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- [00:00]
Dr. Eric Rose
This is an iHeart podcast.
- [00:04]
Jasper AI Advertiser
This podcast is about bold moves, the kind that change everything. At Jasper, we bring that same energy to the way marketing teams work. Jasper is the agentic content automation platform used by thousands of marketers to streamline how content gets created, reviewed and shipped. From global campaign launches to SEO and GEO to multi language localization, Jasper helps teams create better content faster and at scale. It's not just AI for writing, it's an engine for modern marketing execution. Start building scaled content pipelines at Jasper AI. That's Jasper AI.
- [00:38]
Jamie Napoli
What future innovations might offer an answer to heart disease, which in 2025, six decades since the era of the cardiac cowboys, remains the number one cause of death in the world? Why is it essential that medical professionals and laypeople alike learn about the history of medicine? Is there a connection between surgery and music? These are just some of the topics I discuss with two world renowned surgeons who also happen to be executive producers of this podcast. From OSO Studios, I'm Jamie Napoli and this is a special bonus episode of Cardiac Cowboys, a podcast about life, death and innovation in the American heartland. Dr. Eric Rose is a world leader in cardiac surgery and cardiovascular research. He was surgeon in chief at the Columbia Presbyterian Medical center and Chairman of the Department of Surgery at Columbia University. Eric performed the first pediatric heart transplant, and he is the main reason every surgeon I reached out to leapt at the chance to work with us on this podcast. Eric, welcome. Sure.
- [01:54]
Dr. Eric Rose
Thank you.
- [01:55]
Jamie Napoli
Dr. Gerald Imber is a plastic surgeon and author. He's an attending surgeon at New York Presbyterian Hospital and assistant clinical professor of surgery at Weill Cornell Medical College. He wrote the medical history books Genius on the Edge, about William Halstead, the father of American surgery, as well as Cardiac the Heroic Invention of Heart Surgery, which was published in February of 2024. Welcome, Jerry.
- [02:19]
Dr. Gerald Imber
Thank you.
- [02:20]
Jamie Napoli
Now, Jerry, before I met you, the only cardiac surgeon I'd ever heard of was Christian Barnard, the South African doctor who performed the world's first human heart transplant. You were the one that introduced me to the cardiac cowboys. Surgeons like Walt Lilleheim, Michael DeBakey, Danton Cooley. How were you first introduced to these figures?
- [02:42]
Dr. Gerald Imber
I was a plastic surgery resident at Cornell at New York. It was then called New York Hospital, not New York Presbyterian in the 70s. And at that time, the recently deposed chief of surgery and still head of cardiovascular surgery was Walt Lillehei. And he was wandering around the halls terrorizing everybody. Not really. I mean, they were all just kind of afraid to approach him. But he terrorized me and I just kept my Distance because the stories about him, little Legion. And it was kind of a lot of fun to sit around the coffee room waiting for your case and, and hearing stories about the things that little I had done. That was my introduction to this.
- [03:28]
Jamie Napoli
What brought you years later to writing the story?
- [03:32]
Dr. Gerald Imber
Well, decades later, indeed. I had written Genius on the Edge, the story about William Stuart Halstead. And it was a relatively successful book and speaking tour on the whole business. And then someone suggested that I do another book. I think it was my agent and I was thinking about the very famous feud between Cooley and DeBakey. It was the longest standing feud in medicine and very few feuds in the medical world are covered in the New York Times on a regular basis or on the COVID of Life magazine. So I thought that was really great. And I had written that and my agent probably said this is terrific if you're writing a magazine article, but there has to be more to it. And so in my research, kind of the other three names popped up. Shumway and Lillahy, of course, who I knew.
- [04:34]
Jamie Napoli
And Christian Barnard Lillehai emerges as a undersung hero both in your book and in the podcast. He's certainly not a household name, at least for laypeople. Eric, how common would you say it is for surgeons or medical professionals to be aware of the history of their field and how important do you think it is?
- [04:55]
Dr. Eric Rose
One, I think it's very important. Two, I think cardiac surgeons of my generation were already losing the chain of thought recognizing Lilah. And I was lucky enough to go to his 80. I was invited to his 80th birthday party in Minnesota and everybody was. Anybody was there, including Cooley and DeBakey. And it was clear that this, at this point, you know, his genius had been recognized in the field again. And his role, the more you look into it, there is no operation, as far as I know that's called little high procedure because he basically invented all of them. Closure of vsd, repair of tetralogy, maybe a mustard operation. I guess he didn't do stuff like that. But that, that's esoteric. His contributions, be it, you know, cross circulation, then the hard lung machine, which he simplified, made available to the glasses at a reasonable price, as you depict in the story here is is he brought the can opener to the picnic.
