Centennial Oral Histories:
Victor Dzau, MD

Peter Feaver  0:19  

Welcome to the Duke Centennial [Oral Histories] Project. My name is Peter Feaver, and I have the privilege of having a conversation with Dr. Victor Dzau, who is the former chancellor of the Duke Medical System, and also one of the leading medical innovators in the world. And so, welcome.

Victor Dzau  0:34 

Thank you. I look forward to it. 

PF  0:37  

You came to Duke midway through your career. You had already established an impressive record of service and innovation. So talk a little bit about how you got into medicine, even before you came to Duke.

VD  0:50  

So, I would say that coming to Duke is one of the greatest things I’ve ever done. Great decision. But you know, I was born in China — Shanghai — right after the war. And that’s why my name’s Victor. Then because of [the Chinese] civil war [and] communist China, we were refugees from Shanghai to Hong Kong. So I remember the train ride crossing the border at night. We started out, I would say, pretty modest and impoverished. That had a great influence on me wanting to be a doctor. So at age 18, I went to Montreal’s McGill [University] to go to college, and then medical school. After that I did my training in Boston at the Harvard systems, became a faculty member, went off to Stanford, and then went back to Harvard. At both places, [I was] Chair of Medicine, and [I was] Chief of Cardiology at Stanford. So when I got called about this job, I said, “What an opportunity.” It was an incredible opportunity for me to come to Duke.

PF  2:00  

Well, I’m going to ask you about that in a moment. But I want you to talk to us a little bit more about your research, and the contributions you made to cardiovascular surgery and treatment. I saw one place you were called “The Healer of Hearts,” which is a wonderful phrase. So, talk a little bit about what you were able to accomplish in that phase of your career. 

VD  2:20  

A little hyperbole. But still. I would say I started my career as a physician-scientist — a doctor who does research. This is all under the model of William Osler. So, I was really interested in finding ways to do research that could make a difference to patient care. Luckily enough I was at Harvard with lots of great role models. So then I entered [my] career looking at cardiovascular disease. And at the time, hypertension was a really big issue — and still is. Not too many good drugs. So it was at that time when a system called renin-angiotensin was discovered. And then I was in a lab trying to purify renin and make an antibody to block it, to show it is important for blood pressure reduction. And sure enough, I did publish in Science. So at the time, suddenly people [were saying], “Okay, this is a great area [in which] to make drugs.” So then the idea of one of the enzymes in the system called ACE [angiotensin-converting enzyme] became a target. I was very lucky to get really involved with some of the earliest work in that area, including working at the Mass[achusetts] General [Hospital] to synthesize an inhibitor. Then of course pharma companies came up with all the drugs. I was the first to study end heart failure, [and] put it into patients. I can tell you stories about those days, where there was so little to give to patients that those drugs really saved lives. So, that’s the history behind my work. Now, I’ve always done research everywhere I go. I still do research here at Duke, even though I’m in DC. When I was chancellor, I was still running a research lab, because it’s really part of my passion.

PF  4:08  

Well, “Healer of Hearts” doesn’t sound hyperbolic to me. Duke was known at the time as a center of excellence in heart treatment, cardiology in general. So was that what drew you to Duke? What drew you to Duke?

VD  4:24  

A lot more than that. But just talking about Duke’s reputation — surely, when I was in training, you heard about the Duke cardiology [reputation]. And in particular, the Duke Data [bank that Duke Medicine Chair] Gene [Eugene] Stead started in the 1980s or whatever. And of course, that was the basis of the DCRI [Duke Clinical Research Institute]. You’re going to interview [Dr. Robert] Califf later, right? So Duke had always been at the forefront of cardiology, but I came for a lot more than that. Because [it was] a time when I was Chair of Medicine at Harvard, and I could see that what I was doing was important. Maybe you’ll talk to me about Paul Farmer later on, right? But when Duke called, I said, “Wow. It’s got a medical school, a nursing school, a university, a hospital, [and] a community.” That, at least, gave me the chance to think about much bigger issues of how to improve health communities, how to get research going, [and] how to improve education, rather than focus on a single department. Duke, with its world-class reputation, was too good to turn down. So here I am.

PF  5:41  

Did you have much experience in the South? Talk a little bit about what it must have felt like coming from the West Coast or the Northeast and then coming firmly into the South.

VD  5:52  

Almost none. I mean, I’d visited Duke before. And so the South — I grew up in my life in Asia, then on the East Coast, West Coast, [but] never in the South. So, it was a really interesting adventure. I would say my wife was a little hesitant [laughs], but now she loves Durham now. She’s the one who would, “We’ll never leave.” Which is why I’m in DC now. I said, “Ruth, I’ll commute. You don’t have to move.” So, we love the South. 

