In this episode of The Social Leader, Fr. Justin Mathews talks with Dr. Tom Curan, Senior VP, Executive Director, and Chief Scientific Officer at Children's Mercy Research Institute. Dr. Tom highlights the importance of checking your assumption at the door and doing the “right thing” for the “right reason” when it comes to leading.Children's Mercy Research Institute
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EPISODE 3 - TRANSCRIPT
Fr. Justin Mathews: Well hello my friends. Good morning. My name is Father Justin Mathews. You are about to join The Social Leader, episode number three. You're not gonna want to miss this conversation with Dr. Tom Curran of Children's Mercy Hospital Stick around! We'll be right back.
Welcome back to The Social Leader, the show where we talk all about the best of business, faith, and philanthropy for social good, where we're trying to hone our leadership and learn more about how to be social leaders and how to have leadership that makes a community impact. I am super excited today to welcome Dr. Curran. Dr. Curran is an incredible researcher here at Children's Mercy Hospital in Kansas City. Welcome Dr. Curran. How are you today?
Dr. Tom Curran: I’m very good, thank you.
Fr. Justin: I want to tell everybody this morning that the show is sponsored by Reconciliation Services at 31st and Troost. Dr. Curran, you have an incredibly long title, but I want to make sure everybody knows who you are. You are the Senior Vice President, the Executive Director, and the Chief Scientific Officer at Children's Mercy Research Institute. You have an incredible history. You have led pediatric research at a number of institutions. Now, thankfully, here in Kansas City at Children's Mercy Hospital, you've had focus on pediatric brain tumors on pharmacology with kids. You've been published over 290 times you've been cited over 50,000 times in numerous articles. It's an honor to have you on The Social Leader this morning. Did I miss anything? About your history or about your title?
Dr. Curran: Well, there are other things, but they best be left unsaid.
Fr. Justin: Well, I'm looking forward to having this conversation with you today and I want to jump right in. You know, one of the things that when you and I talked last that we were really focused on in our conversation, was this idea about equitable access to care, particularly for kids right now. In this time when everybody is struggling with COVID-19 and when the hospitals are really getting pressed, you know, equitable access to health care is something that's been in the news and it's something that's been highlighted. Talk to me a little bit about the research that you've done, what the current situation is at Children's Mercy hospital, and generally, how do we improve access to care for all in our region?
Dr. Curran: Let me start by talking about where we're at right now at Children's Mercy. The hospital is still functioning. One hundred percent focus is on clinical care. To a large extent research has been pushed out, so we're working remotely. That is to protect our frontline caregivers and patients and families because any additional encounters increase the risk of virus transmission. We've also canceled most elective surgeries and other treatments. So the hospital is not very busy right now so we can focus on the COVID-19 patients. Fortunately, children are not as badly affected as the aging population so we have a relatively small number of patients. That's a good thing, but we're, of course, very concerned as to how this will take off moving forward. So right now, we've actually put a lot of thought into what we can learn from this current situation to improve our ability to deliver health care and to integrate research because ultimately research is the answer. We don't have treatments and we don't have a vaccine right now. Those are critical if we're going to overcome this global pandemic. And the integration of research with a hospital operation is key to enabling those discoveries to impact the improvement of health in everyone, not just children.
Fr. Justin: When you talk about equitable access to care and improving the health of everyone, including the kids in our region, can you break down just very simply for those who might not be familiar with the idea of equitable access to care? Can you describe what it is that we're talking about at the root and why there isn't equitable access, generally within the medical system?
Dr. Curran: So the concept is actually an old concept. It's really the concept of precision medicine: treat each patient as an individual, treat the whole family. The information you collect is relevant. Rather than thinking of patients as categories of disease, one size doesn't fit all, so tailoring response to the individual. If you accept that premise, you have to accept that all patients should be treated the same way because that's the only way you can learn, if everyone is given the same high quality level of service. It's challenging in the US system, because we have a very complicated care system and mix that actually gets in the way of being able to apply that equally. Now the situation for children is somewhat better. All children really do have access to health care. But there are economic barriers, there are sociological barriers, there are issues of trust, all of which have to be overcome. But if we truly embrace that original concept of precision medicine, which is it's all about the individual, all those other things will fall into place.
