This week I am talking to Frank Veith, MD, Surgeon, Professor, and author of “The Medical Jungle” where he lays out the six pillars of his pioneering tenure as a vascular surgeon in some of the most prestigious vascular programs in the country and the groundbreaking—and at times controversial—advancements for which he tirelessly advocates.
He started out in medicine and fell in by chance, in part in an attempt to avoid having to do paperwork – as we all know that proved out the other way. He has been responsible for some incredible advancements in medicine including Lung transplantation, salvaging of limbs, and endovascular surgical intervention
But all this was not without challenges, pushbacks, and even total rejection from some peers and colleagues – as he says in his book. He would hear back-channel chatter from competing hospitals:
“This guy is nuts. He’s a maverick working at a third-rate institution in the Bronx. How is he going to accomplish that!?”
We discuss the elements of success and facing adversity and the importance of never giving up (never surrender) – famously a statement made by Sir Winston Churchill in his infamous speech “We Shall Fight on the Beaches”.
You can hear his thoughts on some of the incremental elements of his journey, including the importance of focusing on solving the problems that others would not take on and the value and compassion we must bring to the service of our patients.
We discuss some of the groundbreaking work he championed including innovations in Lung Transplantation which were seen as impossible at the time, the salvaging of limbs that the medical profession deemed impossible but he and his team proved were, and the incredible end-vascular revolution that built on the work of others including Dr. Charles Dotter (aka Crazy Charlie) who brought into the world the use of catheters to unblock arteries. This was the early instance of angioplasty and is now part of the mainstream treatments.
He continues the journey of innovation and carrying the torch for the advancement of science and vascular surgery with his highly successful VEITH Symposium (@VEITHsymposium) which is now in its 50th year, and continues to educate and advance the fields of vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists
Listen in to hear his continued hope and drive for medicine and where we continue to have opportunities to innovate and keep driving success and how to go about that and if you can get his book that is filled with insight on life and how to create a path to success.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. Frank Veith. He is a surgeon professor and the author of the medical jungle. Frank, thanks for joining me today.
Frank Veith
It’s a pleasure to be here, Nick.
Nick van Terheyden
So this is a special pleasure for me. You and I have through some of our mutual friends, we’ve never actually met. But, you know, certainly our courses and careers have intersected. So this is a real privilege for me. And I’m excited to have you here. If I could, could I ask you, just to set the stage, you’ve had a very illustrious career, let’s be clear, you’ve done some amazing things. But that all started, you know, many years ago, could you help us by sharing a little bit of how you got to that point of being a vascular surgeon and the story up to, you know, the early stages?
Frank Veith
Well, so many things in life, are determined by luck. And I sort of fell into medicine. My mother was a nurse. I had an uncle who was a dentist, and they acquainted me with some of the rigors of general surgery at that time, and I thought it was probably much better than a legal career, which was what my father did. Because I didn’t want to do paperwork in the evenings turned out that that didn’t happen at all, you know, in academics, one ends up doing more paperwork and writing and talking and preparing talks than then I would have ever realized. But I sort of fell into medicine by chance. And I fell into surgery also, by chance. Having witnessed a young man with a perforated ulcer, as I was a medical student and came into the hospital, we made the diagnosis very quickly went to the operating room, and was fixed. And that sort of appealed to me. And I was not really particularly turned off by some of the intellectual aspects of, of medicine and internal medicine, which was the other possible career. So I fell into a surgical career and liked it. And also had the good fortune to train a couple of very good institutions and meet some mentors that guided me into a surgical career. And things went from there sort of largely by luck, and happenstance. And I ended up as a Marshall Scholar, and one of my friends, Mark Freeman, got a job in the Bronx at Montefiore Hospital when he enticed me to join him, after a career in the army and some other things. And because it was somewhat of a lesser institution, I don’t like to say third grade, second rate, but lesser in an intelligent community, I had opportunities there to develop and vascular surgery, which appealed to me a lot more than other aspects of general surgery. And that seemed to work out.
Nick van Terheyden
So a couple of things to highlight in there. And, you know, one of the things I think, like always plays a part. But I also think that we make our own luck and making ourselves available for those opportunities when they arise. As you look back, prior to that Montefiore offered opportunity, and the work that you’ve done there that we’re going to cover in a second, was there anything that stood out to you that really sort of provided a step that you think had it not happened, you might have taken a different course it sort of provided some insight, or perhaps experience through that, that you think was really, really important to the development of your career?
