The Means Report is kicking off 2019 by focusing on health and cancer research. At the new Bert Storey Research Building they are leading the way with scientific research at the Medical College of Georgia. Part of that growth includes the search for a new leader for the Georgia Cancer Center. With the help of the Dean of the Medical College of Georgia – Dr. David Hess – The Means Report also takes a look at the future of oncology and what it might hold, especially in Augusta, Georgia.
Brad Means: Here to talk a lot more about that is the dean of the Medical College of Georgia, Dr. David Hess. Dr. Hess, no stranger to the Means Report. I welcome you back to the show, Dr. Hess and I congratulate you here in 2019 as you celebrate your thirtieth year as a part of the MCG team.
Dr. David Hess: Thank you, thank you very much, Brad. Great to be here.
Brad Means: So you did just cut the ribbon on the Bert Storey Research Center. The governor came to town to help out with that. What happens inside that building? Is it cancer research only?
Dr. David Hess: Yeah, it’s pretty much focused on cancer research, broadly defined. So that gives us about 73,000 more square feet of space. And about 20,000 of that is dedicated research space. And if you do quick arithmetic, a good researcher needs about a thousand square feet of space, so that’s 20 more basic science researchers that we can put in. Plus it has this connector. The connector’s relatively unique. The connector connects the basic science labs with the clinical operation. One of the hardest things in medicine, and where we fail in medicine, is bridging this translational chasm between basic research and getting things into people. Well, the whole idea of this connector, it’s somewhat symbolic, but it’s more than a symbol. We’re actually gonna have basic scientists’ offices right next to clinician’s offices. They’re actually gonna have tea time at four o’clock everyday where they’re gonna get together for tea, like in the British system, and talk about research and how we can collaborate. So it’s a great opportunity. And I think it’ll actually really work by forced mixing of minds.
Brad Means: What about applying some of the research, to patients perhaps or at least to animals at the very least? Does any of that go on in that building? And can any of that collaboration come into play there?
Dr. David Hess: Oh yeah, of course. And we have some great examples already. I’ll give you two quick examples. One was the research that Dr. David Munn and Andy Malore did. Goes way back to the 1990s, early 2000 where they discovered an enzyme called IDO, which actually they discovered it as an enzyme which allows a woman to tolerate her fetus. So it’s the reason a woman doesn’t reject her pregnancy. And IDO is an enzyme secreted by your immune cells to allow you not to reject your own tissues or a fetus’ tissues. Now if you look at the flip side of that, okay, if you rev up the immune system and you block that enzyme, then those same immune cells can attack a cancer. And that’s how this is being used. So these IDO inhibitors, which were developed by David Munn and his group with an outside company, are now in clinical trial, and particularly used in kids, many children who come from all over the world, with these terrible brain tumors that have refractored to every other type of treatment. And some of them now have lived a long time. That’s one good example of it. Another good example is work by Ravindra Kolhe. Now he’s an immunopathologist who’s on our pathology faculty here. Kind of grew up in the cancer center in the Department of Pathology. And he’s developed something which is really, really quite important. And that is developing precision treatment for a cancer. So we now know that many tumors, for example a breast tumor and a colon tumor, or colon cancer and an intestinal tumor, they could actually have genetic mutations which are very similar. So it doesn’t so much so matter anymore where the tumors begins or where it is, but what the genetic mutation is. So he has this new system he calls Augusta Oncotarget. And he screens about 170 different genes. And then he finds what the mutations in those genes are. And then he basically takes that information and then he plugs it into artificial intelligence, we’re hearing all about artificial intelligence. Well, Watson, which is an IBM Watson, he works with IBM Watson, and this genetic information to then pick out the right treatment for the patient. So it’s an individualized treatment for the patient based on their genetic abnormality.
Brad Means: Are you talking about research and applications that are still being tested and developed? Or are you talking about things that patients who are watching right now can start to get excited about?
Dr. David Hess: Patients right now, this is being tested in patients. His lab is one of the seven selected in the country to be a lab for the Match trial. This is an NCI-funded trial where people with refractory tumors then have their DNA and RNA analyzed, and then they pick the most appropriate drug to put them on. So it’s happening right now.
Brad Means: How can people get involved? How can people, and maybe the ship has sailed on these cases that you’ve mentioned in these clinical trials, and perhaps benefit from them?