- [06:09]
Jamie Napoli
Yeah, I'm interested in that because I know that I can't remember. I think it was you, Eric, who was saying that a lot of medical students aren't aware of some of this history and some of these figures. I mean, Jerry As a medical historian, can you speak to the importance of medical history, why people should know these stories, not just how to use these tools and how these procedures work, but who created them and the stories behind them?
- [06:34]
Dr. Gerald Imber
Well, I, I think it's important for a number of reasons. It's always important to know where you came from. But we all think of ourselves as normal people. And when you think of the people who were historically important in our field, I don't really know our fields. They were just regular people too, and they happened to be at a certain time in the history of medicine when things were, were just wide open. And it was kind of a time when people would take a chance because nobody knew the answer to things. And I'm sure exactly the same thing is going on now, but we're just regular people and we can't see it. And if somebody says something wildly, far, far fetched, we just laugh it off and go about our daily, our daily business. It was the same thing with Li as it was with with Halstead. The things that they did. Most people will say this kind of wacko, but they were in the right place at the right time, they were courageous and they taught us that if, as Lilly said, if something has to be done, it has to be done. And they, they, they hate to use analogies and ball playing analogies, but they, you brought the ball down the field, you know, they just did it. And it's important to know how it happened. It didn't just materialize. Somebody had to have the, the audacity and the, and, and the, the insight to do these things. And we all benefit from them. And you know, the next step is up to us. I mean, when you said that Eric did the first pediatric heart transplant, but he was their progeny, you know, it just, he wouldn't have done it if they hadn't done this first. And so it's really important to know that. And I think that it was very important that Eric sent them royalties all the time, every time he was a kid.
- [08:31]
Jamie Napoli
Something that fascinates me about the characters in these stories, the doctors that we call the cardiac cowboys, is just how willing to fail they all were. Walt Lillehei using a dog's lung as an early heart lung machine. Denton Cooley trying out a total artificial heart that had really limited success, if you could call that in the lab. So Eric, how do you square that, that risk taking culture of the 1950s, the 1960s and into the 70s with the work of surgeons today? How has that changed?
- [09:05]
Dr. Eric Rose
Well, the morbidity and mortality underlying diseases is obviously improved, but in an era, especially with the initial patients being kids, you know the risk that you take to get a living patient that had the potential for decades, if not more of life versus certain death, it was a different ballgame. Now congenital heart disease now is no death sentence anymore for the vast majority of the kids. That was not the case then. Same thing with pediatric oncology and things like that. Leukemia was a uniformly fatal disease in, in young children in the past and a similar story evolved in chemotherapy and the like that now leukemia in childhood is a curable disease. So I think I said at one point that now being a heart surgeon is a lot more like being the pilot for United Airlines or whereas the original surgeons were more like fighter pilots and my generation was kind of between. But that's the evolution of progress.
- [10:24]
Jasper AI Advertiser
This show is about modern mavericks, risk takers, builders and rule breakers pushing new frontiers. At Jasper, we know that spirit. We're doing for marketing what these cardiac cowboys did for medicine. Throwing out the old playbook and building something radically better. Jasper is the agentic content automation platform that helps marketing teams move fast and stay in control. Whether you're launching a product, optimizing web content for LLMs, expanding campaigns into new markets, or scaling audience personalization, Jasper gives your team a repeatable intelligent system for orchestrating content at scale. Unlike generic AI tools, Jasper doesn't just write with structured workflows, brand safe automation and and built in intelligence that understands your voice, audience and goals. Jasper replaces scattered tools and disconnected processes with one seamless content pipeline. It's already helping thousands of teams reduce production time, cut agency costs and publish more content that's actually on brand. If you're a marketing leader looking to transform how your team works or just trying to keep up with the pace of change, check out Jasper AI. That's Jasper AI.
- [11:26]
Jamie Napoli
Eric, what areas within the field of heart medicine do you see real innovation taking place today?
- [11:32]
Dr. Eric Rose
Pediatric surgery is just an exacting field now. The quality of the work is just spectacular. You know, these walnut sized hearts that are fixed by these guys and women now that's the other big change in cardiac surgery, a lot of women doing it. But other areas are still, I think, more sex appeal than progress. Cooley's use of an artificial heart sounds really sexy. It still hasn't happened and arguably it won't because there have been parallel technologies that made so much progress that dying from cardiogenic shock, for example from a heart attack. Just recently, a randomized trial of a temporary LVAD show reduction in mortality from like 50% to 20%.
- [12:27]
Jamie Napoli
LVAD being a left ventricular assist device.