Frank Veith
Well, I always thought in my naive nature, that if one worked hard, did what was right, that that would lead to success, as it turned out. Some of the Blind Cat maligned characteristics of human nature, enter the fray and, and hard work and confidence doesn’t always pay off, you run into jealousies and other people’s lust for power and stuff like that. And so it was somewhat of a rude awakening. Because I always thought that hard work and and, and trying to do a good job would be the secret to success. And obviously, that’s not always true.
Nick van Terheyden
So in that regard, I think one of the things and I certainly got this as I read through the book, which was okay, so I mean, I think that’s true. And we, perhaps most if not all of us, come to discover that that’s You know, part of the human nature and the course of life. But one of the things that you must have had to apply was the ability to sort of pick yourself up and say, Okay, well, that’s what’s happening, but I’m not going to be beaten down by it. Is that a fair assessment?
Frank Veith
Absolutely. I mean, the idea of never giving up, because if you write a good paper, or submit a good grant, typically it gets rejected. For probably for bad reasons, or impermeable, inappropriate reasons. First, but if you keep trying and trying and trying, and and revising and not giving up, very often you’re rewarded with ultimate success. So the the Winston Churchill, aphorism of never, never, never, never give up was something that, I guess did guide me. And, and I tried to get that across to some of my younger colleagues and partners.
Nick van Terheyden
So you go through this sort of early training, it provided you I think, some great opportunities experienced that you might not have had, and you arrive at an institution where you know, because of the nature of it, you’ve got more opportunities. You’re in vascular surgery, which I correct me if I’m wrong, I think it’s still not a specialty in its own right. It’s a subspecialty.
Frank Veith
Of very correct, ironically, and with great disappointment, although it is a specialty, it is not recognized in the United States, it’s still regarded as a sub specialty. And that, of course, is one of the chapters in the book, where we were very much involved in the leadership of trying to get vascular surgery recognized as a specialty, which clearly is, and fulfills all the necessary criteria for being such. It hasn’t happened for some of the noxious reasons that I mentioned that human nature and the desire of other people to keep power and so forth, has prevented us from becoming a separate specialty with still many disadvantages to not only to us, but to the patients we care for.
Nick van Terheyden
Right? So I hear you are you’re in at the time of subspecialty. We haven’t seen the emergence of that to date, I recognizing that, as you rightly say it is a specialty, it’s just not recognized as such. But you now start down a journey, doing some things that were really I want to say completely against the prevailing wisdom. And I use inverted quotes for that, that, you know, and a couple of things I’ll pick off initially was, you know, lung transplantation was just not a thing. I mean, at the time, even heart transplantation was very new, but there was some early successes. And then Len salvage, which, you know, as you look back, and I recall this in my career that, you know, we would take a limb off for fear of losing the patient to affection, you turn that around. Tell us a little bit about that story. Well,
Frank Veith
that that was sort of typical of what we were talking about. One of my thoughts in being an academic vascular surgeon, and wanting to do something that was meaningful was to address problems which other people thought were either unsolvable or very difficult to solve and that those two areas the lung transplantation, and the limb salvage were two areas where, firstly, were not very popular because they were deemed impossible. And there were many difficulties particularly with the limb salvage. The patients aren’t particularly glamorous. They’re usually old, sick people in the end stages of their life that are faced with losing a limb which is basically a disastrous complication, particularly for a sick old person. And because we did not have a lot of patients when I went to Montefiore who had the glamorous diseases of vascular surgery namely carotid disease, and aortic aneurysm disease and occlusive disease of the aorta and other vessels, we started to attack an area where we had abundant patients all faced with loss of a limb and for which there was no really good treatment or no accepted good treatment. And so we cautiously approach that problem. Using some techniques, which I was lucky enough to have learned from doing AV fistula access word micro semi micro techniques on the small blood vessels. We found that much to our surprise and delight. Some of these unexpected procedures worked. And because they worked for us, we began to do more of them, publish them. Court we met, we met with a lot of resistance hostility and, and doubt skepticism. You couldn’t be right. You couldn’t do these things they never worked for us. How can they work for you? And we, we just persisted and kept doing it. I train people, my trainees and partners to do it. And we kept publishing it. And it’s now become standard of care around the world.
Nick van Terheyden
So thinking back to that time, and you know, the push back where, you know, one of the fundamentals of science is repeatability. So you were able to achieve some of this limb salvage and capabilities. Others were saying they couldn’t, you’re obviously facing, you know, what some would consider a wall, an insurmountable task. What was it at the time that allowed you or helped you persist and keep pushing towards this goal, which ultimately, you’ve been proven 100%, right, it’s now standard of care standard of practice?
