July 27, 2023
Dr. Edelman works at the intersection of the physical sciences and medicine to improve healthcare.
This episode was made possible by our partnership with Edwards Lifesciences.
Julie Gerbeding: Welcome to the Gary Bisby Show. It is my poignant honor to be your host today, and I have an very exciting guest. Dr. Elazer Edelman is the Edward j Pores professor in medical engineering and science at MIT. A Professor of Medicine at Harvard Medical School. An attending physician in the coronary care unit at Brigham and Women’s Hospital in Boston. He and his laboratory have done amazing work in vascular biology and in other dimensions in the development and assessment of biotechnology in this area. He directs the MIT Institute for Medical Engineering and Science, as well as the clinical research center. The Harvard MIT biomedical engineering center, of these activities are oriented around the development of the basic science and the translation of that science into interventions that really help patients. And one of the things that I find so fascinating about in his career is that he really is in the sense, the epitome of convergence, that connection of different disciplines and the friction that. Occurs when you bring different disciplines together to focus on a problem, the creativity and the innovation. So I wanna start by, first of all, thanking you for joining us, but also by asking you, what is it about the culture in these institutions when you’re, where you’re working, that allows you to have this kind of convergent innovation really thrives so incredibly well.
Elazer Edelman: So thank you for a wonderful introduction. And thank you parenthetically for all you do because it, it is a matter of culture. Those of us who have been blessed to practice medicine in the last 40, 50 years, Have seen this remarkable transformation of medicine as a dedicated art form into medicine, as an impact on global health through the melding of science and engineering with that art form and it has occurred because, People like you. Dr. Gerberding have helped us build conceptual, supportive communities so that people like both of us could bring all of our talents together. I’m often asked if I’m a 20 80, 50 50, 80 20, and anyone who knows those numbers knows that what it means is, Do I spend 20% of my time thinking about clinical medicine and 80% research, or is it flipped or is it 50 50? Which means that if you believe that I exist in two disparate domains, two different cultures. The very essence of your question is that I’m a hundred percent always a clinician scientist, always a clinician engineer, and I belong in one vibrant conceptual community. That holds that we have to embrace all of these disciplines to have impact.
Julie Gerbeding: When I at your career your early. Science and the mathematics of drug elution from bare metal stents and so on and so forth. Through your whole progression into some of the most interesting and innovative interventions and devices, I think you have 80 patents. As a matter of fact, people might be a little surprised to know that in your earliest iteration of an innovator, you were running an eighth clinic while you were a resident in the very beginning of the H I V epidemic. I was in your cohort, so you and I both started in an era when we were facing our first pandemic. So fast forward to 2020 and your time in the coronary care unit at the Briga. First of all, you should ask you were you surprised to find yourself in a situation where you were once again on the front line of a really frightening pandemic. But also I’d like to have you talk a little bit about what that was like for you, and then maybe we can touch on some of the things that you and your team did to adopt your sort of core capacities in biomedical engineering of vascular disease. Two of the Covid front lines and some of the innovations that came of that. So tell us a little bit about that experience that, you have had a unique vantage point to appreciate.
Elazer Edelman: Thank you for your question. The Covid epidemic does have profound residences with what you and I experienced with aids, what you taught us all through your practice and through the c d c and what we understand are very powerful messages. The first message is, These things sneak up on us, and the realization is late and dawning. But once we understand it, we come to realize two very important things. First, that whatever happens to us is happening around the world. Medicine is not a first world problem. That’s not a third world problem. It’s not a problem in Americas or in Asia. It’s a global problem. Whatever happens with harmonics over time and space. Now, that’s an engineer speaking, but what that means is that the flu epidemic started in the United States and it resonated throughout the world, and then it had harmonic appearances every few years. The same thing was true for everything like polio, for for for aids, for covid. And the response requires each time the same marshaling of groups, disciplines, and cultural alignment. First, the appreciation that we’re dealing with something powerful that affects everyone. Second that we can learn from everybody. And third, that it is precisely technology that with its double-edged sword can solve at the same time as create problems. So what do I mean by that? We made the first diagnosis of AIDS and therefore, as a very young clinician, I was assigned all the AIDS patients and suddenly I was running an AIDS clinic as someone who. We didn’t have that expertise, and so I needed to rely on community to help me. Infectious disease doctors, indeed, the Centers for Disease Control Publishing a pamphlet Weekly helped us all. And then it was the sharing of information that led us to understand how to deal with things. It was this incredible push of an entire community to isolate the primary organism and then to bring together, One, two multiple chemotherapeutic approaches. Same thing was true of Covid. We saw Covid in November of 2019 without understanding that it was Covid, but I was working with colleagues in Milad on a science program when Covid erupted there. And then we had continuous dialogue about best practices. Technology has helped us in a way, unlike never before, is that at the height of Covid, we could take skulls of technology like MIT and redirect all of its resources to look at everything from the manufacturing and provision of protective equipment, personalized protective equipment, to the very essence of. What is the nature of these diseases as they affect certain organs in a very dickens like way. It was the best of times and the worst of times. And the final lesson, and then I’d love to engage you in this ’cause you know far more about this than I do, is that we not to pretend that this is once in a lifetime or once in a century event. These are the larger manifestations. Of medicine in its totality. This is no different in a sense, than the plague of cardiovascular or an atherosclerotic disease or the transition of diabetes from an acute illness in children to a chronic, debilitating series of processes in adults, the ramping, the rampages and ravages of. Obesity and metabolic syndromes are very much akin to the infectious diseases that we cite as pandemics, and the same cultural realignment is what’s required to solve those problems.
