5 Questions with Dr. Bhatt

A Conversation With William E. Boden, MD, FACC, FAHA

Deepak L. Bhatt

For this issue, Dr. Bhatt talks with Cardiology Today’s Intervention Editorial Board Member William E. Boden, MD, FACC, FAHA, professor of medicine at the Boston University School of Medicine; lecturer in medicine at Harvard Medical School; and physician research lead and scientific director of the Clinical Trials Network of the VA New England Healthcare System in Boston.

After graduating from the State University of New York, now Upstate Medical University, Boden completed 5 years of training in internal medicine and cardiology, including a year focused on research and a year of chief residency at Boston University.

William E. Boden

Since then, he has held numerous academic appointments; served as chief of cardiology and medicine in multiple hospital systems; led many important trials; and conducted valuable research that has significantly influenced the current state of care in cardiology.

What advice would you offer a student in medical school today?

Dr. Boden: I would tell a medical student that if they want to develop a career in academic medicine, whatever discipline that may be, find yourself a mentor and do not sell yourself short. Also, don’t be bashful about seeking out an expert in the field because you will be surprised at how receptive people will be to a student who approaches them and asks for guidance.

Who has had the greatest influence on your career?

Dr. Boden: It is difficult to name one person, but William Williams, MD, the chair of medicine at my medical school, encouraged me to reach high and apply to the best programs in the Northeast and not be held back by the perception that I did not go to a high-profile medical school.

Also, Robert Eich, MD, who was a down-to-earth, excellent clinical cardiologist, taught me and my fellow students how important it is to engage patients at the bedside and take a careful history and physical. These are skillsets that have unfortunately eroded over the last 2 or 3 decades as medicine has become more electronically driven and less personalized, in many respects, which is understandable, but being a good clinician depends upon them.

What has been the greatest challenge of your professional career thus far?

Dr. Boden: Much of the research that I have been involved in during the last 25 years has been to examine critically the role of PCI and optimal medical therapy in the management of patients with CAD. I have been the study chair of two large, multicenter clinical trials — including the landmark COURAGE trial published in 2007 — that have shown, perhaps to the disappointment of some interventional cardiologists, that we have been unable to demonstrate, to date, the superiority of PCI on top of a background of optimal medical therapy in patients with stable ischemic heart disease. As a result, I received many disparaging comments from my own colleagues who viewed me as a sort of enemy of intervention. Moreover, it created an unhealthy polarization in the academic and practicing cardiology community that was detrimental.

Although there has been an acceptance of the fact that medical therapy is critical to improving outcomes in CAD over the past decade, the challenge for me has been reconciling those differences. I lamented the fact that many people viewed my research as being unsupportive of interventional cardiology because I never had a dog in that fight. When we designed those trials, the goal was not to have a winner or loser but rather to determine which treatment strategy is most beneficial for our patients. Hopefully, people recognize that all I have tried to do is get to the right answer scientifically and not to necessarily get a “win” for one strategy or another.

What area of intervention most interests you right now and why?

Dr. Boden: We have 16 million Americans with CAD, half of whom have stable ischemic heart disease. Therefore, we designed the ISCHEMIA trial, which has been running since 2012 and will end in June, to address the very important question of whether patients with moderate to severe ischemia benefit more from revascularization plus medical therapy vs. medical therapy alone.

We are also trying to conduct a new trial evaluating patients with what I would call low- to intermediate-risk left main CAD. The guidelines have indicated that patients with left main CAD should undergo revascularization, but the guidelines do not discriminate between those patients who have severe vs. mild symptoms or take into account the severity of angina or severity of ischemia.

What’s up next for you?

Dr. Boden: I have felt privileged to have the opportunities that I have had throughout life, but several years ago, I began looking to define an exit strategy. I had been a chief for 27 years, either a chief of cardiology or chief of medicine, and frankly, it becomes burdensome after a while. I wanted to see if I could contribute in a different way. I wanted to do more of what is fulfilling for me, which is research and mentoring and promoting younger cardiologists seeking to develop a career in academic medicine. Hopefully, I will continue doing that as long as I can.

