We need to expand investment in scientific and medical research. We are falling behind on these investments relative to many countries, and we risk losing our leadership in medical innovation. What investment could be more important in national interests than one that is proven to improve health, eradicate illness, extend longevity, and enhance national productivity? This is an issue of national strategic importance. Unless we invest in new discoveries, we are destined to be dependent on other countries for the very health of our citizens and the future productivity of the nation.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Kevin J. Tracey, MD, president and CEO of The Feinstein Institutes for Medical Research at Northwell Health. Dr. Tracey is a pioneer in defining the molecular basis of inflammation and the founding father of a burgeoning new scientific field, “bioelectronic medicine.” The Public Library of Science Magazine recently recognized him as one of the world’s most 1,000 impactful scientists. Dr. Tracey graduated summa cum laude from Boston College, majoring in chemistry, and received his MD from Boston University. He trained in neurosurgery at the New York Hospital/Cornell University Medical Center and was a guest investigator at The Rockefeller University. Since 1992 he has directed the Laboratory of Biomedical Science at the Feinstein Institutes in Manhasset, NY, where in 2005 he was appointed president and CEO. Dr. Tracey delivers lectures (including a TedMed Talk) nationally and internationally on inflammation, sepsis, the neuroscience of immunity, and bioelectronic medicine. He is the author of Fatal Sequence (Dana Press) and more than 350 scientific papers, and the inventor of 68 United States patents.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
While training as a neurosurgeon-scientist in 1985, I treated an 11-month-old girl, Janice. One day, Janice was crawling under her grandmother’s legs when she was cooking spaghetti, causing her grandmother to trip and spill the boiling water on Janice. After weeks of treatment, Janice was recovering, but unexpectedly, on the day after her first birthday, she went into shock and died in my arms. At the time, I knew no reason for this to have happened. Devastated and baffled, I decided to study shock in the laboratory, a pursuit I continue today, 34 years later. In 1987, my colleagues and I first discovered Janice’s shock was caused by her immune system. The name of the molecule we found as the cause of Janice’s shock and inflammation is named “TNF,” and the antidote is termed a “monoclonal anti-TNF antibody.” This key finding became the basis of new drugs, since used by millions of people with severe inflammation. Sales of these drugs now account for more than 5% of total sales for the entire worldwide pharmaceutical industry.
And as often happens in science, an important discovery leads to another important question. I began to wonder: “If TNF made by the immune system can be so deadly, then how do our bodies normally control the immune system to maintain health?” My colleagues and I discovered an answer in the nervous system. You never think about it, but your heart rate and other organs are controlled by your brain. Similarly, we discovered that TNF production is controlled by signals originating in the brain traveling to the immune system through a nerve in your neck, the vagus nerve. Upon discovering this, we invented a method to control these signals using a device to turn off TNF. Today, we are seeing clinical trial results of patients with rheumatoid arthritis and Crohn’s disease who have been helped by small electronic devices controlling the vagus nerve to prevent the damage caused by TNF. The highlight of these decades of research is meeting patients in remission from the treatment we invented.
Can you share the most interesting story that happened to you since you began leading your company?
We were studying brain damage caused by a stroke, hoping to block TNF in the brain of mice and rats as a possible therapy. The most interesting thing happened when we looked in the spleen and other organs of these animals. There we unexpectedly found TNF was also blocked in those organs as well. This finding made no sense at all! We cut the vagus nerve, and the effect was lost. This was the first proof signals arising in the brain and traveling through the vagus nerve control the immune system and TNF. This surprise led us to formulate a vagus nerve stimulator theory that now is helping patients by stopping their immune system from overproducing TNF.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
After discovering a vagus nerve circuit to control TNF in the immune system, we assumed that someone else must have thought about this before, because the vagus nerve controls most of the body’s organs, including the heart, lungs, liver and gut. But looking in the scientific literature, we could not find anything like this idea. This created a very funny new problem: How do you introduce an outrageous idea like this when no one else is even thinking about it?
I decided to have a contest in the lab. I invited anyone who could write the first sentence of the paper to be a co-author, even if they had not worked on the project before! Many people contributed dozens of ideas, all hoping to be a co-author on what they believed would be an important paper. Because the vagus nerve is involved in regulating bodily functions including digesting, sleeping, defecating, and, well, sex, well you can only imagine the gist of what some of these sentences looked like!
Sadly, most of these could not be printed then, or now. And from this, I learned the power of teamwork and collaboration to solve a problem. Inspired teams generate an unlimited supply of fresh, new ideas. Oh, and they were also right about the importance of the paper, because since it was published in Nature, it has been cited many thousands of times.
