Interviewer: E. Magnus Ohman, MD; Interviewee: Thomas F. Lüscher, MD, FRCP


December 07, 2016

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Editor's Note: This interview was recorded on August 27, 2016, at the European Society of Cardiology (ESC) conference in Rome.

E. Magnus Ohman, MD: Hello. I'm Magnus Ohman, and I'm here with Professor Tom Lüscher, a cardiologist from Switzerland. But for most of the audience, you probably know of him as the editor-in-chief of the European Heart Journal—a very prominent journal in the field of cardiovascular medicine. Welcome to the program.

Thomas F. Lüscher, MD, FRCP: Thank you for having me.

Dr Ohman: The journal has taken off in such a dramatic way over the past several years since you took on the editorship. It would be interesting for people to know [about this], because most physicians when going to medical school really do not start thinking about running a medical journal. Somewhere along the way, you must have had some interest in this area.

But before we get into that, it has only been about 8 years [since you became the editor]. Tell us a little bit about your background, where you were born, and a little bit about your family.

Philosophy, Science, and Tragedy

Dr Lüscher: I was born in Zurich and raised in a doctor's family. Initially, I was not so interested in medicine. I was more interested in philosophy—to understand the world—and started to study philosophy. But over time, I felt that it had to be a bit more practical. Science became my substitute for that—to understand the world, to understand the human body and the mechanisms of how it works, and how it becomes dysfunctional.

[My father] died suddenly after seeing his last patient, and then I became very interested [in practicing medicine].

My father was a traditional physician, a surgeon, a gynecologist who did everything, and I helped him in his practice. He died suddenly after seeing his last patient, and then I became very interested [in practicing medicine].

Dr Ohman: Did he actually die while practicing medicine?

Dr Lüscher: Yes.

Dr Ohman: That is quite unusual for medicine.

Dr Lüscher: He worked until age 73, because you can work as long as you want in our country when you have your own practice. Now you can do this everywhere (even the United States), but at the time it was maybe a bit unusual. He saw his last patient and then dropped dead. I tried to understand why this happened, and still today I am interested in myocardial infarction because of that.

Dr Ohman: But that is not where your interest went later on. Was your mother working as well?

Dr Lüscher: She was working with him; she was an x-ray technician. She did all of the x-rays for him. This was the environment I grew up in.

Dr Ohman: Did you have siblings?

Dr Lüscher: No; I was the only son in the family, so maybe there were a lot of expectations.

Dr Ohman: Did you feel pressure from your parents to go into medicine because both of them were in the medical field?

Dr Lüscher: Yes, of course. They expected that I would pass the exams, and so I tried to and was reasonably successful.

Why Philosophy?

Dr Ohman: When you set out to do philosophy, it's not usual that people later go into medicine. It's a very different part of the psyche. Tell me a little bit about what interested you about philosophy when you must have been a high school student.

Dr Lüscher: I wanted to understand the world or how it evolved. Then more and more, I realized that biology with Darwin, and today molecular biology, offer a lot of insight into how we developed, how we work, why we are here, and why we look like this. Medicine is basically studying why things go wrong.

Molecular medicine gets very close to philosophy. There are lots of questions about ethics and how far can we go. Do we ever understand the brain? It is getting closer for those who think more of this philosophy of science, which is very Anglo-Saxon, in fact. It brought me into science—I was really excited to do science for many years, and also bench science to find out how things work.

Dr Ohman: You brought up an interesting thing about the Anglo-Saxon approach, but is the Germanic science a bit different?

Dr Lüscher: Yes, I think so, with philosophy in particular. They want to understand that it's not so down to earth—not so practical, like the Anglo-Saxon philosophy that is interested in understanding how science works, how we get evidence, and how we are sure that it is true. Today, this is actually a very important question. With all of these conflicts of interest, is it more important that I know about the financing of the study, or is it more important that it survives the test of time? I actually wrote an editorial about conflict of interest and the proof of scientific discovery[1] where I make the point that of course, we have to be transparent, but it's only the test of time that really tells us whether a study is true or useful or not.

Gruentzig did the first balloon on the kitchen table in the house that was owned by my mother.

Dr Ohman: Such as aspirin, which has been around for several hundreds of years.

Dr Lüscher: Right. That is a good example.

Dr Ohman: You eventually swore off philosophy, although you are still a heart a philosopher in how you think about things. Where did you go to medical school?

Medical School

Dr Lüscher: I went to medical school at the University of Zurich, where there was, of course, a huge tradition of cardiology. We had Åke Senning, who implanted the first pacemaker and invented the Senning procedure for transposition of the great arteries (which is no longer performed). He became a real pioneer. We had Andreas Gruentzig, who did the first angioplasty. In fact, Gruentzig did the first balloon on the kitchen table in the house that was owned by my mother, where he was renting the apartment.

