A (3:36)

I am sure there's an extensive archive of back issues which I think would be really fun to go through. I mean, you can literally read about the foundations of, you know, modern medicine. Have either of you had a chance to look at some of these old journals?

C (3:48)

Yes, I have. I have been working on a drug called thalidomide, which everyone will be familiar with, caused teratogenicity, is in the. In the 60s and was banned. When I was researching the history of these things, I had to go through old journal articles page by page. And in that capacity, I went through many, many old copies of the Mayo Clinic Proceedings published in the 60s to identify articles related to thalidomide and Mayo's contributions in that science.

A (4:16)

And Dr. Nath, I'm sure you've gone through the archives.

B (4:19)

I'll give you two instances. One, the Nobel Prize was awarded to Kendall and Hench at Mayo Clinic in 1950, but many of the linchpin articles were published describing the efficacy of cortisone in Mayo Clinic proced. So I looked at some of those original articles, and I also looked at articles in 1955 pertaining to the first description of a series of patients undergoing cardiopulmonary bypass. So the very first description of the efficacy and the feasibility of using a pump oxygenator to provide cardiopulmonary bypass was described in Mayo Clinic Proceedings by John Kirkland and his team at Mayo Clinic. And so I was privileged to actually get my hands the feel on what is truly an original work, which is in essence, touching history. Wow.

A (5:09)

What is that like?

B (5:10)

You lose the gap of years and the passage of time. You actually feel that you're there in with Dr. Kirkland and his team getting ready to do pioneering surgery on individuals with otherwise lethal cardiac conditions.

A (5:24)

How long have you been reading the Mayo Clinic proceedings, Dr. Rajkumar?

C (5:28)

Well, I first encountered the Mayo Clinic proceedings when I was doing my medical school at The Christian Medical College in Vellore in India in 1986. Now, there were like a few journals that would be displayed, and one of them was the Mayo Clinic Proceedings. And I did tell myself then after reading it, because they had issues on antibiotics, they would put special issues where they would cover every antibiotic, penicillin, ampicillin, one by one indications, uses, everything. And I told myself, you know, it would be really cool if one day I could be at the Mayo Clinic.

A (6:02)

Same story with you, Dr. Nath?

B (6:04)

Very similar. I went back from where I did medical school at the University of Edinburgh. I went back to the island of my birth, Trinidad, where I did an elective at the Port of Spain General Hospital. Unlike Dr. Rajkumar, I saw a limited number of journals, one being the West Indian Medical Journal and the fourth being Mayo Clinic Proceedings. And I thought, there is something magical about the Proceedings and something magical about Mayo Clinic.

A (6:30)

And here you both are working for the Proceedings, which is, if you think about it, poetic. And it's a lovely full circle, isn't it?

B (6:38)

Like Dr. Rajkumar, I feel very privileged. It's my opportunity. And career at Mayo was really a dream I had many years ago.

C (6:46)

Yeah, absolutely. I mean, like, I joined the Proceedings editorial board in 2003. And Carl, I've been with the Proceedings probably like a quarter of its existence.

A (6:58)

Talk about history. I love that. Now you both know that I'm a journalist, so I was. As I was preparing for our conversation today, I thought, boy, both of these doctors have kind of taken a crash course in publishing and journalism. If you think about it, did you have any prior experience, either of you, in writing, editing, content creation, before you actually ended up at the Proceedings?

B (7:19)

Like Vincent, I previously served other journals. Before I became editor in chief of Mayo Clinic Proceedings, I was editor in chief of Journal of the American Society of Nephrology. I take it one step further. Being taught English on a former British colony, I developed a true reverence and love for the English language. And so being an editor of a journal really fulfills not just my medical desires and career, but I love the English language and I love writing.

C (7:47)

So I've written for the Proceedings from a very long time back. I. I think my first paper in the Proceedings was in the year 2000. But like Dr. Nath, I'm very keen on how something is expressed and how you have to be, you know, clarity is critical and to be able to write extremely simple is not easy unless you really understand the subject. And so naturally evolved into editing. So I've been working with many journals. I work with the leukemia journal. I work. I'm editor in chief of the Blood, a journal which is published with the Proceedings. So it's initially, it's like, you know, you start off by writing and learning to write and publish, and then you evolve into reviewers of journal articles for other journals, and then you move into editorial board and then subsequently into the editor position.