Frank Veith
Well, basically, I was in an institution where we had a lot of indigent patients. And I guess I got some support from the institution, I also had a lot of pushback, because many of the patients would stay in the hospital a long time, till we got their revascularize foot heels. And of course, that cost the institution money, which didn’t make them too happy. But basically, we had enough success that we could continue to do this, it was not a particularly financially rewarding area to be in, but it was personally very rewarding to see these people come in with a gangrenous foot and walk out of the hospital. Whereas if they’d had an amputation, and they would be, that would be the end of their life, because unlike a young person who can be rehabilitated with a prosthesis, all people rarely walked when they had a major amputation. So it’s gratifying.
Nick van Terheyden
Right? So I, as I pick out from that it sounds very much like, you know, critical to that was actually the patients and the reward that you saw that helped continue to drive you to demonstrate that success to others.
Frank Veith
Yeah, and people would come to visit us from, you know, far away, but we had one other very fortunate thing that we had, which I can’t claim credit for is we had unusually good arteriography. So whereas other people weren’t seeing the still paint and vessels in the lower leg or foot, we could visualize them and and do reconstructive bypasses, to those vessels, which much to our surprise worked.
Nick van Terheyden
So for those of you just joining on Dr. Neck, the incrementalist today, I’m talking to Dr. Frank veeth. He’s a surgeon professor and author of the medical jungle, we were just talking about the innovations and the push that you had with both lung transplantation art limb salvage, the art of limb salvage, which, you know, at this point is now standards of care. We see this as sort of regular practice, but at the time, was not perceived as normal. But you didn’t stop there. I mean, some people just stop there and say, wow, you know, I’ve achieved this, but you continued on. And at this point, you’re a vascular surgeon. You know, some of the primary challenges we see in that area is, you know, the challenge of repair of aneurysms, something that occurs again, in that older population, significant sort of pathology and morbidity and mortality. And you start down a track of doing this in a way that at the time was completely revolutionary. Tell us a little bit about that experience.
Frank Veith
Well, I always first of all, the our limb salvage patients were always sick and old. And we early on back probably in the late 70s and 80s. We embraced a technique of endovascular treatment of occluded arteries, which was popularized by or really invented by an interventional radiologist named Charlie daughter. And he devised the technique of angioplasty, that is endovascular approaches to occluded arteries, and then opening them with either a tapered catheter or, as later was developed with a balloon, so called percutaneous, balloon angioplasty. And I was young age I was president of the New York cardiovascular society. And I invited Charlie daughter to speak at our, our meeting. This was probably in the late 70s or early 80s. And he was sort of regarded as a crazy man. Certainly by all surgeons, this is not possible. It can’t work. And he was known as crazy Charlie. And he came, he gave the talk at our meeting. Talking about the way the angioplasty were, like footprints in the snow, to reopen an occluded artery, making the plaque like a footprint in the snow, which wasn’t the way it worked at all. But everybody in the audience thought he was crazy. They were all surgeons, it was a surgical society. And but I thought maybe had something here. And because our patients were so old and sick, I asked our interventional radiologists see more spread Reagan to go out and watch this guy work and bring his techniques back so we could use them rather than doing these big horrendous operations on these old sick patients. And he went out there and he came back and he started doing them. And I would sit in the angio suite with him, watch the procedures and they worked. And they worked much better than the big open abdominal aorta. femoral bypass is. So we started embracing endovascular techniques. I became very good friends with a guy named Barry Katz and who I also invited to speak. He’s an interventional radiologist, world. We’re now at our New York cardiovascular Society meeting. And that launched him on his career. He talked about lysing clots with streptokinase. Again, nobody believed him. It didn’t work very well. But we became good friends. He invited me to his interventional radiology meetings and I saw what the interventional radiologists were doing. And even though I had my doubts, I said, Well, maybe these things can work for us. And I actually, at that meeting, I saw a presentation by a guy named Julio Palma is the father of stents for opening and keeping arteries open, and he presented a talk on the possibility of treating aneurysms endovascularly with a stent and a graft. And subsequently, a guy named Juan Perotti. Did the first endovascular aneurysm repair in Argentina, nobody believed him. He was regarded as a pariah by all surgeons swelling, this good open operation that we did. But we had a very sick patient that we couldn’t operate on with a big threatening aneurysm. And we might Marin and I said, What are we going to do with this patient who can’t operate on at least who sick? I said, Let’s go to Argentina and learn how to do this procedure that one Brody was talking about, and nobody believed. And so we got friendly with corroding, made phone calls. And he didn’t want us to come there, because various reasons. But we induced him to come to the United States, and do the