Julie Gerbeding: You’re bringing a very broad lens on and I like your concept of harmonics, even though obviously I’m not an engineer. I think that really resonates with me and I also recall our conversation about what is happening in clinical cardiology today. I think you told me that when you are attending in the coronary care unit right now, it’s actually unusual for someone to come in with a myocardial infarction and die. Largely that’s a consequence of the incredible progress we’ve made in diagnosing, treating invasively and non-invasively coronary artery disease. And yet the mortality in the coronary care unit is 20% During admission, I. 20% again before discharge, and then 20% in the next six months. So what you’re really talking about is not coronary artery disease, but the ripple effect, the harmonics of the obesity, the diabetes, and the overall poor state of health that are communities really experience in an incredibly dis equitable way. If I could use a non-English term, So when you’re thinking about how technology plays into that space, what are your thoughts and how do you redirect your effort beyond the blood vessel to the broader concerns that are causing the patients to be in a coronary care unit?
Elazer Edelman: Such a wonderfully phrased question, and it requires a two part answer. It requires a historical answer which is philosophical, and then a very practical one. So historically, the appreciation that the cardiovascular system is a circulatory system. Comes about at the very beginning of the 17th century, but is directly influenced by science. William Harvey in 16 8 0 3 16 8 0 4 explains that everything’s a circuit. The consequence of our blood flowing in a circuit means that the norm is that in effect, that one part of the circuit will be felt everywhere. Now the fact is, the historical fact is that Harvey actually seized on the work of another physician, Nicholas Copernicus, by directly taking his work on the solar system and applying it to the cardiovascular system. Indeed, in the 17th century it was professors of anatomy who actually taught astronomy. The degree that they got Dr. Medic Medicina in Arts they got a a degree in arts and technology is the degree we give at MIT today. So what it means is, it means first that if we really appreciate modern physiology, it’s unusual for anyone to have a single organ disease and as technology. Addresses or supports patients who are profoundly ill with one disease, they can make another emerge. So you’re right. When you and I started in medicine, the cardiac inten, the coronary intensive care unit was called the coronary intensive care unit because we treated people with myocardial infarctions with a heart attack, but we didn’t really treat them. We watched them as we began to treat them. We prevented them from dying and the consequences that many other organ systems erupted with other processes, either immediately in the near term or in the long term. And that’s what modern medicine is. And so our coronary unit care unit has become the cardiac intensive care unit and it’s multi organ failure Now. What technology has done is not only prolong people’s lives, save those who might have passed away, but it’s also created inequities. It’s allowed diseases to emerge, but it also means that while there are global diseases, there’s not global access to technology. And so I treat patients who are in at least two forms of advanced support. I give patients technology with ventricular assist devices that we help write the algorithms for devices like stents and new valves that we’ve helped invent. But that’s not available to everybody. And that’s the challenge. The challenge is that everybody has a circulatory system. And everybody’s organs are be at the consequence of everything within that circulatory system. But not everyone has the access to the same technological advances.
Julie Gerbeding: This whole it’s almost a paradox, isn’t it? We have, science is on our side. Science has never known more and had the capacity to do more than we’re looking out on today and in, in the. Foreseeable future. yet that very science creates some incredible societal challenges that focus in many areas. But one of them is that whole concept of translation. First bench to bedside. So let’s talk about that a little bit, and you’ve already brought up the equitable access and affordability of these scientific interventions, this technology. But there are other science and society issues that we have to contend with. The whole issue of transplantations and artificial organs, the safety of artificial intelligence and machine learning, complexities and ethics of gene editing. these are really vexing issues. I know in your lab you have a cadre of incredibly brilliant people who are working on various dimensions of these problems, but I’d like to know how you as the leader really instill in them not only their scientific competency and capacity development, but the ability to take on. Think about and really operate in this world, the juxtaposition between science and the societal challenges that we are actually creating and need to have some accountability for solving. So as the leader, how do you bring these 300 people that you’ve trained through the years along that pathway so that they really are part of the solution to this conundrum.
