COMMENTARY

Life and Times of Leading Cardiologists: Deepak Bhatt

E. Magnus Ohman, MD; Deepak L. Bhatt, MD, MPH

Disclosures

May 10, 2019

This transcript has been edited for clarity.

E. Magnus Ohman, MD: Hello. I am Magnus Ohman, and I want to welcome you to another edition of Life and Times of Leading Cardiologists. We are very fortunate to have with us my old friend, Deepak Bhatt, who is professor of medicine at Harvard and head of the interventional program at Brigham.

You and I got together very early; I want to say in the '90s. We both learned a lot from working with Eric Topol and Rob Califf. We used to get together and have lunches at meetings, so this is almost like one of those lunches again.

Deepak L. Bhatt, MD, MPH: It brought back a lot of good memories when we were trying to figure out exactly when and where we met. Those were really great meetings. We got to know a lot of folks at Duke and Cleveland Clinic really well.

Ohman: Rob and Eric trained a lot of good people. Both of us trained with them, so we should be happy. Let's talk a little bit about your life. Where did you grow up, Deepak?

A Father's Academic Path

Bhatt: I consider you a good friend, and we have known each other really well for a long time, but you are right; we have never really talked about those sorts of things. I was born in India, but when I was really young, my family moved to the United States. My father came over, I think, on one of the old Ford Foundation Grants in the '60s to get his PhD in linguistics at the University of Wisconsin–Madison.

Ohman: This is why you are such a good writer. That is an amazing coincidence.

Bhatt: In fact, when I was older and he had moved to Boston University (BU), he would have me do copyediting for him. Maybe that did spark my love of writing. At any rate, we were in Wisconsin for a while and my parents were planning to go back to India once he got his PhD. There were not a lot of roles for academic linguists with a PhD in India, so he stayed in the United States. We traveled around the Midwest following his career. He was on the faculty at Michigan State, University of Minnesota–St. Paul, and the liberal arts College of Wooster in Wooster, Ohio.

Ohman: My daughter applied there.

Bhatt: Yes, it's a lovely town and a great liberal arts college. He was recruited to BU, where he spent several years on the faculty teaching linguistics and other sorts of things.

Ohman: Was this in English or Hindu?

Bhatt: Linguistics is the study of language, so it transcends any specific language. Back then I suppose it was more of a liberal arts–based field. It has evolved now, in some cases to more of a technical field in terms of computational linguistics, natural language processing, and artificial intelligence.

Family Life

Ohman: Where in India did the family come from?

Bhatt: My parents lived all over in India. I was born in a really small village called Udupi, but it has grown since then, like a lot of places. You would not have heard of it, although it is famous for its vegetarian cuisine. It is very well known among people who like Indian food.

Ohman: Did you come from a large family? Any brothers or sisters?

Bhatt: No. My family is pretty small; it's just my parents, my sister, and me. The families my parents came from were larger. My mother had two siblings. One had died, unfortunately, at a young age. My father came from a huge family. He had 13 siblings, but he too had a sibling who died. He lived in a small village and came from a rather poor background. As you might imagine, coming from a village and a large family like that, there was not a lot of money. There was a lot of love, but not a lot of money.

Ohman: The Bhatt family was basically half the village, from what you described. Did your mother work during this process?

Bhatt: Absolutely. She was a science teacher in India and she really liked that. I am not sure she ever loved linguistics. My parents never pressured me to go into anything, but the one thing my mother would always tell me is, "Do not go into linguistics—there is no money and you need to move around a lot." Other than that, they did not really care what I did. She did not get to teach here because I think the barrier of entry was too high. She would have needed to get all sorts of new certificates and everything. She stayed at home when we were young, but later on she worked in downtown Boston at Jordan Marsh (what is now Macy's).

Again, when I was really young, we moved around a lot. For some people, especially at a young age, moving can be traumatic. As a parent I always think about whether it's a good idea or not to move, because of the kids. I got used to moving around and getting plopped in a new city and having to make new friends quite a bit, so it never bothered me. I don't think it has done any psychological damage, but you can be the judge of that.

