50 Years of Caring for Kids: A Nationwide Children’s Story – PediaCast 605
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Description
Dr Bruce Meyer and Dr Roger Friedman visit the studio as we celebrate 50 years of caring for kids at Nationwide Children’s Hospital. These seasoned physicians have witnessed the transformation of our institution from a small community hospital into a nationally recognized leader in pediatric care, research, and education. Tune in for a behind-the-scenes look at how Nationwide Children’s became what it is today!
Topic
50 Years of Caring for Kids: A Nationwide Children’s Story
Guests
Dr Bruce Meyer
Professor Emeritus of Pediatrics
The Ohio State University College of Medicine
Nationwide Children’s Hospital
Dr Roger Friedman
Pediatric Allergy
Ohio ENT and Allergy
Links
Nationwide Children’s Hospital – Who We Are
History and Milestones – Nationwide Children’s Hospital
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast is brought to you by Nationwide Children's Hospital.
[MUSIC]
[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of PediaCast. We are a pediatric podcast for moms and dads.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 605.
We're calling this one 50 Years of Caring for Kids, a Nationwide Children's Story. I want to welcome all of you to the program. We are so happy to have you with us.
For more than 50 years, Nationwide Children's Hospital has been caring for kids and supporting families across central Ohio and beyond. When I say more than 50 years, I mean a lot more. We began caring for kids back in 1892, so that's 134 years ago.
But really, in the last 50 years, there has just been tremendous change, both with our hospital, like the physical hospital, but also the way in which kids are cared for with regard to pediatric medicine. So, what exactly did that look like, the care of kids 50 years ago? How has that care changed, and what has stayed the same?
Well, today we are taking a walkthrough time with two seasoned physicians who have seen it all over the past 50 years. Dr. Bruce Meyer is Professor Emeritus of Pediatrics at The Ohio State University College of Medicine and an Associate Medical Administrator at Nationwide Children's Hospital. Dr. Roger Friedman is a Professor of Allergy, Immunology, and Pediatrics at Ohio State and Chairman of the Medical Alumni Association at Nationwide Children's and a Pediatric Allergist at Ohio ENT and Allergy. Together, they have spent decades caring for children, building programs, and shaping our hospital into what it is today. We're going to talk about the changes they have witnessed and explore how medicine and Nationwide Children's itself has evolved over the past half century and what that means for families today. Before we welcome our guests, I do want to remind you the information presented in every episode of our podcast is for general educational purposes only.
We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, please call your health care provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.
So, let's take a quick break. We'll get Dr. Bruce Meyer and Dr. Roger Friedman settled into the studio, and then we will be back to talk about 50 years of change at Nationwide Children's Hospital. It's coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Dr. Bruce Meyer is a professor emeritus of pediatrics at the Ohio State University College of Medicine. He also served as associate medical administrator during a period of tremendous growth at Nationwide Children's Hospital. He helped shaped our hospital's transformation from a community-based children's hospital into a nationally recognized leader in pediatric care, research, and education.
And with decades of leadership and institutional insight, he offers a behind-the-scenes look at how Nationwide Children's became what it is today. Dr. Roger Friedman is also in the studio. He is a professor of allergy, immunology, and pediatrics at the Ohio State University College of Medicine and a pediatric allergist at Ohio ENT and Allergy.
He also serves as chairman of the Medical Alumni Association at Nationwide Children's. He has spent decades caring for kids with complex medical conditions while witnessing firsthand the dramatic evolution of pediatric care. From the early days of treating serious infections to the modern era of new vaccines, targeted therapies, and a focus on prevention, both of our guests bring a unique, long-view perspective on how far we've come and where we are headed.
Before we dive into our discussion, let's offer a warm PediaCast welcome to our guests, Dr. Bruce Meyer and Dr. Roger Friedman. Thank you for stopping by the studio today.
[Dr Bruce Meyer]
Thank you. So glad you have us.
[Dr Roger Friedman]
We're excited to be here.
[Dr Mike Patrick]
Yeah, I'm excited to have this conversation as well. Bruce, why don't we start off with just sort of take us back before 1976. What was Nationwide Children's like in those early years?
[Dr Bruce Meyer]
Well, I appreciate your inquiry about history because it is one of my primary interests. Even though I was pre-med, I was a history major. So, I guess, real quickly, just a couple of starting points.
The concept of the Children's Hospital was 1892. And then on Franklin Park, there was a home there that served as the first hospital with nine beds and mostly chronically ill. If we go forward, I think, can't go through all the history, but I think some real outstanding points are in the 1950s.
And for some reason, this history is buried. There was a voting, what do you call it? Ballot?
There was a ballot, but there was an issue on the ballot of raising money for all the hospitals in the city. Children's wasn't included in that. And what happened is the other hospitals came, the Children's, and said, we need you because you're the ones who everybody likes.
And Children's said, we'll do it on one condition that you chose, close all your pediatric units, and we centralize them at Children's. To me, that's very significant because we're one of the few large cities that has that as an advantage. So, from there on, when Children's became the primary place, we were still a very small community.
We are also a very small local children's hospital with very few faculty and totally run by the general pediatricians with very few specialties after that. So, I think one of the outstanding things that came from that is it developed a certain community, close, warm culture that has continued to this day.
[Dr Mike Patrick]
Yeah, yeah. There's lore about a bake sale. What was the bake sale?
There's history stuff about the hospital when things started. It started with a bake sale. Do you know what I'm talking about?
Yes.
[Dr Bruce Meyer]
Obviously, there were a few families of prominence that added money to get the original hospital. And so, what they did is they did community raising events. There were so few people that I don't know how many people ever showed up for those.
And I don't have any statistics to say how much was raised.
[Dr Mike Patrick]
Yeah, yeah. But, you know, people show up for bake sales. Even back then, folks loved their baked goods.
So then if we fast forward to 1976, so that's around the time you became involved at Nationwide Children's. What was the place like back in those early years?