PF  6:21  

What was the reputation of Duke when you came? If I had been talking to you before you came, and I said [to] describe Duke Medical and Duke University, what would be the way you would have described it, before you came?

VD  6:34  

I would say “excellence” is the way to describe it in clinical care. Great reputation in research and education. Because Duke has a very unique curriculum in medical school. So it has a great reputation. And my predecessor, Ralph Snyderman was one of the first to launch a health system — the idea of bringing hospitals together under one roof. That was new. So for me, that was very exciting. But let’s face it, if you did your homework, you also knew that there were issues in which the trustees said “We need a new chancellor to work along with the university better.” And then the committee said, “We need someone who can work with us, who can trust.” So it was a challenge, but I give Ralph credit for his vision of creating it. My job was to make it work, and then elevate it to even higher heights, and then prepare for the future.

PF  7:35  

So talk a little bit about the challenges that you thought you would face as you were coming in. You said, “Okay, there’s a new health system. I know, I’m going to have to be doing…” What were the things you thought you would be focused on from day one?

VD  7:47  

First, listen. And create relationships, and get trust. Key importance. We all know this. [The] PDC [Private Diagnostic Clinic] and the Health System, they didn’t trust each other. Not in those days, right? 

PF  8:00

Explain what [the] PDC is?

VD  8:05

This is the Private Diagnostic Clinic, [which is] the faculty practice, a for-profit that’s not part of Duke. And so the struggle always is, you know, I run the hospital, you run the practice — who’s in charge here, right? And the trust issue is a big issue. [Also] community. We took over two community hospitals. Durham Regional [Hospital], and `Duke-Raleigh [Hospital]. And the doctors in the community were really upset and didn’t trust Duke. I still remember the meetings I went to where I had an earful about, you know, “You’re coming in there to take over what we do,” and the whole bit. And we had our detractors after [the] Santillan [case], which was a major issue of patient safety. The community and the public didn’t trust us too much about many issues. And then the university relationship. So I had a fair amount of work to repair all those things. But I really want to hasten to point out that this is not a criticism of Ralph. This is where it is and was. He had to build it. As you build new things, people are always a little bit uncomfortable. And my job at the time was to make sure I make it work to create an integrated system, [to make sure] that everybody [saw] the same vision and worked together in the same direction.

PF  9:32  

Well, talk a little bit about that. One of the things you worked on was a mission statement that would explain what Duke’s health system was about. Can you talk a little bit about that?

VD  9:42  

Yea. I think it was really important to take a step back and to say, “What are we all about?” It’s easy enough when you think about a medical center to say, “We are about outstanding patient care, research, and education.” That’s the triple threat, if you will, right? That tripartite mission. Almost every center says that. We brought people together to say, “What are we all about?” Well, at the end of the day, it’s about transforming medicine, right? Because [with] the research that we do, and the clinical [focus] first, we can change the way we do medicine and make it better for everyone. Second, it is about improving people’s health. Not just caring for disease, but looking at the population health. And third, really importantly — and you see it in Durham, but everywhere now — the inequities that we see in the country. So the statement says that we transform medicine locally and globally, improve population health, and eliminate health disparities.

PF  10:47  

And when did you work on this in your tenure, was this at the very outset?

VD  10:54  

At the very outset what we decided to do is to do a strategic plan. And of course it was not easy to bring everybody together. And then you start a strategic plan, usually, with a vision and a mission statement. But after you’ve done all the kinds of listening to people, etc., you can see, “These are the pieces.” And it makes a lot of sense. Because when we build a health system, when Ralph built it, it was supposed to be “Well, we have enough hospitals in this community. Now it’s our job to take it take it out to the community to serve the people we serve.” And, of course, also expand it to think about the inequities that we have in our society. And importantly, globally. So we added a global mission to this.

PF  11:39  

Talk a little bit about the financial piece of it as well. That may be less well understood. Part of the reason for creating the Health System was a financial one. So can you talk a little bit about that and the changes that were taking place at that time in the provision of health care.

