Life and Times of Leading Cardiologists: Gregg Stone

E. Magnus Ohman, MD

Disclosures

May 31, 2016

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Editor's Note: Dr Ohman's guest is Gregg W. Stone, MD, professor of medicine, Columbia University; director, Cardiovascular Research and Education, Center for Interventional Vascular Therapy, New York Presbyterian Hospital/Columbia University Medical Center; and codirector, Medical Research and Education, The Cardiovascular Research Foundation, New York. This interview was recorded April 1, 2016.

An Innate Curiosity

E. Magnus Ohman, MD: Hello. I'm Magnus Ohman from Duke University, and I want to welcome you to another edition of Life and Times of Leading Cardiologists. We are very fortunate to have Dr Gregg Stone with us today. He is professor of medicine at Columbia University, director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy, and head of the Cardiovascular Research Foundation. Gregg, welcome.

Gregg W. Stone, MD: Thanks, Magnus.

Dr Ohman: You've been leading the area of interventional cardiology for many years now. To what do you attribute your success? What has made you be the man that people go to if they have a new device that they want to test?

Dr Stone: You're very kind, Magnus. I think I've been very fortunate to be surrounded by a lot of people who have helped me in my career, who have stimulated me and motivated me to work harder. Perhaps I was blessed with an innate curiosity and desire to want to discover what is unknown. Most important, however, I've been around people who gave me the opportunity and mentored me in ways that have put me into the position to learn the skills, to be able to ask and then try to answer unknown questions.

It started when I was very, very young, even as early as high school, and then continued in undergraduate and medical school—every step of the way up to where I am now. This is a field where nobody does this by themselves. If you surround yourself and take advantage of working with so many other smart, gifted people, and if you can make a small contribution collectively, then I think you're very fortunate.

Dr Ohman: You referred to innate curiosity. When and where did this start?

Dr Stone: It started very early. I don't know where it started or why it started, but I was always fascinated by science and always wanted to know the way the world worked. I remember when I was in elementary school, building a computer. You have to remember that this was back in the 1960s.

Dr Ohman: This was before computers.

Dr Stone: I remember that there was a book. It was about this thick [holds up thumb and index finger to indicates approximately 5"] and it was for building this big, giant circuit board. Basically, you'd push a button and it would turn on two or three lights. My father helped me with this as a school project and it took us about 9 months to build it. It was really extraordinary, and it got me thinking. I had a chemistry laboratory at home and I did my own experiments. I was ordering all sorts of probably illegal drugs, back then, and compounds and elements. I tried to recreate the elemental table in my basement, yes. There were about 100 elements there and I think I was able to collect about 70 of them.

Dr Ohman: Wow. You said drugs. You mean compounds, probably.

Dr Stone: Yes, of course.

Dr Ohman: Just to keep it clean, because in the '60s—

Dr Stone: That's right. No, especially in elementary school. There was no experimentation with drugs.

Growing Up in the Midwest

Dr Ohman: Where did you grow up, Gregg?

Dr Stone: I grew up in Ohio. Shaker Heights, which is a suburb of Cleveland. I'm a Midwest guy, born and bred and true.

Dr Ohman: And the garage still stood after all your experiments?

Dr Stone: Actually, it was pretty interesting because when I was very young—I probably shouldn't say this—I would forge my father's signature and order nitric acid, sulfuric acid, chlorine gas, and phosphorus that you'd have to store in liquid. I had this giant chemistry lab. After I moved out after high school, my folks had to call a hazmat team to be able to clean up the house. There were so many chemicals there. The fire department came. They didn't know what to do. It was pretty interesting.

Dr Ohman: Your father and mother were very forgiving. What did they do?

Dr Stone: Neither were in medicine or science. My father was in advertising and he ran an advertising firm in Ohio. My mother was a housewife. It's an amazing story because my mother was an incredibly intelligent, gifted woman who went to college at Ohio State University when she was 15 years old. When she was a junior, she met my father and they got serious. So her father said, "Okay, that's it. You can drop out of college now because you are ready to get married." And that's a true story. It's amazing how times have changed.

Dr Ohman: That must have sparked in you a certain amount of interest in education.

Dr Stone: Yes, always. I've always been around intelligent people, and my parents always emphasized learning, higher education, and trying to do the most with what you have.

Sibling Rivalries and Research Opportunities

Dr Ohman: Where did you go to university?

Dr Stone: I went to the University of Michigan. You have to realize that my mom went to Ohio State and my brother went to Ohio State, so of course, I had to be different and went to the University of Michigan. You can imagine the rivalries we had growing up.

