Science As a Force for Social Good: Dr. Richard Horton, Editor in Chief of The Lancet

Shiv Gaglani: Hi. I'm Shiv Gaglani. The first scientific paper on the clinical features of patients infected with what came to be known as COVID-19 was published in The Lancet, launching that famed medical journal's prominent role in COVID research, which it has maintained throughout the pandemic. But being an influential force in science and medicine is nothing new to this nearly 200-year-old publication -- published by Osmosis' parent company Elsevier -- and we're going to explore that role today with its Editor in Chief, Dr. Richard Horton. 

A physician by training with a three-decade career in publishing, Dr. Horton himself has often been described as a global force in science and medicine, leading to many recognitions and honors including the 2021 Physicians for Human Rights Award presented by Dr. Anthony Fauci for, "working to bring evidence-based and rights-based solutions to the global COVID-19 response." 

Dr. Horton, thanks so much for taking the time to be with us today and thank you to our CEO, Kumsal Bayazit for putting us in touch. 

Dr. Horton: Thank you, Shiv. And yes, indeed, thanks to Kumsal.

Shiv: We often like asking our guests to talk about what their background is, and what got them interested in pursuing a career in medicine in the first place. I know our audience would be very excited to hear this because it contains so many people who are current and future clinicians who, obviously, are familiar with The Lancet. 

Dr. Horton: Yes. That's going back a few decades now, Shiv. Our system in Britain, unlike yours, is very unforgiving because we have to make a choice early on in our school careers between science and the humanities. And I found this a horrible choice to make. I loved English literature, and I loved writing, and I loved reading novels and thinking and talking about novels, but I also loved experimental science and particularly, biology and chemistry. 

We have this terrible decision at the age of sixteen, which is awful. You're nothing at sixteen and you have to decide, "Am I going to go down the humanities route or am I going to be a scientist?" So, at the age of sixteen, I opted for science and I have no regrets about that choice. I love science and I love choosing medicine as a career which allowed the application of science in the human setting in a way that no other discipline I could see would allow me to pursue. But there was this lingering love of literature and writing, which eventually got the better of me. I loved medicine, I loved academic medicine, I loved research, but I had to do something that involved the written word and that's what led me off the straight and narrow path into The Lancet.

Shiv: That's really interesting. I'm glad you brought that up because so many in our audience feel this artificial pressure to choose and become a physician of some sort early on. There are these six-year programs straight out of high school in the U.S.  called BSMD programs, and I think maybe growing up watching people like Doogie Howser, you feel like it'd be very cool to be an eighteen-year-old doctor but I think patients often benefit from clinicians who have a little more experience or are able to draw connections between different fields. Is that how you felt as well? 

Dr. Horton: Absolutely. I remember decades ago now going to the National Institutes of Health to interview Harold Varmus for The Lancet and in the profile that I wrote about him, one of the things he said to me was that here he was, this Nobel prize winning scientist, head of NIH, but actually one of the things he was most proud of was the fact that he did a major in poetry when he was at university. And I think that having that broader scholarly background enables you to have insights into not just the science but, people...the history, the diversity of people that you come across. 

Numbers are important, clearly, in science. But also, you need to be able to think about concepts and interpretation. Some of the conceptual agility that you need in science can actually come from analyzing a text in a different discipline, thinking about a historical pattern in a way that you might not think about a particular scientific pattern. I think there are many skills from many disciplines that can come together, and trying to separate those off too early in somebody's life, that's a loss. Trying to keep them together as long as possible would be my hope.

Shiv: Certainly. Obviously, there's people who've managed to very successfully combine those loves, like yourself -- and we'll get into your career at The Lancet -- as well as people like Lisa Sanders, who's the head of the Diagnosis column for the New York Times. Her story was non-traditional. She was a journalist who became a medical student at Yale and then has had a very fulfilling career at that intersection. 

Can you talk to us a bit about your own evolution at The Lancet? How did you start and how did you become editor in chief? 

Dr. Horton: Well, I didn't actually plan to stay at The Lancet. I was actually starting a PhD in London at a teaching hospital, The Royal Free Hospital, and I wanted to become an academic hepatologist. I did, and I still think, the liver is the most fascinating and interesting organ in the human body. But I had this lingering feeling that I wanted to try something that involved the written word. As I say, I love science and medicine, but I also love literature and politics and so I wanted to find a way of mixing these things. 