- [12:29]
Dr. Eric Rose
And I would Predict, you know, 10 years, it'll get down to five, or maybe even one with a temporary device. And you keep your own heart too. A total heart sounds easy. The heart seems like it's simple, it's just a pump. But it's a lot more than that. It's a conduit. It doesn't clot and it regulates itself. It's also an endocrine organ. It secretes some hormones. So there are a lot of things about the normal heart that are just not duplicable. I think long term by a machine, maybe I'll be proved wrong, but in my lifetime, I just don't think it's going to happen.
- [13:08]
Jamie Napoli
You're not optimistic about a total artificial heart? Well, then let me ask you this, Eric, because I'm curious about your thoughts on the future. One of my favorite moments in the show is from our episode about the first total artificial heart. Dr. Billy Cohn quotes Dr. Lynn Warner Stevenson, her famous line that a heart transplant is the answer to heart failure the way the lottery is the answer to poverty. I know where Billy Cohn stands on this. He's been working on the Bivacor total artificial heart. What do you see as the answer to this problem? Where do you think the future of heart medicine lies?
- [13:45]
Dr. Eric Rose
I think there's no question that invasive procedures with sternotomies and the like are being replaced by much less invasive procedures. By definition, implantation of a total artificial heart that's permanent or semi permanent has got to be an invasive procedure and arguably a very sick patient. Now, when you can put a temporary LVAD into a human through the femoral artery or even in some instances, maybe even a radial artery without a sternotomy, a device that has a diameter of a pencil can pump 5 liters of blood and be put in in the field instead of waiting for the patient to get to the hospital. That to me is much more progress.
- [14:36]
Dr. Gerald Imber
It's interesting that you say that, Eric, because as you was Talking about the LVAD, the new LVADs, they are temporary and temporary to Watts. So even though they're wonderful, what's the end point? If a quarter of a million people are waiting for a heart transplant and they're only 3200 a year being done, and you have an LVAD and you're still waiting for heart transplant unless there's a tah. Total artificial heart, is that not so?
- [15:02]
Dr. Eric Rose
I think there are two kinds of patients, the acute ones, in whom the heart muscle itself is quite recoverable. And that's where there's been a lot of progress by getting these devices in early and resting the heart muscle. It comes back and the degree to which it does is is generally enough that they don't need another mechanical device long term. And long term VADs are also improving, but they still have these drive lines that come out of the body. And until that kind of problem is solved, it's a very unappealing way to live your life. Even if it's pumping for you with a garden hose coming out of your abdomen. I think that's a solvable problem. You know, there's room for both. But right now, the acute heart failure issue is really at the forefront, I think, of problems that are being solved. Not, not fully, but hell of a lot better than dying.
- [16:04]
Jamie Napoli
So another question directed to you Eric, is is about funding for this government funding. You know, looking back at the cardiac cowboys, a number of Those surgeons, Michael DeBakey, most famously owed a lot of their accomplishments to funding from the National Institutes of Health. Over the last year, the NIH has faced thousands of layoffs, billions of dollars in funding cut threatened with a 40% cut to its budget. I'm interested how you think the ramifications of that the atmosphere of uncertainty impact the would be Michael DeBakeys and Walt Lillehy's of today.
- [16:37]
Dr. Eric Rose
It's concerning and I hope it's temporary. But cardiac replacement with parts and parts of ventricles and the like now is a viable industry, which it wasn't even 10, 20 years ago. So there are LVAD companies now that can capitalize progress in this space. JJ just bought a company that I was on the board of for a lot of money with a lot of investment that already has about a billion a year of revenue because of its effectiveness and acute heart failure. So I think it's less important because when you get a therapy that makes it capitalism works. It's earlier stage therapies that I'm concerned about. And I'll give you an example. I'm on the board of a company called Corvion, which is trying to make LVADs for kids. They're tiny. They're about the size of a quarter. It's a very elegant device. We had a board call last week saying that Doge had not funded the NIH grant that was sustaining this company. Now it turns out the Doge as is it's bent, reversed its decision. But you know, the company was scrambling and that was that, I think is the luster of, you know, what can go wrong and shouldn't.
- [18:02]
Jamie Napoli
Right. I mean, I have to imagine that's multiplied by tremendous number of early innovations that are facing those same kinds of chaos.
- [18:09]
Dr. Eric Rose
No question, most of which will fail. But that's the nature of this work to begin with.
