Heart Health and AI: Marschall Runge on Revolutionizing Patient Care and Prevention
Hey Heart Buddies! I welcome Dr. Marschall Runge, a leading expert in cardiovascular disease and AI in healthcare, this week to help us explore the transformative role of AI in heart health and discuss its potential to improve diagnostics and predict health outcomes. Runge shares insights into AI's ability to analyze complex medical data, enhancing preventive care and treatment precision. I ask him to address concerns about maintaining human connection in healthcare amidst AI advancements. The conversation highlights the importance of patients being proactive as the "CEO" of their health. Runge expresses optimism about AI's role in revolutionizing healthcare practices and outcomes.
This is a fascinating episode and a break from our usual story telling. I hope this episode empowers you to think outside the box of your current health care. Let me know if you liked it!
Amazon.com: Coded to Kill: A Techno-Medical Thriller: 9781637589274: Runge M.D., Marschall: Books
Marschall S. Runge, M.D., Ph.D. | LinkedIn
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Transcript
Welcome to Open Heart Surgery with Boots, where we explore the
Speaker:journey of heart health through the eyes of those who live it every
Speaker:day. I'm your host, Boots Knighton, and in season
Speaker:five, we're focusing on what it truly means to
Speaker:thrive. We'll dive into cutting edge medical advances,
Speaker:share powerful stories from both sides of the stethoscope,
Speaker:and learn how to be better advocates for our own health.
Speaker:From candid conversations with cardiac patients to
Speaker:insights from dedicated healthcare professionals, each
Speaker:episode brings you closer to understanding the complex world
Speaker:of heart health. Whether you're navigating your own cardiac
Speaker:journey or supporting someone who is, you're in the right
Speaker:place. So let's get to today's story.
Speaker:Hello, welcome to another episode of Open Heart Surgery with
Speaker:Boots. I am your host, Boots Knighton coming at you from
Speaker:Victor, Idaho, where it is snowing today.
Speaker:I'm recording this in early January and I am
Speaker:so excited for this season. This is the fifth
Speaker:season of Open Heart Surgery with Boots and
Speaker:I am bringing you my A plus game this
Speaker:season, bringing the most distinguished guests yet. And
Speaker:today I am so thrilled that Dr.
Speaker:Marshall Runge, who wants to be called Marshall,
Speaker:has agreed to come on and share his
Speaker:expertise and wisdom with us. And let me just talk about
Speaker:Dr. Marshall Runge for a second. He's a distinguished
Speaker:physician scientist, considered a leader in
Speaker:academic medicine, and an advocate for the integration of
Speaker:AI into healthcare systems. He
Speaker:currently serves as dean of the medical school at the
Speaker:University of Michigan. Wow. Aren't we lucky to have him
Speaker:today? With numerous accolades and awards, Dr.
Speaker:Range has earned a reputation as one of the foremost experts
Speaker:in healthcare innovation. His work is bridging
Speaker:technology and medicine and has been pivotal in reshaping
Speaker:the modern healthcare landscape. Dr.
Speaker:Runge, aka Marshall, thank you so much for
Speaker:saying yes in your busy schedule. It really is an
Speaker:honor. Well, thank you, Boots, and thank you so much for
Speaker:that very kind introduction. My entire
Speaker:career has been focused on cardiovascular disease, although
Speaker:I have other responsibilities, both in seeing
Speaker:patients, trying to help patients understand their disease, and in
Speaker:both doing research in my own research area,
Speaker:as well as being able to help interpret some of the
Speaker:research that we see and we see quick headlines in the
Speaker:press and trying to help people, and we're all people, after all,
Speaker:understand what they can do for their heart. And I think the
Speaker:opportunities we look at in the future with AI and
Speaker:large language models are just so
Speaker:intriguing. Say more about that because I was
Speaker:just reading an article recently, I think maybe it was
Speaker:in the Washington Post about just the
Speaker:journey of even chat GPT and
Speaker:GPT5 and how hard it is
Speaker:to get that I had no idea how expensive it
Speaker:is and then how cutthroat it is and, and so
Speaker:it made me think about our upcoming conversation. It just
Speaker:sounds like it's not as easy and straightforward
Speaker:as I thought it was. Well, I'll make
Speaker:a couple of comments. So the first is that in terms of just day to
Speaker:day use of AI, I now use it all the
Speaker:time and platform I use is offered for free at
Speaker:our university at the University of Michigan. It's chat
Speaker:GPT4 and you have to get comfortable with it a little
Speaker:bit. But once you understand what kinds of questions to ask
Speaker:and that you're really having a conversation as weird as that might be with a
Speaker:computer, you can find out so much that
Speaker:is meaningful information. I always double check
Speaker:it. But to give you an example, part of what I do,
Speaker:and most physicians do is I have to do continuing
Speaker:medical education and maintenance of certification. And in doing that
Speaker:I every quarter I have to answer a bunch of questions and I
Speaker:find that I can get really
Speaker:outstanding data and interpretations from
Speaker:ChatGPT in a much more rapid
Speaker:manner than if I use any traditional medical resource. So I've
Speaker:come to really find it to be invaluable. And
Speaker:if for you or you probably know this, but for any, any of your
Speaker:listeners or viewers, I think what they'll find is you have
Speaker:to give, you have to kind of train yourself to use it, but then it
Speaker:is, it is invaluable. So I'm a big fan of, of that part of
Speaker:AI. I also, what I find so
Speaker:amazing and intriguing is that AI works.