[Dr Bruce Meyer]
Again, it was still a small hospital, but I think it was in 1923, I don't have it down here, that they moved to the site we're presently on into one building. It obviously became a much more progressive hospital, but it was still a small community hospital with referrals for a lot of specialty care all over the country. In 1978, Grant Morrow came as the chairman of the Department of Pediatrics, originally at CHOP, and then in Arizona, board certified in, I think, three or four specialties, and really developed a tremendous relationship with the community pediatricians who were basically still running the hospital.
We think at that time there were about 10 full-time faculty. In 1977, there were 19 residents. We now have 270 residents.
And also, during those early years, there were two ED doctors, and the emergency room was run by the residents, totally. Now we have a full ED staff and our acute care staff. And then also the last thing in about the 70s that I remember, Grant, in particular, pushed for us to get more people here so that we didn't have to refer people and not be just a small local hospital, but be able to take care of all kinds of illnesses.
[Dr Mike Patrick]
Yeah. As we think about not only the hospital, but just pediatric medicine in general, Roger, I want to bring you in. What did practicing pediatric medicine look like in the 1970s when you got started?
[Dr Roger Friedman]
That's a great question, Mike. And that is my era of when I started. I started my residency here at Nationwide Children's, Columbus Children's at the time, in 1977.
So, at that time, as Bruce stated, we had 18, 19 residents. And actually, the next year, 78, was when we hit our low point of the residency. We only matched eight residents because people didn't want to come here.
And they didn't want to come here because we didn't have a chairman yet. Dr. Morrow hadn't yet been made chairman. There was a lot of, in those days, and you lived through them too, residents worked literally 100 hours a week.
As Bruce said, we ran the hospital because there wasn’t enough primary care. I mean, there weren't enough specialty cares. There weren't enough, we had a total of eventually of 30 attendings.
And we worked literally every third night, every other night. And it was very, very tough at the time for us. Now, we didn't know any better.
And that was true in many institutions. So, we weren't necessarily worse. It was just a tough time to be a resident.
We did learn an incredible amount. And to add to some of that, I'm going to use the word excitement, a brand-new disease popped up in 1978, 1979, called Rye syndrome. And Rye syndrome, a heretofore unknown disease, in which, again, young children, previously well, developed a mild infection, often a flu or viral infection.
And they suddenly ended up having severe intracranial pressure and severe brain issues. And the case fatality rate, when it first came out, was upwards of 90%. And it was actually at Columbus Children's where we came up with the first successful protocol that dramatically changed that.
And we did it with some of the great docs of the time with us, the head of infectious disease and GI, cardiology, neurosurgeries, Drs. Kosnick and Hilty and Crane and McClung. And they came up with a protocol. The problem with the protocol was it involved the residents being one-on-one with the patient.
So, we'd be in the ICU, and as soon as their pressure started to go up, we'd infuse mannitol to lower it, and we'd hyperventilate them. But it basically, we spent much of our electives those first couple of years helping to save children's lives. And then a bit later, we had the second international symposium on Rye syndrome was here in Columbus.
And it's there that people discovered that this syndrome was partially related to aspirin. And it's why all of our folks out there don't use aspirin much in children, because it was the association of this virus and aspirin that led to this dysregulation of the liver that led to high levels of ammonia in the child. And it taught us a lot.
As residents, we learned how to take care of critically ill kids at that time. And also in the 70s, so much of the hospital was filled with children with meningitis. We had lots and lots of bacterial meningitis of H.
influenza and pneumococcus and Neisseria meningitis. And so, we spent an awful lot of time with that. And then the number one disease for admissions, and this became my particular passion, was asthma.
We had; the wards were literally filled with kids with wheezing and asthma. We didn't have anywhere near the medicines we do now. And so that was a big deal.
And then one of the exciting things I'll say is, in 1978 is when children's did the separation of co-joined twins. That's always a bellwether mark for nationwide children, especially our surgeons. And I was a resident at the time, and they spent countless hours practicing how to go about separating the twins.
It was done skillfully, very successfully, and that helped kind of put us on the map a little bit.
[Dr Mike Patrick]
Yeah, absolutely. As we think about this history, I want to run back real quick to the meningitis story. A lot of those cases were caused by a bacteria called Haemophilus influenza type B, which is not influenza like the flu, which is a virus.
This is a bacteria called H. flu. And there's now a very successful vaccine against this particular organism.
Another organism that caused all those cases of meningitis back then was strep pneumonia. And we also have vaccines against strep pneumonia these days. And so, can you just give us some insight of what that was like when there were all of these kids, like if they had a fever, were you worried about meningitis right out of the gate?
Those two vaccines alone have really improved lives for kids. There are many children who would not be with us today if it weren't for those two vaccines.
[Dr Roger Friedman]
No, that's so accurate. And as you know, there's a lot of vaccine skepticism going on right now. And if some of these people could have lived during those eras and seen what we did, they'd just appreciate how much this changed the lives of children, of parents, of pediatricians, too.
I mean, Bruce would see 50, 60 people in a day, and a lot of them had fevers, and you had to figure out, okay, which one of those could be meningitis. And you didn't want to ever miss that. That was kind of the mark of a good pediatrician.
But so many of these kids who had meningitis ended up having damage. They didn't all end up normal. It was very sad.
The only good news from the residents, and Mike, you were part of that later on, too, we got very proficient at putting in intravenous lines, drawing blood, and doing spinal taps, which fortunately now the residents don't have to do anywhere near what we had to do.
[Dr Bruce Meyer]
Yeah, absolutely. Mike, I'd add to that that those people, as Roger said, who don't do that, we spent, at least in my era, which was a few years before Roger and you, when we were on the unit, it was a meningitis unit. It wasn't just infectious disease.
And we spent all day doing LPs and starting IVs. And then you do a repeat LP, because in those days, if you wanted to know the medication was effective, you would have to do a repeat LP. So, it was a tremendous experience.
It was a good feeling because so many of those kids did well. But even because of some of the drugs, there was deafness and other complications. So, it was a real era.
In fact, I just hope anybody realizes what that difference is.
