Selected Podcast

Cultivating Discovery: From Ideation to Innovation

Join Dr. Dan Berkowitz as he discusses the intersection of artificial intelligence and anesthesiology, highlighting the importance of diversity in thought within medical teams. Explore how these elements can transform patient care and enhance research in anesthesia.

Cultivating Discovery: From Ideation to Innovation
Featuring:
Dan E. Berkowitz, MB BCh

Dr. Berkowitz is the Alfred Habeeb Professor and Chair of the UAB Department of Anesthesiology and Perioperative Medicine. He received his Bachelor of Medicine and Surgery from the University of the Witwatersrand in South Africa before completing his residency in anesthesiology and an Adult Cardiothoracic Anesthesiology Fellowship at Duke University. Following his fellowship, Dr. Berkowitz joined the faculty at Johns Hopkins University, where he spent 25 years as a clinician-scientist and academic leader. At Johns Hopkins, he made significant contributions to the field of vascular pathobiology as an NIH-funded researcher and held several leadership roles, including Director of Cardiac Anesthesia and Vice Chair for Research. At UAB, Dr. Berkowitz has continued to be a leader in patient care, research, and education with a focus on high-performing teams and care collaboratives. He has also played an important role in advancing the field of Anesthesiology through his involvement in professional organizations including the IARS, AUA, and SAAAPM.

Transcription:

 Matt Sherrer, MD (Host): Welcome to season two of the Fresh Flow Podcast. Mitchell, right off the bat, just tell me, did you think we'd make it this far?


Mitchell Tsai, MD (Host): Um, no. That truth, honest truth right there. And, this is why I think our guest decided to show up on season two instead of season one. So.


Matt Sherrer, MD (Host): So you're saying that our guests didn't think we would make it this far either.


Mitchell Tsai, MD (Host): You know, he was hedging his bets. He's a smart man.


Matt Sherrer, MD (Host): Smart guy. Alright, well, that's a perfect segue, let's get going. I have the pleasure of welcoming my boss here today, and actually, the guy who we should give lot of credit for this podcast existing. So, today we have with us, Dr. Dan Berkowitz, the Chair of Anesthesiology here at UAB. Dan, welcome in, man.


Dan E. Berkowitz, MB BCh: You know, considering the eminent folks that have been on your podcast previously, I feel pretty humbled to be here. So thank you for inviting me. I'm really looking forward to this. Should be fun.


Matt Sherrer, MD (Host): Yeah, it'll be fun. And thank you for supporting us. This was a crazy idea. Gosh, a year ago or more. And, just like you frequently do when I come with crazy ideas, you go, yeah, man, sounds good. Let's do it. So.


Dan E. Berkowitz, MB BCh: I've given you a long rope and you haven't hung yourself yet, mate. So, there we go.


Matt Sherrer, MD (Host): Give it time, give it time give it time. Well, let's dive in to your background. You're clinical anesthesiologist for sure, working in the operating rooms, but in an extensive research background, coming to us, from Baltimore, leading that effort at Johns Hopkins. Tell us about that, your history in research, and then how you feel that that kind of prepared you for this next step, which is taking on a position of a Chair at an academic program like this.


Dan E. Berkowitz, MB BCh: Sure, well, I kind of emerged into my research career at the time of the explosion of the molecular medicine. And, I'd always been interested in molecular medicine. I did a fellowship in human genetics after my internship. But more importantly, I was very, very fortunate to have had a visionary chair in the Department of Anesthesia when I did my training at Duke.


And Duke was kind of emerging as a pretty highly, well respected academic Department of Anesthesia at that time, just emerging. And Dr. Reeves, Jerry Reeves, at that time realized the importance of anesthesiology research training, true training, like other specialties. And, he had sent some of his fellows. One of them was Dr. Deborah Schwinn, who, subsequently became a Chair, and then ultimately went on to be a dean, to the lab of Dr. Lefkowitz, who ultimately in 2014, won the Nobel Prize for G protein coupled receptors, and so he really understood the importance of anesthesiologists doing fundamental basic research, so that we could really lead in science and in, in academia, and really be players.


So I was fortunate to be able to work with Dr. Schwinn. And that was really the beginning of my academic career. I was able to get a fair grant with her on molecular mechanisms of alpha one adrenergic signaling. And ultimately, a lot of that work on adrenergic receptor subtypes led to the development of some very important drugs that all of us will use, as we get older.


