Brian L. Strom - Chancellor of Rutgers Biomedical and Health Sciences | Shaping the Future of Global Health

In my career as a primary care doc, much of what I did, you did not need a physician's training to do. Today, we're honored to welcome Dr. Brian L. Strom, a true pioneer in the field of pharmacopodemiology, and one of the leading minds in biomedical research. As the inaugural chancellor of Rutgers biomedical and health sciences and executive vice president for health affairs at Rutgers University, Dr. Strom has redefined healthcare systems. People do bed behavior, they get sick, they come in, they treat it for the sickness, they sent back out where they do the bed behavior again. You're not focusing on keeping people healthy and focusing on treating them when they're sick. We don't need as many MRI machines, we don't need as many CT scans, we need people to think more. With over 650 papers written, 15 books published, and more than 275 groundbreaking research projects under his leadership, these contributions have earned him international recognition from shaping the future of healthcare to tackling global health challenges, get ready for this extraordinary conversation. Welcome to success story, I'm your host, Scott Clary. The success story podcast is part of the HubSpot podcast network. I am a huge fan of HubSpot because they support entrepreneurs, a lot of entrepreneurs, founders, executives, listen to this show, and for entrepreneurs that are trying to build, I have a question for you. Does it feel like your teams are getting pulled in a million different directions? Everyone's digging in on different projects with different platforms in different places. It can be tough to stay focused on a common goal and that throws a wrench into things. That's why HubSpot brings everything your team needs into one easy to use and easy to love customer platform with it. They have everything they need to scale the business at their fingertips. So your marketers can write blog posts in a snap with AI and build better leads with in-depth campaigns, sales can build connections and close deals faster with tracking tools and real-time performance insights and service can get a hand from AI-powered chatbots for better support and more five-star reviews. And everyone can deliver killer results and grow revenue faster than ever before. Because when your teams work better, your business grows faster. Visit HubSpot.com to get started for free today. Brian, I'm super excited. I'm really glad you decided to join and come on. This has been a long time in the making, actually. I'm glad we finally got a chance to sit down and record together. But I want to kick this off. I want people to get to know you a little bit better. I usually ask this question at the end, but I thought it'd be a fun question to actually ask at the beginning. So if you could go back in time after your entire career and your incredible career and you could tell your younger self one piece of advice, what do you think that piece of advice would be? Do you enjoy it? And it's actually the piece of advice I give to a lot of young people now. In medicine people tend to look at the next job and say that's the division chief above them, the department chair above them, whatever. That's where I need to go. That's where I need to go. And my advice to them and my advice to my young self would be the same. Get in touch with what you want and what you enjoy and then do that. Because that's just going to be good at. That's what you're going to enjoy most. It was only a few years ago that one of the young kids here at Rutgers made up a Wikipedia page for me. And it wasn't until they did that that I saw that every position I've ever had. I have been founding or inaugural of whatever it is. I have never moved into an existing position that created them all along the way. And that would be my advice to people. Don't do what you think you should do. Do what you get in touch with what you enjoy and do what you want to do. That's so fascinating. That's such an entrepreneurial personality that would do that. So you're telling me, so you over your whole career, you made the positions that you walked into. Everyone. Which I didn't realize until just a few years ago. And it's interesting to comment about how to entrepreneurial. My father is a small businessman in New York. He parented that at two brothers. He parenthetically tried one older one. He tried to get each of the three of us to join his business by overpaying us for a summer. We all hated it. None of us went into it. But I grew up with the business sets. And now I often say I wish my father could see it now. And now I run a $2.3 billion business. And it's very entrepreneurial. When I walked in, this place was a disaster. We were very, very deep in the red. And now we're the only part of the university that's in the black. We're spinning off in large margins. And can't say profits, but contribution margins. Each year, it hours is an entrepreneurial world in healthcare. And it's a, yes. So it's a teaching. And I never thought of myself as an entrepreneur until you just asked them. No, you definitely are. I think that, listen, if somebody is entrepreneurial and I actually love what you said about advice to your younger self and medical students and not just doing what they think they have to do next. Because the lessons that we learn in one field parallel everything else in life, it's so interesting. So many people feel like they need to jump into entrepreneurship because it's cool. And they don't want to build within a company. They don't want to find ways to be innovative within a company. If you look at some of Nvidia's employees, I mean, they've made a lot of money. Being very entrepreneurial, innovative within a company. And they didn't have to have the risk of starting their own thing or all the stress or all the struggle. They just built within a company. So I think that maybe not always having to follow the course that you think is laid out or the quote-unquote right way. I think that's actually a really, really great lesson. I actually appreciate that a lot. When you were starting it, it's like, so maybe walk me through. Your background, you got paid. Your dad tried to bribe you to work in his family business. Let's just say, call his mate a spade. Yes. Yes. So what was the best? Why didn't you like it? Why was it not aligned? Where did you find yourself as a young Brian? He was a landlord in New York and running rent control buildings. And I just felt it was boring. It was an interesting. He did everything himself. He didn't have any employees and any assistants. It just wasn't the kind of world I want that I live in. But when you think about medicine, so there's so many pathways to medicine, how did you take your own advice and not follow the route that everyone else took? You know, I went to I went to college in the 60s. I landed in the 60s. It was V&M. Our, the buzz word of a generation was relevance. And, and, and so, so, you know, I started out in college. I have majoring in math, major in physics. Decided it wasn't relevant. Wanted something more concrete and more human oriented switched to psychology, though. In those days, it wasn't a rigorous science. It is now, but it was a bit of wasn't that. And ultimately stumbled into a field, like about physics and biochemistry, which, which in college where I was, we were one of the first, I was one of the first majors in that interdisciplinary field. But I stumbled into it as something that that sort of covered was biological. A science was rigorous, so covered, covered the bases and decided, to go into medicine to apply science to be able to help people. But also, it was, also, I was interested in politics. And I was interested in policy from that point of view. And I knew from the beginning I wanted to do research that was policy related. So, so I combined that in medicine, but went into medicine in an unusual, a little bit unusual way. You know, when you started in medical school, you know, you're taught, you know, you use this drug for this purpose. Well, what's the basis of that? Well, you look a textbook of refers as references. You look back, what does it refer to other textbooks? What does that refer to other textbooks? There was no basis for a lot of what medicine did. The still isn't. Medicine is as much an art as it is a science. And training in medicine is really an apprenticeship. Have you ever been to colonial Williamsburg? Medicine and pharmacy with the same profession in those days? When you worked in the pharmacy like a plumber, like a carpenter, for endless years being treated like dirt until you get your certification, and then you get advanced and you do that to other people. Well, pharmacy split from that became a more academic field. Medicine still does internships and residencies, and has very much the same kind of training. We are learning from the professor rather than look at what makes sense scientifically. And so I wanted to contribute to the science, but also science that was policy