te live on c-span two. next you monday with dr. patrick o'gara on recent advances in heart surgery. and another chance to see british prime minister david cameron take questions from the house of commons. ♪ >> this week on "q & a", our guest is dr. patrick o'gara, senior physician at brigham and women's hospital. and immediate past president of the american college of cardiology. brian lamb: dr. patrick o'gara i read a quote from a doctor, a

your heart doctor, he said to you, don't ask leading questions. do you remember that? dr. patrick o'gara: i do. brian lamb: what did he mean by that? dr. patrick o'gara: he was talking about how to become a better doctor. i think what he was saying no was -- i think that what he was saying was don't pre-suppose , what the patient will tell you. make your questions open balanced, fair, and provide the patient an opportunity to tell his or her story. oftentimes, in a hospital, people are in a hurry to get things done. emergencies are confronting you. you have telephone calls to manage, other patients to see, and one of the natural reflexes is to try to focus or narrow the discussion before it starts. this is in an attempt to get to the goal line more quickly, but you could lose the forest for

the trees. you could miss the diagnosis if you are not careful. he was saying, try to take a step back, ask questions in an open way, and just listen to what the patient is going to tell you. most often, they were tell you what their exact problem is. you just have to provide them opportunity. brian lamb: what is your current job? dr. patrick o'gara: a general cardiologist in boston at brigham and women's hospital where i have been there for just about 20 years. before that, i was at another hospital. my job really entails a variety of act remedies. but, the core focus of my job is to see patients, i see them in boston, new england, in the u.s., and internationally. they have various types of heart disease. oftentimes it is a situation where i will provide a second or third opinion about what the kind of treatment they need will

be. and, i have a teaching load that requires me to teach fellow residents, teaching students and i do research, and have administrative activities, as well. so the portfolio of activities may involve as many as five different things on annie -- on any one day. it adds up to a great opportunity to try to make a difference in the life of an individual, or something more broadly, with the teaching or research i might be doing. brian lamb: i ask you here for two reasons, the first reason, the most important, you were the president of the american college of cardiology and spent time on their board. the second reason, just as important to me you are my first cousin. i have known you all your life. your father -- your mother and my father were brother and sister and the important thing is, because of your schedule your family has not been able to interview you, we cannot get you pinned down.

so, this is an opportunity for our family, to find out what you really do. dr. patrick o'gara: i think it is a great thing. it is also fair to say nowadays, when starting an interview or talk in the medical profession one must disclose their relationships with the industry or conflicts of interest. so, i think sitting across from you, the oldest member of the family i believe, is tremendously humbling and a little bit intimidating. so i hope that your audience has , insight into this dynamic as well. brian lamb: i will start with personal things. you are from a family of nine kids. dr. patrick o'gara: nine children. brian lamb: when in your life that you decide to be a heart specialist? dr. patrick o'gara: i don't think i really decided until halfway through college. but, looking back on some prior experiences i had, i was likely

more influenced the in i had previously appreciated. in particular, i had a friend from my hometown whose father was a cardiologist. this friend of mine and i, what occasion -- on occasion, we would go with his father to chicago to make around on patients. i remember a couple of things. we were teenagers, not paying much attention. i remember one time, he drove way too fast and i was surprised that a physician would drive so rapidly down lakeshore drive. the other was, that i was really impressed by his understanding of biology and science, yet his ability to talk to people and to make a difference in their lives. it was a very comfortable situation in which, taking a step back, i began to think about what it would be like myself in that person's shoes.

and then we had other , interactions over the course of time. in high school, college, summers always and being over at their house or doing something with them. slowly but surely, i think what he did for a living had an impact on me as much as it did on his two sons. both of them, whom by the way up our cardiologists -- bty the way, are cardiologists, one in chicago and one in arizona. brian lamb: you got your education where? dr. patrick o'gara: at yale university, being the fifth of so many children, this was a departure from past practices. i had to make sure i had funding to make the transition from a non-big ten school. and another thing that my father said to me, good luck out there and i hope that you do not become a communist.