VD  11:54  

Changes at the time, and change that is still happening. I think that this US health system really needs to be markedly improved. Fragmentation, fee-for-service, all this stuff. But this is where, at that time, the idea was to say, we’re going to now have, shall we say, fewer beds. And we’re going to reimburse differently. So the financial pressure was there for Duke to expand to more hospitals — even fewer beds, look at how to distribute the beds differently. And like specialty versus, you know, psychiatry, pediatrics, etc. It was very much financial, but also, I think, for the right reasons, too. Because if you want to care for patients, you want the whole spectrum. From acute care hospitals, complicated cases, to more routine cases of surgery, to ambulatory care, to long-term nursing homes. So an integrated system allows you to have all those things within one system. And the good news is that it’s much less fragmented. That is to say, if you’re a patient coming to Duke Health, you will have the ability to say, “Okay, I’ve got a plan that takes me from being in the hospital, to going all the way home, along with rehab, etc.” So that may be a financial drive, but there was also a right reason to do this. But we were losing money, big time, when I first came. I still remember the first year I wrote off a 200 million dollar loss in the Duke Raleigh Hospital. But, as you know, and this is documented over the years, we did enormously well, at least under my watch. We actually rebuilt, improved the efficiency, looked at how to build the referral system, looked at our specialty care — cancer, cardiovascular — and created a really, I think, successful system.

PF  14:09  

I don’t know that this is well-appreciated by folks who are far from Duke, but the health side of the Duke enterprise dwarfs the campus side and the other sides of Duke. That if you all are healthy financially, that has profound consequences for the rest of Duke. But vice versa, if you’re struggling, that has implications for the rest of Duke.

VD  14:33  

Yeah, also we are part of the University. And certainly, I believe strongly that the strength of being at Duke and Duke Health is [that we are] part of a big university. Not only because of the students, but because of all the other disciplines. These days when we think how [we] improve health, it’s no longer just medical sciences. It is the social sciences, it is economics, it is policy. All of those have to come together. So when you’re in a university like Duke, you have access to all these great minds, and the idea to bring them all together to really work on improving health.

PF  15:14  

Well, I want to push you now on some of the innovations. But right before I do, I want to say the other role of the chancellor is crisis management. And shortly after you arrived, you faced such a crisis. I’m thinking now of the [2005] hydraulic fluid issue. Do you want to talk just briefly what that was like and how you thought your way through it? And did you have second guesses about, “Why did I come?”

VD  15:38  

You know, that actually was a big lesson for me. I came — and before I came, there was a well- known case called Santillan. [Jesica] Santillan was a young girl who got a lung transplant and they had a mismatch. And it was a famous case where news media were all over the place. So you say, “never again.” And yet in December, six months after I got here, I got a call from my COO saying, “We’ve got a problem.” That we might have [used] hydraulic fluid to wash [medical] instruments. Now, what happened was that at one of our hospitals, they were draining hydraulic fluid from the elevator, and they put it into a bin. The color of hydraulic fluid looked just like detergent. Now, you can imagine that right? That bin, on the other hand, [was labeled] as detergent. And so, you know, it was an error. And the staff said, “Okay, there’s a bin of detergent, let’s move it to the loading dock to be picked up by the supply chain to use it again.” And that’s how the whole thing started. So we had to figure out how many places people used [the] hydraulic fluid. We recorded over 3,000 cases. Now, the good news is that at the end — we did serious research to look at what [would happen if] you had the instruments washed in hydraulic fluid, [is] it now easily contaminated [because] of chemicals. The good news is, as you know, after [the] hydraulic fluid, you still [had] to go through tremendous heat — autoclave and the whole bit. So the answer is no. Then we mainly — so there was no complication — we dealt with a public outcry. That’s one thing. But I said to myself, “Wait a minute, twice bitten, right?” You’ve got to have a system that really is ready for patient safety and quality. That’s when we really took this on seriously and created a full-time position for patient quality and safety, created a center [for] patient safety. I met with community leaders all the time [and] patients. And we report directly to a Board of Duke Health, in terms of the Safety Committee. So we changed the way we were told to do things. And at the end, I can still remember that we would have annual meetings where 600 nurses and doctors would come together and talk about their work on patient safety. And how seriously we took it. We took pride in looking at that’s what we do. Crisis management — Learning from mistakes. So that was a big one for me.

PF  18:32  

How do you emphasize patient safety without slipping into a zero-defect mentality, where you don’t take the risks that you need to to save patients’ lives and move medicine forward?

VD  18:45  

Well, there are two things. One is that you can’t blame individuals for errors. You know, the National Academy of Medicine which used to be called IOM has this famous report [that says] “to err is human.” That is to say that mistakes happen. I make mistakes [as do] others. But systems have to be in place to prevent mistakes. And that’s what we did. We create a system whereby if you have to go to a hospital they check your bracelet, they check the date of birth, they check left side, right side — all that became a system by which we could prevent mistakes. That’s really important. So when you create a system, you become a lot more confident that, in fact, you have all the checks and balances.

PF  19:33  

You were a world-class researcher when you came, so surely part of your ambition was for Duke to take its own research to the next level. So, talk a little bit about your vision for that and the steps you took to implement that vision. 

