Clint Betts

Dr. Boom, thank you so much for joining us on today's show. What an honor to have you and to learn more about your life, how you lead, and in particular what you're doing at Houston Methodist. I want to start with, hey, your name is Dr. Boom. That's pretty cool. That's got a nice ring that almost feels like a Marvel character or something.

Dr. Marc Boom

Well, I'm glad you like the name. My wife's still not so sure even after 33 years. There's actually three Dr. Booms now because my wife's a pediatrician and my daughter's an intern right now at Children's Hospital of Philadelphia doing pediatrics as well, so she became the third Dr. Boom this year. I think it's a really cool name, but my wife's not so sure. It actually is Flemish in origin. My parents are from Belgium originally and emigrated to the United States. It's pronounced Boom there and it means tree actually in Flemish. It's a big, long family, I guess fable about how that came to be, whether it's true or not.

Clint Betts

I love it. My word, Dr. Boom, I don't think it gets any better than that. Hey, tell us about Houston Methodist and how you got there and what you're up to.

Dr. Marc Boom

Well, great sure, happy to. I've been privileged to be at Houston Methodist for 26 years. I've been the CEO for 12 and so I've gotten to see it through a decent part of its history. We're 105 just about a year, I guess 104 years old right now and really one of the premier institutions in the greater Houston area. We cover the entire greater Houston area, a geographic area that's about the size of what you think of the state of Massachusetts. So, it's a very sprawling area that we cover. We're a flagship academic medical center, 1,100 beds or so with all of our academic enterprise.

So, the research and the education that happens, hundreds of residents plus tens of millions of dollars, actually more than $100 million in research being conducted. And then we have six and soon to be seven community hospitals that cover that greater Houston area as well that care for people across Houston. About 1,400-1,500 employed physicians as well as a few thousand affiliated physicians with us as well and up to about 32,000 employees now. So, one of the largest employers in the city of Houston.

Clint Betts

How have you created a culture within your organization? That sounds like you're dealing with some high stakes stuff. This isn't like a candy shop or whatever, this is people's lives and you're training people to go and save lives and help and serve people. How have you defined culture?

Dr. Marc Boom

Thanks. That's a great question and you make a really critical point, which is this is not fluffy work. This is really serious work and every moment of every day, literally people have other individuals' lives in their hands and countless people come to us expecting us to be our best each and every day. Culture is something that I believe is created very intentionally. And so, we have very intentionally done so for now 104 years, but particularly almost the last quarter century.

In the year 2000, moving into 2001, there was really an effort to call out what is our culture. What's the culture we want? What's the culture we don't want? And a set of values were derived at that time called ICare, which fits of course very well in a healthcare setting. It's a mnemonic but also has its own layer of messaging. Those are integrity, compassion, accountability, respect and excellence.

And literally for almost a quarter of a century, we have intentionally built and built and built on that culture. What that culture ultimately says is we demand the absolute best of ourselves. We call that unparalleled, and our vision for the second century now having entered our second century, is six simple words, unparalleled. Meaning nobody's going to be any better and we're never going to be satisfied tomorrow with what we were doing yesterday. So, we're on a constant improvement trajectory. So, it's unparalleled safety, quality, service and innovation.

And that combination of focus and intentionality really, I believe, is the secret sauce of how we get the very best people working here and then can provide the best outcomes for the people we are privileged to serve.

Clint Betts

Tell us more about the history of the institution. It actually sounds quite fascinating. It seems like it's been around for a very long time. How much do you think about the history of the institution, the legacy that it has and how you extend that legacy in your role?

Dr. Marc Boom

Well, I think a lot about it and I'm very privileged to hold an academic chair, that's one of the things we do in academic institutions. Named in honor of two of the really founding figures of Houston Methodist. So, I've been a student of the history of the organization and with the centennial that we celebrated at the end of 2019, had a chance to really spend extra time in telling the stories. We did a book, we did a movie, really all about that history and it was a lot of fun to do. So, we go back to the last day of 1919, December 31st to be exact. A physician named Dr. Oscar Norsworthy in 1905, 14 years before had graduated from Tulane Medical School, moved to Houston.

