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Oby: From the campus of Harvard Medical School, this is ThinkResearch, a podcast devoted to the stories behind clinical research. I'm Oby.

Brendan: And I'm Brendan. And we're your hosts. ThinkResearch is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center.

Oby: And by NCATS, the National Center for Advancing Translational Sciences.

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Oby: Have you ever thought about being a researcher, the steps needed to stay engaged in research, and the drive necessary to be successful? On today's episode, join us as we talk to the Faculty Director of Education at Harvard Catalyst, Dr. Elliott Antman. Learn about what led him to research, what keeps him engaged, and his work in leading the Education Program at Harvard Catalyst. Dr. Antman is Professor of Medicine at Harvard Medical School, a Senior Investigator in the TIMI Study Group, and a Senior Physician in the Cardiovascular Division of the Brigham and Women's Hospital.

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Oby: Hi, Dr. Antman. Welcome to the show we're excited to talk to you today.

Elliot Antman: Thank you very much. It's a pleasure to be here.

Oby: We have so many questions we could ask you. And today, we want to focus on the history and kind of the path that led you to research in your work, leading the Education Program at Harvard Catalyst. So I'm going to jump in. We're curious to get to know you. When did your interest in medicine and research begin?

Elliot Antman: Yeah. It's a great question. Like many individuals, events occurred when I was younger that sparked my interest in medicine and research. And they were the unfortunate deaths of some individuals who I just felt very close to, an uncle or my grandfather. And they happened to have died of a cardiovascular-related event.

And I just simply wanted to know more about why this happened to them, and was there anything that could be done to prevent this or delay an event like that from occurring. When I was in high school and college, my science classes were of great interest to me. And I felt that they were putting me on a path to begin to get answers to some of the questions that I had had since I was a teenager.

An interesting event occurred when I was at Columbia College. There was a program that was available at the College of Physicians and Surgeons, which is Columbia University's Medical School. They had a program available for individuals who had decided they were very interested in medicine, and they could apply after three years of college. And I took advantage of that program. And fortunately, I was accepted to the medical school. So I actually never graduated from college, and I went to medical school after three years of college.

And in medical school, I found myself really simply enthralled with all the physiology, and in particular with pharmacology. And when I was a fourth year medical student, now we're fast forwarding a couple years from since I started medical school, I took a research elective in the laboratory of the chairman of the Department of Pharmacology at the medical school.

And that got me interested in research. Now, that happened to be large animal research. When I say "large," it was dogs. It wasn't petri dishes or anything like that. But it was experimental heart attacks in dogs, and I was studying drugs to stabilize the heart rhythm. So this was beginning to converge for me in a career path that I was very, very inspired to follow and was very excited about.

Oby: Thank you so much for all that background. So we've gotten to the point where you're interested in cardiology and you're doing a little bit of research. But what are some of the driving factors that kept you interested in research over the years?

Elliot Antman: Another really good question. I did my training in cardiology, my cardiovascular fellowship, at what was then called the "Peter Bent Brigham Hospital" from 1977 to 1980. And then I joined the faculty at the Brigham, now called the "Brigham and Women's Hospital." And I became the director of a coronary care unit, the cardiac intensive care unit. And as I took care of patients in the CCU, I just had so many questions as to how we could be improving the treatment for those patients.

It was around this time that my mentor, Dr. Eugene Braunwald, formed a clinical research group called the "TIMI Study Group." And that was a wonderful environment for me. I had questions that I saw in the CCU that I had when I was taking care of patients in the CCU. And I could walk out of the CCU and step into the research environment in the TIMI Study Group and begin to formulate plans for how we could get answers to those questions in clinical studies in the TIMI Group.

We had biostatisticians that we were working with, research coordinators, research nurses. And Dr. Braunwald was really ahead of his time in thinking of this multicenter approach to clinical research. And I got involved in it very, very early on, probably around 1984.

Oby: Can you tell us a little bit about the TIMI Study? I know you've mentioned it a few times, and some people may know. But could you give us some background on what the TIMI Study is?