[Dr Mike Patrick]
And I think that's why there are so many of us in pediatrics that are passionate about vaccines, and especially when you've seen the difference that they make in kids' lives and families' lives. It's really tremendous. There's another disease process that's caused by H flu called epiglottitis, and that's when you get swelling in the throat that can compromise the airway.
I have never seen, in 30 years of practicing pediatrics, I've never seen a case epiglottitis, and that is because of the vaccine for Hib and strep pneumonia to some degree, because after the Hib vaccine came out, there were still some sporadic cases of epiglottitis, and it was usually strep pneumonia that did it. And so again, between these two vaccines that are so important, and I always try to impress upon families when I have vaccine-hesitant parents, these are two vaccines your kid really needs, and here's why. Because we don't want to see those again.
I would imagine you have seen epiglottitis.
[Dr Roger Friedman]
Many times. Many times, especially during the late—during residency and then early years in practice, because the Hib came out, I think it's 1992, so right before, I think, your residency. But we saw it for those 10, 15 years and Bruce 10 years before, and it was a scary disease.
It was, you see this cherry red epiglottis, and you'd make sure you call someone really smart and really good who could intubate the patient if they needed to be intubated and work on saving their lives really quickly.
[Dr Mike Patrick]
Yeah, yeah. When I started my residency in 1994, it was drilled into us, this is what a kid with epiglottitis looks like. If you walk in the room and they're, you know, kind of holding themselves upright and maintaining their airway, leave them alone.
Like, don't get them worked up, just leave them alone and go get help. Now, I don't even think we talk about epiglottitis other than you need to know about it for your pediatric boards, and that's almost it. And again, because of these vaccines.
[Dr Bruce Meyer]
So early on, when I was first starting practice, everybody still sees croup, but it's handled so differently. So, you would get a call in the middle of the night, and you'd listen to the kid, and you said he had croup. The problem at that time is you didn't know if it was croup or epiglottitis since we were seeing epiglottitis.
So, you'd send them to the emergency room at any hour of the day so they could be looked at, and their epiglottis could be looked at because obviously the treatment for croup and epiglottitis are totally different. So, it's nice to know that the vaccines are there, the people practicing, they don't have to worry about that. We definitely worried about that.
[Dr Mike Patrick]
Yeah, absolutely. As we look back from 1976 and then sort of move forward to today, Bruce, what stands out as the most significant transformations at Nationwide Children's?
[Dr Bruce Meyer]
Well, mainly it has to do with the number one thing is all the growth. And the growth I mean by physical growth, I mean by research has been huge. Grant started pushing for the research.
The first research building built with the Wexner money was in 1987, I believe it was. And then that was RB1. And then since then, we have all the way to RB4.
Actually, RB1 was just closed in recent time. It's being used for something else. Part of that research, I think most glaringly now has been the gene research, which to me in my lifetime, I went over one day, Jerry Mundell, who found the gene and is working with the SMA kids.
And he said, Bruce, do you want to see what these kids are doing? This is about two years into it. And I walked over there and he showed me this three or four-year-old who had SMA and had the gene therapy.
And she's one of the first ones. And she did a little ballet for me. I mean, I cried because I had had in practice an SMA patient.
I think besides research is obviously the tremendous advantage in medical care, but in particular, the number of specialists we have so that we don't have to refer anybody almost anywhere except for the very rarest. And then most importantly, generally, I think the thing that's occurred is we maintain that warm, intimate, collaborative culture that has been developed and maintained over years by all the CEOs and by all the CMOs, CEOs. And right now, Tim Robinson and Rick Miller, the CEO and the CEO, you and I can walk into their office, talk to them and give them an idea.
That culture, I think, exists here. And every time I talk to a new faculty from someplace else, they agree that that's one of the things that changes here, that makes us what we are.
[Dr Mike Patrick]
Yeah, so important because that sort of culture then is seen by families. So, like if you're a practicing pediatrician or a specialist and you're seeing these kids, when you feel supported and you feel like you're working in a culture that's warm, you know, you pass that along. And that really does make a difference for families.
So, I think it's so, so very important.
[Dr Roger Friedman]
I want to add one thing and just that what's so unique here and both Bruce and I have been away at times with some of our training is the incredible relationship between the town and the gown. The relationship between the practicing pediatricians and the specialists here at Sheldridge. Even as we've gotten huge here, we still got a really good relationship.
We had an organization of CPP, we had Central Health Pediatric Society, where they get together, socialize, know each other. And so, you can pick up a phone and say, hey, you're the cardiac surgeon, you're going to take care of my kid here. I can tell my parents that, you know, I trust you.
I know who you are. I know what's up. And Dr. Meyer here deserves a lot of that credit too because he's spent the last decades and decades of fostering that relationship. And if a pediatrician in the community or an allergist in the community has a problem, they know they can call Bruce and he can help solve problems for them. And that's really been amazingly helpful.
[Dr Bruce Meyer]
Yeah. Thank you for mentioning because that was on my notes is I think that's part of the culture here. All the pediatricians as well as family practitioners and the community himself feel that this is their place.
[Dr Mike Patrick]
And there is a strong presence of community pediatricians still in the C-suite that are involved at the very top levels. Bruce, obviously, you're there. Folks like Bill Long, now Trish Lucene is there.
And these are practicing pediatricians in the community that have a say at the highest levels of administration. And that makes a difference for kids.
[Dr Bruce Meyer]
And to give them credit, we also have Michelle Gola and Renee Jospel, who's part of the primary care network of children's, which, again, the relationship, I think, which is remarkable between the primary care physicians that are employed by children's and, quotation marks, private practitioners. It all runs together. There is no competition, which I know does not exist in some other institutions.
[Dr Mike Patrick]
Yeah, absolutely. Roger, we talked about meningitis and Reye syndrome. You briefly mentioned asthma, but I want to focus in on that here real quick, because that is a disease that impacts lots and lots of kids and families.