[laughter] brian lamb: he had strong views. dr. patrick o'gara: strong views? i do remember that he probably voted for barry goldwater. brian lamb: in your lifetime among them a nine -- among the nine children, do you all have the same politics? dr. patrick o'gara: i doubt very much we have the same politics. some of my siblings would accuse me of being a socialist, having lived in massachusetts for so long. the past 37 years. of course everyone in massachusetts are democrats, and those who choose to be republicans, really want to be democrats. it is interesting, we have a republican governor, a democratic legislature, but i think that some of my siblings are right of where i am. the three spec to some of my political views and policies and what i think the role of government should be in the

lives of the people. brian lamb: i want to go to the american college of cardiology what is it? dr. patrick o'gara: it is a professional organization composed of cardiovascular providers, from cardiologist medical doctors, as well as the other members of the cardiovascular care team ranging from nurse practitioners to nurses physician assistants and even the cardiac administrators who work behind the scenes to manage offices or manage grant money around research. it is a broad organization, now about 50,000 members. we are located in washington dc, but we have local chapters in each of the 50 states.

and in addition, we have chapters in 32 or more international countries or foreign countries. ranging from places like japan brazil, argentina, turkey, saudi arabia, and many places in between. over the course of its existence, the college has had its mission, activities to improve the cardiovascular health of patients worldwide. as is becoming a global agenda more so than when it was first formed some 66 years ago. as the world has become smaller and we interact with clinicians across other countries, it is clear we have common problems we need to fit those resources together and become smarter about choices. brian lamb: want to talk to you about the heart, but first, from 2009, i found this on youtube. you are talking as a doctor of

cardiology from brigham and women's hospital, talking to an average person. >> we are here today to talk about your cardiovascular health. if you have a family history of heart disease, i think it is right for you to be concerned about what your risk is for developing heart disease. we used to think that the risk for heart problems was quite high if your mother or father had a heart issue when they were younger. more recent research has shown that if a brother or sister has had a heart disease event, that you are at a much higher risk for the same problem. when we think about family history of heart disease, we have to think quite broadly with respect to all of those things that could affect the function or structure of your heart. brian lamb: what has happened since 2009 when he made that video about the heart, anything new? dr. patrick o'gara: there has

been a tremendous amount of new knowledge brought to the recognition, treatment, and prevention of heart disease. knowledge has exploded particularly in cardiology. what i was referring to was the family history. what are the problems that your siblings were your parents have faced, or even your children have faced. the degree to which genetics contributes to predisposition and the development of disease or to the reaction of a particular medication, or to the predicted effectiveness of the medication, has been increasingly understood with scientific advances over this now six-year period of time.

i would think, as a more recent example, i would share with you with what's happened on the hill, where the committee has looked into something called 21st century cures. the president has mentioned this in his state of the union address, and paid some attention to what is now known in the vernacular as precision medicine or personalized medicine, where we have the scientific wherewithal to know extraordinary amounts of information about each of us based on a single tissue sample that looks at our genetic makeup. and predicting how that make up will interact with environmental influences, like air pollution or problems related to the cleanliness of water. or how you could react to medication. so, we are trying to become smarter about predicting who will get disease, we are trying to become smarter as to

identifying the most effective means to prevent a disease and then trying to be smarter about following up over a longer. of time. we are trying to harness the promise of the human genome research project that has now been in existence for over a decade. with all of the informatics that can be given by the giants of the industries, like google. information about sociology, geography, demographics, where you live, where the railroad tracks are, what your likelihood to get diabetes is, based on your educational background. and, what your likelihood is to develop something like diabetes or hypertension if you live in a certain part of the city where you have less access to the right kinds of food. or the impact of sodium intake. it could have enormous impacts

on population health. we have come a long way in the last six years, to the extent where we have a huge amount of information, about how to put all of these things together and filter it in a way that is practical. brian lamb: i want to ask you about that. how much a video does brigham and women's hospital do? dr. patrick o'gara: we do an enormous amount of video. two take advantage of social media, video streaming, even electronic messaging to get information out to patients and families who can access it and understand it. simply providing them with the tools to become more knowledgeable about their own diseases or or predisposition to diseases. so they can ask more sophisticated questions in a one-on-one situation. they can come armed to an office visit with a better understanding of where they would like to go over the next five or 10 years with respect to

