Bill Tierney
===

Vince: [00:00:00] We had a wedding in early May from, uh, two, the couple is from Indy, lives here, but they were getting married down in Jacksonville, Florida. So we've known the groom for a long time, indirectly kind of known the bride, um, for a while and her family. I don't know why I didn't make the connection, but I didn't.

And so we go down there and I had like a day or two of work before. The wedding weekend, anyway Friday night they have like the rehearsal dinner and a bunch of obviously everyone's pretty much out of town. We're all there and hanging out and I'm just sitting there and I just happen to look up. All of a sudden, I see Bill and his son Ryan.

I'm like, what the hell are they doing here? So I yell out and Bill's like, um, that's my niece. Brian is my niece. Oh, wow. My sister's daughter. Okay. But her last name's Owen, so you wouldn't have made the connection. True. Yeah, correct. But that was, you talk about a small world, all of a sudden you guys are.

It's [00:01:00] not like you're at a restaurant in Indy, or you're in Florida, or you're heading out. Well, no, but is that, is that the, you know, Indianapolis, we like to say is two ways back to Kevin Bacon, instead of seven in New York City. And so that was just basically taking Indy, moving it down to Jacksonville for a weekend.

True. That was the same thing there. Because there were multiple other people there who, again, probably shouldn't surprise me that they were there, but there were several people there that we knew. It was wild. It was a good, it was a good weekend. I agree. Um, Ron, I'm not exactly the, the biggest guy to go on the dance floor.

Not shocking. I know. Okay. Um, but, but Ryan took, took my spot. And so Cindy, who likes to go out and dance, and then I had someone to. You had someone to, uh, pass that off on. Nice. Nice. Outsourcing your dancing. I like it. There's an app for that, right? Yeah, I'm sure there is. You have moves like Plymouth Rock.

Yeah, exactly. Right. That's about right. Um, and then, of course, a couple weeks later, we had Indy 500 and, um, Bill has [00:02:00] joined the Todd clan at the Indy 500 for At least a decade out of that. But I was only, uh, like five, less than a week post op from my prostatectomy, then I wasn't in any shape to go. Yeah, yeah.

That would have made a long day. Yeah. But, next year, hopefully you'll be back in the saddle. No pun intended Okay, yeah, all right, well let's roll into it boys sounds good, okay Hey

guys, welcome back to another episode of this summits podcast Thank you all for joining us from wherever you get your podcasts or if you're checking us out on the heroes foundation YouTube channel Thank you for doing so while you're at it. If you hadn't hit that subscribe [00:03:00] button, please do so with that little bell notification icon too, so that you can be alerted when new episodes like this one drop, we would greatly appreciate it.

It doesn't cost you a single penny. Uh, today we are very, uh, privileged to have a guest, Dr. Bill Tierney. Um, I'm, I had to write all this stuff down because A, I wouldn't memorize it and B, I don't want to, I don't want to mess any of this up because he's got a long and, um, prestigious career and I want to make sure I get all this right.

Um, so. I don't want to make him blush here, but his current title is Associate Dean for Population Health and Health Outcomes at the Fairbanks School of Public Health in the Department of Global Health. Bill Tierney is an internationally recognized for research in biomedical informatics, health services and clinical database epidemiology.

All those words would never be used to describe me. [00:04:00] So, clearly the IQ in the room just went up immensely. As I'm, as I'm kind of lagging all of us behind. But, uh, Dr. Tierney, welcome to the Summit's podcast. It's fun to be here. Thanks, Vince. Um, it's our, it's our honor. Why don't you, um, Provide our listeners and viewers a little background yourself.

Okay. Well, I was I'm 72 now. I was born in 1951 in in Detroit lived there only six months moved to New Jersey and was there for the next 16 years And then moved, Indiana. I've been here ever since I went from being a surfer to being kind of a Uh, you know, cornfield surfer, um, uh, and, uh, I went to Indiana University as an undergrad.

In fact, I entered Indiana as an undergrad in 1969 and I left in 2015, so 46 years later. Wow. Um, so I went there, so I was an undergrad. I went to the IU School of Medicine. I did an internal medicine internship and residency at IU. I was chief resident [00:05:00] in internal medicine at, uh, was then Wishard. Hospital is now Eskenazi Hospital.

Um, I did a two year fellowship in biomedical informatics and health services research at a place called the Regas Reef Institute. Um, and I've been on, I was on the IU faculty from 1980 to 2015. When I took a five year sabbatical to help start a new medical school in Austin, Texas, the Dell Medical School.

And I was the chairman or the founding chairman of the Department of Population Health. Um. And I did that for a total of five years, started his department, and I did that. I never really moved to Austin, so I commuted there from Indianapolis, um, and, uh, that wore itself out after about five years. And so I moved back to Indiana with my current role in the School of Public Health.

Because of the launching I did from my. population health work in Texas. So I kind of bridged from being in a medical school to a public health school, but I actually am the br work is a bridge between the public health school and the medical school. Medical [00:06:00] schools are now getting much more into what's called the social determinants of health.

The problem is they're not trained how to deal with those things. That's what public health schools do. So one way of doing that is to, is to collaborate. And that my I work that interface between the two schools. That might be a separate podcast episode in and of itself. Yeah. Dealing with the various... A lot to say.