What do you think makes your company stand out? Can you share a story?
The Feinstein Institutes for Medical Research at Northwell Health stands out because of our focus on our mission and culture of collaboration. Our mission statement guides everything we do: “produce knowledge to cure disease.”
Whether it’s revealing the role of a specific molecule, launching new clinical trials, deploying nationwide telemedicine programs, or inventing new bioelectronic medicine opportunities, our team of 5,000 collaborators are laser-focused. This motivation stems from the very top, as Northwell Health’s CEO, Michael Dowling, is a champion for innovation, excellence, and cooperation across the entire health system. There are many research institutions around the world, but none exceed our concentration on medical research done collaboratively, thanks to Northwell Health’s vast network of hospitals and clinics, the largest health system in New York.
What advice would you give to other healthcare leaders to help their team to thrive?
Focus on mission and collaboration to benefit patients. The world is increasingly focused on business outcomes, reputation credentials, media impact, and other secondary measures of real success. Indeed, fiscal responsibility and outreach are a requisite tool for success, but it is not the reason we do what we do. We work to discover ways to help people; it is a noble mission. Collaborating teams work harder and more effectively when the goal is helping others. They need little encouragement to thrive in pursuit of this goal.
I know this from my own experiences because when I was five years old, my mother died from a brain tumor. I remember my grandfather, a pediatrician, and professor at Yale Medical School, explaining that her neurosurgeon had limited options and tools, and she died soon after surgery. “Someone,” I remember saying to him, “should do something about that.” Looking back after four years of medical school, nine years of training as a neurosurgeon-scientist, and decades as a researcher, I am more motivated than ever to find ways that might prevent suffering for other mothers, fathers, daughters, or sons.
During meetings at Northwell Health, it is not unusual to begin with a video clip of a patient’s story. It grounds us in a reality knowing anyone can be swept into the chaos and helplessness of being ill. And these stories may be one day our own, or our family’s. Our team thrives on working on projects today, knowing they may help someone else’s tomorrow.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Many of the most important discoveries and advances in the history of medicine occurred in the United States. This country is home to the most sophisticated treatment options for severe, fatal medical conditions that cannot, or will not, be treated in other countries. When hope seems all but lost, millions of patients worldwide turn to the United States for treatment because it is home to excellent healthcare systems. It is difficult to overstate the importance of these accomplishments to the history of the human race.
Unfortunately, studies like the one reported in Newsweek in 2017 are at best misleading because it mixes apples and oranges by including lifestyle and social factors as indicators of the quality of medical care provided by healthcare systems. For example, one of the reported measures, life expectancy, is significantly influenced by the disproportionately higher death rates in the United States compared to other countries from motor vehicle accidents, substance abuse, gun violence, and obesity. These are significant social and lifestyle problems, but certainly cannot be an attributable measure of failing by America’s healthcare systems.
Another misleading assertion stems from measuring infant mortality. In the United States, any newborn, no matter how ill, with any sign of life, is counted as a live birth. This is, of course, entirely reasonable, but is by no means a worldwide norm. It is misleading to compare infant mortality to other countries counting as “live births” only in infants who survive more than 22 weeks. This is not a failing of America’s health system, but rather a testament of its commitment to save lives, every day.
And while these cited statistics look at monetary expense, they fail to measure value. Patients with many forms of cancer survive years or decades longer in the United States as compared to other countries. One cannot merely measure expense without asking: just how much is a year of your life worth, anyway? The wait time for treatment by a specialist often exceeds 4–6 months in other countries. Do you want to wait 4–6 months to see a specialist as the clock is ticking on the growth of your tumor?
Astounding medical and scientific advances occur weekly in the United States. Some or all of these may benefit you and your family. These advances are the product of decades of work and millions of dollars of investment, to hopefully be available when you most need it. These new therapies are, by definition, expensive. But not forever. The first doses of penicillin were entirely unaffordable for anyone but the most wealthy, so to the first doses of almost every new major therapeutic or surgical cure. Is it worth it? Of course it is, because time passes, knowledge accrues, costs come down, and life-saving therapies become widely available. Today, penicillin is cheaper than bottled water, but look around to the number of people walking down the sidewalk sipping on that luxury and think about the value of health care.
And discoveries will continue to be made in America, enabling early diagnosis and treatment of illnesses. More complex, expensive treatments will continue to allow patients to live longer and with a better quality of life. So be careful of the question, because, for all its faults, the United States healthcare systems will remain a destination for those most in need to get the best treatment when they cannot obtain these options where they live.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
As great as the United States healthcare system is, we can always try to improve it. In my opinion, there are five areas to assure strategic and tactical leadership in healthcare.
