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A Conversation with Paul A. Gurbel, MD
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In this issue, Dr. Bhatt converses with Paul A. Gurbel, MD, director of the Sinai Center for Thrombosis Research at the Sinai Hospital of Baltimore and associate professor of medicine at the Johns Hopkins University School of Medicine.
Gurbel earned his medical degree at the University of Maryland School of Medicine and completed an internship and residency in internal medicine at Duke University Medical Center in Durham, N.C. He then completed his fellowship in pulmonary and critical care at Johns Hopkins University, followed by fellowships in cardiovascular disease and interventional cardiology as well as a chief residency in internal medicine at Duke.
Deepak L. Bhatt
Paul A. Gurbel
Currently, his research laboratory is focused on determining the antiplatelet effects of agents and the relation of platelet reactivity to ischemic event occurrence in patients undergoing stenting. His laboratory pioneered the concept of antiplatelet response variability and was the first to demonstrate the relation between high-platelet reactivity to adenosine phosphate and ischemic event occurrence in the PCI population.
What are your hobbies outside of practicing medicine?
Dr. Gurbel: I enjoy running and try get in about 6 miles every day, often taking my dog with me. I like playing ice hockey and used to play in a men’s league for many years. I also really enjoy the water and have a small fishing boat on the Chesapeake Bay.
Who has had the greatest influence on your career?
Dr. Gurbel: There are two physicians. The first is Theodore Woodward, MD, who was the chief of medicine at the University of Maryland. He inspired a love of internal medicine in me and a curiosity about human diseases. He inspired me to become a medical doctor instead of a surgical doctor and got me interested in going to the medicine training program at Duke University because of the intensity of the program.
The second person who had a major impact was Joseph Greenfield, MD, the chief of medicine and cardiology at Duke. He is a brilliant physiologist and did landmark work in coronary blood flow and got me very interested in hemodynamics, asking questions and doing research. Over the years, he has trained many leaders in cardiology.
What area of research in intervention interests you most right now and why?
Dr. Gurbel: The area of coronary thrombosis because that event is associated with poor outcomes in patients undergoing PCI and it’s the lethal pathophysiologic event. Unlike restenosis, which can also be lethal, stent thrombosis is usually the most critical event. It’s the No. 1 thing I focus on in my lab. The whole process of stent thrombosis and how potentially deadly it is stimulated my lab to study it. This, in turn, got us to begin looking at the pharmacodynamic effect of the different drugs to try to understand how effective one drug is vs. another in blocking the physiology of the platelet, which is believed to be one of the major players in the genesis of thrombotic events after stenting.
What advice would you offer a student in medical school today?
Dr. Gurbel: I would say find a mentor early on who can give you guidance in your career path. You should read and learn about the research that your faculty is doing at your medical school. Understand their interests and find a mentor who you have similar interests with and seek guidance early with someone you respect.
The other thing I’d say is don’t be afraid of hard work. When we trained back in the day, we looked at medicine as the primary part of our lives for 3 years when we learned to be internists, which precedes the training as a cardiology fellow. The No. 1 concern that we had was learning everything we could about being a doctor. That meant taking care of the patient, reading the literature about the diseases and knowing extensively about the diseases that each one of our patients had. Being a physician requires an immersion in the field and a complete dedication for a minimum of 3 years to be a good clinician before you can ever become a cardiologist.
What’s up next for you?
Dr. Gurbel: We’re currently doing some work in drug development, helping to develop new parenteral antiplatelet agents. One drug, in fact, works by a novel pathway to inhibit platelet function. A large goal for our lab is to lead a multicenter, personalized antiplatelet therapy study in PCI patients to better understand the utility of personalization of antiplatelet therapy. And the third thing we are working on in our lab is getting a better understanding of the role that biomarkers and markers of platelet physiology and coagulation play in the identification of high-risk patients with CAD.