Dr Ohman: Do you still talk?

Dr Stone: We do now. I must say that, back then, it was pretty intense.

Dr Ohman: The University of Michigan is a great school. Did you have a lot of fun?

Dr Stone: Michigan was fantastic. It was absolutely the right combination. There were higher academics and incredible opportunities. At the same time, you'd find yourself as a person and you'd make friendships that would last forever. There were also great research opportunities at the medical school, and that's where I first became interested in research.

Dr Ohman: Tell us more about that. How did you go from being a very bright chemistry student to somebody who wanted to practice medicine?

Dr Stone: I became interested at the University of Michigan. I remember going to my counselor and expressing this interest. My counselor's name was Otto Graf. "Autograph." I'll never forget that. He said, "You should do some research." And I said, "Well, how do I do that?" And there was a whole list of possible mentors who took undergrads. So, I met a gentleman by the name of William Lands, who was a professor of biochemistry and was investigating a new field called prostaglandins.

This was when prostaglandins were being discovered, and I remember going to meet him. He gave me a book of proceedings. It was this thick. It was basically an abstract book, because there was nothing published. And he said, "Go read these." So, I'm reading about prostaglandins E, G, and I, and I really don't know what I'm looking at, but I'm soaking it all in. I worked with him for a couple of years and figured out how to change the oxygen microenvironment concentration of renal cells and see what that would do to prostaglandin biosynthesis, and I published a very early paper.[1]

Dr Ohman: Yes, I was going to say that you must have published at a very early age.

Medical School on the East Coast

Dr Ohman: Where did you go for medical school?

Dr Stone: I went to Johns Hopkins University for medical school, which was an extraordinary experience and shaped me as a physician for the rest of my life.

Dr Ohman: Who were your mentors at Hopkins? I presume Dr McKusick was there when you were there.

Dr Stone: Yes. Victor McKusick was the father of modern genetics, and he was the head of medicine at the time. And Myron Weisfeldt, who was the head of cardiology. I got to know Bernadine Healy Buckley and actually did some projects with her. There was also Ken Baughman. The department of cardiology was so strong.

I got to know an electrophysiologist very, very well—and that's where my early research was—a gentleman by the name of Phil Reid, who was a professor of both cardiology and electrophysiology and chemistry.

Dr Ohman: Were you tempted to go into electrophysiology?

Dr Stone: I was.

Dr Ohman: Phil is a very dynamic person.

Dr Stone: Oh, you know Phil?

Dr Ohman: Yes.

Dr Stone: He was amazing, and he was so organized and so thoughtful in the way he did things. It was a real learning opportunity for me. I also got to work on the first automatic implantable defibrillator for a short while with Michel Mirowski. We were doing experiments with fish tanks, looking at electrical isolation of the defibrillator. That was extraordinary.

And, as a medical student, I became one of the four readers of electrophysiological studies at Johns Hopkins.

Dr Ohman: Oh my goodness.

Dr Stone: Back then, those studies came out on paper this thick. The studies—especially when you were doing something like Wolff-Parkinson-White—would take 6 or 7 hours to do. And then I'd go home for the weekend and read those studies. I think that soured me a little bit on a career in electrophysiology. But it was amazing.

Dr Ohman: Electrophysiology would have been very different if you had gone that route.

Dr Stone: It would have.

Dr Ohman: I believe Eric Topol was at Hopkins. Was he there at the same time?

Dr Stone: No, he wasn't there when I was there.

Dr Ohman: So you didn't overlap?

Dr Stone: No, we did not.

Two Fellowships, Two Coasts, and a Marriage

Dr Ohman: So, now you're in the cardiology fellowship. Did you meet your wife at Hopkins? Or was it before then?

Dr Stone: I met my wife during fellowship. After medical school, I did my internship and residency at the New York Hospital-Cornell Medical Center, and then I did two cardiology fellowships. The first one was at Cedars-Sinai Medical Center in Los Angeles, which is where I met my wife.

Dr Ohman: Okay. And you were hired to New York. What made you go to New York? What was exciting about New York?

Dr Stone: I don't believe in staying at one place for a long time. For example, at Duke or at Harvard programs, they stay there for 20 years and they're training. Those programs are absolutely fantastic, but I think it's valuable to get exposed to different thoughts and different approaches to things, to try to keep going to better, different, and interesting programs that meet your interests at that time.