I had started to subscribe to The Lancet as a medical student and could see that it had this mix of science, medicine, politics and so on. I saw that there was this job that was advertised. I was actually in an English pub at the time and was with some friends and we'd had a few drinks and I was saying, "Should I go for this job or not? Should I try it?" And I actually called up who I found out later to be the deputy editor at The Lancet from the pub and said, "Could I apply for the job?" 

God knows what he must have thought because he would have been hearing behind me people saying, "Three pints of lager and a packet of crisps, please" while I'm trying to have this sensible conversation about changing career paths. Well, anyway, to cut a long story short, I applied for the job, got it for six months and then stayed for thirty years. (laughs) So, go figure.

Shiv: (laughs) Actually, it's funny. I would argue that you being in that pub probably made you more human, made you someone like, "I can see myself working with this person. They have a personality." And obviously, a lot of great people have made amazing decisions in English pubs. 

Dr. Horton: (laughs) 

Shiv: Probably the most famous example, I believe, were Watson and Crick. But also C.S. Lewis.

Dr. Horton: Well, that's true. (laughs)

Shiv: And JRR Tolkien, right? In The Eagle and Child pub.

Dr. Horton: (laughs) I hadn't thought of it like that. But yes, that's true. 

Shiv: (laughs) 

Dr. Horton: All the crazy decisions people made in English pubs...someone needs to write a book about that.

Shiv: I'm sure that's already been written probably from somebody in a pub. So, thirty years at The Lancet...it's obviously grown a lot under your leadership. What does that look like? There are over twenty journals The Lancet publishes now. Can you give us a sense of scale and reach of the publications and what you are proudest of? 

Dr. Horton: Well, it is funny looking back because when I joined The Lancet, it was this tiny little cottage industry operation. We all sat in this...I mean, honestly, it was Dickensian. 

Shiv: (laughs)

Dr. Horton: (laughs) I can remember we weren't supposed to have personal phone calls at work. We didn't have mobile phones when I started. We didn't even have computers. And I can remember somebody called me up, a personal call, and I wasn't on the call longer than a minute or two when the deputy editor -- the guy I'd spoken to from the pub -- who was sitting behind me in this open office started tapping the table behind me. Honestly, that was Charles Dickens. 

Shiv: (laughs)

Dr. Horton: It was kind of bizarre to think that we existed in an environment like that. Now, I'm sitting here in our London Wall offices -- well, we don't come to work anymore, do we...we all work remotely -- but yes, it's changed dramatically. We had one journal thirty years ago. We now have twenty-four journals. We had about, I don't know, a staff of no more than thirty. Now, we have a staff of over 200 and the reach of The Lancet has become truly global in a way that we weren't before. We were rather a quaint English scientific medical journal, and now, we're very much a global operation. 

I think what I'm proudest of is two things. Firstly, expanding the number of journals of The Lancet to diversify our content, building the organization we have today. I think the other piece that I'm probably even more proud of than that is the vision or the idea that I had when I first joined the journal, and that is that science can be an enormously powerful force for social good. We might talk about that more. I always wanted The Lancet to be not just a campaigning journal, but for the work that we published to have some sort of social purpose. Not just publishing for the sake of publishing. I think in a small way, we've managed to achieve that objective and I hope that will continue. 

Shiv: Yes, and that's continuing a great legacy of the intersection of science and change, some of which is inevitable when something is discovered or invented -- the cat is out of the bag, as we often say -- and you can't unsee it.  There are examples such as greats like Linus Pauling, who won a Nobel Prize for chemistry, but won it a couple years later again for the activism that he and many people did on nuclear disarmament. 

So, I'm curious. What are some of those highlights? There's been a lot of social activism over the past several years, especially during COVID. But well before that, over thirty years, what are some examples of that that you want to specify? And then also, how do you strike the balance between the impartiality required to edit The Lancet as a scientific journal with the mission of impacting social change?

Dr. Horton: I think the place I would start here is to say it is easy for people to suddenly jump and think, "Oh, gosh. Science is all about neutrality and you should be this neutral journal or holding a mirror up to the scientific community and it's not your role to be political." Sometimes, where we've got into controversies in the past, that's what people say: science should not be political. It shouldn't engage in these kinds of activities. But I think that's a misreading of the history of science. 

If you go back to the Enlightenment, and you go back actually to Diderot's Encyclopedia -- which was the first time that some of human knowledge was put together into a single document -- the introduction was by a guy called d'Alembert. What he wrote was that the purpose of putting together knowledge into one place was not to satisfy the egos of the people who were putting knowledge together or just to produce a book to put on the shelf of a library, but the purpose of acquiring human knowledge was to advance human progress, to advance social progress. And that was the reason why there was an Enlightenment. The whole point of that word is that we were supposed to be opening up the possibility of greater clarity to chart a path forward to advance the human condition. 