One of them is, Flomax, okay, because understanding the, unfortunately we will be using it, uh, understanding the alpha 1 adrenergic receptor C subtype, and targeting drugs to that was kind of the original fundamental work that we were actually doing in the lab. So when I went to Hopkins, I actually was a little bit of mentorless for a while.


And then I found myself associated with the department of biomedical engineering with Art Shoukas. Art actually was one of the folks who worked with Suga and Sagawa, defining the pressure volume loop. So, you know, the fundamental pressure volume loops that we know in the heart, that work was all done, in Sagawa's lab and Dr. Shoukas was a venous biologist, and I came with molecular, with some molecular skills, and so we were able to work together, and I was able to establish a vascular biology lab.


And my focus, in the vascular biology lab was really the role of nitric oxide and its role in dysregulation in disease processes, particularly vascular stiffness and aging, which is what I got my first R01 grant on.


And then we did work on atherogenesis, some pulmonary hypertension work. And then, I actually did work with NASA, which we, worked on both understanding the molecular mechanisms of orthostatic intolerance in astronauts and also the endothelial dysfunction associated with radiation, with deep space radiation, so I was funded through NASA.


And I, probably not many people know that I actually had a project on board STS 107. STS 107 was the Shuttle Columbia, was at the landing site. So we had lab set up, we had rats on the shuttle, and unfortunately we know what happened with STS 107. I was waiting in the stands for Columbia to land and unfortunately, it, fell apart, broke apart, over Texas and unfortunately we had no data from that, but obviously it was much more of a disaster than that.


So, what I've fundamentally found about research is number one, discovery is so important, in terms of the scientific process for our specialty, in terms of idea generation, problem solving. But when I speak to new candidates and new fellows, new residents, and try and entice them to go into an academic career and do research, what I say to them is the most important thing is you will meet interesting people. And you will go to interesting places and it'll broaden your horizons and make you less judgmental. And, it'll just make your life interesting. And so that's really what it's done for me. And it's allowed me to frame what I think might be important pathways for progress in our specialty.


And those have obviously changed. And, but I've actually been very, very fortunate, in that the institution was generous. I was able to establish a lab now here. It's been very exciting. We've transitioned a little bit to work in the area of endothelial function and in preeclampsia. And that's been a fun academic exercise and it's really, what it's enabled me to do is to actually bring in our clinicians with our basic scientists to come together and solve important problems, and come up with new potential, new therapies and new ideas about mechanisms.


So that's my research trajectory and track.


Mitchell Tsai, MD (Host): Dan, I just want to echo what you said through your research career that, you know, that as a specialty, we need to lead. And then what I want to do is I want to pivot, right? You started as Chair at the University of Alabama and then you sort of had to pivot with the pandemic, right? And so now that you're on the other side, you're an administrator, you're in charge of a department. Has it gotten harder or easier to sort of push that research mission?


Dan E. Berkowitz, MB BCh: I mean, I think that's a good question. I think what it's been, I would say easier and I'll tell you why it's been easier. I've been able to acquire number one, the resources, and being able to channel them in the directions that I think are the most valuable for our specialty.


And so that's entailed making bets. It's entailed, investing in people that I feel are going to be successful. And my strategy for success in our department has been twofold. What I've tried to do is to find folks that are just on the cusp of success. These are young folks that are doing good cutting edge research, haven't quite gotten to independence, but are getting there, have either had foundation funding, and are in the process of writing a grant. So those are the folks that I think are the worth investing.


And actually we've been pretty successful in their, in their domain, in terms of having people funded, and doing their interesting work. We've also had the strategy of recruiting, more seasoned investigators. That's an expensive proposition, but it's worthwhile and I've been fortunate to have some of the resource to be able, resources to be able to do that.


You know, I think we've also made some investments in health services research and in AI as, we're going to potentially, hopefully we'll talk a little bit about later, because I think those are areas in which I think our profession can really lead; particularly as it pertains to things like precision and predictive medicine and predictive perioperative medicine, particularly. So I think it's been easier just because I've had the ability to make the decisions myself and to create a team myself and not really be behoven to someone else's vision. I can be behoven to my own vision, which is much more fun.