Speaker:This sounds a little corny, but AI works in mysterious
Speaker:ways and it gathers all this information and it integrates
Speaker:it. And in so many instances in medicine, and I'll talk about
Speaker:some in heart health, it'll come up with answers that we just would never have
Speaker:thought of asking, questions that we never thought of asking, that
Speaker:can be extremely helpful. And there's some great examples out there,
Speaker:some in cardiovascular disease, some in prevention, some in
Speaker:therapeutic areas. And so I think we're facing
Speaker:a moment in which things are going to really change
Speaker:dramatically in healthcare and in health and all of us thinking
Speaker:about our own health, it's been called this AI movement's been called
Speaker:a Promethean moment. I had to look up that. So pro
Speaker:Prometheus was a Greek God who, you know, caused lightning and
Speaker:fire and all kinds of things. And after these moments everything was different
Speaker:going forward. And I almost. That's somewhat of an exaggeration, but I think
Speaker:things are going to be very different in our coming years
Speaker:with AI and what it can bring us. So I'm hearing
Speaker:excitement, lots of excitement. Okay. For
Speaker:me, I feel a sense of trepidation
Speaker:because I, admittedly, because I, I believe
Speaker:in like heart connection. Right. I'm, I'm thinking hard all the time
Speaker:and having this, this connection with you and in
Speaker:community. And so as a patient, when I hear
Speaker:you say that, part of me is like, oh cool. It's kind of like
Speaker:double checking your thinking when you're working with a patient and helping them
Speaker:find like the, the proper way to treat whatever needs to be
Speaker:treated. But then also part of me is like, well, then we take out that
Speaker:soul connection with our providers and our community.
Speaker:And so I realize that's more of an existential
Speaker:question or thought, but part of me has a little bit of
Speaker:trepidation because I don't want to lose that, that, that connection with
Speaker:fellow humans. Boots, that is a great
Speaker:point. And you'll hear different people talk about AI
Speaker:and how maybe an AI bot could
Speaker:replace a healthcare provider, replace a doctor or
Speaker:a nutritionist or a therapist. And I don't think
Speaker:that's going to happen. And the reason I don't think that's going to happen
Speaker:is because you miss that human connection. And that is so
Speaker:important. As people connect with each other, as they connect with their care
Speaker:providers, as their care providers connect with them, there's
Speaker:subtleties in the way that all of us interact that cannot
Speaker:really be replicated by AI.
Speaker:The best I've heard is that explanation, and I don't know when,
Speaker:if ever this will be overcome, is that AI can mimic, that
Speaker:it feels you, that it has emotional responses, but it does not have
Speaker:emotional responses. That's based on what you're telling it and what it thinks you
Speaker:want to hear. And so, and in some cases that's turned out to be
Speaker:somewhat dangerous because a person can get so connected to
Speaker:an AI bot that becomes their friend. And that's just
Speaker:not realistic. No. Well, there's just not a soul
Speaker:there. There is no soul. Yes, it's
Speaker:soulless. Right, Right. Taking a step back, you
Speaker:mentioned you could go and ask a question.
Speaker:Could you give us some examples of when, of what
Speaker:that would be? What. What is a recent question you've asked of
Speaker:maybe regarding a patient or. I don't know what you can share, but I'm just
Speaker:really curious. Well, I'll give you both my personal
Speaker:experience and also what is out there in the medical Literature. Now I think
Speaker:I'll start with what's out there in the medical literature. So AI turns
Speaker:out to have a predictive value for heart
Speaker:disease from examining retinal scans.
Speaker:So if you go to the doctor, and particularly if you have diabetes,
Speaker:you'll have a retinal scan, a photograph of your retina, sort of the back
Speaker:part of the eye where the business part of seeing occurs.
Speaker:And what's been found recently, which is
Speaker:just amazing, is that based on those retinal
Speaker:scans, AI is picking up cues that can help
Speaker:it predict if your likelihood of having
Speaker:heart disease and even your five year mortality.
Speaker:And so how does it do that? Well, that's part of the
Speaker:unknown about AI. It's taking together these huge amounts of data
Speaker:that we don't really, we can't assimilate. I mean, I can't assimilate
Speaker:everything in the world at the same time. And it's looking
Speaker:for patterns. Now sometimes those patterns turn out to be spurious and they're not really.
Speaker:It may be a pattern kind of like, well, I feel like every time I'm
Speaker:humming a certain tune, I get a green light instead of a red light. So,
Speaker:you know, it can be as spurious as that. But many of these findings have
Speaker:turned out to be true and have turned out because it's picking
Speaker:up a pattern that we wouldn't be looking for.
Speaker:So I think that's where AI can really have an impact. It picks up patterns
Speaker:that we're maybe not used to. So to give you a common
Speaker:everyday question that I get, let's think about people who
Speaker:have a elevated LDL cholesterol.
Speaker:So LDL cholesterol is the bad cholesterol. It's associated with buildup
Speaker:of plaque in the coronary arteries, associated with a
Speaker:increased risk of heart attack and stroke and cardiac
Speaker:death. And what we have known for a long time
Speaker:is that statins drugs like
Speaker:Atorvastatin or Lipitor or Rovastatin or
Speaker:Crestor have a protective effect. And if you take
Speaker:all the big studies that have been done, they show that that
Speaker:protective effect against heart problem, heart related
Speaker:problems, including cardiac death, can be up to 22%.