Elliot Antman: Sure. The TIMI Study Group is what is referred to as an "Academic Research Organization," or "ARO." There aren't that many of them around the world. And they are dedicated teams of investigators involved in clinical research asking a variety of questions. The funding for this research could come from a variety of sources, the NIH or industry. And the TIMI Study Group has had funding from both of those major sources.

Oby: OK.

Elliot Antman: And we do clinical trials, clinical trials everywhere along the spectrum, from phase one through phase four. And I've been involved in every single one of those. The team coordinates the conduct of the clinical trials by having a database of institutions where there are like-minded individuals who can help enroll patients.

This was both nationally and now internationally, and we've done over 70 clinical trials over 40 years' worth of existence. And I have been involved in many of those. And for me, one of the most exciting aspects of this was that, as a consequence of the research we were doing in the TIMI Study Group, many new products were getting approved by the FDA. I was personally involved in four studies that led to FDA approval.

One of these was a biomarker assay for cardiac-specific troponins. This was done through the 510(k) pathway for medical devices. And then there were three drug studies that I did, pharmacology studies that I did. One expanded the indications for an anticoagulant, called a "Low Molecular Weight Heparin."

And then there were two new drugs that had not yet been approved for clinical use in the United States. And I was the principal investigator on those two clinical trials, which were international multicenter trials. And these were two new drugs that got approved for the management of patients with clotting disorders that were affecting their heart.

Oby: Wow. That is incredible. Can I ask you a little bit about your patients? And kind of generally, I have had the pleasure of going on service with you or seeing you on service and was just struck by how attentive you are to your patients and how thoughtful you are in their care and kind of the teams that you lead as you go in and out of rooms. How do you think about that while you do clinical trials and that being the care of an individual?

Elliot Antman: So this is something that I feel very passionate about. The patient-centeredness of what we do is so important. And we've heard this from many, many individuals. But I really feel it's important to live that mission, if you like, when you interact with patients. So I think of it from several different directions.

One is, if I was a patient or a patient's family, what would I want to know? And so the questions that I ask from a research perspective are, how can we answer questions that might be in the minds of patients or their family members right now? Conducting that research needs to be done in a humane and ethically-bounded fashion.

Oby: Right.

Elliot Antman: And so again, from a patient perspective, thinking about what's fair when asking a research question, what's fair to ask of the patient, applying the science, and really using every bit of understanding of all the physiology we studied and learned is fascinating to me and trying to convey to the patient not only the fact of what they should do but why it's important to do that.

And that, to me, is a very important aspect of the interaction with a patient, not just simply telling them what to do but explaining the rationale for your choice of your recommendation. And that helps a lot, because it really improves the likelihood that the patient will comply with the recommendation.

Jason: Hi, ThinkResearch listeners. We're taking a brief break from the podcast to let you know that Harvard Catalyst offers e-learning opportunities in many different topics, including grant writing, biostatistics, mixed methods research, and more. Right now, we are accepting applications for the TRANSforming Care with Emerging, Novel Devices, TRANSCEND, hybrid course that will take place in April and May of 2022. TRANSCEND explores the current climate for the development of Class II and Class III medical devices. To learn more about our offerings, please visit catalyst.harvard.edu/train. Thank you, and enjoy the rest of today's episode.

Oby: I could talk to you all day about your work as a cardiologist, as a physician, as a researcher. And we are going to transition here and talk about your leadership of the Post-Graduate Education Program at Harvard Catalyst, which I'm lucky to be a part of. And what led you to this role? What interested you in education in this space?

Elliot Antman: We've been talking about how I was inspired all the way along in my educational development and career development path to pursue my passion and to ask the questions and to learn more about how to do research. When I was growing up, if you like, through that process, through that pathway, there were many things that I had to just simply seek out in order to learn more about them.

