Welcome to Becker's Healthcare podcast. I'm Mariah Taylor,
assistant editor, and I'm thrilled to be interviewing
Stuart Goldman, chair of the department of children
health and senior vice president of research at
Phoenix Children's and the University of Arizona College
of Medicine Phoenix on the podcast today. Doctor
Goldman, thank you so much for being here.
I'm so excited to dive more into the
pediatric
pediatric research you're doing and everything that that
has produced.
But before we get into my questions, I
would just love to take a second for
you to introduce yourself and tell us a
bit about your background.
Well, thank you. I'm also really excited to
be here and to really talk about not
only the wonderful things that are happening at
Phoenix Children's and the University of Arizona,
but in pediatric research in general.
I am a pediatric hematologist
oncologist
who for the last
35 years has practiced pediatric neuro oncology. I've
become a brain tumor specialist.
And I was originally at the University of
Chicago where I trained and stayed on as
Faulk Brain Tumor Center,
ultimately becoming the division head of Hematology
Oncology,
Neuro Oncology and Stem Cell Transplantation,
the longest division name ever created.
And then in April of 2021,
I moved to Phoenix Children's Hospital in the
University of Arizona
where I'm here to really witness
firsthand
the growth of an academic powerhouse
and
an institution that gives the best care to
children throughout the state and our region.
That's amazing.
You have such a deep background in pediatric
research. And so I'm wondering what are some
of the current gaps in pediatric research within
health systems?
Well, I really think that we're in a
critical time for the future
of pediatric
research.
And when you think about
some of the amazing things that have happened
due to notable
pediatric scientific achievements,
for example,
it was pediatricians
that developed the Haemophilus influenza
Type B
treatments
and gave us eradication of that invasive disease
in many, many ways.
It was pediatric
pediatricians and researchers who developed
and eliminated
phenylketonuria
in congenital hypothyroidism by doing congenital screening. It's
thyroidism by doing congenital screening.
It's pediatricians that help reduce the risk of
sudden infant death with back to sleep and
safe to sleep.
It's pediatricians
banding together
to treat rare diseases for my beloved children's
oncology group where we now have more than
90%
of kids with average risk leukemia
surviving and being cured.
And not to even mention the changes we've
made in life expectancy
with children and adolescents with cystic fibrosis,
sickle cell disease
and not to mention how we've decreased the
risk of transmission of HIV from mothers to
infants to now less than 1% of birth,
all through the really
intensive work of pediatric researchers.
But
I said this was a critical time because
right now, if you look over the last
few decades, less and less
physician scientists are going into the pediatric research
field.
And that's really multifactorial
from the lack of funding to support folks
to the lack of time and mentoring. In
fact, here at Phoenix Children's and the University,
we've developed
a cohorts
of
young,
scientists who are just finished their training to
be mentored in research
of clinical,
translational
and how to develop that research career because
it is becoming so and so difficult.
And really another issue is the partnership between
hospitals and academia. And that's one of the
things that really made me feel lucky to
be here at Phoenix Children's is this great
partnership we have between the university
and the hospital system.
So there are some real, real changes here
that are worrisome.
In fact,
I know
just to mention the fellowship match for the
20 5, 20 6 year just happened this
last week
and actually
3 37
spots were unfilled, that's 36%
of the programs. And if you think
about
specifics
like Peds GI,
31% of the programs went unfilled,
there was 99 positions filled, 23%
23 until that's almost 19%
nationally.
HemOnc even more
concerning nationally,
31
of the
77 programs did not fill and 21
0.6 percent of the national positions
went unfilled. And I'm very concerned as I
think many of
the physician leaders about the future of our
academic
and research
due to these trends.
Absolutely.
What do you think systems can do to
create a strategy that brings in more of
those senior and junior investigators to their communities?
And how can they get buy in from
the C suite leaders?
Well, I think
we should never forget that
I reject that the C suite is different
than your practicing physician,
different than your academic institutions. We're all really
here for one thing and that's to improve
the lives of the children that we are
so honored to serve,
children we have served in the past and
those will serve in the future. And so
I think we're
really all trying to get to the same
place. There are competing interests, of course, right?
We need to make sure that
institutions stay financially sound.
As in my old institution, I heard many,
many times no margin, no mission.
But one of the things we can do
is
we need to advance clinical excellence and innovation
through the recruitment of these physician researchers and
surgeon scientists.
