Cardiothoracic surgeon Todd Rosengart, M.D., discusses his career as a medical problem-solver
Cardiothoracic surgeon. Serial entrepreneur. Inventor. All of these titles apply to TODD ROSENGART, M.D. In 1997, he was part of the team that performed the world’s first viral-based cardiac gene transfer procedure. Later, Rosengart co-founded Vitals.com, a website that allows patients to find and rate doctors, and then XyloCor Therapeutics, a startup that aims to use cardiac gene therapy to treat patients with end-stage coronary artery disease. A professor and chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine and a professor of heart and vascular disease at the Texas Heart Institute, Rosengart also holds 12 United States patents.
Q | What motivates you to create?
A | I’m definitely a ‘let’s fix it’ type of person and I want to make a difference. The work that I do on behalf of the department or the college—from fixing someone’s heart or helping other surgeons—is very important.
Q | Why do you think you became a medical problem solver?
A | My dad passed away doing exercises when I was 16—from a heart attack. I came home from high school one day and there were ambulances in front of my house on Long Island. This is 1976. Bypass surgery is still relatively new. Even though my dad was a recently educated physician, an obstetrician, the news had not gotten to him—or at least in a way he understood—that he probably could have had surgery and be alive today. Somehow, that was a disconnect. Subliminally, that concept of making sure people are well-informed has been very important to me.
Q | Is this why you chose to become a heart specialist?
A | Subconsciously, because he died of heart disease, I thought I was going to be a cardiologist. I’m a big believer in serendipity. My mentor at Northwestern was the chief of cardiology Michael Lesch, M.D., who co-discovered Lesch-Nyhan syndrome [ juvenile gout]—and he said: ‘You’re going to be a great cardiologist. I want you to spend the summer at NYU.’ It was all a mistake because I did this as a second-year student and, typically, you don’t do a clerkship until you’re a third-year student. It took about a month before they figured out that I didn’t belong there, at which point I’d really become a member of the team. By the end of the summer, I said: ‘I love these surgeons. They’re so cool. They do great things.’ I went back to Northwestern and told Dr. Lesch I was going to be a heart surgeon rather than a cardiologist. I ended up going to NYU and starting my career there.
Q | How did your interest in fixing things lead to entrepreneurship?
A | Operating is phenomenal, but being able to do something that helps many, many people with the same effort is really cool, too. When I was at Northwestern, one day I got a phone call—this is before Facebook and before cell phones—from an uncle who needed a cardiologist. I gave my uncle a name and I thought: ‘This is so crazy. If my uncle had not called me, he would not have had access to good information about a good doctor. Why is this?’ I helped start this company called Vitals.com. We created this website that had information on physicians all over the country to better communicate with people. It’s very frustrating when people are forced to make decisions without information that should be readily available to them. So many bad things happen because we don’t communicate well. It’s been a very significant element of what I’ve tried to do, though I’m not really involved in Vitals anymore.
Q | How did you decide to focus your website on the patient perspective?
A | When we were doing Vitals, my partner— who is a business guy—said we were going to get the patient perspective. I said: ‘The patients don’t understand; we need the doctors’ perspective.’ I allowed my partner to convince me I was wrong and it turns out the patient perspective, in many ways, was more valuable than the doctors’ perspective and that’s the way we ended up doing it. At its peak, Vitals.com was getting about 15 million visitors a month. The value was the patient perspective. We were early to the online reviews.
Q | Can you describe your work with gene therapy and heart disease?
A | I was a junior faculty member at Cornell [New York-Presbyterian Hospital and Weill Cornell Medical Center] and we were doing this work with gene therapy and having the heart grow its own bypasses. We had no business thinking about injecting a virus into the human heart or doing cardiac gene therapy. No one had ever done it before. But we said: ‘Why not?’ We were the first ones ever to treat someone with gene therapy for heart disease. I was 38 at the time. It’s something I talk to my residents and students and junior faculty about. Believe in what you’re doing; have a little bit of temerity to go beyond where you should be and persevere to do it. If you feel like you’re doing the right thing and you’ve done your homework, don’t be shy about persevering on it. We are now ready to start a new trial here in the Texas Medical Center—same work, taking it to the next level 20 years later.
Q | What’s the advantage to the body growing its own bypasses?
