Life and Times of Leading Cardiologists: P.K. Shah

Interviewer: E. Magnus Ohman, MD; Interviewee: Prediman K. Shah, MD


May 03, 2017

E. Magnus Ohman, MD: Hello. I am Magnus Ohman, and I am here with Dr P.K. Shah from Cedars-Sinai in Los Angeles. We actually met a long time ago, and it was a memorable meeting for me. We were in a meeting in São Paulo, Brazil. It was in the 1990s, and we were sitting there, and you said, "I am working on creating a vaccine for atherosclerosis." I said, "Wow, that is something to start with." Obviously, most of us think that somebody who takes that on must have had a very unique life. This series is called Life and Times of Leading Cardiologists. It is about your life and what made you tick and why you took on such a challenge as this. Welcome.

I had thought of becoming a detective because I used to read Arthur Conan Doyle and Agatha Christie all the time.

Prediman K. Shah, MD: Well, thank you very much, Magnus.

Dr Ohman: Where did you actually grow up?

Dr Shah: I was born in Srinagar, Kashmir, in North India, and I was one of eight children and the only one who went to medical school. My motivation for going to medical school was triggered by the very tragic death of one of my sisters, who was 19 at the time. She died of a very rare form of lung cancer; she was a nonsmoker. I was devastated. I was in my teens at that time. Prior to that event, I had thought of becoming a detective because I used to read Arthur Conan Doyle and Agatha Christie all the time. That day changed my motivation to become a physician because I wanted to prevent cancer from happening. That was the start of my interest in medicine.

Dr Ohman: The detective part is kind of interesting because all of us feel like we are detectives in our science quest.

Dr Shah: Of course; there are many similarities.

Dr Ohman: You grew up in Kashmir, India, and went to medical school.

Dr Shah: I went to medical school locally, and the medical school was not affordable. I had to take a loan from the government, which I repaid from the United States many years later. It was the equivalent of maybe $70 for 4.5 years of medical school.

Dr Ohman: My goodness.

Dr Shah: A loan was a little bit more then than the current.

Dr Ohman: At what time period was this when you went to medical school in India?

Dr Shah: Late '60s, early '70s.

Dr Ohman: Kashmir is a beautiful part of the world.

Dr Shah: It is known as the Switzerland of Asia.

Dr Ohman: How does a young man from Kashmir find his way around the world to end up in Los Angeles?

Dr Shah: After finishing medical school and an internship, I went to New Delhi, to All India Institute of Medical Sciences, which was the premier academic institution in India. I spent a year doing the residency in neurosciences and OBGYN, thinking that I would eventually land up in general internal medicine. My interest piqued in moving to the United States. Through an elaborate series of next steps, I landed up in the United States as a guest of a former classmate of mine, who had already emigrated to the United States, stayed with him for 3 months, cleared the exams, got an internship in Milwaukee, and that was the beginning of my career in the United States.

Dr Ohman: Moving to Milwaukee, so this was probably in the mid '70s?

Dr Shah: Right.

[I came to this country] as a single man with $8 and a suitcase. The suitcase got stolen on Canal Street.

Dr Ohman: How did it feel coming from the beautiful Kashmir to Milwaukee? Nothing against Milwaukee, but it is a very different climate and lifestyle.

Dr Shah: Well, one interesting parallel was that Kashmir in winter time is like Milwaukee. It is very cold. It freezes, and it snows. In that sense, I did not mind it. The rest of the local culture was completely alien or foreign to me. I was young and willing to take on anything at that time, so I did not really mind it at all.

Dr Ohman: Did you come to this country as a single man?

Dr Shah: As a single man with $8 and a suitcase. The suitcase got stolen on Canal Street in New York. I had to borrow money from my friend to buy some clothes and had only $8 in cash.

Dr Ohman: You stayed with your friend. That was a very thoughtful friend. What was the name of your friend?

Dr Shah: Dr Ashok Koul, a pathologist, now retired.

Dr Ohman: He set you on this pathway.

Dr Shah: Absolutely, he and his older brother. They gave me refuge, if you will, so that I could start my career in the United States.

Dr Ohman: In those days, having gone through medical school, you could go straight into residency. Did you repeat anything?

Dr Shah: I repeated another year of residency at Albert Einstein in Montefiore before starting a cardiology fellowship there, which was really a turning point in my career. Prior to starting cardiology, I was thinking about neurosciences, but then I listened to the chief of cardiology at Montefiore give a grand rounds on atrial septal defect. It was brilliant, and I said, "This is what I want to do." That was the second turning point. I decided to apply for cardiology fellowships. Luckily, I landed a fellowship at Montefiore Einstein and spent 2 years there.

Dr Ohman: Who was the professor who gave the wonderful lecture on atrial septal defect?

Dr Shah: Dr James Scheuer, who subsequently became chair of medicine at Einstein. Now, he is retired; he is a gifted clinician and a wonderful basic scientist, a rare mix. He was a real mentor and really a fantastic human being.