I need to be PC somewhere here. Dealing with the very, like, like any large corporation per se, you're dealing with a lot of different departments, a lot of different mentalities and fiefdoms and... So on and so forth. Yeah, but that's what I've always done. I've always done a, I've, I've done a number of things.

I've run a number of things, but my job isn't really to run the thing. I hire a staff person to do that. My job is to work the interfaces and look, create opportunities for people and do the, be in the, the facilitator and social networks between different schools, departments and things like that. And, um, I, that's what I find fun doing.

So that's the use. You know, I don't see that as being a problem. I see that that's what I'm skilled at, and that's what's necessary to do [00:07:00] multidisciplinary work. Yeah. Well, they're leveraging your experience, which makes sense. It's something you enjoy. They should be. I hope they are, anyway. You're teaching them how to listen, hopefully.

Whether they do or not remains to be seen. Let's backtrack a little bit. So... Growing up in New Jersey, then you come to Indy, how old were you when you moved to Indiana? 17, uh, 16. Okay, at that point in time, did you know you wanted to go to medical school? I've known since I was in junior high. Okay, and what would you say maybe sparked that?

I had a, um, a pediatrician. That, uh, that, that I just liked what he did, and I also like science, but I like the interpersonal stuff. So what could I do with science and interpersonal stuff, and medicine just became obvious to me. Okay. So I was, I was targeting that ever since I was in literally junior high school.

Right. Okay. Interesting. Um, what was your undergrad major in? Biology. Biology. Yeah, like everybody else. Yeah. Like everybody. And I do that now. I've never used it. It's [00:08:00] funny you say that, because so we had a guest not too long ago, Dr. Ted Brower, who's a, who's a dentist. Um, thought he wanted to be a physician, ended up switching when he was an undergrad at IU.

Very similar answer. Um, he was in, well, he was in dental school, so maybe it's a little different. But he said, you know, the one interesting thing was that amongst the, I don't know, 100 other dental school, uh, classmates, it wasn't all biology or chemistry. There was certainly a decent amount of that, but it was a, it was a much wider mix of, of it wasn't the case when I went to medical school.

It was mostly, mostly the, the hard sciences. Okay. And, you know, I've never used it. I've never had to use it. I, I, I'm encouraging people now, you want, you want to, to go into medicine then, yeah, you have to take those basic science courses and stuff like that, but you ought to major in something that, that's broader than that.

And if you're going to be working in medicine, unless you're going to be somebody working in a lab, which is a minority of people, you're going to need to have interpersonal skills. You're going to need to have a philosophy. You're going to be able to communicate with people. You're going to be, you're going to have to [00:09:00] understand things outside.

what you're taught within the confines of the walls of hospitals and clinics, you know, and so I would encourage people to get a public health undergraduate degree, you know, that's going to help you much more than knowing the Krebs cycle, which I had to learn four times and I still can't rattle it off, um, and never had to use it.

So I would encourage people to look at something else and be well rounded, and I think you actually will have a greater chance of getting admitted to medical school than if you are just kind of a straightforward chemistry science geek. Sure, yeah. Sounds like somebody else we know. Uh, Dr. Katie Todd, I think, I want to say, I should know this, my own sister, but I think she was public health and English, I think.

Okay. You know, and those people actually are going to become better physicians because they're just not, they just have a broader background and wider interest. Sure. Yeah. Has there been any shift to? More people going into medical school doing that? I think so. I'm seeing that, yeah. As a matter of fact, at my school of public health, you know, if you get a degree in public health, what do you do with it?

[00:10:00] Why don't you go work in a public health department? You know, the pay there is not so great. Or you can focus on a health... related degree in either nursing or pharmacy or medicine or, um, you know, physical therapy or something like that and, and, um, and be better prepared for it. And so I'm saying that as we recruit people, start looking at the people that are focusing on health careers.

I think they're going to be really benefit. There's a real move now to merge medical care with social care. Okay. Like, like if somebody doesn't have a place, doesn't have a home, it doesn't matter what medication you give them, they're not going to take it. Right. They have no place to put it. You know, you know, there's no, you give them insulin, I don't have a refrigerator, you know.

And so, um, it's, it's, it's, you have to meet the social needs before you meet the medical needs. And we're, and the health system is just now beginning to realize that. Okay. Did that start to happen pre pandemic? Did the pandemic have anything to do with that whatsoever? Um, it was happening pre pandemic. It started happening [00:11:00] probably in the mid teens.

Okay. Um, to, to, uh, rapidly operate. A rising degree, but the pandemic just made it so obvious that the people who suffered the most of the people who had the work, you know, I can't not stay at home. I've got to work. Why? Because I'm a manual laborer. I stock the shelves in the supermarket, or I do, you know, and those are the people who end up suffering.

Yeah. Um, so you're, you're 15 to 20 years, maybe even longer that I take that back 35 ish. Before you went down to, um, start the Dell Medical School, um, if you had to pick, you had, you had multiple roles there, if you had to pick which one you enjoyed the most, which one would you say? I, I, I liked building the department.

I mean, the, the, the medical school there was unusual in that the, the, the, Citizens of Travis County, Texas, which surrounds, [00:12:00] um, uh, the city, the city of Austin, the state capital, much like Indiana, um, uh, uh, voted themselves as a property tax increase in 2008. the middle of the Great Recession, right? to fund a new medical school.

It was the largest city in the country without a medical school. Okay. Um, and so when the dean came in, he said, you know, well then, we owe it to the citizens to make Austin a model healthy city. Um, and most And most medical schools do that by just treating people. But he said, no, we got to do it by getting out in the community and making the community healthier.