And even I can remember when we still used theophylline, like there was this very toxic drug that would help kids with asthma. But when you gave it, you had to follow blood levels because you had that narrow window. And it was challenging to treat kids with asthma before inhaled bronchodilators, right?
[Dr Roger Friedman]
Yeah, no, that's correct, asthma, obviously, as an allergist and asthma specialist, that's been my main passion in life, and that is finding better treatments. And I got excited about asthma as a teenager because my girlfriend at the time had asthma, and she had really bad drugs, and she wasn't able to go out and play as much, wanted to go outside and stuff. And as the new medicines came out, we turned her into a super athlete, and that was one of my passions, that kids with asthma, it used to be considered kind of like soft, you had asthma.
You didn't want to say the disease because it had so bad social connotations. But it was a disease of bronchoconstriction and a disease of airway inflammation, and that was what really changed. And I was part of a group back in the late 80s, 89, and then the first asthma education program, National NAAP Guidelines, came out in 92.
Asthma was the second disease that had guidelines. And at first, doctors really didn't like guidelines because, well, you're telling us what to do, and if we don't do the guidelines, then maybe we're going to get sued or bad things. But in fact, they codified how to treat things better, and they gave better information, especially to primary care docs about, oh, here's some new stuff.
And you're so right. I mean, theophylline was a dual-edged sword. It bronchodilated you, but boy, very narrow therapeutic index and side effects go lower and stuff.
And then the big drugs that came out, of course, is the inhaled steroids. That was in the 90s, and medicines, again, people won't know, but you will, like cromolyn sodium that came out, and other drugs that were mass cell stabilizers. And we could finally keep kids at home, and we could decrease the incidence and prevalence of disease, keep them out of the hospital, let them play sports.
I mean, even now today, I'll have some parents, when I'll say they have asthma, they'll say, oh, does that mean he'll be able to play soccer? And I said, well, if he's good, yeah. I can't make him a good soccer player, but I can make his airways good and stuff.
And so, that's been just a tremendous change in the last 40. And like I said, it was always the number one disease in America, in hospitalizations for children. One of the things that, this is a little anecdote, but in 2000, in 2020, I, for the first time, was able to cure asthma, okay, and things like, what do you mean you cured asthma?
I said, I cured asthma because we had a COVID pandemic. And during the COVID pandemic, no one went to school, no one got sick, there was no air pollution, no one played sports. And so, literally, admissions to hospitals and things went away.
Now, that wasn't sustainable, obviously, but we now have so many new options and new therapies and we call it smart therapy and stuff we can do now to keep kids out of the hospital, keep them on the ball field, and keep them well. So, it's been one of our great successes. Yeah, absolutely.
[Dr Mike Patrick]
Bruce, as we move from the 1970s to the 1980s, we have talked about Dr. Grant Morrow and the increased emphasis on research and really building up more subspecialties at the hospital. Any more interesting tidbits around the 1980s?
[Dr Bruce Meyer]
Yeah, a couple other things in the 80s. Number one, and going along with what we talked about, the closest in relationships to the community, a group was organized by name CPP, Community Practicing Pediatricians, which almost all the community practitioners joined, paid a small fee for, but it was very collaborative and they weren't allowed to discuss prices or competition. But what they did do is talk about how we can continue to educate all the pediatricians, how they can help themselves with practice ideas that they could share.
And it just again showed the collaborative work of all the pediatricians. So, for example, when I was in practice, it was collaborative. In my building was two more practices of pediatrics.
We didn't feel that kind of competition. And CPP was helped to organize by children. So, the meetings were children's and they allowed us to share a hospital administrator, which continues to this day.
And that was in 1985. I could go on and on. It's an extremely successful association that has really been beneficial to community pediatricians.
Yeah. I already mentioned one thing in 87 was the first research building one, RB1, pushed by grant and subsidized mainly by the Wexner’s. And interestingly, in 84, I believe, Ronald McDonald House was started.
So, we had a Ronald McDonald House. It's been in different buildings. It's presently in a building across Livingston.
And interestingly, most people don't know this, it supposedly is the largest in the world. So, those are amazing things that happened there.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. It would be easy for a place as large and comprehensive as Nationwide Children's, who's, you know, the only pediatric provider in terms of an institution that hospitalizes kids in Central Ohio, it would be easy for a big place like that to sort of do what they want to do and make their own decisions without the input of community pediatricians.
But the hospital continues to have physician liaisons that go out to the offices and say, hey, what works? What doesn't work? What do you need from us?
And, you know, that started in the 80s with the organizations that you're talking about. But it continues even today. They still, you know, the hospital still has that connection with the community pediatricians.
And as you say, that's just so important for families in Central Ohio.
[Dr Bruce Meyer]
And I would emphasize along the same lines, basically, there are liaisons from the lab that go out and talk to all the practices, tell them what they can and cannot do. And for home care, there's liaisons that go to the offices. Again, that collaborative effort is, I think, unique.
[Dr Mike Patrick]
Yeah. And that's how PediaCast actually got started. I was practicing in a community practice at the time and really felt like I didn't have enough minutes per visit to educate families like I wanted to.
And so, I was really looking for a way to say, hey, here's the three-minute answer in the exam room, but if you want the 20-minute answer that has like, you know, all the science behind it, check out this podcast. But back then, it was kind of expensive putting a podcast together in the early days of podcasting. And one of the Nationwide Children's liaisons came out to our practice and I just said, hey, is this something that you would want to sponsor?
And so even, you know, even this podcast is because of that collaboration between the hospital and the community practices, which again is so important. As we're thinking about the 1980s, Roger, HIV or AIDS was really coming about. It was impacting children because kids born to an HIV-positive mom, you know, is now you've got a little baby with AIDS.
How did HIV kind of change pediatric care back in the 80s?
[Dr Roger Friedman]
Yeah, that's a great question about HIV. And unfortunately, or fortunately, I was Columbus's first HIV expert. When I finished my fellowship in 82, I had been exposed to HIV education and knowledge and patience.