Speaker:Now that's a big, that's a big impact. And I personally am a big fan
Speaker:of statins. I take a statin, my LDL cholesterol is somewhat
Speaker:elevated. My brother, who has basically the same LDL pattern I
Speaker:do, chooses not to take a statin. We're both still alive and
Speaker:well. And so it begs the question, well, what
Speaker:are these studies showing? Us and when you really look at those in
Speaker:detail, it's that not all the 20,000 patients who were
Speaker:studied on or not on a statin, they didn't all get a
Speaker:20% benefit. It's a small number who get a big benefit and then a whole
Speaker:bunch of people who don't get any benefit. And as you know, I'm sure
Speaker:you're viewers and listeners know statins do
Speaker:cause myalgias, muscle pains, or other kinds of side
Speaker:effects that for some people make it virtually impossible to take a
Speaker:statin. Well, think about if we could be much more precise in
Speaker:who would really benefit from those statins and
Speaker:prevention. I think speaking broadly for American
Speaker:healthcare and the costs of healthcare, and in the
Speaker:case of cardiac disease, the number of procedures or bypass
Speaker:surgery or whatever, when you think about those things
Speaker:and the cost of those things, the way out of our
Speaker:conundrum is prevention. So
Speaker:in the United States, obesity is now well over
Speaker:50% of the population, and that carries with it a risk
Speaker:of diabetes, a very high risk of diabetes. And
Speaker:so if we could prevent this really tsunami of
Speaker:obesity that's hitting the United States or lessen it, that's
Speaker:how we save money in healthcare. It's not by. I mean, we do need all
Speaker:the advanced procedures, and I'm a great fan of advanced procedures, but what we
Speaker:need to do is lessen the entry into that
Speaker:inevitable pipeline. So I gave
Speaker:the cholesterol example. I'll give you another one that is really intriguing to me that
Speaker:I don't understand very well at all. But AI has turned out
Speaker:to be really valuable in both
Speaker:wearable devices. I have a not advertising for Apple, but I have an
Speaker:Apple Watch and in other types of wearable
Speaker:devices and picking up patterns that we wouldn't ordinarily
Speaker:associate with increased risk. So, for example,
Speaker:the amount of variability you have in your heart rate when you
Speaker:are not exercising or exercising is quite
Speaker:a predictor. And AI can analyze that in a way that's difficult to do
Speaker:in anything less than a wearable, as
Speaker:another example, and this has been shown mainly in Alzheimer's
Speaker:disease, but very subtle changes in
Speaker:phraseology using social media, for example, or
Speaker:your intonation when you're speaking on a phone can be analyzed by
Speaker:AI and predict memory decline.
Speaker:Alzheimer's maybe five years before any other
Speaker:known tests, including cat scans and MRIs, et cetera.
Speaker:So what is it picking up out of all that? I don't know. People are
Speaker:studying what it. What is it that is picking up. But what's clear is it's
Speaker:picking up these patterns that are very difficult for us as, you know,
Speaker:thinking, interacting human beings to pick up in each other. You know,
Speaker:it's not like someone says, oh, I feel awful, I'm so depressed.
Speaker:It's very subtle changes that can be picked up by AI. And
Speaker:I want to say one last thing. One of the. And then I'll stop talking.
Speaker:One of the great unknowns in heart disease that I've studied
Speaker:in our own research, but also is a big
Speaker:topic is when are you at risk? If you have a plaque in one of
Speaker:your coronary arteries, you have a blockage, when are you at risk of
Speaker:that plaque cracking or causing
Speaker:that artery to be blocked off? And you don't want to. If you think that
Speaker:if you had data that you're at high risk in the next few weeks,
Speaker:you'd absolutely want to get something done. On the other hand, if
Speaker:you have data that shows you're not at risk and you need to continue your
Speaker:exercise, you need to continue your dietary measures, your statin or
Speaker:whatever medications, then you wouldn't have to rush off and have
Speaker:a cardiac catheterization. Well, AI is proving
Speaker:in early studies to be able to detect what those subtle differences are
Speaker:between what's called a vulnerable plaque, one that might rupture, and
Speaker:a stable plaque. That's been something that's been studied
Speaker:for decades, including invasive
Speaker:studies looking at putting a catheter in and examining that plaque
Speaker:and seeing how much fat or calcium or whatever is in that plaque.
Speaker:But it appears to be the case that AI may be able to detect
Speaker:the difference between a dangerous and a not dangerous plaque based on
Speaker:imaging like a CAT scan or an mri, non invasive
Speaker:imaging. So I just give this as a few examples of where I
Speaker:see the future going there. We're not there yet. And with with
Speaker:the caveat, the important caveat that you mentioned, we need to have
Speaker:healthcare providers be able to have a conversation with
Speaker:their concerned patients about this. It can't just all pop up from a
Speaker:search of ChatGPT, but I think those tools will be very valuable.