And so that's why he had a Department of Population Health. And we were like the 11th Department of Population Health in the country of all 155, you know, they called allopathic medical schools. There were only 10 or 11 that had Departments of Population Health. They're all different. They're mostly just epidemiology, statistics departments.

Um, and so he said, you got to be our interface with the community. And so, so that part I enjoyed because, because the, the first people I hired were a couple [00:13:00] of secretaries. The next people I hired, I hired nine people from the community to be my community strategy team. I actually paid them to meet with me once a month to dope slap me and do what we need to be doing because they came from the part of the community.

Boston is the third most segregated city in the country. Um, and they came from the other side of I 35. You know, um, where, where are the, you know, the majority underrepresented minorities, mostly black and, and Latino, but, um, uh, and, and just where, and the other thing is when you start a new medical school, who do you bring in as faculty?

Well, you bring in people who were successful at other medical schools, right? Right, yeah. So who are they? They're old, white, rich, and not from here. Yeah. So we're going to come in and make them, make their city healthier? Right. How arrogant is that? And so I, I said, I, I, when they asked me, they said, what are you going to do to, the toughest interview I had when I was going down there at the beginning of your chair were these, were these four, uh, women of color from, from East Austin.

And they sat back and said, [00:14:00] so what are you going to do to make Austin a healthy city? I leaned forward and I said, I have the faintest idea. You tell me. And they all end up on my strategy team, and they did tell me, and that established a rapport with the community that made a huge difference in both the things that we initiated and the people that we initiated them with.

We didn't initiate them ourselves, we initiated them through people in the community. And that was brilliant. That's the reason I went down there and I would work with within Wishard Eskenazi help all the way up to being chair of the Department of Medicine and on their medical executive team The CEO is my former fellow.

I mean I so I could I have no problems running a health system like that Yeah, get outside the walls. I don't know a thing about that. And that's why I went down there I wanted to learn about about so how do we do these things get? In the community, and how do we link those with traditional health care, where we're wasting a third of the, you know, the three and a half trillion dollars we spend a year on health care, we're wasting a trillion dollars, okay, well now, there are things we could spend that on to get, get more return on the [00:15:00] investment, and that was, that was our job to find out.

Right. So that was fun. The other thing that was fun was, was, you know, medical schools tend to be these big, you know, expensive, well encapsulated things that ignore the rest of the university. Okay. They just do. They exist in a huge silo. Down there in the new medical school, you couldn't afford it. And our medical school was right on campus with the University of Texas at Austin, which is this huge, really good school.

And so the first thing they started meeting with people in the other schools. And as I built my department, I had 80 faculty after five years. Of those 80 faculty, I only employed 40 of them. The other 40 were people who had courtesy appointments from other schools. Um, can I ask somebody from the School of Architecture?

Why? Because they had an urban development program, you know, and we care about housing and we care about food and food deserts. There's a guy there who's focused on food deserts. So, so he's now a member of our department and I'm not paying his salary. So, so, but [00:16:00] the thing is the interaction with campus was really neat, you know, and, and, and, um, still growing.

I mean, it's, it's fundamentally different than any other medical school I've been in. So that was a lot of fun being able to find who's doing what and trying to link that into. building this, uh, medical school that looks outside its walls. Right. Was there a particular program that you implemented in the community that was just, like, an outstanding success?

Yeah, yeah. We did a thing called community, uh, community developed, it's these, we changed the name in the middle of the thing. I don't want to get it wrong. Uh, community, uh, CDI, Community Developed Initiatives, I'm getting it wrong, but the idea was, is that, is that we would send out a call for proposals, where people in the community, we said, give it, write 300 words of a problem in your community having to do with health, anything, okay?

And then give us 500 words and how you think you might be able to solve it, okay? [00:17:00] And the first time I did that, we got 170 proposals. Wow. Um, and so we vetted them with, with, with a mixture of people from academia and people from the community and identified a dozen of them that we... move forward. And by moving forward, we helped them develop the plan for it, and we funded them up to 15, 000 to, and this is done with a grant from the Michael and Susan Dell Foundation, to, to implement these programs in the community.

And, and I, about two thirds of them were successful. You know, about, about, there's a nearby town called Bastrop. It's a, it's a suburb of, of a rural farming suburb of, of Austin. It is a food desert. Because all the food he sent to Austin. And so we opened up a food pantry. And I mean, a farmer's market there that had the local farmers save some of their stuff to feed their local population.

Yeah. No one would have thought of that. Yeah. Um, so, there are modalist programs that after we started them, they've been sustained either by other funding or just by the [00:18:00] effort of the people involved. Okay. Another one was, was, was, we had a bunch of low income people who actually own their houses. And they had back, or were paying mortgages on it, they had backyards, and they wanted to put in gardens, but they were elderly, and they couldn't do that, so we linked them up with high school students, who would then help, you know, dig the ground, put in the railroad ties, put in the dirt and stuff like that, and help with the plane and stuff like that, and it turned out that the elders started mentoring the kids.

And they established long term relationships that, that lasted after the program was over. They're still getting together and, and working on the garden and, and, you know, so things like that were very inexpensive, um, but, but there were problems identified by, who's got the CEO of the problems in the communities?