A (8:36)

It is an art to write simply and elegantly. Very few people can do it well. And as much as I admire my friends in the medical community, your area of expertise is not simple. And I wonder how you help your colleagues learn to write simply and clearly. Do you have guidelines for them? How do you help them?

B (8:57)

I think one of the best guidance was Strunk on White's principles are clear writing. And I think it's important to use declarative sentences for the most part, avoid too many adjectives and adverbs, use an active voice and less embroidery and less overwrought stylistic approaches. I encourage all the time.

C (9:19)

It evolved from speaking. You have to speak in a way that people who are absolutely not familiar with the disease can still sit in the back row and understand. And I had two of my kids when they were in middle school and elementary school, even join me at lectures, and they were sitting in the back row watching me give lectures. And I would go back after that and say, did you get any of that? He said, like, yeah, I think we got it. Because you started with, this is a cancer. This causes deaths of so many people. And we are trying to find new treatments. And this is where we are. This is where we are going. So you want to be able to say that clearly. And we do take a lot. Dr. Nath particularly takes so much time in editing manuscripts that are submitted to make sure that the. Not just the language, but the style, the delivery, the simplicity, the message comes across. Because even within medicine, it's complicated. Like, I'm an oncologist, If I'm reading a cardiology article, I need to really be able to grasp everything that I need to come to terms with in the first paragraph. It sets the stage, and then I'm able to understand the rest of it. It comes with time, but it's really like, very important.

A (10:25)

Sounds like journalism, to be honest with you. You know, Very much so. Very much so. How do you both decide what makes a study proceedings worthy? What's the process?

B (10:37)

Most articles are submitted to peer review. So we send an article, but before peer review, we make a decision. Is this article basically within the ballpark and landscape of the proceedings. If it's not, then there is a triage system where the article is considered. Thank you for submitting our work. But this work is better suited elsewhere, or if it's a little bit above that, we send it to one of our expansion journals. So if an article has passed the triage system, then we send it out for peer reviews, and so it's sent to experts in that field. These individuals provide reviews, we read the reviews, we do our own evaluation of the paper and then make a collective decision based on the external expert review on our own assessment. One of the things I always ask myself, is this article of interest to me personally? Number one, is this article of interest to our readers? Is this article something that adds, however incrementally, to the current store of knowledge? And is this article, with a passage of time, is it going to stand? And so those are the sort of bullet points I go through either consciously or subconsciously, in terms of evaluating a paper.

C (11:58)

The Mayo Clinic Proceedings itself is a very, very unique journal. We have hundreds of thousands of medical journals, but these are not affiliated with one single institution. The Mayo Clinic Proceedings is affiliated with the Mayo Clinic, which has a worldwide reputation for scientific rigor, for credibility, integrity. So when, when we get papers, we are looking at them as like, you know, these have to be Just like Dr. Nat said, true, and will stand the test of time. And I have to make sure that these are articles that are really worth it for our readers. The second point is again, even though it's called the Mayo Clinic Proceedings, it is a worldwide journal and more than half the submissions to us come from researchers around the world. And we publish articles from researchers around the world. And so it's really a general internal medicine journal, which, when it was a print journal, had a circulation of over 100,000 copies. So it's worldwide audience, worldwide authors, which means that we have to publish articles that are relevant not just to Minnesota Mayo Clinic or the US even, but to medicine as such. Busy healthcare professionals. This one's for you. Find Mayo Clinic talks on your favorite podcasting app or visit ce mayo.edu podcasts to learn more. Every week we share succinct, relevant and practical medical insights tailored for healthcare clinicians that you can immediately apply to your practice. Each episode covers common health issues seen in a primary care practice shared by Mayo Clinic experts. Foreign.

B (13:52)

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A (14:32)

Can you dive a little deeper, Dr. Rajkumar, into maintaining that scientific rigor, as you say, while keeping each of the issues relevant to real world global clinicians?