And so, when I came to Columbus, and I always remember the first grand rounds I gave about immunology, I talked about HIV. And at the end of it, there were no questions. And I went up to Dr. Morrow, and I said, you know, usually I'm enthusiastic and someone asks questions. Did I do a bad job? Did I not explain things well? He says, no, no one know what to ask because it was so new and different.
And people didn't know anything about the immune system back then comparatively. And so, in fact, Dr. Morrow asked me would I be willing to be in charge of the HIV program at Children's. And I said, no, I really wanted to stay in practice and to be honest, take care of patients who were going to continue to live because at that time no one survived.
And I said, you know, my good friend, Mike Brady, who was infectious disease was coming back here. And Mike, I promised to educate him up and then he did way beyond that. And Mike ran our HIV program and AIDS clinic and with Katie Karani and they just did a phenomenal job.
But what was different and again, how did things change? One real important thing, and Bruce will remember some of this from his time, we never wore gloves. I mean, during residency, during medical, you wore gloves as you went to surgery.
You wore gloves as you were going to put a catheter in a deep area. But in general, drawing blood, doing things, we never wore gloves. And part of understanding before we understood that AIDS was due to the HIV virus was, we invoke universal precautions.
And we started to do that to prevent that. And the other thing that happened is we were still very scared and not knowing, and a little bit like COVID, about how contagious it was and how you would get it. And there was a lot of shaming.
Shaming, you know, if someone had AIDS, maybe they did something bad to get it and not thinking about it as an infectious disease. And there were a couple of key figures in the country. Magic Johnson was kind of the first, you know, famous person to get it and survive.
And you may remember, Mike, I'm sure you did, Bruce, a little boy named Ryan White. He was a little boy who had gotten AIDS from a blood transfusion, and he was shunned in his class, and no one would touch him, and no one would talk. And the parents wanted him out of the things, and finally some compassionate people and more knowledge learned that, no, he wasn't a danger to anyone.
He wasn't, you know, if he wasn't bleeding, if it wasn't, he was okay. And we worked through that a lot through; I gave lectures for the Red Cross about being careful about what we were doing with our blood and to hematology about kids with hemophilia. And again, we very much, again, like COVID, a new entity.
And so, we have lots of discovery in there. And then the big change was the discovery of AZT, which was the first treatment for HIV-AIDS that was successful and really started to convert it from a disease of death to a disease of long-term. And again, I give a shout out to an old friend of mine who helped educate me a bit named Tony Fauci.
And Dr. Fauci was the leader of our AIDS pandemic response and also convincing and insisting that the pharmaceutical industry, they found one drug they needed more because they were going to develop resistance. And he was so right in it. And it really saved millions of lives here and in the rest of the world.
[Dr Mike Patrick]
Yeah. And then this is the Dr. Fauci that went on to lead our COVID-19 pandemic efforts, correct?
[Dr Roger Friedman]
The same Tony, yes.
[Dr Mike Patrick]
Yes. Let's move on to the 1990s. And now we're getting into, I went to medical school from 90 to 94, did my residency, a fellowship year.
This was all in the 90s. So, this I am very familiar with. But Bruce, tell us a little bit in a nutshell, what was going on at Nationwide Children's during the 1990s?
[Dr Bruce Meyer]
Well, there was a rapid acceleration of change in the 90s. Maybe it's because more recent than the 70s and 80s. But some of the outstanding things are, is that Graham Morrow stepped down.
We had an interim of Tony Eaton, who was the chairman. And just to mention Tony, because she's the first female AAP chief. And she also really started the advocacy programs at Children's.
So following Tony was Tom Hanson, who I think a lot of us would agree was really instrumental in having insight and foresight into what was going on. So, at the same time, interesting, Tim Amundson, who is our present CEO, was this lowly person in finance, but became CFO. And between he and Tom, they made some advances here that we weren't regularly doing.
So, they went out and started recruiting the top-notch people. And just to mention a couple, they had Mark Galanowicz came as an open-heart surgery. He was front-page news in the dispatch, the local paper, because of what we went out and got.
So that was one, I mean, he just started everything anew. Also in 91, we became a level one trauma unit. The interesting one of the other aspects of it, which is sort of negative-positive, Riverside opened up what they said for local pediatricians, they could put kids in for IVs and so forth.
Negotiations, typical above board, they closed that and we got back to it. In 94, PFK, Partners for Kids, was organized. Without going in detail about Partners for Kids, it's a phenomenal organization, and believe it or not, covers now 400,000 kids in this area, southeast Ohio and western Ohio.
Also in the 90s, I think it was in 91, started the foundation where it became really a true fundraising organization headed by Jeff Kaplan. We had our first off-campus NICU when we worked collaboratively with Riverside to open it. And now, as many of you know, we have units that are run by children and leased out of their units in the different hospitals in the city.
Another fact I found was in 1999, the hospital saw 371,000 patients, and I'll just skip to today where we're seeing 2 million, which is amazing. One of the other things as we talked about the advances in research, Phil Johnson came here as an infectious disease doc, and Grant got him to be head of research, and research just took off from there, and is now just phenomenally one of the top five in the country.
[Dr Mike Patrick]
Yeah, yeah. Roger, on the medical side in the 90s, what was happening in pediatric medicine? We did talk about some of the new vaccines.
[Dr Roger Friedman]
Yeah, a lot of what you're, we've talked, we've hit on a little bit, but things, the vaccines, the Hib, and of course, chicken bots, varicella, that was a big deal. And pneumococcal came out at that time, meningococcal. Chicken pox was interesting, and you probably remember, and Bruce for sure, it was a bit controversial too.
People weren't sure, should they get it? Because they were, would it give lifelong immunity? And chicken bots, for the most part, wasn't that severe a disease for the majority people.
Back in the old days, we'd have chicken pox parties where your mom would break, if someone had it, they'd bring three kids over to get it, all get it at once, so she'd only be out of the kids being itchy and scratchy for a week or so. But there were significant complications from chicken pox and getting it turned out to be a very good thing. And that was one of the main things.