Fr. Justin: When you talk about precision medicine, I know one of the things that you've worked on in your leadership at Children's Mercy Research Institute with regard to equitable access is you've talked about overcoming barriers through innovations. What are some of the innovations that hospital systems, or in particular Children's Mercy, has put in place in order to make sure that everybody has equitable access in terms of transportation or economics or other barriers that could be there? What innovations have you put in place? And then how do we track those innovations to know that they're working? I mean, it's not something to be assumed that there's just going to be equitable access for kids.
Dr. Curran: So the way we do that in research is we collect data. For example, we have pioneered the use of genome sciences, genomics, to treat pediatric diseases including rare diseases. There are many barriers to getting access to that higher level technology and it's very expensive. It's not currently covered by most insurers. So our solution there was to start a research project and offer anyone who qualifies the opportunity to sign up for that research project. If you sign up for that project, the genomic testing is free. It's all covered. Now to ensure that we're really being representative, we collect data on all participants and then we study the statistics of those data. And that's actually really important from the scientific perspective. In science, we study differences. In fact, we celebrate differences. If everything was the same, we'd have nothing to study. By having as diverse a population and a range of diverse properties and perspectives, the science is better. So it's very important for us when we run these research studies to be sure that we're reaching as much of that diversity as possible, because that's what drives the quality of the study.
Fr. Justin: One of the things that you've talked about is really taking this patient-centered approach if we're going to achieve health care access for all, if we're going to have some kind of equitable access to care and make that a priority in our leadership. One of the things I hear as an undercurrent of what you're saying is that we've really got to not treat just a symptom or not just look at kind of big data, but we have to really drill down into a patient-centered approach. How does a patient-centered approach lead to better outcomes? Tangibly what's happening in a patient-centered approach that's different from another approach, and how does that lead to better outcomes and care?
Dr. Curran: This is really a kind of a throwback to original medicine, sitting down and listening to patients and families. My physician colleagues tell me about this all the time. They have so much pressure on them to process patients quickly, to fill in forms, they often don't have the time to spend that they would really like to. Many of them have shared with me insights that came through that conversation with a mother. Mother's pretty much know their children, and when a mother makes a comment that something is unusual for her child, the physician’s ears prick up. Then they dig into that conversation to try to understand what is unique about this individual child that the mother already knows, but is somehow not being perceived in the medical system. If we simply follow the symptoms, we're missing the underlying causes. Now, again, that goes back to the way physicians historically have dealt with patients and families by really understanding the entire family circumstance. All that background information plays in too. It's almost like a detective story sometimes. We at Children's Mercy see some very rare and unusual conditions and the obvious answers are usually not correct. Digging into that next level of information to uncover that the underlying causes turns out to be very important in those very challenging cases.
Fr Justin: You said something that reminded me of Dr. Martin Luther King from a Birmingham Jail. One of the pieces of the letter that he wrote said that even the most interested social analyst certainly wants to go beyond the symptoms and get to root causes. One of the things that you talked about there was listening to a mother who might know something is off, looking at that family system, and treating that opportunity to listen as not just something to the side of patient care, but really a way to get a glimpse at the root of patient care. I think a lot about leadership, and I know we're talking about scientific research and that's your forte, and certainly that is not my forte, but one of the areas that I've spent a lot of time thinking about is how do we translate our desire for equitable access to care and the innovations around that and a patient-centered approach, a holistic approach, this desiring to get at the root causes? How do we translate those things into our everyday leadership? Now, there are a lot of people listening who aren't in the medical field, they're not researchers, but I know that you and I've talked a lot about leadership in general and you have quite a depth of wisdom about that from your years of leadership in various locations. How do we apply these gleanings to our everyday leadership as leaders in whatever field that we're in?