Speaker:Mind blowing and relieving because it's. Heart
Speaker:catheterizations are not fun. Absolutely not
Speaker:fun for anyone. I've actually
Speaker:literally said I'd rather have an open heart surgery than a heart
Speaker:cath. So that says it all. Yeah, my
Speaker:therapist was like, why on earth would you say that? And I was like, well,
Speaker:because you're asleep for your open heart surgery. Yeah,
Speaker:it's terrible. But anyway, I so
Speaker:much hope in everything you just shared as a As a heart
Speaker:patient, and I so appreciate it and I would love to add a little something
Speaker:to the heart rate variability. I have a
Speaker:Garmin watch that I'm actually taking a vacation from right now
Speaker:because I noticed this can be like a two part
Speaker:discussion. I noticed it was causing health
Speaker:anxiety. And that's like an delicate line you
Speaker:walk, right? Like, okay, I'm watching my data,
Speaker:but I noticed that my data was stealing my joy
Speaker:and my sense of peace. And since I've stopped wearing
Speaker:it, I feel so much better. And I was just reading
Speaker:another article, I'm forgetting where now I read a lot. But how,
Speaker:you know, healthcare anxiety actually does have adverse
Speaker:effects on our health. So here's AI
Speaker:informing me on my wrist of, you know,
Speaker:lack of sleep, lack of health, heart rate variability. And I'm starting to
Speaker:panic, which becomes like this, this
Speaker:snowball effect. But as you're saying, you know, it's
Speaker:also very beneficial to know when something is
Speaker:amiss because I was able to go to my
Speaker:cardiologist over a year ago and be like, something's not right.
Speaker:And we were able to make some changes because of my watch.
Speaker:Right. So it's this fine line and I think that's where like
Speaker:having a cardiac psychiatrist or a really good therapist, like, I have people
Speaker:who can help manage the emotional and mental stress
Speaker:of having a heart issue, but also, and at the same
Speaker:time harness the power of AI to
Speaker:improve our lives. You know, boots, that's interesting because
Speaker:I haven't had anybody personally tell me a story like yours, but
Speaker:I absolutely believe it. It's sort of an extension of
Speaker:what we have called for years white coat syndrome. So I've been
Speaker:a doctor for over 40 years.
Speaker:White coat syndrome. Oh, white coat. Yep.
Speaker:White coat syndrome is when you go in to get your
Speaker:blood pressure measured. Doesn't matter if the doctor's actually wearing a white coat or not,
Speaker:but your blood pressure goes up because of this anticipatory stress,
Speaker:just like you're talking about with your watch. And I've been a doctor
Speaker:for over 40 years. I have white coat syndrome. I have to like,
Speaker:just Zen out, you know, when I go for my annual physical because my
Speaker:blood pressure, you know, bounces up over what it normally
Speaker:is. Just thinking, well, golly, what could be going wrong? I'm having my
Speaker:annual evaluation. So what you're talking
Speaker:about is taking that to a whole new level where it's bothering you all the
Speaker:time, not just when you go get your blood pressure checked. Yeah,
Speaker:and I totally can believe that, you know,
Speaker:the Interesting thing about heart rate variability to me is
Speaker:it has different components, how much your heart rate varies when you do different things.
Speaker:But I'm finding myself using it with my watch is when
Speaker:I'm doing some episodic exercise. So the other
Speaker:day I was playing tennis with one of my kids and, and I was running
Speaker:all, all over the place and I thought, well, let me see what my heart
Speaker:rate is. So it had gotten up to like, after a long point had gotten
Speaker:up to 135. And so, you know, that's not terribly high,
Speaker:but it's not, you know, my normal is about in the 60s. And so
Speaker:I wanted to see how long it took for it to start
Speaker:dropping down. And it took a minute or two, didn't ever get back down to
Speaker:the 60s. And then we kept playing. But it's that
Speaker:one part of heart rate variability that I think
Speaker:people can monitor for themselves has to do with your conditioning level.
Speaker:And so the better conditioning you are, the faster your heart
Speaker:rate drops. If you do something and it gets your heart rate way up and
Speaker:it just is kind of staying up there very slowly
Speaker:dropping, what does that tell you? Well, it tells you you could be better
Speaker:conditioned. And so that's not quite the same as looking at
Speaker:your, your wearable and thinking, oh my gosh, what's happening now?
Speaker:So, so there's some good things that you can get out of that. And again,
Speaker:these are all things that just work. Weren't present when I started practicing
Speaker:medicine, when, when I started practicing cardiology. In fact, it was before
Speaker:the earliest of these drugs, called
Speaker:thrombolytic drugs that would dissolve a heart clot in one of your coronary arteries,
Speaker:those were just being test studied. It was in the mid-80s. Now,
Speaker:when you think about all the tools that we have, you know, one other thing
Speaker:I forgot to mention having to do with heart surgery is
Speaker:I think that our ability and heart disease and in other
Speaker:areas to use robotics has been limited.
Speaker:And it's partly because of expense, because you buy that robot for I don't know
Speaker:how much, millions of dollars. And all the proprietary supplies
Speaker:that are used with the robot are expensive. And to date,
Speaker:the outcomes haven't been shown to be better than a highly skilled
Speaker:surgeon. But I could, I could foresee a
Speaker:way that those could be used as they are in other
Speaker:instances with a minimally invasive approach. So not having to crack
Speaker:your sternum, your breastbone, and the recovery
Speaker:time for that is much, much faster. There's, there is minimally evasive
Speaker:cardiac surgery now where the Recovery time can be in
Speaker:days rather than in the month or more that it takes for your
Speaker:breastbone to heal, your sternum to heal. So I think all these things
Speaker:are things we can look for in the future when we're not there yet.