Dr Ohman: You moved from Milwaukee to New York.

Dr Shah: That was another major change and culture shock.

Dr Ohman: Is there a large Indian community in New York that you could tap into?

Dr Shah: There is a very large Indian community, but I was really more interested in learning medicine. I spent most of my time at the hospital.

Dr Ohman: Was there any particular mentor along the way here who had any influence? Obviously, the people in—was it in Mumbai, you mentioned, or New Delhi, where you went to the All India Institute of Medical Sciences...

Dr Shah: Most of my mentors, after India, were in the United States with James Scheuer at Montefiore Einstein. After finishing cardiology, at Montefiore Einstein. I applied for a research fellowship at Cedars-Sinai because I was fascinated by the Swan-Ganz catheter that had just been introduced into clinical medicine; and Jeremy Swan, Willy Ganz, Jim Forrester, Eliot Corday, and Kanu Chatterjee were all at Cedars-Sinai. I wanted to be with them doing research, so I applied for a research fellowship. Along the way, Dr Chatterjee moved to the University of California, San Francisco (UCSF), so I met him at UCSF, and he encouraged me to go to Cedars and not to UCSF. He said it was a better program.

So, I landed at Cedars-Sinai in '76, July, to start a research fellowship in clinical research.

Dr Ohman: You got the bug, the cardiology bug, from people who talked physiology. Then you moved with the physiology piece to work with Dr Swan and Ganz and all of the others who were there; they really focused heavily on the physiology part. Was that where your interests were?

Dr Shah: Yes, absolutely. In fact, I spent the first year of my research fellowship in cardiac surgical suites introducing coronary sinus catheters into patients undergoing bypass surgery, so I could measure coronary blood flow before and during various steps of the bypass surgery to see what happens with myocardial blood flow. That was my project during the time I worked with Dr Richard Gray and Dr Willard Harris, who were in charge of that project at that time.

It gave me a strong footing into the physiology. At the conclusion of the fellowship, I was invited back by Dr Scheuer to come and run the coronary care unit (CCU) at Montefiore, but the California bug had gotten into me. I said that I really wanted to stay in California. I went to see Jeremy Swan and asked him if he could give me a position in his division. He was gracious enough to offer me a position. Subsequently...

Dr Ohman: I am curious. What was it in Los Angeles—or, I guess, what was the California bug that really got your interest?

Dr Shah: Well, it was Cedars-Sinai, number one. That was really a big attraction. It was a fantastic institution that I thought was where I wanted to work long-term, and the good weather in Los Angeles didn't hurt.

Dr Ohman: Cannot complain.

Dr Shah: No. I could not complain about that.

Dr Ohman: Somewhere along the way, you must have met your wife.

Dr Shah: It was a few years later.

Dr Ohman: A few years later. You were focusing on research at that point pretty much the whole time. This is good. You started here as an attending physician. What area were you interested in?

Dr Shah: In the CCU because my loves were teaching, physiology, and taking care of critically ill patients. The CCU offered all three aspects.

Dr Ohman: Still physiology.

Dr Shah: Physiology, taking care of critically ill patients, and teaching medical students from UCLA—residents, interns, and fellows in training. It made me complete, or whole, in a sense, that I could satisfy all three needs during that rotation.

Dr Ohman: How was running a CCU, such a prestigious place, at an early stage in your career? Today, this does not happen, so I think people will be interested.

Dr Shah: I ran the CCU for about 15 years, and it was fantastic. It was one of the greatest experiences of my life because I really blossomed as a clinician and teacher. This was one of the best opportunities that I could possibly have had in my career. After that, I took over as Chief of Cardiology, a position that I held for the next nearly 20 years.

Dr Ohman: At that stage, we were going from the physiology to reperfusion, so you were living through those days.

Dr Shah: Absolutely. I worked very closely with Willy Ganz on thrombolysis and the development of thrombolysis for acute myocardial infarction. That gave me a taste of clinical research. I did a lot of clinical research in acute myocardial infarction, the role of ejection fraction, the role of right ventricular infarction and thrombolysis, recognition of reperfusion at the bedside, and many other related events. Then in the early '90s, I got the bug of basic research.

Dr Ohman: Tell me, how did that happen? You were very prominent nationally. When I met you, you were actually internationally prominent. What made you go from clinical researcher to switching gears altogether to basic science.

Dr Shah: Another mentor was Valentin Fuster. He had just moved to Mass General as chief of cardiology. I was always impressed by his command of basic science and clinical science. I said, "This is the kind of person whom I would like to emulate." I wrote to him. I said that I would like to do a sabbatical in his lab for a year at Mass General. The question was how to pay for it because Cedars was only paying for 6 months of a sabbatical. I wanted to spend a whole year, so I got a grateful patient to actually donate funds to Cedars to cover the other half of my salary.

Dr Ohman: How remarkable. How did you make the connection with the patient?