Dr. David Hess: Well, I think any patient that has a cancer that’s not responding to therapy, now their oncologist or cancer doctor may or may not be aware of what we’re doing at the Medical College of Georgia now, what we’re doing with our cancer center. They should certainly contact us, and see if we can help select out a treatment that’s more tailor-made for their type of cancer.
Brad Means: Does their doctor know to do that?
Dr. David Hess: Well, we’re trying to get the word out. Our doctors are pretty good, you know? There’s a pretty close communication amongst oncologists. I think most of the ones in town do. But this is something that you still, we’re always doing CME, we’re always trying to educate oncologists about what’s available. That’s available right here, and that lab test, you can send in specimens from, you don’t have to be in Augusta. You can send their blood and their tissue here. And we can analyze it here.
Brad Means: Should I interpret what you’re saying as, MCG going down the road to a potential cure for certain types of cancer? Or should we see it as better treatment?
Dr. David Hess: Well, we look at cancer now as more of a chronic disease. We do have some cures in some certain cancers, but more cancers are gonna be managed, like melanomas. Look at Jimmy Carter. He had metastatic melanoma to his brain years ago. Twenty years ago you wouldn’t have survived. Now, he’s still alive. So you can manage cancer, but having more information about what the genetic mutations are in that particular cancer can make you pick out a better treatment. And that’s what we’re aiming for now.
Brad Means: You mentioned the National Cancer Institute’s involvement already with MCG. Does this research and this collaboration get you closer to having that designation that we continue to seek with the NCI?
Dr. David Hess: Right, it’s a step in that direction. NCI designation is difficult to get. There’s only one NCI-designated cancer center in Georgia, and that’s the Winship
Brad Means: Is it impossible to get?
Dr. David Hess: No, no it’s not impossible to get.
Brad Means: ‘Cause it’s taking a while.
Dr. David Hess: No, no, no, in God’s good time we’ll have it, as I always say. And it may take three or five years, but we have advantages. We’re the other Georgia, we have an underserved population that is not getting served. If you look at Georgia, particularly south Georgia, south of I-16, but even coming up into Richmond County and some of the counties near us, we rank in the bottom 40 to 50 in most healthcare measures. Cancer’s often detected very, very late. So we have to detect cancers earlier and offer better treatments. African Americans have higher rates of certain cancers, particularly prostate cancer. And so we have to factor that in. So we do a very good job at our cancer center of getting African Americans into clinical trials. ‘Cause clinical trials is how you make advances, and you offer the latest and best treatment to patients.
Brad Means: Are you talking about people having to come here to take part in those trials, or do your campuses all over the state get to help out as well?
Dr. David Hess: Well we have a network all throughout, our cancer doctors are gonna go soon to Columbia, South Carolina. They’re going to Make and they go to Athens. They go all over, all right? And so whether they physically go or whether they refer the patients, you can get in either way. But we really wanna be, before we’re NCI-designated, we are already a destination cancer center. So we’re doing bone marrow transplants. We’re increasing, we’re going into a record number of bone marrow transplants. We’re doing a lot of things you can only do here and at Emory and at MUSC. There’s not a lot of places that can do bone marrow transplants.
Brad Means: So you’re doing the cases here. Those cases, I’m guessing, are growing in number year after year. You’re serving an underserved population. And doing the research that it takes to help better treat the people of Georgia and beyond. How long do you have to do that? How many cases do you have to stack up before they say, “Okay, you’re good. “It’s not just Emory, y’all too.”
Dr. David Hess: Well, for NCI designation, there’s kind of three. You have to have a certain number of patients, which we’re close to. You have to put a certain percentage of them into clinical trials. And what’s important, you need more examples of what I already shared with you, with David Munn’s work on IDO, of developing treatments here in our basic lab and putting them into patients here. We call that investigator-initiated research. It’s being done here. And then we have to have a certain amount of NCI, National Cancer Institute, funding of our basic scientists. And then we need prevention programs, which we have, which we need to expand. So we have to do it on multiple levels. But we’re making progress. We’ve hired about fifteen cancer doctors in the last year. So our number of cancer doctors, and our expertise, Zach Clawson, I think you’re very familiar with him.
Brad Means: Yeah, great guy.
Dr. David Hess: He’s been on your show twice.
Brad Means: Mm-hm, he has.
Dr. David Hess: He’s an expert on prostate cancer.
Brad Means: He is.
Dr. David Hess: And we’ve got a lot of great, young, excited doctors like that, they get me excited.