VD  19:48  

My feeling is that a place can only progress with innovation. Without innovation, you get stagnant. You think about, “How do we do things better, and differently, every single day?” And that’s how you move a university health system to be better and better. So innovation really has to be a DNA of what we do. Innovation is research. Innovation is also doing things differently. So when you think about innovation, [there’s a] whole spectrum of new research, but different ways of doing business, different ways of managing, right? So there’s organizational innovation, there’s research innovation, all that stuff. Education innovation. I mean, this is part of my life. As I told you, I came from a background of having to survive in different environments. And even going from Asia to Montreal, that’s a culture shock. Going from Montreal to Harvard, that’s another culture shock. And so everywhere I feel I have to do things better, and I’m driven by how do I do things differently and better? So when I came to Duke, the system, as I said, was all put in place, and we have now people who are working in the same direction. But you can’t rest on your laurels. You can’t say that this is the way it’s gonna be forever. So therefore, we have to think about innovation. One of the things I thought about is, what’s the right model for an academic health center? We then called it a system, right? The model is to be able to move from discovery research — the great research that [Nobel Prize winner] Bob Lefkowitz and others do — to be able to move it to human translation [like] the research that DCRI does, to be able to take that information and apply it to patient care and our hospitals. But [it’s also important now] to move all the way down to the community [and] society. All these take new ways of doing things. And that’s what innovation is about.

PF  22:11  

And you changed some of the ways Duke operated at each one of those points. So talk a little bit about some of the institute’s, or [initiatives that were] established on your watch.

VD  22:22  

So I actually created quite a few institutes. They’re still alive and doing well. And first would be the [Duke] Global Health Institute. I’d like to come back to that. One is the Duke Institute for Health Innovation. One is the Duke Translational Medicine Institute. DCRI we already had, right? And then we also did the medical school in Singapore [the Duke-NUS Medical School]. And then of course, the Duke Cancer Institute. Let me start with last, because the Duke Cancer Institute is an example to me of what needs to be done to deliver best care. We all know about the famous history of Duke Cancer Center being one of the first comprehensive cancer centers and NCI-designated. But it was really a research center. And the work that was done by the clinicians –and we know many of them — was great. Surgery is another segment — they do surgical oncology, they do radiation oncology. So a patient had to navigate themselves between different departments. You remember those days, right? Where you’re in Duke West, Duke South, whatever. So it became very obvious. If you think about the patient, you want to put everything in the same place. You want the doctors to be in the same place, the nurses to be in the same place, you want research to be close by so that the kind of research you do is informed by patients. And vice versa, changing care. It was quite a task because the Department of Surgery, the Department of Medicine, the Department of Radiology, [all said] “No, no, we’re doing fine.” So I had to find ways to kind of carrot-and-stick to create a true integrated cancer institute. To build a building. To recruit a director. To make it like a brand new launched cancer center – closer to what you can see in Sloan Kettering and MD Anderson. So that’s an example.

PF  24:31  

And that was a bold move for you — someone from cardiology — doing that in cancer, not in cardiology. Why did you pick cancer as the place? 

VD  24:41  

Because I feel that in cancer, first of all, patient needs. Patients navigating cancer have never navigated all these things. Secondly is the opportunity to bring together all these pieces to make it even better. Cancer was a perfect one. If you look where we are today, I mean, you think back on the Tisch Brain Cancer Center [Preston Robert Tisch Brain Tumor Center], the ability to operate on brain tumors, we’ve looked at the research that has been done — all those things can be integrated for the patient. Immunotherapy now, CAR T-cell [therapy]. So that was the right thing to do. In cardiology, we did it more functionally than structurally. In other words, we did have a service line director [and] surgery and medicine in cardiology were working closely together. So I didn’t see a need to do it as much as a need to do it in cancer.

PF  25:44  

Talk a little bit about the Innovation Center, because that brings in the business side of things as well.

VD  25:51  

Yes, very much. Because again, the whole idea is that if you’re going to be better and better, you’ve got to innovate. And so we learned, especially after patient safety, how frontline people are thinking about how to do things differently. You want to listen to them. They [might] say, “You know what, I see something like this — something we can do differently.” And there are lots of clinicians and researchers who can see how our current way can be improved. So we wanted to create a place for them to say, “I’ve got a good idea. And if the good idea is supported and realized, then we can improve patient care and research.” So that was the idea of DIHI, as we call it. But the question really is — how do you make sure that the right innovations are there? So we created this institute whereby we have resources, we give out grants. They have to be competitive. We look at if it is a good idea, and [they can be] selected. [To be] selected [they have to] align with the executive and directions — meaning that they have to have an owner. If [the idea] is selected, somebody who’s an executive says, “I own it [and] I’m going to work with them to see it through.” It’s not just that you’re going to be out there doing things. And then we had people who are actually investors along with [us] looking at, “Okay, those are great ideas, where would I like to invest in it?” So I think what’s happened at DIHI is that AI is the big, big issue. They’ve done so much in AI. They can use AI to predict sepsis. AI to look at people who are likely to get renal failure, so you can early intervention. AI to manage patient care. So that, among many other things. I will say the timing was great, because now we really can take a new technology and look at how to do things differently and better.