Elazer Edelman: So I’ll give you the answer that my PhD advisor would’ve given. Its I always made fun of him for it, but it’s true, and it is that it’s they who lead me. So the wisest and most inspired thing I do is invite them to become a part of our community and then allow them to reach beyond their potential. So when you, I, Bernard Cohen, was this. Great historian of science. He wrote this book on revolutions and science. And if I can distill down this 6, 7, 800 page book to just one thought, he said that science becomes revolutionary when it advances conceptual thought and creates conceptual revolutionaries. And that’s what we do. We create an environment which. Has the flip side of any good organization. We create focus, but have a diverse set of perspective and skills. We have a shared and common vision, which is that everything we do is trying to answer the how and why questions, not just the what of medicine. And I try very hard to direct. Keep people on a track, but also to empower them to be autonomous and then above all, constantly challenge people, but allow them to feel safe and secure. In saying that they don’t know, but they want to investigate. So it’s, if you will, the whole rules of how you create any. A community that is simultaneously innovative but also safe.
Julie Gerbeding: It’s an interesting challenge. You it the wise crowd, but the wise crowd has to. Mobilized in the direction that actually accomplishes the overall mission and purpose of the organization. But certainly you’re situated in, a mecca where that kind of multidisciplinary approach with really bright people who are not just on a mission, but are motivated by their internal sense of purpose. And yeah, I think there are many places I would like to think around the country and the world where such a culture exists. But arguably, MIT Harvard. It’s gotta be one of the incubators of this kind of community of collaboration. What is it about the environment that you operate in Boston that makes this so much more common perhaps than it is in many other settings?
Elazer Edelman: I would answer that there are two things, inspired mentorship and a common embracing of the moral obligation of a clinician scientist. So what I mean by that, and I’ll start with the second, is that clinician scientists have a unique moral obligation. That you alluded to earlier, they are bound, not just by the ethics of science, but by the obligation to use their science to improve the human condition. That is not an obligation of virtually anybody else alone, but the clinician scientist must do that. You cannot take time away. From the learning and practice of medicine to engage in science unless that science makes you a better clinician and improves the qualities of people who rely on you when they are vulnerable. And then second, there has to be not only a community of like-minded people who embrace that message, but a community that through its own entire infrastructure, Wants to help other people do that, and that’s what inspired mentorship is. It’s not the reliance on a single individual to provide for everyone. It means that all of us embrace the moral obligation of translating science into medical impact, into translating engineering, into improving the quality of people’s lives. We equally embrace the responsibility to enable others who are before us, others who will come after us, others who we will never meet, but through our writing and our teaching can achieve the same thing.
Julie Gerbeding: It is a really beautiful re-articulation of the Hippocratic. a sense, that it’s not just about the practice of our craft, but it’s about our. Moral and humanitarian obligation to do something for people on behalf of people in the pursuit of that craft. And is that something we talk enough about in medicine? I think so. It’s really lovely to hear you articulate it in such a profound way
Elazer Edelman: Thank you.
Julie Gerbeding: that does lead me to touch on another framework that you and I discussed earlier. And that really is the framework of the. Translation of science, not just from the bed to the bench to the bedside, but translation of science from scientists to citizens to society. We’re living in a world right now where trust in science arguably is as low as I think anyone have anyone could ever imagine it would be in this day and age. Trust in our institutions is declining. Trust in doctors has declined in many settings. and yet, we have the knowledge we have a moral obligation to present our knowledge and perspectives in ways that help people understand and have the information they need in the way they need it to make better decisions. Also the responsibility to make sure that goes beyond individual patients and has a broader influence in our communities and in our decision makers. And you talked a little bit about some of the things that you have personally done to try to be an ambassador of science in that way, but also some of the things that you encourage your students and trainees and postdocs to participate in as well. And I think that’s so important. So I’d love to hear you dive into that a little bit.