their own disease. brian lamb: what has been your specialty? dr. patrick o'gara: within the field of cardiology i started off interestingly enough in critical care, or the management of patients that were very ill or required in intensive care. i was also performing what is now called interventional cardiology, in a crude way when it first started in the late 70's or early 1980's. over the course of the last 20 years, i've migrated to become a general cardiologist with more of a focus on evaluation. i will often times refer them for procedures they might need. brian lamb: we have a video from scottsdale health care, this is about a trans catheter aortic valve replacement. dr. patrick o'gara: i have not personally done that replacement, but i have taken care of patients who have

required this or participated in lectures and symposiums about this particular transformative technology. this is a game breaker. brian lamb: this is animation. we will show it and you can explain what we are watching. ♪ >> this is the aortic valve, very calcified and not opening well. this is a pictorial display of aortic stenosis looks like. this is a very common valve problem, especially among older persons. it is characterized by a lot of calcium and thickening. a wire is placed up the aorta and down through the valve and this system you see is actually a balloon system over the wire that is stationed in the region of the valve.

the balloon is invaded, the velvet is cracked and the whole is increased in size in order to accept what is now being advanced up the aorta and now. this is actually a valve that has been crimped onto the catheter that is now being positioned into the diseased valve, and it will be deployed in a second here, with the balloon being inflated as a new valve and it will be inserted into the old, calcified stenotic valve. the wire will be withdrawn. what we have just seen in this pictorial display is replacement of a diseased aortic valve in a manner that does not require open-heart surgery.

brian lamb: how long have you been able to do this? dr. patrick o'gara: this technology has been available since they first aortic procedure in 2002. so, literally across, more than a decade period of time, this technology has transformed our ability to take care of older, very sick patients who would otherwise have a great deal of difficulty negotiating the open-heart surgery to accomplish the same and. brian lamb: is the patient out during this process? dr. patrick o'gara: nowadays they are not out. when we started, they had general anesthesia, they had in the operating room, a sort of hybrid, an anesthesiologist who continues to participate in this procedure, surgeons, in

interventional cardiologists, as a team performs these procedures across the united states and across europe. without exaggeration, now over that. of time, hundreds of thousands of these have been performed. this as i said has transformed the way that we care for patients who would otherwise be at risk for major complications with open-heart surgery, which until 2002, was the only way to approach this problem. brian lamb: you had to open the chest. dr. patrick o'gara: yes, crack the chest and put them on a long -- lung machine. and this now can be done with a beating heart. and, in healthy older persons who are candidates for this particular procedure these days, they can actually have the procedure without the need for general anesthesia and go home the next day. brian lamb: so, this is a washington related question. how much of the taxpayers money

from some place in this town would have gone to funding this solution, the research money? dr. patrick o'gara: that's a good question. i think that the research that was done in order to substantiate the effectiveness and safety of this technology, was done really as a partnership with the device manufacturers. and so, there have been two leading device manufacturers in the united states who have heavily, and we would think appropriately invested in research dedicated to prove that this is not only affect have but it is safe. i think that in the trials that continue to be designed and executed to look further into aspects of these devices have received funding from a variety of sources, including taxpayer money.

but, the initial launch, the trials necessary to complete this, more of a public and private partnership which is a topic unto itself on where we stand in the united states with respect to our tolerance of industry-sponsored research compared to government-sponsored research. all of the concerns we have heard over the past decade about how investigators can easily find themselves in conflict situations where they could either be paid or they could even subconsciously begin to make it decisions not in the best interest of their patients or in the best interest of the research. but, i think we're beginning to learn that our government is so strapped in respect to the ability to fund research, we have to get back to a common ground about public-private

partnerships in order to make this successful. brian lamb: i need to say a couple of other things, people watching are probably thinking this is a set-up. i have tried to get you here for six months and you have been busy. and secondly, we did not talk about this interview before it started. dr. patrick o'gara: not at all. brian lamb: i want to show you as long as we're talking about the government involvement i want to show you a brief clip of the president of the united states talking about the health care bill and then we will show you someone who is opposed to it and tried to get you to put it into if. -- into perspective. >> it is important to remember that the affordable care act is more than a website, because it millions of young people have been able to stay on their parents plan until they were 26 years old. seniors now have access to prescription medicine. it is all happening right now,