Speaker:Well, you know, it's interesting. I've had a couple of conversations with
Speaker:surgeons about that, because with one of my
Speaker:defects, myocardial bridging, I'm part of a Facebook support group for
Speaker:that. And there's more and more people on, in
Speaker:that forum that are going to
Speaker:a couple of different places in the United States for
Speaker:robotic unroofing. And it's been mixed results. A
Speaker:lot of them have had issues with their lungs afterwards. A lot of
Speaker:collapsed lungs, a lot of pericarditis that I
Speaker:normally haven't been hearing about through, like, the more traditional open heart
Speaker:surgery route. And my surgeon, before I had my surgery, I had
Speaker:my surgery by a trained Mayo surgeon who
Speaker:is down at Intermountain Hospital in Marie, Utah. And
Speaker:I asked him about the pros and cons because at the time I was still
Speaker:like, should I travel to Chicago? Should I come to you?
Speaker:And, you know, he was saying, it's just too dangerous. Like,
Speaker:it really is good to have eyes on the heart. And I
Speaker:can't remember exactly. It was four years ago now, but, you know, he,
Speaker:he said it just is almost safer to still
Speaker:have actual hands in there. Getting the lay of the land.
Speaker:This is my own way of explaining it. Getting the lay of the land of
Speaker:the heart and seeing what needs to happen. But that was four
Speaker:years ago, maybe. And, and maybe you can speak to that a little more eloquently
Speaker:than I just did, but it just, it doesn't seem foolproof
Speaker:to me yet. You were pretty eloquent there, I'd say.
Speaker:And you hit the nail on the head. And there are these
Speaker:concerns. So, for example, removing that thin piece of
Speaker:tissue that's lying on top of your coronary artery, causing a bridge,
Speaker:it means different things if you're, if you're, if the
Speaker:surgeon's looking at it and can expose your entire
Speaker:heart versus if the surgeon's looking through a
Speaker:little scope at what the robot is doing. And I, and I
Speaker:can. I. I had never heard before that there's an
Speaker:increased incidence of pericarditis, but I can
Speaker:believe it because the pericardium, you can treat very
Speaker:gently if the surgeon. I'm not a surgeon. The surgeon can treat very gently if
Speaker:the chest is open, whereas that may be more difficult to do and more
Speaker:irritating to the pericardium, if it's done by this
Speaker:robot that's being instrumented. What I have heard
Speaker:is, although it's not common, there are certainly
Speaker:cases where there's a problem with the robotic
Speaker:approach nicking the wrong artery or causing
Speaker:bleeding or something like that, that it converts to an
Speaker:open heart procedure, so an open chest procedure. And
Speaker:so honestly, Boots, I don't see that there's been a
Speaker:huge step forward in robotic heart surgery at
Speaker:present. It's not used very many places, as you know.
Speaker:Yeah, I think that's, as I mentioned before, partly expense,
Speaker:partly lack of better outcomes, but I think
Speaker:also they're like everything. There are a lot of things that need to be
Speaker:worked out. Maybe it'll turn out that it's never a great approach,
Speaker:but the only way we'll know is when we learn more about it. Right. Here's
Speaker:an example where maybe AI is not
Speaker:necessarily the route. And this is where we have the human to human
Speaker:connection in the operating room. Right,
Speaker:right. Yeah. And I, you know, with all my excitement about, about
Speaker:AI, and I am excited about AI, I think all of
Speaker:this needs to be looked at very carefully because
Speaker:it's very doubtful, even to me as an enthusiast, that
Speaker:AI is the cure all. It's just not a cure all. I think of it
Speaker:more in terms of being able to look at information,
Speaker:patterns from vast, vast stores of information that would be
Speaker:impossible to look at otherwise. Yeah, one, one example I saw
Speaker:recently had to do with rare, what are called
Speaker:orphan or rare genetic diseases where they
Speaker:don't occur commonly, but they do occur, and they're thought to be
Speaker:some of these. I think the definition is fewer than 4,000 a year in the
Speaker:United States. So a pretty small number of conditions.
Speaker:And what AI has found is that although there may be
Speaker:a gene, a specific gene that's thought to be the problem, there
Speaker:are other contributing genes that may affect the, that
Speaker:do affect, seemingly affect the severity of that
Speaker:gene defect, such that in one person it's not a big problem, in another
Speaker:person it's quite lethal. And so trying to understand
Speaker:all those parameters, because as advanced as geneticists are these
Speaker:days, and as large as the databases they look at,
Speaker:it's just not currently possible to analyze all the genes in the
Speaker:genome. 30 over 30,000 genes, and they're
Speaker:over 3 billion base pairs. And so how
Speaker:do you analyze that? Well, I'm hopeful, not proven, but I'm
Speaker:hopeful that AI can help us look at these things. For
Speaker:example, I'll take two other examples. Lots of people have A high cholesterol, it
Speaker:never bothers them. So my mother had a LDL
Speaker:cholesterol of 250. I mean, that's sky high. But she had an
Speaker:HDL cholesterol of her HDL cholesterol was like 100, which is
Speaker:also sky high. And so she lived to be
Speaker:94. She never took a statin. She never, I mean, she walked, but she
Speaker:wasn't like a major exerciser. And so
Speaker:that what might have been fatal for somebody else wasn't at all for
Speaker:her. And it's all around these surrounding genes, I think that
Speaker:we just don't understand. But that gets back to this question about
Speaker:even something as seemingly simple as cholesterol management. If we
Speaker:knew more about who would benefit from cholesterol lowering drugs and in whom
Speaker:there is no benefit, you could say the same thing about drugs that help with
Speaker:remodeling the heart. So after a person's had a heart attack,
Speaker:there are, we have sort of the guideline driven five
Speaker:drugs that are supposed to help in remodeling. Those help in many people,
Speaker:they don't help in all people. And maybe it's a contribution of one drug more
Speaker:than another. But when, when a person is asked to take five drugs
Speaker:up to three times a day, you know, that's very
Speaker:difficult to do. And, and talk about raising your stress level. Did I
Speaker:miss my noon dose? It's, we can
Speaker:do better. And I think AI will be a tool that will help us
Speaker:do better. And that's the key. It's a tool
Speaker:and I think that it's important how we frame it.