Brad Means: Do you have to sell them on the city of Augusta? Or can you just sell them on the hospital itself, or is it both?
Dr. David Hess: It’s kind of both. A lot of these people, our secret sauce is to take Medical College of Georgia students or residents, send them off for training somewhere else, and then bring them back, that’s what we do. And most of these people like living in Augusta. I mean, Zach Clawson, he’s a hockey player from Canada and he likes it here, so.
Brad Means: He loves it!
Dr. David Hess: So I think Augusta has a lot of charm, that’s how we sell it.
Brad Means: What about the, whether it’s money or whether it’s just getting approval for research and treatment techniques that you’re pursuing, how much red tape is there behind the scenes that you have to go through? Or have you been in the business long enough to know the right folks, where things are just kinda ushered through?
Dr. David Hess: Well, there’s always gonna be red tape in research. As long as you’re dealing with the FDA, and the FDA has gotten better in the last five or ten years. They really have. There’s Institutional Review Boards, I mean, all researchers complain about it. But there’s red tape, but the red tape is not preventing us from moving ahead.
Brad Means: When we come back on the Means Report, we’re gonna continue our talk with Dr. David Hess, the Dean of the Medical College of Georgia. Looking at what the future holds when it comes to research and treatment, and continuing to discuss all things MCG, when the Means Report continues.
Brad Means: Welcome back to the Means Report. Dr. David Hess, the Dean of the Medical College of Georgia, is our special guest today. We spent our first segment talking about, well, the paid professionals, the doctors, the researchers over there at MCG and the groundbreaking efforts that they are undertaking each and every day. I wanna talk about the medical school itself now, Dr. Hess. Your students, they’re entrepreneurs. They’re innovators, they’re doing great things, right?
Dr. David Hess: They are, we got bright students, the brightest students. They’re a lot brighter than I am. I mean, innovation, they’ve got this group called Innovation X, Incubator X, and they’re out developing companies, and they’ve got a lot of great ideas. It’s hard to keep up with them. It’s still very, very hard to get into medical school. We get over 3,000 applications and for 230 slots. And Georgia ranks 40th in physicians. So the good news is, medical education was birthed in Augusta in 1828. We’re the 13th oldest medical school in the country. But we’re about to embark on our largest expansion of all time. We hope to go up with hopefully state of Georgia funding to 300 students, from 230, over the next, by 2022 we’ll start this expansion. We have a campus in Athens, they’re expanding. And we wanna expand also here. And what’s really unique, and I’m gonna tell it first in the Brad Means show.
Brad Means: Thank you so much, please do.
Dr. David Hess: We are looking at a three-year medical school curriculum.
Brad Means: Three years?
Dr. David Hess: Yes.
Brad Means: How, just go nonstop 24/7?
Dr. David Hess: Pretty much so, I mean, we’re gonna have to you know, right now medical school is four years. The first two years you do basic science, but we think we can compress that to 18 months and be more targeted in what we teach. And that allows certain students, not all, to complete medical school in three years, particularly those that wanna go into primary care, they know they wanna do family medicine or pediatrics or internal medicine. So we can have a shortened curriculum for them, and then have them enter residencies that we run or that are run by our partnership campuses in Georgia.
Brad Means: So is it just a matter now to reach that 300 goal, of marketing MCG as a place where we can get you out faster? And I would certainly guess, that would save money, instead of having to pay for a fourth year. And letting people know that you’re here. Is that what it takes now to grow those numbers?
Dr. David Hess: Yeah, I think. Well, we had no trouble getting good applicants. But I think the issue is, one of the things is medical school debt. I mean, four years. Most of our students graduate with $160,000 of debt, just from medical school. Now if you owe 160,000 from medical school, maybe 100,000 from undergraduate, you may not be able to go into family medicine, ’cause they don’t make as much money.
Brad Means: They won’t.
Dr. David Hess: But let’s see if we cut your tuition by basically a fourth, and we’re even actually looking at some loan forgiveness or tuition help for people that will go to underserved areas. This could markedly reduce your tuition bill, get you through medical school quicker, and get you out practicing in Georgia quicker. That has a big difference in getting physicians out into rural areas.
Brad Means: What should we major in, what should we study, to have the best chance of getting a job in the medical profession? Is it still nurses, or is there a specialty that you’re seeing a shortage?
Dr. David Hess: Well, there’s a shortage of nurses. Nurses are short particularly. And everything in rural Georgia is more acute. We have a lot of physicians in Richmond County and a lot in Atlanta, but we don’t have a lot of physicians elsewhere in the state, and same for nurses. There’s a nursing and a physician shortage.