related. So medical school, I spent the summer working at, I found a program in our school of public health. I found a faculty member in a medical school who was on the state legislature. I went to him and I said, what can I do research wise that would help you policy wise in terms of, and he had just passed a law called anti substitution law. It was the first such law passed in the US. All 50 states have those now. It's a law that says if you prescribe a drug by brand name, the pharmacy has to dispense that brand name, not a generic equivalent. And he said, why don't you study the impact of that, which is what I did and published a number of papers from it. Got me interested in drugs that are pharmaceuticals to be clear. And again, applying rigorous scientific methods to be able to study the effects of pharmaceuticals, and a field that ultimately became the, so back into a field that we then called drug epidemiology, we ultimately called renamed it pharmacoepathy biology, because people's comment was, oh, drug epidemiology. You study heroin. No, not exactly. Yeah, prescription drugs. And sort of it was really sort of a scientific trying to use the methods of epidemiology, which no one knew what that was pre-pandemic. We used to work on the t-shirts going, no, I'm not a skin doctor. Now people know what epidemiology is. But using the methods of epidemiology to study the effects of drugs in large numbers of people, typically adverse reactions, because normally when a drug is approved in the market, you know it's effective in 500 to 3000 patients that study, which that's all it takes to do that. And what it means is if it causes rare adverse effects, even if it's very serious, drug can be killing people, you won't know about it before it's marketed. And so not until it gets into the market, and you can study large numbers of people, do you end up knowing what a drug real effects are? Well, that's how, I was going to say that's very, that is to hear that. That's very scary, but your goal in life was to obviously affect policy and not just affect policy, but I guess I want to understand, when you look at that process as a young person going into medicine, I understand that you do want to affect policy for the right reasons, and you want to understand how some of the scientific choices or some of the drugs that are created are actually potentially interpreted or allowed through public policy and government, and given out to the people. But when you see that process, you just described, what's the red flag or what's the concern from your perspective that a young Brian was trying to change or trying to improve or trying to optimize, because the way that you just mentioned that, that sounds very scary, to the average person saying only 3,000 people were tested, and we only know the effects after it goes to market. What does this mean for me? And it should be scary. And one of the lines I often use in press is, all drugs are poised. By definition, we are giving them to interfere with the body's normal system. They will be poisons, they will do her. It's just they also do good. And so you make an unequal decision that the benefit is worth the her. When you look in, parathetically, natural products, herbals, whatever, they've never been proven to do good. So if they're doing harm, there's no positive trade-off. But in terms of pharmaceuticals, we know they will do good. We don't know what their harms are when they market it. It's appropriate to be scary. What I've said to my patients through all the years, when they come to me with an ad for a new drug or whatever, you know, do you want to prescribe this to me? If you see those drugs on TV, those are exactly the ones you don't want to use. Because they don't get know what their effects are. And if it really was compelling, that it was dramatic, we'd better than other things, and we'd better prescribe it to you already. Besides that, let's let the world experiment on other people and find out what the real effects of the drugs are. And so the answer is, as a young Brian, as a current Brian, doing studies, we want to find out what the real effects of the drugs are, and the ones that are hurting more people than they're helping remove them from the market. Most cases that's not the case, there's a balance, but in order to make that balance as a patient, as a doctor, to make those trade-offs, you need to have the full data, and the full in understanding of what the effects of the products are. And we don't have that at the time of marketing. That's okay. It's not a flaw in the marketing process, because to go from 3000 patients to 30,000 patients to 300,000 patients, we would delay access to good drugs and keep them off the market financially for a decade or two decades when people could benefit from them. That makes sense. So it's always a risk, but there is always a risk. That's basically the net takeaway, and you just have to be aware that whatever you see on TV, that lists out a thousand side effects after they play the commercial, maybe that's not something to jump into immediately, but the point is to talk to your doctor. That's really the takeaway. But when you spoke about impacting policy, are there policies that have changed over your career? You've had a long career in this that are a net positive or a net negative for that process? What is something that you are happy to change? What is something that you aren't happy that changed? And then what is something that you still wish would change? Interesting. Wait a minute. So what are things that I'm happy to change? There's only a number of drugs, I give you two examples. One is a drug called turtle. We studied the effects of it, but it's an Advil-like drug. It almost came off the market. It didn't come off the market because of our studies showing its benefits. So we showed it that it's relative safety, relative to other products. An example of something which was wrong was a drug of the same class. Zomax, great marketing, been the name of the drug. It's a mip racket. It's another Advil-like drug. It was the first drug marketed as an analgesic. It's the first drug of the class market as an analgesic. As an analgesic, you would expect it might have a problem with serious allergic reactions. Ultimately, it did have a problem with serious allergic reactions. That removed from the market. We did a study showing it was no different than other drugs used in that same way, but they had destroyed their market in the process. Another example, not drug-based for 50 years. The American Heart Association, the American Dental Association, recommended that people with heart valve abnormalities, which include stop to 10% of the population if they're going to network, have taken antibiotics before the dental work. So we were exposing 10% of the population to antibiotics twice a year, typically, with allergic reactions with antibiotic resistance that caused without any evidence that it made sense. The evidence was animal data. It was data that you have blood. You have bacteria in your bloodstream. When you have dental procedure, which you do, but you have bacteria in your bloodstream every time you have bowel movement or brush your teeth. Was dental work any worse than any others? In fact, ultimately, we did a study that showed it was. And it got confirmed by people in the Netherlands. And all the recommendations changed. This was now, at this point, probably, 20 years ago. All the recommendations of getting dental work every time you have had getting antibiotics any time you had dental work has disappeared. As part of that, based on our data, what do I wish would change that hasn't happened? Is it better or be? Yeah, like a policy, a policy or something that you still want to affect. Yeah, herbals would be, herbals, herbals, it would be a perfect example. So I'll give you one that did have, again, policy-wise, did have a good effect and didn't have a good effect. When the statins were coming off patent, the drug companies wanted to make them over the counter. You know, to benefit from it coming off patent. I very deliberately wrote a letter to the editor in New England Journal carefully timed to get in the way of that happening, and it's exceeded. I mean, they don't make no sense as an other counter drug. You need to measure liver functioning, you need to measure cholesterol. It's not what an over-the-counter drug is about, we went with a patient, can judge the effects of the drug themselves. Country is the herbals. Herbals have never been proven to be shown to be effective for anything. They undoubtedly have harm, like any other chemical, and yet they're an extremely widely used product that people say, well, I take it and it makes me feel good. Well, they had nothing to do with the other. When do you take a medicine? You take a medicine when you're feeling worst. You take whatever it is. You feel better. It's the statisticians call it regression to the mean. The spontaneous return to normal will fool both you and the doctor into thinking it did some good. And so it's a, that's