1) We need to expand investment in scientific and medical research. We are falling behind on these investments relative to many countries, and we risk losing our leadership in medical innovation. What investment could be more important in national interests than one that is proven to improve health, eradicate illness, extend longevity, and enhance national productivity? This is an issue of national strategic importance. Unless we invest in new discoveries, we are destined to be dependent on other countries for the very health of our citizens and the future productivity of the nation.
2) A need to establish a pipeline of future researchers. As a society and a nation, we need to celebrate excellence in science like we celebrate success in sports, cinema, or songwriting. We must launch a cultural shift to expand achievements in STEM (science, technology, engineering, math) programs and to capitalize on the successes in science and medicine produced in the United States during the past several decades. Silicon Valley companies and computer technology are essential to the future. Still, with the absence of additional expertise in biology, basic science, and medicine, it will not be possible to harness the full value of new electronic or telephonic technology in healthcare. There has been a drain on young talent from these scientific career paths, and by failing to stop the leak, we risk a national crisis by producing a nation less healthy tomorrow than today.
3) We need to align incentives from discovery to deployment of new therapies. Many stakeholders are responsible for moving new therapies from the stages of inception and invention to widespread clinical use. Sadly, at each step along the way, the incentives of the stakeholders are at best misaligned and at worse, confrontational. We need to create a new dialog and process that engages the scientist, inventor, early investors, clinical developer, regulators, insurance companies, manufacturers, prescribers, healthcare deliverers, patients, and payors to work together to share the risks and maximize the efficiencies. It is essential to shorten the timelines and costs of the current process for developing new therapies, which are so desperately necessary.
4) We need to redefine value and profit. As long as people value their quality of life and longevity, something unlikely to change, then the success of a healthcare system should be determined by the value it creates for those measures, namely quality of life and longevity. How can it be otherwise? Should we define the success of a system by how much profit it puts in the bank, or by how the health of the people it serves? Clearly, the latter. We need to place focus on creating value for patients. In this way, we can redefine fiscal responsibility and fair access to monetary assets to accomplish what is the right thing to do for patients, rather than financial gain. This will affect all sectors of the healthcare spectrum, including the pharmaceutical and insurance industries, where profits are extracted regardless of meaningful value creation.
5) We need to support a cultural change celebrating scientific discovery and success. It is too easy today to make a hero from someone who made the most money, had the best year playing a game, or sells a computer app that lets you send a photo of your cat to friends. These are good things to have and enjoy, but they aren’t what you need when illness strikes. At the most challenging times in your life, you will experience the benefit and likely be grateful for those individuals who made the scientific and medical discoveries to alleviate suffering and prolong lives, including yours. The names of the people who do this, and make these cures possible, should be as household and well-known as today’s current “celebrities.”
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Perfecting the healthcare system, with its massive size, scope, the economy of scale and complexity, is the focus of some of the best and brightest minds on the planet — people who are highly competent, dedicated, and brilliant. If there were simple, concrete, readily implementable steps to fix significant problems, they would have been activated already.
What I recommend all four groups you listed to start doing right now is reframe discussions about fixing healthcare so that they are based on value to the patient, family, society — not based on financial profit and costs to the components of the system. In these discussions, leaders must define goals focused on the national interest and on society, which requires infrastructures for personal safety, defense from threat, and health. The importance of these priorities to the national interest cannot be overstated. The future of the United States rests in no small part upon healthcare leaders today formulating goals and objectives, developing strategic plans, and defining a consensus around the value of a healthy individual and a healthy society. If not, and as long as the focus remains on dollars and profit instead of value, then little will change.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
The mind and body are inseparable, and the concept of separate mental health and general or bodily health systems should be eliminated from policy, practice and medical jargon. Advances in neuroscience, psychology, and the molecular biology of disease has revealed signals from the body which modify or change the behavior of the brain and signals in the brain which change the behavior of the body. These bodily and brain behaviors are neither isolated nor distinct. Moreover, individuals are embedded in an objective world and culture that also exerts direct influence over the body and the brain. So society cannot be left out of the conversation to understand cause and effect on the brain and bodily health.
At the Feinstein Institutes for Medical Research, we are studying the relationships between these molecular, neuroscientific, psychological and cultural influences on health and illness, from the genetic foundation of conditions, to the development of new treatments, and to innovative ways of deploying healthcare models in patient communities. Medical and scientific conversations are changing rapidly as the linkages between body, brain, and society are more fully defined. This knowledge will continue to expand, and I am optimistic that the currently parallel tracks of general health and mental health in the business of health care will eventually converge.
