:36] Mm hmm. Yeah. I hope to explore some of these these initiatives and these issues that you're concerned about in your current role at the National Academy of Medicine. But but actually, before we get to that, and I'm wondering if you could just give us a very brief overview of what the National Academy of Medicine is and what it does for the benefit of our listeners who may not be aware.
Victor Dzau: [00:28:59] Yeah. National Academy Medicine or NAM finds its roots in National Academy of Sciences, which was founded in 1863 by Abraham Lincoln and Congress. At the time of Civil War, the government decided they need an independent -and not part of a government- independent organization of experts and scholars to advise them. They created a National Academy of Sciences. Over the years because health and medicine has become such an important topic, as has engineering, we evolved into three academies: National Academy of Sciences, Academy of Engineering, Academy of Medicine. National Academy of Medicine started as an Institute of Medicine, or IOM, within the National Academy of Sciences. And this started in 1970. And then the last six, seven years, we became the third academy of the three academies. We are about the following: number one, our mission is to look at what we can do in the area of health and improve health for all. And over the years, we've done lots of very important studies and reports that make recommendations for the nation what to do, including patient safety, you know, medical errors. Hiv/AIDS as a medical crisis. Sequencing the human genome back in the 80s, when we say it should be done all the way to population health, the importance and naming and coining that term and to pandemics. And we work directly with Congress because Congress will ask us to do assessment before they pass a bill to give them the information recommendations with director, with directly with NIH, CDC, FDA, you name it, to help them with policy.
Victor Dzau: [00:30:57] But we have certainly worked directly with the population, not just the government, because we believe the importance of serving the nation is serving everyone, not just the government. And then, of course, the last decade or more, we have been very global, directly worked with W.H.O., World Bank, G-20, G-7, etc.. So the way we look at it is the following. We need to be there when there's a really important issue that confronts health and medicine. For example, the existential threat of COVID-19 pandemic. The climate change and health. And the issue of structural racism. These are the things we work on. But we also take on, as you heard, clinician burnout is such an important issue that when you step in, the opioid crisis, and of course the issue of health equity. So we work in all these things, but we also work on science based issues such as genome editing, genetics and genomics and many others. So the other thing is that we have really amazing membership. We elect 100 a year, a steady state where about 2000 members. We have 18 Nobel laureates and some of the best minds and we bring them together, help us do our work.
Tyler Johnson: [00:32:26] This is a side issue, but I think many of our listeners might just be interested to know, you know, I know Stanford every year when the new elected members are announced, Stanford always puts out a press release. You know, such and such number of faculty have been accepted or elected or whatever. How does that process work? How does a person how does a person get nominated and how do they get elected to the name?
Victor Dzau: [00:32:51] Yeah, it's a pretty competitive process. First of all, you need to be nominated by a member. It's not an application approach and the member's nomination is usually confidential. We usually nominated people into different sections, whether you're internal medicine, whether you are in neuroscience, whether you're in molecular science, epidemiology, public health, you name it. And then the sections begin to look at and rank order, the people nominated. Then they go through a pretty extensive membership committee and selection process whereby eventually we put forward a slate to be voted upon by the entire membership. So in those we put forward, say, X number of people to be able to select the first 100. And then all membership will vote. And the people who, of course, gets the best ranking will get elected. And so that's the way we do it.
Henry Bair: [00:33:59] So I just wanted to clarify the selection criteria. Is it based on research record? Is it based on leadership? Or is it based on clinical experience or something else?
Victor Dzau: [00:34:13] All of the above. We look at excellence as the criteria. We look at impact contribution as a criteria, and we look at service as a criteria. So impact, it's what you do. So we have sections where they are mainly administrators and leaders. They haven't done a lot of research. But for example, a former secretary of Health and Human Services who's done a lot on the area for human health, FDA commissioner can be elected and not have done a lot of research, but in terms of impact is what they've done right. But of course, research is a very easy one to measure. If you are in, you know, molecular biology or whatever, Right. Hence the idea of what impact have you made in your scientific field and just specific field and impact relate to health and medicine. So that's really important. I mentioned the issue of commitment to service. We look at when we bring them in to members, will they be active and help us do our job and advising the nation about health and medicine. So therefore, we want people who really truly committed to coming in and devoting their time to do the things that we do. Right. And of course, we always look for the kind of individuals, the quality of individuals who are truly outstanding individuals in their own right. So I think those are the kind of criteria that we use. It's not the endpoint being elected members. It's Nice. I think the endpoint is being able to work together to make a difference. And I would hasten to point out our work goes well beyond our members. We actually bring together people from all different sectors, lawyers, economists, etc. to do the work that we do. So we convene the very best minds to the work that we do and report and discussions in ways to advise the government.