how our blood destroyed with herbals. Maybe some of them are effective? If that was the case, they would be drugs not herbals. And we would know that. So the policy I wish would change is herbals should be regulated like drugs and required to have data on efficacy in order to be on the market. Hey guys, Scott here. I just wanted to take a quick moment to say a heartfelt thanks to every single one of you. Six years of this show and it's really all because of you. Your listens, your support, your shares, it will keep this thing going. When I started, I had no idea how big this would get, how many lives we touch. The stories we share, the lessons that we learn together, it's truly humbling. And I believe that we're building something really special here. A community where no one has to reinvent the wheel. We're all in this together, learning and growing. And here's my ask. If you love this show, if it's made a difference for you, please share it with somebody who needs it. Hella friend, host on social, whatever works, it's the best way to keep this thing going strong, bring on even better guests, and share more life, changing wisdom. And you can find us on all the spots. So you can go to successstorypodcast.com if you like listening to podcasts. If you like video, you can go to YouTube. It's youtube.com slash c slash Scott Declary. Or the newsletter newsletter dot Scott Declary.com just spread the word. I'm eternally grateful for each and every one of you. Let's keep learning, let's keep growing and let's keep making this world a little bit better together. All right, let's get back to the show. It actually seems just very, very anecdotally without the data to back it up. Just through a casual conversations, it seems like more people are trying herbals and Eastern medicine. And all of these things that don't seem to be Western. And it's so interesting because I think there's cultures that seem to default to Eastern medicine or herbal medicine. I mean, I'll give you an example. Growing up, I didn't, it was just, it was just regular drugs. I don't even know how to describe it. It's just like, it's like Western medicine and doctors and prescriptions and antibiotics and anything else. And then, so, so my, my, my better half. She, she's, she's a couple different things. But her, her mother is Jewish, Israeli. And her dad is Russian. And she has tried so many different herbal things to get better. And when she's sick, the default is herbal this or herbal that or try that. And there was like a, like a Chinese doctor that she went to go see one time. I'm like, I don't understand. Any of this isn't from my, my world or what I knew growing up. So I feel like, and maybe just because I have proximity to it. But I also hear it in conversations. Not a complete lack of trust in Western medicine. But some lack of trust in Western medicine. And I'm so curious why you think that's happening. And if I'm incorrect in that, you could tell me that too. But I felt that in conversations. I, I think you are correct in that assumption widely used. And the herbal's non-typical treatment is entrusted or taken widely. And people instead take herbals and other things. And it does come a lot from lack of trust. Part of it is that given where health care has, has come. And that was a, it is evolved. Physicians don't spend much time with patients. And as, as health care has more and more become a business, rather than sort of the solo practitioner doctor who comes to your house and whatever, you know, trust people as much. And again, if you talk to most patients, they'll all say, health care is terrible. It's that my doctor, he's great. And, you know, people who have a primary care doctor and then biased, I'm a primary care doctor. But people have a primary care doctor. Typically, we'll trust their primary care doctor. But he, it's a, but more and more as medicine has become corporate. And as health care has become much more expensive and hasn't become corporate, the times people spend, docks spend with patients is less and less. More of that is in front of a computer screen. And so the doctor is interacting with the computer rather than the patient. There's much less trust. And part of what alternative health care providers do is they spend more time with patients in part because they're cheaper. So if you're going to make extra number of dollars per hour that whatever that clinical specialty is, you know, if you're a surgeon, they want you in the operating room. If you're an anesthesiologist, they want you in the operating room to give me anesthesia, not spending a lot of time talking to patients. And I think it has definitely hurt the trust of medicine. I think the other thing that has hurt ironically was years ago when the people came out with the 80-hour week, which probably doesn't mean anything to you, but the expanding to your audience. There was a, there were people who clearly were hurt and they hit the press because the doctors taking care of them were too tired. And so they put in place a rule for residency. We talked before about treating your trainees like, like Dura does endless slaves as residents, that you're not allowed to work more than 80 hours a week. Now, the way the word resident comes from is people they lived in the hospital. They were resident in the hospital. They were also about a house staff. Because again, they lived in the hospital accordingly. It was a commitment to your patient that was inherent in becoming a physician. The nature of professional ethics was your patient comes first. And you stay in the hospital until your patients come in well. You do whatever is needed. The 80-hour week of the rule imposed because of fear that people were too tired, made doctors into shipwriters. That at the end of your 80 hours you have to leave or the program is penalized in accreditation. It's changed the character of medicine and our trainees completely with that. And I think there's a big loss to physicians in terms of self-worth. But it's also a big loss in terms of patient care. But I think the corporatization of medicine has been a big part of it as well. Do you feel like there's an eat, not an easy but even any solution to that? Because I mean, that's not a great path that everybody's going down. If they don't trust and now you have this profit machine, not just profit machine, you have, okay, respecting the wellness, physical mental of the residents. I understand where that comes into play. But when you're talking about surgeons are in the operating room. Anesthesiologists are in the operating room. There's a dollar value attached to every hour of a medical professional. There's this, there's this industrial complex that's driving this behavior. Very hard to beat an industrial complex. So how do you, how do you create trust or space for medical practitioners, medical providers to have that time with the patient so they can restore the trust? That seems to be the X factor that has to be solved for. It certainly is one issue, no question, no question. I think one way is we need to make it make better use of other professions. You don't need a doctor to do everything. So in my career as a primary care doc, much of what I did, you did not need a physician's training to do. Why did I do it? Because physicians could build for it. What we now know, nurse practitioners, physician's assistance, can often do it better and cheaper and more routine tasks. And so by, and one of the advantages we have in Rutgers health, is all of those schools are under us under one roof. So if we need more practice, nurse practitioners, we train them. If we need more PAs, we train them. And as the world moves to more population health, going forward and we move away from fee to service accordingly, because we're bankrupting the country and healthcare and yet don't have good outcomes. One of the solutions is we need to think more population-based and we need to make better use of other professionals who can actually do a better and cheaper job of it and save the physicians who are the most expensive than the things that you really need the physicians time for. And you know, it's, I think your health has sort of done this using more time from psychologists and social workers and saving the physicians to write the prescriptions. And in which case, it's not as satisfying to the physicians that they don't have the relationships with the patients. But you know, there's no one silver bullet here, but I think we've become two health care, it's become too much of a big corporate entity. Focusing non-ernd health is really to come sick care, not healthcare. It's really been, you know, people do bad behavior, they get sick, they come in, they treat it for the sickness, they sent back out where they do the bad behavior again, whether it's smoking or drinking or whatever it is, they're doing too much of, you know, you're not focusing on keeping people healthy, you're focusing on only treating them when they're sick. And that's because the current incentive system, that's what it is. And that's what is changing