Then, we created this machine of science where it was all about getting grants, getting publications, getting tenure -- all of which is important -- but we kind of lost the purpose of it. So, what I wanted to do was to go back to the origins of the Enlightenment and to remember that the purpose of generating knowledge was to use that knowledge as an instrument for social and political progress. I don't find that controversial. It's what science was all about originally. So, that's not about impartiality. 

In my world of medicine, it's about making sure that we work so that everybody has the right to access the highest quality of healthcare, that there is health equity and that there should be some elements of social justice because the determinants of health go beyond healthcare. They are affected by the economic, social and political circumstances. The commercial determinants of health. Race as a determinant of health. I mean, these are all issues that are part of our world and determine our health and well-being.  You can't be impartial about those issues. You have to make a choice about what your view is of them, and then you have to apply yourself to address them. 

So, I don't apologize for not being impartial. I would say it's the only way you can be. You have to look at the world, diagnose what the world view is that you have, and then we use our journal to try and achieve certain objectives. 

There have been some notable papers in the past which have got us into important debates. If I go back to the early 2000s, we published two papers from groups at John Hopkins University looking at the civilian mortality from the Iraq War. That war was initiated on a false piece of evidence. We didn't know that at the time, but what we did know was that the war was killing hundreds of thousands of civilians because of the way the war was being prosecuted. It was through two papers published in The Lancet that we tried to hold the Bush government accountable for its decisions to go to war in Iraq. Now, we got into an awful political fight about that work, but to me, it was a very good example of how science can hold politicians accountable for their decisions, and rightly so. 

In more recent years, over the last twenty years, what we tried to build up is a program of Lancet commissions, where we try and take a subject that's neglected -- both in the clinical arena and in broader public health and global health arenas -- and try and look in depth at that by bringing together the smartest academics in the world around a table. They work together for two years, on average, and then we gave them the chance to publish an extensive report, which is really an investigation and a manifesto for action. 

Those subjects have ranged from the political determinants of health, through to adolescent health, through to dementia. Just this year, we published commissions on the value of death, on stigma and discrimination in mental health, on depression, on the future of child health. I think now we've published almost 100 commissions looking at different dimensions of medicine and health. To me, a commission is the perfect example of what we were talking about a moment ago, which is using science as that instrument for social progress.

Shiv: That's fascinating. It obviously takes a lot of courage to wade into this. Even in our short history at Osmosis, we've seen that when we've taken a point of view in our videos -- we've done a lot around health equity and partly why we were so comfortable joining Elsevier is that they walk the walk in terms of their commitment to this -- we've inadvertently, and sometimes purposefully, gone into firestorms. Everything from LGBTQ healthcare to systemic racism to firearms control, which is a major issue, especially here in the U.S. 

Dr. Horton: Yes.

Shiv: You may not know this, but we're proud we published a short column in The Lancet years ago on the work we did in Syria with a couple of dozen medical students who, at their three different campuses, got together and translated a lot of our videos into Arabic. Two of the med students -- Dr. Lamia Kouba at University of Damascus, and Basel Amin at University of Tishreen who were on opposite political spectrums -- came together and published this work on increasing access in Arabic with Osmosis. Our advisor on that was Dr. Amin Azzam at UC Berkeley. 

Dr. Horton: Wow, that's fantastic. 

Shiv: Yes, I'll make sure to share that with you.

Dr. Horton: That's a great story, actually. And that's a beautiful story also of how science can bring communities together in a way that very few other disciplines can. In my world of medicine and health, working together on healthcare can bring conflicting communities together in ways that sometimes other diplomatic maneuvers can't. Health can be a bridge for peace in a conflict, and that's very important. That's a lovely example, actually. 

Shiv: Yes, totally. I'll make sure to share that with you. It echoes some of our other guests, like the International Medical Secretary of Doctors Without Borders, who say the same thing: medicine can be an agent for peace and change. 

So, let's go to COVID because that's actually why we launched the Raise the Line podcast. Everyone was talking about flattening the curve -- and we were obviously helping do that with patient engagement and education in public health -- but “raising the line” is about how to strengthen our healthcare system. Can you walk us through the early months of COVID and your decision to publish this paper? And also the crazy last two-and-a-half-years The Lancet has gone through and emerged as the leading publication in that topic? 