Mitchell Tsai, MD (Host): We've discussed this too, Dan, just the academic anesthesiology, right? And we need to do as a specialty across the country, building networks and, you know, you are one of those individuals out there that sort of sees our specialty just not only within your department or across your department, but sort of across the country, maybe the world.


Dan E. Berkowitz, MB BCh: Yeah. I appreciate that. And, we've like I say, Mitch, we've been a beneficiary of both your and other people's great insights and intellect and ideas as adjunct faculty and, and you're right, we really need to create a much greater community of anesthesia thinkers and researchers and idea generators. So yeah.


Mitchell Tsai, MD (Host): Or at minimum for Matt to make fun of me on each of these podcasts.


Matt Sherrer, MD (Host): That's really, really my goal every time. My goal, every time is to get a good jab in him on Mitch, and if I do, I'm happy. So Dan, you mentioned your vision. You mentioned AI. The three of us were involved in an article on the Infinite Game, and we kind of used that as a framework to discuss the future of our specialty.


What are some of those things, from your perspective, that are worth investing in? Where should we be putting our time and energy for the future of anesthesiology?


Dan E. Berkowitz, MB BCh: Well, think that number one, when we talk about sort of the Infinite Game, I really think that we need to see our specialty through the lens of, actually in our department, we've done that, as almost a third component of the organizational structure. You know, we think about our organizational structure.


I like to think about it in the terms of a CENX framework. What are the things that are important for our specialty? Well, having a sustainable, nimble organization because we live in a world that moves so fast, that's changing so fast, we have to have this existential flexibility.


We'd be able to, we need to flex quickly. We need to be able to change. The most important thing for a healthy organization, again, is to have great trusting teams. I mean, that's as you know, trusting teams are what creates, an environment where people enjoy coming to work and enjoy the work they do.


We need to have courage to say, look, the way we've done things in the past, has not served us well. We can't fight with our CRNA colleagues. We need to create teams where everyone's contributions are valued in the same way.


And ultimately that's the only way we can build and create value in our specialty. And I think that this value proposition, for our specialty. I don't have the answers. I don't have all the answers, but I really think we need to so fundamentally change the way we think about our specialty and what it is that we actually do. I know what we do.


I mean, I think that number one, we are a data driven specialty. We have more data than any other specialty. We have the ability to actually access, process that data. And so that's one of the areas that I think we really need to leverage, for our specialty, and that is precision medicine, predictive medicine.


I think what's important as well, and something that is important from the context of our specialty is that we need to ensure that as we pivot and create value, we actually train our residents in these new technologies, in these new techniques so that we're not trying to teach them the same things that they were learning you know, 30 years ago as the primary, focus of our specialty, but that they understand our value in some of these new ideas.


Mitchell Tsai, MD (Host): I'm just going to add, you know, we've had an informal book group over the last couple of years. And the most recent one that you've thrown out at us is, "Thank You For Being Late" by Thomas Friedman, right? And in this book, Friedman talks about the story of Edward Teller and how AI and sort of the technology that we're living in right now is exponential and the human brain has evolved for linear growth, right?


So we're struggling with this gap and you mentioned that we need to train people differently. Friedman points out that we need to, the curricula in colleges and undergraduates are going to become non existent or useless in five years, right? And medicine has not kept up with that pace of change, right?


And so, I fully agree with you. How do we pivot as academic anesthesiologists to ensure that our future anesthesiologists are able to compete, right? Because if we're going to compete on the dollar and the value proposition, I think ultimately in 10 years, we're not going to win.


Dan E. Berkowitz, MB BCh: Yeah, I 100 percent agree with you and, I think that's our challenge. I think it's a tough one, but, I think therein lies our challenge. What they're also, brings to the fore is that actually what we need to do in our departments is create a much greater diversity of thinking of people within our department. You know, we primarily now we recruit clinicians and physicians and maybe what we need to be doing is having within our department, you know, systems engineers. Maybe we need to have and hopefully we do and can, we have, AI experts.


We're very fortunate in our department to have a very robust IT department. So, that helps us. But like you say, if we're going to address the issues, the problems, if we're going to grow in this technologically, accelerating environment, we're gonna have to play with the big boys. I mean, ultimately otherwise we're going to get lost. We all will be lost.


Mitchell Tsai, MD (Host): I just want to point out that, you know, when Michael Porter came out with his value based healthcare platform from the Harvard Business School, one of them was that you needed an infrastructure, right, for the data management, all the systems that you need to keep a business going. And, you know, Harvey Cushing, neurosurgeon, father of the anesthetic record, right?