because of the affordable care act. already many americans have it used the new marketplace to find affordable coverage. brian: as you know, there is a whole other side of this. where do you come down on what the president has done? dr. patrick o'gara: i think that in massachusetts we refer to some of this as romney care, because as you are well aware efforts to try to provide medical insurance coverage to a broader population began there during governor romney's former term and it was a successful demonstration, i think, of cross-i'll can genealogy and partnership between republicans and democrats. there was input from insurance carriers, the coalition for the homeless, and other people who

contributed to the conversation about the need for health care coverage. and, i think that's at the time of the passage of this, and then its use as a template for national legislation, to some extent, i felt a degree of pride that we would make a conscious decision as a community to establish health care as a right, rather than a privilege. and of course, the devil is in the details, what we have now learned is that we are in a situation where much of this could unravel because of the inability to manage the website, or because of the intricacies of the law and that is so difficult to understand that we find ourselves still scrambling for a valid methods for the promise that we have made to the public.

brian lamb: how has this affected your life as a heart specialist? dr. patrick o'gara: with more people now gaining access to insurance, there is an influx of patients who require evaluation and many of these will have previously unrecognized heart disease, or are at-risk for heart disease. particularly those who operate at the lower end of the income spectrum, who are the most vulnerable to hypertension and obesity and are the most honorable to inappropriate foods, etc.. so on the other side of the coin, how you manage that increase and do you get paid by providing to that group. during my day to day life, this has not had a significant impact on me, has had a significant

impact on our health system which is partners health care and they are, we, us, are trying to figure out how to navigate an very uncertain future where the financial sustainability of the current system is at risk and what shape this might take over the next 5-6 years, is at further risk. i don't think anyone has a clear idea of that. we are operating out of a range of almost no data at this time. people are very concerned about this that we may not be able to afford the future. that there could be a restriction. that some practitioners of medicine may choose not to participate, concerned that they cannot recoup their costs at the cost of providing services. i think there is a lot at stake. nobody seems happy at the present time.

back to principles, i'm so proud of the fact that we have extended coverage to millions of people. brian lamb: let me run a opposite view. this is a medical doctor. he is no longer in the senate. here is tom coburn's position on health care. >> you can thank the democrats for obamacare, because there was not one republican who voted it. this is not the u.s. congress that did this. it was the president and his allies that created this mess that we are about to experience. i would say that the administration is lawless in its implementation of this bill. they will pick and choose, regardless of the law, they will pick and choose what they will implement. i think it is unacceptable. i think it is unfair to the average american. brian lamb: any reaction?

dr. patrick o'gara: i think there are a lot of opinions about the flaws in the affordable care act, this is one. i think that some of the opinions seem to border on a theory about the government or subversive intentions, things of the sort that detract from a more open discussion, about do we believe in this as a right and of so, how do we prioritize it and pay for it against other social obligations that we have a acquired as a country, ranging from social security to all things in between. i do not agree with the notion that this is harming patients. i know some patients have been confused by virtue of trying to digest the information. i also understand that there was misinformation provided about whether you can maintain your

current health care coverage or whether you needed to migrate to a different platform. i don't know if that is a bigger problem than the prior unmet need of many people graduating from college you did not have coverage and now they can be extended to their parents plans until the age of 26. one of my own children, finding herself as a contracted employee, and she can go out toto the exchange and find the health benefits she needs until which time she becomes a full-time employee. i think that we live in in -- complicated times. there are many different angles and i am not sure that the summation of all of the aspects of the plan are as negative as some people say. i hope very much that we can continue to make this work. brian lamb: how often do you see patients? dr. patrick o'gara: every day, usually.