Now keep in mind, Houston, which is now the great Houston area, is about 7.2, 7.3 million people growing 100,000 people plus a year. Back then it was probably 50,000 or 60,000 people, a totally different place. He comes and realizes that to care for his patients, he needs some beds. And so, in 1908, he built a little wing next to his house. Literally could say bye to his wife, after he eats his toast and jam and goes out the door and goes to see the patients. Of course, it wasn't really that way because you can imagine he was constantly in and out and caring for these individuals, but that's 1908 medicine, very different.

In 1919, he decided to move on, do something else and he went to the people he knew and trusted with the Methodist Episcopal Church. And they literally passed the hat at churches and did bake sales and things like that to acquire this small facility. Through the next 100 years, probably the most pivotal moments were a couple-fold. One was in 1951 moving into an area that was envisioned in Houston called the Texas Medical Center, which if I look out my side of my window, I can see every major medical academic institution and not-for-profit health system in the city.

I can literally look out as we're speaking here today. And so, we were one of those founding institutions, a pivotal, pivotal moment. Another pivotal moment was Dr. Michael DeBakey who came here, and Dr. DeBakey, you'll be familiar with the name of one of the top physicians of the last century. He died in 2008, just shy of his 100th birthday, but he was here for 60 years and he was somebody who pioneered transplant surgery, pioneered heart surgery, and particularly vascular surgery. Some of the procedures done on the carotid, some of its procedures done with the aorta, and just a remarkable individual.

And then really about almost 20 years ago, pivoting, becoming what we call an independent academic medical center and driving and owning the research mission, the educational mission, all the other things that we do as an institution.

Clint Betts

As you think about the future of medicine and even the future of the institution, what does it look like? It must be interesting for you to look out and see artificial intelligence disrupting so many different industries. You're probably already using some versions of AI in your practices already. But how do you think about AI and just the future of medicine overall given the seat you're in?

Dr. Marc Boom

Well, I think we're at a particularly remarkable potentially watershed moment in healthcare. As a result of many technologies, AI certainly being at the forefront of that, but much of the work in genetics, particularly now with CRISPR and the ability to actually start modifying genetic code and hopefully doing a lot of good with that along with AI. A number of years back now, almost a decade ago, we created something we call the Center for Innovation. Actually, it started with a group informally that would meet around digital technology and healthcare. And that group decided to call themselves DIOP, D-I-O-P, which was Digital Innovation Obsessed People.

And I wouldn't let them change the name because it's actually a really cool name to describe what they do. And they're there embedded into operations in our system really looking constantly at what's the next big thing? What's coming out next? What's the next technology? Not in the traditional sense you would think of in a hospital system and an academic enterprise like ours where there's a lot of research being done of, okay, what's the next device? What's the next drug? That's being done, that's not what I'm talking about here. What I'm talking about here is really digital innovation and AI fits very well obviously as we look at that.

I personally believe we're going to see a huge transformation as a result of that. We're using AI in a number of very interesting areas right now, but I think we're only just scratching the surface. If you look at healthcare, it's a little odd because when digital technology came out, medical records would be one of the things that early in my career, everything was on paper. And of course, that transition got made, well, if you look at banking, you look at the airline industry, you look at just about any industry, all of that digital work facilitated things, streamlined things, decreased costs.

In healthcare, most physicians, nurses, other people who provide care would tell you it gets in the way. I'm sitting here typing right now looking at a patient across the room instead of having that interaction. But one place, AI for example, we're already piloting holds incredible promise is essentially summarizing the care and the provision of care that happens. So, if I'm sitting, let's say in a primary care visit, I'm the doctor visiting with you about the knee pain you're having or your hypertension or your high cholesterol. It will literally listen in the background to that entire interaction, weed out all the stuff we should be doing, which is some of the social aspects and people connection aspects.

And when I say weed out, all that doesn't need documentation, right? But we'll figure out how to summarize then that visit and say, "Mrs. Smith was talking to Dr. Boom and she was complaining of right knee pain and it's been going on for three months and it's worse when she goes upstairs, not so bad when she goes downstairs," whatever that course is. And it has the ability to transform the physician-patient relationship, the nurse-patient relationship, and bring those people back to the personal touch that they can have with individuals. I think that's going to enrich healthcare tremendously.