And I think that that speaks not just
to us as scientists, but to our C
suite because
bringing in these people
leads to more collaboration
and innovation
and helps to attract the very best physicians
in health systems. And
in my own institution, we've had
tremendous buy in from our CEO
who wants to make sure that we're doing
this in a rigorous fashion to really return
benefit to our patients and our community
by bringing in really good researchers and training
and
retaining
physician scientists for the future.
I can't speak enough about the importance of
mentoring so that not only do we make
this investment
in teaching our young folks how be physician
scientists, but then encouraging them to retain
this skill
and to go on forward even fighting with
all the lack of federal funding
that is so difficult for us.
Absolutely.
Now it seems that your system is kind
of at the top of things when it
comes to pediatric research. So I'd love to
know what are some of the advancements that
you've seen at Phoenix Children's Research Institution,
and what has changed or what has that
done to change patient outcomes or care?
Well, I think we can talk about
things where
we have an immediate impact
and where we have an impact that's going
to change for generations
to come. You know, we've really
between the collaboration
between Phoenix Children's and with the support of
our C suite that you just mentioned
and the academic
our partner, the University of Arizona and the
Dean, we developed what's called the Phoenix Children's
Research Institute at the University of Arizona,
capitalizing
on making sure that we combine our partnerships
between a university institution and a strong children's
health system.
And that's really allowed us to recruit some
of the top scientists from around the country.
And I'll just mention 2 things just briefly
that those top scientists are doing. You know,
Doctor. Kalinichenko
in the American Journal of Respiratory and Critical
Care Medicine last year published a really seminal
paper
where he was able to take
a mouse's
genes and put them into a blastocyte and
then actually grow
a mouse's lung in a rat. And when
you think about that, that's going to lead
down the line growing children's lungs in an
animal model so that we can have proper
transplantation
for those premature children who have their lungs
affected by the necessary treatments to keep them
alive when they're young or children who had
other conditions that hurt their lungs.
Another one of our recruits, Doctor. Callan,
just published in the last year an exciting
paper I believe in EMBO
and this really showed that we always think
that
cancer cells spread because they we want to
block those blood vessels and starve the tumor
cells. But we found through some mechanisms like
FOXF1 that maybe
what we want to do is increase the
blood flow to those tumor cells to stop
metastatic potential. And this has really been shown
in her model for
lung cancers
and childhood tumors that metastasize
to the lungs. These are
findings in an animal models that are going
to down the line change the future.
But we're currently doing real time research that's
changing the lives of children from Doctor. Sitzman
and his craniofacial
team who are really making
tremendous changes in the care of kids with
cleft lip and palate,
helping them to get good nutrition early on
and have adequate feeding.
You know, I can go on and on.
Doctor. Kreuer and his work
with kids with different types of movement disorders
and cerebral palsy and looking at individual genetic
causes and how we need to treat them
differently and find answers.
So there's so much going on. You know,
I'd love to brag and tell you that
we have over 700
studies in different areas, almost 150 I'm currently
accruing from the spectrum of cancer to kidney
disease to development
to avoiding
social behavioral problems. And so
the array of what we're doing is really
exciting. And I have to tell you, even
though
I'm at the farther end of my career,
I've never been more excited about the future
of research
and what pediatricians will do to change the
world.
I love that. So, let's talk about the
future. What's coming up next in pediatric
research?
Well, you know, that's
one of the really difficult questions because
when you think you know the answer, you
might be closing your eyes to some new
fields. But I do see
understanding
individual
differences,
you know. Why is it that
2 kids, the same weight,
the same age,
the same height,
one takes
25 milligrams of Benadryl and it's the appropriate
dose, let's say, and falls fast asleep and
the other ones running around like they're on
fire because we have different
pharmacogenomic,
pharmacodynamic,
pharmacokinetic
differences.
And so this leaves us this whole idea
of precision medicine or what I really like
to call individualized medicine.
Understanding
our genetic makeup and how we interact with
the world and how we can best individualize
the therapy to give the best outcomes with
the least amount of toxicities.
And we need to do that for so
many diseases.
And there's so many things that we can
do to impact the world. So I see
the difference with genomics,
precision medicine
and really excitement over some of the changes
we can do for behavioral health to affect
our health of our children and families.
Amazing.
Well, thank you so much for sharing some
of what you're doing over there in Phoenix
and for all of your expertise and your
hard work for patients.
It's been absolutely a pleasure talking with you
on the podcast today.
Thank you so much.