“Medicine is actually a little behind if you want to say that, particularly when it comes down to care of patients. So, it entered research fairly early and that was a field that was kind of an early that early adopter. But that wasn’t true for how we treat patients and that’s finally changing to some degree. But it’s still kind of rusty if you ask me.”
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JESSE: Welcome to the Smart Athlete Podcast. I’m your host Jesse Funk. On today’s episode, my guest actually has really excelled in I’ll say the academic field although it’s more than that. He has both his MD and his PhD, and he’s a board-certified dermatologist. So, we’re definitely gonna delve into that. Not only that, the fun part about this particular podcast is that people are very well rounded. He’s an international handball referee. He also plays in the top tier of the Buenas Liga as a tennis player in Germany. Welcome to the show Christian Posch.
CHRISTIAN: Hi, Jesse, how are you doing?
JESSE: Doing pretty well. It’s like we were talking about before we got going. I always have to restart the conversation for the actual recording, which is always a little odd because you don’t typically restart a conversation with somebody once you’ve already started a conversation. But everybody seems to do pretty well with it. So, I’m always like, we’re flexible, human beings, we’re flexible with things, it’s gonna work out. So, tell me about– If you are on iTunes, you’re missing out on YouTube. Chris has got a bookshelf behind him which I’m assuming are very interesting books. Tell me what’s going on there?
CHRISTIAN: What’s going on behind me?
JESSE: Yeah.
CHRISTIAN: There’s quite a good variety of different books, all spanning from like arts and medicine to like all the new fields that open up right now like deep medicine, pretty fun book to read if you want to look into that. So, all the new technology is basically now finally finding their way into medicine too. We’ve had these new technologies for a while in all different kinds of aspects of life. But medicine is actually a little behind if you want to say that, particularly when it comes down to care of patients. So, it entered research fairly early and that was a field that was kind of an early that early adopter. But that wasn’t true for how we treat patients and that’s finally changing to some degree. But it’s still kind of rusty if you ask me.
JESSE: Is it a matter of like I know so the US we have the FDA and things have to go through them before they can be used for medical treatment. Is it a matter of bureaucracy holding things back? Or is there something else at play?
CHRISTIAN: Good question. I guess there are a few things actually holding it back. There are some people who are just very traditional, and they like pen and paper. The other thing would be that, obviously you wanna apply really high standards in terms of privacy, data security. Well, that has always been an issue. You know, as soon as it’s electronic, you basically open it up to, I wouldn’t say to the whole world, but you open it up to certain individuals you might not want to share this kind of information with. And it’s also not the same as you would just lose a credit card. You know, you get just issued a new one with a new number on it.
But the thing is, if you lose medical records, that can be a pain in the butt actually, because how would you restore it? Right? So, if it’s gone, and it’s tied to your name, people have it, it’s not going to change a whole lot, right? You might like, only add something on it but that’s it. So, there’s really no good way to kind of restore once it’s lost so it can’t get lost in the very first place. So, I guess that makes people a little more conservative when it comes to new technologies. But I think at the end of the day, people now are realizing that it’s necessary. We have to do this kind of like forward-thinking more of the medical field because pen and paper just doesn’t do it anymore. Yeah, let’s keep it [??? 04:30]
JESSE: Right. And like you said there’s kind of an encryption issue with digital. It’s like, with the benefits of, I know, there are companies here in the US that are working on digitizing medical records so that when you go from this hospital to that hospital or this care provider to that care provider, it’s easy to just be like, hey, send over the record, you’ve got everything. You don’t have to worry about weird faxes of doctor’s notes and not understanding things, it’s digitized. [crosstalk]
CHRISTIAN: But it’s not, not at all. Actually everybody runs his own system, his or her own system. They introduced features that they think are valuable. And then these like different ports and stuff, they don’t really connect. And what do you do if you have data in a different format? Well try that in any other field, it’s gonna screw up the system. So, it’s not that easy to share stuff right now. Usually, when you’re within a system, I don’t know. Kaiser Permanente, to just name one of them, if you stick within the system, you’re pretty fine, you’re good, right? There’s not a whole lot that can go wrong. So, hospitals and doctors can share information.
But as soon as you leave that closed up system, it’s kind of getting a little more difficult to do that. So, yeah, they’re pros and cons to it. But the main problem is there is no standard, there is no consensus in the way this data should be used. And at the same time, that would be super valuable and important to do.