first open endovascular aneurysm repair with us at Montefiore in 1992, by inviting him to our meeting, so he could promote his technique. And it’s a long story. It’s of course, it’s been detailed in the book. But he ultimately came after much backing and filling and adversity. We talked him into coming and got permission to use the palm is stent, a giant Poma stent, which was necessary for us to make the graph. And that first case was dramatically successful. And the guy the patient lived, the next day was sitting up on a chair reading Playboy, and his aneurysm was fixed. And so we then that’s i and Mike Marin started a program where we made our own endovascular grafts, some for aneurysms of the aorta, some for other diseases. And unbelievably, they worked in situations that were otherwise hopeless, hopeless. So we thought we would present this work at a major meeting of young vascular surgery leaders, and I got permission to present it Oh, that was resisted, because of various reasons. And we presented this work, which was dramatically successful. And nobody believed us. My friends, all these guys were hotshot leaders. They said we’re either lying or crazy. And but we kept kept doing it kept talking about it, accumulated more experience, and I was fortunate enough at the time to be president of a couple of societies, one of them being the major SPS And I advocated telling vascular surgeons that if they don’t wake up and realize that this stuff was going to work, they were going to be out of a job. That was not well received either. It was a talk on Charles Darwin and vascular surgery, and how we had to evolve as a species, or we would become extinct. And we were disbelieved by all the major leaders in vascular surgery for about five to seven or eight years. And then gradually, people started to realize that this stuff might work. And now it’s become, of course standard of care.
Nick van Terheyden
Yeah, so fast forward to today. And just, you know, for everybody, listening, clarity, this is absolutely the standard of care, you would essentially approach the majority of these kinds of cases, because minimal intervention, I mean, this is what we call keyhole surgery. And I know I’m oversimplifying, but just for the benefit of the audience, this is, you know, minimally invasive. And as you rightly see, I’ve seen it a number of times as well, it’s truly astounding when you compare, you know, the traditional surgical repair of a triple A to the repair done endovascularly patients, you know, longtime in ICU, and as you said, up the following day, and you know, mobile and at this point, probably discharge. So I just incredible progress, as you think back to the course of all of this, what do you think, are the learning points that people should bring out of this? What is it that we’ve got? And you’ve learned over this? I mean, you’ve had enormous experiences pushing back against lots of resistance. What What should we take away?
Frank Veith
Well, go counter to human nature, don’t always accept the standards of the day as being being the truth, and challenge, current thinking. And then if what you do works, be persistent. And keep at it, don’t give up and don’t get upset when you get your papers rejected or your grants rejected, be persistent and be lucky.
Nick van Terheyden
Yeah, so to be clear, that the lock I agree with you, there’s there’s components of that, but you know, it’s being ready for that. And being in the mindset that continues to be open to those opportunities. You know, you continue to this day, and I think, you know, one of the legacies that you leave is, obviously the mentorship and some of the people that you’ve influenced over the course of your career, and continue to influence. And not just that, but also the delivery of the VT symposium, which cleverly uses your name, but I think is actually stands for something within
Frank Veith
an acronym has nothing to do with me.
Nick van Terheyden
Yeah, no, I, I believe you but millions wouldn’t. So what do you think? What do you think is the future as you look at the potential for all of this innovation that’s now taking place? I mean, we seem to have accelerated and and as I look back over the course of some of the things that you’ve managed to achieve, all of that seems pretty fast, but we seem to be going even faster. Where are we going now?
Frank Veith
Well, we’re gonna end up using artificial intelligence, more slicker computer technology, to image the body and the vascular tree without using radiation. So one doesn’t get cancer from being overrated, lose the hair, on one’s arm, and so forth. So I think for vascular surgery, the sky’s the limit, because new technology is opening up all sorts of new challenges. And even though the endovascular techniques worked very well, they also create a whole group of new problems that have to be solved. And some of the things happening today, by my younger colleagues and successors are beyond my belief, they can do things now that we never could have dreamed of doing. And part of it’s because of the constructive relationship, positive relationship between industry and medicine and doctors, which has been decried by a number of universities and politicians, etc. There have been some abuses, but by and large, the relationship between doctors and industry is a tremendous boon to society. And
Nick van Terheyden
so unfortunately, as we do each and every week, we’ve run out of time so just remains for me to thank you, obviously a tremendous privilege and opportunity for me to get to talk to you here a little bit about some of the history that you’ve managed to create and make for the benefit of medicine vascular surgery, and You know far beyond Frank thanks for joining me today
Frank Veith
well it’s been a real pleasure and a privilege for me to to be with you thank you so much
