Duke Colleagues
Robert M. Califf, MD: Hello. I am Rob Califf from Duke University, and I want to welcome you to this new episode of the Life and Times of Cardiologists. We are here with theheart.org on Medscape, and I am with my friend, Magnus Ohman. Magnus is also at Duke and has been there for quite a while, with a few escapades in other places.
Our goal for this series is to provide inspiration about what makes people tick who have accomplished things in their careers as cardiologists, and to understand where they came from and what they plan to do in the future. Welcome, Magnus.
E. Magnus Ohman, MD: Thank you, Rob.
Dr. Califf: Magnus, what was your early life like? What kind of a household did you grow up in?
Dr. Ohman: I am an only child, although I wasn't destined to be. Unfortunately, my mother had 2 stillbirths and I was in the middle, and so I led a somewhat protected life, as you can imagine. My mother was a stay-at-home mom (although later she started working), and my father was in the clothing business. It was a family business for about 60 years, and I was destined to follow if I hadn't gone down the medicine route.
Dr. Califf: I am trying to imagine growing up as an only child in Stockholm. What was that like?
Dr. Ohman: Stockholm is a beautiful city, particularly in the summer. It is a bit heavier in the winter; a bit cold. I had the usual schooling in Sweden, and I had great friends. It is a great environment in which to grow up.
A Rebel, Not a Hippie
Dr. Califf: I have heard that you were a little rebellious, though.
Dr. Ohman: I did a few things. I was interested in music, although I don't play any instruments, but I worked in a record shop for the better part of 3 years in my spare time. I probably could have gotten better grades in school if I hadn't done that, but it was a great experience. I interacted with a man from New York named Richard Berlin, and Richard Records was the place for records in Stockholm in the early 1970s.
Dr. Califf: Was it a hippie hangout?
Dr. Ohman: No, we were past the hippie era. This was the 1970s, so it was rock and fun music, and great people. Many of the artists who came to Sweden came to the record store because of Berlin, and so I ran into people there, which was fascinating. But I stayed clear of all the badness that happens in music. It was a fun time.
Dr. Califf: What was your favorite subject in high school?
Dr. Ohman: History. I loved history. It is a great educator; my best subjects were English and history. I was decent in the sciences.
Dr. Califf: Why were you interested in English?
Dr. Ohman: Coming from a country that had no simple way of connecting with the rest of the world, you had to learn English. I was sent to England during the summers as a young child. I went to New Forest, and I worked at a kennel that bred Pyrenean mountain dogs, so I used to walk these Pyrenean mountain dogs in the New Forest. It was an incredible experience. These are big dogs, and I am not that big -- but it was an interesting time.
I went there without any dictionary or any way of learning. It was basically what is now called "immersion learning," and at the end of 2 summers, I was pretty fluent in English.
Dr. Califf: Did you play sports in high school?
Dr. Ohman: I played 2 sports: golf and curling.
Dr. Califf: You played curling?
Dr. Ohman: I did, and I participated in the Junior Championship games. We were never very good, but we played and it was fun. Sweden has very long winters, so you have to do something.
Dr. Califf: What is the real trick to curling? It looks to me like you push this thing down the ice and then you start screaming at it, and it is how much you scream at it that seems to be important.
Dr. Ohman: It is a very strategic game, because you essentially have to always mark out your route so that you can get the greatest number of stones in the center of the circle. It looks easy, but it is a fairly difficult sport.
In the summers I played golf, which I really enjoyed, and that is the sport that has stuck with me.
Leaving Sweden for Ireland
Dr. Califf: So when the time came to go to university, you didn't stay in Sweden. Why was that?
Dr. Ohman: In my day, you had to do military service and it is obligatory, so I was carted off to do a year of that. I decided not to do the standard service, which is about 9 months; instead, I did officer training, because I wasn't mentally stimulated by the basic military training. I did that for a year and a half.
By that time, my parents had divorced and my mother had married my stepfather. He was a toothpaste manufacturer, and they were moving the factory to Ireland. So I thought, why not go to medical school in Ireland?
After about a year, my stepfather had some health issues and eventually died of a ruptured thoracic aortic aneurysm, but he had had a number of transient ischemic attacks (TIAs) and other events before that, so they got cold feet about moving. In the meantime, I was having a really good time in medical school and I just stayed. I never regretted it a bit.