It also has that potential then to handle what is a problematic situation that we see already, but all the projections of significant workforce shortages, whether you're talking physicians in essentially every specialty. Whether you're talking to nurses or other people, because there's great promise. And that's just one example of a way that we're using AI right now.

Clint Betts

How would you improve the healthcare system? I know that's a loaded question and that's something that many presidents and politicians have tried to tackle. But say you could wave a magic wand. I don't feel like we hear people who sit in your chair, their perspective on this nearly enough. So, how would you improve it?

Dr. Marc Boom

Well, there is a loaded question. That's a complicated question as you can imagine. Here's a couple of fundamental issues with our healthcare system in the US. First is if you have access, and by access, I mean you have the insurance coverage or somebody who can cover those difficult situations where you're particularly ill and if you have access physically, right? You're in a rural area where hopefully there's a hospital nearby or you're in a city someplace where there is great healthcare nearby. We actually have a system that is the envy of the world.

People come from all over the world to Houston Methodist, for example, to receive care because they know that what they can get here and in the United States is better than what they can get at home. But there was a massive if in that and that if was coverage getting to some place. And the reality is we have a situation in the United States where we still don't have coverage for everybody. It varies tremendously by state, I'm in a state in Texas where we did not expand Medicaid after the Affordable Care Act came out. And so, we have some of the highest uninsured rates in the country.

And of course, we have some safety nets in place. We do tons of charity care at Houston Methodist, we do about $400 plus million of direct at cost charity care every single year, which is a very high number, but also a very high percentage as you look at that. But think about the individuals who have a lack of healthcare insurance. They aren't getting the preventative care, they're not getting the wellness care. They're often dealing with the problems, the dollars I mentioned, but that's a human being coming to our hospital in need. Whether that's a cancer diagnosis or whether they've had a heart attack or a stroke or they fell and broke their leg, whatever that is. Those are human beings in need who don't have that coverage.

And if we weren't providing charity care, those diagnoses can be financially ruinous events in addition. So, first and foremost, we as a society have to tackle that issue. Every other major developed society in the world does a better job at that than us, and there's no reason we can't do that now. So, that's first and foremost. When we do that, we actually start to eliminate a lot of the perturbations in the whole system because the whole system now is a crazy shell game of cross subsidization. We can't just find $400-$500 million of charity care.

And there's another $1 billion in other community benefits like education and training of the next generation and underpayment on Medicare and a bunch of other things that you can count in the benefit we provide as well. But you can't do that just waving a wand out of the blue, you have to have a top line revenue. And so, what's happening is there's a hidden tax that goes to most of the employers out there to cover the lack of governmental programs and societal programs where we've had that tough conversation that says, "We got to cover everybody. How are we going to do this? How are we going to pay for it? What's included? What's not included?" If other countries can do this, certainly the United States can do this and lead the way. So, that's step number one.

Step number two, if you have that in place, we have to appropriately target governmental reimbursement right now. Whether you're a physician, whether you're a hospital, every single provider of care is grossly underpaid compared to the actual cost of providing care. So, a whole other cross-subsidy is all the private employers basically paying for the fact that the government doesn't pay for the cost of healthcare as it sits. And I laugh because we get into all these discussions and now, we've had one bill that's gone in the right direction, which is, okay, should the government negotiate with pharmaceutical companies?

And there's a short list of drugs now where they're allowed to do that. And I laugh because they don't negotiate with doctors, they don't negotiate with health systems. They just tell us what they're going to pay us, and they say, "Hey, if it costs you $100, we'll pay you $81 or $82,” that's basically the way that works. So, we have to normalize that right size to stop moving the shell game around. And then really at the end of the day, we need to all be in the wellness business and the life enhancement business, not just the sick people business. We need to be looking at people holistically, looking at communities holistically, and putting in place the infrastructure to do that.

That's a longer-term goal, there needs to be a pathway to that. There are places in the country that are doing some more of that than others, but over the long term, we have to figure out how we do those kinds of things.

Clint Betts

Yeah, I wanted to ask you —

Dr. Marc Boom

That's a short answer on something that I could probably spend three hours on with you.