as we move to more to population now. It is because, you know, we're bankrupting the country, we're approaching 20% of the gross national product. And yet we have bad outcomes. The countries that spend half as much as we have, have better clinical outcomes than we do, because we focus, you know, we don't need as many MRI machines. We don't need as many CT scans, we don't need as much surgery, we don't need as much testing, we need people to think more. But our, the health care system, classically, doesn't pay people to think, it pays people to do. Surgeons are paid a lot, our Medicare docs have paid much more. Pediatricians, neurologists, psychiatrists are all paid much less than surgeons or other higher paid specialties. And we're in this cycle where, where if you want to maintain salaries, income, we need them to spend all the time in the operating room and spending less time with patients going forward. So it's not one solution. I think the closest to one solution is really population out. It's really sort of moving to a, a patient per month basis for reimbursement, where suddenly the risk of the providers, you know, instead of being paid to do too much, you're taking the risk of patient gets sick. Yeah, I understand. So now the incentives are aligned. Now the incentives are aligned. Yeah. But now the incentives are aligned in the wrong direction. Now the incentives are aligned to do too little. If you pay per month, it also changes the character because individual docs can't, or individual hospital, can't possibly afford that one transplant patient would bankrupt you. So the docs come together, the hospitals come together, everything is all coming together and that's what's happening, what is happening, and healthcare is the consolidation. Accordingly, in order to deal with that, you also in order to prevent under treatment, you need a huge data infrastructure. You need to be able to say, as everyone has gotten, that COVID vaccine got in their COVID vaccine, as everyone has gotten, who has a high blood pressure, are they getting treated? Are they at high cholesterol? Are they being treated? You need a huge data infrastructure to do that. And again, that requires a mass, a scale, to be able to put that together and afford to do that. And so what you're saying, seeing, of course, the country is, is this enormous consolidation, as we move, we're in this funny and between now, moving from a fee-for-service system to a population system, and the health systems have a very hard time in different speeds in different localities. If you move too slowly, you'll go bankrupt. If you move too fast, you'll go bankrupt. Because right now, in many places, when the embarrassment, it's still primarily fee-for-service. So if you move too much toward prevention, well, you know, you keep people out of a hospital, the hospitals go bankrupt. But we don't need anywhere near the number of hospitals we have, if we actually focused on keeping people healthy, rather than waiting for them to get sick and treat them when they get sick. So they're twisted and send a system. So I mean, maybe use, maybe use Rutgers as an example, what are you doing to, when you talk about keeping people healthy? Yes, agreed. I've never gotten work-out advice or nutrition advice from my doctor ever. And I'm not even American. I'm Canadian. And so already, I don't have to worry about paying for too much compared to coming down here. And I've actually found that, ironically, for the past year, I've paid more in insurance than I've ever built. So like, it seems like I could just pay every time I go into the doctor and I'd still spend less money. I think I spend about 12 grand in insurance over the last calendar year. I did not have, I'm 34, I'd not have 12 grand worth of things happen to me, God forbid, if we had a pregnancy, God willing, that'll happen very soon. Maybe there's a couple of points in my life. Or if I could hit by a car, again, God forbid. But anyways, the point is, it's a very interesting system. And it doesn't quite make a lot of sense. And it's so funny, because even when I speak to my friends down here, they also don't understand it, even though they've been, they've been American their whole lives. They still get confused by the whole insurance system. But that's besides the point. In any system, I've been a part of. There's never really been a focus on prevention or wellness. So at Rutgers, I was bringing back to my question. What are you doing to sort of prime doctors for this concept of wellness prevention, focusing on, on true health, not just fixing sickness, as like a, sickness is like a lagging indicator, at the end of the day, but a doctor should be doing it. Absolutely. So let me give partial answer, a few partial answers to that, because we certainly haven't solved the problem. And so, one is, you know, I've been here now 11 years. When I walked in, every New Jersey was all filled with one disease and two disease. The docs will separate, the hospitals will separate. In the interim 11 years, there's been an enormous consolidation. In our part of Rutgers, maybe Rutgers Health, I walked in, we had two separate nursing schools. We have two separate medical schools. We're now merging the two medical schools, bringing scale, and in terms of bringing them. You don't need to duplicate everything everywhere. We're training more physician's assistance. We're training more nurse practitioners. We're focusing a lot more on the well-being of the docs, also, as part of that. But they're still trained as physicians. Their job is to treat people who are sick. We don't necessarily need one of each separately in New Brunswick and separately in Newark. If we can hire one person because it's one school, we'll practice half time in one and half time in the other, treating people with the less common diseases between them. And so we're combining, we're bringing things to scale. But the other is as we develop our, as we're merging the medical school, we're developing the two medical schools now. Robert, we found some medical school in New Brunswick and New Jersey Medical School in Newark. We're merging them into the Rutgers School of Medicine. We are choosing as a theme for the entire school health equity. So this will be when it's accredited in a couple of years, combining with the schools. The second largest medical school in the country. And the entire focus is good band health equity. They were dealing with populations in Newark, New Brunswick. With the people who get sick and have the biggest problems who need the health issues, they're not people like you and me, who are going to be exercising on our own. And I assume you don't smoke. I don't, you know, but you know, you take a look to take care of the people who suffer the most of the underprivileged, who are barely making it. And how do you, and they're the ones who are going to be more likely to be hit by a car or a shot or otherwise. But they're also the ones have high cholesterol that nobody picked up, but a high blood pressure is that nobody picked up. So we are running, the simple thing is we do things like, like having our medical students and PA students and other nursing students and others. So they learn in the process, go out and screen populations, run campaigns in the populations in the community, have your blood pressure checked. Have you have, you know, for easy to teach somebody to measure blood pressure, the blood pressure is elevated, you then refer them for care. The students are learning prevention. And at the same time, the patients are getting intervened on to the degree they need it. From a medical school point of view, our whole, our plan is the entire medical school, new medical school, have merged with the two old medical schools, is going to focus on health equity as a team. So everyone from top to bottom is going to get the medical students, the secretaries and the clerks who see patients, they want to be treating patients right, whether the patients are underprivileged or not, they shouldn't be treated any differently accordingly. And just, just have a general, but also staffing appropriately. So, so, you don't need a physician to do a non-physical work as part of that. So, so this is a process and experiment. Again, we will be the first medical school in the country to do anything like this. And, and as the second biggest medical school in the country, hopefully a model that others can copy from that because health equity is such a focus. You know, in New Jersey is perhaps the one or two most diverse states in the country. Kind of, we have 20% of people in the state of foreign board. And, and I, you know, a lot from South Asia, a lot from, from Latin America, there's a huge population from Baja, Mexico, here in New Brunswick, huge, huge populations from Brazil and other countries in Newark, huge African American populations and, of course, the state. We are a very wealthy state, but also a very underprivileged state. And, you know, the other piece of that is, is wanting to generate the scholarship money to be able