People who live there. Yeah. Hey, me. Yeah. So we just, we just said, tell us what you think. And then we would fund these things. So we had. three rounds, I think we had 379 different proposals submitted and we funded, not funded or otherwise supported, something like 50 of them and, and the majority were, were [00:19:00] successful.

So that was, that was pretty cool and just, it just kind of operationalized the answer I gave when I was being interviewed. You tell me, you know, I don't know the answer. You tell me the answer. And a couple of those things, some of our faculty. Said, hey, that's a neat idea. You showed in this little thing that it works.

I'm going to write a 2 million NIH grant to be able to do that for a much wider population. So they actually did, were able to then connect to the wider academic, well funded, well schooled machine, but starting with something that we showed that worked in the community and going back into the community to expand it.

That's pretty cool. That's impressive. Yeah. Um. What led you back? Community driven initiatives.

Bill, what led you back to Indy? Um, uh, my wife. You know, when I was down there, I was really busy during the day, and I'd come home and tired at night and just wanted to be [00:20:00] quiet and stuff like that. She was alone here in Indianapolis, and so it got, um, I said when I started, I'd spend five years doing that, and you know, my son and my granddaughters live in Austin, so it wasn't the fact that we weren't going there, but, um, I heard social networkers here, so I lived here and commuted, so during the week, you know, she was kind of living alone up here, and so I decided that I'd move back up here.

I moved back up here, um, uh, a month before the pandemic hit, so, and everybody was working remotely anyway. So we're just working remotely while still working down there and then I, I kind of, I still work for the University of, the Dell Medical School, um, at a small percent, 20% of my time and they pay for that, but the rest of my time is up here working in the School of Public Health.

So it was really coming back, you know, coming back to where I, you know, my home is and not taking long commutes away. But I still go to Austin, I was there last week. Okay. Okay. Um, tell us a little about the Regent's Reef Institute. I mean, [00:21:00] you have spent a fair amount of time there. Uh, to me, and maybe I'm, maybe I'm wrong, but I think there's a lot of people here who don't even know much about it, if you're not in that world.

Yeah. Um, and I, again, I, you correct me if I'm wrong, but I would think that as technology has also grown. That has played a, an even bigger role with what that facility does. Although it's not just, technology is, is where it got its initial name, but that's not the only thing that it does. Okay. So Sam Regenstreif was a self made industrial engineer.

Um, he's from Austria. Um, his, uh, he lived in, in Connersville. He started a, a design, the DNM, Design and Manufacturing. He designed the, the innards of really the first effective dishwasher that Sears ended up buying and giving a lot of money. And, um, and two things Sam's money wouldn't buy. Sam was a very rich man.

Okay. Two things that Sam's money wouldn't buy him. A, [00:22:00] children. He was childless and B arteries. Okay, so, so he had, um, he had a niece, but he didn't have any, have any kids, and then when he got to be more old, he started developing heart disease. His son happened to be Harvey Feigenbaum, who's a very well known international cardiologist who works at the IU School of Medicine, and established the field of echocardiography.

So um, um, and he happened to be married to Sam's niece. And so when he got sick, he brought Sam up here and Sam, you know, got care, got the best possible care and saw that the system was really broken. It really was highly dysfunctional. And he says, I can't believe that all the money we're spending on healthcare, it's this dysfunctional.

And so as he saw his, um, you know, when you have a couple of major heart attacks, you start thinking about, so what am I going to do, you know, with my money when I'm gone? And he started saying, I want to make this better. I'm an industrial engineer. I want to make this better. And so, um, [00:23:00] he'd, he helped, he worked with IU School of Medicine and at, um, you know, Uh, well, I ended up being, um, uh, Wishart Hospital to establish the Regenstrief Institute.

The first people who worked there were industrial engineers from Purdue. Um, and just say, how can we make, how can we make healthcare better, right? And, and as a system, you know, and, and you're not going to do it by talking to people who work within a system that's broken, right? So they, they got this outside influence.

But then they saw, you know, computers are now, And this was back in the late 60s, early 70s. They're saying, computers are beginning to run business. They're going to be in health care. We need to be in front of that. So they went and searched for a computer medicine guy, and they ended up hiring a guy named Clem McDonald, who is probably one of the half dozen global leaders of the The founders of the field of biomedical informatics.

And he established one of the first electronic medical record systems in the world at Wesher Hospital. Wow. Really? Interesting. Um, where he [00:24:00] practiced, um, until he left 40 years later. Um, uh. And so, uh, and, and so that's where the, the technology, you mentioned it earlier, Vince, about, is known for technology.

Well, it was known for the Reagan Street medical record system. Yeah. Name. Say you, you say the name Clem, you don't mean it's, it's like Brazilian rock soccer stars. It's just one name. You know, Uhhuh , Ronaldo Pale Clem. You know, they're a bunch of people in Informatic Mission, their first name. Everybody knows who they are.

So everybody knows who Kleem is. Everybody knows who Rigging Street is. Um, and, and it, it kind of developed the notion of what do you do with electronic record. Um, and then unfortunately, uh, for reasons we can't go into here, um, uh, a lot of money got put into that and the commercial systems, the mostly billing systems took it and ran with it and they became highly dysfunctional and the physicians hate them and, and, um, they didn't hate the system we created, they actually liked it.

But it got kicked out for one of the commercial systems and, and, um, uh, they're now finally getting better because the physicians have been [00:25:00] complaining so much, but it's, but, but they are, they were really meant to, the people who are doing the, the programming don't practice medicine. So they don't know where you would look for something that they don't know how workflow is.

