Episode Transcript
[00:00:03] Speaker A: Welcome to the Ortho Joe Podcast, a joint production of the Journal of Bone and Joint Surgery and Ortho Evidence.
Join hosts Mohit Bhandari and Mark Swankowski as they discuss current topics and publications
[00:00:15] Speaker B: in the world of orthopedics and beyond.
[00:00:19] Speaker A: Well, good morning, Mo. I trust you have a cup of Joe somewhere nearby.
[00:00:23] Speaker B: What do we got?
[00:00:24] Speaker A: We got Tim Hortons. Oh, yeah. Okay.
[00:00:25] Speaker C: Good old Canadian Tim Hortons.
[00:00:28] Speaker A: I'm still supporting my Boston colleagues, spending all those years visiting Needham of. And I've got a. I've got a really nice latte here this morning. So it's. It's a. It's a very good morning, and we have a very special guest this morning. But one of the reasons why we have legions of people that want to come onto this podcast, Jeff, is that they want the priceless Ortho Joe travel mug. So you'll be receiving that shortly. We do have people that watch ebay to see if anybody's selling them on the secondary market. So if you're trying to make financial gain from it, just try. Try another method. So our guest this morning is Dr. Jeff Katz from the Brigham and Women's. I guess now Brigham, Mass General is the.
Is the way we speak of it.
[00:01:22] Speaker B: Mass General. Brigham, I guess Mass General.
Brigham.
[00:01:26] Speaker A: Oh, yeah, I got to get the.
Right. Maybe, But.
So, yeah, okay, but a professor of both orthopedic surgery and rheumatology, who I believe has been there his whole career. But we'll ask Dr. Katz about that. And I got to know Jeff, and I believe the year was 2002, when Jim Heckman was the editor, and it became apparent to the editorial board that the statistical and analytic methodologies were getting so complex that we needed expertise in this area. And in addition to being a busy clinician in his rheumatology practice, Dr. Katz is a renowned researcher. Huge contributions in the question of degenerative meniscus management. Low back pain developed and validated, I think, the most commonly used carpal tunnel assessment instrument. Dr. Katz was one of the people that were interviewed, and he had done work for the journal, but agreed to take on that important role and really worked with several individuals that we may discuss in this podcast to refine our processes, to make sure that what we're publishing was of the highest quality and that the statistics and methodology were sound. So, so welcome, Jeff. I missed seeing you on a regular basis very much. We've had so many great conversations. But can you just start off with maybe your educational pedigree and how. How you Ended up at Harvard and the Brigham.
[00:03:08] Speaker B: Sure, sure, I'll say, first of all, it's a pleasure to be here. Thank you for the invitation, which I accepted without knowing that I was getting an ortho Joe mug. So I'm thrilled. But I, but I really came for the enjoyment of speaking with both of you and didn't need any additional enticement. So, so yeah, I was, you know, I'm from a middle class family, public school kid, kid. And I went to Princeton where I studied biochemistry and the history of science and I was a medical student and then a internal medicine resident at Yale Medical School. And while there had the opportunity to work a little bit with Alvin Feinstein and Ralph Horwitz, two of the real, as you guys both know, real sort of, you know, grandparents as it were, of clinical epidemiology. And so that was, that was pretty foundational in my finding, you know, an area that I found very intriguing methodologically.
And so I got interested in rheumatology as a wild guess because, you know, as, as, as, you know, most of medical students life is spent in the inpatient setting and most rheumatology patients are outpatient. So it was really by kind of process of elimination and dumb luck that I became a rheumatologist because I've really enjoyed the field. And I came to Harvard in 1987 to do a rheumatology fellowship at the Brigham and at the same time to get a master's degree in public health at the School of Public Health at Harvard, where I learned some fundamentals of epidemiology and biostatistics and study design at a master's level. I'm not a sort of doctorally trained methodologist, but I very intrigued by methodologic questions, so I've been learning them all my life, as have the two of you.
And so that's how I ended up in Boston. And Harvard and the Brigham are places where you can grow and change your interests and change your kind of activities every decade or so without having to leave. So I've, you know, done a lot of different things and kind of grown in place, which I've really liked because my wife and I, and now we have two kids, have really enjoyed being in the Boston area. And so, so, so, so now I'm coming toward the end of my career and I've spent it all here, which, which I really enjoyed.
[00:05:53] Speaker A: Can you just describe for us? And then I'm going to turn it over to MO for a bit because I've been talking way Too much. But how did you really come to be. I'll use the word embedded in the orthopedic surgery world. As a rheumatologist, I think our listeners would like to hear that interesting story.