At some point, I will retire, but I don’t know exactly when that will be. We bought a small house in Florida last winter, though, so maybe my exit strategy will also include 6 months living in Boston and 6 months in Florida. – by Melissa Foster

Deepak L. Bhatt

For this issue, Dr. Bhatt talks with Cardiology Today’s Intervention Editorial Board Member William E. Boden, MD, FACC, FAHA, professor of medicine at the Boston University School of Medicine; lecturer in medicine at Harvard Medical School; and physician research lead and scientific director of the Clinical Trials Network of the VA New England Healthcare System in Boston.

After graduating from the State University of New York, now Upstate Medical University, Boden completed 5 years of training in internal medicine and cardiology, including a year focused on research and a year of chief residency at Boston University.

William E. Boden

Since then, he has held numerous academic appointments; served as chief of cardiology and medicine in multiple hospital systems; led many important trials; and conducted valuable research that has significantly influenced the current state of care in cardiology.

What advice would you offer a student in medical school today?

Dr. Boden: I would tell a medical student that if they want to develop a career in academic medicine, whatever discipline that may be, find yourself a mentor and do not sell yourself short. Also, don’t be bashful about seeking out an expert in the field because you will be surprised at how receptive people will be to a student who approaches them and asks for guidance.

Who has had the greatest influence on your career?

Dr. Boden: It is difficult to name one person, but William Williams, MD, the chair of medicine at my medical school, encouraged me to reach high and apply to the best programs in the Northeast and not be held back by the perception that I did not go to a high-profile medical school.

Also, Robert Eich, MD, who was a down-to-earth, excellent clinical cardiologist, taught me and my fellow students how important it is to engage patients at the bedside and take a careful history and physical. These are skillsets that have unfortunately eroded over the last 2 or 3 decades as medicine has become more electronically driven and less personalized, in many respects, which is understandable, but being a good clinician depends upon them.

What has been the greatest challenge of your professional career thus far?

Dr. Boden: Much of the research that I have been involved in during the last 25 years has been to examine critically the role of PCI and optimal medical therapy in the management of patients with CAD. I have been the study chair of two large, multicenter clinical trials — including the landmark COURAGE trial published in 2007 — that have shown, perhaps to the disappointment of some interventional cardiologists, that we have been unable to demonstrate, to date, the superiority of PCI on top of a background of optimal medical therapy in patients with stable ischemic heart disease. As a result, I received many disparaging comments from my own colleagues who viewed me as a sort of enemy of intervention. Moreover, it created an unhealthy polarization in the academic and practicing cardiology community that was detrimental.

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Although there has been an acceptance of the fact that medical therapy is critical to improving outcomes in CAD over the past decade, the challenge for me has been reconciling those differences. I lamented the fact that many people viewed my research as being unsupportive of interventional cardiology because I never had a dog in that fight. When we designed those trials, the goal was not to have a winner or loser but rather to determine which treatment strategy is most beneficial for our patients. Hopefully, people recognize that all I have tried to do is get to the right answer scientifically and not to necessarily get a “win” for one strategy or another.

What area of intervention most interests you right now and why?

Dr. Boden: We have 16 million Americans with CAD, half of whom have stable ischemic heart disease. Therefore, we designed the ISCHEMIA trial, which has been running since 2012 and will end in June, to address the very important question of whether patients with moderate to severe ischemia benefit more from revascularization plus medical therapy vs. medical therapy alone.

We are also trying to conduct a new trial evaluating patients with what I would call low- to intermediate-risk left main CAD. The guidelines have indicated that patients with left main CAD should undergo revascularization, but the guidelines do not discriminate between those patients who have severe vs. mild symptoms or take into account the severity of angina or severity of ischemia.

What’s up next for you?

Dr. Boden: I have felt privileged to have the opportunities that I have had throughout life, but several years ago, I began looking to define an exit strategy. I had been a chief for 27 years, either a chief of cardiology or chief of medicine, and frankly, it becomes burdensome after a while. I wanted to see if I could contribute in a different way. I wanted to do more of what is fulfilling for me, which is research and mentoring and promoting younger cardiologists seeking to develop a career in academic medicine. Hopefully, I will continue doing that as long as I can.

At some point, I will retire, but I don’t know exactly when that will be. We bought a small house in Florida last winter, though, so maybe my exit strategy will also include 6 months living in Boston and 6 months in Florida. – by Melissa Foster