Henry Bair: [00:36:25] That's great. So earlier, you gave us an extensive list of the issues that the NAM is currently trying to tackle, and that's there's a lot there that we can we can talk about too much for the limited time we have here. But perhaps just to just to touch on a few of those.
Victor Dzau: [00:36:42] Yeah, I want to add two others because we now need to focus on reproductive health. To be fair. I mean, obviously it's a really important question. But yes, the Dobbs decision triggered a lot of concerns about the unintended consequences. We're not a political organization, so we're not about to say this is a right or wrong political decision. However, our job is to say if such a decision should be made, how can we be sure that women's reproductive health are protected? How can we assure that the physicians and nurses and obstetricians and all this work can be carried out? How can we ensure that people have access in the red states where in fact there's fewer and fewer health care workers in this field? How do we look at the issue of what's constituted emergency abortion? In fact, if a mother's life is at risk right now, a physician can be challenged by saying if you abort, you are criminalized versus I really want to save the mother's life. So we want to give guidance to those things and things like that. Right. But also how to enhance maternal mortality and in terms of lifespan, reduce mortality and many issues. So that's a really important issue. So that's a good example of how we jump into action when something like this is staring at us. The other one is firearm violence. So we have a task force to look at more research how to prevent this from happening. Again, we don't get into the politics, but we get into what's needed, not prevent, prevent injury and reduce the firearm violence. So those are two examples. But I mentioned opioid. We're now looking at fentanyl. How do we actually look at treatment, prevention and recovery? But now we're looking at social determinants. How do we actually look upstream on those issues that actually puts people at risk and how to prevent those issues by prevention and intervention.
Henry Bair: [00:38:58] So, you know, it's hard to think about the issues you're talking about and the questions you're asking and think that this can completely stay out of politics if I'm being completely honest, just because even if the NAM does not operate through a partizan lens, I think the recipients of the products that you're producing, the work that you're producing, the guidelines you are you're creating are going to interpret them and certainly implement them in a very political arena. Right?
Victor Dzau: [00:39:30] Well, let me say the following, I think, as scientists. Health care workers. We have an obligation to speak up. To stand up for signs and what's right for health and medicine. So to be sure, we shouldn't be shying away from those issues, we should be able to say so to say this is the right thing to do. The politics issue is got to do with challenging a political decision or getting involved with advocating for political decision. We have to do that because we have to remain neutral. Otherwise, people are not going to trust us as advisors to the issue. Right? So if Congress is now House Republican, they can say, "boy, this is a left-leaning organization. We can't trust them to advise us." So we have to remain neutral. But Henry, the way to remain neutral is to be science- and evidence-based. So, yeah, you can interpret whatever you want, but we believe we're going to go according to science.
Victor Dzau: [00:40:36] So, for example, women preventive services, we believe the science behind it, the policy and politics and law behind it is not something that we would be per se directly involved with. But we have to respond to what happens if there were a law. Or what happens if one is deciding to pass a law. We can give them the scientific evidence issues. Covid is a good example. You're right. There's a polarization of science, right? But still we have people like Tony Fauci, Ashish Jha, Francis Collins, who said "This is what science tells us." We can't help the polarization. However, we will continue to give the signs.
Tyler Johnson: [00:41:25] And I think that one of the things that has become so interesting, at least over the last especially over the last ten years in particular during the the time of the pandemic, is that almost regardless of what an organization that is, a self professed organization of experts like the NAM, almost regardless of what they say, the very idea of listening to them has become politicized. Right? Because we've we've sort of re picked up, this has been true intermittently throughout American history, but we've we've sort of redeveloped this. Some political factions have redeveloped an allergy to listening to experts as if the rejection of expert advice itself is somehow a political bonus. Right. And I think that's that creates a really, really difficult dynamic.