One of the amazing things, that was the start of the human genome project that began in the 90s, 1990, and finished in 2003. And that's really what's led, as we know, all these incredible gene therapies and gene ideas, and curing and working at being able to cure diseases that before we never had a chance to, the potential for sickle cell disease, this potential for cystic fibrosis, that we'll talk again a little bit about what Jerry Mandela has done at Children's. From neonatal, that's when CPAP became a much bigger problem, a much bigger solution to solve the problem of chronic obstructive lung disease in babies, premature infants.
And the infant mortality in America went from 16 per 1,000 down to 5 per 1,000. So again, better care, better institutions that really made a big difference. One little add to what Bruce said, and that was with neonatology, opened up a unit at Riverside.
When I came to Children's, again, in 1977, we had one neonatologist. That's all we had. It was one neonatologist.
And by the time I left in 80, we had three neonatologists. And now, again, I imagine their numbers are in the 60s and 50s and 70s, or 100 for all I know. I mean, we've got neonatologists everywhere.
And back in those days, too, there was a lot of collaboration with the pediatricians, because they were forced to practice neonatology. There were people who did extra training and did extra information. And at a lot of the community hospitals for a long time, they had pediatricians, and Larry Heine, his partner, would do lots of neonatology.
And then Craig Anderson, who was trained here, was a resident, and then a fellow in my years, and opened up at Grant and helped improve the quality of neonatal care outside of the main campus.
[Dr Mike Patrick]
Yeah, yeah. I love how you said the local pediatricians were forced to be neonatologists, and that's because we then began saving a lot of babies who normally would pass away from their diseases after birth. And so, you save these kids, but now they have complex medical conditions, and they go out into the community, and the neonatologists generally don't see them after they're discharged, at least back then.
I know we now have developmental clinics and such, and there's definitely more of a role in neonatology, you know, after a kid's discharged. But back then, that was it. You would go see your pediatrician, and suddenly you needed to learn how to take care of those kids, for sure.
I also want to mention, on chickenpox, I can remember, back in the 90s, there was almost always at least one kid in the ICU with complications of chickenpox who had brain swelling or they had a lung infection with the virus. And I mean, kids, it was unusual, but kids did get sick in enough volumes that I remember seeing it. And so, I was a big proponent of the chickenpox vaccine when it came out, because again, when you see kids and families suffering in such a way, and there's a way to prevent it, that becomes really important to you.
And I think that…
[Dr Roger Friedman]
Mike, you're completely right. And I don't want to minimize it. I kind of minimize it among parents who were minimizing it, because they get to see what we did, and the chickenpox encephalitis and other things.
But it's been another good game changer.
[Dr Mike Patrick]
Yeah, yeah, for sure. As we move, then, from the 90s into the early 2000s, Bruce, what kind of changes were happening at Nationwide Children's during that era?
[Dr Bruce Meyer]
Well, I've written down a couple. Number one, again, when I mentioned Mark Lanowicz came in surgery, we tremendously upgraded surgery with tineodids coming. In 2006, Steve Allen became the CEO.
And basically, what he did is continue to push forward all of the visionary things that Tom Hanson's seen and even went over and above that. Another significant thing in the 2000s was Rich Brule became CMO. Within a very short period of time, he developed Zero Hero, which I'm not sure a lot of people here realize, but that became Nationwide.
And he actually became an international figure on safety in hospitals. So, I think that was very significant. Also, during that time, we started really increasing our behavioral health program.
John Campo came here, and he rapidly not only improved the care here, but he also became chairman at OSU and then went to Hopkins. And since then, where you've gotten Dave Axelson, who has done a phenomenal job of helping, for example, open the BHP, the Behavioral Health Pavilion. Another significant thing that was started by Tom Hanson's when he was here, but Steve Allen continued it, was the opening of the new building, the new hospital in 2012, which was very significant, and the transition to moving in there.
An interesting non-medical thing that was going on there is the children got involved in the community a bunch more. So, we now have a whole program when we're rehabbing houses that we started in the early 2000s here in the local area, and now they're doing in Linden. And Kelly or Kelleher has done research on this, and it's amazing how they changed the ER visits, the numbers of graduates, the numbers of early pregnancies in these communities by clearing them up.
So, it's not necessarily medical, but I think it's amazing that people were able to do that. Oh, and then 2007 is when we changed the name from Columbus Children's, which some of us really loved, to Nationwide Children's. But as it turns out, we've all accepted it.
It's very beneficial, and their 100 million has helped. Yeah, absolutely. Even though we're not named after Nation.
And I think the last significant thing was 2019, Tim Robinson became CEO, and it's continued, and it even advanced so many of the things. Yeah, yeah.
[Dr Mike Patrick]
And then, Roger, on the medical side, in the 2000 era, what's been going on in terms of the treatment?
[Dr Roger Friedman]
That's been an explosion of things, Mike. And some of which I'm emphasizing with Bruce, too, autism being a disease that really came to the forefront of more knowledge, more understanding, better treatment, and having the behavioral health building and having experts in autism have really made us a leader in that. Simple things that you don't think about, glucose monitoring, continuous glucose monitoring, insulin pumps all came in the 2000s, targeted therapies, targeted therapies, especially for malignancies, for cancers, where we could actually figure out a lot of the gene and make a chemical against it directly happen.
And we also had a couple more vaccines, rotavirus, which ended up, again, it's a big thing in America, but a huge one in the rest of the world that led to lots of deaths in children. And HPV, a vaccine that can prevent cancer. I mean, again, these were huge things.
One of the things that we did at Children's that was really unique was an asthma school program where we're trying to take kids who are at high risk for asthma, maybe didn't get to see specialists as much and didn't have as much access, but we could get them at school and get them to take their medicines at school and work through that. And that was a great thing from our pulmonary department, from Karen McCoy and Beth Allen and all of them. Pardon me?
[Dr Bruce Meyer]
Bill Long is an important name with the pediatricians.
[Dr Roger Friedman]
Yes. Yeah. No, no.