There was no well-defined instructional pathway or supportive educational resource environment. And I realized that, if I had not had the passion to seek those things out on my own, I might not have actually learned what I learned, might have dropped off in terms of my interest level. So I feel a inspiration to actually train the next generation of our biomedical workforce so that they don't have to seek things out as much, but it's there available as a training pathway for them.

I also feel that we have an obligation to learn how we can do things better in training that next generation of the biomedical research workforce. And, OBY, you and I have had many conversations about, how can we improve the way we deliver our educational resources? And this is a work in progress. We're finding different ways to deliver the information. And I'm sure that different types of learners will find delivery methods that suit their needs that are different from some of their colleagues who may learn by a different method.

And you've been very, very attuned to that and very helpful in identifying things that we should be experimenting with. And "experimenting" is an interesting word there. Because very often, people just assume they have the answer to the best way to deliver educational material. And I hope that we can think more about what we call "A/B testing." We're going to compare method A versus method B and decide whether A is better than B or B is better than A and then for whom. And that's an important aspect of our continued work in our educational program.

Oby: That's a great point, especially about education generally. Right? We all are different types of learners. And I loved how you ended that with, which version is best for whom? Right? Because A may be great for one population and B maybe fantastic for a different population.

Elliot Antman: Absolutely. Yes.

Oby: So we need all of them. We need both. Wow. There's so many questions I could ask you. I have your time. What are some of your favorite parts of working with the Education Program?

Elliot Antman: It's an absolute joy to be working with the Education Program for several reasons. We have a number of extremely passionate individuals who are very dedicated to just what we've been talking about, trying to provide a rich learning environment and educational environment to help do that training for the next generation of the biomedical research workforce. And I love working with every single one of those individuals. Each one brings a different aspect to it, all of which are very, very valuable.

Oby: Right.

Elliot Antman: I actually feel that developing new programs or new approaches to biostatistics teaching or omics, for example, are very important to me. Our mentoring programs. Our writing and communications center. Developing all these new programs, many of which have been suggestions that bubbled up from the individuals who work in our Post-Graduate Education Program. That, to me, is a particularly exciting aspect of the job. It's different every time we talk, and that's what's so exciting about it.

Oby: Perfect. For all the aspiring researchers listening to the podcast today, what advice would you give them about getting involved in research and having a fulfilling career?

Elliot Antman: I'm glad you asked that. Because many individuals who are trained in clinical medicine, which is how people often get started in medicine, need to realize that doing clinical research requires a commitment, a commitment of time. You have to put aside the time to learn the basics. And if I were to say there are three important aspects that are-- I'd list as the basics.

One is research design. Many times, research projects are undertaken without a clear understanding of the advantages and disadvantages of particular research designs. And the second would be a grounding in statistical approaches to analysis of research findings. That doesn't have to be very, very complicated and sophisticated statistical analyses. But understanding the basics of a specific statistical approach are very, very important.

The third and perhaps one of the most important here is to understand that whatever we're doing has to be grounded in an ethical fashion. We need to understand the ethics of human investigation. That's so important. If one commits the time and sticks with it and stays grounded and learns those basics and starts small, pick a small project and grow with it, you will be rewarded over time.

There's a phrase that's often used, "delayed gratification." And that's very apt here, because you really do need to commit the time and become more and more experienced over time. For me, I ran the coronary care unit for 29 years. And that was a wonderful opportunity to keep asking those questions. And for clinical research, I've been doing it now for over 40 years. If you commit the time and learn the basics and progress through this process, you will be greatly rewarded by a very rich and inspiring opportunity.

Oby: Thank you so much, Elliott. It's been a pleasure to have this conversation with you, and we hope to have you back soon again.

Elliot Antman: All right. Thank you very much. I hope it's been helpful to people who are listening.

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Brendan: Thank you for listening. If you've enjoyed this podcast, please rate us on iTunes and help us spread the word about the amazing research taking place across the Harvard community.

Oby: To learn more about the guests on this episode, visit our website. Catalyst.harvard.edu/ThinkResearch.

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