I sat down recently with Mayo Clinic’s John Davis to discuss some key issues facing rheumatologists and patients. I learned that he enjoys fly-fishing with other researchers in the summertime and what motivates him to work so hard the rest of the time. I’m glad to bring you his perspective and I know you’ll enjoy getting to know Dr. Davis.
Skilled and caring mentors in a noble profession
John M. Davis, III, MD is a consultant in the Division of Rheumatology at Mayo Clinic in Rochester Minnesota, Assistant Professor of Medicine, and the Research Chair of the Division of Rheumatology. His work has included significant focus on Rheumatoid Disease, understanding ways to improve care and outcomes of patients, and understanding the impact of the disease on health with an emphasis on cardiovascular disease. He spoke with me about his background and what motivates him in his career.
Both Dr. Davis’ father and grandfather were physicians. “Medicine has been part of my life always,” he said, and he always considered it to be a noble profession. His internist grandfather, an early mentor, passed away recently in Raytown, Missouri. His father is a hematologist oncologist in Kansas City, but also began as an internist. Academic experiences sparked Dr. Davis’ interest in immunology, but he is quick to add he is equally driven by the rewarding personal interaction in helping to care for people with a chronic long-term disease. “I have an opportunity to make an impact that is more than I could with acute care.”
Dr. Davis was drawn to rheumatology by both “the science and the human aspects” pointing to other key mentors such as Dr. Sara Walker in Missouri and his father who he said “is still my hero for taking outstanding care of people. My father and grandfather were early pioneers in patient-oriented medicine.”
Rewarding and challenging work
Diseases such as Rheumatoid Arthritis are challenging for doctors as well as patients. On the one hand Davis admits, “It can be very draining for a physician when a patient has ongoing pain, fatigue or ill health that does not get better despite trials of standard, available drug therapies.” “Yet,” he continues, “it is rejuvenating to channel this frustration into conducting research studies. We address these difficult challenges by taking a team approach, involving different disciplines including rheumatology, immunology, and pain management, for example.” Dr. Davis finds it rewarding “to know that even though these diseases are not curable, we strive to understand what’s wrong and to treat in ways that can profoundly help the way a person can feel and function. These diseases are very challenging, mostly an art since tests are frequently not helpful and the physician must be astute to recognize what is wrong and treat it. This is why research is so important to me. We identify what is holding us back and find new solutions to improve health and outcomes for people; so clinical work and research go hand in hand.”
With rheumatological diseases, many specialists are often involved in the care of one patient. Dr. Davis remembers an example of a lupus patient in hospital and the proverbial tug of war over decisions between a cardiologist, neurologist, pulmonologist, and an infectious disease specialist. As the rheumatologist who knew the patient and the disease best, he could clearly see what needed to be done to save the patient without further complications. “It is tremendously gratifying to have the wisdom and experience to foresee potential complications that other physicians cannot and convince the team of doctors and family to act and ultimately prevent a bad complication.”
The greatest need in rheumatology
There are several great needs right now in rheumatology, yet according to John Davis, “The most immediate is to identify prognostic tests to enable us to better understand the disease process for an individual patient. We must find better ways of tailoring the treatment to the individual patient.” He says the key is to arrive at the right treatment at the right time, “early in the disease course. Delayed treatment is bad for many reasons, not the least of which is people continue to suffer.” He also acknowledges the chance of attaining remission decreases over the months and years. “There is a high burden of ongoing suffering and ultimately tissue damage that, if we had better predictive tools, could be preventable.”
He sees tension between the greatest need and perhaps the greatest challenge: “Use of quantitative measures of disease activity in a widespread fashion would be better. Many doctors in the U.S. do not use them due to time constraints and concern that the data is not specific enough or because they weren’t trained to practice that way. But, we have mounting evidence that measuring disease activity and knowing when treatment needs to be modified helps eventually to get patients into remission.”
A cure for Rheumatoid Disease
Dr. Davis believes we will see much progress toward a cure in our lifetimes. “We may well see a cure. Over the next ten to twenty years, we may understand what leads to autoimmunity especially with a common disease like Rheumatoid. And then we could understand how to induce tolerance as we understand better the tissue antigens involved and the mechanisms of immune regulation that we could perhaps augment.” He believes that resetting the immune system to not attack tissues is one feasible option to achieve self-tolerance. “These are big ideas that people are working on.”
Causes of low funding for Rheumatoid research
I asked Dr. Davis why RA has historically gotten so little attention from the scientific community and dreadfully low research funding in the U.S. He told me, “I think the reason funding is historically lower is that, first, it took many years for the rheumatology community to become aware and embrace the systemic aspect of the disease in terms of the greater mortality. There is a growing awareness of cardiovascular mortality, malignancies, infections, and changes in body composition. So that was under-recognized and people think of ‘arthritis’ as not that great of a problem and that it’s just something you have to deal with.”
“And the disease has also been perceived as rarer than it actually is—we have found that in Rochester, Minnesota, the lifetime risk of RA is 3.6% for women and a 1.7% for men. So funding has not risen to the levels of some other chronic diseases. We do need the voice of patients to lobby for awareness.” Dr. Davis believes that recognition of the toll on patients’ and families’ lives, and on communities financially, is one way to get the world’s attention.
High hopes for the new Rheumatoid Patient Foundation (RPF)
Dr. Davis plays a valuable role for the RPF. He told me: “As a member of the Advisory Board and an active collaborator in activities of the foundation, I believe RPF plays a very valuable role in advocating for people affected by Rheumatoid Disease. Led by patients, RPF can play a great role in providing patient support, education, community, and advocacy. RPF will combine grass-roots advocacy with Congress with also partnering with physicians and researchers. They will help identify what the problems are and identify treatment strategies that are acceptable and appropriate from the point of view of the people who are actually affected.”
Changing the name of Rheumatoid Arthritis will benefit patients and physicians
Dr. Davis believes changing the name of Rheumatoid Arthritis will have a positive impact on patients and the profession. “There is a need to change the name of RA. I’ve learned from patients and others to have a growing appreciation that the words ‘Rheumatoid Arthritis’ do not do justice to this disease.” He explains that a name ought to be identified which is more reflective of the systemic nature and the mechanisms of the disease. He also believes that updating the name of RA will increase awareness of the disease: “We will be able to enhance awareness of the disease, what it is, and what it means to people.”
According to Davis, patients and doctors will benefit directly from the name change because “It will help doctors and patients to be able to communicate better. It will also be easier for me to teach about the disease to medical students if there is a name that lives up to the full aspects of the disease.” Another benefit could be increased research dollars because “a name that’s more representative of the disease will make it easier to advocate for research funds.” Both patients and doctors will benefit when “we advocate for a treatment to be approved by payers who cover costs,” he says. “It would be to our advantage if the name reflects what we are dealing with and is not mired in historical misconceptions about the disease.”
Dr. Davis says the RPF has a critical role to represent patients as a collective voice in speaking to physicians and other stakeholders to attain a better name. He does not think there will be much opposition from the medical community to the change: “I don’t think many physicians will argue that the current name is adequate. If we clearly state the need and rationale, it can clearly be done.” He points out precedent for changing names of diseases for the right reasons. “Not much will stand in the way, but it will take time. It does need to be changed and it will be changed. Ideally soon.”
A talented doctor – and a dad
Dr. Davis makes me smile when I hear him talk about hope of a cure and his family legacy of patient-centered care. But, he makes often someone else smile – his daughters! Another of the doctor’s talents is singing, having performed with choirs and a band in previous years. These days, he sings in the car while driving his girls to school. He laughs as he admits they often ask him to stop.