That and Bill, obviously Bill too. And there again, that Zero Hero was such a big deal for all of us to learn about. That's when it came out about the number of people dying from my iatrogenic diseases and that we as physicians needed to do a better job, whether it was hand washing or just following through on things that we did.
That's also when Mike Brady became the chairman of pediatrics when, again, he was chairman through the end of Tom Hanson and beginning of Steve Allen. And he did a lot of stuff, him and Dave Fisher and things. And then some of our great legendary docs were part of that time, the Dennis King and Donna Coniano in surgery who were just amazing clinicians and amazing people and made us a special place.
We'd always been good. They made us even great and neurosurgeons and stuff. So just a lot of really incredible medical and social stuff.
And one more point, and that's Daryl Robbins, who's been very helpful in all this and thinking about it. It's when Columbus became great. I mean, that's getting people to come to Columbus, Ohio back in the 70s was a challenge.
I mean, we were, of course, everyone knows we were a cow town, and we hadn't grown to a sophisticated town that we are. And that made it easier to recruit high quality physicians and high-quality residents and stuff. And our population exploded and we had avoided some of the inner-city problems that some other cities had.
And we were a university town, a capital city, and we had the limited, we had nationwide, we had AEP, we had lots of high-quality jobs and people coming here. And we became a place where it was really good to live. And the expansion of Dublin and New Albany as communities.
And for anyone who's from Columbus, drive out 23. When I first came here, the directions to go to Cedar Point was you drive up 23 and you go two hours and 20 minutes to Cedar Point. And now if you go up 23, it takes you two hours and 20 minutes to get to Delaware.
Because we've grown so much. And I think that helped the institution and help get good people here.
[Dr Mike Patrick]
Yeah. Yeah. You mentioned Columbus was called a cow town.
I learned not that long ago the history behind that. And so, I always thought, well, just, you know, it's kind of a small capital city and there's a lot of rural areas around it. But apparently, and maybe you'll remember this, the south side of Columbus had a lot of cattle yards and downtown would smell like cow manure on a fairly regular basis.
And that's how it became known as a cow town. And then our Columbus Clippers, minor league baseball team, folks would take cow bells, you know, and ring them. That was kind of the thing and still is to some degree.
[Dr Bruce Meyer]
That's interesting. And just to reemphasize that in the early seventies, who turned out to be my future partner in practice, Larry Heine, I remember talking to him and saying, you know, how did you get to Columbus? Cause he went to school in Milwaukee or Detroit.
And so, he said, I was passing through Columbus to interview south of Columbus, but someone said, you ought to stop there. He said, in truth, he said, my impression before I got there was a stadium with cows around it. He said, I fought that with and then the hospital would be right next door to that.
I mean, I laughed, but it was so typical that people talked about it, but he made it real.
[Dr Mike Patrick]
Yeah. Yeah. That is fantastic.
[Dr Roger Friedman]
My wife and I in medical school lived in university arms apartments and we'd go to the medical school. And there was an area we drive behind where they had student housing and it's where the ag school was at the time. And there were two occasions where we were stopped by cows that had jumped over their little gate and they were in there.
And so, so it was for us a cow town too.
[Dr Mike Patrick]
Yeah. Oh, that is fantastic. I also want to talk a little bit more about the Zero Hero program and Dr. Barilli, you know, this was something that really started, you know, an emphasis on quality improvement and there was, you know, new research came out of that, sort of new language came out of it and the transparency of, okay, when we make a mistake, we're going to announce it to let everyone know that we've done this. And we're going to get to the bottom of it without necessarily blaming individual people to realize that when there is quality issue, it often is systemic and not necessarily because of individuals. And when we blame individuals, then you get into second victim syndrome and people, you know, don't do as well practicing and can't learn from mistakes that happen. And so, the whole culture of, well, let's get to the bottom of it and improve the system.
So, it's less likely that those kinds of errors will happen again, has really made a huge difference in the quality of care and not only at Nationwide Children's, but that really has spread to both children's hospitals and adult hospitals across the country. It really all started right here. Correct, Bruce?
[Dr Bruce Meyer]
Absolutely. Rich Barilli deserves all the credit. Rick McCleed helped him in doing that.
They produced their own magazine. They traveled all over describing it. And to me, it was amazing because at the time, to tell you the truth, I thought, come on, don't interfere with asking us to do all these statistics.
As it turned out, they were so much more right than me. And it became, actually, he's known internationally in quality programs.
[Dr Mike Patrick]
Yep. And the big journal in pediatric quality and safety is, you know, as you said, was started by Dr. Brilli and Dr. Rich McClead, who was my attending, my very first run through when I was in the NICU as a fourth-year medical student. He was my attending and we have had, he's retired now, but we've had a great relationship.
And I actually at one point produced some podcasts for his journal. That was a lot of fun. Oh, was that right?
Good. Yep. Yeah.
The PQS journal. So, Roger, you know, for folks who are listening today, what are the most important takeaways, you know, sort of the culmination of these 50 years of progress at Nationwide Children's Hospital? Why should families care about that?
[Dr Roger Friedman]
Because we improve lives and save lives and the best is yet to come. Our knowledge in medicine is so expanding and biologic therapies, therapies, again, diseases that we talk a little bit about, but diseases like cystic fibrosis, where now we can have a normal life. Diseases like SMA, where, where those babies used to die very young, they're now going to maybe live forever in normal, normal existence.
Keeping kids with asthma on the sports field. There's so many, Jerry Mandel, again, you've been mentioned, but his work in muscular dystrophy and, and, and finding gene therapies and this, you know, new therapy of CRISPR gene insertion, that's just mind boggling. Our, we, our, over at Children's and our research, the brewers with their work in, in, in artificial skin and developing, you know, valves that will keep growing with kids and stuff.
It's just, it's incredible what's going on here. It really is just a tiny anecdote. Many decades ago, a little boy named Zachary, I got referred and he, he turned out he had a rare immune deficiency.