Ohman: No, in fact it explains a lot about your ability to communicate with such a broad array of people. It's wonderful to hear this. You went to high school in Boston?

Bhatt: Yes, I am a product of the Boston public school system. I went to a couple of public schools before that, but then I went to Boston Latin, the oldest high school in the country. I graduated from there and was valedictorian.

Ohman: Did you have a valedictory speech?

Bhatt: I did. It was the typical type of valedictory speech, mostly just about young people and making sure they use their talent to do something useful in the world, with a lot of optimism and encouragement to make the world a better place. That idealistic stuff.

Deciding on Medicine

Ohman: When did you decide on science and medicine? Obviously, your mother was an influence.

Bhatt: A couple of different things influenced me. Sometime in the '70s, when I was age 9, I had really bad stomach pains. My parents took me to Kennedy Children's Hospital in Boston, which has since gone bankrupt and no longer exists. The intern said it was probably a gastroenteritis and discharged me. She said to my mother, "Oh, it's nothing. He's just a kid; he's complaining." This was in the days when the attending physician was on premises but nowhere in sight. Only the intern saw me.

The surgeon drove in through a blizzard, did an emergency appendectomy on me, and saved my life.

With her background in the life sciences and a lot of common sense, my mother said, "He is not a complainer; I am really worried that it is something." But the doctor said to go home. My parents took me home, but it turned out to be appendicitis. The appendix ruptured and I got septic, with a really high temperature—actually documented at 108˚, if you can believe that. It looked pretty bad. A surgeon drove in through a blizzard, did an emergency appendectomy on me, and saved my life. I was in the hospital for a long time, but obviously I survived. I could have died.

Ohman: Surgical healthcare was pretty good in the '70s. What was your reaction as a very sick 9-year-old patient in the surgical ward?

Bhatt: First of all, my parents were not at all litigious. If they were, that was going to be a slam-dunk case, for a number of reasons. They were just thankful to the doctors and nurses and God that I was alive. For some people, that would have been a negative experience; but for myself, I loved the hospital. I really liked the doctors and nurses, and they were friendly and nice to me. They were doing good stuff with the other sick kids there too.

That one experience did not necessarily crystalize things. I liked science and writing—I enjoyed many things. I did not want to go too far from home for college. When deciding between Harvard and Massachusetts Institute of Technology (MIT), I received a better financial aid package from MIT so I went there.

Ohman: I see MIT more as a technical school. Besides the financial aid package, there must have been something else you liked about MIT.

Bhatt: I thought it was just going to be a terrific place to go and would be a great platform to do other things. I think my advisor there, Dr Robert Weinberg, had a big effect on me. He had discovered the first oncogene and was a really brilliant individual. I was thinking of being a cancer researcher. I thought, "Why not cure cancer?" It is a nice, lofty goal for a young person, but I was a bit naïve, not fully understanding at the time how complex cancer is.

I still remember a conversation vividly, when I was asking what motivated him to go into science and so forth. He said it was the love of science. He loved the beauty of science and its elegance. He said if what he was doing never translated into anything, he would not be personally disappointed. That is easy to say after you discover the first oncogene, because obviously he has made a huge contribution. But he was sincere in saying it was not necessarily a motivation to do something that would be immediately clinically applicable.

I had done a fair amount of basic research at MIT, including in some pretty high-powered labs, working with folks like Dave Housman and Richard Mulligan. But I thought, "Wait a second—I want to go into this to cure cancer." I realized that if I spent a career in the lab and maybe published in Science and did neat stuff that my peers thought was great, but it did not end up helping patients in my lifetime, I would feel disappointed. I would not feel fulfilled. That caused me to change my trajectory away from being a basic science researcher. Ultimately I went on to do medicine for that reason.

Ohman: Did your sister go into science too?

Bhatt: No; her love and talent really had to do more with languages. She did not become a linguist, although she had quite a talent for language. She ended up in the insurance industry, ironically.