in my office, i see patients about 4-5 times a week. brian lamb: the ever come in and ask about the cost of health care? dr. patrick o'gara: very much so, routinely they will talk to me about the cost of medications, particularly the size of their co-pay. or they will talk to me about whether or not, by virtue of changes that occurred in insurance coverage, that they have to pay more out of pocket and was the case before. -- than was the case before. patients are quite worried about their vulnerability going forward and how it is a will -- they will save money to afford health care when they are older and more likely to develop diseases. brian lamb: what do you say to someone who finds out they need a procedure, maybe the one we just saw, and they cannot afford it? what does the hospital do? dr. patrick o'gara: i think for the most part, nowadays, hospitals will help that person apply for medical coverage on the open market.

so the hospital is able to facilitate the process by which all patients can receive coverage. this is not always the case, antilles options became available. brian lamb: from the moment you are told you need a procedure, you can apply and you have to begin an insurance. -- you have to be given insurance. dr. patrick o'gara: usually that is the case. it is very state dependent. i think that you are aware some states have not increased medicaid coverage, others have chosen to do so. it is a disagreement as to whether states can afford to do that or whether it is a federal obligation. i don't pretend to know the intricacies of that. the average patient requiring health care in the u.s. can find coverage in order to enable the provision of the health care. but the hospital that i work for and many others in boston have been in the business of

providing free care for generations and are not about to stop. i think that the financial statements at mass general and others will include a line item for unreimbursed care. brian lamb: you also worked at harvard medical school, and you went to northwestern. did they discriminate against you? dr. patrick o'gara: just mean from the midwest monday had taken many from northwestern when i applied. but the opportunity came up. brian lamb: how often do you teach? dr. patrick o'gara: i teach every week, formally in a lecture format, twice a year at the medical school. that is where i attempt to engage medical students, usually in their second or fourth year. the teaching, what i deliver have to do with teaching the fundamentals of caring for

patients. i'm teaching in the process of evaluating and manage -- managing patients, those in my office, i will have a student with me and they will begin to acquire the tools of applying what they understand from a basic science level, into the care of patients. brian lamb: what do you say to a patient that you have said your heart condition is so bad, you probably will not make it? dr. patrick o'gara: i think that end of life discussions are increasingly important, because of the extraordinary array of technological interventions that we can now bring to bear on just about any patient problems at any time. -- just about any patient's

problems at any particular time. we often find ourselves in situations where we talk about we could do this, but should we do this? engaging patients, preferably well before a terminal illness might set in, is the appropriate time and more appropriate venue in which to have that discussion. our colleagues in oncology and many of my colleagues that practice heart failure cardiology, advanced heart failure cardiology and are dealing with patients on transplant lists or patients with assistive devices, are much more sophisticated in dealing with families, talking to them about goals of care, the appropriate venue for patients and families to consider where it is they want their care provided as the end becomes near. we have an increasing alliance

of colleagues from ethics -- from psychology, excuse me, and paleo to medicine -- pallets of aitive medicine which is an important specialty for us, to help with this conversation. every family and patient is different in terms of how they deal with that information. brian lamb: how has it changed over the last 20 years? dr. patrick o'gara: i have attempted to be as careful as possible. i had many conversations on a weekly and monthly basis with patients with whom i think continued interventions are not going to reverse their problem and we need to reset goals, the most important things for them to do over the course of months ahead of them. many patients, once that conversation is broached, begins think more concretely about how

it is they wish to navigate and for many of them, being less sure of wrath is -- breasts -- -- less short of breath, for example, is more important than to live an additional week. i think we get back to this point, brian, empowering patients to make decisions on their own behalf and being able to provide them with information, and sometimes recommendations, in a way that is transparent and is targeted to their level of acceptance of the information. how much they understand sometimes you can have sophisticated conversations and other times it is more big picture. one of the great challenges is feeling comfortable so that you can get patients what is -- give patients what it is required to that they can make

their own decisions, but not prematurely lead them down one path or the other, or exercise your own preferences at their expense. that is an idealized interaction that i believe happens to infrequently. -- too infrequently. brian lamb: last week i was reading a book by a british neurosurgeon and the fellow named sam keene was writing about that book, the title of the book is "do no harm." here is what he says. like most surgeons, he was gung ho when young, willing to operate on any patient, no matter how bleak the prognosis. but he grew more conservative as he aged, less willing to open people up for what amounted to practice, more willing to let