Dr Shah: I took care of the patient. He was grateful for my care, and he wanted to pay back in some way. This was the payback.

Dr Ohman: It is interesting because philanthropy is not something we talk about in medicine a lot, but it can play a huge role in the development of individuals.

Dr Shah: Absolutely. It certainly did in my case. I spent a year at Mass General doing pipetting and basic cell cultural work and basic research in vascular biology.

Dr Ohman: Did you miss the patients at all?

Dr Shah: I missed them, but I knew it was only a 1-year period, so I knew that I was going back to them. I began to develop a portfolio on basic science, my interest in research, with the idea that I would come back to Cedars and set up a parallel basic science program next to my clinical research interest in atherosclerosis and vascular biology.

After spending a wonderful, productive year in Valentin's lab, I moved back to LA and set up the Oppenheimer Atherosclerosis Research Center, again with a contribution from a patient, another grateful patient who helped set up the laboratory because we did not have grants at that time. We were just beginning. We started our work in apolipoprotein A-1 Milano, and then subsequently the vaccine concept emanated during that period.

Dr Ohman: Did your wife mind traveling all the way out to Boston from Los Angeles? The weather is very different.

Dr Shah: Right. Well, she did not mind. She loved being in Boston. In fact, our kids were young at that time, two kids, a son and a daughter. My wife loved the whole year. In fact, she wanted to persuade me to stay on in Boston, but we really wanted to come back. She was very supportive, and she is a fantastic human being.

Dr Ohman: Were either of your children influenced by dad to go into medicine?

Dr Shah: Not quite, although my daughter is planning to go to PA school, which is the closest to medicine.

Dr Ohman: She got the clinical bug at least, yes.

When I met you in São Paulo in Brazil, you were a master educator. I mean, it was wonderful to hear your lectures. I remember that you went to many different places. How did you become so interested in teaching science around the world?

Dr Shah: I guess it was the influence of my own teachers, both in medical school and after moving to this country—people like James Scheuer and Kanu Chatterjee. I believe that teaching is a very noble profession, and extending a hand to people who are at the beginning of their career and seeing them blossom into clinicians or researchers is one of the sources of great satisfaction. Teaching is another way to learn. The best way to learn, I think, is to teach because then you are forced to know your subject. I think it, in a way, helps the teacher as much as the student.

Dr Ohman: It is the ultimate learning.

Dr Shah: The best way to learn is to teach.

We have to reach out to people less fortunate than ourselves and bring them into the fore either through education or directly extending help to them. That is ultimately what medicine is all about.

Dr Ohman: I remember that you had a number of postdocs from all over the world in your lab working with you. This international feeling, is it still with you?

Dr Shah: Absolutely. My laboratory of 20 people is mostly composed of foreigners: China, Iran, Japan, India, and so forth. It is like a United Nations. For me, this kind of reaching across various cultures and countries and having a group of people from diverse backgrounds is what makes it challenging and interesting at the same time.

Dr Ohman: Tell us a little bit about the idea that we take people from all over the world, and medicine is completely international. We speak the same language of medicine in all of the different parts of the world. What do you see going forward? How can we preserve this very important part of what we do?

Dr Shah: I think that we've got to break down the barriers that are being created at the present time. I do not want to get into the politics of the matter, but we have to reach out to people less fortunate than ourselves and bring them into the fore either through education or directly extending help to them. That is ultimately what medicine is all about—reaching out and helping others.

Dr Ohman: And caring for others, yes. You must have been back to Kashmir in India a few times?

Dr Shah: Many times.

Dr Ohman: Reflect on the changes that you have seen since you were there.

Dr Shah: Well, India in general has progressed tremendously in the biomedical field, not in research as much as clinical care. Now you can get state-of-the-art medical care in most private institutions in India. There is a lot of work still to be done because the rural areas and the poor communities still do not have access to high-quality care. The rich people can get the best care, but the poor, not necessarily so. We have a lot more work to do in that regard.

Dr Ohman: You have been very much part of that evolution. You are partially responsible for the change in India given the fact that you have been there a lot. What is next for P.K. Shah in the world? Obviously, we hope to see the vaccine soon.

Dr Shah: Right. Currently, my major focus is to develop the vaccine into a clinical reality. Right now, it is still in the preclinical stages. It would be a great dream come true if we can land up proving that the vaccine concept works and actually helps human beings.

Dr Ohman: You have tried very hard for a number of years. Do you see light in the tunnel?

Dr Shah: I think we are getting ever so much closer to the clinical reality. Hopefully, within the next couple of years, we could be in human studies.

Dr Ohman: Isn't that a wonderful journey from Kashmir to the vaccine for atherosclerosis, the number-one killer in the world?

Dr Shah: Yes. I feel very fortunate to have this opportunity.

Dr Ohman: We have been very fortunate to be able to listen to you share this inspiring life story. Thank you very much.

Dr Shah: Thank you, Magnus.


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