Clint Betts

That was a wonderful answer actually, that was super informative. I'm wondering, I wanted to ask you about the wellness piece. And preventative care is like, "Hey, how do we make sure you never show up at a doctor's office?" Which is maybe counterintuitive to the business, I don't know. Is that a change in the culture of medicine where we're trying to make sure you never come into the hospital. Obviously never is a hope and a dream — at some point you're probably going to end up in a doctor's office. But what is the shift that needs to happen to where we focus on wellness as a society? Because obviously we're getting more and more obese.

There's all these different things and obviously there's these miracle drugs now where maybe that would help with weight. Maybe you can give me your thoughts on that as well, but what do you think on the wellness side of things and how does that affect business?

Dr. Marc Boom

Well, so I'm a primary care physician. In fact, I still have about 120 or so patients that I see in a primary care practice as one tiny percent of what I do as CEO here with a very large organization. But I saw two people in the clinic or one person yesterday, I guess I've got a few coming up in a couple of days. And that's very meaningful to me. You're asking a question that's right up my alley because as a healthcare professional, as a physician, I'm all about long-term relationships with my patients and how do we keep them as healthy as possible. What I can tell you with 100% certainty, every person who's one of my patients or you or me or anyone else we talk about, we will all die someday, right? We all know that nobody's cured that.

And while we're seeing life expectancy increase, and I think we're going to see some mind-boggling increases in life expectancy in my children's, and particularly even my grandchildren, I don't have it yet, but a someday generation. I think we're going to see tremendous advances and hit probably even some inflection point where we see that and that's going to raise all sorts of societal issues. But the dream needs to be, you're healthy, you're happy, you don't suffer from mental illness, you don't suffer from physical illness, you don't suffer from aches and pains and everything else.

But as we all get older, we get the aches and the pains and the medical issues start to catch up with us. And what we need to do is try and prevent as much of that as we can. And then my wish for every one of my patients, for myself, my loved ones, and then you happily pass away someday hopefully very, very far down the line in your sleep in a very peaceful fashion.

That's obviously what we'd wish for everybody, it's not of course what happens. And so, we have a lot to do on that and it's also a multifaceted complex answer. You hit on one of the issues, which is, and we are worse than most of the world, but there are other pockets of the world in different aspects.

We have to get a hold of the personal issues that drive healthcare, right? Some of that we can help with drugs. There is a presentation we give where one of the experts at Houston Methodist comes and talks to the community about dementia and Alzheimer's disease, heart disease, stroke, sexual issues. Joint pain, joint aches, there's not one of those where when you start asking them about, well, how can that be better? The first thing they tell you is, well, exercise helps it, certain diets help it, watching your weight helps it. And then of course certain medicines and other things can help that as well.

Sleep in terms of having solid, good, effective sleep affects that, social support systems affect that. And so, we have to have those conversations about how we do that better societally. After that, it's one of the reasons when I gave you this wave of magic wand and we have a better health system over the long-term, you want a large sophisticated organization and all the wonderful people who work here. You want them thinking about how you are as the patient who's plugged in here and you as a community that are plugged in here, how you're going to lead the safest, healthiest, happiest lives you possibly can.

You have to align the incentives and that's where I was talking about saying when you start thinking on a population basis as opposed to on a, "Hey, if one more person shows up in the emergency room who broke their leg today, you'll make more money if one less person breaks their leg." Or maybe that's not the best example, one person with a stroke shows up that maybe we could have prevented if we treated their hypertension more aggressively. We'd had the infrastructure in the community. And so, it's a multifaceted approach.

Clint Betts

My grandpa told me, "Hey, there's no shortcuts in life." And then Ozempic came out and Wegovy and these various things. A lot of people are on these, they seem to be doing okay on them, but it's a fairly new drug. Something like that would really make me nervous personally. But what are your thoughts on that? Could that actually help? Could that be a part of the solution? Obviously not the entire solution.