Elazer Edelman: So certainly, and it is almost ironic for you asking me that question because people. Like you are heroes. You’re the people who who dedicate their lives to serving as the ambassadors and advocates for science and community, not science and community, not community and science, but science and community together. I think as you said part of our moral obligation, part of our responsibility is not simply to engage in ethical science, not simply to make sure that people can read and hear about what we do, and not even make sure that everyone has access to what’s good and great to become better. There’s a fourth pillar to that, and that is we have an obligation to explain to everyone what we’re doing and then to listen when they talk back to us, to make sure that they understand and we understand and can learn from them. I think it is important for every single one of us to become those advocates. We need to go into elementary and middle and high schools. We need to go to the halls of Congress. We need to explain what we’re doing and then we need not to be afraid to be honest, part of why people are suspicious is because a hundred truths are undermined by one falsehood. A hundred successes are undermined by one, one event where things did not go right when we promised that they would. So the most important thing is to be honest and forthright and then to engage the community as our partners. Physicians are sometimes afraid, and scientists especially of not admitting that we don’t know everything and that there is a risk to any path we take, and so we need to. Be those advocates and teach advocacy and recognize and reward advocacy so that it doesn’t follow or fall rather on the select view who are most good at it, but it becomes a part of every scientist, clinician, engineers, scholars portfolio.
Julie Gerbeding: It’s really An essential tool in our black bag, but it is not one that is emphasized in very many settings, especially when people get swept up into the pursuit of their, their scientific endeavor or their bedside. Demands, and yet I’ve always thought that the most effective way to be an ambassador for science or for helping people have an honest appraisal of where we are, is to, no matter who I’m talking to, whether it’s someone my work setting or in the congress or in the news media, to always in my mind feel like I’m speaking to a patient. Because when doctors speak to patients, we’re rarely absolute. We often have to acknowledge that we have uncertainty about the best course or what’s going to happen if we do X, Y, or Z. And that kind of intimate honesty is so important to the patient. It is what engenders that trust that happens in the doctor patient relationship. We just need to figure out how to instill that in a broader universe in which we operate in the rest of our world. And if we could do that better, I think more people would would we would regain trust and where we’ve lost it and strengthen it, where we still have it. certainly you are an exemplar of that capacity to be able to bring into an environment where citizens can grapple with it and Congress, and I know you’ve worked with the F D A and other organizations as well, but I. Thank you for that because you have your own persona and your own track record and credibility to bring to that effort. But you also have the brand of Harvard and MIT and that also matters ’cause those are very credible resources and people have high expectations and it helps us all when that perspective can be brought forward despite your demanding professional work. So I just wanna end on a fun note because I hope everyone will Google you and read your resume and just see the amazing things you’ve done. But you also have a family three sons I believe, and, a very interesting lives outside of work. And it’s always important to acknowledge that leaders are better when they have balance. their lives. And so maybe you could just say a little bit about that in your own life, but also how you try to encourage that in your students and trainees that you’re leaving.
Elazer Edelman: That is an interesting question. And it’s doubly interesting because this morning I was driving my. Son to the train. And as always, he was late. And he said to me I know I’m late. I know we may miss the train, but I feel bad because I know you have a call in five minutes and you’re gonna have to take it from the car. And then he did what every child does to a parent. He asks the stunning question and he asked me, he said, dad, have, having us as children negatively impacted your career?
Julie Gerbeding: Good.
Elazer Edelman: I said to him wonderful question, which is always a stalling. And I said, Austin no. But what it really did do is changed what I wanted out of life. It changed what I consider to be important in life, and it changed what I wanted my career to be. And I can’t imagine life or my career without family. And I try very hard to convey that to all of our postdocs and students, all of our fellows. It, I’ve never met and I deal with a lot of end of life issues. A person who at the end of their life said, you know what? I spend way too much time with my family. I think that the family and community are one, right? It doesn’t mean that everyone has to have a child, but everyone has to view that they have to be part of a world around them, and that fuses with their personal sense and what they call their career. My, my PhD is in a branch of physics called Continuum Dynamics. It sees the world as a continuum. There are no discontinuities, and that’s how I view community, family medicine, science, engineering. It’s all a fusion of a universe and I, you cannot be a scientist without living in the world, and you cannot be a clinician. Without. I know. ’cause you and I have talked that those of us that were both blessed and burdened with the very early part of AIDS could never come away without this angst for those who were entrusted themselves to us when we had no idea what was going on. And then this incredible empathy, not sympathy. Feeling the pain and suffering and realizing that people had to hide who they were and that the disease was both destroying that part of their persona as well as their physical essence. So the short answer to your question is there cannot be a career. And to Austin’s question, there is no career without family. There is no science without community. There cannot be engineering without a global friendship and sibling.
Julie Gerbeding: It’s a beautiful way to end a conversation. I’m inspired and I’m sure our viewers will be similarly in. just thank you for this, but also thank you so much for what you do, for your leadership and for bringing that diaspora of incredibly talented people through your lab and through your coronary care unit. I am grateful for your time and with that, we will end our program today and thank our viewers and hope that you will log on to see other episodes of the Gary Bisbee Show. you.
Elazer Edelman: Thank you, Dr. Gerbeding, for everything you’ve done. Thank you.
Julie Gerbeding: You’re very welcome.
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