For me, Cornell was an incredibly clinically rich environment. R Gordon Douglas, who was one of the top infectious disease experts in the world, was the chief of medicine. I also knew other people in New York, so there was great appeal for me to go to the big city at that time.

Dr Ohman: Great. And, just as a side note: If you could take a sabbatical today for 3 months anywhere in the world, where would you go?

Dr Stone: I would say Duke, of course.

Dr Ohman: Thank you.

Dr Stone: If I could take a sabbatical right now, there would be so many fascinating places to go. I don't know that I could limit it to one. Fortunately, I spend a lot of time in multiple different places around the world, from Russia to China to Korea to, of course, all over Europe. A place where I've not spent a lot of time from a medical point of view is South Africa, which I think is an incredibly vibrant, emerging new center. A friend of mine, Bernard Gersh, is going to be doing an extended sabbatical there. Maybe I would join him.

Dr Ohman: Join Bernard in South Africa?

Dr Stone: If I had the opportunity. We'd probably spend our time in the bush and not work, but that's okay.

Dr Ohman: You said you did two cardiology fellowships.

Dr Stone: Yes.

Dr Ohman: Tell us a little bit about how that came about.

Dr Stone: I had an amazing experience at Cedars-Sinai. [Jeremy] Swan and [William] Ganz were there. Jim Forrester was there, as well as PK Shah, who is an amazing clinician and an incredible mentor. I did a lot of research work on noninvasive imaging with Dan Berman, Jamshid Maddahi, and Alan Rozanski.

I also got exposed to the catheterization laboratory. Frank Litvack and Neal Eigler were the codirectors of the cath lab, and we were doing a lot of fascinating work in laser and other new interventions. Balloon angioplasty was still relatively new back then.

I decided that more than just being a thinker, I wanted to be a doer. It comes from wanting to correct things, wanting to find a problem and then do something about it, either academically from a research point of view or helping a patient. I was so thrilled by the potential of interventional cardiology at the time, and I could see that balloon angioplasty was just the start of it. I really had that suspicion.

There were very few fellowships at that time, back in 1988. I was very fortunate, for reasons that I still don't fully understand, to be one of about 400 people who applied to work with Geoffrey Hartzler. He selected me to come spend a year with him at Mid America Heart Institute in Kansas City, so I packed up. I went from New York to Los Angeles and back to the Midwest, to Kansas City. My wife and I had gotten very serious. We weren't married at the time, but she came to Kansas City with me and that's where we got married.

Dr Ohman: Great. Was it a 1- or 2-year fellowship?

Dr Stone: One year.

Private Practice in the Bay Area

Dr Ohman: Where did you head next?

Dr Stone: After that, it was time to do a combination of practice and research. It was a very different time. At that time in interventional cardiology, not much of it was university-based. There weren't many randomized trials when I was starting. Most of the research was coming out of individual private practices.

My wife already had a practice setting in Northern California. She had an offer to join a great practice. She's a pulmonologist and sleep-disorder specialist. I said that, if possible, I would try to join her. I found a tremendous practice to join, which was called the Cardiovascular Institute, centered at El Camino Hospital and Stanford University Medical Center. It was a large private-practice group, but they also supported any interest that I had in trying to set up a research division. It was a group of about 11 physicians, which was large at that time, especially in California, and they were controlling a fair number of patient lives. They promised me that if I went out there, I was going to be the interventional cardiologist for the group. It was a very, very exciting time with unlimited potential.

Dr Ohman: That's great. And then you got involved in the PAMI studies[2] with Bill O'Neill and others.

Dr Stone: Right.

Dr Ohman: Was that because you participated in the trials? How did you move that along?

Dr Stone: It's a great story, and there are a lot of lessons for younger people. It's very different coming out of a fellowship. Something unique that Geoff Hartzler did was create a database. He had the largest database of interventional cardiology at the time, but it was just a single practice-centered database. Randomized trials were just beginning. I was very, very interested in primary angioplasty and myocardial infarction, which Geoff was the originator of. He was so convinced that it was the right thing to do for patients that he thought it was unethical, even back then, to randomize. Less than probably a tenth of a percent of the patients in the world were treated with primary angioplasty, but he would not randomize. I really believed that we had to do a randomized trial to try to convince the world.

Dr Ohman: So, you were holding the science honest.

Dr Stone: Yes.

Dr Ohman: That's great.

Dr Stone: Well, we had to. So, when Cindy Grines—supported by Bill O'Neill—decided, "Yes, let's see if we can do this," I basically begged them. "Can I please be part of this? This is so important." And they were very gracious and took on a young guy like me out of my fellowship.