to support. Right now, somebody who comes from one of those backgrounds, no matter how poor they, no matter how motivated they are, no matter how smart they are, can't afford to go to medical school. Our medical students graduate with a debt of $200,000. We have students who have a debt of $400,000. You know, attract people into medicine who come from poor backgrounds. If that's the case. And so, they won't go back into those communities. If that's not the backgrounds, they come from. They're also less likely to go into lower paid specialties. They kind of want to become surgeons or otherwise, so they make more money. And they're also less likely to stay in New Jersey, which is an expensive state. Uh, limit. So wanting to mobilize the resources to be able to attract people students from those populations as part of what we want to do, and wanting to have the entire school going, going forward, focusing on, on top health equity is a focus. You know, way, you know, and another different example, we have, um, one of the things Rutgers has is the lots of students. We have 70,000 students. Um, and we, we have a program, um, where we, um, uh, we have our undergrads get very involved in service learning across the state. What, what's that? Yeah. We are, as a student, you're doing a course, which is really providing service. So, so the example from a health, like his health point of view, we, um, is we have students and we've had hundreds and hundreds who have applied to us now. So far, we've only been able to do it with about 40 from a financial point of view. We have, we have, the students mostly come from New Jersey. And, um, some of the undergrads, especially come from poor areas. We're, as a summer job that, that get course credit and they'll get paid to go back to their community. And screen for blood pressure, screen for diabetes, screen. So you educating the students, you're educating the parents. And the meantime, you're educating the community. They, these, you know, students get, is going to get credit for it. It, as well as getting, getting paid for it again. So, you know, service learning so that it's helping the community while at the same time they're doing it. And one of the things I'd love to do, um, we haven't worked this out yet, is randomly assigned to different counties in New Jersey. So that students in different counties would do different intervention. They go back home over the summer and one county would focus on, stop smoking. One county would focus on, treat cholesterol, one would focus on, on treat hypertension. And then you'd have easy metrics. You've randomly assigned them across the different counties. Um, all of them should benefit. But you look at, as this county has county access smoking, improved more than county Y, where county Y, Y's blood pressure has improved more than county X. And so we could study the actual clinical benefit, health benefit of this, this kind of intervention. Um, but, but either way, it educates our large number of students and students who, hopefully, dismal, personally, will go back into those communities. I just want to take a second to thank the sponsor of today's episode, HubSpot. Now, HubSpot has an incredible podcast network. Success stories part of it. And if you like success story, you're going to love other podcasts in their network. One of my favorites is, I digress, is hosted by Troy Sandage. What Troy does exceptionally well is in under 30 minutes, he helps eliminate complexity, complications, confusion in your business. He talks about frameworks, strategies that really work to help you achieve, scalable, and sustainable success. So you need to go listen to I digress, one of the most useful podcasts for entrepreneurs and founders, part of the HubSpot podcast network, wherever you get your podcasts. I love that. I think that's very smart. I didn't realize that common sense is in common. And it seems like that's such a smart, a smart program, but I didn't realize that that, and what Rutgers is doing is, is that novel, and no one else is doing it. Because if I just objectively take a step back and look at, like a problem that I would see, so a lot of health problems are disproportionately affecting a different socio-economic class of individuals. And then it almost turns into this negative flywheel, because now you have this class that's overburdening the local health care system, which already doesn't have the resources to deal with it, which is then going to cause even more issues for that particular class, or that segment of the population. And it just seems like, there's no positive outcome in this scenario the way. And this is probably how the U.S. is literally right now in 2024. This is how it is. That's exactly correct. There was a great description. We refer to it as the social determinants of health, and the social determinants of health are probably much more important than anything we do clinically. And so by trying to intervene, one of our hospitals in New York has just built housing for some of its, it's a state hospital, it's the only state hospital. It just built the housing for some of its poor patients, where in sick patients they have a nurse who lives in the housing. The people don't have to go to the emergency room and they can just go to the nurse. But instead of being homeless, they're living in nice housing. So intervening on the social determinants of health and recognizing the importance of the social determinants of health is a key part of what we want to do in the medical school, new medical school going forward as we focus on health equity. That it's not just the highest tech care and the most expensive care. But it's really, if you want to have pot intervention that affects larger number of people, you need to affect them where they live and intervene on things and again, it's often not the dark. The dark is time is too expensive, the too well-trained, it's not an efficient way of doing it. But rather we should have used things like community health workers who we hire from the community, train them, they go back into the community in order to try to intervene on some of these issues. COVID pretends at all home so, so loud and clear because it was the underprivileged communities that were suffering the most, dying the most, and yet weren't getting vaccinated because they didn't trust health care. And... That's such a sick, that's such a sick, like twisted, truth, like so, they're dying them because you would look and you'd see the charts and the graphs and just lower socio-economic populations, they were just getting demolished by COVID. But I didn't realize I didn't realize that they also didn't want to get vaccinated because of lack of trust. Exactly. They didn't think that it's a self-fulfilling prophecy to a degree. 100% And so, you know, and no Newark, for example, we tried our, the dean of the medical school in Newark, is African-American. He's been there forever. He's got close ties in all the churches throughout the city, using him and some of our senior African-American faculty to go out into the community to try to educate the community. You know, I gave a podcast with the mayor, again, talking about COVID, talking about the vaccine and the importance of vaccines, trying to educate the community who immediately resisted it. They immediately didn't want to do it because of lack of trust. And, of course, our political environment didn't help that. The national political environment. Not in the jerseys. But it's a, it's a, it's a, our hardest hit communities of the ones that suffer most. And we, our focus in, again, we teach pedagogically by social deterrents of health. But we want our new medical school to have that as, a health equity and the importance of social deterrents of health, running from top to bottom, be the focus of the schools. One thing that I thought was very interesting, when we were prepping, I was looking at a couple of different things to speak to you about, and one thing that came up was research priorities. Because that's a, I mean, this is, this is probably what you deal with every single day. So you have health challenges facing New Jersey, you have health challenges facing, all of the US, right? But you have to figure out what areas to prioritize. But there's influence, and there's money, and there's people that want some things studied, and there's people that don't care about other things. So how do you balance all the influence, all the initiatives? I mean, who, maybe even like, lay it out. Who does influence what you research and what you don't research if it's not just you and your team? Yeah. So directly, it's not me and my team, because we're an academic center. People, faculty have the, the freedom to do what they want, to study what they want. So, so pardon the influences, funding, NIH decides its priorities, and, and so on. But the, the biggest way we influence it is who we recruit, and who we hire. And recruiting people who see this as a priority. We have a faculty member, for example, who's a superstar, who's a very interesting