Because that will be the source and basically the foundation for anything we want to put on top of that, just big data analysis, everybody talks about artificial intelligence and neural networks and whatnot. But what you need for that is, is a good foundation and that is annotated data that you can rely on and that is somewhat correct. So, if [??? 06:26] how would you analyze it, right? Anything that comes out of it is going to be crap.
JESSE: Right. And I’ve talked to a few data scientists, and it’s like part of the problem too is, as you mentioned, some kind of normalcy, a standardization of that data, where it’s like– My girlfriend actually kind of works in this field. She works with a stroke unit at a local hospital and analyzes the data and makes sure that stroke patients are receiving the care that they need.
But going back to the data, sometimes through other people that have entered the data, say one field should be yes or no. And they’ll enter kind of, maybe sometimes. It’s like, no, these are not– It’s yes or no, it’s a one or zero value. You can’t start entering twos, threes, fours, and fives because then the data just falls apart.
CHRISTIAN: Yeah. But at the same time, I’m gonna jump in here, it’s not always black and white.
JESSE: Right.
CHRISTIAN: Yeah, it’s not that easy, right? So, it is a scale. And maybe there should be another button like yes, no, I wouldn’t say maybe, but maybe just include a range. Have a scale where you can just like move things around. And even that would be more valuable than just leaving it blank, right?
JESSE: Right. Right. But at the same time, it’s like, there should be something like you said a scale even and say, okay, to what degree does this measure? Is it zero or is it 10 and then separately, along with that data, which you could use to standardize between patients, some kind of notes field, which is a way to annotate abnormalities without screwing with the data fields.
CHRISTIAN: Yep. And then you need natural language processing to actually [??? 08:10] have that data too. Because that can screw up the whole thing too, once you call it cardiovascular disease, but actually meaning a stroke or a heart attack. What is it now? Right. And if you [??? 08:25] that leaves that open to the reader too.
JESSE: See, I kind of think of the problem as like– this is a very mundane example of this. But talking about standardization between health systems, be it within the US or US to other countries or whatever it is. We as humans have trouble trying to get the same phone charger on all of our phones, let alone the same record system in all of our hospitals.
So, it’s like even– I’m sure you remember when cell phones were first coming out and every single phone had a different charger and it was simply insanity. Unfortunately, it’s still, we seem to have mostly settled on the micro USB, aside from like Apple products, but it took time to sort even that very small problem out.
CHRISTIAN: And just think of the waste of resources [??? 09:27] like it’s crazy. Yeah. So, in the [??? 09:30] has been a discussion just recently, where they actually want to mandate a standard for chargers now. Like just everybody has to use that one. And every company comes in from each angle and saying like, well, this feature is better and that’s patented and whatnot and how are we gonna get reimbursed for our inventions and [??? 09:48] but it’s the right thing to do. I agree.
JESSE: Yeah. That’s kind of the argument for government oversight is like some people want to go small government, don’t interfere with anything. But it’s like there are some benefits of that where a government has the ability to be like, okay guys like this is ridiculous. Not only are we costing consumers money, but it’s just increasing the amount of waste that we have. Let’s fix this, legislate it.
But at the same time, I also think about the possibility for that to become a problem down the line where it’s like, say right now say we adopt micro USB as the standard, but then there becomes a faster, more effective charging method, then you’ve got to re-legislate it. So, I feel like if you legislate, you’ve got to have some way to say, if 80% of companies producing these products decide on a new standard, then they’re allowed to move to the new standard or something.
CHRISTIAN: And I imagine that for healthcare.
JESSE: Yeah. [crosstalk] really complicated.
CHRISTIAN: That’s a tough one. But yeah, it would be useful for sure.
JESSE: Yeah. So, you were telling me, obviously, you’re a board-certified dermatologist. I actually saw– Well, we don’t want to talk too much about this. But on your Twitter, you’d posted an image talking about Coronavirus, and it was basically a meme about stay home unless you want to be intubated by a dermatologist. And I thought that was pretty amusing just, given the light of the situation.
CHRISTIAN: [??? 11:23] you laugh and then you kind of choke.
JESSE: Oh, then you’re like, wait, that sounds like a terrible situation.
CHRISTIAN: Yeah, that’s why I like to put on top of that in all seriousness like stay home guys.