So they don't match what's on the computer information flow with the workflow and it makes everything harder. And, you know, a million clicks and it's, it's. So, that's getting better slowly, but it got, those of us in the field, when the 20, it was called the High Tech Act, when they put 27 billion into bribing hospitals and doctors to put health information, you know, electronic medical records into their practices and hospitals.

those of us in the field were saying, don't, don't put the money in. They're not ready. Yeah. Um, and they did and, and we were right and, and ended up kind of blowing up in their faces and, but they finally now have physicians and nurses and pharmacists working within those systems to try to make them better.

And, and I have to and they are improving. Mm-hmm. . But it's, it's been a, that was high Tech act was in, you know, it was back in the [00:26:00] early two thousands or 2008 maybe. So, um, it was, uh, problematic. Yeah. And so, but anyway, so develop that record system, and then, then it spun off a Center for Health Services Research, which I actually developed, and then it spun off a Center for Aging Research, and those are the three centers that are in now, Biomedical Informatics, Health Services Research, and Aging Research.

They bring in about 50 million a year of funding from, from outside sources and mature, from a lot of variable outside sources, and they work within health systems to try to say how can we, how can we improve the quality, efficiency, and outcomes of care. Um, uh, there are about 60 some investigators who work there.

I worked there from 1980. I became the president of the institute in 2010, and then, you know, in 2016 when I left to go to the, the Dell Medical School, I stepped down as president. Yeah. Okay. Um, you, you know, the basis for this podcast is, is sharing our stories and, and this [00:27:00] is where you and I's paths actually cross, um, what, uh, Bill, why don't you share, uh, if you would, what, what is your cancer story?

Yeah. So, so I, um. And in 19, in 2000, I took on a new job. I took on a job as the chief of the division of general internal medicine and geriatrics. I had 125 full time faculty and about 500 staff and a 75 million budget. And we were running general internal medicine, inpatient, outpatient at the VA, Eskenazi, uh, Wisher back then, health and, and IU health, which was just developing at the time.

Um, and, uh, um. And that was in January of 2000, and, and In February, I went to see my doctor. She said, you know, for the past, for the past two or three months, I've been having these intermittent episodes of really bad chest pain, you know. And, um, and then it would go away and it would come back and everything.

And, and, and she said, um, well, you know, it's, it's likely you just had different viral illnesses. I said, yeah, and I don't know, the second most likely thing is I [00:28:00] have lymphoma. You know, and so she started, yeah, yeah, right. So she started a physical exam, and 30 seconds into her physical exam, she finds a big mass in my, what's called the supraclavicular fossa, above my collarbone here, which, of course, I never saw.

And now I look at it, it was obvious, but, you know, I'm shaving in the morning with a t shirt on. I don't see that, right? So, so, and as I'm getting biopsied, and I have what's called large cell lymphoma, um, of the, of the, They, they look how well differentiated it is, and this was only moderately well differentiated.

So I only had like a 50 50 chance of it responding to chemotherapy. Um, uh, so all of a sudden there was, I practiced primary care medicine for 20 years, emergency medicine for 20 years, hospital medicine for 20 years, and all of a sudden I've got, you know, I've cared for people with cancer, and all of a sudden I've got cancer.

Um, and it was, it was hard to deal with. I mean, because you never, you don't think about those kinds of things, and I, I, I tried to be, you know. Be realistic about it, et cetera, but there are times you just got really emotional and kind of, [00:29:00] I remember running around the track of the, uh, the National Institute of Fitness and Sport, you know, just still trying to stay in shape and just bursting into tears, you know, and running past people, there's cycling machines and stuff like that.

I'm just crying right around the field. It's just, it's just, you know, just experiencing something, a life threatening illness like that was just nothing I'd ever even thought about in the past. Um, and, um, and as I, as I, um, You know, eventually, you just say, look, it's going to be what it's going to be. I'm going to do what I'm told to do, and I'll do as well as my doctors can treat me, and I'm just going to go back to just, you know, doing the work that I was doing.

Um, uh, and fortunately, you know, my, my lymphoma responded to chemotherapy. Um, uh, you know, people think with chemotherapy, like, you can get a barf in your brain. I was never nauseated at all. The, the treatment I have for nausea now is just awesome. Okay. But I had a lot, a lot of other things that happened here.

I developed a, i, one of the drugs I was on was called pro, uh, pre, uh, it's dexamethasone. It's a, it's a corticosteroid. [00:30:00] Very high doses every, every three weeks. And I developed a myopathy from that for the point. I couldn't walk up a flight of stairs, you know, all my proximal muscles get, you know, up upper arm, upper leg.

completely went away. Um, and then one of the other drugs called Venkristine or Oncovin, um, you know, killed the nerves in my legs and arms and other places and, um, which I'm still suffering from these days, today. And then I developed 18 months of chemo brain where I just couldn't think straight, I couldn't remember things.

I'll give you an idea. I was, I was the editor of a medical journal at the time. And, um, and I, uh, you know, when I was getting ready to move out of my office, I bound all the issues of our, of our, um, journal and in 2000, there's a really fat issue. And it's because we had published a supplement on, and I forget what it was about, but we published a big supplement of the couple of hundred extra pages, right?