C (14:44)

Yes, and I think what we think about it is we are a general internal medicine journal. So we don't want to write or have articles which are very niche, very deep that only like a person involved in that particular cancer or that particular disease would know it should be relevant to physicians in day to day practice internists. The other thing is we are experts in narrow spectrums. I'm in oncology, Dr. Nath is in nephrology. So we have a team of associate editors and editorial board members spanning the spectrum of medicine. And what we do when we get an article is beyond the initial triage. We do assign it to somebody who's really an expert at that, who will take over the editorial processing because they are really aligned with that field and would know and they might say in five minutes, no, this is only relevant to interventional cardiologists. This is not really relevant to all of medical practitioners and tell us that otherwise they will send it for peer review. Eventually Dr. Nath does make the final call. He has to ultimately decide whether he's going to agree, overrule, send it for more reviews and so on.

A (15:48)

I felt that the Innovations by Dr. Lerman at Mayo about voice biomarkers for cardiovascular health, absolutely fascinating. Maybe Dr. Nath, you can tell me more about them and why you decided to publish them.

B (16:01)

I am particularly drawn to observations or findings that are improbable. Who would have thought that the inflections and intonations and stresses in an individual voice would have anything to do to cardiac disease? Yet the evidence as marshaled by Dr. Lerman and colleagues is incontrovertible. I think some of the best discoveries in science and in medicine for are ones where it's improbable. You never thought of it, it was unexpected and that is the way I felt about the human voice. And so there was one the element of improbability. But to use your word, Kathy, if you drill down beneath the surface, there are a number of physiologic reasons why the voice and how you create voice could be related to what's happening in the coronary circulation of an individual. For example, sympathetic tone, parasympathetic nerves, circulating humoral substances, our stress state, our anxiety level or lack thereof. All of those things come together and integrate to have an effect on blood flow. I thought this was something that was new, it was novel, it was original, it was reproducible. And above all it made a connection that none of us had ever anticipated before. There is a follow up studies by Dr. Lerman that in fact has looked at the physiology and the underpinnings from a cardiovascular standpoint that could make that connection even more persuasive.

A (17:31)

You know what I thought when I first read that? I thought, I wonder how this makes its way into routine care. And I wonder how far off we might be from something like that with.

B (17:40)

What'S happening in artificial intelligence. The world is our oyster I think. Set machine learning to it with an expert and I'm sure there's going to be some algorithm that's going to be developed that what will make it utilizable.

A (17:53)

Dr. Rajkumar, are there discoveries that you've read in the Proceedings that surprised you and how quickly they influence medical practice?

C (18:02)

Penicillin, I think 1940s or 50s, they started writing articles in the Mayo Clinic Proceedings about the anaphylactic reactions that people get. The benzathine, penicillin used in streptococcal pharyngitis. And then fast forward in time, we have had articles in the Proceedings that have been on like hardcore research subjects but also on like regular mundane things like you know, what is the incidence and prevalence of disorders. And one of the things that I was involved with which I published was on the prevalence of monoclonal proteins or monoclonal gammopathies in black people from Ghana showing that there was a higher risk of monoclonal gammopathy in Ghana, which is a precursor for multiple myeloma, the cancer. We did that study mainly because we felt that the higher prevalence of monoclonal multiple myeloma in African Americans is related to genetic reasons. Finding that it's not just restricted to African Americans, but also Africans from Ghana, led to many, many follow up studies to find out why, what is the reason for the disparity. And the whole field has taken off now where we are able to almost say why is there a disparity? And by understanding why there is a disparity you can understand why people get multiple MYELOMA all, all 15, 20 years of research.

A (19:20)

And once something's in the proceedings, gentlemen, do you find that it's like a pebble in a pond, you know, with the ripples that go out. Do you hear back from your colleagues and other parts of the world that they read the article, they synthesized the information? Does it get a discussion going within the medical community?

B (19:37)

Yeah, I'll give you an example of this which is near and dear to my heart. The Mayo Clinic Proceedings has been one of the forerunners in bringing the attention to the medical community and to lay people the overarching importance of cardiorespiratory fitness. In other words, what the Proceedings did was that to show that if you've got cardiorespiratory fitness as measured by certain specific measures, you are not just protected against, as one would anticipate, cardiovascular diseases, but you're also protected from non cardiovascular diseases, for example, cancer, chronic kidney disease, inflammatory bowel disease, even depression. And I've received feedback from my colleagues saying, you know, that's remarkable what you all have published in Mayo Clinic Proceedings showing the of the protection that's provided by cardiorespiratory fitness in terms of generally against medical diseases. And that's one of the wonderful things to experience as an editor because you feel as though there is having an impact among your own colleagues within your community.