Dr. Curran: So let me work with that term “translate,” because that's something that we work on as the kind of science that translates discoveries into new interventions, or treatments, or medicine. It's a very difficult field because you come into that field and you know the answer that you want to get. You want to have a treatment that helps people so they feel better and they do better. That means you have to constantly be on guard to check your assumptions. Because if you go into the process with that strong assumption, you start to bias the data. You have to step back from that. We're seeing this in the COVID-19 outbreak. There are experimental treatments and the scientists, like Anthony Facui, get up on TV and say, “I don't know that the data is really there. It's promising, but…” That's really important. Now that's very different from a political statement or the kind of optimistic statement that says, “hey, it's going to work because we need it to work and we really want it to work.” Well, every scientist wants their treatment to work, particularly those treatments that help children, but we have to be so careful to be objective, to do the controls, to segregate the information, to really look beyond the superficial. Be wary when you think it's working the way you want it to work. Second guess yourself. Go back to first principles. Have an independent metric. Ask “did it really go the way that I wanted it to go?” You take that scientific approach and it's kind of humbling. I often tell people that the way I run my research operation now, the way I'm running the Children's Mercy Research Institute, it's based on all the mistakes I made before. I remember them all. You really need to own your mistakes and then figure out the learning that they provide. Now it's great to have successes, but I have to tell you I remember the mistakes more than I remember the successes because I learned way more from those mistakes.
Fr. Justin: You bring up a common entrepreneurial saying, this idea of failing fast and really embracing our mistakes and pivoting. So in your work in leadership at Children's Mercy and as you see this need to translate our good intentions, how do we as leaders begin to practice this work of translation for ourselves? If there were sort of three things that we needed to take on as leaders? One that you just said was we've got to embrace our mistakes, we've got to not shy away from our failing. What would be a few other things that we need to focus on as leaders?
Dr. Curran: Keep keeping your eye on that long term prize. It's so important, and this is true of all careers. I tell young scientists to establish your goal early on. Know where you want to go and then be persistent. Persistence is probably the strongest criteria for success in almost all endeavors. Don't let yourself get burdened with the failures you'll have. You will have failures. You will trip and fall, but be persistent and keep the vision in mind. In our case, that's the healthy child. Keep in mind, that's what we want. We want that healthy, happy child. We want that family to thrive. Every decision we make every turn in the path, we should keep in mind what that long term goal is. So that level of focus I think, is very important.
Fr. Justin: Yeah, those are three really good points. Number one: embracing our mistakes and learning from them. Number two: Keeping our eye on that long term goal. Why are we here? Why do we get up in the morning? What's our path towards that goal? Then persistence. That word is really important right now, especially in this time when people are at home or they're working on the front line. There's a lot of frustration. Mental health is a big struggle for people right now from the work that I'm doing on Troost Avenue with our team at Reconciliation Services. One of the things that's really difficult is to just be persistent, whether you're looking for housing, or you need an ID but the DMV is closed, or you need access to health care but you don't have the insurance. Those three things of embracing our mistakes, keeping our eye on the long term goal, and persistence are really powerful concepts. I think translating those into our own universe is important. You're a researcher, you track the data. What are the things that we need to do when we're applying these concepts to our own life as leaders? How do we track that? Or how do you track that in your own life? Where does the data come from and then how do you apply it in your life as a leader.?
Dr. Curran: So there are of course, many sources of data. You really want to rely on the robust sources that are carefully documented, whether real metrics that go with them. I do often talk about gut feeling or subconscious insight, and it does exist. Your subconscious mind sometimes makes links, logical links that are not apparent on the surface, but that's not enough. You have to then back that up with the rigorous logic that comes from looking at real data. And real data goes back to the source. We've had many situations in science where scientific publications don't stand the scrutiny of time and they get overturned and shown, wow, that was a mistake. Well, those mistakes were always in there and if you look at the raw underlying data, as opposed to the processed information, you're closer to understanding that truth. So I really recommend people look at the unvarnished truth and sometimes that's tough when it comes to leadership. It means questioning your own perceptions and your own intrinsic biases. That's the unvarnished truth and you need to know that to be able to gauge how you should respond moving forward to challenging situations.