Speaker:To me as a patient, it's like, okay, take the human aspect of
Speaker:my provider, my healthcare, my team. I have a whole team
Speaker:and consider AI as part
Speaker:of the team. Yeah, that's exactly it. And,
Speaker:and I tell, yeah. And you're still CEO. The CEO of your healthcare.
Speaker:We are CEOs and we hire you. We hire all of y'all
Speaker:heart healthcare providers and AI. Right. So yeah,
Speaker:I think that's a great way to look at it. And, and obviously you've embraced
Speaker:this, but I think for those who listen and view your, your podcast,
Speaker:I think it's important for people to be the CEO of their own
Speaker:healthcare. And I think I strongly feel like the more information they have,
Speaker:the better. I will tell you that when the Internet got
Speaker:going and people could look up stuff, could get information, even
Speaker:before Google, people would come in sometimes to see me
Speaker:highly motivated, sometimes highly educated people would have a
Speaker:stack of papers this thick and they wanted me to read it, I'm like, oh,
Speaker:come on. But as is true with the Internet, in so
Speaker:many circumstances, what you get from Internet
Speaker:responses is more or less like social media. It's opinions.
Speaker:And so having something that helps weed out those opinions, whether it's
Speaker:a medical reference, like up to date, or whether it's AI or whether it's
Speaker:whatever it is, I think can really help people
Speaker:simplify how they think of being their own health care
Speaker:CEO. I love that term. Yeah. And can we unpack
Speaker:that a little more? Because where I'm now going in my brain is,
Speaker:should I show up in your office today as a patient,
Speaker:how would I. And I want to get an A plus from you is like,
Speaker:rock star patient. You know, what would that look like to you as a
Speaker:provider? And let me give you an example. One thing I make up that would
Speaker:look, you know, be A plus rock star would be I
Speaker:show up with, like, my list of medications I'm on. I can
Speaker:give you maybe I have a heart rate or,
Speaker:excuse me, a blood pressure monitor at home, so I can maybe show up with
Speaker:some data. I can show up with maybe a food log of what I've eaten
Speaker:in the past week. Like, I. I always come at. I
Speaker:always approach it as, how can I help? You have the best
Speaker:picture of me because I only get, like, a certain amount of
Speaker:minutes with you. Right. But add to that or subtract from
Speaker:it. Like, what. What is a rock star patient that helps you
Speaker:perform your best care for the patient? Well, you've got a
Speaker:lot of components there in what you do, and I think
Speaker:meaningful information is extremely valuable.
Speaker:In some cases, your healthcare provider may want to get that in advance so they
Speaker:can look at it. Other times, you can just bring it forward. I think, from
Speaker:the provider standpoint, from the physician standpoint, having
Speaker:that distilled in a way that if I'm seeing you,
Speaker:I can take a look at what you've brought in, and in two or
Speaker:three or four minutes, I can understand it is incredibly much more
Speaker:valuable than hearing about each single episode that you've had
Speaker:that you think might be important to your health. And so I think that will
Speaker:be. That is an advantage of having some quantifiable information
Speaker:that you'll have from your. From your watch, from whatever. And so. But rather
Speaker:than showing, Bringing every tracing in, showing it, say, well, here's what the summary
Speaker:is, and they may want to dive into it more. So I think
Speaker:that I think food logs are great. I think exercise logs are great. I think
Speaker:exercise logs along with if you have a wearable, what's going on with your
Speaker:wearable when you're exercising? If you say, well I'm, I'm walking,
Speaker:you know, three miles a day and it turns out you're walking one mile an
Speaker:hour and your heart rate never varies, that's not the same thing as a brisk
Speaker:three mile a day walk. So I think those things are all very
Speaker:valuable and I think having them, you're being able to
Speaker:produce them which takes a little bit of work on your, on your side in
Speaker:a way that's pretty easily understandable and digestible. It's is
Speaker:invaluable to your healthcare provider. Some of these things. If I could
Speaker:interrupt and to yourself, because think about it, I mean
Speaker:it's so interesting the conversations I have with people
Speaker:who, and you know, I'm pretty well known in my community. A lot of people
Speaker:know I had heart surgery and I ended up speaking on the TEDx stage about
Speaker:it. So then you know, that made friends. Congratulations. Thank you. It
Speaker:was really neat. So I find that I'm like the heart
Speaker:confessional. So people are like the health
Speaker:confessional. People just come up to me and just start talking, talking to me
Speaker:about like their life which I'm happy to hold space for. But it's
Speaker:so interesting to me. I'll ask questions and how
Speaker:people hadn't thought to even raise awareness around that
Speaker:aspect of their bodies or their health or that perspective.