Dr Ohman: Is the table saved anywhere?

Dr Lüscher: No, we did not save it at the time, unfortunately. I could have sold it at Sotheby's for quite some money.

Anyway, there was a lot of stimulation to go into cardiovascular [medicine], so I did. I started in hypertension because initially [my chairman] felt I had to go into hypertension and not cardiology. The chairman in our country was quite powerful, and he decided for you.

Dr Ohman: Very few people will recognize that back in the day when we went through medical school, people actually told us what they thought we ought to do. It's so foreign [now]. Hypertension and philosophy are not really aligned, so how did you receive this?

Dr Lüscher: I thought I should make the best of it. My father had had high blood pressure, as did many other people, so I thought it was an interesting problem. Eventually, if I do well, I could expand to cardiology, and I did.

On to the Mayo Clinic

Dr Lüscher: My chairman, Hans-Peter Krayenbühl, used to be one of these hemodynamic people—you know, dP/dt and tao and all of these things that today most fellows do not even remember that we had to do. But [before I went into cardiology], he said I should go to John Laragh in New York to study hypertension. I wanted to see this for myself, so I bought a round-trip ticket.

Dr Ohman: You paid for it yourself?

Dr Lüscher: Yes. I flew to nine institutions, talked to the guys, and then eventually I met Paul Vanhoutte at the Mayo Clinic. I had coffee with him, and I said, "These endothelial cells that cover the blood vessel are actually quite interesting. This may be important for anything in the circulation."

Dr Ohman: Including hypertension.

Dr Lüscher: Yes. I went to the Mayo Clinic, although I could have also gone to Ed Haber at Massachusetts General Hospital. I felt that Mayo was more innovative. Although Boston was, of course, more attractive than Rochester.

Dr Ohman: Were you at the Mayo Clinic for a couple of years?

Dr Lüscher: Yes; I worked in basic science in the lab there for about 3 years, and then I also did training in echocardiography. I wanted to do interventional cardiology, but this was not possible for foreigners—although I had passed the visa qualifying exam, which was quite tough. And so I said, "Okay, let's do echo; I haven't learned that yet." I went to Jamil Tajik and Jim Seward and learned a lot about the heart. I am really grateful that I did that. Eventually, I did interventional cardiology.

Dr Ohman: Before we get into that, did you have a family?

Family Life

Dr Lüscher: Yes, I went there with my wife, and my daughter was born there. She is a US citizen, which was quite good—she just did an LLM at New York University, so she could apply as a native. We just had the ceremony and convocation in New York, and that was quite nice.

Dr Ohman: Had you met your wife in Switzerland?

Dr Lüscher: Yes, in Switzerland. She came with me to Rochester. She is a technician. She ran the chemistry laboratory of a famous private clinic of Bircher-Benner, who invented Birchermüesli.

Dr Ohman: That was in the food area.

Dr Lüscher: Yes, in the food area, but they had remarkable patients—from Chagall to Formula 1 drivers, you name it. Then we went to the States, and we had a very good time. We still have a lot of friends from there.

Dr Ohman: After 3 years at Mayo, you decided to go back to Switzerland. How did that transition go?

Opportunities Back in Switzerland

Dr Lüscher: I was scheduled to go to Zurich, and my chairman even visited me. I came back and I talked a lot about the endothelium at that time. This was very novel in the German-speaking world. The professors always thought that knew everything better—it has changed a lot [since then]. But I thought I would go back to the United States because at my age and at that time, it was much more open in the United States. You were accepted more easily, and I even had a position in Boston.

Then Fritz Bühler, a very visionary man from Basel, came as a visiting professor. I decided to go [to Basel] because there were more opportunities for research—which my chairman didn't like (he wrote me a nasty letter). But things developed very well in Basel, and so I stayed there for a while.

Dr Ohman: Are you now fairly involved in the basics of the endothelial cell? And atherosclerosis, to some extent?

Dr Lüscher: Yes, right.

Dr Ohman: Did you run your own lab at the time and build it up?

Dr Lüscher: Yes, it built up very nicely. We were able to publish in top journals, such as New England Journal of Medicine and Journal of Clinical Investigation. I acquired a lot of funding, and so this worked extremely well.

Then I wanted to do interventional cardiology. In Basel, they felt that they had enough of those guys. But you shouldn't give up your dreams; that is my message to the young people watching. Then, fortunately, Bernie Meier became chairman in Bern; he asked me to be cochairman, and I learned interventional cardiology from him.