[00:06:13] Speaker B: Sure.
I got interested in sort of musculoskeletal problems as I.
In the process of thinking about rheumatology, and as I started to learn rheumatology. Rheumatology.
I'm a little bit of a unicorn now because, as you know from your own colleagues, the rheumatology world has become fascinated with inflammation. And that's been buoyed by these really extraordinary drugs that we now have, the biologic drugs.
And so one of the problems that's happening in rheumatology is that musculoskeletal problems are almost falling off of the curriculum and are certainly not the things that draw people to the field, but they drew me. I can't say exactly why, but as a consequence, some of the early work that I did was in carpal tunnel syndrome and spinal stenosis. And then my mentor, Matt Liang, who's a rheumatologist with very broad interests, had a close relationship with Clem Sledge, who was the chairman of surgery at that time. Time, this was in the 1990s. And Clem was a very broad thinker.
He died recently, sadly, but was really quite a legend. And he was a very broad thinker, and he welcomed me with open arms to participate in some activities involving joint replacement, which was his area of great interest. And so Barry Simmons was a senior hand surgeon, a very prominent hand surgeon. And Steve Lipson, who's also died unfortunately, a.
A very innovative spine surgeon. And the three of them were at the Brigham and were very welcoming of my interests. And so.
So. So I felt, you know, that I was really made to feel very at home. They. They appreciated what I was bringing, which was kind of a more, you know, kind of methodologically critical perspective on some of the problems they cared the most about.
Yeah.
[00:08:21] Speaker A: And I would just. Sorry, Mo. I just pointed out that you hold the Sledge Thornhill chair.
[00:08:27] Speaker B: Yes, yes, yes.
[00:08:29] Speaker A: That's a great thing.
[00:08:31] Speaker B: Yeah.
[00:08:32] Speaker C: Jeff, if I could go back with you a little bit again, you've definitely taken a path I would think is the less traveled path. And I've always been curious with individuals like yourself who have made such a huge impact in numerous areas, but particularly, I think, when we think of all of your knowledge around just research, strategy, sort of a wisdom that comes with just understanding studies and where to go and sage advice. When you go back to the origins, like when you started, let's say, medical school, did you have any idea that you would be so involved in research as part of your career? Was that always embedded in you, that I'm going to start my medical training and I'm going to be a physician scientist? Or did that somehow, you know, was there events that changed that for you that, you know, really accelerated that part of your life?
[00:09:21] Speaker B: Yeah, I had no idea whatsoever. You know, I, you know, I went to college really knowing nothing about medicine, having no real medical role models and having really no idea about medical research. And I went to medical school similarly, not really knowing much about, I'd never met a clinician scientist. I didn't know what that meant really. And so, but as I said, I, I did have this kind of opportunity to, you know, to, to, to see what, you know, what Dr. Feinstein and Dr. Horowitz were doing. And it was, that was very intriguing to me. It was really the first time I understood, you know, what sort of clinical research might look like. And it was fortunate, right, because they were doing very, very high level, kind of rigorous clinical research. But that was kind of my exposure to it.
And Matt Liang, similarly, very creative, but also methodologically, you know, very, very rigorous. And, and so, so, so, but that, that, that was, you know, when, when I, you know, finally chose to become a fellow. I had made that decision because I got the public health degree concomitantly.
[00:10:37] Speaker C: Do you, you know, like, there's tons of research that talks about the importance of early career physicians and scientists getting that early win, you know, whether it's through getting engaged into a very high value network. You've talked a little bit about that with Dr. Feinstein Horowitz, but was there. Can you go back and recall, like, what you felt? Oh, this is a really big opportunity. How lucky am I? And I think this may in fact change the trajectory of my career. Did you ever have that moment? And can you share that?
[00:11:08] Speaker B: Yeah, that's a wonderful question, for sure. When I arrived at the Brigham and was doing rheumatology, which I found that I really enjoyed, but also I was spending the segment of my life in this clinical EPI community, which included taking intensive course courses one summer and then having a Friday morning seminar with people across many different fields gathering every Friday morning to present studies and critique them in preventive cardiology and in pulmonary. But the common denominator was Clinepi and thinking about the design and the analytic problems. And so Lee Goldman, who was really another early Sort of pioneer in clinic epi, led a lot of those efforts. Danny Singer, Fran Cook, those were some of the people that I worked with in the first decade at Harvard. And that. That is exactly as you describe it. Mo. That was when I began to sort of feel like I had met my people in a sense. You know, they. They were good, you know, role models. And, and, and, and, and Matt. Matt Liang was. Was a very supportive, you know, mentor and, you know, and I think one thing that I.
