What if the way you think about your health is already outdated? Medicine is shifting fast from reacting to disease to catching it earlier, treating it more precisely, and in some cases, preventing it altogether. So what should you be doing now to stay healthy? And when it really matters, how do you know you're getting the best care? Hi, everyone. I'm Lynn Toman, and this is Three Takeaways. On Three Takeaways, I talk with some of the world's best thinkers, business leaders, writers, politicians, newsmakers, and scientists. Each episode ends with three key takeaways to help us understand the world and maybe even ourselves a little better. Today, I'm excited to be with Dr. Tom Mahalchevic, President and CEO of the Cleveland Clinic, which is consistently ranked one of the top hospitals in the world and widely seen as a standard center for patient care and medical innovation. Tom is a heart surgeon, and he's helping shape a very different future of medicine, one that could change how all of us think about our health. Welcome, Tom, and thanks so much for joining Three Takeaways. Delighted to be here. My pleasure. When you look at healthcare today, what's already changing patient lives and what's coming next? Well, there are so many breakthroughs in healthcare, so it's difficult to summarize them in a few sentences. But just to start with a few that I think everyone should be aware of, our strides in taking care of patients with heart disease over the last 10 to 15 years have been in an enormous. So very few people today die from heart attack, certainly in much, much smaller numbers than they're used to in the past. We are really transforming cancer and a cancer diagnosis from a death sentence into a chronic and manageable disease. And technology that we're having today is really helping us to take care of ourselves better and to advance the health, not just individually, but also the health of nations and health populations. Personalized medicine sounds promising, but when will patients actually feel the difference? Some patients are feeling the difference already. Going back to the example of cancer care, most patients in the United States, in particular, being cared for at the large, renowned institutions, will have the sample of their cancer analyzed, and we will have the genetic print of a cancer. We will know a specific genetic print of the host of the patient as well. And then we will choose individualized treatment for that type of the cancer and for that particular person that is typically more effective and less harmful to the patient. So individualized medicine is already here. That's so exciting and wonderful for patients. You're working with big data and artificial intelligence and with the company Palantir Technologies. What does that change for patients? It changes a lot for patients because in order for us to take good care of patients, we need to know so much more about them than we thought was necessary even in a relatively recent past. Just like anything in our lives. We rely on the big data to guide us, in this case, in patients' treatment. We now can aggregate and agglomerate the long medical histories, years of treatments, hundreds of blood tests on an individual patient's understanding exactly with digital technology what is the best next step in their care by aggregating all of the data, which would be impossible for a single physician to do effective. 15 years ago, let's say if a person were to come who suffers from diabetes for their care and for their checkup, we would need to draw the blood, analyze glucose, blood sugar levels, and then make a decision whether to increase or decrease the amount of insulin that a patient has received. Today, we can take a look at all of the glucose levels on that particular patient over the last several months or years. So we much more informed about the way how to treat those patients because we know what does a patient respond to how have they responded to it in the past Technology is changing everything and data are essential When everything works the way it should, what does great care actually feel like for a patient? The great care for a patient would be, firstly, one that is easy to access. It is still a big challenge for most patients to actually get to a healthcare provider. So the ease of access would be one. The second would be the tailored approach, meaning if I have a chronic condition, I would really like a provider to understand a lot about me and to tailor the treatment to my specific needs. And lastly, obviously, it would be a healthcare that would be associated with a better long-term outcome so that we can live longer, but not just live longer, live healthier. We hear a lot about less invasive procedures. Are we really moving toward a world where major surgery becomes rare? There's absolutely no doubt about it. As you mentioned briefly, I used to be a heart surgeon. That's my profession, original profession. Now I'm much more responsible for the running of our healthcare system. But I can share with you the transformation that happened in heart surgery. When I began with my training 25, 30 years ago, every patient who needed, let's say, a heart valve operation had to have a big incision on the chest, stay in the hospital for a week or two, a long recovery, painful. and for many elderly patients the surgery was not an option even if they needed it because it was just too invasive. Today we can