PF  27:48  

Let’s talk now about globalization. You came to Duke originally from Shanghai, so you saw the world as much bigger than the South. And you brought that vision to Duke. So talk a little bit about the steps you took.

VD  28:02  

I think that if I were to look back, the areas I would emphasize would be leadership, innovation, globalization, and equity. Globalization is really important. But I will say — given my background, you’re right — but it wasn’t until I met Paul Farmer, who was a member of my department at Harvard, and Jim [Yong] Kim. The two of them. Paul is, as you know, a Duke graduate. So Paul, when he was here, suddenly discovered anthropology and looked at the migrant workers in Haiti and became really passionate about this. He went to Harvard Medical School and took an anthropology kind of emphasis — medical anthropology — with a good friend, Jim Kim, who then became Dartmouth’s president a while back. The two of them began to do these things, and they founded an NGO called Partners in Health. When I first arrived at Harvard at Brigham and Women’s Hospital, the chairman of the board then, John MacArthur who was the Dean at Harvard Business School told me, “You ought to meet these two guys. They are really interesting.” So I met them, and it ignited the stuff in me for all this while about global health. And so what I did is I helped them create a home — a division called Global Health Equity. Because they were [working] part-time in Haiti, the rest time they had to do [inaudible]. And there are many young people taking the elective time, but when they’re all done they say, “I can’t do this any further. There’s no pathway.” So I created this for them, so there’s a career pathway, research, etc. And today, that division has [around] 60 faculty members doing really well. 

So when I first came to Duke, that was the year the book Mountains [Beyond] Mountains [by author Tracy Kidder] was the must-read for freshmen. Paul [Farmer, the subject of the book] came to campus [to] Page Auditorium. And it was packed with students. He was ready to sign books. So I went to [former Duke President Dick] Brodhead, I remember we were at a retreat with [former Duke Provost] Peter Lange. I said, “We need to think about global health.” And sure enough at the end, we got a committee together with Bart Haynes and others to look at what’s [related to this at] Duke. There are a lot of pockets. We decided to create an institute. And Brodhead and I both put down money to create $35 million to recruit a new director, who Peter Lange and I both oversee. And that was the beginning. But it was actually capitalizing on the passion already there. The work was already there. What we did — just like I talked about with the health system — is that we brought people together. And it’s amazing. When you bring people together, the power is amazing. And people were [saying] “Wow, the University Health System really cares about this.” Students said, “We want to do things like this.” And of course, Mike Merson, who we recruited as first director, reached out to undergraduates, [and] it was a great success. But I think what’s exciting are the following [points]. One is that we’re doing what’s right for low-resource countries, like Paul Farmer would have liked us to. We’re doing great research. But [for] the young people – that exposure — understanding the world is not equal, there’s a lot of work to be done, we can do good — I think really is inspiring. So that’s the Global Health Institute. 

Almost the same time, as you know, the Singaporeans said, “We need a new medical school, and we need this research school of medicine versus a clinical, to really look at how we can take advantage of the fact that we’re investing in this biomedical enterprise called Biopolis.” [This was] in the year 2000. And [they] needed a school, and they decided to select Duke. So I was very lucky to be the Chancellor [for Health Affairs at Duke] and to be the one to make it happen. And we had [R. Sanders] Sandy Williams, [K.] Ranga [Rama] Krishnan, and other great people. We took it seriously. And I would say, without being immodest, it is probably the most successful international medical school ever. People have tried at Hopkins and others and have failed. Ours is going strong. I’m in Singapore a lot, and they continue to sing our praises [of] how wonderful this is. And it’s good for Duke. As you know, they explore innovation [such as] new ways of education [like the] flipped classroom that came back to influence us as well. So this was a great thing.

PF  33:06  

Wonderful. At the same time that you had this international focus, you also had a very local focus here in Durham. So let’s talk about that a bit. And there, of course, is health equities — inequities, I should say — right in our own hometown. So talk about how you were able to bring the global to the local issue, and [have an] effect at the local level.