them die in peace. for all of the marvels of modern technology, he realized keeping people alive at all costs is rarely the human thing to do." -- humane thing to do." how does that strike you? dr. patrick o'gara: i would agree with the implication that with time and experience the ability to help patients understand that our technologies are limited in what it is they can deliver. you do not know that when you start out. you have an obligation to do everything you can, because you do not know better, you haven't had experience to know what the limitations are and how likely they are to be successful. this is a person reflecting back on years of surgical practice and i think all of us go through the same process. we are less willing as we have more experience, to expose patients to interventions that we think have little likelihood of changing their long-term outlook. brian lamb: i want to show this picture of you at inaugural ceremonies where you became president of the american college of cardiology.

it is not on your screen to see though but you can see it back there. there is. it is over here. right there. why all the stuff, the red garments and all that stuff? dr. patrick o'gara: good question. brian lamb: this organization, you have to wear these garments when you become president of the american college of cardiology? dr. patrick o'gara: it is a tradition has been passed down. i would not disagree with where you are going with the question, what kind of place does this have an the 20 i think that is pretty legitimate. they probably would have voted me out if i tried to take the robes off. i took the taxi does out of another dinner we used to have on an annual basis.

but good question. what kind of impression does this give? is it that we are a college of cardinals? they are red. are we elitist? do we think of ourselves of academicians rather than card-carrying physicians there at the bedside, struggling with patients and families? i think in the 21st century, these kinds of ceremonies, while they are important in one aspect, they do raise questions in other areas. brian lamb: what was your year like? how many places did you have to travel? dr. patrick o'gara: i had to deal with many issues that i had not looked at previously. being a clinician, educator, researcher, i found myself often times in a world of public

policy, or advocacy, on behalf of patients or physician members or things of that nature. a great experience and how the world works or does not work. i think if one does not go through a year of this sort, being able to identify gaps in his or her skill set, then you are not paying attention. i think that the president of the american college of cardiology is a spokesperson for the organization, not the decision-maker. like you, you have to be on your game every day. being able to say things in complete sentences, articulate clear messages, have people understand what you are really saying and not insinuate what you might be saying, and i think that takes practice. it really does. in terms of the travel portion of it, travel is a parcel of -- part and parcel of being a representative of a 50,000 person organization. but like all things, i think that travel can be prioritized. there are appearances more

important than others. my year, i made an effort to try to delegate a great amount of the travel to other people, not only because i thought it could create opportunities for them to have leadership experience, but also because it is not important for the primary spokesperson of the college to be all places, all times. brian lamb: where did you go? dr. patrick o'gara: israel china, germany, south america, japan, and many places across the u.s., ranging from west virginia to alaska. during the process of representing the college and a meeting people, you can only become humbled by what some people are doing. on an individual basis to improve the lives of patients. going to alaska in february, meeting a group of people who

were so much more resilient and the people i work with every day, i can't do anything other than work in a bristling high-tech academic environment. it you go to alaska and people are taking care of people in bad weather, you shrug your shoulders, get this done. why don't we go out to where they live in a twin engine plane in the middle of the winter and just pick them up and we will bring them back and take care of them. we get these things done. you sort of stop and pause and think, what is it like to be self-sufficient in a situation in which you do not have all the resources you need? you just do things. you do these things selflessly and the people i met who are working very in the indian health service in anchorage are

my heroes. i would not have had the chance to meet them before. or folks in israel who do not know if they will be safe from one week to the next, but they are doing the same high level cardiac care that we do here in the u.s. all sorts of things, very interesting. brian lamb: this video from brigham and women's hospital this is an aortic without stenosis. watch a little bit of this and after, i will ask you to explain it to us. >> this operation is being performed on a 67-year-old individual. he has a gradient of over 100 millimeters of mercury. >> a 100 millimeters gradient. a very calcified aortic valve we are trying to remove. the good news is he has normal coronary arteries that allow us to do this procedure, because we don't have to do any concomitant coronary bypass.