Dr. Marc Boom

Well, it's not the entire solution. I finished medical school, I hate to admit it now, 30, 31 years ago. And the advancements we've seen in medicine are mind-boggling, right? And go back to Dr. DeBakey who I was talking about, when you see the decreases in death rate from heart disease that have happened societally over decades in a sustained manner. And of course, there's a couple huge inflection points for that. Getting far fewer people to smoke was a big one of those. Treating cholesterol was a massive one of those and then many other drugs. And of course, the ability to go in a Cath lab or go in a bypass surgery, many, many things that have happened.

My wife's two grandfathers died about my age from heart attacks. And nowadays, we don't see nearly the degree that we used to. We now have cancer, which is moving more and more into the chronic disease realm. It's not there yet, don't get me wrong, and some cancers are better progressed than others. But clearly, we've made tremendous progress in medicine. Infectious disease was the first one of those that happened in terms of the things we've conquered. Now, we're conquering much more degenerative disease and neurological diseases.

So, I lay that as context to say, I think when you talk about Ozempic and Wegovy and all these things, they're another in a line of great advances and all the data looks extremely encouraging, they're obviously very effective. I remember talking to a friend who's a scientist who was involved early in some of the studies around some of these things 10, 12 years ago saying, "Marc, we've been developing these drugs more for diabetes and they look like they have these other effects." And it was not just this class, it was another class he was talking about as well.

If they prove to be true, they're game changers and they are potential game changers. But, we're dealing with a health institution. It goes back to my pharmaceutical discussion earlier about pricing. The companies that made these deserve to make a ton of money, these are transformative drugs, I'll start with that. However, the way they're being priced, no mortal can afford them individually and no society is going to be able to afford them. And frankly, no institutions are going to be able to afford them.

So, what you're seeing most employers do now is crack down on the use and make sure they're used by people very appropriately for the intended reasons. So, if somebody, let's say with diabetes and who has a very, very high body mass index and most definitely in every single study will benefit from losing weight as opposed to, "Hey, let's put somebody on it because they just like to be a little bit thinner." It's not totally clear whether they're going to lose weight. And then you get into those societal questions of who should pay for those kinds of things.

And so, I don't think the way they're pricing them, we're going to see as many people benefit from them as they could. And I think this is one of the fundamental challenges we often have when you get back to the cost of healthcare. We can't have rampant capitalism, we need appropriate capitalism. There needs to be a great profit motive, but we shouldn't be spending multifold times the cost for a drug in our country, what somebody does in another country and effectively subsidizing the other countries. We should allow a good profit, but we have to find ways that technology helps decrease the cost of healthcare, not where we end up pricing things. Another example of an amazing advance was hepatitis C drugs.

These are drugs to cure Hepatitis C, phenomenal. When I was in medical school, it wasn't even a dream that we'd have a drug that could cure hepatitis C. Hepatitis C in some percentage of people will lead to chronic liver failure, can lead to liver cancer, and can ultimately require a transplant. Many people pass away, many people live with it and don't have dramatic issues. And so, now you can cure it, you can prevent all of that. Well, those drugs got priced, I don't know, somewhere in the $90,000 to $100,000 range for a course of therapy. Game changing, absolutely, they should be expensive, the company should make a lot of profit.

But how did they price that? They said, "Okay, let's look at all the people with liver disease from hepatitis C. Or let's look at the population of people with hepatitis C. What do they cost on average to society? Okay, it costs about $100,000 so we'll price it at $95,000. We'll save society a little bit." Well, that was a missed opportunity among many where we should have said, "Okay, no, it's $20,000, $30,000," something very healthy from a profit standpoint, but where society not only has obviously healthier, longer living people but also then has a savings to the healthcare system. So, another piece of that complex interweb we were talking about.

Clint Betts

Yeah. What do you think about trust in the medical industry? The medical industry is a very broad industry. But healthcare experts and doctors and things like that were never questioned in my lifetime like they've been questioned over the past few years, COVID-19 being the big one. And it's become political in a way, which must be fascinating for you. I wonder and in particular it's pharmaceutical companies, let's just be honest, right?

It's pharmaceutical companies that we distrust as a country even more so now as we come out of this pandemic. How do they rebuild trust? How do you build trust within your institution and with your patients and with your students?
I feel like trust is something that is so missing in leadership today. Not in every industry, but in particular, I just wonder how they rebuild trust given the way the pandemic shook out.