How would you define an “excellent healthcare provider”?
A person, or group of people who provide services to prevent and treat illness, and add significant value to the quality of life of individuals and society. Major healthcare issues today are a complex interplay between genetics, the environment, and society itself. Providing excellent healthcare requires people and systems to address all of these factors comprehensively. Discoveries are coming fast, promising cures and longevity. Still, the pace of these advances is accelerating more quickly than the capability of most healthcare systems to implement and adopt these ideas into daily use. Excellent healthcare providers have to be rigorous in assessing these advances, and flexible in taking new methods in the best interests of individual patients and society.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Imagination is more powerful than knowledge,” said Albert Einstein. I have spent most of my life looking at objective, scientific, medical findings, and imagining how they define a practical problem or a previously unimagined solution. Many scientific advances happen as the result of an accident or an unexpected experimental result. Often, I have been surprised by an experiment that did not go as planned, and whenever this happened, I said, “Great!” The unexpected result is the one that demands a new explanation. Answers are born in the imagination first, then articulated to be a narrative recited into the future. A better future is not realized until it is first imagined. This bedrock principle applies to inventing a new cure, running a business, and to improving society and the world.
Are you working on any exciting new projects now? How do you think that will help people?
My colleagues and I are working on developing bioelectronic devices to control nerve signaling to deliver therapy without the use of drugs. In the past few years, we have seen this idea tested in successful clinical trials, and I have met patients who are in remission from Crohn’s disease and rheumatoid arthritis. This is just the beginning of an idea we first implemented by combining molecular biology, neuroscience, and biomedical engineering. There are many projects in my laboratory and dozens of other laboratories across the world, studying how it should be possible to use these approaches to treat cancer, diabetes, hypertension, asthma, and organ transplantation. In my opinion, these approaches have the potential to revolutionize how we think about treating patients using electronics instead of drugs. There will always be a role for pharmaceutical treatments for illness, but the ability to use electronic devices that are very safe, have limited or no serious side effects, and can be individualized for specific patient needs, is one of the most exciting things I could have ever imagined.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
There is a wealth of information in the professional healthcare literature which I reference for specific current topics. I find inspiration; however, in classic nonfiction and fiction work because they encapsulate a rich world of essential ideas and archetypes, and deliver a philosophic and structural framework to guide my professional life.
One of my all-time favorite books, “Tale of Two Cities,” by Charles Dickens, is a story of sacrifice and transformation in the lives of individuals caught up in a rapidly changing society. Another book, I’ve also read many times, “The Swerve,” by Stephen Greenblatt, recounts the 15th century re-discovery of “De rerum natura (On the Nature of Things),” by the Roman philosopher Lucretius from the 3rd century B.C.E. Drawing on the teachings of Epicurus, this ancient poem presents a prescient theory of the universe comprised of individual particles (atoms) that combine to molecules, matter and life. Because these atoms are in constant motion, with occasional unpredictable swerves, all the world is a process of constant evolution and change.
“The Lives of the Cell,” by Lewis Thomas, is an optimistic and scientific account of life as a composite collection of individual cells, each operating under discrete rules of molecular biology, coming together to become an evolving animal or human. Viewed from this perspective, there is an unexplored universe inside each of us waiting to be revealed and understood.
“Sapiens,” by Yuval Noah Harari, is an exceptionally provocative and timely book because it begins with the big bang, and in a few hundred pages lays out the entire history and evolution of life, from single-celled organisms up to modern culture. The world has always been about change and evolution, but changes today are occurring at an ever accelerating rate.
And, as brilliantly told in “Factfulness” by Hans Rosling, the world today has changed into a much, much better place for humanity than at any other time in history. More people are healthier, safer, better fed, and richer than ever before, but this is not widely known because good news tends to be ignored or obscured by bad news.
Success in leadership depends in part on understanding change, seeing its patterns, imagining what is coming next, and articulating a narrative for action based on understanding all the news, and moving towards what is good.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
I would like to see a movement that celebrates the successes humanity enjoys today across the spectrum of abundant food supplies, historic lows for maternal, fetal and war deaths, and an ability for people to communicate across global internet platforms regardless of language or distance. Beginning with clear definitions of all that has gone right for humanity, this grassroots movement could then imagine goals to improve society even more. There is unimaginable power to be realized if we could unleash the combined potentials of generous spirit, productivity, and kindness within individuals across humanity.
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Thank you so much for these insights! This was so inspiring!