Fr. Justin: Yeah, the unvarnished truth is hard to find sometimes when we're actually looking at our own heart. When you think about the unvarnished truth about yourself, it gets a little bit uncomfortable. What do you do, personally, to make sure that you're seeing the unvarnished truth about yourself? Do you have any kind of practices or things that you maintain to keep that level of awareness?
Dr. Curran: Um, that's a really good question. I don't know if I want to get into all of my unvarnished truths, but it means just dropping all the pretensions and looking at, well, what is the greater good? What is the outcome here? The stage I’m at in my career I don't have any personal ambitions. It's irrelevant to me whether I get recognition or accolades, but that's because I've got the gift of time. I can look back and say, “yeah, I did this, I did that,” but now I'm really focused on the children. At those early stages of my career, every now and again, I had to take a step back and say, “is that for the kids or is that for me?” And when I came to “maybe that was mostly for me,” I dropped it. That was really hard to remove that selfish aspect because we all have it. We're all ego driven. We all like to think of ourselves as we're the good people and we're doing the right thing. But make sure you're doing the right thing for the right reason and it's not a personal or ego driven issue. That's probably one of the most difficult things to deal with.
Fr. Justin: One of the things that we talked about before the show today was that you reminded me of that old adage that you can determine the quality of a great society by how we treat the most vulnerable. How do you think we in Kansas City are treating the most vulnerable when it comes to equitable access to patient-centered approaches? What kind of a great city are we? What's the quality of this city to you?
Dr. Curran: To be honest, I've been very impressed by Kansas City in a number of ways since coming here in 2016. I've lived all across the US and, of course, I come from Scotland originally. One of the things that impressed me in Kansas City is that we have some very wealthy business people who choose to give back to society. The philanthropic support of Kansas City is really quite high up there. Do we have challenges? Oh yeah, we sure do. We have fantastic historical challenges if you look at underserved populations. I think the history of Kansas City is really interesting, and unless you understand that history, it's sometimes hard. What is 18th and Vine? Well, you know, it was set up that way, a very long, long time ago. Why do we have so many distilleries and bars? Well, you know, this was a mafia led town during Prohibition. Those things all add color to the environment. But I do feel that intrinsic sense from some of our leaders that you pay back, you give back to the society from which you emerged. I come from a very poor working class village in Scotland. Maybe only 1,000 people in that village. I spent my whole youth escaping, trying to get away. So my sense of payback is to others who come from impoverished environments. Everybody deserves a chance. Everybody deserves a fair break. I think that attitude is relatively prevalent in Kansas City. We have to, as you said, translate it into actions and that's where there's more work to be done.
Fr. Justin: Yeah, it's difficult in any company or in any organization and in our own lives to really do that difficult translation work, taking that unvarnished approach to who we really are, to what our company really is, what our company culture is, what the nonprofit's aim really is, where our funding is coming from, and how do those things line up with the with the ultimate good. But it's difficult to translate those good intentions into action in all of those areas of life. As we wrap up our time together, I'd really love to hear you talk about this idea of children first because you guys have done some amazing genomic research. You've really done some groundbreaking work in pediatric pharmaceuticals, which I have to admit, I know almost nothing about, so you're gonna have to speak like a layman to me. Talk to me about why it is important to put children first. What's the role of Children's Mercy regionally, or even nationally, in leadership in that field?