I looked at that and I said, wow, I didn't know we published a supplement here. This is really neat. And my co [00:31:00] author, my co editor said, You ran it! I had no memory of that at all. I said, I'm pretty good when I'm brain dead. So that was, that was really tough. And then, and one day it went away. It was amazing.

It just, one day I woke up and the sun was shining, the clouds had parted and I said, I'm back. But it was, that, that was the toughest thing was just, just being so frustrated that I couldn't think, I couldn't sleep, I couldn't, I mean, it's just, uh, it was just being, like brain dead. It was, it was really, it was really difficult to deal with.

Yeah. I try to claim, uh, chemo brain on occasion still today, but that doesn't work so well anymore. It can last, you know, I, I, I, I'm going to experience it. But, but so I, I, I got through that. Um, uh, and interestingly, you know, cause I was there at this journal, we got called by a guy I knew from the university of Washington, Seattle and said, we got money from national cancer institute to have a, a a seminar on quality of life and cancer.[00:32:00] 

And we would like to publish the papers from that as a supplement to your journal. And my co editor and I said, yeah, sure, we'll do that. And then I called him back and I said, you don't have any patients talking. This is about quality of life and cancer. You don't have any patients talking. And they said, well, we didn't know where we could find somebody who could talk to an audience like this who, you know, was in the process of having cancer.

And I said, I know one. And so I went up and spoke at their meeting still, while still being bald from my chemotherapy. And, um, and about quality of life in cancer from the physician investigator's perspective. And the paper ended up getting published in this supplement. But it, but it, um, it, Um, it just kind of drove home to me the fact that, that, that they're thinking of all this without involving the people who actually have the disease.

Um, and, and what it taught me is what it was like to have the disease. And so after I was done with this and I went back to, you [00:33:00] know, being on, you know, in patient service and outpatient service, I get a patient with cancer, you know, and, and I know what it's like when you're told you have cancer, right?

And so I put a picture of me with no hair. And I said, you know, half the people with cancer never die of it. Right? And the other half live 20 years, 10 or 20 years. Um, and I'm one of them. Okay. And, and then we just talk about their fears because I know what they are. Yeah. Um, and, and that bothered me a little bit because I say, do I have to have cancer to be able to be empathetic?

about how people are feeling with their cancer? Well, I'm a general internist. I care for people with heart disease, and kitten disease, and arthritis, and do I have to have everything just so I can be a good doctor? And as I thought about that, I said, you know, it's, it can't be. So what's the alternative?

The alternative is to listen to the people who actually have it. Give them time to tell you how they're feeling and how they're reacting to it and [00:34:00] what their fears are, etc. And don't rush it. And, you know, you, you know about how things are, I'm given 20 minutes to see a patient and part of that is the 10 minutes I have to write my note, right?

So, so you rush through everything and the last thing you want is somebody going on a long dissertation about something and that's what they need. And that's what I think primary care ought to be. And I, I, I've actually pushed this before and I haven't been able to, not until recently got any traction with it, is that I, I think most of the stuff I dealt with as a primary care general internist, a nurse practitioner could deal with.

It doesn't take somebody like me. Even, even my nurse could deal with it. She was smarter than I was, you know. She could take, didn't, didn't take me. So I, I think that people in need who have, just come in for a blood pressure check, come in for a blood sugar check, come in to, to um, get your medications refilled, just see how you're doing, you know, a regular annual checkup visit, doesn't take me.

You know, anybody else can do that. I could train a high school student to do most of that. And so, I think that, that those [00:35:00] people ought to be seen by, Not me. And that I'd be scheduled to see a patient in an hour. And it ought to be somebody who has a bad diagnosis, new to the practice with multiple things going on, and we got to really, you know, get deep dives into what's going on.

Somebody just got out of the hospital, you know, trying to figure out what the heck happened in the hospital and what do I need to do to keep them going, et cetera, and spend the hour. And I think if you do that, then you can listen to people's cancer stories and then say, you have this fear. Okay, well, that's a reasonable fear, but let me put it into perspective.

Um, because when you're in the middle of this, you're like in the bottom of a well. There's no perspective at all. You're drowning in it. And if somebody gives somebody, I've been there, I know you're drowning in it, but if you come out of the well, the rest of the world's still out there. Um, and, and this is how you get out of that.

And this is what, this is what generally can happen. You know, the people with, with your condition. And then if they're, if they're not going to get out of it, then, then you, you have to [00:36:00] get good at helping them make the most of what days they have left. And there's, that takes time too. Sure.

So, if we go back to that listening piece. Yeah. Yeah. Yeah. I mean, it's, it's, um, you know, the people are the experts in what they got. They might not know anything about the biochemistry, but they certainly know about the, about the physiology and they know about how it affects functional status and things like that.

And um, you know, listening to them can, can, can give you at least some insight into how to help them. You know, as a general interest, I rarely cured anything. It's just bailing wire, but, but, but, but, you know, you make better what you can make better to help people deal with what you can't, um, and it's, and, you know, to do that, you have to know how it's affecting their daily lives, and, and you don't live their lives.

You don't know what that's like. You have to listen. Yeah. Well, we, we appreciate you sharing that story with us, and glad you're still here to do so. Yeah. Sounds [00:37:00] the aspects of that sound vaguely familiar. Yeah, he said being Christine as I go. Yeah, I remember that one Yeah, that wasn't a lot of fun. Yeah, I Don't even know I, is that still part of a regimen today?