Dr. Marc Boom

Boy, I talk about a great question and something keeps me up at night, frankly, and I spend a lot of time thinking about it. And having been somebody who lived through the obvious leadership of a big institution that cared for tens of thousands of people with COVID. We vaccinated 1.1, 1.2 million people with COVID vaccine. I've experienced firsthand that lack of trust, the misinformation, the divisiveness that is out in society. Let me be really clear because I know I was beating on them a little bit. We are so fortunate to have an amazing, robust scientific and medical scientific, even industrial connection to advanced science. And the pharmaceutical companies are heroes in that.

So, I want to be real clear, I don't agree with how they price things and I think there's some issues there. But in terms of the advances we get from them, they're nothing short of amazing. Your question really doesn't just apply to them, it applies to me as a physician, it applies to me as a hospital executive, it applies to the people who work here. Trust has been shaken and there's a lot of very pervasive insidious factors at play when you look at that. So, let me say what I mean by that. This isn't just mistrust of medicine, it's mistrust of science. Somehow in a century where we are all here living decades longer than we would've lived in most of human history, enjoying the fruits of science and technology.

Whether you're talking about the ability to hop on a plane and go someplace, whether you're talking about obviously everything we enjoy in terms of the internet streaming, all the different things that happen. Of course, medical technology, there is an undercurrent of just lack of trust in that. I think it comes down to a lot of stress and strife in our society, which I worry a lot about. So, this year I've had the privilege of being the chairman of the Greater Houston Partnership. The Greater Houston Partnership is essentially the Chamber of Commerce economic development, unified organization across all of Houston.

There's some small, very good niche ones that focus on certain communities, certain aspects, certain industries, but this knits together the business community. And one of the privileges you get is to speak at the annual meeting with a couple thousand people there. And I framed my entire talk on the beauty of the world, as opposed to the problems of the world, and really reflecting on the fact that I believe that when people succeed, businesses succeed, and when businesses succeed, people succeed. And you can put that in healthcare and everything else as well. But what we have really is almost inescapable, I used the example of the siren call.

If you think of Odysseus in the Odyssey and the sirens and him strapping himself to the mast so he wouldn’t get seduced by the sirens who would've led him and his sailors toward the rocks where they would have died. The siren song right now is for politicians in particular, but for many people in society is this idea of retreating into one way of doing things or another way of doing things when the right answer is almost always somewhere in between. And so, we saw that, I mean, on steroids in COVID. Very early on, we recognized that we would stay data-driven, we would focus on the facts, we would present the facts. We would acknowledge the fact that sometimes with the data we know today, we might three months later have to say something different because the data evolved.

I've learned this in every disaster we've dealt with. Of course, running a hospital system, you get a hurricane in Houston and it’s all hands-on deck. I'm at the hospital, and I know that we'll make a decision at eight in the morning watching the thing barreling down at us and five hours later you're like, "Oh, that was a stupid decision." You make a different decision based on the facts on the ground, right? You'd hear the same from anybody who's in an armed conflict or anything else like that. It was the same with this. And unfortunately, we saw people and our political leaders decide, "Oh, I'm going to take this viewpoint, I'm going to take that viewpoint. There'll be nothing in between and I'm going to throw rocks at the others."

And so, if you ask about this trust question, it goes back to that. We need to bring people's voices back to where the middle has a better voice. And I'll be really clear, I'm not saying we shouldn't listen to people with views that are very, very conservative or views that are very, very liberal or progressive. They deserve voices, so does everybody in between, the bell-shaped curve in between. And the fact of the matter is most of our society is somewhere in the bulk of the bell-shaped curve. Not the tails of the bell-shaped curve, but the voices and the voting and the primary systems are all going to the tails of the curve.

So, we want to fix trust in science, we have to fix some of that. We have to think about, and I don't know how to do this, but decorum and how we interact with people in times when we are, let's say a little more anonymous than when you and I are sitting here on a Zoom or on a podcast. You go out to the internet, you're interested in a hobby, and you go to a hobby site where people are chatting about your hobby and people start yelling at each other and getting nasty with each other. What are you doing here? You're talking about a hobby, for instance. We're not even talking about politics.
So, we've got to back up and it's been one of the downsides of social media.