- [18:19]
Jasper AI Advertiser
This show is about modern mavericks, risk takers, builders and rule breakers pushing new frontiers. At Jasper, we know that spirit we're doing for marketing what these cardiac cowboys did for medicine. Throwing out the old playbook and building something radically better. Jasper is the agentic content automation platform that helps marketing teams move fast and stay in control. Whether you're launching a product, optimizing web content for LLMs, expanding campaigns into new markets, or scaling audience personalization, Jasper gives your team a repeatable, intelligent system for orchestrating content at scale. Unlike generic AI tools, Jasper doesn't just write. With structured workflows, brand safe automation, and built in intelligence that understands your voice, audience and goals. Jasper replaces scattered tools and disconnected processes with one seamless content pipeline. It's already helping thousands of teams reduce production time, cut agency costs and publish more content that's actually on brand. If you're a marketing leader looking to transform how your team works or just trying to keep up with the pace of change, check out Jasper AI. That's Jasper AI.
- [19:22]
Jamie Napoli
Jerry, you've written two books that one might describe as being about the wild men of Medicine. Dr. William Halstead, the subject of Genius on the Edge was in addition to being a genius and revolutionizing surgery, he was famously addicted to cocaine and morphine. He was the inspiration for the show the Nick with Clive Owen. Is that a theme that you're consciously pursuing in your work? What do you look for when you're approaching a new topic for medical history?
- [19:49]
Dr. Gerald Imber
Something that's interesting and important and if it's not a little, I guess if the topic or the way the topic is pursued by the heroic personnel is not a little bit wild. People aren't interested in wasting their time reading it. They're not interested in, in progress, in, in evolution. They're interested in revolution. And in medicine. Revolution comes at a price. And part of the price is having that personality willing to take a dive off the high board without looking to see if there's water in the pool. You know, it's just that they're different, they're different kinds of people than we are. So through history there are a number of, of people like that, you know, Semmelweis. You can just go through medical history and Find people who took a chance and who were castigated, who lost their careers because what they believed in and what they believed in was right. But there are so few people that have done more than one thing and just taken that leap into the pool so many times and changed so many things. There's a limited pool of stories. They're all very interesting. But there has to be something beyond what interests just a doctor in that field. Has to be something that. That the public at large can understand, be. Be excited by or thrilled by or repelled by or frightened by.
- [21:11]
Jamie Napoli
Yeah, I mean, I'm curious. You had brought up parallels between Halstead and Walt Lillehy earlier in this conversation. I'm curious about that. If you think there is a relationship between perhaps their. Their success as an outlier and also their personal failings.
- [21:30]
Dr. Gerald Imber
Well, that's an interesting question, because they would have hated one another. Or certainly Halstead would have despised Lillehai. Because, I mean, Lillehai just, you know, he was a cowboy. And when you think about Halstead, you say, oh, he was addicted to cocaine and morphine and yada yada. But the reality was those things were the result of experimenting with this new anesthetic that a guy named Sigmund Freud had been exposed people exposing people to in Vienna and using it on patients as a local anesthetic and. And using it on himself first and on his students first. So they either became addicted or most of them died. And he became addicted, but he did not have what we would call an addictive personality. He was using enormous amounts of cocaine, testing it for medical reasons. It was just as simple as that. He was a morphine addict because nobody knew about cocaine addiction. So in order to. To get him off the cocaine, they gave him morphine. So he became addicted to that, too. But he was a total rigid, straight arrow, and he knew the things that he wanted to do, and he did those things. And he would not countenance anyone deviating from his orders or having their own. Their own ideas about things. Lil High was exactly the opposite. Lil. I lived the life of a. Of a guy having fun little. I didn't want to know what previous experiments had been done on a particular subject because he didn't want to bias himself. He just left.
- [23:04]
Jamie Napoli
So while we're on the subject of the personalities of geniuses and drawing these parallels, Eric, I. I hope I'm not embarrassing you by asking this, but I understand you were in a band in high school. It's on your Wikipedia page. Is that right?
- [23:18]
Dr. Eric Rose
Yeah.
- [23:19]
Jamie Napoli
I work for my father in Our conversations making cardiac cowboys. Dr. Billy Cohn spoke quite a bit about playing trombone. He's in several bands. Dr. Ken Maddox spoke extensively about his background as a singer. Dr. Michael DeBakey played saxophone and clarinet. Do you think there's a connection between music and surgery?
- [23:39]
Dr. Eric Rose
Oh, for sure.
- [23:41]
Dr. Gerald Imber
Oh, you're nuts.
- [23:43]
Dr. Eric Rose
Absolutely. First of all, especially good music is a team sport. Any good surgery, it gets complex. Or science is a team sport, too. And to be playing with other people, you know, that are good makes you enthusiastic. It's very different from sports. For example, I think I was never any good at any. Any competitive sport, but I was pretty good at playing piano. And it was fun. And the exposure to people who obviously were much better than you. You could absorb it and enjoy it and not be threatened by it. And I think surgery is often that way, too. But there are a lot of sports types that view surgery more competitively than that, too, and there's room for both.