I think just my parents, you know, kind of, kind of helped me to see was to always try to surround myself with stimulating people and to be a good listener. And so I was sort of drawn. I had the great opportunity to meet my, you know, longtime colleague and friend, Elena Losina, who both of you know, well, Elena is a really brilliant statistician and, you know, represented.
Represents really kind of the highest level of methodologic thinking. And for her part, I think Elena always felt like the methodology, in the absence of sort of a clinical context, was not meaningful. So we had very complementary interests and, you know, developed a group together now over 20 years ago.
And, you know, although we had a couple of clinicians on the faculty, the majority of have always been methodologists. And that's been very helpful to me as well. It's sort of been lifelong learning. You know, most of the statistical analyses that I'm comfortable with now, I learned, you know, over the course of the last 20 years rather than, you know, in the classroom. So, so. So sort of the idea of lifelong learning was something that I think has been, you know, has been very helpful
[00:13:43] Speaker C: to me for the past 20 years. You know, you've grown this, you know, just amazing program with great colleagues.
When you think about, you know, as we all do, you know, I'm starting to. We all think about it is how do we set the next generation up to be able to exceed what we've done in many ways, and, you know, whatever little we've contributed, we want others. I think Mark feels strongly, and I'm pretty sure you do. Can you speak a little bit about how you've. What your view is to mentoring the next generation? And I think mentoring, as you know, and we all know, goes beyond, like, how do you create that next individual who can. Who has those multiple skill sets to both collaborate, build networks, do research, which is the science, but also lead?
[00:14:28] Speaker B: Yeah, yeah, sure. Well, I'll. I'll answer that, and then I'll have to qualify. You know, kind of the moment we find ourselves in, which sort of extends to the larger, you know, political moment and the funding environment, which has really made all of this very difficult. But, but I think the basic principles remain. You know, I think that it's, you know, and a lot of this has taken me years to really understand and be able to implement, I think, effectively, but is to try to have a keen eye for people who have fire in their belly, who are, you know, who are creative and who are hard workers and who are very, very smart. Because I think you need all of those things and then to sort of believe in those people, you know, and allow them to take risks, but at the same time really insist on rigor, insist on their also surrounding themselves by smart people, by taking, you know, the coursework that gives them the basic tools and by, you know, you can't really teach humility and curiosity, but you can model it. But I think they're really critical. As soon as people start thinking they're, you know, right core quote unquote, they, they really stop learning. And, you know, we are working in an environment where the top 10% of grants get funded at, at best, and, and the rest do not. And so, you know, you can't get into that group by, you know, just assuming that you're, that you're right and everybody else is wrong because, you know, the, the reviewers are the reviewers. So, so, so I, I think that, and, and again, you know, I, I, I, that to some extent is sort of characterologic. And I think that was just, you know, how I was raised. Two very humble parents who I think really kind of insisted on that. And, you know, and I'm very curious. I don't know why, but I am, I always have been.
But I think that's really important, you know, because the idea that gets funded today, you know, is not going to be fundable five years from now. So you just have to continue to kind of grow and expand your mind and ask, you know, questions and listen to people.
[00:16:38] Speaker A: That's great, Jeff. I want to get down just a little bit in the weeds because I think this is important for the readers of the journal. There seems to be more of a push, I'll use the word, towards Bayesian analyses.
And I wonder if you could just comment on the use of that approach and what the benefits and risks might be.
It's a bit of a technical question for our listening audience, but I know there are authors out there who are kind of trying to sort through this because they see it from podiums everywhere.
[00:17:15] Speaker B: Yeah, yeah. You know, I'm not that knowledgeable and I, I kind of feel like over the years I've seen a of lot, lot of things come and go, including Bayesian analysis, including alternatives to randomized trials, including, you know, various forms of machine learning. And, you know, I think they all have sort of a place, you know, if you're in an area where there really are some well recognized priors, then, you know, then the idea of what constitutes a chance finding is different in a. Than it is in a more exploratory phase of research.
But I think every question has probably more than one analytic approach, but often some better and some worse. And so I kind of feel like depending on the question, Bayesian approaches might be more appropriate than others.
But not every question. And I'm not knowledgeable enough about Bayesian analysis to say that terribly. Much more than that, frankly.