VD  33:27  

Among the many important lessons learned, I would put that among the top. We talk about globalization and innovation, but I’ll say that community became something for me that’s really, really serious. And I learned a lot. Why? Number one, we serve 90% of the population in Durham. So we can’t be an ivory tower, just to say, “When you’re sick, we can take care of your surgery.” If you really want to take care of people, you’ve got to reach out to the community. Secondly, our employees. At the time I was there, we had 25,000 employees under Duke Health. There’s probably a lot more now. So you can measure their families. They work for us. So suddenly I realized that my responsibility is more than a hospital, more than a medical school, more than a nursing school. It’s about the people we serve. And I mean this sincerely. I’m not kind of saying it because it’s the right thing to say. So at the time, when I came here, there was a lot of lack of trust. They had to have us run the Durham Regional [Hospital] because they were losing money left and right. So it was a lease and a management contract that we had, right? And so there was always the tension. And I would like to have a shout out for MaryAnn Black who was just wonderful. She was my EVP for Community Affairs. She taught me a lot. We went to communities, met with people, met with the mayor, and really [came to] understand that if we were going to do well, the community has to trust us and we need to serve them. That started a journey of creating community health centers [and] clinics, and I’m very proud of the City of Medicine Academy. 

PF  35:15  

Talk about that, what is that? 

VD  35:17  

So we own the land on — well, we long-term lease the land on — Durham Regional. In our negotiation for the next phase, I said, “Let me give you one acre of land to build that school.” Because the Mayor already had the idea, and few others, to build something. You know, “the City of Medicine,” right, Durham? So we wanted to leverage [that] to teach our young people the opportunity about a health profession. It could be a radiology technician, could be pathology, could be medicine, you name it, right? So they really have the [inaudible] of this. All they need is our know-how and the resources to make it happen. So I said, “Okay, build it in our hospital so that your graduates can actually have access to it. We’ll bring in our faculty.” And in fact, to accredit people like Tallman [Trask] and others, we gave a lot of equipment and stuff that we don’t need. They took a bond. And they built a building there. And then they created the school where the emphasis of curriculum — part of it, they still get the regular curriculum — is health professions. It’s a lottery school. But with a lottery school, everybody applies to it. They have 600 students, and the graduation rate last time I checked was 100%. Very proud of it. It’s a kind of, shall we say, partnership with the community. So I’m very proud of the fact that when I stepped down, the Mayor gave me a key to the city. I feel that that’s one thing, is serving people. That links with the global health issues [and] serving people. That’s why our mission statement is so right — eliminate health disparities and improve population health.

PF  37:21  

I’ve met many people in Durham who say, “Well, I don’t root for Duke in sports, but I root for Duke Medicine.” That they’re alive, or their loved one is alive, because of the care they’ve gotten. So the Health System is having an enormous impact in Durham. How has Durham changed the Health System? 

VD  37:40  

Oh, in a big way. Let me put it this way — our doctors and nurses are the best. They focus on taking care of that patient that comes to them. So, if you’re a cardiac surgeon, you focus on that. You’ll hear that from [former Chancellor Eugene] Gene Washington, too, that what’s changed is that we understand that we also serve the entire population. We serve the entire community. And therefore, the issues are not only, do you have an illness? It’s [also], where do you live, where do you work, what food do you eat. We call that social determinants of health. Those things matter, because the data shows that health care only accounts for 10% of health outcomes. The rest is social, behavioral, or there is prevention. And if we don’t pay attention to this, all we’re doing is providing sick care. We want to provide well care. Prevention. So understanding these issues — for example, I remember an old lady, an African American lady with asthma. Until you go and visit her at home [and] walk up the four flights [of her] dust-filled home, you [won’t] realize why she’s got asthma. And [there’s] people who have environmental justice issues, you name it. Food insecurity. You remember Marie Lynn Miranda, she’s now President [Chancellor] of [the University of Illinois-Chicago]. She did geospatial mapping. We used the map because we are taking care of all the patients in Durham, we have the information on them. We used the map [related to] where the disease clusters; we’d map where the barber shop is, where the good food is versus, you know, grocery stores. All this stuff. And you can see [where] diabetes [and other diseases are] and we can begin to design the care. That, I believe, is really the lesson we learn in terms of community. Because at the end of the day, we are citizens of a community. And they are what make up what we are. They are workers, they are leaders, and the whole bit. And we need to work alongside with them.

PF  40:08  

It’s my understanding that interest in Durham is a family business now for the Dzau family. So, can you talk briefly about what your wife is doing in that space?

VD  40:19  

My wife has done so much. She was at one time the president of The Center for Child and Family Health. If you go down towards the city, there’s a big building called The Duke Center for Child and Family Health. She was the chair of the board, not president. And they really look at these children who come from difficult families, who have traumatic backgrounds, and they do great stuff. She was on many boards, but her passion right now is Durham history. She was one of the people involved with the founding of The Museum of Durham History. She’s still on the board, she was chair at one point. And believe me, she’s working so hard from a, shall we say, small footprint. They have aspirations. Because she’s so proud of Durham, that the history of Durham needs to be told. And if you care about the history of Durham, you obviously care and are proud of the community and try to make a difference.