- [24:36]
Jamie Napoli
Denton Cooley, I think it was his daughter, Louise Cooley Davis, who talked with us about his background as a basketball player, relating so directly to his work as a surgeon. But that high level of specialization, but also working within a team, I think is an interesting parallel.
- [24:51]
Dr. Gerald Imber
I respectfully point out that as a musician, my classical guitar teacher fired me. That's how good I was.
- [25:02]
Dr. Eric Rose
Yeah, but if you joined a rock band, you might have been the Beatles or something.
- [25:09]
Jamie Napoli
Well, I think it all worked out the way it was supposed to. So, Jerry, back to your books. You've written two riveting medical history books. Is there a new story coming down the pike? Are there any subjects you're interested in exploring?
- [25:23]
Dr. Gerald Imber
Yeah, well, I'm committed to two projects right now. One of them is very amusing. I'm working with a writer named Mark Leiner, who's pretty well known, and we were asked by Harper Collins to write an amusing book about aging, which. I mean, what could be funnier, except for people who are aging? But there are a lot of funny things. So we're just. We're laughing our heads off doing that book, and we haven't written three pages yet, but it's fun. And then I'm. Then I was asked by a university here to write the history of a particular department of reconstructive surgery. And I'm doing that because it was an honor to be asked. And there that's. It's for nyu, and I'm from Cornell, and we were about two miles separated down First Avenue in Manhattan, and they were the enemy. And here I am writing a book about them, but I couldn't say no. So those are my projects now, and that's the next six months of my writing life. But I have a day job, so I gotta have to keep going.
- [26:37]
Jamie Napoli
So my final question to both of you, Cardiac Cowboys, the podcast came out a little over a month ago at the end of September. Both of you were executive producers on it. What are your highest hopes for the podcast? What do you hope it achieves?
- [26:51]
Dr. Eric Rose
I hope that Walt Little High becomes a household name. I don't know if that's true or not, but I think you and the tactical people and the storytellers and Jerry with this, have done an enormous service by pointing out his role. I hope he becomes better known and I hope the wibbles that he had become recognized for what they were, almost nothing.
- [27:18]
Dr. Gerald Imber
He was a human being.
- [27:20]
Dr. Eric Rose
He was a human being.
- [27:21]
Dr. Gerald Imber
It's interesting you say that because I had a conversation with someone who is a generation younger than I at now at New York Presbyterian, who, when we talked about Lillehai, thought the worst of him and said, oh, you know the stories I heard. He was just a terrible this and a terrible that. He just knew his bad reputation because he had been fired from New York Hospital, from his positions there because he was a terrible administrator and he was losing his eyesight and he wasn't no longer the surgeon that he was perhaps, but even someone from that institution didn't understand the importance of Walt Dillahai in not just the history of cardiac surgery, in the history of medicine. So you, I agree with you completely.
- [28:08]
Dr. Eric Rose
He was, he said he's just in another league.
- [28:11]
Dr. Gerald Imber
Yep. Yep. Agreed.
- [28:19]
Jamie Napoli
Cardiac Cowboys is a production of iHeart Podcasts, OSO Studios and 13th Lake Media. Our executive producers are Christina Everett for iHeart Podcasts, Dub Cornette and Jason Ross for OSO Studios. Dr. Gerald Ember, author of Cardiac the Heroic Invention of heart surgery. Dr. Eric A. Rose, John Mankiewicz, Joshua Paul Johnson and myself. James A. Smith is our supervising producer. Editing and sound design by Joshua Paul Johnson. Our composer is David Mansfield. Our cover artwork is designed by Alexander Smith. For more information on the first cardiac surgeons, check out Dr. Gerald Imber's book, Cardiac the Heroic Invention of Heart Surgery. Hi Kyle, could you draw up a quick document with the basic business plan? Just one page as a Google Doc and send me the link. Thanks.
- [29:28]
Dr. Eric Rose
Hey, just finished drawing up that quick one page business plan for you.
- [29:32]
Jamie Napoli
Here's the link. But there was no link. There was no business plan. I hadn't programmed Kyle to be able to do that yet. I'm Evan Ratliff here with the story of entrepreneurship in the AI age. Listen as I attempt to build a real startup run by fake people. Check out the second season of my podcast Shell Game on the iHeartRadio app or wherever you get your podcasts.
- [29:52]
Dr. Eric Rose
This is an iHeart podcast.