Speaker:Right. And so I guess that's where like your
Speaker:role comes in as provider. Being able to ask the right questions
Speaker:to boil down to what needs to be addressed that day.
Speaker:But I just find with the wearable, just the
Speaker:food log, I bring that up because like when the more I look at a
Speaker:food log, the wearable, yes I'm taking a vacation from it right now.
Speaker:But it, what it did do on a positive level is
Speaker:raise my awareness and it helped me make the
Speaker:changes I needed to make for my health because
Speaker:therefore, because then I was aware and I was getting the real
Speaker:time input data input day to
Speaker:day. So that's another good thing about AI is that it
Speaker:can raise your awareness. And I know there's like apps on the phone now for
Speaker:even food logs. I did like the standard like pencil and paper
Speaker:but there are, there are so many tools and tricks that we have at our
Speaker:palm on our, on our iPhones that like can help us raise
Speaker:our awareness to be better patients for healthcare providers like
Speaker:you. Yeah, those are great comments
Speaker:Boots. The food log reminds me so I've off and
Speaker:on had trouble with my weight and particularly as your metabolism starts
Speaker:slowing down in your 30s and 40s. And so I remember
Speaker:my internist at the time said, one, just go see
Speaker:this nutritionist. I'm like, I know about nutrition. And they said, no, just go
Speaker:see him. And so one of the things they did was we sort of talked
Speaker:for a while and they said, well, why don't you do a food log? And
Speaker:I said, why? They said, well, maybe you're, you have some
Speaker:eating habits that you could think about. And they said, for
Speaker:example, do you eat at night? And I was like, yeah, but not that much.
Speaker:So when I kept that food log, it was just, it
Speaker:was, I don't know what. It was astoundingly terrible. So, you know,
Speaker:I was, I was, I was getting in an extra, you know, 6 or 800
Speaker:calories after dinner. So. And that, that was a habit
Speaker:I'd had for a while. And I, I just thought, well, you know, how bad
Speaker:can like, some chips and dip be? Well, it can be bad.
Speaker:And you're like, oh, yeah.
Speaker:So I think, I think your comment, I'm kind of
Speaker:circling back to your comment about self
Speaker:awareness. It, it is, when you do things like that, it is very
Speaker:helpful. I also want to make one comment about interaction
Speaker:with healthcare providers and AI. So you may
Speaker:well be aware of this or you may not be. There's, there
Speaker:are programs now or they're products that use what's called
Speaker:ambient AI to record your interaction with your healthcare
Speaker:provider. We, we use one here. The one we use is called
Speaker:Nuance. Dax. Dax. But there's several of
Speaker:these, and they don't just record your conversation. They put it
Speaker:into a, into a note. So you and I are
Speaker:talking. And if this were, if we had nuance
Speaker:on at the end of this, I'd say summarize my conversation with Brooks and
Speaker:it would have it all summarized, or in the case of a medical visit,
Speaker:it'll have it all summarized into what your present illness is, what
Speaker:your past medical history is, what your review systems
Speaker:are. And what that does is it frees your
Speaker:doctor, nurse, healthcare provider from having to take notes. Or
Speaker:many of us have both personally on the provider side, but also on the patient
Speaker:side, met with our primary care physician or our physician, and
Speaker:seeing them, they're just typing away, you know, furiously during our
Speaker:interaction. This frees them to really have a much more meaningful
Speaker:conversation. And that, that is again another example
Speaker:of benefit from AI. Now since we use that, I know
Speaker:that I need to read that because it may be Full of errors or may
Speaker:have misinterpreted something. But it still is so much faster than my
Speaker:starting from scratch to dictate or type in a
Speaker:medical. A note from our medical interaction. Well, and how
Speaker:many patients do you see in a day? Right. And you have to keep all
Speaker:those people straight. That's right, yeah. My cardiologist
Speaker:uses. I don't know what the program is, but yeah, she.
Speaker:She is sold on it. She said it has saved her so much
Speaker:time. Yeah, I think it's saved many people. And electronic medical
Speaker:records, or electronic health records, I think have
Speaker:many positive to them, but from the provider side,
Speaker:they have been an enormous time sink. So I think these
Speaker:new approaches will be helpful. In fact, it's a little bit
Speaker:of an aside. I have a hobby of writing
Speaker:medical fiction, so I. I wrote a. I wrote a novel about electronic
Speaker:medical records and things that could go bad with electronic medical
Speaker:records. It's a novel. It's not factual. I'm glad you brought that up. What
Speaker:is the title of it? I was just reading the summary of it.
Speaker:Oh, the title of that is Coded To Kill. And the.
Speaker:The premise is that there's a group of ne'er do wells
Speaker:who are hacking into the unified medical records of a big
Speaker:hospital and using it to dig up
Speaker:dirt. But also, have you heard the term Internet of things?
Speaker:No. So IoT or Internet of things is
Speaker:a term that's used to describe how everything's
Speaker:connected to everything. And a lot of what we do, you know, for
Speaker:example, we don't have a system like this in our home. But if you.