JESSE: Yeah.
CHRISTIAN: Because it’s funny, and it’s not funny at the same time, right?
JESSE: Yeah.
CHRISTIAN: I mean, I have friends in Italy and this is a real, excuse my language, shit-show. What they’re having down there is really a big, big mess. And it’s because the system is overwhelmed and they can’t handle it anymore. They have to have personnel doing things they haven’t been trained for and that’s a major problem. And they need to do things now and take care of things that they’re not specialized in. And I mean, what’s going to be the logical result of that kind of action? Right?
But at the same time, you gotta do it at less now instead of not doing anything. So, that’s where this whole like post was going. Right? I mean, yes, [??? 12:21] then, by the way, in case you really get intubated by a dermatologist, you want to be intubated by me, I actually did that before because I had some training in the ICU.
But it has been 10 years from now so I wouldn’t feel comfortable doing it right now again without a refresher. But that’s where this is going, right. In some countries, in some areas, it’s so bad that the real professionals are overwhelmed, need to stay home, sick themselves. So, you get treatment by a second tier, third tier and sometimes I wouldn’t say even students, and it’s not how it should be.
JESSE: Right, right. Right. But at the same time, it is what I would consider the logical course of action. Just when you become overwhelmed, you don’t have the staff, you’re gonna go to people that are the next most knowledgeable. You’re not going to take me to the hospital and be like intubate that guy because I’d be like I don’t know what you’re talking about. I have no medical background at all. So, obviously, you’re gonna go to somebody who has some kind of medical background before you start picking up average Joe off the street to be like, hey, perform this complex medical procedure and don’t kill somebody.
CHRISTIAN: Yeah, I agree fully. But this is line 25 maybe, right. We’re talking about line three, four, and five. And that can already get bad. So, yeah, if we don’t have to go to like street Joe and ask him to intubate before it gets bad.
JESSE: Yeah, yeah. Anyway, so I just saw that but it made me wonder because you also are doing research, like how much do you spend time in the hospital? Or are you mostly in a more academic lab kind of setting? Like, how do you split your time professionally?
CHRISTIAN: Right, right. So, I actually do both. So, I see patients on a regular basis, actually, pretty much every day. But I have a lot of [??? 14:23] time for the lab. So, I run my own lab. I have a few people that work with me in that lab. And I have a ton of collaborators because this is how it’s being done today. Like you have to have people and specialists in all different kinds of fields that help you with realizing certain projects. It’s getting so complicated these days to get all these fancy techniques working. I mean, but guess most of you have heard about CRISPR CAST and all these new sequencing techniques.
If you want to be really good at that kind of stuff, I mean, you have to spend significant time in that. But nowadays, these projects not have like just one single technique, but they have five, six, seven, 20. So, you gotta have people to help you make that happen. But then yes, I do see patients and I’m the head of dermatology oncology. So, I see all of skin cancer that works in the Technical University of Munich here.
JESSE: That’s what I was wondering, I mean, since your research is in skin cancer, I was just kind of wondering what the crossover is with you and oncology how that meshes. ‘Cause like I said, I only have kind of vague delving into medical hierarchy and specialization. So, it’s like, obviously, there’s crossover, but they’re also a separate fields. So, is the crossover you, is that where the link is?
CHRISTIAN: So, if you mean crossover by different specialties within medicine like clinical medicine, yes. And that varies from country to country. So, If you look at the [??? 16:01] region like Germany, Austria, and Switzerland, those are areas where dermatology is a very, very broad and open field. So, within dermatology, you can actually specialize in pediatric dermatology, you can specialize in dermato-oncology [??? 6:20], infectious diseases, and other inflammatory diseases. And we’re actually getting training in all these different subspecialties. If you have enough people, you can actually like even make small departments of it. And that’s what we’re having here. So, that’s a really nice setup.
In other countries like in the US, I’ve spent quite some time there. It’s a little different. For example, if we talk about skin cancer, the deadliest one being melanoma, so the [??? 16:47] kind of skin cancer, right? If you talk about that, in the US, you might get diagnosed by a dermatologist. So, he picks up a mold that doesn’t look good and cuts it out and turns out to be melanoma.