we will now stop the heart, pump off a minute. down please. i will clamp the aorta. which i have just done. in order to protect the heart, we need to do cardio plea just -- cardiopliga. it takes about five minutes to do this to protect the heart and get it nice and cold so we can open the heart with impunity. brian lamb: a lot of things, why would that have to be open heart surgery instead of using the catheter? dr. patrick o'gara: this may have been done a few years ago prior to the routine use of the transcatheter valves we currently have. it could have also been that this person, although he had

critical aortic stenosis, was resilient enough enough withstand this surgery. what we saw here is the test was -- chest was open, that large yellow thing was the beating heart at the onset of the video. the surgeon was preparing the field prior to making an incision to expose the valve and then take it out and replace it with another valve called a prosthesis. this is the type of cardiac surgery that has been with us for decades, which is highly successful and sets a high bar for our ability to prove that these transcatheter techniques will be equally effective in lower risk patients. the tension in the field of putting valves in with a catheter, is they have been demonstrated to be useful in very sick patients.

well, how do they stack up in healthy patients and are they as good as surgery? surgery is now the gold standard for someone who is healthy and can withstand it. brian lamb: one more video that we will fit in. this comes out of the university of chicago. this is minimally invasive micro valve repair surgery. i read that 20% of american people have something wrong with their micro valves, they give you penicillin when you go to your denniston something like that. how serious is the micro valve? dr. patrick o'gara: it is serious. although there are a lot of people with micro valve disease, they may not need surgery. mitral disease is what we initially equated with rheumatic fever, the typical person with rheumatic fever having a stripep

meningitis when they are a child. and then these streptococcal organisms that cause inflammation of your heart valve and over time it scars and he -- you develop a mitral valve problem. the kind of mitral disease we operate on in the 21st century is different than what we operated on in the 20th century, because we do not have much rheumatic fever anymore. we have something called prolapse mitral prolapse. floppy valve. they tear and they can be associated with leakage and you can get in trouble when the valve leaks. brian lamb: this is animation, but this is not either catheter or open heart. this is lacroscopic. let's watch this for a bit. >> unlike traditional mitral valve repair surgery in this procedure a surgeon manipulates the highly advanced robotic tool

and makes only tiny incisions. robotic arms are inserted close to the heart and then we open the sternum. we make key incisions. the tiny camera provides a view of the disease valves. we see that the valve is oversized, and it is not close properly, which allows blood to go backwards. we remove the misshapen portion of the valve. and reconstruct it with sutures. we insert an artificial ring to reduce its size. we sew the ring into place and the valve now closes properly so blood no longer leaks back.

after the procedure, only a few scars remain, instead of a large scar in the middle of chest. brian lamb: how old is this procedure? dr. patrick o'gara: this is an example of robotic repair. this procedure is now probably 15 years old. in the united states, there are only a couple of places where these kind of interventions are done with high volume. there is a steep learning curve. in other words, in the first few cases that any team would try would take several hours and a variety of attempts, where the puncture wounds might go, and it is simply another means by which to get to the heart of the problem.

no pun intended. you have to leave the operating room with a mitral valve that is no longer leaking. i think that robotic surgery is a form of mitral valve repair surgery that actually occupies relatively small segments of all of the repair surgery done in the united states. brian lamb: if you are told that you had to have mitral valve surgery, would you have a robotic surgeon or would you have a surgeon crack your chest? dr. patrick o'gara: i think the discussion for a patient to have, if the time has come for mitral valve repair, then i would strongly prefer that they have the right mitral valve surgeon and the surgeon can then explain his or her approach to the valve. some surgeons are very good with robotic interventions and others have not chosen to pursue that

and do a limited chest incision, also minimally invasive. i think the premium is placed on the quality of the surgeon as the first priority. the surgeon and patient can then decide what is the preferred approach. at the end of the day, i don't want my patient have a second procedure because of the technical flaw of the first one. brian lamb: do you do robotics at brigham and women's hospital? dr. patrick o'gara: we do not do it routinely. brian lamb: how many heart surgeons you have? dr. patrick o'gara: six cardiac surgeons, over 100 cardiologists. many of them are doing research on a full-time basis on more than 50 or 70% of their time. so we have a big group of people in our heart and vascular center, but currently six cardio -- cardiac surgeons.