Medical Education and a Growing Family

Ohman: You were doing science and interested in cancer research but wanted to do something more immediate to help people. You decided on medical school. Where were you wanting to go?

Bhatt: I loved being in Boston but had this view in my mind that New York was the epicenter of the world, so I really wanted to live there. I applied and got into all of the New York City medical schools. Cornell gave me a really generous financial aid package so, thank you, Cornell. I had a great time there and got to do some clinical research as well. I worked with Dick Devereux and the hypertension group, doing research on hypertension, echocardiography, and left ventricular hypertrophy.

Ohman: This was the leading group in that field at that time.

Bhatt: Yes. Dr Pickering was also doing great work in hypertension and its effects on left ventricular remodeling. I developed a love of hypertension research, but more broadly, clinical research and cardiology research.

Then I did the usual interview circuit for internal medicine. I loved University of Pennsylvania, in part because of the program director, the great Dr Martin. He was this spectacular warm, fuzzy, caring guy, and I said, "Why wouldn't I want a program director like that?" I had a great time there.

Ohman: Where did you meet your wife?

Bhatt: We met in New York, and that is also where we got married. We have four kids. People often think I had a second marriage because I have two older kids (26 and 21 years old) and two younger kids (10 and 12 years old). We just had a big pause between the two.

Ohman: Sometimes when you have a lot of children real close, you need a little hiatus. Your father may not relate to that.

Bhatt: He ended up being the oldest after his older sister died. That encumbered him with a lot of responsibility, financially and otherwise. His father died at a relatively young age, in his mid-50s, of insulin-requiring diabetes.

Ohman: So, then you were at Penn, doing an internship and working 24/7.

Bhatt: Exactly. The house officers would be up all night admitting patients. There was no going home early the next day. You just had to take your lumps and be happy about it. There was camaraderie. I have never been in the military, but it was probably like being in the Marines. It's tough, the hours are grueling, it's physically challenging as well as mentally challenging, but you develop great bonds with people.

Choosing Cardiology as a Specialty

Ohman: Did you know out of Cornell that you were going to do cardiology, or was that something that materialized a little bit at Penn? At the time, Penn had a very strong cardiology program.

Sometimes residents and fellows do not realize what a huge impact they have as teachers and mentors.

Bhatt: Yes, you are absolutely right. At Cornell, I got a sense of it. In my fourth year, I was a Papanicolaou Anatomy Scholar and doing and teaching anatomy of the thorax. I really liked the heart. As part of that, a cardiology fellow showed us cath films. This was when intervention was just starting to take off, and it had a huge impact on me.

It is a great message. Sometimes residents and fellows do not realize what a huge impact they have as teachers and mentors. I never told this individual (and I don't remember his name) that it was a transformative day when he came down and showed those films.

Ohman: After finishing medicine at Penn, you picked a cardiology fellowship.

Bhatt: Yes, I did the usual circuit. I was not particularly geographically constrained at that point. A lot of exciting stuff was going on at Cleveland Clinic in terms of devices and drugs. A few other places, like Duke, were doing both. I went to Cleveland Clinic and had a great time. I did a number of fellowships there—general cardiology, interventional cardiology, and peripheral cerebrovascular intervention—and stayed on as faculty.

Ohman: When you were at Cleveland Clinic, how did you know you were going to do interventional cardiology?

Bhatt: I loved being in the lab the minute I entered there. The F. Mason Sones Cardiac Lab is a historic place, and that history really carried through. When I started there as a fellow, a lot of the nurses, techs, and attendings had worked with Dr Sones. It was a great group to work with. The staff was really talented and had been there for a long time—which may have been different in a place like Boston—and that is why Sones's legacy was still there. It was a great experience.

Mentors Along the Way

Ohman: Your research career has been phenomenal. You have published—I don't know—700, 800 papers. Maybe more. Who were the mentors that really started you on this?