But what happens next is you’re going to be sent to a surgeon to do surgery, take a biopsy of lymph nodes and stuff. When the surgeon is done you’re going to get referred to a medical oncologist to take care of if needed, right, some sort of medical treatment. And dermatology basically just does the follow up on all the remaining molds you have, right, to make sure you don’t develop any new ones. So, here it’s different.
So, if a melanoma patient comes to my unit, we basically diagnose and treat them from very beginning to hopefully, a healthy outcome. But that even ranges into hospice care, into palliative treatment where you kind of have an end of life situation.
So, this happens all at one spot. And arguably, you can think that that might actually be preferred because as we talked about information getting lost on the way or not [??? 18:00] to be shared, right? It stays within our department because we diagnose it and we have a dermato-surgeon, so a dermatologist who specialized in surgery, and does all the necessary surgeries except for like the really big ones.
And then they come back to us and they actually get their medical treatment and follow up. So, it’s all under one hood and you have always one point that collects all the data and is kind of like for patients to central [??? 18:31] if you wish, where he/she gets his or her information from and where they can go to if they have any questions. So, I do like that kind of system. But arguably, both of them work.
JESSE: Yeah. Well, I was thinking about like you’re talking about changing standards. At this point, I don’t know how you would, like even if you could say definitively one system or the other is better, how you would enforce like a changeover in either direction, just because of how people are already specialized. You’d have to get them to re-specialize, trying to retrain an entire medical force. I know we’re like, in the US, we’re short on doctors.
So, I know– my college roommate and his wife are both doctors. And he’s told me basically, once you’re board-certified, you can pretty much go wherever you want because there’s need everywhere, there’s so much need. So, try to retrain like an entire medical system, when you already have a shortage just seems in short bananas. Even if you could like I said, prove one way or the other was better.
CHRISTIAN: Yeah. And that would even be hard to prove, right? How would you try to that? You could basically measure it by the outcome of patience. That seems to be fairly the same. So, what’s the argument to doing one or the other? Then you can compare it in terms of expenses, what costs more for the same care, for the same outcome, that’s super hard because they’re very different charges for different procedures and what whatever is being done, right, in different [??? 20:13].
So, that’s really hard to do. And all these medical systems basically have been grown over time that to really change anything in that kind of perspective is going to be really hard.
But talking about shortage of doctors, I mean, I was actually very interested in staying in the US after I finished my postdoc over there. And I talked to a few people, actually some people who could make that kind of decision. And this is where it gets complicated. So, I was a board-certified dermatologist at the time already, but what the US system would require me to do would actually be to start residency again, get board-certified again, which I did not particularly have great interest in because I did that already and I studied at two really good universities.
So, why do that all over again. And he said, the only reason for that is if you want to work at a great hospital, let’s say, UCSF, for that matter, that’s where I spend some time. They’re considered a tertiary facility.
So, your first go to family practitioner, right? If he doesn’t know what to do, you go to the specialist, outpatient specialist. If they don’t know what to do, they send you to university clinic. So, if you get to university clinic, insurance companies expect every doctor working there to be board-certified. Otherwise, you don’t get money. You don’t get reimbursed for all the services you provide. To be board-certified, you actually need to be training in the US because you need to have residency in the US. So, this is where all things come together. [??? 21:59] not to happen to me, for example, seeing patients in the US is because they don’t get reimbursed for it even though I would qualify but I guess pretty much all measures. But it’s not gonna happen anytime soon.
JESSE: Yeah, I can see both arguments too where it’s like, on the one hand, it’s like with the system, as I understand from you explaining it, where we say, okay, you have to have residency in the US and have gone through one of our systems because we’re more familiar with the measures we’ve put in place before you can be board-certified. So, it’s like, okay, you just like in our public school system, we have standardized testing. It’s like, trying to measure the efficacy and knowledge of a particular person. So, it’s like, okay, I get that. But at the same time, it’s like, clearly, you are licensed to practice medicine in another country. And we’re not talking about just a developing country.
It’s not like your standard of care is going to be lower, or that you’re just like hanging out in a hut or something, and you don’t know what you’re doing. So, it seems like there should be some way to say this is an equivalent certification, this is an equivalent level of knowledge so that you can have a crossover. But I mean, we’re obviously not going to solve all of Healthcare’s problems today, unfortunately. So, I guess, you spent time on cancer research, but for listeners that don’t know, let’s start with the basic thing that– We have all these kind of charities here in the US to fight cancers is the phrase, I’m sure you’ve seen that. So, let’s start with just the fact that cancer is not one thing. And then can you tell me– So, can you expand on that? And then also, tell me a little bit more about what you’re researching in particular?