I mean, it was . Yeah. Yeah. I mean, chop the, what we had, what I had before you probably had too is, is it's, it's been supplemented with some things before. Vin Christine is, is, it's actually vinca is growing in my garden right now. You know, it's, it's a, it's a, it's a ornamental plant, flowering plant that people plant in the garden.

Um, uh, and, but the vinca alkaloids are, are still used in various cancer regimens. But, but what they do now is they check for the gene that encodes the enzyme that breaks it down. And if you don't have enough, they give you lower doses. They couldn't do that back then. So I got a standard dose and it killed my nerves.

I still can't, my feet are still numb and I can't, I have problems with balance and things like that. Wow. Yeah. Yeah. All right. Well, do you have any questions for us? Well, I, the, [00:38:00] the, you know, people with cancer, Are more likely to get a second cancer than people without cancer to get a first cancer. And I've, you know, I'm kind of the, the, the poster boy for that.

You know, back and I, Vincent and I, you know about this, back in, in, in last November, I had a, a little cyst on my leg that had been bothering me a little bit with my dermatologist. And he took it off and said, I, I, uh, and came back as a, what's called an a metic malignant melanoma, which means a melanoma with no pigment in it.

Okay. And so, I got a metastatic workup and it had spread to the lymph node under the skin, in other words, in the skin, but not to anywhere else. Okay. And so, it was stage 3 E. C. and they started to treat me with a, with a, um, uh, an immunotherapy to help my body recognize it as being cancer. But in part of the metastatic workup...

show that I had prostate cancer. Oh, wow. Great. As a friend of mine who is a [00:39:00] former director of the Cancer Institute said, you know, 15 yards on God for piling on. Yeah. Um, and so I end up having a radical prostatectomy about seven weeks ago and I've been working through getting biweekly infusions for the other cancer and so it's but it's, it's, it's kind of easier the second time around because you're I've been through it before.

Plus the prognosis of this is much better. These two are much better than the ones that I had before. But, um, you just have, as you get older, you just have to, as they say, getting old ain't for sissies. Yeah, true. You have to deal with these things and realize that these things are going to come back and you have to do all the surveillance and things like that.

Like, I get, my mother died of colon cancer, I get colon pops, I've gotten a colonoscopy every three years, you know. You have to do these things, um, and you can't just, Say, well, I had mine. I can move on. No, you have to worry about cancer. Never really. You're always waiting for the other shoe to fall. You know that.

[00:40:00] I mean, you're always waiting for the other shoe to fall. Yeah, for sure. Well, um, I guess we escaped that one. Yeah. Yeah. So, no questions for us? Um. I was thinking you might have one or two in there. Well, I'm interested in the Heroes Foundation, so tell me a little bit about it. Tell me what it does and, uh, and, and what you think it's been its highlight.

Yeah. Um, I'll answer that two ways. I mean, one of its highlights is the fact that it still exists. I think if you had asked us, you know, when we started this at 26, 27 years old, we had no experience. We didn't know what the hell we were doing. Um, did I envision it still being here 23 plus years later?

Probably not. Um, and like anything else, whether it's a non for profit charity or a for profit business, it takes a variety of hurdles. You've got to overcome and walls to, to break through, to keep yourself going and persistence is key. Now we talk about that. Just, [00:41:00] you know, I guess this podcast or anything you do persistence is key.

Um, I guess that, the other thing is, so, what, 26 when we started, I'm 50 now. I'm starting to think about, okay, not what are we doing tomorrow, but how can this thing be out, be around 23 more years from now, like beyond any of us. Um, so that's what we're trying to build because yes, we're, we're funding cancer research.

Yes, we're funding cancer support programs, uh, in cancer centers. And yes, we're trying to educate the public on different types of cancer prevention. Um, cancer will still be here 23 years from now. People will still get diagnosed with cancer. We just hope that, um, over time. And there's, you know, hundreds of different types of cancer, but over time that it won't be as devastating.

It won't be a, as [00:42:00] much of a potential death sentence as it is today, or as it was 20 years ago. Um, and so that's, that's, that's the goal, you know, that's the goal is just to continue to help make progress and to continue to, um, improve on the treatments that are being done. I mean, you know, I had treatments that yes, allowed us to survive, but the treatment sucked.

I mean, in, in non medical terms, um, there are aspects of, of what we went through that I, I would not, not really want to go through again. Um, but when you consider the alternative, we, we do what we gotta do. One of the, one of the, I guess, positive side effects of our, um, having, having more success with treatment cancer is that you've got more survivors.

Correct. And some of the survivors just back to normal like they were before, and they can go ahead and ignore it. Um, I would guess that most of us are not like that, that there's some residual that you have to live with, whether [00:43:00] it's physical or mental or some combination of the two, that um, that has generated, seen more and more cancer centers and cancer research focusing on their survivors.

That, that the treatment lasts, you know, my treatment lasted for six months. I've been 23 years as a survivor, you know, and, and it's affected me every day of my life since then. Right. Um, and I've learned to accommodate it, but, um, uh, I, I think that, that, that we're beginning to see much more care and research focused on so then what?

Right. Um, and because in the past it was, it was kind of beat the reaper, right? Just, you know. Yeah. In fact, I had a friend that had a tie that said beat the reaper on it, you know, just as a resident with me. And, um, but, but it goes beyond that because people might have 20, 30, 40 years to live as a survivor and, [00:44:00] and the degree to which you can improve their functional status, both physically, mentally, or whatever, I think it's our obligation to do that.