Bhatt: It's over 1000 papers, but who's counting. I was lucky; I had a lot of great mentors. Eric Topol was very generous, giving me an early start and offering leadership roles in trials. Steve Nissen, Mike Lincoff, Dave Moliterno, and Jim Young played key roles in mentorship. A lot of people gave me opportunities with trials and writing. Sometimes fellows do not necessarily view it as an opportunity when someone says, "Here is a book chapter—write it." But I always thought, "Wow, it's so nice that they thought enough of me to offer." Maybe they could not find anyone else to do it, but I did not know that.

Ohman: You were lucky to work with one of the most prolific book writers in cardiovascular history. Eric Topol has written more cardiovascular books than anybody else I can think of. You were in the right place.

Bhatt: In fairness, I had a lot of mentors, even outside of Cleveland Clinic. I have to give Rob Califf credit because we worked collaboratively on a lot of things. When I was a junior faculty, you gave me opportunities early on with the CRUSADE registry, which has since morphed into the American College of Cardiology's acute coronary syndromes registry, so thank you for that.

Professional Career

Ohman: You're welcome. How many years were you in Cleveland before you decided to go back to your hometown of Boston?

Bhatt: The Midwest has always been home, too, because I spent a lot of time there. I ended up spending around 14 years at the Cleveland Clinic and I have been in Boston now about 11 years.

Initially I came back to Boston to be chief of cardiology at the VA, which was a Brigham appointment, because historically that chief of cardiology has always been a Brigham appointee. When folks like Dr Braunwald, Dr Libby, and Dr Loscalzo came calling, I thought they seemed like good people and mentors. And you are not going to say no when Dr Braunwald is asking you to take a position. I made the move and had a great tenure. I loved being in the VA and I loved taking care of veterans. I had dedicated colleagues there who loved clinical care and especially loved teaching. I worked with house officers and medical students from throughout the city. Even though I had a Harvard appointment, we had BU medical students, folks from Boston Medical Center (BU's primary teaching affiliate), Beth Israel house officers, and some from other teaching hospitals rotating through there. It was great getting to interact with different folks from different institutions.

An Interest in Prevention

Ohman: You are an interventional cardiologist, but you have published a large body of evidence around prevention. That is an unusual combination. How did that come about?

The best intervention is to prevent the need for intervention.

Bhatt: I don't think it is actually so unusual. Interventionalists who are thoughtful realize that prevention is part of that continuum. You can just be a technician and implant stents or transcatheter aortic valve replacement valves, and so forth. That's fun, it helps patients. But I think it's better to be more of a complete doctor. We should understand that some patients should get referred to surgery, while medical therapy is appropriate for many patients. These are often complementary approaches. The best intervention is to prevent the need for intervention. I think they are related. There are other folks who have done it too. Roger Blumenthal, for example, had been an interventionalist and now he is a prominent preventivist. It is pretty logical along a continuum, and I have maintained my interest in both of those areas.

Family and the Future

Ohman: Maybe the oncogene had more of an impact on you than you thought. Are any of your children going into medicine?

Bhatt: We are not pressuring our kids to do anything. My wife may be a little bit, but I am not. I don't want them to blame me and say, "You are the one who said do it." The oldest might be heading towards medicine. He will finish a post-baccalaureate program at Northeastern in May. The second one is a senior at BU and is probably going to take a year off and then apply to medical school.

Ohman: What is next for Deepak? What do you see in your future?

Bhatt: That is a good question. I think every human being, as they get older, needs to think about what is next. Right now, I am certainly enjoying what I am doing. Things are going really well at Brigham and Women's and at Harvard. I am involved in a lot of stuff at Brigham, including administratively. I am involved with a lot in terms of research, obviously. I am involved at Harvard Medical School as the editor-in-chief of the Harvard Heart Letter, which lets me interact with cardiovascular specialists at all of the Harvard teaching hospitals. I am doing a lot of stuff that I really enjoy.

Ohman: You have a big basket to pick from. Deepak, this has been terrific. I really appreciate you sharing your fascinating story with us. Thank you.

Bhatt: Thank you, and thanks for playing a big role in that story.

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