C (20:46)

We have been at the forefront of highlighting the problems of physician burnout. Why do physicians get burned out? What can we do about it, and what happens when you have the burnout? So Dr. Shahnenfeld, who's an associate editor with our journal, he was at Mayo and then now he's at Stanford, led a series of studies that we published in the Proceedings showing that physician burnout leads to medical errors. Physician burnout is common. It starts even at the early stages of one's career. We've received so much good feedback from physicians worldwide, from physicians within Mayo Clinic and others, in terms of what can be done and how can we reduce burnout. And there's been again a series of articles on mechanisms, on how to prevent that, how to deal with that. Even though we publish on almost every subject, there are subjects like cardiorespiratory fitness, plasma cell disorders and monoclonal gammopathies. Rochester Epidemiology Project, Epidemiologic studies burnout that you will see that a number of articles are concentrated and published in the Proceedings. As we get more feedback, we then say, like, okay, I think this, this journal can be a forum for this particular topic.

B (21:53)

In 2017, that same physician, Tate Shanafelt, with the CEO of Mayo Clinic, Dr. John Noseworthy, at the time, published an article that's entitled An Institutional Approach to Burnout. That article has been cited more than 2,200 times. And a colleague of mine who was in the leadership of another institution called me up and he said, carl, I saw this article that was published in Mayo Clinic Proceedings. We are trying to this at an institutional level at our institution. And to your point, it's always gratifying where you have individuals in your own milieu calling you up for what you've published.

A (22:34)

You mentioned artificial intelligence for just a moment, Dr. Neff, and I'm wondering, how does your editorial team prioritize groundbreaking emerging technologies like AI bioprinting? How do you decide what to publish when some of this is so very new one?

B (22:54)

Is it new enough? Does it break new ground? Is it believable? Is it credible? Does it have relevance to patient care? And then we send it out to an expert in artificial intelligence and we get their opinion about it, as well as others who may not necessarily be an expert expert on artificial intelligence, but would understand the ramifications for that particular instance. So the ECG first became available in Mayo Clinic in August 1914. 105 years after that, Dr. Paul Friedman, the head of cardiovascular medicine, had the insight to apply artificial intelligence to the EKG, what's known as the AI enabled EKG. And what is remarkable is that in 2019, individuals who are in completely normal sinus rhythm, the AI enabled ECG could actually detect occult atrial fibrillation. And so in other words, here is an EKG which you give to an expert, to all intents and purposes would look completely normal. But if you use apply the power of AI, you could actually diagnose a hidden and significant arrhythmia of the heart. From 2019 up to 2025, there's been an evolution of really exciting diagnostic clues provided by the so called AI enabled ekg. Even down to the extent that an AI enabled ECG could tell someone's biological age, which is often different from the chronological age, the sex of the patient. It could tell whether we have active Covid, whether or not they've got cardiac amyloidosis. And this is remarkable. In my lifetime I'm seeing this. To me, that's the beauty of serving the proceedings. When you have innovation coming at you and you're seeing how even in a relatively short period of time, it's actually changing the face of medicine. Hi, I'm Dr. Bill Maurice from Mayo Clinic Laboratories. Curious to learn more about healthcare innovation.

A (25:03)

I'm Dr. Bobbi Pritt, host of Answers from the Lab, a podcast that explores trends and innovations in laboratory testing and clinical diagnostics.

C (25:12)

New episodes drop twice a month.

B (25:13)

You can subscribe on your favorite podcast app or visit mayocliniclabs.com to learn more.

C (25:24)

Busy healthcare professionals this one's for you. Find Mayo Clinic talks on your favorite podcasting app or visit ce mayo.edu podcasts to learn more. Every week we share succinct, relevant and practical medical insights tailored for healthcare clinicians that you can immediately apply to your practice. Each episode covers common health issues seen in a primary care practice shared by Mayo Clinic experts.

A (26:02)

I'm wondering, though, there is great responsibility, is there not? When you write about these emerging technologies, you know, because they are so new, we're not exactly sure where we're going with that, right, Dr. Rajkumar?