In fact, we didn't even know what he had, but he got sick all the time with frequent bacterial infections and stuff. And Bill Burson and I took care of him for a whole long time and ended up; he had something called leukocyte adhesion deficiency. Again, we, we took care of him before we even knew what it was.
And we just treat him and Bill, Bill deserves a great credit in infectious diseases of keeping him alive and for, for decades. And just this past week, they announced the discovery of the gene therapy for that. And that's what we, that's what our future is.
And, and the use of, you know, again, I'm no expert in AI by any means, but, but it's going to change so much of what we do. And, and I always tell people that back when, when Bruce and I, and even you, Mike, when we started, you know, we were, doctors are thought of as gods and we weren't God, but we had all the information. Patients had no access to information.
So, they, they believed what we told them. We, we, we got it from our medical journals. We got it from our books and things like that.
And once the internet came and once it, it flattened the world. And so, they can get the same information I can get. Now they can't always interpret it.
And they, most good families understand that. And they'll ask when they trust their doctor, they'll say, hey, I read this. Is this, you know, tell me about that.
And that's a great relationship. And, and AI is going to make it even better for us as physicians to, to sort out things for us. And so, it's just such an exciting time to be a physician and, and, and, and a better time to be a patient because we got better treatments.
We care about disease. We care about side effects. And, and I think it’s; it's just this institution is part of the reason why, why the world's a better place.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. Bruce, as you think back of 50 years at Nationwide Children's, what innovations make you most proud of our institution?
[Dr Bruce Meyer]
What's interesting, it's not necessarily the basic scientific medical innovations. So to me, without looking at that part of it, the best, as I have emphasized before the culture, we have shown the world that you can continue over a hundred years, a good culture, which is respected by the faculty, by the patients, by the families and by the primary care. And I guess the second thing is, is we've shown the country that you can run a community large, I think we're the second or third largest children's hospital in the country with a tremendous amount of respect and cooperation with the community who are the people who started the whole thing anew.
So, I think those are the main things that, that I think, I think, yes, the quality programs that we've been into, gene therapy, they're all fabulous. I sort of let that to you, you and Roger, because I'm most proud of the, the art of medicine kind of things, the cultural things that I think I'm so proud of.
[Dr Mike Patrick]
Yeah. Yeah. There's a lot to be proud of.
And one thing that always strikes me is when folks visit Nationwide Children's for the first time, maybe they're coming for a conference or they're coming to interview, they're always surprised at just how well-developed our facilities are. And they have just grown and grown and grown. We're building another huge tower next to the one that opened up in 2012.
That's going to, you know, make our inpatient capacity even larger than it is today. And we have, I think, the largest primary care network across the city of Columbus of any children's hospital. And our behavioral health pavilion, which is a standalone hospital for kids with mental health issues.
And there's not a lot of reimbursement in mental health, unfortunately. And so, it's not a moneymaker, but the hospital's like, this is important enough that we need to do this for the community. And that kind of culture of really just caring and doing what's right, and not always what makes the most money is so very important and makes a big difference for kids.
[Dr Roger Friedman]
Well said. And one more, just one thing from what Bruce had said too. One thing that our institution has done, that Children's has done in particular, is they've taken the time and effort to honor the healthcare providers.
We started 30 some years ago, career contribution awards and golden stethoscope awards and Dr. Meyers sponsored awards that those of the physicians who work hard and dedicate their time can be honored because sometimes we forget that it's a tough job. And to try ways to avoid burnout is to try to make sure that we say thank you. Thank you to all of our docs.
And I think Children's has done a great job of doing that through the years.
[Dr Mike Patrick]
Yeah, absolutely. Well, this has been a really fascinating conversation. And as a history buff myself, I could go on, we could do another hour of this, and I would be absolutely fine with it because I love hearing the stories and just seeing where we've come because it really does inform the future and what lies ahead for Nationwide Children's Hospital.
If you are interested in learning more about our institution, just head over to the show notes for this episode at pdacast.org. We'll have links to some resources on our website, a history and milestones of the hospital. If you want to dig a little bit deeper into our history, you can check that out again in the show notes.
So once again, Dr. Bruce Meyer and Dr. Roger Friedman, both with Nationwide Children's Hospital. Thank you so much for stopping by and chatting with us today.
[Dr Bruce Meyer]
Can I just give a shout out to a couple of people who have been very beneficial in this. John Joseph, just so everybody knows, is an archivist. So, if you want to find more about Children's Hospital, it's a great resource.
I'd like to thank Darrell Robbins, who basically gave us the first concept of a talk, which made it easier for us not to start from the beginning. And then I'd like to thank you and Roger for doing this with us.
[Dr Roger Friedman]
And my last, I want to thank everybody. I want to thank Katherine Kaczewski, our medical, she was helpful too, and she's been a great add to our institution and has been just fabulous.
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[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it.
We really do appreciate your support.
Also, thanks again to our guests this week, Dr. Bruce Meyer, Associate Medical Administrator at Nationwide Children's Hospital and Dr. Roger Friedman, Pediatric Allergist at Ohio ENT and Allergy. Don't forget, you can find our podcast wherever you get your podcasts.
We are in the app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is pediacast.org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and that handy contact page.
If you would like to suggest a future topic for the program, or if you just want to say hi, I love hearing from listeners and I do read each and every submission on that contact page. Reviews are also helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media.
You'll find us on Facebook, Instagram threads, LinkedIn, X, and Blue Sky. Simply search for PediaCast. We also have a program for pediatric providers.
It is called PediaCast CME. It's similar to this program. We do turn the science up a couple notches and offer free continuing medical education credit for those who listen.
That includes doctors, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And it's because Nationwide Children's Hospital is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state's continuing medical education requirements. Shows and details are available at the landing site for that program, pediacastcme.org.
You can also listen wherever podcasts are found. Simply search for PediaCast CME. And then an additional podcast that I host is called FAMEcast.
That's a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine. So, if you're a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you. And you can find FAMEcast at famecast.org and wherever podcasts are found by searching for, you got it, FAMEcast.
Thanks again for stopping by. And until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long, everybody.
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