community oriented research, and, in COVID, she was folks spending her time and community engaged research, trying to say, how do we get the community more engaged? How do we get them, wanting to get vaccinated, wanting to be, be treated properly? And by, by recruiting the correct people, you, you, you change the focus. Now again, the school will never be prestidious, if it's also not doing the high tech stuff, and the transplants, as well. But, but by making sure we recruit people who, who are, have a focus on social determinants, and one of the things that was striking, coming here, I mean, when I did my first strategic plan, now, you know, I've been here 11 years, I mean, I, first strategic plan, so 10 years ago, 9 to 10 years ago, 50% of our faculty had community engagement, as, as their primary focus. Striking, that, that, there was that high, again, with the State University of New Jersey, and, and the, our faculty really care about this kind of thing. And, and yet, not many of them were researchers doing research and, there were clinicians or otherwise. So, another way to deal with that, is to take some of these people who are really talented and really care about this, and train them. So, I, I'll give you an anecdotal example. One of my, my mentees, now, came from a, very poor background and, and, south Jersey. Um, Pell Grant, you know, drugs, alcohol, in this family, um, uh, Tony was going to be a professional baseball player, and, but in, in the high school, in Georgia's own, didn't realize it could be a, it was a picture. Didn't realize it could be repaired. Um, depressed, dropped out of high school, um, they got into a lot of trouble with the law, uh, in the meantime. And New Jersey, very much to its credit, this is long before, I was here, involved, obviously, time, my credit. And, um, uh, said to him, he did, and he was a total change of his life. He, went back to high school, did really well, went to communion college, did so well, that Cornell gave him full scholarship. Wow. After the last two years, Cornell, went to medical school after that, became a trauma surgeon, uh, was a star trauma surgeon, and a faculty member with us, ninety-nine percent clinical. And then his father, who was a contractor, fell off a roof and broke his neck. And he's a student, prevent, that, and that prevention was more powerful. So on the side, he ended up, um, going to a school of public health and getting a master of public health. Um, and then decided public health focuses on interpreting research from a policy point of view. He wanted to do the research. Instead people pointed him, Brian, if you want to, his, his mentor, his trauma surgery, mentor said, you go out and learn to do research, talk to Brian, um, referred him to me, to do research, he's gotten multiple NIH grants, but he cares enormously about underprivileged populations and changing things. So we can direct people's research through training. If they care correctly, we can direct research through who we recruit into the field. We can't tell them what to do, because back in the beginning. So do you not get a lot of pressure from pharmaceutical companies as well to do research on uncertain drugs? And how do you balance that out when a huge pharmaceutical company is asking you to do research, because they're trying to get to an end result versus you as an institution wanting to make sure that the research is independent and sound. Yeah, the pressure to do controversy, absolutely. I'm happy to do them as long as we have control and independence. Exactly. You're talking about we will never accept a grant without the ability to freely publish it regardless of the result. So if they come to us to do a study, they are taking the risk that no matter what the result is, it's going to get public because it's completely true. Does that like I mean without naming? That makes. Does that upset some of the people that come to you? Oh yeah, they won't fund us. There's companies that won't fund us. Really? Like names if people would know would not fund you because they're worried about OGs. That's not good. But there are other organizations, contract research organizations that they go to and set where they can control the results. And there are certainly companies, IEI, do a lot of consulting for drug companies myself, as well. And they're good. And I always make clear to them up front. Is this consulting or is this economic? If it's consulting, they can keep it private, but it can never be able to publish. And often they come to me and give them advice to help them design a study or whatever, and they say, we'll publish that in the interest now because you didn't take the risk upfront of being transparent about it. So real academic freedom and transparency is critically important to all the major academic centers in the country. And is the difference between contract research organizations and academic centers? And then the net effect is their companies that won't won't help us do the research. But what it means is when we publish it has more credibility. And is that something that, I mean, if I'm an average American, I'm looking for a drug to solve X problem. Just last thought on this point, what are the things that I should think about, or look into, or even ask my doctor, or even understand if my doctor is being incentivized to push me one way versus the other? compound question with it is a compound question. I know I'm sorry. I know, but great said question. To start with your last one, conflict of interest of your doctor is something absolutely to be sensitive to. And there are field like orthopedic surgery or cardiology with it where there are more, there are more often conflicts because they've developed a new toy or a new hip or a new knee. And they only want to use theirs and the hospital pays you pay three year insurance. And that drives up costs, but there's clearly conflict ventures and no question there. So ask your doctor about conflicts of interest of them making recommendations like that. I think more broadly, physicians don't have the time or the expertise to read, to critically appraise the literature in detail. That's what, as a clinical epidemiologist, that's my specialty. But I think when you talk about prescription drugs, people should feel comfortable because you have FDA regulation. FDA goes through it in painstaking detail. It actually gets the actual data from the company and reanalyzes it. So if FDA gets a different answer than the company, God, you know, if the real data showed this, the FDA regulation will eat it. If it's FDA approved, it means it works. And it means it's as safe as we know, subject to the kind of things we talked about before and into the limited samples. If it's not FDA approved, like herbals going back to that conversation, we're like, like herbals and so on, then it's, it's cavity entered. You, you cannot know. And the doctor's not going to know. And nobody's going to know because science doesn't know in most cases, because the studies haven't been done. And so it's a, you know, we have a system of a learning intermediate area. There's what the lawyers call it with the patient goes to a doctor. You know, if somebody has an adverse reaction, they typically don't sue the doc. They sue the company, which is a deeper club. But it's why the company you talked about the ads with all those adverse reactions, all those adverse reactions are basically the company's legal friends. Well, I told them. And it was in my advertisement. So the patients should have read it. But we really haven't learned it in to mirror a intermediary process where where the companies provide the doc information of the docs, the docs make the judgments for the patients. And then the docsist should should have the the ideally the expertise to do it. But that's where FDA comes in. Goes back to my comment about why statins are not over the counter-drug because they're both both to measure their efficacy and their safety and their adverse reactions. You need position expertise and access to laboratories to be able to do it. When you looked at emerging some of the the two largest medical institutions, I mean, this is very difficult to do. It was very complex. Talk to me about some lessons learned, maybe even from like a leadership perspective, the you had to the you had to figure out when you're doing this when you're doing this merger. Yeah, so it's I mean, again, to clarify, they weren't the largest to begin with, but they will be the largest would say, okay, once merge. Yeah, it's been a real education. Yeah, as as people have said to me, when I came from Pennsylvania, New Jersey is not one state, it's three. Yes, it's small, but South Jersey, Central Jersey, North Jersey are very different, their rivals in different cultures. And here I'm I proposed now happening, merging medical school from the central part of the state and the northern part of the state, merging together. Those two together, by the way, I've certainly 5% of the population of the state. But it's it's a it became a little bit of