Dr. Horton: We'd spent a decade building up trust -- probably that's the most important word, actually -- and a network of advisors in China. We'd seen over a decade ago that China was emerging as a scientific superpower. When we looked at the number of papers being submitted from countries in the world, the United States was always the number one country, the United Kingdom was second and then a collection of mostly other European countries followed. China was never in the top ten. 

But over the last twenty years, we could see that China was gradually climbing. It's a very, very interesting and sensitive measure of the other countries' developmental progress, their output of science. For everything that people say about China today, China really wanted to engage with the world -- still wants to, actually -- and engage in a predominantly English language world. 

What we were seeing was that China's output was increasing. The quality of the papers wasn't as good as we might have liked, but the volume was getting higher and higher. So, we thought, "Well, let's go to China." So, we went to China over a decade ago. We built up a good set of relationships.

And then at the end of December, early January 2020, we are alerted to the fact that a number of people had fallen sick with an unidentified pneumonia in Wuhan. We immediately activated our editors in Beijing and said, "What's going on?" They then contacted their contacts at the called the National Health Commission and the Chinese Academy of Medical Sciences and by the early part of January, we were aware that something very severe was happening. 

We had six papers submitted to us in early mid-January which described the first clinical series of cases. Now, of course, at the time, most European governments were seeing this as something like flu. Probably not very serious. A bit of a health scare. Let's not overreact. Everybody should keep calm. But we had the papers and we saw the severity of the illness that they were describing. The patients were falling sick very quickly with this unexplained pneumonia. Certain patients -- particularly those who are older, with comorbidities -- were being admitted to intensive care where they were getting very, very severe cytokine storms, multi-organ disease, multi-organ failure, and with complications that didn't quite fit any previously known patterns -- cardiac complications, for example. Basically, something that was extremely unpleasant with a mortality that was quite frightening.

So, we published these papers at the end of January, which really described the pattern of clinical disease that we were to see over the next two to three years. I think what was so shocking to us, or certainly to me, was that despite the fact that we published these papers all before the end of January -- and remember that WHO issued its Public Health Emergency of International Concern at the end of January 2020 -- nothing happened. 

You've got six papers from The Lancet describing the severity of the cases, describing the fact that it was person-to-person transmission. You had Gabriel Leung from Hong Kong, having done modeling based upon the transportation system from Wuhan, for the first time saying that we basically were facing a global pandemic. You would think that on February 1st, 2020, the world's governments would say, "Oh, my God. There is a crisis. We need to do something. We need to do something together and we need to act decisively to shut down this potential pandemic." 

What happened? Nothing happened. Nobody did a damn thing, I'm sorry to say, until in the case of the United Kingdom, we went into a lockdown on March the 23rd. But by then, we, and many other European countries, had allowed thousands of separate seedings of the virus across their populations and it was too late to turn the pandemic back.

And you had political leaders, I'm afraid, like President Trump who not only was slow to react but actually -- when the scientists and his scientific advisors realized the severity of the danger -- took a completely anti-science position against the pandemic. It wasn't just that they were slow, but they were actually resistant to what the science was saying. 

I hope sometime, someday -- and it might not be within our lifetime or maybe this is for historians -- these people who presided over the needless deaths of literally hundreds of thousands of our fellow citizens...I hope that there's a reckoning for them, that their reputations will be reviewed in light of their decision-making. Because the deaths that took place did not have to take place based on what we knew in January 2020. This was an entirely preventable situation, what we've gone through over the past three years.

Shiv: Wow. Yes. I think there's so much more to say, and the public has been blunted a bit to that fact. Just like in many other crises before, you only start seeing clearly years after the fact, once the dust settles. 

I'm curious, what your views are on things that need to be done over the next decade to prevent the next pandemic, which inevitably will happen. It seems like the pendulum has turned back again. Now, there's recession, the war in Ukraine...people don't want to think about COVID much, and it seems like public health funding has not kept up to speed despite promises that were made in 2021 that this could never happen again. So, what are your views, and some of the key things and maybe bright spots that are happening to prevent the next thing? 

Dr. Horton: Well, Shiv, you're so right, aren't you? It's amazing how attention shifts very quickly. The pandemic's not over even now, but the world has moved on. News media has moved on. Politicians have moved on, and we're not prepared for the next pandemic. To answer the question of how to prepare for the next pandemic it's important, as always in medicine, to make the right diagnosis. I don't think we've made the right diagnosis because this is not just a pandemic of a virus. This was actually a synthesis of epidemics, a syndemic, because you had three intersecting problems. 