Dr. Curran: So, at Children's Mercy, we talk about our true north. Our true north is the child, each individual child. Take them one at a time and give them the very best medicine and the very best support that science and technology has to offer. Now, historically, that wasn't always the case. Children are considered a vulnerable population. There were actual concerns in the pharmaceutical industry that if you give experimental drugs to children, you might cause side effects that would not be good for them. So they tended to put childhood testing of drugs last or they develop drugs for an adult disease and thought, well, let's just give the same dose or a lower dose to a child, and then they'll be fine. But children's diseases are very different from adult diseases. Children are not little adults, they're growing, they're changing. Every few months, they change dramatically, their biochemistry changes. And drug treatments don't work the same way in children. So we have to specifically develop interventions and treatments for children. To get children to the front of the line, we at Children's Mercy decided, let's develop the very latest science and technology particularly in the field of genomic medicine and precision therapeutics specifically for children, putting them at the front of the queue. Now, very interestingly, that's turned out to be a really good decision in the scientific world. When you study genomics in children, you're looking at individuals before they've been impacted by a lifetime of insults. So in a sense, the data is cleaner. We know there are maybe about 8,000 rare genetic diseases in the world. Well, 7,000 of them start in children. So children are like the first site where you see evidence of gene mutations causing issues. And coming back to that mother, the mother that says, “something's not right” is often correct and she spotted a rare genetic problem based on her life living with her children. This one child, “something is not right” and we need to listen to that and then develop an intervention and a treatment specifically that addresses that problem.
Fr. Justin: I really appreciate you bringing out again the mother and listening. I feel like so often in the medical world, in the social services world, and really in all of business, faith, and philanthropy, we can kind of begin to lose sight of our true north and we can lose sight of this simple listening that can be done. Something as complex as a genomic malfunction in a child and, actually, the mother knows. I remember when my first son, who's now 17, was still in the womb, my wife, his mother, with a stethoscope was able to hear a fetal heart arrhythmia in the womb and pick up on it. Why? Because she had that ear of a mother. There's some deep deep wisdom that I am excited to hear about how your team is really peeling that back and being able to connect these things, leadership, genomic research, scientific approach, as well as a human-centered patient-centered approach where you take the family all together. If we lose sight of any one of those things, I think we lose our true north, don't we?
Dr. Curran: Yeah, absolutely. That's really coming back to that original statement: keep your eye on the prize. Keep your eye on that healthy child, that healthy society, that environment where mental health is not a stigma, but it's something to be dealt with and treated appropriately with the right kind of resources.
Fr. Justin: Have you studied in your work at all the effects of trauma on children and on the care of children? Have you done any work around trauma and mental health?
Dr. Curran: Not me personally, but that's actually a big area of research in Children's Mercy. Particularly those. In fact, the science is really coming into play there. The observations are that childhood traumatic experiences can actually change genes. They change the control elements of genes, the epigenetic component, and we actually have investigators now trying to understand the nature of those changes. Are they reversible? Can we use them as a biomarker to come up with prevention strategies that can help those individuals? It's absolutely clear that childhood trauma has long term effects. We can call them psychological, but actually they may have a fundamental presence in the genome. Changes in DNA modifications, DNA methylation, may end up causing long term issues in those individuals
Fr. Justin: These genomic changes that may result from trauma, are those things that can be passed on to other people and to successive generations?
Dr. Curran: They're not passed on in the way a mutation is passed on, but they're passed on through the environment of the womb, of the placenta. Because the next generation needs a healthy environment in the womb to develop appropriately. So there are issues that go from one generation to the next and it can be seen in a couple of different ways. It could be environmental exposures. It could be a stress-associated changes. The signs are at an early stage, but that is something that is really fascinating right now to try to understand. And again, it's like, people tell us that they have these effects. They tell us that they'd never emerged from their childhood and now we're actually seeing evidence of why.
Fr. Justin: In our work at Reconciliation Services, we do a lot of trauma therapy. We do a lot of social service work and a lot of economic community building here on Troost Avenue, which is the racial and economic dividing line historically in our city. One of the things that our Master’s level clinicians tell me all the time is that the same kind of traumas that they're seeing in their current clients, and in the current guests that are coming in, actually, as you unpack a family story, you see those repeated generation after generation. Those things are not just environmental, but there are ways of thinking that lead to retraumatization. What's the connection? Do you think between this generation that's experienced trauma and the next generation that comes, if it's not a one for one genetics? How does the research indicate that that trauma is continued in the next generation?
