Faculty Q&A: James Stein
Dr. James Stein is a professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison. In the following interview, the physician-investigator explains how his passion for cardiovascular disease prevention permeates his busy clinical practice, his broad research program and his teaching and mentoring.
How did you decide on your specialty?
I settled on cardiovascular medicine because heart disease is the leading killer of people in the United States and worldwide. Yet we know what causes it and there are many things we can do to help people who have it -and help them quickly.
You concentrate on prevention. Why?
Early in my career, I became very interested in how we could treat high blood pressure and cholesterol to avoid heart disease and strokes from occurring in the first place. I saw it as a great opportunity. With prevention, we have the possibility of virtually eradicating the disease. I'm passionate about prevention. It's the focus of all my work.
I'm from Wisconsin originally but left to go to Yale for medical school then did most of my training at the University of Chicago Medical Center and Rush Medical Center. I met my wife in Chicago. We never intended to leave. But I came up to interview at UW in 1996. Two things made me fall in love with the place. No. 1: The quality of life here. No. 2: When you're here you really feel like you're at an academic medical center. You can feel that the science that's done here every day spills right over and improves patient care.
Over the years you've taken on several leadership roles.
I'm the director of the Preventive Cardiology Program, the Vascular Health Screening Program and the UW Atherosclerosis Imaging Research Program. I'm the associate director of Adult Echocardiography at UW Hospital and Clinics.
You are a physician investigator. What is your philosophy about this dual role?
The two roles absolutely complement each other. I firmly believe that to give your patients the best care possible, you need to be on the cutting edge of the medical literature. But it's more than just reading the journals and being up to date. In order to really understand what's presented in the top journals, you must be a scientist.
What's the focus of your research program?
We use ultrasound to assess the structure and function of blood vessels. Such measurements can help predict who's going to develop heart disease and determine what factors increase people's risk of developing heart disease and stroke.
The Associated Press recently reported on some of your research. What was that about?
The research entailed teaching Wisconsin doctors and their staff how to do ultrasounds of the carotid artery to see if patients were at increased risk of heart disease. They used handheld echocardiography machines that are smaller than a laptop.
This was based on your earlier research?
Yes, it involved measuring the intima-media thickness of the carotid artery with ultrasound. It's called carotid IMT. We can see if the carotid is thicker or aging more quickly than it should be and whether there are other pre-clinical signs of disease. We saw how powerful it was in the lab and said, "Why can't we use this in patients?"
So you developed a tool?
I helped develop approaches that could be used to translate the test from research laboratories in academic medical centers into ones that could be used in doctors' offices. I was the lead author on the 2008 recommendations on how to use the test, which is now widely used in the U.S.
How has the carotid IMT test helped you in your practice?
By knowing the "vascular age" of our patients, we can give them more precise estimates of their risk and start preventive care earlier if it's needed. In some cases, we can tell people that they don't need aggressive care or might be able to avoid medication. It's a great example of how being a researcher directly plays into clinical care.
What about your other research?
In 1999, we were the first group to show that the drugs that were helping people with HIV live much longer than before also caused blood vessel dysfunction. That opened up a whole new world of treating HIV patients. HIV drugs today don't have the same cholesterol effects. In fact, we think - and we're studying this - that the new drugs may help prevent heart disease.
Tell us about the "MESA" study.
This is a large multiethnic, population-based study that's been going on since 1999. It looks at what causes atherosclerosis and how it differs between the races. We're in charge of the carotid ultrasounds. Currently, we're analyzing the progression of blood vessel damage caused by air pollution over the past decade. Factors such as how much time people spend in their cars, how close they live to major highways and if they're exposed to cigarette smoke or secondhand smoke will be considered.
Are there other smoking-related studies you're involved in?
We've been doing a lot of work on smoking cessation with Dr. Michael Fiore at the UW Center for Tobacco Research and Intervention. The question was if you quit smoking and gain 15 pounds and your blood sugar goes up, are you better off just smoking? We found that the answer was clearly no! The ill effects of smoking on blood vessels dramatically outweigh any adverse effects of weight gain.
You are also involved in teaching and mentoring. Tell us about that.
I love working with trainees at all levels. Right now I have undergraduates, medical students, medicine residents and cardiology fellows working with me. I try to give them really top-notch mentoring - regular meetings with substantive discussions about what they're trying to accomplish and the progress they're making. I emphasize the importance of setting specific, realistic goals.
What about your own teachers and mentors?
First and foremost, Dr. Patrick McBride, who was head of preventive cardiology when I arrived. He fueled my passion for prevention and facilitated research opportunities. He also gave valuable guidance on balancing my clinical, research and teaching loads with my private life. Another influence has been my colleague Dr. Peter Rahko, director of the Adult Echocardiography Laboratory. He supported me when I wanted to branch off from traditional cardiac ultrasound and get into blood vessel research. He helped protect my time so I could achieve my goals.
What do you do for recreation?
My hobby is cycling - I try to get in more than 100 miles a week. I especially like climbing hills. I also go to a lot of Brewers games with my son.
What about the rest of your time away from work?
I spend as much time as I can with my children, wife and parents. I try to do a good job of separating my work life from my private life. It's hard - a matter of organization, prioritization and delegation. I also do a lot of volunteer fund-raising and philanthropic work in the Jewish community. For five years I was chairperson of Camp Shalom, Madison's oldest and largest day camp. That activity nurtures my soul and distracts me from work. It's another way to help the world.
This article appears in the summer 2011 issue of Quarterly.
Date Published: 08/31/2011