A | For some patients who have advanced disease, typically because they are diabetics, there is nothing we can offer them [to restore blood flow to the heart]. They are literally incapacitated with angina or chest pain. And when we do bypass or angioplasty, often we can’t revascularize or get good blood flow to the whole heart. We know statistically that patients who don’t get adequate blood flow to the entire heart won’t do as well. This gene therapy can be used as an adjunct to standard therapies like bypass or angioplasties. About two years ago, I was at a Texas Heart Institute transplant review board and these patients had such incapacitating angina that they were candidates for heart transplants. They were going to take this poor person’s heart out with perfectly good function. This is an alternative.
Q | What’s the latest on XyloCor?
A | In a couple of months, we will be treating patients with end-stage coronary disease.
Q | Is the clinical trial for patients to grow their own bypasses ready to go?
A | Yes. We are finalizing approvals. We have FDA approval. We have independent review board approval. We are hoping to do our first patient here at Baylor St. Luke’s before the summer.
Q | You lead hundreds of people at Baylor. How do you approach running one of the nation’s largest surgery departments?
A | We have 150 faculty, 130 trainees and staff. What I love about being the chairman of the department with so many wonderful people is that everyone becomes a force multiplier. To help everyone become successful really brings me joy. I give out the book Team of Teams by General Stanley McChrystal all the time. I love what he said: He is an enabler. He is there to make it possible for everyone else to do what is within their ability as a servant-leader. It’s the first book I underlined in 30 years. He talks about empowering people, disseminating information, giving everyone a voice and giving people the ability to get done what they want to get done. What I love about the TMC—and it’s the first thing I talk about when we are trying to recruit someone—is that everyone supports each other here. If Jim Allison wins the Nobel Prize at MD Anderson, I am proud of that. That’s rare. You don’t see that in New York and Chicago. It’s a zero-sum game in many places, unfortunately.
Q | Was there any moment that crystallized your view of Houston?
A | I had not experienced anything like Hurricane Harvey. I did not fully appreciate what happens. When I heard over that weekend that the department and everyone else had already established ‘go’ teams, I said: ‘What?’ People took it upon themselves to say: ‘I am here for the duration.’ They did it without being asked and they did it without being expected to be thanked or recognized, which is amazing to me. In the next thought, I said: ‘Well, of course. That’s what this place is all about.’ That’s what you have to love about Houston and the Texas Medical Center. We’ve recruited 120 faculty and that sense of collaboration and collegiality comes through.
Q | November marked six years since you arrived in Houston. You’re an empty nester. What do you do for fun or outside of your various professional pursuits?
A | My son, Eric, is 25. He is in New York—in real estate. Michael is 27 and he’s a clerk for a federal district court judge in Tampa, Florida. It’s a tremendously rich time with my wife, Debbie. We golf together. We have two dogs that we love and that we walk. Truly, my comfort zone is work, but we travel and see friends and family.
Q | You turned 59 in January and have a trim physique. What is your personal health regimen?
A | I was never a big believer in training until I started doing it. Now I realize: How could you not? I do an hour in the gym two or three times a week and eat well. My dad died of a heart attack, so I am careful on that. One of my other hats is that I am president of the Society of Surgical Chairs. We have a major national initiative to ensure the well-being of physicians as we get older in terms of our cognitive function. We are actually going to try to launch a national campaign to teach physicians how to take care of our cognitive aging. The physician workforce is growing older and there is a shortage of physicians. We want to make sure we train those physicians in their cognitive health when they are 50 or 60 so that they can continue to contribute. I also play backgammon to take care of my mind.
Q | What’s on the medical horizon that excites you?
A | I think we are at an inflection point on how we take care of each other and how we take care of our patients. Between artificial intelligence and genetic engineering, I think we are going to live decades longer. I think we are going to live healthier. I think we’re going to look back on how we take care of patients in 10 years and say: ‘What were we thinking?’ It’s just very primitive. I think artificial intelligence will play a major role in diagnosis and picking treatments. We now have computers that can give us an early warning of sepsis that is completely changing the mortality risk of critically ill patients. That is very simple and yet it’s been a game changer. I think in the next five years we will expand that to 80 or 90 percent of diagnoses and treatment. It’s both scary and wonderful, which means the role of the physician is going to change dramatically. It is impossible for physicians now to really keep up with all the guidelines in evidence-based medicine and the computers are going to do that. But, just like the pilot monitoring autopilot’s takeoff and landing, we’re going to be there to make sure that it all fits and that our patients, as human beings, are comforted and supported and helped in the decision-making—which a computer is never going to be able to do.
Todd Rosengart, M.D., was interviewed by Pulse assistant editor Cindy George. The interview has been edited for clarity and length.