C (26:14)

Yeah, absolutely. I mean, there's quite a bit of judgment and we have to take ourselves with a lot of caution and seriousness because what we say, and I do think about this, sometimes there might be technologies or things that are new, but once it's published in the Mayo Clinic Proceedings with the Mayo brand, it carries a certain level of trust and people's acceptance that we have to be really careful. Are we sure of these things? Are these too new that we should take a breath and just pause and not publish it ahead of time? So yes, I think the judgment that goes in and deciding when to publish something like this, we do reach out to people with expertise within our institution and peer reviewers, and we really rely on those. We have two expansion journals where we sometimes delegate articles to if we think that they're new, they're innovative, but maybe too cutting edge for the Mayo Clinic proceedings. And then we pass on to the other sister journals.

A (27:14)

Speaking of innovation, have there been innovations published in the Proceedings that have challenged your own thinking, perhaps, or led you to change some of your clinical approach?

B (27:24)

I'll tell you one it hasn't changed. It came unexpectedly to me, but I think it's probably going to be borne out. It's changed my way in terms of an appreciation of the innovation, and I'll cite two examples. Mayo Clinic discovered a compound known as pep, which is purified exosome product and it's derived from platelets. And what this compound does, it has tremendous trophic effects on tissues. In other words, that could promote healing. And we published a patient with intractable wound healing, wound healing that was not occurring despite all the measures, a patient who've had a number of surgeries, et cetera. The application of this compound in within months led to the healing of a wound which proved intractable before that. And so I became a believer after I saw the hard evidence of this compound. I'll give you another example, spinal cord injuries, which are intractable to many of the conventional treatments. A few years back, we published the first observation that if you take autologous stem cells and apply that to an individual with intractable spinal cord injury, there was remarkable recovery of function. This was headed by Dr. Mo Biden and he subsequently published in Nature Communications the feasibility and the safety of this approach. So ultimately, I think the proof of the pudding would be the test of randomized clinical trials in which large number of patients are randomized with or without autologous stem cells. But the first foray or the first pass into on the one hand, either purified exosome product for wounds that are not healing or spinal cord injuries that are not healing. I became very impressed and optimistic that ultimately, with the passage of time, we're going to see the introduction of new therapies.

C (29:28)

Years ago, the Mayo Clinic proceeding is still one of the first, not one of the. The first report of using a virus to treat cancer. That's the measles virus, but the attenuated form of the measles virus, the vaccine strain of the measles virus. And we used to treat a patient with multiple myeloma who had failed every other treatment up to that point. And that patient is still doing well now. I think it's more than 10 years later and. And the effect of that that we published then has led to a series of viral therapy trials where we are taking the virus itself and its tropism or its affection for a particular cell, exploiting that to see if we can use the virus, an attenuated form of the virus, to kill cancer cells. Viral therapy for cancer. And I think there have been subsequently many, many programs at Mayo looking at viral therapy for solid tumors for multiple myeloma. There are many trials ongoing still. I never thought it would work, but seeing this and seeing the first publication and was cover carried in multiple media outlets was like a really remarkable thing. And particularly given it's in my field.

A (30:35)

Since we are talking about the proceedings celebrating its 100th anniversary in 2026 and it has a storied history. Let's talk about the future. You two have worked at the Proceedings for a while now. I'm wondering how do you envision mentorship, perhaps the next generation of contributors, where are they and are you nurturing them?

C (30:55)

Our journal has always been one where we want to nurture younger faculty even from the residency position onwards. So we do have resident clinics, subspecialty clinics that we have, that the Mayo Clinic Proceedings has published for a very long time to get people into the art of writing, into the art of publishing from a young stage. And then we are also recruiting from young faculty to the editorial board to give them the experience. And then at some point in the stage, they can become editors. Dr. Nath goes to each division and gives lectures about the proceedings, who we are, what we are doing, and encouraging people to submit. We cannot promise acceptance, but we can promise fair review, timely review and good feedback if we don't accept it. In terms of where they can send it next, I think it's very important for us to make sure that there are qualified people who can carry on the torch. And Mayo has a great tradition of rotating editors and editors in chief. Every seven or eight years they find somebody new to lead. So that allows also people to grow and take over.