brian lamb: we started this discussion by me admitting that you are my first cousin. we talked about you having a family of nine children, what was it like growing up with nine? dr. patrick o'gara: i probably have grown to appreciate the opportunity with each passing year. i think it was a little competitive at times. there was clearly a hierarchy as was commonplace growing up in the 50's and 1960's. you felt those who world or were really old. and i was right in the middle. brian lamb: retreated badly by -- were you treated badly by any siblings? it's a chance to get back at them. dr. patrick o'gara: i was. it left a mark on my development as a consequence. but i think probably nothing more than the usual sibling rivalries or sibling hierarchal approach to things.

the wonderful opportunity to learn about a group dynamic, things that i could take away from that experience would be that i think we all respect each other and that has grown as we have been fortunate enough to go -- get older and get older and a -- in a healthy way, so that we can see and interact with each other. i think that subsuming it yourself in a larger group and not taking yourself too seriously are good things, good experiences to have as a youngster. learning that perhaps your accomplishments are no more than those in your same household. that i am grateful for. that kind of exposure to a broader number of people, all of

whom have had individual successes during their lifetimes, and we've all had individual failures, but that is part of growing together. brian lamb: any other medical people among your siblings? dr. patrick o'gara: none of my siblings. none of the other eight have gone into the medical profession. one has had her consulting business in the medical field for more than 25 years. she advises hospitals and physician groups under aspects of things. no other siblings are practitioners of medicine. my oldest son, brian, has recently finished his boards in anesthesiology and is the first our parents' 29 grandchildren to pursue a medical career. the only one to this point. i think my lifestyle must have

convinced others not to approach this or they think i am a nerd. brian lamb: i won't go there. the public has seen a lot of stories in the last few years, about everything in our society including doctors who have stepped over the line. i got on your website and there is a huge ethics part of all this. what do you -- how close do you think -- why have the doctors gotten so close to some of the drugmakers medical companies , has that hurt the relationship between doctors and patients? dr. patrick o'gara: i think that is a broad question. i mentioned this in some earlier remarks, that we have to understand it is easy for the entire medical profession to be painted with the same broad brush of distrust when any

member acts out or crosses the ethical line. that unfortunately is the reality of working in a profession that generally is still well respected by the public. i think if we rank ourselves against other professions, the legal profession, congress physicians still rank fairly high on the list of trustworthy professionals, but we have to take responsibility that there are those among us who have crossed the line for personal gain or personal enrichment and oftentimes at the expense of a patient. or researchers accused of broad who have fabricated results. -- accused of fraud and are found to have fabricated results. we have to be able to regulate ourselves and police ourselves to maintain the highest possible standards, because we do have this obligation. brian lamb: if you were to tell a member of congress or the

president one thing that you have learned over the years that you would like changed by government, as it pertains to the medical profession, what would you tell them? dr. patrick o'gara: one thing? brian lamb: one thing that would improve medical care for the public. dr. patrick o'gara: well, you caught me flat-footed. brian lamb: i tried. dr. patrick o'gara: i'm torn between the argument needed to convince the president and congress to increase funding for medical research in the u.s. lack of our ability to do so will make us vulnerable to several things, one of them, the continued progression of disease, but also a loss of opportunity for entire generations of physician scientists who can make a difference. the other one, something along

the lines of, can you please help us create an environment of less externally imposed regulatory authority. -- authority? how have we gotten into this mess where we are so distrusted that all of our activities are regulated and often times any -- in a duplicative way? it is difficult to remain cheerful and upbeat if you spend so much time documenting instead of spending time with patients. we want to be trusted to the extent where we will not need to duplicate the amount of regulatory checkouts that substantiate the fact that you are actually doing a reasonable job. brian lamb: i call you the director of clinical cardiology and a professor of medicine at harvard? dr. patrick o'gara: my position at the hospital has recently changed, so right now, it is a senior physician at brigham and women's hospital.

brian lamb: thank you for joining us. dr. >> for free transcripts or to give us your comments about the program visit us on q&a.org. q&a programs are also available on c-span podcast. monday night on "the communicators" austin meyer zannier zanof and hank johnson talk about technology issues and patent legislation before congress. >> 97% of the people that are sued by