And when you ask about AI, there's so many positives, but where I lose a little sleep and I worry a little bit about is what are the negatives going to be that we haven't anticipated? Because I think we let social media just run and get out of control to a point now where we're trying to figure out how to put some structure around it so that it doesn't really lead to some of these stressors in our society. When I talk to my board, I tell them the most important job I have and they have is the culture of our organization, circling back to some of our early discussion.

Well, when you have a great culture and you have 32,000 people who share a common culture yet are all over that spectrum of political thought and opinion thought and other things like that, that's a wonderful thing. We can share that culture. Why can't we do that better societally? I think it takes real significant leadership. I think businesses are a big part of the answer to that.

Clint Betts

Do you think in 20 years, we'll look at social media the same way we look at cigarettes today?

Dr. Marc Boom

I don't think that's a fair analogy. There's no use of cigarettes, period. They were one of the worst things we ever invented, the dumbest things we ever invented.

Clint Betts

Yeah, there's no actual —

Dr. Marc Boom

Mind boggling. There's lots of good uses for social media. Okay, let's be clear. Lots of wonderful uses for social media. So, I think it's a matter of understanding where the boundaries are and trying to understand how we should be acting, how we should acknowledge the fact that it's there. It's a broad cultural societal discussion that we need to have. And I think there's a lesson there for as we are rolling out AI, which probably is not the right word because it's rolling on its own. But as we do, we have to have the right people, the philosophers, the educational leaders, the experts in the content, our political leaders and many others.

Having the tough decisions and tough discussions and putting some of the structure and expectations in place. In medicine, excuse me, CRISPR is a great example of that. Some of the gene editing, there's actually been a lot of effort through the field to say, "Hey, this is game changing." The people that are going to be helped medically, there are trials out there now starting to dribble out where you're taking people with sickle cell disease and you're able to change enough that you can dramatically transform their lives. That is society changing one of the best things that could ever happen.

But you can see some of the same technology being used for bioterrorism, for instance, for eugenics. And so, that field, I'm not saying they got it solved, has really tackled that. I think we're at a moment with AI where we have to tackle many of those same issues.

Clint Betts

I wonder, just back on the social media thing real quick, and I think it's actually even a larger point. Obviously you don't get lung cancer, so the corollary isn't that great, but I actually live in a state in Utah where they've sued these social media companies. And they've really tried to limit the effects and access that children have. I don't think they've done a good job of it yet, or even if it should do that. I actually have no real sense of it. I've interviewed Mark Zuckerberg and he tells me it's not a big deal.

And so, I don't know, but I wonder about the mental health of our society, how you think of that. And that's what I think when people say that, ask that cigarette question, they're like, "Well, will their mental health have the same type of effect on social media or just like society at large?"
And particularly coming out of COVID, the state of mental health of society and all of us being cooped up that long. Our only outlet was fighting with each other on the internet and talking to each other via Zoom calls. I wonder what you think about societal mental health and then individual mental health.

Dr. Marc Boom

Well, I guess I'll start as a physician. One of the things that has trended very well I'd say in the 30 years I've been a physician, is thinking about mental health more like we think about hypertension, high cholesterol. We're not there yet, don't get me wrong, but there was a time when nobody would talk about the fact that they had a mental health issue. And where it's much more socially acceptable to talk about it. Now, let me be clear, it's not fully socially acceptable to do so. But if you think about it, we have some artificial distinctions in medicine that are there for a good reason of how we treat people, the expertise you might have.

But the lines between what a psychiatrist does, what a neurologist and a neurosurgeon does, those are blurry lines, right? Because at the end of the day, whatever you're talking about, whether you're talking about depression or bipolar disorder, whether you're talking about Alzheimer's disease or whether you're talking about multiple sclerosis or stroke. Every single one of them is your nervous system not functioning the way it's supposed to be, right? And different causes, different reasons, the problem is through humankind. If you had bipolar disorder, schizophrenia, worse, let's say 1,000 years ago, you were possessed by demons is what people thought, and it got treated that way and literally demonized.

