Personalised genomic medicine and surgery
In 2011, Dr. F. Charles Brunicardi, a gastrointestinal surgeon-scientist, rejoined the UCLA faculty as Professor and Chief of the Santa Monica-UCLA General Surgery Group and as Vice-Chair of the Department of Surgery for Surgical Services at Santa Monica-UCLA Medical Center. In 1999, Dr. Brunicardi became DeBakey/Bard Professor and Chairman of the Michael E. DeBakey Department of Surgery at Baylor and has held that leadership position for the past 12 years.
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Dr. Brunicardi graduated from Rutgers University School of Medicine in Piscataway, New Jersey. Upon graduation, he served as a research assistant in the Department of Anesthesiology at Cornell University Medical Center in New York. Dr. Brunicardi was a Surgery intern at Mount Zion Hospital in San Francisco, California and was a Surgical resident at the State University of New York (SUNY), Health Science Center in Brooklyn, New York. From 1988-1989 he was the Chief Resident of General Surgery at SUNY Health Science Center. Dr. Brunicardi’s research interests focus upon Translational Genomic Medicine and Surgery. His clinical areas of expertise include Gastrointestinal Surgery and Surgery of Neuroendocrine Tumours. Dr. Brunicardi has held continuous research funding since 1992, and he has a vast bibliography with more than 250 publications. He is the editor of the surgical textbook Schwartz’s Principles of Surgery.
Among his numerous honours, Dr. Brunicardi has been distinguished as one of Texas Super Doctors since 2006 and as one of Best Doctors in America in 2011
During this session, Professor Brunicardi talked about his vision of the future of Medicine in the 21st century: personalised therapy based on the individual genome of each patient.
FRONTAL: Your career has been remarkable in various aspects, among which your multitasking ability. You have devoted yourself to research, to teaching, to clinical practice and to the editing of one of the currently best known surgical books. What is the secret to conciliate all these activities successfully?
Charles Brunicardi: It is the same as what you do. You have many classes, you have many duties, you have to study and then you have your personal lives, your families… and so you use time management techniques and you can balance many things. That is how I do it. I have a system – I’ve written a paper about it that is available for you to read.
F: The first edition of “Schwartz’s Principles of Medicine” was released in 1979, when you were just 25 years old. As a student back then, did you use it as an information source? How do you feel when acknowledging that it is now one of the most internationally recognised surgical books?
CB: I took over the Schwartz’s book in 2002, so it has been 11 years. I was deeply honoured to take over the book from Professor Schwartz himself. You now have the 9th edition, and the 10th edition will come out later next year. It is a wonderful honour to carry on the tradition of the textbook, it is the textbook I used when I was a student and a resident. We gathered the best surgeons from the United States but also from many countries and we all participated in the writing of the new edition. It is also available online on two wonderful websites: Access Surgery and Access Medicine.
F: You have been distinguished with the title of “Texas Superdoctor” in 2006 and elected one of the “Best Doctors in America” in 2011. In your opinion, what qualities must a good doctor have?
CB: I’m not sure! [laughs]. I’m deeply honoured to have been given those awards, I try my best to take excellent care of my patients. My patients do very well – I get very upset if they have any complications so I try to avoid them. I have become a much better surgeon over the past 24 years: I’ve become much smarter on how to prevent complications and provide high quality care. In addition to clinical, I then published papers on research and the textbook. Plus, I’m always teaching so I think that it is because of the combination that they have given me that award.
F: One of your main interests and research fields is Personalised Medicine. What does it consist of and what role will it have in the future of Medicine?
CB: I think it is the future of Medicine in this century. We have been on earth for 7 million years walking upright and it was only on the 1500’s that we’ve learned about Anatomy and then in the next few centuries we’ve learned about Physiology. Then we began with Chemistry and in the 20th century we developed Molecular Biology and we can now do the human genome. Now the genome represents the Anatomy of the 21st century and the epigenetics and signaling represent the physiology of the 21st century – so how can we, surgeons and physicians, practice without knowing the Anatomy and the Physiology? That’s what will happen this century – we will be able to tell everyone’s genome and then we will decide which therapies we should use to treat them, whether it is for prevention, standard therapy or, even better, target therapy. Now the next step is to go down to the atomic level. I’ve written a paper on the atomic theory of disease and I believe that it is the atom and the subatomic particles that actually cause the disease. So that will be the next level down, after we’ve mastered the genome.
F: And how long do you think it will take until we start studying this “atomic etiology” of diseases?
CB: Hopefully your generation will begin to study it. However, these cycles usually take 30 to 50 years. So it will probably be 30 to 50 years.
F: Along with your career as a doctor, you have also had a very successful musical career as a composer and a folk singer. You have even performed at the Cambridge Folk Festival in 1978. What is the connection between music and Medicine?
CB: Very good [laughs]! It’s a wonderful connection. There is something magical about the artform of the popular music – when you hear a popular song it can take you right back to when you were 20 years old, 15 years old… There is something magical about the 3 minute popular song. I’ve always been intrigued by it since I was a little boy. My father introduced me to playing when I was 7. As I have one brother and two sisters, all of us played instruments and performed. I’ve played in many bands at college and medschool and then I had a two-records contract in the 1970’s while I was a medical student and I toured England as a folk artist. I then had to decide whether I wanted to do music or Medicine and in 1980 John Lennon was shot – this was near the place I lived in New York City – so I decided I belonged in Medicine. So I went into surgery and I’ve been working ever since. However, I always play for my family and friends and I keep writing. Recently, this summer, I’ve recorded an álbum of 12 songs – it will be coming out soon online.
F: What advice would you give to medical students that look up to you and aim to have a career as bright as yours?
CB: I don’t know [laugh]. I think that what you have to do is follow the thing you love to do – I love taking care of my patients, I love waking up and going to work every morning. Don’t worry about the economic state of your country, don’t worry about your salary – just think that now you work very hard, you don’t receive any money and you are very happy. Just follow your passions.
[hr]Interviewer: Catarina Palma dos Reis Writers: Catarina Palma dos Reis, Thalia Moço