a political football. It became a lot of rival, a lot of rivalries. It's like having two children in each thinks the other is the favorite. And why are you doing this? You're doing it to benefit them. You know, the people in Newark, because the university is based in New Brunswick, the people in Newark were afraid we were abandoning Newark. And the process that it was New Brunswick taking over Newark. And which is anything, but it's actually the opposite effect, but it's a it's a it's a as much as I tried, including people and talking to people and talking to faculty and so on, it it I couldn't do enough because it generated a backlash of people opposing it. Now that now I did a much better job of educating our governing board because they unanimously voted for it. Now that our two deans are working on the merger, they've had very, very wide engagement. Hundreds of faculty, students, staff are involved. And the opposition is melted away. And so it's a there was a lot of fear of we're going to abandon so and so. My comp plan is going to change to their comp plan. My salary is going to go down. I mean, there was an enormous misinformation out there. And as much as I did spend time trying to address it in retrospect, it obviously wasn't enough. But now that we're in that process and the two deans are in the process of doing it, it's a you know, the faculty's into school didn't even know each other. They didn't know each other as a curriculum. They didn't know each other processes. They're both training docs. You know, they got together and they said, Oh, you're much more similar to us than we thought. Yeah, you're both training physicians. It's ironic how this is a little micro example of the world at large, but I'll leave that. I'll leave that be. Yeah. And it's a bit, but with a lot of resistance that admit a lot of in the process, which again has since melted away. And the irony with the concern about about the abandoning Newark, the wrong concern about abandoning Newark, we're in the process of building a new big new research building in New Brunswick, which will have a lot of space for laboratories and space for spin-off companies as well, incubated space for companies that part of it. So the labs at the medical school, which will also be moving into New Brunswick, uh, can spin-off companies accordingly. The building in the medical school building in Newark is old and dilapidated. We had renovation plans for that too, but it's easier to build a new building. And the governor was more interested in that, um, and then the, uh, then old building, then renovated old building. But part of what we've had found out since in looking planning for the accreditation of the new combined medical school is the students on the two campuses need a comparable experience. And so it accelerated the renovation in Newark. So rather than us abandoning Newark, the fact that we're combining the two schools has actually led to, it's talbing Newark and accelerating that renovation. So, and we're certainly not abandoning it. I mean, the best medical schools give students an experience in community hospital, private hospital, and safety in the hospital. We had them split. And it makes much more sense from a student point of view to have both options in the same school. So people can be educated in all of them that the expertise in the two schools is different. The scale of the two schools, um, again, they're both sort of comparable, but together we will have a scale, you know, both of our cities are not that big to be able to be able to have enough people with uncommon diseases to keep a physician busy. Having one physician who can practice in both places makes much more sense. Without that, people have to go to New York or Philadelphia for care of the rare conditions. People who socio-economically can afford that, it's inconvenient, but they can do it, that the poor can't. And so again, from a health equity point of view, it means we can better meet the needs of the community, because we can meet the needs in New Jersey, which parenthetically ends up being much cheaper also, because it's not out of network engineering, um, and meet the needs of the local communities and meet them locally. You know, my cancer center director likes to say cancer doesn't travel well. If you're in chemotherapy or radiation therapy, and we are going every day for treatment, you don't want to be going back and forth, of course, to the river, and have course bridges to be able to get that kind of care, delivering it locally is much better for the people of the state of New Jersey. So it's better for education, it gives a larger scale for research, and it's most of what's better for the people of the state, because we can treat uncommon diseases that people would have to go to New York or New York or Philadelphia. New York or Philadelphia, to get that treatment, which again, is it inconvenient for people to can't? So I mean, like really, but what I'm hearing is like the future of health care, and this is what you're doing in New Jersey, but this can be a model that you can replicate in other states, you can replicate it anywhere really. It's all about interdisciplinary collaboration. That's really it. And it's so strange that that's not the case right now. Yeah, interdisciplinary and interprofessional. So certainly it's not the case now, and you've got the surgeons, you've got the internist, you've got the cardiologist, you've got the each is separate, each is separate silo, because each has separate regulation and separate licensing responsibilities. And it doesn't even make rational sense that a cardiologist, that's a subspecialty of internal medicine. Cardiac surgery is a subspecialty of surgery. Cardiologist has a lot more in common with a cardiac surgeon than they do with an endocrinologist who's treating thyroid problems or whatever, but that's not the way medicine is organized, and it's not historically, it's not been interprofessional, where you don't reach to nurses and physicians assistants and so on to give care, because it's all been physician care only. And so the consolidation gives the opportunity to be able to do that and to be able to pay more attention in the process to the whole equity. You know, people like physicians assistants and nurse practitioners are much better at focusing on health equity, spending more time with patients, spending on health and staying healthy, giving counseling to people accordingly. Physicians are too busy to be able to do that. You need a system that really combines them all and really, you know, we have the advantage of rough years, and I said this publicly many times, we're developing the health care system of the future because it's all in the one roof. And yeah, we produce the physicians, we produce the nurses, we produce physicians assistants, we produce the physical therapists, the occupational therapists, whatever it is, everything. We can change the numbers as need be in order in order to do it. And I need to grant experiment to try to help improve a very inefficient and not very effective US health care system using New Jersey as the laboratory. I was going to say, I mean, it is an experiment, but just to echo your point, I don't think the existing is a great, is working very well. I don't think it's working very well. If you look, I mean, if you look at other countries, nobody looks at the US as the epitome of health care. I mean, you know that and else to this, we spend much more money and we have worse outcomes. Yeah. Yeah, at part of it, again, how many people show up at a safety and a hospital in Newark, when the first care they get when they're pregnant is showing up and they burn through in labor. And I think about the problems in the offspring and the costs that involved and the trouble that could have been prevented if they had been treated beforehand and seen beforehand. But instead, we're focusing on the transplants and the high end things and we have to do that too. The US is really good at that and spends too much of its money on that. Yeah, but I mean, that's, I mean, we also have to take care of the rest of the population as well. That's also very important. Ideally, keep them out of transplants. The point is they don't need kidney transplants if we treated their blood pressure right, and the kidneys never went bad to begin with. It's very interesting and I don't want to go down this rabbit hole, but it's very interesting how I find that out of all the topics that are discussed in the political arena, health care is not prominent. It's very interesting how that's never addressed. And it's just sad, I think, because it has to be. But it's good that you're addressing it other ways. That's it. It had been in the past and Obamacare was a major compromise, but a major advance toward that. And then then prior president tried to undo that over and over and over again, unsuccessfully. So it's sort of the one party can't undo it and the other party has succeeded in going as far as, you know, what we really, my personal view, what we really should