He understood it back then. And I think that the opportunity for our specialty is, even with MPOG, right, you're looking at data in the past to try to predict the future, right? But with your background in molecular medicine, genomic medicine, precision medicine, how do we actually get to the point where the patient that comes in, we know what anti nausea medication to use, right? I think that is a huge opportunity that we sort of haven't really looked at.


Matt Sherrer, MD (Host): Wait, do we have more than one nausea medication?


Mitchell Tsai, MD (Host): Well, if you're in Vermont, you sort of give what the pharmacy orders for you. But you know, I think Tom Gan said, you just, if the first one didn't work, just keep throwing them on.


Dan E. Berkowitz, MB BCh: Just as a side note, because my office at Hopkins, was right next to Henry Brem's, the chair of neurosurgery. And they have a panel, like a board, for each of the chairs that they've had of neurosurgery and, I used to walk past, they had one for Harvey Cushing and I used to walk past pretty much every day. So just a side note, so.


Mitchell Tsai, MD (Host): We should give him an honorary chair position in anesthesiology.


Dan E. Berkowitz, MB BCh: I understand what Mitch is saying. What I think is that the integration of all of this data, is going to happen very soon. I would say that the only barrier right now to integration of all of the information that you're talking about, is health privacy.


I think that the large language models that we have now are absolutely perfectly capable of integrating all this information and throwing it out. We know that they can go through current drugs and find uses for new therapies.


I mean, these large language models can go through billions of references and can scan the whole of PubMed in no time. So the only thing that I think we're missing for integrating that is the ability to actually put this data out there.


I mean, I think, once we can actually put patient data out or have it within being able to scan it in these large language models; I think that's the only limitation quite frankly, right now. I think, a lot of us are playing with these models, with these languages, language like perplexity it's just, they are just incredible in what they can actually do.


The deep fundamental research that they can actually do, is beyond anything that one can imagine. So I think we're at the point where we will be able to do those things. We will be able to do the precision assessment of patients data, that'll actually, be able to direct therapy and care in a way that we've never been able to do in the past.


Matt Sherrer, MD (Host): Yeah. So, Dan, a bit of a pivot here and a bit of a risk, cause I'm going to go off script a little bit. Do you really want to do that when you're talking to your boss, but I'm going to try it anyway. I've heard you mention a few times, this diversity of thought. I heard you mention earlier, this kind of more inclusive approach to our teams, moving away from the conflict in our teams.


And I have to think that your background plays a little bit into the back end of that. You're a proud South African. You sent Mitch and I some really wicked pictures from your adventures in South Africa here recently. Uh, you're a braver man than I am. I am not a hang glider and I'm not going to be a hang glider.


But you are. Has your South African upbringing influenced who you are in a way that maybe we see here as in your leadership style?


Dan E. Berkowitz, MB BCh: That's a really good question, actually. And I'm glad you asked it. What I'll say is this, that I grew up sort of a humble ish guy in Johannesburg and never in my wildest imagination would I have ever thought that I would have the opportunities that I have in my life now and so I am so grateful that I've been able to do the things that I've done and the opportunities that have been given to me and I think there are certain characteristics of growing up in South Africa. South Africans in some way, we were never told how to sell ourselves, we kind of just got on with doing what we had to do, which I think is helpful to some degree. I will tell you, I grew up in the height of apartheid in South Africa, and I think that influenced me a lot.


 I saw a lot of suffering and I saw a lot of injustice. And I think part of the reason I left is that I didn't want to continue to be a part of that injustice. And so I think that helps me to frame perhaps the love of diversity and inclusivity. And, I don't know, but I hope that drives some of that. Again, I think most of it comes from the idea and from the feeling of tremendous gratitude that I've had opportunities that I really would never have even dreamed of as a kid growing up in South Africa.


And, so I think that sort of drives my enthusiasm, my optimism. And I think that it's the optimism that, that I really like and enjoy and I enjoy both you and Mitch, and that's why I think we get on so well.


Mitchell Tsai, MD (Host): You know, finishing up, I believe, the first five years as chair, or I could be wrong. Or A little bit off here.