PF  41:34  

So, let me go back to your emphasis on research. How did the research profile of Duke Medicine change over the 10 years of your tenure?

VD  41:45  

Well, I mean, I can’t take credit for this, but boy, certainly during my time, we got the first Nobel Laureate. [Robert] Bob Lefkowitz. And then Paul Modrich. We had cochlear implant [breakthroughs] by Blake Wilson. We’ve done lots of really groundbreaking stuff [so] that finally we got the recognition for this discovery type research. Bart Haynes’ work on HIV. Great stuff. But DCRI played a really important role. Because it’s not just sitting in the lab doing the stuff. It’s trying to say, “How can we actually make a difference in clinical care?” And DCRI became the largest academic research organizations, to Califf’s credit, and many of his successors. And our reputation clearly is — Duke Health is a medical center of innovation, from basic research all the way to clinical research.

PF  42:49  

Now, that kind of emphasis on research puts pressure on the individual researchers. And there’s an ethical pressure that they experience as they’re struggling to get grants [and] produce results. And that leads to my question about one of the other hard chapters in your tenure, which was the [Anil] Potti case.

VD  43:11  

You know, if you asked me, “What are the two major setbacks – lessons learned at Duke while I was there for 10 years?” Those were the two. So, we were at a time where genomics was getting to be hot. And people began to be able to measure gene expression. And also genes — now you can sequence but then [it was] still early. But we were at the time when people said, “It makes sense to have precision medicine, because if you know your genes and your gene expression of a cancer, you can predict what the problem is and you can tailor treatment for those.” That concept is absolutely correct. And still is. If you look at what’s happening in the cancer area, there are a lot of very targeted cancer therapies now, right? Amazing. The concept was right. The science is almost there. So, the pioneers are moving this direction. And we believe in it, too. Duke was pioneering this area. I mean, we had [inaudible], we have Hunt [Huntington] Willard, people like that. So, we had a young investigator by the name of Potti, and he said, “Hey, I got something. Look at what I’m doing.” And, you know, in many ways, we could have learned better to say, “Let’s look carefully at what you’re saying.” But because the momentum was there, and people believed this could happen, and the Duke had the ability to do it, I think a lot of people believed in him. Senior scientists, and many others [inaudible] the public, and therefore he got elevated to be a lot more visible. And that was our mistake. We learned, of course, that you’ve got to be very, very cautious. And so we actually went back and looked at data provenance. [Asking questions like] have you seen the original data? How good is it? Data governance. Who’s overseeing this stuff? And of course, integrity. Research integrity. All that stuff. And so we learned a lot. And, of course, that changed us tremendously, looking at the way we organized research. So you’re right. I mean, what you’re saying is [that there is] a spectrum. When you have innovation [and] great ideas, you’ve got to do the right thing. So, along with it has to be scientific integrity, oversight, and excellence. That’s all a spectrum. I still say Duke does it all. A few blemishes. Those blemishes have taught us big lessons.

PF  46:12  

You’ve mentioned a number of names over the course of our conversation. Are there any other names that stand out — either from earlier before you arrived, or during your time — where you say, “They really made a mark on Duke, and helped move Duke forward.”

VD  46:28  

[Wilburt] Davison, the founding dean. Bill [William] Anlyan. Bill was really an amazing guy, and coming, I believe, from Egypt. We were not known as much of an entity, Bill made the reputation, at least in the U.S. I already mentioned Ralph [Snyderman]. But I think these were the giants we built our programs on. And, of course, we need to do even more and better. So absolutely. I would also say that people like Sandy Williams and Ranga Krishnan. They are really great people who did a lot for the organization — high quality excellence, integrity, innovation. I can name a lot of people like Bob Lefkowitz. I already named him.

PF  47:24  

When you stepped down [as] Chancellor, you did not retire from the medical profession. You moved on, and you have an important post now. Talk briefly about what your current post is.