Dr. Califf: A toothpaste factory is unusual. That was a big business, though, as I understand.
Dr. Ohman: My stepfather's family had manufactured toothpaste for many years and had actually expanded into Russia, which is interesting. They needed to expand rapidly. The business environment in Sweden in the 1970s wasn't very good, so they decided to try to manufacture the toothpaste elsewhere, and that is how it came about.
Dr. Califf: You played golf while you were in medical school and had some great experiences there, but it is also very different from medical training in the United States. How would you compare the two?
Dr. Ohman: They are very different. In Ireland, as in most of Europe, you essentially start medical school right after high school (although I had done something different in between). You do 6 years. The first year is your pre-med year, and then you have 5 years of medical training. It is less focused on research, so I had no research experience in medical school, but great clinical teachers -- physicians who had real knowledge about how to communicate with patients and others. So it is a very different way of doing things.
Dr. Califf: Did you have a mentor in medical school?
Dr. Ohman: Not directly. I worked fairly closely with a vascular surgeon named David Bouchier-Hayes. He was very helpful in saying, "You need to look into this and this." But it was after I finished medical school and started my internship in Ireland that the research started taking off.
Dr. Califf: What stimulated that, without any background in research?
Dr. Ohman: A physician who had done a lot of his training in the United States --John Horgan -- came back to Ireland, and he said, "If you do anything in medicine, you have to research it." I started some smaller projects (nothing to be proud of), and he was encouraging. I had help from people with knowledge in statistics and other things, but much of it I actually learned myself. The first book on statistics that I read was Stuart Pocock's book[1] on clinical trials. I read that and started learning about research.
At that stage, I was more interested in translational work. I wanted to understand "why" in physiology (which was my favorite subject in medical school), and how does it really work? Why does this happen?
I became interested in adrenergic receptors, which was my route to Duke, eventually. I developed projects to explore the effect of adrenergic stimuli on the cardiovascular condition. To do so, I had to collect lymphocytes that had beta-receptors on them, so I could characterize the receptor density and the signaling that went on. I did this for exercise and other conditions to really understand it.
Dr. Califf: At what point did you decide you were going to be a cardiologist?
Dr. Ohman: The first rotation I had was with John Horgan in the coronary care unit (CCU), and that was it. Because of the physiology, and the ability to understand what you are doing and explore it further, cardiology has always been in the forefront.
Dr. Califf: It is also amazing how a mentor, or finding the right person at the right time, can change your life.
Dr. Ohman: John was terrific because he was a busy man, but he gave me a lot of opportunities to run with.
Time With the ISIS Cartel
Dr. Califf: You ended up at Duke; how did that happen?
Dr. Ohman: Before this, I had done 3 years in clinical pharmacology and did much of my adrenergic receptor work during that time. Then I was exposed to the Oxford Group, and the International Studies of Infarct Survival (ISIS). It happened purely by chance. Many things in life happen by chance.
I was at a wedding with Peter Sleight in Ireland, and he said they needed a man in Ireland -- so I became the man in Ireland. I went to Oxford to learn more, so I had some basic knowledge, but I learned clinical trials from Richard Peto, Salim Yusuf, and Rory Collins.
Dr. Califf: The cartel that was there was quite amazing, wasn't it?
Dr. Ohman: It was an amazing time, and I was part of this early ISIS group. Salim had published a meta-analysis -- the first meta-analysis in the European Heart Journal[2] showing lowered mortality if you aggregate all the trials [on fibrinolytics] -- and here we were starting the largest trial ever done in the field. With a very simple trial, we realized that we could translate things on a large scale.
Dr. Califf: I imagine that the excitement of the whole team was remarkable.
Dr. Ohman: Rory Collins was a great guy, and we connected in many ways and worked together on a lot of things. ISIS-2 didn't come out with a whole lot of publications because the case report form was a single page, so there wasn't a whole lot more to look into. But it was a great starting point for understanding clinical trials, and with the right people and size effect.
Dr. Califf: You had the basic medicine, the clinical pharmacology, and the clinical trials, so why didn't you just stay in Ireland and have a career there?