have is at least a public option, and maybe not worse to it. The most efficient health care in the US, by far, no is Medicare for the elderly. We don't have the huge bureaucracy. We spend 20, 25% of our health care dollars on dealing with this huge bureaucracy. And so if everybody was offered, even young people, or for Medicare as an option, for example, it would make much more sense. Well, I think I wish somebody would focus on them. That's the yes. Okay, so one I want one thought on what you're excited about for the future of health care or medical research. And then also one thought that you're excited about on just the future of health care or medical care. Interesting. So let me respond this way. Well, my refrain since I've gotten here, the first and last slide of every talk I give, different pictures, but to build one of the best economic health centers in the country within Amazon one. And the tagline of the Amazon one is integrating one of the things I've done my entire career, has been to take different fields in my personal career. I bridge across multiple separate fields. That one of the difficult decisions I had when I first arrived was which school do I take my tenure in because of the multiple options. So I think the nature of health care is we need scale and we need teamwork and we need people being able to work together in a way that they don't now, they work in silos that don't focus on the patients, they focus on themselves and their professions rather than the best serve servicing the patients. And I think we're building a model for that and the medical school will be building a model particularly one that focuses on health equity trying to keep people healthy rather than just waiting for them to be sick. Research wise, I think certainly researching figuring out how to do that is going to be a key question. I think completely different. This is completely different is what's the role of artificial intelligence in health care. We talked about doctor patient relationships. Computerization of electronic records has had many advantages of the disadvantages. One of the disadvantages has been getting in the way of doctor patient relations. As we move to AI, how do we make sure there aren't mistakes made and people getting the wrong thing because of AI and how do we make sure it doesn't get in the way of the doctor patient relationship? Much of what, again, I'm a general internist, there's no data behind what I've about to say, but an anecdote that sort of rings very true, that is a general internist, you know, 5% of your patients are going to die no matter what you do, 5% are going to get better in the matter. 5% you're going to change that course. The other 90% are going to get better in a matter of what you do. It's regressing to the mean that they come to you when they're worst, they're going to spontaneously get better. They feel better because of the physician laying on the hands of the physician relationship and having the time with the doc and interacting, how do you protect that in the face of scale, corporatization, the need for efficiency? Those are major research questions in terms of how do you design a healthcare system that's optimal and how does AI help that? Where is AI going to help that? They're going to hurt the health. If AI gets in the way of the doctor-related physician, doctor provider, not just doctor, relationship, then AI is going to be harmful. If AI allows you to be more flexible, I had more efficient. So, for example, we've developed now an AI program. When some of the hospitalized, you summarize the hospitalization with COVID-Distart summary. It takes a lot of work for the doctor to put that together. Everyone was answered and I paid for it, but it's an appropriate part of important in care. We've now developed an AI program that will present to the doctor based on scanning the electronic medical record. It just starts summary that summarizes it. Doctors start out to read and edit it somewhat, but so far it looks like it's working really well. We'll save a ton of work and let people get much more efficient. That won't get in the way of the doctor-patient relationship. That'll save time. That reduces the cost. How do you use the AI in order to be able to improve the efficiency of the healthcare? And increase the time where you can have those human-to-human interactions, basically. Absolutely. What would be one piece of advice that you've received from one of your mentors or one of your peers over your career that's really influenced how you work? Here, but the patient first, patient has to come first. I mean, how that's the theme? Yeah. Healthcare is designed around the doc. Sometimes this fights should be designed around the nurse, should it be around now? It should be around the patient. It should be what makes most patients. We are building a new cancer center. We are the all-in-one building. A patient with cancer doesn't have to go. When end of a complex for radiation therapy in a different end of the complex for chemotherapy, the different end of the complex for blood testing, I mean, those silos are how healthcare is now organized. And there are lots of different ways, even in our construction and our architecture, that we can change that by being more patient-centric. I love that. We wanted to a lot. What do we not go into that is sort of on your mind right now, something that you'd like to leave the audience with. You're not sure. We did cover a lot. You don't need an answer, by the way, for this one. I'm just giving you the floor. There's no right answer for this. We went into a lot. I really appreciate it. I'm glad I'm glad we sort of covered as a wide range. I mean, chatting with you is fascinating. I probably talked to you for hours, but I want to keep it within the confines of what we've spoken about today. A fun question that I thought of, if you look at historical medical figures that are innovative, that have changed the way that we do things, who is one that you most associate with? Who is one historical medical figure that you wish you could collaborate with them today? Interesting question. Crop. William Olser. As a disciple, sort of, and I'll describe what I mean by that, a temp tumulti, telep tumulti, F Hopkins, around the medical school. They focused on the patient. They focused on clinical skills, not just technology. Tumulti was my advisor in medical school, and I had this talk that he gave, you know, something was books on the wall, and I quoted on every graduation speech about the power of being a physician and the importance of being a physician and the ability through your personality and the laying on of hands and having a conversation to make the to cure people and to make the dying feel better as they die, and the enormous power in that. And yet, tumulti didn't even know how to read nakedgy. He was the ultimate physician's physician. When you didn't know what was wrong, you presented, we had what we call tumulti rounds. You presented the case to him, he'd go through a detailed discussion, it's a differential diagnosis of what may be wrong, what may be right, and you know, why ultimately he thinks it's in this disease. Someone was in a hospital for two weeks doing the testing, and it always proved him right. That's so funny. I mean, clinically enormously skilled, not tied to just technology. I mean, we here, I mean, don't come along. Our modern medical technology is fantastic, but we sometimes lose sight of the personal aspects in the meantime. I love that. Right, I appreciate you a lot. If people want to learn more about what you're doing, connect with you, where do they go? I mean, you can send people anywhere. I'll put a whole bunch of links in the show notes as well, but where should people go to explore? Yeah, so one is, I mean, where's Chris Holtz? What we're doing in Breaker's Health websites is probably, and if people want to connect directly, I have a chancellor email address. Let me, I mean, I don't know what it is often. And that's fine. And I can, here it is, a chancellor at rbhs.ruchkers.edu. So it's a chance at rbhs.ruchkers.edu biomedical and health sciences. We've changed our name to ruchkers health because it's a better name, but, but our legal name is still rbhs.edu. And it's a, you know, one of the sort of bottom line messages is that this is a very exciting time in medicine. It's a very exciting time in my life in terms of being able to, to, you know, I've always been a change agent. I came here with knowing that that, and in fact, you know, my job, the chancellor job, was created when UMDNJ, University of Medicine, in Dentistry of New Jersey, was merged into ruchkers. Every time the presidency of UMDNJ became available, I was asked to look at it and I refused even to look. But when this job became available, merged into ruchkers, I saw the potential for the kind of change that I could drive on a statewide basis and we're doing it. We got a long way to go, but it's just sort of very proud of what we've been able to accomplish and what we will accomplish in the future.