Brad Means: People just don’t wanna go to those areas?
Dr. David Hess: Yes, it’s difficult to go to those areas. I mean, if you go and you’re a family physician, I mean you may make less money. You know, unfortunately, hospitals in rural areas are reimbursed less, so it’s very difficult for hospitals to make it. Now there’s ways around that, but think about it. You go through medical school, you lived in bigger cities, and you have to go to a remote community?
Brad Means: Right, like Doc Hollywood.
Dr. David Hess: Yeah.
Brad Means: Yeah.
Dr. David Hess: Well he’s an exception, he’s one of our heroes. He works down there in Albany. We formed a task force, and he was actually on it, led by Doug Patton and Neece Cornegie to look at the public health of Georgia, and he was on it. And he works at something called a federally-qualified health center. And these are very, very important in Georgia. There’s many of them throughout Georgia. And some of their recommendations were to actually get our students out into federally-qualified health centers and train them there so they’re more likely to stay there. So we’re working on that. Besides expanding the class, we gotta look at how we train medical students. We gotta do it differently. We gotta put them in rural communities, put them with the Doc Hollywoods. There’s other Doc Hollywoods out there that are true, true great physicians who we’ve gotta expose our students to.
Brad Means: All right, so let’s say we do convince a few of them to set up shop in those small towns. For those who don’t wanna go there, one of your babies is Telemedicine. Is that helping to fill that gap where people can’t be is to use the Internet to serve patients?
Dr. David Hess: I think it helps somewhat. I think it brings specialty care to some of these areas. But it’s a combination, you need some boots on the ground. Not everything can be done by Telehealth. So you need a combination of boots on the ground, and Telehealth so those doctors, and those nurses, can then get a specialist consultation, whenever it needs to happen, without sending the patient up here, so it’s a combination. Telemedicine is not a magic bullet. It’s an aid, it’s an aid to help us get doctors out into rural areas.
Brad Means: I wanna go back to the cancer research real quickly and just ask you to speak to the patients out there. Would you say that Augusta is or should be a destination for people seeking cancer care, like an M. D. Anderson, like other hospitals around the country?
Dr. David Hess: Yeah, it is a destination cancer center. Now M. D. Anderson probably has expertise in all the cancers. Right now, we can treat any cancer, but we’re particularly excellent in treating a number of cancers right now. And bone marrow transplant, leukemias, we’re excellent at that, some other tumors. We wanna be excellent at a wide arrange of tumors.
Brad Means: So when it comes to getting treatment for those types of cancers, people need to think MCG.
Dr. David Hess: Yes, yes.
Brad Means: Let me ask you this quickly about concierge doctors. My friends have discussed it lately. I’m going to pay a doctor a retainer. He or she will be available for me more. Do you like that?
Dr. David Hess: I think it’s not gonna solve our major issues in America. I think if you have the means, people can do it. You know, the Brad Means.
Brad Means: Sure, the means, no.
Dr. David Hess: I’m sure you can do it. But not everybody’s gonna be able to do that. What we have to have is better access. And we really need to be able to get patients in the same day, next day. We’re already working on it at MCG. In many of our clinics we have same day, next day appointments. But you ought to be able to call up your doctor at MCG and get an appointment that day. You shouldn’t have to pay extra for a concierge service.
Brad Means: Do you want to merge with University?
Dr. David Hess: That’s a very good question. What I would say about that is we have a unique opportunity in Augusta. They are our close brothers. They were our medical, they were our hospital. We’re the first medical school in Georgia. They were the first teaching hospital in Georgia. They took the first resident back in 1888. That’s where our doctors trained until the 1950s. We are very complementary to them.
Brad Means: Residents still rotate over there.
Dr. David Hess: Residents rotate in family medicine. In fact, we can learn a lot from them. They’re an excellent community hospital, very, very well-run. We’re an academic medical center. You put those two together, and we have something really special.
Brad Means: I’m hearing a maybe, slightly yes then from you, that that should happen down the road, or could.
Dr. David Hess: I think it’s a great idea.
Brad Means: Dr. Hess, you are doing some great things at MCG, the research certainly, the education of our future doctors and nurses. And for that I thank you.
Dr. David Hess: Thank you.
Brad Means: Absolutely, welcome here any time, David Hess, Dean of MCG.