replace very many valves in the human heart without any cuts on the skin of the patients. We can do it with the catheter and the patient is not staying in the hospital for a couple of weeks they're just living on the following day or at the same day of the procedure. Wow, if you're healthy today, what are the three things you would do right now if you wanted to stay that way as long as possible? There are no secrets about what needs to get done in order to stay healthy Nutrition is extremely, extremely important The second thing that is always important to keep at the back of my mind is activity, physical activity and exercise And the third one is sleep So good nutrition, plenty of physical activity, paying attention to sleep. And then there is another thing is an avoidance of the habits that are not healthy. Minimize the alcohol, no smoking, obviously drugs, poor food, and lack of sleep. I mean, those are the habits that are not associated with the long and healthy living. What is one number or signal about your health that people should know? There's more than one. For us, it's really because there's more than one signal of bad health, and some of those signals are not immediately apparent to a person. It is really, really important that people see their healthcare provider frequently. And in particular, as we age, that becomes much more important. So really, really paying attention to the regularity of your physical visits. I always tell to my colleagues, my friends, family, I say if there is one recommendation that I would give to anyone, do make sure that you do your comprehensive health exam. We call it here at the Cleveland Clinic, executive health is very effective because typically in a day, day and a half at the clinic, We can really assess the patient, not just through one provider, which is usually a general practitioner, but through the entire team of different specialists and give a person a comprehensive insight into her or his skulls, and then it's a pair of on-imports. Most people wait until something goes wrong. How much of what we call disease is actually preventable? Most of it is very preventable. with an exception of genetically caused disease. But most of the diseases of modern era are very much preventable, and they're preventable by maintaining these healthy habits that I mentioned. And for most people, the biggest challenge is maintaining the habits, meaning having a consistency of healthy behaviors over time. I mean, it doesn't mean that a person, you know, shouldn't occasionally have three scoops of ice cream or, you know, lunch pizza. I mean that is not going to be detrimental But the overall behavioral patterns healthy patterns need to be maintained over years to really result in a predictable good health Many people today rely on annual checkups. Is that enough or what should people be doing instead? No, I think it is enough. It is a wonderful starting point. And, you know, what is included in the annual checkup, that changes over time as it should. For example, we have screening mechanisms for different cancers or different conditions today that we didn't used to have in the past. We have very many well-established screening practices that one needs to pay attention to. For women, one example, breast cancer. Obviously, screening exams are really, really important. For men, it is typically prostate and a prostate cancer. For both genders, cardiovascular disease. So the answer to your question is, regular annual checkups are important, but what is even more important is what's included in them. I would advise people that at least once every five or six years, depends upon their condition, that they do their annual checkup in a larger healthcare organization, where that checkup is not going to be done by only one provider, but by a team of providers. because today it would be unreasonable to expect any single general practitioner to have a comprehensive knowledge about every disease entity that one needs to pay attention to. What's one question that every patient should be asking their doctor but almost no one does? Probably the most important thing that one needs to ask is how much does that doctor or their team, how much experience do they have in the treatment of this condition? And what is to be expected if that patient went to trust them with their care? The reason why that is not frequently asked is because for most patients, it is an uncomfortable question to ask. If you're seeking help by someone, to ask them about their qualifications to help you, it's kind of a difficult thing to do. But when it comes to general health, it's relatively easy. But if you've got a person where you need a complex surgery or a complex intervention for life-threatening disease, I will definitely ask about the experience of the team. And every provider, they are very much attuned. They know what their outcomes are, and they're going to give you a straight answer. When it comes to screenings and blood tests, where are we under-testing and where are we over-testing? We are under-testing for sure in almost all cancer screenings, just speaking on a population level. So a lot of cancers in particular could be prevented if people were to adhere to regular screening guidelines. In the United States, generally, let's say compliance for cancer screening for one of the more frequent cancers, like a colon cancer, is only about 30%. So 70% of our population does