So we need to get beyond the survival point, because we're getting pretty good at that for many cancers. Sure. Um, um, and some cancers you don't, that you don't cure, people live for decades with. Um, and so, so. I, I think that that's something that we, we, um, it's nice to see more focus on that. There needs to be even more focus on that because there are more and more of us out there.

Yeah. The trend that I like to see, and this is coming from a, you know, non medically educated, non experienced individual living, kind of living in this world indirectly, is watching the research being done that, um, Does two things. One, it's improving the treatment, but it's, it's making the treatment less lethal.

So it's, it's finding treatments that are attacking the cancer, but not every, it's not carpet bombing everything, [00:45:00] which we know. I, we both know of cases where it was killing the cancer, but it killed the person because it was killing so many other things. And you know, that was just 20, 30 years ago. Would that person survive today?

Possibly. It depends on the situation, but to see treatments that are more focused on. attacking the cancer and not everything and then knowledge that I think improved their the statistics for for surviving but it also probably improves you know now they don't just have a five year runway maybe they have a 25 year runway so I like seeing that but I also like seeing so Heroes Foundation you know it have been really easy for me to say okay we're gonna lymphomas because that's what I had But my, my whole attitude was, you know, my mom had breast cancer, uh, fraternity brother of mine has had a son that passed away from a brain cancer.

Like there's cancer everywhere, like it all sucks. And to me, like mine's not any more important than anybody else's. And so, well, I know we can't be everything to [00:46:00] everyone cause that's very difficult, but I wanted to attack cancer in general. So what I like to see is, um. Certain cancers are certainly more prevalent, have more survivors, so they can carry the message more, may have more of a focus.

But, what I like seeing is when they're focusing on that type of cancer, they're also looking at saying, Okay, whoa, hey, what we just discovered might also work for this rare cancer over here and this cancer over here, who aren't getting, you know, the publicity, so to speak, that still deserve it. Um, and that's what I like to see.

I like to see where they can, where they can do that. And, and that also infiltrates the pediatric space. Because the pediatric space is not getting, uh, nearly the funding that the adult side is, for that's a whole other conversation. But, when they uncover something maybe for the adult side, they say, oh, this could have positive implications for the pediatric side too.

Let's, let's go. Yeah. I, I, I, and I think that's exciting to see, see drugs that are found to where, like the one I'm taking, the Volumab, this, the more and more cancers seem to be responsive [00:47:00] to its ability to block, the cancer's ability to block your body's ability to see it as being foreign. Right. So, so as, as they begin trying that on, on cancers that have not responded with therapy, they're finding sometimes dramatic responses.

And so, um, it's, It's, it's opening, there are things like that that open new windows that people are saying, well, how about, and, and that's exciting to see. And those are whole new, um, some of these are very new approaches. And the initial approach like CAR T cells and things like that is just making my head explode trying to think about all this stuff, but, but, um, uh, but having said that.

You know, the, the cost of these things is going to have to, is going to have to be dealt with too. I mean, if I go through a full year of my, of my Nevalumab treatment, it's more than half a million dollars. Wow. I mean, that's the negotiated price insurance company's paying. Yeah. So it's, it's, it's more than 20, 000 a treatment.

That's unconscionable. [00:48:00] Right. And especially if you're using more and more cancers, the price ought to be going down. So somehow we have to deal with that, because otherwise there's just going to be rich people like me getting treated, right? I mean, it's just, or, um, uh, I don't know, it's just, that, that's been bothering me a lot, thinking that, okay, for that cost, we could, we could vaccinate every Medicaid kid in Indiana.

You know? So, how do you justify that? And, um, it's hard. It's hard to justify it. And so, and that's just one treatment. CAR T therapy is even more expensive, you know? Right. So, it's, well, I mean, somehow we have to deal with that because, because they work. Right. And they're expensive. If they were working, they're cheap, or they didn't work and they're expensive, that's, you can deal with those things, but when they work and they're expensive, then who gets them?

Right. Mm hmm. Yeah. Agreed. And it's not just cancer. Hepatitis C drugs. They're real expensive, they work great, and who has Hepatitis C? Poor homeless people. On Medicaid, so how many Medicaid patients can [00:49:00] go through 75, 000 worth of therapy? I mean, it's, uh, we need a solution to how to deal with these things, and I'm not smart enough to know it yet.

Yeah, well. We appreciate your thoughts. We appreciate you sharing your story. Um, appreciate your time for coming in. We really do. Uh, you, you got quite, like I said earlier, at the, uh, beginning of the episode, you've got quite a distinguished past and, um, I look forward to having this conversation in another decade to talk about.

Yeah, I'd like to have a distinguished future. Well, I think, I think you will. I think there's a lot more for Dr. Bill Tierney to accomplish. So, I look forward to having that conversation in another decade. Whether it's at the Indy 500 or anywhere else. And we'll have some Bloody Marys here to commemorate it.

Well, thanks Vincent Daniel. It was fun being here. Yeah, thanks for being here. All right, guys, that wraps up another episode of the Summit's podcast. Thank you all for joining us today from wherever you get your podcasts or if you're tuning in on the Heroes Foundation YouTube channel. Thank you for doing so.

Guys, we appreciate your time as [00:50:00] well. Don't forget, beat cancer.