VD  47:35  

Yeah, so I’m not sure in my vocabulary, there’s such a thing as an “R” word. Maybe that’s because my whole life I’ve been driven to try to do better and to be making a difference. So when I was at the tail end of my chancellorship — 10 years — Brodhead and I had many conversations about what I wanted to do in the future. As you remember, Dick extended his [position] for a few years. We considered this. I was loving my job. Also, we considered that it was time to move on. And would I stay to run DIHI and take some of those Institutes that I put together to the next level. Then the Institute of Medicine [was] knocking on my door. [The] National Academy [of Medicine]. I will say what attracted me there is the following. I’ve done research [and] patient care. I’ve done departments and medical centers so they become local [and] regional. The National Academy is national and international. The platform is such where I think I can make a difference based on my experience that I have. Bringing my research, my education, and clinical experience. And the policy, and the community. So it fits me nicely, because what we do at the Academy is basically looking at, really, what are the issues we need to deal with, for this country and globally? How do we go forward? The founding organizations — the National Academy of Science – was spun out to be three academies. In 1863, Abraham Lincoln’s Congress founded us as independent. [We’re not] part of the government. But [we exist] to advise them during civil war and [inaudible]. And now of course, all of these issues. So my feeling is, I’ve got a chance to really do more for this country. And I mean this sincerely. This country has given me a lot. I’m an immigrant. I became an immigrant in the 1990s. [It]s been] 20 years – it’s been a little less than 20 years [since] I came to this country. And so, [for] me, having the opportunity and then also a global stage is important. So we do great things. And I see a lot of Dukies in D.C. work[ing] together like Mark McClellan, Rob Califf. We’re making a difference. 

PF  50:20  

Apply your new perspective back to Duke. As you look at Duke, where does Duke need to go in the future to maintain a positive trajectory?

VD  50:31  

So here’s some predictions. If you look at the last century, think about all the things that have happened in the last century. Or even 15 years [like] the iPhone. Or even 50 years [like] the [Human] Genome Project. And the drugs that we have [now]. So to me, health and medicines are going such gangbusters. The innovation, the emerging technology, AI, genome editing that can cure disease. I think we’re going to see phenomenal changes in health in the next decade [or] two decades. [Priscilla] Chan [and Mark] Zuckerberg created an initiative on biomedical research in 2018. And they asked the question, when they launched the initiative — By the end of the century, will we be able to cure, treat, or manage all diseases. What’s your answer? That’s 80 years from now, 75 years.

PF  51:43  

It’s hard to imagine. I mean, it feels like that’s part of the human condition. And you’re saying that it’s within reach to change things?

VD  51:52  

If you look at 80 years — I started practicing medicine in the 1970s. I am a cardiologist. What did we have? We were just beginning to have coronary care units. The defibrillator pacemaker [had] just started. We didn’t have drugs. We didn’t have angioplasty. I treated heart failure [and we had] two drugs, [inaudible] and diuretics. [Inaudible] doesn’t work. Now we have so much. We have obesity drugs. I think it is totally plausible in the next 75 years that [we will get] everything that we need. So that’s my question — then what? It’s that a lot of people don’t have access to it. Yes, you can. You can have gene therapy for a million dollars a shot. But can the average individual have it? You can have AI, and how are you going to oversee some of those usage and regulation [issues]. So I think we are entering a very different era. A very different era from where everything that we did is possible [but] things that we do are not available to everyone. Let me make my case. American life expectancy is dropping, not flattening, right? While we have this great increased life expectancy, with all the drugs we have, we will begin to see this. If you go to Durham and just go between Hope Valley and down in the low-income section, you could see a 20 years difference in life expectancy. It’s called equity, access, affordability. I think for Duke to continue to lead, they have to stay ahead of — just because we can invent [and] we can treat better, we’ve got to really get into the social issues. Because that’s what we are about. Human beings. Improving their well-being, their health. And I think in the next decade or more, the ability to bring in social policies, social science, economics, things like that, to make a much better community. I think that is where we will need to go.

PF  54:10  

If that initiative is successful sooner, you and I will be able to gather 25 years from now and have another follow-up conversation. At that time, looking backwards, what will you want to say is true about Duke. So 25 years from now, looking backwards, what do you want Duke to have accomplished?

VD  54:31  

I will say the following. Number one, as a university, we continue to be the knowledge capital of the world, producing the best people and leading society in so many different ways. As a health system, that we continue to be, as we aspire to be, that system that improves care. Being the very best. But most importantly, [I hope that] we became really the place where we think about everybody that can benefit from us. So people will no longer say, “That elite university, [the] Harvard of the South.” To that’s the place where everybody would like to be. Because it’s so wonderful [to] serve everyone. I don’t mean to be Pollyannaish. But I sincerely mean it. I spend a lot of these days thinking about what I do, and how to improve the social issues. The systemic issues that we’re faced with. Because I think that’s in the way of achieving wellness. It’s not technology, it’s not innovation. There’s plenty of people out there, especially it’s a market-driven [landscape]. I want there to be a more mission-driven approach to the area.

PF  55:51  

Duke has a chance of achieving that vision, in part because of your hard work and your contribution to Duke. And for that I thank you, and I thank you for this conversation.

VD  56:00  

Thank you. I really enjoyed it.