[00:18:22] Speaker A: Yeah, Jeff, that's the answer so wonderfully illustrates just your, your approach in this whole area. And you really recruited a bunch of people knowledgeable in various aspects of statistics. You already mentioned Elena, but Brent Graham and others who have served the journal very, very well. And one of the things that you've taught me is that statistics and methodology is a lot like orthopedic surgery is different.
People will approach a question in a different way and there's room for discussion and there's room for sharing knowledge. And you've made the journal so much better and more reliable, I think, source of information through your decades of service and mo. I'm going to just throw it out to you if you have a last question. But Jeff, I'm incredibly grateful and I'll just tell a story. When I was approached and asked to consider being the editor in chief, I said there are two people that I absolutely must have on this board if I'm going to take this job. And you are one, Tom Bauer being the other.
Thank you so much for hanging in with me.
I'll let you take us out here.
[00:19:33] Speaker C: I mean, it's very hard to follow that.
Our sentiments are amazing. What you've done for. And I'll say the same, Jeff, what you've done for just science, but also particularly for the field of orthopedics and also for the journal are really unparalleled. And I think your, your legacy is etched. But on that note, as you think forward, maybe I'll ask this question. You brought up the idea and I think it's such a true thing, especially I always say, and I'm using the statement, in the age of AI, the one differentiating factor is going to be humans. And you know and how we use our creativity, how we use our curiosity.
Just for those out there, how do you cultivate that on a personal level? Are there habits you have? Thinking time? You know, do you go for walks? What kind of things do you do when you're, you know, trying to either work through a problem or think about, okay, where are we going next?
[00:20:25] Speaker B: You know, I don't, I'm not sort of a meditator, and I don't, you know, so I, I don't really, I don't block out thinking time. It doesn't really come to me that way. I think some people do, and I applaud that. And I don't think, frankly. I mean, I, I, People I respect a great deal have told me I'm not a terribly original thinker. And I said, you know, the things that I've done are, are kind of, they're, they're not. I, I don't think they're revolutionary. I think they were sort of logical next steps. I think I've done them well, and I think they're very clinically, clinically informed. So, you know, to be honest, when I've taken on new projects, it's frankly usually followed discussions with really, really insightful clinicians who I think have more often been the idea generators. And I can sort of, you know, by virtue of my training, I can sort of understand what it would take to take a hypothesis that somebody is sort of germinating based on what they observe clinically and to really create designs and studies to do that. I think that's where my talent, if I might, you know, has lain rather than in.
But, you know, curiosity and originality, you know, can, you know, like my colleague Elena, who we've mentioned, is a very original person. If you look at the things that she's undertaken, they're just, they're breathtakingly original. And I think that.
I don't think my own work sort of looks like that, but I think that the steps that it takes to go from idea to proposal to implementation, that is a very creative process. I've learned it's often a bit underappreciated to the extent you both have worked in wonderful groups and you can probably name now sort of master's level project managers and even, you know, recent college graduate research assistants who figured something out, you know, using their creativity. So, so it's, it's, it's, you know, help.
And I think what perhaps, you know, helps to encourage rather than discourage, that is to, is to have a fairly open inquiry kind of environment in which you, in which you work, in which people are really.
They know they're accountable to the things they're supposed to be doing, but they feel really, really free to make suggestions, whether it's kind of doctoral level colleagues about design and things like that, or some of the people more at ground level about how we're approaching patients or just fostering the ability for people to be original and to feel free, free to contribute their ideas. I think that's important and I, I think I'm pretty good at that. I, I don't know what the sort of. But I think it does have to do maybe with just not really feeling like I know what the right answer is, but that I want to surround myself with people who are, you know, are generous with their thinking and, and feel free to offer their thoughts. I guess that's as bad as, as, as that's probably my response to that.
[00:23:48] Speaker C: Wonderfully stated.
You've given tons of, tons of pearls there for all of us. So I think we'll be decoding that for a few days yet. But thank you so much and maybe I'll let Mark sip the final words. Jeff, but thank you so much for participating this morning.
[00:24:04] Speaker A: Thank you.
Yeah. Thanks so much for spending time with us this morning and again for your decades of contribution to, to the journal and making it a much more reliable source of information for the readers of the journal. So.
[00:24:18] Speaker B: Oh, every minute a pleasure. Yeah, thank you. Every minute a pleasure. I enjoyed this too. Thank you guys both.
[00:24:25] Speaker A: Have a great day.
[00:24:26] Speaker B: Yeah.