B (32:00)

Kathy I entirely agree with Dr. Rajkumar. And the other thing that I may add is that in 2026 we are hoping to introduce a program called Fellowship in Training Editors program, where we'd have a relatively junior person at fellowship level who would tag along with seasoned editors who so as they get a feel for the thought processes, the mechanics, and how a journal performs and how decisions are made about content, accepting it or moving forward with it, or conversely rejecting it.

A (32:34)

What's the future of a medical journal in the decades to come? How do you think it has to evolve to survive and thrive? I'm sure you've been thinking about this question.

B (32:44)

I'll tell you what I think is going to be important in the future. I have become a real convert to the importance and the power of digital medicine. I think artificial intelligence is going to be integrated into the running of a journal, not necessarily making the final decision, but in terms of the mechanics and the administration of the handling of papers and putting together reviews and collating what reviewers say, as well as having some oversight in terms of directions of a journal. I think there are so many ways digital health and medicine is going to be involved in the mechanics of journals, as well as in terms of informing a lot of what a journal does. The second thing is that I think the explosion, the activity and the importance of social media is a roadmap for communication for humanity in whatever form, form, or setting. And I think journals will become more akin to social media where you could provide an opinion, provide findings, and engage in a dialogue with individuals from whatever direction in terms of the conventional and traditional format of a journal. I think it would become much more of a forum for ideas, for findings to be fed in and for our dialogue to ensue.

A (34:10)

Well, I give you credit for being on YouTube at this point. It's a different skill to have and it does allow you to reach a different audience. If you think about it. What thoughts do you have on moving the Proceedings forward into the future?

C (34:24)

One of the areas that I focus on in the Proceedings is the guidelines and review articles. And I'll tell you what I've become more and more convinced of is that the amount of information out there is just so vast and it's coming in all directions from newspaper articles, various journals. I feel like eventually people will not be able to tell what is true, what is real, recommendations, what is real, from, what is not. And so I think the Proceedings has over the last hundred years done a really good job in providing besides the original research content, practice guidelines, review articles, authoritative reviews authored by experts, meta analysis of multiple research studies, pulled together, editorials which put context of whatever you hear in life in perspective when it comes to medicine from respected authorities. So I think one of the important functions of the Proceedings in the future is going to be to expand and provide true, good, validated information that can provide physicians with, hey, this is the resource we can go to their sour. So many people talking about, say, should we vaccinate or not? Is measles a problem or not? Does this cause cancer? Does that not cause cancer? So we want to be able to provide guidelines for treatment of common diseases, review articles on controversial subjects, editorial opinions on topics of controversy and importance to public health, keeping real, full responsibility that we are going with the Mayo Clinic brand and we have to be very, very careful about what we say and how we say because people will come to us as the source of adjudicated good, validated information.

A (36:07)

What kind of an honor has it been to work on the proceedings given its long history?

C (36:11)

Dr. Rajkumar, for me it's an incredible honor to be in the Mayo Clinic. I would be happy if I was like an intern at the Mayo Clinic for a day. But here I am being here for like almost 30 plus years and then to be associated with the Mayo Clinic Proceedings for a long time.

A (36:26)

And Dr. Nath, as editor in chief of Mayo Clinic Proceedings, you know, I.

B (36:30)

Am very much like Dr. Rajkumar. I never expected in my career that I would serve Mayo clinic for almost 30 years. I love this institution. I think this institution puts the needs of the patients first its eight value statements are things that I believe personally in my heart. I never believed as a little kid growing up in the island of Trinidad I'll ever end up my career at this stage at Mayo Clinic. So it's a dream come true. Mayo Clinic Proceedings is a joy. I love to write, I love thinking, I love trying to find a balance between things. I get to work with brilliant people like Dr. Rajkumar and that for me is a true privilege and honor. Wow.

A (37:09)

It has been my joy to talk with both of you. Thank you for doing your good work as well, and we all appreciate it. And thanks for taking the time to talk with me.

C (37:17)

Thank you so much.

B (37:18)

Much, Kathy, thank you.

A (37:20)

Dr. Carl Nath has been with us. He's the editor in chief of Mayo Clinic Proceedings. Also with us, Dr. Vincent Rajkumar. He is on the editorial board and a longtime contributor to the Journal. Tomorrow's Cure is a production of Mayo Clinic with production help from the Podglomerate. Be sure to follow Tomorrow's Cure wherever you get your podcasts. I'm Kathy Werzer. Thank you so much for listening.