Dr Ohman: And you were in the Bay Area with a lot of industry connections with all the hospitals.

Dr Stone: Yes.

Dr Ohman: Does anything stand out from that period that changed how you would move forward?

Dr Stone: It was an amazing area. With Silicon Valley, there was so much of the early innovation that was occurring. We also probably had the richest concentration of top interventionalists in the country. There were [Simon] Stertzer and [Richard] Myler at Seton Medical Center. There was John Simpson in Redwood City. There were other really good people in multiple other areas. We actually put together an intercity Bay Area collaborative cath conference and meeting where we got together every month or so to share ideas, and it went from balloon angioplasty to directional atherectomy, which of course was the home of John Simpson.

I got to know all these people and had stimulation and motivation. I felt really blessed to be in this environment.

Dr Ohman: When you had been at El Camino for about a year or 2, I actually met you at one of the teaching courses. It was great. There were three fellows: one from Boston, me from Duke, and you from Hartzler's place. We were just three people teaching other people to do these procedures. It's pretty amazing, looking back at it now.

You weren't in Palo Alto for a long time, despite the wonderful weather and everything. You went east again.

Dr Stone: I was there for about 10 years in this large group. Initially, I was the only hardcore interventionalist, and then Fred St Goar joined me. He was doing his own thing and developed the MitraClip and other inventions. He's an amazing guy. I was doing as much research as I could on my own. It was pretty much on my own and I hired research nurses. You have to realize that this was very early. For the PAMI trial, we didn't have a database. We had an Excel spreadsheet. There was no funding for the PAMI trial. We consented the patients ourselves and then we entered the data on a paper case report form and then the data got summed up on an Excel spreadsheet. That's how research was being done. However, we were doing a lot of it, so I was published as much as I could and started some first registry studies, followed by some small multicenter collaborative trials.

A Call From Back East

Dr Stone: I knew that if I was really going to make an impact, I had to put myself around other very smart people to learn from and in an environment with a lot of other like-minded people, where I could really grow. Fortunately, Marty Leon came calling, and it was like manna from heaven.

Dr Ohman: He was in Washington, DC at the time.

Dr Stone: At the time, he was at the Washington Hospital Center.

Dr Ohman: So you went back east?

Dr Stone: We moved back east. We sold our home and took our daughter, who was 2 years old at the time, and made the big move back East. I was convinced that that was the last move in my professional career.

Dr Ohman: How wrong you were. When did you start educating? One of your major strengths over the years is how you have educated people about the procedure and about the science. When did this develop? You wouldn't have done it much with Hartzler. I remember that we talked about it at the time. When did this bulb light up? This is important and, of course, the Transcatheter Cardiovascular Therapeutics (TCT) annual conference was already operational at the time, but it was a very small meeting.

Dr Stone: This was even before TCT. The triple threat of what I consider being a complete physician-scientist is 1) taking care of patients, which is always at the core of what we do, 2) academic research, and 3) teaching. Because I've been so fortunate, I've always felt a great desire and need to give back, to pass on not only what I've learned, but what other people have learned. I've always thought that there should be a great effort to share and not hold back knowledge, to continue to improve patient outcomes through education.

I had my opportunity fairly early when I was in Palo Alto. There was a course by ACS, Advanced Cardiovascular Systems, which was the predecessor to Guidant, which was the predecessor to Abbott Vascular. They were running a fellows course and they would fly the fellows out to La Costa in Carlsbad, California, a beautiful tennis and golf resort.

Dr Ohman: No longer allowed.

Dr Stone: No longer allowed. We would spend about 4 hours/day in a classroom with all the world's experts, learning interventional cardiology. Then, we would have the afternoons off, and it was an amazing, exciting experience.

But, of course, that is no longer allowed. I said, "Well, this is a real shame because I not only met all these giants and was able to network, but I was so stimulated and learned so much." I thought that maybe I could continue that, but within the right kind of format so that it would be allowed. We started the National Interventional Cardiology Fellows Course, which is now about 25 years old. We basically said that we will fly all the fellows out and put them up in a hotel. We'll pay all the expenses through unrestricted industry grants, but through multiple industries. Also, we will not just do it for 4 hours/day, but we'll work them 8 to 10 hours/day, continuing the concept of learning. It really caught on. We had Antonio Colombo, Marie-Claude Morice, and all the top people from around the world come to teach US and Canadian fellows about interventional cardiology over 3 days.