Dan E. Berkowitz, MB BCh: Six, six,


Mitchell Tsai, MD (Host): Six, six. So you're on to your second fifth, right? Alex Macario at Stanford, he's now the president of the American Board of Anesthesiology, but he, you know, he's made a comment to me that if you're not doing something different every five years, you're doing something wrong, Mitch, right?


So, another five years or another five years after that, what's the legacy for Dr. Dan Berkowitz?


Dan E. Berkowitz, MB BCh: I think about that a lot. I wanted to say that I think one of the advantages that I have as a Chair is my trajectory to Chair was never straightforward and it wasn't like I had that in my sights from day one. I'm essentially an older Chair, I became Chair at 58, which is on the older side for becoming a Chair.


So, and also I have the advantage of at this point, not really having the Chair as a stepping stone to the next thing. I don't really have the next thing. So this is my thing right now, which I think it's good, because I don't have to kind of worry about being all that politically savvy, although I guess I do have to be politically savvy to some degree. So, I think in terms of my legacy, I think the two important things that you Mitch have discussed this, and, Matt sort of framed this pretty well for me, in fact, I think his wife came up with this. So I left, she did. The two things are the infinite anesthesia, which is really the humanism, and understanding how we can continue to sustain an organization, sustain the department, using all of the CENX principles.


So that would be the infinite anesthesia, the IA, and then the AI, which is kind of the scientific future of our specialty. AI, and hopefully that component, having built a little bit of a data science group, having hopefully implemented some AI infrastructure within the department and hopefully, it infiltrating all of the different components, whether it's education, research, even operations, will be sort of hopefully, the legacy for the department. And, you know, I don't know. I don't know what the next journey is. I, I've been very fortunate. I recruited, when I came, one of my scientists in the department, Dr. Enica, he developed a new technology for generating inhaled nitric oxide. And, he's commercialized, it. So there's, uh, something on the horizon, hopefully there. I honestly, I don't know where I'm going next, but I know I'm staying here for a while and I'm gonna enjoy it, enjoy what I do here and build on some of the things that we've already started to do. So.


Matt Sherrer, MD (Host): Well, if you don't know what your next got your next gig for you. You're gonna be one of Simon Sinek's optimists. He has a team of optimists.


Yeah, he does. He does.


Dan E. Berkowitz, MB BCh: I didn't know that. That's awesome.


Matt Sherrer, MD (Host): I'm gonna, find a way to nominate you. Because, I will say, being a member of this department, you've been through some rough stuff, man. You walked in, right before a global pandemic and it was not easy, but you have stayed positive and optimistic throughout. So, we appreciate your support, not only as faculty members, but of this podcast and of all the crazy, crazy ideas that we've had. So, Mitchell, anything else you want to get to before we get done?


Mitchell Tsai, MD (Host): No, I think a couple weeks ago, I sent you guys a Harvard Business Review article, Abandon Stocks and Embrace Flows. Academic medicine has always built itself on the ivory towers, right? We own a stock of knowledge that nobody else is going to teach you, except us.


And, you know, from a Chair who's come from not small institutions, right, Duke, Johns Hopkins; it's nice to see an individual who believes that democratizing the information that we have as a specialty is actually going to take us to a higher realm. So kudos to you, Dr. Berkowitz.


Dan E. Berkowitz, MB BCh: Thanks, Mitch. I really appreciate it. I enjoyed reading that by the way. It's really


Matt Sherrer, MD (Host): Yeah, it was good. It


Dan E. Berkowitz, MB BCh: Great, it's really good.


Mitchell Tsai, MD (Host): Probably at 2 a. m. in the morning, right?


Matt Sherrer, MD (Host): He may have read it at 2 a. m. in the morning. There is one thing that I am doing at 2 a. m. in the morning, and that is REM sleep. So, I am not a night owl like Dr. Berkowitz is. So, well, Dan, thank you. Thank you for doing this with us. Thank you for being here. Thank you for supporting us.


And thank you for season two of Fresh Flow Podcast. This is going to be a blast. And, we promise that we will do our best and not let you down.


Dan E. Berkowitz, MB BCh: Guys, this was the best. I haven't had this much fun in a while, so it's awesome. Except, I guess jumping off a mountain with a paragliding, I guess that was fun. But anyway.


Matt Sherrer, MD (Host): You're a wild You'PPe a wild All right. Thanks guys. I appreciate you guys tuning in to this edition of the Fresh Flow Podcast. We'll catch you on the next one.