Speaker:If it's a really hot day and you want to crank down the air conditioner
Speaker:on your way home, on your drive home, you can do that through your Internet
Speaker:of things. In this case, in the. In the novel, because so many things
Speaker:are connected in a hospital setting, these ne'er do wells are
Speaker:leveraging this Internet of things. So, for example, I didn't have
Speaker:any idea until I started working on this. When you're in the hospital and you
Speaker:get a bag of IV fluids, I figured there was a pharmacist or
Speaker:a pharmacy tech who put together those
Speaker:bags. Well, in big hospitals these days, it's done by robots, which are
Speaker:incredibly accurate and they don't make mistakes,
Speaker:except for if they're programmed wrong. And so you can imagine how
Speaker:somebody who's trying to kill somebody in the hospital could
Speaker:reprogram that pharmacy robot to give the wrong medicines or give a
Speaker:lethal dose of something. So anyway, the novel's about things like that.
Speaker:And. Oh, wow. Great thing about. Thing about fiction is you can just make up
Speaker:whatever you want and there's no fact checking. Exactly. Well, I was
Speaker:gonna. Whoops, I just hit my mic. I was just gonna ask. I hope it
Speaker:wasn't based on any true stories that you know of.
Speaker:The novel is not based on any true novel stories. What. What
Speaker:stimulated me to write it, though, was when I was at the University
Speaker:of North Carolina, there was an incident there that a
Speaker:famous athlete, that all kinds of people had looked at their medical record. They weren't
Speaker:supposed to be looking. I mean, those are supposed to be private. But they'd looked
Speaker:because we had electronic medical records. So I had the
Speaker:dubious charge of having to speak to about 50 faculty members who'd
Speaker:inappropriately accessed this athlete's record. And, you know, I
Speaker:know I don't know about you, but about me, I worry that that
Speaker:happens. And so we actually have, at the University of Michigan, as do many
Speaker:places, we have a AI driven scanner of electronic medical
Speaker:records that looks at every single electronic medical record every
Speaker:day and figures out whether if you looked at. If
Speaker:I looked at your record, was that because I'm your cardiologist or
Speaker:just because I'd heard you were in the hospital? And if I was
Speaker:doing that for my own reasons at the University of Michigan, I get fired.
Speaker:And I think that's the way it should be. But you know, that that also
Speaker:is something that's benefited from the advent of AI Even before we were
Speaker:hearing about. AI Wow, you are a treasure. And
Speaker:I either blabbermouth. I'm not sure which one.
Speaker:Before we part, I have two
Speaker:questions that you can answer very succinctly. Number
Speaker:one, what is the medical
Speaker:advice or advice you wish you
Speaker:could give to all heart patients? If there's just something you want to scream from
Speaker:the mountaintops that you don't get to say enough, that you just
Speaker:don't feel said enough to we heart patients. What is it? Well,
Speaker:it's very much akin to what you were talking about. And I always learn from
Speaker:people. You can and you should be the CEO of your health. And
Speaker:there are things that you can do to improve your health to
Speaker:prevent having more heart problems that aren't as terrible as
Speaker:you think they are. So be the CEO of your health. Love
Speaker:it. And then number two, and I think we already have an
Speaker:idea just based on our whole conversation today. But like, when you get
Speaker:up in the morning and you go to work at University of
Speaker:Michigan, what are you the most excited about? Well, I'm
Speaker:excited. We talked a lot about AI. I'm excited because
Speaker:I think there's a future in health care that's going to
Speaker:accelerate more than at any time during my 40
Speaker:years in health care. And I think that's exciting because I think
Speaker:we'll get the tools and have the ways that we can control
Speaker:our own health and that our patients can control their own health in a
Speaker:manner that really was unimaginable 15 or 20 years
Speaker:ago. So I'm excited about that.
Speaker:So being proactive instead of reactive.
Speaker:Right. I'm less excited about the fact that one of the two
Speaker:elevators from the parking lot I park in is being worked
Speaker:on, and it's seven flights of stairs. So at the end
Speaker:of that, I feel. At the end of that, I feel good about it. Otherwise,
Speaker:I'd never be walking those seven flights of stairs when I come in.
Speaker:I hope you get your own parking space, by the way. Well,
Speaker:I sort of have a parking place. Okay. I think you've
Speaker:earned it. I think it's okay. You can own the fact that you have your
Speaker:own. Your own parking space. Well, I will. I will. Then, yes,
Speaker:I have my own parking space. Oh, good.
Speaker:Well, Dr. Marshall Ranghi, thank you so much
Speaker:for your time today. I speak for
Speaker:all heart patients. We all benefit from your work, and I
Speaker:can hardly wait to see what comes next from you and your
Speaker:team at the University of Michigan. And for everyone
Speaker:listening today, be sure to check out the
Speaker:show notes. I'll have a bio in there of Dr. Range
Speaker:and a way to find him and buy his
Speaker:book, support his work and just
Speaker:keep taking care of you, like he said. Like I said, you are the
Speaker:CEO of your own health. And remember, in case no one has
Speaker:told you today, I love you. You
Speaker:matter, and your heart is your best friend. Thanks,
Speaker:Dr. Runge. Thanks, Boots. A privilege to be on your show.