That just stimulated the fires in me. When I went to Washington, part of the reason that Marty recruited me was that TCT was becoming the meeting for what's next in interventional cardiology. It grew from a very small meeting of a couple of hundred people in the basement of the Loews Madison Hotel in Washington, DC to a couple of thousand people. It was getting out of control and he needed a partner, somebody to help him.

Dr Ohman: And in comes Gregg, to take control.

Dr Stone: Yes, take control. I had no idea what I was getting into. I said, "This sounds great." We took it in all new directions. We took it from just coronary intervention to structural heart disease and peripheral vascular disease. We took it from just "what's next" to "what's now." We expanded it to abstracts, late-breaking trials, the whole thing. And it grew from several thousand people to about 12,000 people.

Moving en Bloc to the Big Apple

Dr Ohman: So, TCT grew dramatically. And then you moved to New York.

Dr Stone: Right. After being in Washington for about a year and a half, the group broke up. There was a difference of philosophies on clinical practice vs academics. We moved to New York and brought the whole Cardiovascular Research Foundation, which was about 40 or 50 people. We moved en bloc to New York and joined Jeff Moses as our clinical outlet. Jeff was a good friend for a long time. He had the largest practice in New York and was connected in everything that was going on in New York City. He was kind enough to tell us to come to Lenox Hill. Lenox Hill was a great partner for us. The foundation has always been separate. It's a 501(c)(3) nonprofit organization and we kept it separate under that structure.

Fortunately, we grew the clinical environment at Lenox Hill Hospital and had our natural academic outlet for expression.

Dr Ohman: How do you spend your days now? I know you write a lot of papers. How do you break up your day now?

Dr Stone: It's a combination of clinical care, research, education, and writing. The natural expression of what we do is writing manuscripts. Abstracts are fun and presentations are great, but I always try to tell the fellows that your currency, your legacy is what you write, and that's really how you teach and educate. We have a very strong organized program with publication offices, and we teach from college students on up how to write, how to think critically, how to generate hypotheses, how to test hypotheses, etc.

The bottom line is that I keep my hand in all three areas. Over the years, it's has been shifting more and more to research and education. Unfortunately, there is less time for patient care. But I just love what I'm doing. I wish there were more hours in a day. But let's put it this way: it's a very full and enriching life.

What's Next?

Dr Ohman: So, after the sabbatical in South Africa, what's next in Gregg's life? What are you going to accomplish next? Are you ready for a move again? Looking at the story, you should be moving soon.

Dr Stone: Well, we moved from Lenox Hill to Columbia.

Dr Ohman: Yes, of course. I forgot.

Dr Stone: That was the big move. In 2004, Columbia University came calling and they saw the opportunity to bring our whole group and the Cardiovascular Research Foundation to affiliate with them. Marty and I and the rest became full-time faculty at New York Presbyterian Hospital/Columbia University Medical Center. That has been an amazing move. The hospital has been extraordinarily supportive and we've grown together. New York was not the cutting edge of interventional cardiology. It used to be a very conservative place, but now I would say that it's right at the leading edge.

I've looked at chiefs of cardiology and chiefs of medicine, but I think something that is very important is to be true to yourself and ask yourself what you enjoy doing. Not think about titles and whatnot, but where you can have the greatest impact.

I'm at a stage where I'm very fortunate. I've led about a hundred randomized trials in drugs, pharmacology, and coronary and structural heart disease. Right now, I'm involved in so many interesting things, from left main intervention to mitral valve to heart-failure therapies to refractory angina to newer pharmacologic agents, etc, that it's hard for me to get off this train. I love it.

Dr Ohman: You're still like the fellow in the garage who would make all the different periodic-table compounds.

Dr Stone: Yes.

Dr Ohman: In that way, you're just finding your way.

Dr Stone: There are more questions. We've made incredible progress in the treatment of patients with heart disease, but there's still so much further to go. Technology is exploding and the advances in biotechnology are extraordinary. I think that devices have outstripped drugs in their potential.

Pharmacology is slowing a little bit for new discoveries, but that's not so for devices. With where we are with imaging, computer science, and the interface between biology and mechanical devices, I think it's a golden era right now to be an academician.

Dr Ohman: You have shared a great life story. It has been fantastic to hear your story, and it is easy to understand how the educator who started in the garage can really make a difference in science. I want to thank you, Gregg, for a great interview.

Dr Stone: Thank you, Magnus.

Disclosures: Gregg W. Stone, MD, has disclosed no relevant financial relationships.

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