Leaders in Cardiovascular Research: Valentin Fuster

Watch the interview here:https://youtu.be/6pF7ChiylGE Biography: Dr Valentin Fuster is the Physician-in-Chief of Mount Sinai Hospital, Director of Mount Sinai Heart and Director of the Zena and Michael A. Wiener Cardiovascular Institute. He is also Editor-in-Chief of the Journal of the American College of Cardiology (JACC). Q: What is your secret for success in science—is it ambition, or talent? It is a matter of motivation—of curiosity—and this must be sustainable. I received an award in my first year of studying medicine to go to a seminar led by neurologists. I left 2 days later saying, ‘I want to be an investigator’. I do not think it is a matter of ambition. My ambition over many years has been to stimulate the minds of young people. At the beginning of your career, there is a sense of survivorship; you must publish papers and so forth. Later, you will rarely see my name as first or last author on a paper, because I think you have to promote young people. Q: What would you consider your greatest achievement so far? I am a rather obsessive investigator, and I progressively learn new technologies to get answers to concepts that began years ago. From platelets and Aspirin in arterial disease and CABG (first cardiac trial on aspirin); to the vessel wall with MRI (first study at autopsy); to PCI stenosis prevention with Rapamycin (first study in pigs); and to both CABG vs. PCI in diabetic multivessel disease (FREEDOM Trial). Now driving seven projects, in terms of scientific bases for promoting health, that all started in about 2005/2006, addressing heart & brain. So always following the concepts I get towards the root of the problem. I would not call this success, but I would call this method. I was trained with the Jesuits and I learned to work with a very strict method there. This has been essential for my career. You don’t jump from topic to topic just for the sense of it. You work step by step. I think, if I have any success, it has been in the consistency—in the way that I evolve. Q: Can basic science compete with clinical research for the attention and appreciation of the public? It is very difficult for the public to perceive basic scientists as such unless a practical clinical breakthrough is involved. Today, we work as a team. I tell young people that you may have all the ambition in the world, but if you are not able to co-operate with people, it is not going to work. I started with basic science myself. Today, I am not doing basic science but I have colleagues that are and we are all part of the same project. In a way, it is the team that really counts now, rather than the individual who is doing basic science. This is what we are trying to develop in Madrid, at the National Centre of Cardiovascular Investigation where basic science and clinical delivery is applied with the sense of a team effort. Q: What do you think is the most promising and the most exciting development in recent years? Artificial intelligence has a great future, I believe, but how will we use it and what is the human aspect that is involved? However, I am somewhat concerned because it is technology rather than the patient that is absorbing the attention. Scientists look at thousands of molecules and they will tell you what is happening when, in fact, presenting symptoms derive from his/her emotional status. Technology needs to be in the context of a human being. In this context, we must pay attention to how we are training young physicians. Q: What does the Journal of the American College of Cardiology (JACC) mean to your life? My philosophy is very simple. Insightfulness with simple thinking. This is what I try to do in JACC. For example, I do an audio recording of every article that comes out every week. I do this for two reasons. One, in a small part, is that I really learn. Science advances so rapidly and to be a part of that is an exhilaration in itself. I read each article and then I say what I think. Nobody is telling me what to say and what not to say, a sense of freedom. But most importantly, is that communication today is so different. People do not read as much, they do not have time to read. You must make a journal that can communicate in different ways compared to the past. Q: Given that we publish many things that are difficult for the layperson to understand, do you think journals can have a medical societal impact? I believe that one means of impact will be to try to get into clinical matters that you approach from a more basic science angle. What the readership is going to look at is the translational aspect. I think this is becoming integrated now. And in the future, it will be difficult to distinguish basic science from the clinical. When I took over JACC, which is a clinical journal, I decided that, of the five articles published every week, one is a basic science article and it is translational. Then, we have a new journal that is translational. We are moving to this integration of the two and we are going to see less and less ‘schizophrenia’, I would say, between the basic science and the clinical in journals. Q: What do you think is the weakest aspect of methodology that we see in papers coming from basic science and clinical research? What are the weaknesses that people should try to avoid? The statistics. I think everyone should have had a basic course in statistics. Many look for the P-value. For example, what is the impact if you decrease the relative incidence of an event from 2% to 1%? You call this 50%, but it is very different from a change of 40% to 20%. At least in JACC, half of rejections are based on a questionable statistical level. In basic science, one of the problems I see is that there are times when animals receive medication at a dose which is super-human. I would call this somewhat questionable because you may drive research into an area based on animal models, when in fact the drug that you used is so out of dose context when you introduce it into humans. Q: Changing the topic almost completely, who is Dr Ruster? I started being an advisor to Sesame Street—this is the educational programme for children, which is very successful across the world. I began to see a possibility that we could move into that age group in terms of affecting health. One day at the headquarters of Sesame Street, I arrived and the door was opened by a muppet who said ‘I am you. I am Dr Ruster’. This muppet has now been tested in Spanish languages. It had a significant impact in children to see the Cookie Monster become healthier, thinking about whether the heart is on the right or left and to see a movie of the Cookie Monster performing cardiopulmonary resuscitation. Q: So, what is your next ambition? My ambition is to keep moving and to continue to do what I must do and stimulate the minds of young people.