CHRISTIAN: Yeah, sure. Very good point. Cancer is not just one thing. Couldn’t agree more, frankly. It is many, many things. And if you want to summarize it under one term, it’s an age-related disease, if you want to look at it this way. So, what I’m trying to do in– I’m actually shifting my research focus into that direction. Because if you look at the numbers, it’s quite funny. If we get a really great Cancer Care Program or even treatments that are effective in let’s put out a number 80% of the time, right?
I mean, that’s fiction for many types of cancer as of now, but if we just assume that you would probably increase lifespan by maybe two to four years. That’s what you get with that kind of achievement, right? Because why? You would die from other diseases like infections, from cardiovascular disease, from all other kinds of neurological diseases, big one. Yeah. So, all these are heavily tied to aging.
So, while we were able to actually expand or increase the number of people reaching higher age, the actual lifespan hasn’t expanded a whole lot, right. So, back in the days, people will die when they were younger. So, the average life expectancy was shorter. But [??? 25:42] people were getting to ages of 85, 90 sometimes, right? Even 100 years old. That was rare, but it happened.
Now, more people get to that point where they like, enter 80 and 90. But still, they’re not getting much older than that, right. So, the total lifespan hasn’t changed a whole lot. And if we talk about lifespan, obviously, you want to increase healthy life. You don’t want to be miserable and sick and being like COVID times on a ventilator, right? That’s nothing anybody wants. So, you want healthy more years.
And why do we talk about that? I mean, cancer is probably one of those diseases that are most linked to aging. So, if you age by a decade, you increase your likelihood of cancer like [??? 26:38]. Yeah. It’s a much higher chance of developing cancer of all different kinds than any of the known toxins we know and we [??? 26:48], right.
So, tackling aging, and in this process of aging might actually also lie some of the cure to all different kinds of diseases including cancer, you not only cure one of them, but you might attack all different kinds of problems later on in life. So, as a model, I used cancer because that’s what I specialized in, that’s what I know most about. But I think there lies actually way more in that, quote-unquote, model of disease called cancer that will tell us more about the disease of aging. And I’m just super curious how in my field, melanoma is going to tell me more about that. So, we’ll see.
JESSE: Well, I know like, I mean, that’s from– I’m being a little obtuse. But from a medical standpoint, I mean, the entire goal essentially is life extension, right? We’re trying to rid ourselves of all diseases and keep people living as long as they possibly can. So, once you get past the hurdle of cancer or cardiovascular disease or neurological conditions killing people, then you say, okay, now how do we actually extend lifespan? Because we’ve gotten past all these other biological barriers. So, how far can we push it? And– [crosstalk]
CHRISTIAN: [??? 28:12] That’s one problem. Yeah.
JESSE: So, one thing, I don’t know. So, that’s why I’m asking you. I had read something about, and I don’t know if this was somebody’s opinion, but it sticks out in my head that supposedly the brain has some kind of finite capacity to operate over time like as an un-medical term goes to mush over a certain period of time. Is that also a matter of being able to extend like the capacity for the brain to fix itself? Or is it simply a matter of like a car where you can drive a car for so many miles and if you take care of it, you can get more miles out of it, but eventually the machinery is going to wear out?
CHRISTIAN: Yeah, it’s probably gonna wear out at some point. But there is no reason to believe that it can’t be beyond 110, right? Why not? Or even more? There’s some people out there that aggressively think that 130 is going to be possible in just a few decades. But we’re not quite there yet I would say. So, yes, it’s about maintenance and it’s prevention for a big part.
But again, these two mechanisms of aging and developing disease are tightly interconnected. So, if you’re tackling aging, you’re actually preventing some age-related diseases like cardiovascular, neurological diseases, cancer what’s on, you’re preventing those all together. So, you basically as we say, here, you kill two flies with one clap. I think it’s birds in the US, right?
JESSE: Yeah, two birds with one stone.
CHRISTIAN: Or two birds with one stone, yeah. That’s much more brutal if you ask me.
JESSE: A little bit.
CHRISTIAN: [??? 29:59] flies here.