Victor Dzau: [00:42:13] I think we have to learn how to tackle this issue. We have to learn about communication, the science of communication. So, you know, I think most of us think we only show them the facts and then we describe to them and have a learned logical discussion, rational discussion. People will come to your side of things. And we now know it's not the case. There are many other factors that influence people's listening and decisions. So if we don't learn about those things, we're never going to be able to get the science across. So I would say we stay true to the science, but we need to communicate differently. What am I saying? Well, just by simply telling people, showing data is not sufficient, you need to really get the trust of individuals. So to begin with, let's say you go into community of African Americans, I you have to remember Tuskegee. You have to remember what they are concerned about. You have to really get their trust. So a lot of work is really, first of all, listening to them first, hearing what their concerns are, what their needs are before you try to kind of put forward your ideas. Secondly, you need to engage the leaders and community who can help you communicate those issues. And third, that you need to really resonate with their concerns and being put forward what you want to tell them and then see that reaction and discuss with them. So there's a lot of science of communication that we need to learn all together in the scientific arena that we are certainly not trained to do. But that's going to change substantially.
Henry Bair: [00:44:05] Yeah, that is so important. Certainly, I think during COVID, we all got our front row seat of how the science and the data just aren't enough to reach many people.
Victor Dzau: [00:44:19] I want to say one thing to you guys, though. Our work, Your work is so important because, you know, as physicians, as nurses and health care providers, scientists, we still are trusted by the public because they trust you as a doctor. They trust you as a nurse, they trust you as whatever you do. And we have a job not just to look at the individual patient that's so, so important, but to take it further, to think about the population, health and the whole societal issue. And I think increasingly, this is what I'm passionate about, that our job is more than health care. It's about social issues, society. And as leaders of the community and society, we need to be get actively involved with these issues. I don't mean that as a political activist, but I mean that as a way to help us think about how we using our experience and our capability to serve the nation much better to speak up when we do and to get involved with the community to improve their conditions.
Henry Bair: [00:45:32] I would like to close this out with one last question. You know, many of our listeners are early career clinicians or are still in the middle of their training. They might be interested in embarking on a future career in health care leadership for them. What advice do you have about what it means to be an effective leader?
Victor Dzau: [00:45:55] I think it still comes back to what we said earlier, which is, number one, know what you want to do, what your purpose is, what your values are. Second, understanding that in addition to working one by one, one on one on patients, every life matters and working with your friends and peers. There's also a bigger picture of being able to mobilize more and hence to start thinking about leadership issues. Being able to organize, coordinate. Bringing people together, being able to listen better. I think those are essential qualities. Before you go any further. Leadership is about bringing people together. Being able to listen to people and then being able to pull all this together with the vision. The people work together towards that vision. So some come naturally and some you have to learn. And as you know now, more and more schools and universities are teaching leadership. And I think those who like to do this along the way, further along than career can certainly go off to get an MBA and leadership training and others. And, you know, if I look at the two of you, I think you've already shown leadership. The fact that you say this is a good idea, let's get together and then let's do something about this. Just you're doing communication signs and think about you communicating with your peers, with younger people in the profession. I think you could think about communicating broader with the rest of community and others. And I have a feeling you're going to think a lot more about what you're going to do with the success that you have and really think about expanding its impact, and I would encourage you to do so.
Henry Bair: [00:47:50] Well, thank you so much for your kind and encouraging words. Really warms our hearts to hear you say that. We want to thank you for your time and for the insights and the stories that you've shared with us today. Thank you, Dr. Dzau.
Tyler Johnson: [00:48:02] Thank you so much, Dr. Dzau. So appreciate it.
Victor Dzau: [00:48:04] I really enjoy talking to both of you. Thank you very much for giving me the time.
Henry Bair: [00:48:12] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program, notes and transcripts of all episodes at theDoctorsArt.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:48:30] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.
Henry Bair: [00:48:44] I'm Henry Bair.
Tyler Johnson: [00:48:45] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.