Dr. Curran: There are multiple ways that can happen. It could be through behavior patterns, parents treat you in a certain way based on their exposure as a child. But, as I said, the changes in genes affect how genes are expressed. Did you make a certain level of a hormone? Did you make a certain level of growth factor? And how does that then affect the next generation of children? Because those children are born in a womb that may have changes in gene expression that don't provide the right kind of nurturing environment. So you go from one generation to the next. How do you break that vicious cycle? How do you step back from those epigenetic marks? We don't know, but that is definitely something that we're looking into right now.
Fr. Justin: So as we wrap up, I appreciate you kind of going far and wide with me, we've talked about everything from translational research, patient-centered approach, that driving mission around equitable access to care and putting children first. You talked a little bit about the philanthropic world in Kansas City. Coming from Scotland and other places in the United States that you've lived in, you're impressed with the civic and the business and the philanthropic world In Kansas City. As we think about ourselves as leaders in whatever field that we're in, what responsibility do we have to support the work of Children's Mercy? If we're going to be good leaders and good members of Kansas City society, what responsibility do we have to support Children's Mercy, your research, and why is it important?
Dr. Curran: So in the Kansas City landscape, Children's Mercy is a jewel in the crown. We have a beautiful city, that renovation of downtown is great, but you have one of the best children's hospitals in the world. That is something to be proud of. Because I think we can say Kansas City values children, values the next generation, and wants them to have the best. We're building a new research institute on Hospital Hill. A spectacular building that features the DNA sequence from our patients. So we proclaim to the world we are working on the issues our patients bring to us. We will attract the best and the brightest from all over that want to come here to Kansas City to help all of our children locally, but also make discoveries that then ripple out across the rest of the world. Discoveries made here in Kansas City will have an impact in Africa, in South America, in Europe. That's the nature of research. We have investigators right now doing studies in various African countries and learning things that turn out to be very relevant in rural Kansas because the situations are not as dissimilar as you might think. So by valuing Children's Mercy, by polishing this jewel in the crown, Kansas City is stepping up to the next level, as an environment, as a city, as a leader, in the global landscape. I'm very proud of Kansas City
Fr. Justin: Dr. Tom Curran, I really appreciate how well you've represented Children's Mercy, the incredible work that you're doing in genomics, and the work that you've brought into Kansas City with regard to bringing equitable access to all of our kids. I know that two of my kids have been treated by Children's Mercy over the course of their lifetime. And it's absolutely, as you said, a crown in the jewel of Kansas City filled with great leaders, just like yourself. I'm going to take away, as I think about that true north that you talked about, I'm going to try to remember as a leader to embrace my mistakes, to keep my eye on that long term goal, and particularly right now and this season, to remain persistent. Is there anything else that you want to leave us with before we sign off for today, Dr. Curran?
Dr. Curran: I think you summed it up very well.
Fr. Justin:. Well, Dr. Curran, thank you so much for the great work that you do. I sure hope you'll come down to Reconciliation Services and continue to support the work that we do here. If there's anything that we can do, particularly for the vulnerable population in Kansas City, if there's anything we can do to support your work or partner in research, we're excited to do that at Reconciliation Services. So thanks again for joining me today. And thank you all for joining this wonderful conversation on The Social Leader podcast. Remember we're sponsored by Reconciliation Services, working to cultivate a community that's turning Troost Avenue from a dividing line into a gathering place. Next show I'll be visiting with Megan Hyatt Miller of Michael Hyatt & Company. We're going to be talking about productivity and leadership during this season of COVID-19 and sheltering in place. You definitely won't want to miss that show. Thanks again and I look forward to seeing you back on The Social Leader.