If you had a stroke, everybody knew something really bad happened and dad can't use the right side of his arm or whatever that is. We've come so far with that, we have so far to go. Mental health affects every family. It affects at least a significant plurality, if not a majority of the population at some point in their lives. Of course, the more common things like depression in particular, anxiety, obsessive-compulsive disorder, these things affect inordinate numbers of people. And so thankfully, we've normalized a lot of that. Nothing could have happened worse for mental health than something like a pandemic and everything that went around with that pandemic.

So, we're still societally recovering from that, and I think that's going to continue to be a pretty heavy lift. Your question started around the internet and social media and other things, and I will tell you, I'll give you just a couple disconnected, but ultimately connected thoughts. We like to refer to something called the nature pill. We actually do some study around this here. This is around the benefit of being outdoors. There is benefit to people spending time outdoors, particularly the more nature it gets. In other words, it's fine to be going, exercising, walking down the urban street.

It's a whole other thing to be in a quiet area with chirping birds and beautiful trees and meadows of flowers and everything else. These are actually very important for your mental health. Let's all be honest, right? People do less of that now because they're on their social media, because they're on their devices. The second is our brains are not built to multitask yet we all do it. I'm guilty as charged, I'll be the first to say that I do sometimes. But if I'm watching my streaming show on Netflix, and instead of being engaged on that and I'm doing something where I'm in, I'm instead distracted doing something else on my phone at the same time.

I see it in the younger generation even more. Our brains aren't designed that way so your brain goes back and forth, and so you'll catch bits of this and then go do bits of that. You're not really multiprocessing and multitasking and you're not giving the brain the unwinding. Being connected to devices constantly, always looking at them, having that interfere with sleep. And I think sleep is a huge, still very under-recognized aspect of mental health. So, it's all of the above and I'm no expert on this, but I think we have to think about all those things. I think there is a lot of rationale for people to question themselves and say, "Hey, listen, don't get me wrong. I love my iPhone, I love everything about it. I use it all the time."

I'm not saying change all that, I'm saying figure out how to be present in the moment. We always have to push on it. We have a saying here, which is eyes up, phone down. So, if you're walking through the hallway and what do our patients see? They see an employee who's not really engaged, who's not really there for them, who's not going to smile and make eye contact with them. It's not good service. Not to mention you're crashing into a wall or something else. So, I know that I have to lead by example as CEO. So, barring I have to take an urgent call that rings or something, which is going to be rare if I'm walking from point A to point B in one of our hospitals, that phone's staying in my pocket and I'm going to lead by example.

And because I know if I'm not engaged, I'm sending the message to others. They don't have to be engaged, our employees see that, our patients see that most significantly.

Clint Betts

Dr. Boom, I could talk to you for three more hours, but I want to be respectful of your time. We end every interview at CEO.com the exact same way, and that is, we believe the chances one gives is just as important as the chances one takes. And I wonder when you hear that, who comes to mind that gave you a chance to get you to where you are today?

Dr. Marc Boom

Well, there's obviously lots of people, but I'll reflect on one, I've talked about him before. But when I was in medical school, I saw that I wanted to get into leadership, wasn't sure what that meant, thought it would be what's called an academic chair. But at the end of the day, I decided it was more the business leadership. But in medical school was given a chance to follow the then physician in chief at a neighboring hospital here called Texas Children's Hospital. His name was Ralph Feigen and a few years later, when I was done with my residency, now I'd gone to business school, I was starting to look for a job.

Still in the days of not that much email so I wrote him a physical letter and he opened up that letter and literally paged me in Philadelphia where I was at the time and said, "Hey, Marc, I think I have a job for you." And he took a chance on me for a job. If I'm being honest, it was a little over my head to be the first job coming out of business school and residency, but I learned like this and drank from the fire hose, and he trusted me and mentored me. And so, that's one person who took a chance on me and made a real difference in my life.

Clint Betts

That's incredible. Dr. Boom, thank you so much for joining us. It's been an honor to talk to you. We got to have you on again because I have a million other questions for you and your expertise. And what you do is phenomenal, and the way you've decided to dedicate your life towards this is really admirable. So, thank you very much for joining us and we'll talk again soon.

Dr. Marc Boom

Thank you, Clint. Appreciate it.

Clint Betts

Thanks so much. Thanks.