not undergo regular cancer screenings. Breast cancer, I believe it's about the compliance is higher, but not much higher. That's really something that is underutilized, are the screening procedures. What is overutilized in the United States in general is the use of the emergency room as a primary portal for healthcare delivery. And the reason for it is, as you said so nicely at the very beginning, very many patients do not act on their health until something bad happens. Many do not act on their health until whatever bad happens is not really bothering them a lot. And then the first destination becomes an emergency room. While that is appropriate for emergencies, it is not an appropriate site and not effective way to use it for the treatment of chronic diseases that are being neglected. I think we are over-utilizing our emergency rooms and we should much more utilize our primary care physicians and use our doctors to prevent the complications instead of acting on them only when they have already occurred. Stepping back, when you look at health care today, what's already changing patient lives and what's coming next? Well, there's a lot that is changing patient lives. I mentioned the advancement in cancer care and the advancements in cardiovascular care in particular. So this is a tremendous, tremendous impact on patients' lives. vaccinations have eliminated essentially many diseases that were just lethal only 50 60 70 years ago So that is going to be extremely extremely helpful What's coming next? I think we're going to have even greater breakthroughs in the treatment of cancer. An area that we are particularly focused on is brain health. One of the rising public health threats, as we've kind of, are living longer because, you know, we've not eliminated, but we have made cancer and heart disease less dangerous, so people live longer. As we live longer now, the new phenomenon of our population growing older is degenerative brain disease, dementia, Parkinson's disease. That is now becoming so, so common, and I'm sure everybody on this podcast knows somebody or a family member who suffers from dementia, and we really do not know what causes it. We do not know how to treat it effectively. There is actually very few, if any, therapeutic modalities available, so we are putting a lot of effort in investigating the reasons why dementia develops in the first place. How close are we to catching diseases like cancer or heart disease years before symptoms show up? Oh, we are already there. Genetic screenings for breast cancer. You know, today we know that if a woman carries a certain gene or gene mutation, breast cancer mutation, they're much more likely to develop certain types of cancers, not just breast cancer, but sometimes breast and ovarian cancer. So in that case, we can treat a patient ahead of time. So many people have underwent prophylactic, meaning earlier removal of their breast tissue just to prevent themselves from developing the cancer because the likelihood over a lifetime goes up to 70%, which is really, really high. The other thing that we're doing is we're actually developing a new vaccine against certain types of cancer. So people will be able to be vaccinated if they belong to high-risk groups. And those vaccines would create an immunity against the cancer type. that they may be susceptible to. So we are trying the breast cancer vaccine for the most dangerous and most lethal form of breast cancer. For example, for heart disease, the calcium screening, for the first time, we have a method where we can take a look at the status of the blood vessels on your heart. And those blood vessels, if they get clogged, do they cause a heart attack? So in the past, the only way to look at it is actually to have the procedure done, what's called the catheterization, when we have to inject behind those vessels. But today we don't have to do any procedures. It's a two-minute CAT scan. You can take a look at your blood vessels and tell you whether you have any evidence of calcium, meaning thickening in the blood vessels or not. And those type of tests can warn us about the development of disease years, years before it really starts causing trouble. So exciting. Tom, what are the three takeaways you'd like to leave the audience with today? The first recommendation, keep your healthy habits. Your health is really in their hands. Healthy living is something that we can influence, something that can be really affected in a positive way. By healthy eating, physical exercise and a good sleep will keep doctors away for a really, really long time. The second one is make sure that you see your doctors at least once a year. You make sure that you have a comprehensive evaluation of your physical health in a larger system. And the only third thing that I would say, as any doctor would say, just stay away from bad habits. As simple as that. Tom, thank you so much, and thank you for the great patient care at Cleveland Clinic. Thank you very much. If you're enjoying the podcast, and I really hope you are, please review us on Apple Podcasts or Spotify or wherever you get your podcasts. It really helps get the word out. If you're interested, you can also sign up for the Three Takeaways newsletter at threetakeaways.com, where you can also listen to previous episodes. You can also follow us on LinkedIn, X, Instagram, and Facebook. I'm Lynn Toman and this is Three Takeaways. Thanks for listening.