Dr Ohman: And there was no better person to learn from.

Dr Lüscher: Yes; the atmosphere was perfect in the cath lab, because it was quiet and supportive. It was very good, and he still is a friend.

Dr Ohman: Tell us a little bit about how this jump to be a professor or a professor of the department evolved for you.

Dr Lüscher: In our system, it is a bit more risky. In the States, you can become a professor (there are several positions), and you can focus on what you are interested in. In our system, you have to run the whole department, and there were only five chairs in Switzerland.

Dr Ohman: That's remarkable.

Dr Lüscher: Luckily, when I was there, there was one free chair in Zurich, and I also had a nomination at a place in Germany. I got this position because Marko Turina, the successor of Åke Senning and a really great person, wanted me because he felt that I was doing a lot of innovative stuff. That is how I got to Zurich.

European Heart Journal

Dr Ohman: Now you run a large department there.

How did you become interested in the European Heart Journal? Obviously, you have done a fantastic job with this journal.

Dr Lüscher: I was lucky that Jim Willerson nominated me as a reviewer and an editorial board member in Circulation early on, when I was young.

Dr Ohman: You did another piece of training in the United States.

Dr Lüscher: Exactly. I became an associate editor, working on Circulation: European Perspectives when Joe Loscalzo was the editor. I learned a lot from him. Then they announced the position for the European Heart Journal. At first I was a bit hesitant to apply, but some of my associates really motivated me. And then I got it, thanks to my experience with Joe, really.

Dr Ohman: Running a journal such as this takes a lot of time and it's very busy. You run a department, too. What do you do for recreation, and how do you find time to do other things? You talked about a daughter who graduated in New York. Do you have more children?

Dr Lüscher: Yes, I have two children. And a cat and a dog.

Dr Ohman: And a cat and a dog. How do you find time?

Dr Lüscher: It's very important to be disciplined in how you use your time, so I have a very good team. I have three secretaries, and I have five people for the journal. I have a whole team for the grants and the fundraising, so I delegate a lot—you need to. You can only win, like in soccer, with a team. But of course, eventually somebody has to shoot the goals. It's very important to surround yourself with the best you can attract.

Dr Ohman: You brought up something. Switzerland has a soccer team, and this year, I think they will play in the World Cup. I didn't actually know that Switzerland had enough people to play soccer, or that it was even flat enough that you could play. But obviously it is. Is this something that you enjoy doing as well?

Dr Lüscher: Yes. I really enjoy that people who worked with me now have positions in many countries. This is one of the joys that you have when you [help] develop people, motivate them to do research, be excited about new findings, and eventually find a position that is fulfilling for their professional life. I was lucky to [work with] people from many countries, and we are still in contact. I like them at the US institutions as well. This is really very fulfilling.

Dr Ohman: What is next for Tom Lüscher?

Dr Lüscher: In life, you always have to think for the next chapters, and as we are younger than ever at every age group, we have to make sure that we find fulfilling professional activities at each decade of our life.

Dr Ohman: Finally, have you instilled in the trainees that you have in Switzerland and that you work with this sort of philosophical approach to life in general? Are you able to do so?

Philosophical Approach to Life

Dr Lüscher: I do write philosophical editorials once in a while, because I run a Swiss journal called Cardiovascular Medicine with a couple of people that is just in Switzerland. For instance, lately I wrote about the law and the spirit of medicine. The regulation of working from 8 AM to 6 PM and compensating every minute now in our country changes the spirit of medicine, in my mind. Doctors have to be generous with the time that they spend with their patients. And they are more generous with the time that they spend for a project that needs to be finished, that needs to be pursued for a long time. There is no work-life balance in the modern sense in the first years of your career. You have to be generous with your time; you have to invest it, because you will then get the fruits of your efforts.

You have to be generous with your time; you have to invest it, because you will then get the fruits of your efforts.

Dr Ohman: Do you think that it might be more of a calling, like a priesthood? This gets me back to the philosophical aspect of thinking.

Dr Lüscher: Basically, we should be role models for the young generation, and that is why I am still on call for primary percutaneous coronary intervention (PCI). I am not saying, "I'm staying at home." I sleep, and I also get up at 3 AM if it's necessary to show to the others that I am also involved. I help to pull the wagon.

Dr Ohman: You are very dedicated to your profession and to all of the people you work with.

Dr Lüscher: It's very fortunate that we are able to work in this profession—it's so interesting and fulfilling.

Dr Ohman: Thank you very much. This has been a great insight into the editor behind the European Heart Journal.


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