John Abele, FSIR, the co-founder of Boston Scientific Corporation, is one of the only nonmember Fellows of SIR. He has received the SIR Gold Medal, the Frederick S. Keller, MD, Philanthropy Award and the SIR Foundation Leaders in Innovation award. IR Quarterly spoke with Mr. Abele about his long partnership with IR, the changing culture of medicine and the importance of conscious philanthropy.
What inspired you to begin working with IR?
I was drawn to using tools that might enable diagnosis and therapy with less cost, trauma and time. When I was a kid, I spent many years in and out of hospitals and the thing that drove me crazy was time. The waiting. It’s cruel and unusual punishment. I was intrigued with how to simplify things and do them more locally. That’s the beauty of an interventional approach. It’s a bit like Danish design or Shaker furniture—it’s made with the least material possible, but it’s beautiful. That’s the principle of interventional medicine: accomplish the job with the least effort and trauma necessary.
I think the fascinating thing about IR is that you can really cover a wide range of things. Learning to see differently is something that radiology has been doing forever. Imaging is a way of looking at the etymology of the problem—you can see the big picture and how one problem interacts with the whole person.
You have worked not just with IR, but a range of specialties. How do you handle those potentially competing interests?
I’m interested in culture change. We live in a world where culture change is crucial—you either adjust, or you won’t be around. In the area of medicine, part of that change requires crossing borders, such as bringing together multiple specialties to look at a disease process collaboratively. In my view, one specialty shouldn’t own a disease process. There are skill sets needed to be effective at new technologies, and if you’re looking at an interventional procedure, then you need the skills of the surgeon, the knowledge of a technician and the emotional and social skills of a family physician.
In the early days, I saw IRs be shunted aside. We had some specialists tell us that if we helped IR do certain procedures, they’d never work with us again. That was just embarrassing for them. But every field has its politics. To me, the focus shouldn’t be the politics, but the willingness to collaborate.
But collaboration is a complex word, and it’s hard to understand how you can collaborate in an adversarial manner. Companies do it all the time, but great medicine is being able to balance your needs and those of your opponents and work together to meet the needs of the patient’s family.
What was it like to be involved in the early days of the specialty?
I was a member back when it was the Society of Cardiovascular and Interventional Radiology (SCVIR) and, back then, it was very clubby. It was a classic collection of people who liked what they were doing and got together to share knowledge and understanding. Patient interaction was secondary and almost unusual. I actually wrote a letter in the early ’80s because I was so frustrated, saying that, in my view, Charles Dotter would be sad. The field wasn’t doing what he had said it should. He may have been eccentric, but he had vision.
And like any society, there were islands of viewpoints and arguments. The Ernie Rings and Stan Copes of the world started realizing that as they were doing diagnostic work on a patient, they could just solve the problem while they were there. There were also discussions about whether to grow. I was very much in favor of that, naturally, because we wanted customers. And there were questions about name and ownership, whether to call the field interventional radiology—which I didn’t want.
I like to view myself as a philosopher who can come in and ask why, and push discussions of the principles and values
— John Abele, FSIR
Why not?
I didn’t want interventional medicine to lock itself into radiology. I thought it was bigger than that. Interventional? Yes. Radiology? No. There were a number of physicians in many fields interested in doing things less invasively. From my position, I just look at how we can take care of patients better at a fraction of a cost. I’m not concerned with ownership.
Would you say that you and your products have been a bridge between specialties and areas of knowledge?
I used to be very involved in attempts to get collaboration between IRs and vascular surgeons, and the irony is that I’m a Gold Medal award winner with both groups. It’s an interesting line to straddle but, at the end of the day, I’m just the tool guy! My company is just the one with the tools that allow physicians to do better. We all have the same care and priority for the patient, and I like to view myself as a philosopher who can come in and ask why, and push discussions of the principles and values. We make sure the specialties talk about some of the tough decisions that happen every day.
You’ve mentioned wanting to change the culture of medicine. What does that look like to you?
It’s about making the patient a partner in care. There have been high-profile patients lately who have been working on this, like one man who had a brain tumor operated on and made his surgery public. The physician has the knowledge and the tools, but no one knows your body like you do. To me, the idea of making care more visible is crucial—and while many medical institutions are trying to do that, there’s still resistance.
But the beauty about great imaging combined with good therapy is that you can show people. With ultrasound, for example, technology is becoming handheld. I’m a proponent of having these technologies available to emergency rooms and family physicians, and radiologists should be teaching the technologies to them. Ultimately, I think high school students should be using handheld imaging to look at their frog before they dissect it. That’s learning. That’s looking through different windows and understanding medicine and health in a new way. It’s seeing differently. If you image the frog, you can see the networks and relationships within the body—relationships that aren’t owned by radiologists. Everyone at every level should understand those relationships.
You’ve been recognized for your contributions and philanthropic support of SIR and SIR Foundation. What has driven you to support the society and its foundation in this way?
There is a series of principles that most of us agree to, which is that everyone should have the opportunity to learn. Therefore, I like to see investments in better learning techniques. But I come from a world where it’s not just a matter of supporting something, it’s about being a partner and helping your partner improve. It’s constant evolution. You offer support in a way that they not only learn how to do the research but learn to do it better.
I tend to lean toward supporting underdogs—but at some point, the underdog becomes the overdog and I have to go find someone else. But the goal is to make the process better. Make sure the tough questions are asked earlier. Make sure the knowledge is spread appropriately and the attitude is inclusionary rather than exclusionary.
Where do you think medicine needs to go next?
First, patients need to be better informed. We have a mini crisis here. Physicians who are dedicated to informing are very dedicated, but the medical profession by and large isn’t. It’s something we must change as a society and, like our climate, the change will be slow. It’s something we must adjust and commit to over time.
We must deal with the crisis in mental health. I think that interventional radiology will have a role in mental health—what that looks like remains to be seen, as well as what IR will do in the brain. But there is no question to me that neuroscience will go forward very quickly, and I think that will have a great impact on society. There’s also the question of whether we can treat Alzheimer’s with catheters. We’ll see.
I also believe that being able to encourage more cross disciplinary conversation, including philosophy and ethics, in every specialty is going to be essential. Right now, that takes place to a certain extent in medical school, but then it stops. We must talk to each other.
And finally, we have a huge problem in how we finance healthcare. The incentives aren’t right. Yes, we’ve made some good changes, but we can do better, and I’d love to see how interventional radiology could research and play a role in solving this need.