Dr. Ohman: In medical school, I had spent 2 months at Johns Hopkins University in an externship in ear, nose and throat, and it was very exciting. I worked with Dr. Kashima and Dr. Kennedy, world leaders in oncology. It wasn't my area of interest, but it was very exciting. I met Dr. McKusick, and I sensed that if you wanted to spend your life in scientific medicine, this was the place to be. So it was very clear to me that at the end of my training in Ireland, I would look for specialty training in the United States.
Heading to Duke
Dr. Ohman: How I ended up at Duke University was interesting. I got lucky again. Tom Ryan, Sr., from Boston University gave the Robert Graves lecture in Dublin, and at the time I had 2 offers. One was from Duke, and one from Washington University with Burt Sobel. I said to Tom, "You don't know me, but where do you think I should go?" We spent a little bit of time talking, and later that evening, he said, "I think Duke might be a good place for you."
Dr. Califf: Wow. I did not know that story. Tom Ryan, Sr. -- what a great man. He is so much fun to be around, and an avid golfer, too.
Dr. Ohman: It helped that I had run into Gary Stiles, who was an emerging research scientist at Duke and had worked with Bob Lefkowitz, who later got the Nobel Prize. I thought this was a great place, but by the time I got to Duke nearly 2 and a half years later, I had this love of clinical trials, and I had to tell Dr. Stiles that I was changing focus.
Dr. Califf: How did he handle that?
Dr. Ohman: He actually took it really well, and Galen Wagner, another iconic Duke cardiologist, was extraordinarily helpful in saying, "You can't pick right from the get-go what you are going to do. You need to have flexibility."
Dr. Califf: During all this time, you got married and had a family, right?
Dr. Ohman: Actually, I got married the week before we left Ireland. I had met my wife in Dublin 9 months earlier, although we had known each other for some time. I was faced with this challenge that I was about to leave for Duke, so I proposed to her and we had a wedding and farewell party at the same time.
Dr. Califf: You were very lucky, because she has been the stalwart of the family, hasn't she?
Dr. Ohman: Absolutely. I am very lucky. All 3 of our children were born in Durham, North Carolina.
Dr. Califf: I still remember the week that you arrived. You were in the treadmill lab, and a patient had atrial flutter or venricular tachycardia, and I was rounding on the CCU. I could tell right away that you were intense, because we had quite a conversation that day.
Where I Go, Trouble Follows
Dr. Ohman: This is funny. It was the first day, and we were sitting in the treadmill lab having our orientation, and there were treadmills tests going on. We were called to a code and 3 of us -- Paul Gurbel, Mark Leithe, and myself -- responded to the code. They said to me, "You go and call the CCU," and a fellow by the name of Califf with a very Southern accent picked up the phone and said, "What do you want?"
Unusual things often happened to me. One of the first weeks that I was on call in the CCU as an intern in Dublin, a patient stood up, had ventricular tachycardia, and fell through the window.
Dr. Califf: When you are on call, there is going to be trouble.
Dr. Ohman: The fellows actually gave me an umbrella, with black on the outside and a sunny sky inside, just to be on the safe side.
Dr. Califf: It is good to have someone who can be relied on in times of stress to stick with it. That is a characteristic about you that I have admired. I didn't peg you necessarily for going into interventional cardiology at first, but you really wanted to do that.
Dr. Ohman: It was an emerging time for angioplasty (there were no stents yet). What I wanted to do (and I had some success, through your help and that of others) was investigate it by doing clinical trials. Until the early 1990s, there were very few randomized trials in interventional cardiology, and we did a number of studies to explore treatment strategies.
Dr. Califf: In this life of intensive interventional cardiology, and being a clinical cardiologist and doing research, what would you say to young people now about that sort of lifestyle?
Dr. Ohman: It takes a good family. I am indebted to my wife, who has been extraordinarily supportive of my research activities, and to my children (2 of whom I scared away from medicine because the work hours).
Having said that, I do it because it is fun. I love what I am doing. I am having a great time, and if you have fun, you can work a lot and contribute. If you are not having fun, you have to move on to something else.
Changing Teams in the Triangle
Dr. Califf: You were having a fabulous career at Duke, and all of a sudden you decided to change shades of blue. What was going on there?
Dr. Ohman: Most people in academic medicine grow up and think about being a division chief, and wonder what it would be like to lead. This opportunity occurred next door in Chapel Hill -- although it was stressful to be a Duke fan and work at Chapel Hill. But it was an opportunity.
They wanted to build a heart center, and I said there was no better time to do it. As Dr. Braunwald and Eric Topol said, "It can't hurt. You don't have to move." I felt that it was the right thing to do, and it was a very good experience.
I spent 5 years as Division Chief, and it was stressful, yes, but a different type of stress. You can do a lot of mentoring, which I enjoy. It was building a program from scratch, so that was fun. After 5 years, I thought that I had contributed enough to that process.
Dr. Califf: So, you returned to Duke. You have had this unusual relationship with Chris Granger over the years.
Dr. Ohman: Chris and I became very good friends when we were fellows, mainly because Dr. Greenfield promised us that he would pay for every trip to every national meeting we got into. We were fairly successful at getting us on every program, and he didn't realize that he was going to have to pay for 3 meetings yearly for 4 years. We got a message from his administrative assistant that we needed to reduce the costs, so Chris and I got together and figured out how we could share the cost, and it has been fun. We are very close friends. Our children have been in the same camps.
Dr. Califf: So you room together at all these meetings?
Dr. Ohman: Yes, we have for years.
Dr. Califf: Many of us have wondered about your relationship, and I guess it is all on the up-and-up and we can feel good about that.
Dr. Ohman: Yes. We are just good friends.
The Future, According to Magnus Ohman
Dr. Califf: You are in a phase of your career where you have pretty much done it all. You have a lot of freedom. What do you see for the next 5 or 10 years?
Dr. Ohman: We are in an interesting dynamic right now in academic medicine in the United States. Funding is disappearing -- both industry and government funding from the National Institutes of Health (NIH) -- so there are some challenges. Our work environment is being eroded to some extent, so we need to figure out how to address that issue.
We need to look at other sources of funding. We need to raise philanthropic money to be able to do better research, and we need to do seed projects. If we get funding to do something in a few patients, we can go to the NIH and say, "We have done this in a few patients." That is a great opportunity, and we need to do more of that.
The whole interplay between guidelines and registries is another area. Eric Peterson, Brian Gibler, and I developed the CRUSADE Registry. It was a very successful project because of the collaboration and teamwork. We need to do much more, because we learned a great deal about non-ST-segment elevation acute coronary syndrome.
On the clinical side, I will revert to what my grandmother, who passed away at age 89 back in the 1990s, said: "Don't forget, you are always a doctor." So I have to do some doctoring, too, to keep up.
Dr. Califf: You are good at that. We are all appreciative that you are into the fund-raising part, as well, because a dollar of philanthropy is very useful compared with eking it out of clinical care or from an NIH grant.
When fellows come to see you and ask what they should do with their lives, what is your advice?
Dr. Ohman: I tell them to go where they think that they will have fun. Don't try to figure out where the money will be or where the success will be, because the people who have fun at Duke or at the University of North Carolina are good people, and if they put their minds to something, they will succeed.
We give up many things in medicine by having to come in at 2:00 or 3:00 in the morning for an ST-elevation myocardial infarction. My oldest son still doesn't quite understand why, but it's what we do for the patients.
Dr. Califf: Your children are doing well. It has been fun to watch them grow up. You have an older son who is in the economics field, right?
Dr. Ohman: Our oldest son, Edward, is a strategy consultant with a company in New York, which is healthcare sector-related. My daughter went to school here in Washington, and is probably going to be in the legal realm as an undergraduate. Our youngest son, Henry, is graduating from a local school, the Durham Academy, and will be going to college next year.
Dr. Califf: Has he decided where to go yet?
Dr. Ohman: He is going to go to University of Richmond and be a Spider, and he is talking about medicine, which makes me very happy.
Dr. Califf: I know it would. This has been a great conversation, and it will be inspiring to people who are thinking about what they can do around the world to make a difference. Thanks for joining me.
Dr. Ohman: Thanks, Rob.
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Cite this: Life and Times of Leading Cardiologists With Rob Califf. Guest: Magnus Ohman - Medscape - Apr 30, 2014.
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