You had a virus, yes. But the virus then hit a population that had existing illnesses. The risks of death were higher for certain populations. As I mentioned earlier, those who were older, those who had certain comorbidities such as heart disease and related disorders...a pattern of ill health in the population led that population to be highly susceptible to bad outcomes. In addition to those two elements of the virus on a pattern of poor health, it wasn't even across society. There was a social gradient. Certain groups in our society were more at risk than other groups. 

Just to take an example, I was very fortunate I was able to just work from home from the beginning of the pandemic until the present day, if I chose. I had that freedom. But the people who were running our trains or metro systems or opening our supermarkets or cleaning the streets, they didn't have a choice. Health workers who are on the front line, teachers who are trying to teach our children and keep our schools going, they didn't have a choice. To keep society running at some basic level in the middle of a pandemic required some groups to be out there doing what they had to do, and they were at greater risk. People who were poor, marginalized, socially excluded were at greater risk. There was a shadow pandemic of violence against women and girls who were at greater risk. 

So, if you're really going to understand pandemic preparedness and the response, it's not only about detecting a virus and then preventing its spread, it's also about having a healthy population. It's also about reducing inequalities in health. 

If I was going to be trying to prepare for the next pandemic, I definitely want a strong public health system that can pick up new viruses. That means being able to detect pneumonias of unexplained origin and having genomic sequencing facilities all across the world so you can pick up new viruses, definitely. Building trust and cooperation between nations so that nations share information. 

But secondly, I want to make sure that I have universal health coverage in every country so that there is no population that doesn't have access to a basic level of adequate healthcare because that's essential as part of the pandemic response. And thirdly, I would try and tackle these inequalities so I don't have marginalized, vulnerable populations who are particularly exposed to the virus. Because what you saw in this pandemic was it was no accident that the new variants that arose during the pandemic arose in Brazil, in the United Kingdom, in South Africa. The reason why they arose in these countries was because that's where the transmission was most intense. Anywhere you have intense transmission, you're going to create the conditions for genetic re-combinations to take place. 

To reduce the risk -- not just of the beginning of a pandemic, but the arrival of new variants -- you've got to have universal health coverage and limited inequalities so that you don't allow that transmission to be so intense. You need that three-pronged attack. I don't think that's a lesson that has been widely talked about at all, but it's absolutely crucial to the future. 

Shiv: Yes, those are some valuable insights. Hopefully our audience, many of whom are going to be in a position to be leaders of these different ministries of health or centers or nonprofits doing this work, will pay close attention and follow these recommendations. 

I'm aware of your time so I don't want to keep you too much longer, but I did have several other quick questions. The first is, one of the reasons we're speaking now is that you're about to celebrate the 200th anniversary of The Lancet in 2023. It's interesting to me that there's only been twelve editors in chief of The Lancet over those 200 years. It's pretty amazing, the tenure you've had there. What do you see and hope for the next 200 years for The Lancet? 

Dr. Horton: That's a great question. Survival, in this strange world that we have. If you'd asked me even a year ago whether we would have been having a discussion about the possibility of tactical nuclear warfare in the middle of Europe, I would have said, "Oh, come on. Don't be ridiculous." And yet, that's what we're doing now. We're having a discussion about tactical versus strategic nuclear war in Ukraine. This is just sheer madness, but it's happening, and it's very frightening. 

The human species is a very complex organism. We have capacity for creating beautiful objects, moving images, music that can change your heart and your mind in unbelievable ways. And yet, we also have the capacity for horrific destruction of our planet and each other. Which direction we choose to go, it's not entirely clear. We're doing all of this in the middle of a climate emergency which threatens, by the end of this century, to put us on a path that will destroy our species and all other species as well, at the rate we're going. 

So, when I say survival, I'm not joking. It sounds like a glib answer, but I'm actually quite serious. Our role at The Lancet is to draw attention to the dangers that face the human species, but also, to the solutions that are available to us. We're also the species that is most ingenious, that is the most creative, and has the possibility to solve the problems before us. But whether we have the ability to create the solutions to the problems that we are creating ourselves, this remains an open question. So, I hope that The Lancet can make a small contribution to illuminating that future. 

Shiv: Yes, and you clearly already have. One interesting tidbit that I forgot to mention -- given that you're also an aficionado of history and literature -- is that when I was doing the research on how many editors in chief have been at The Lancet since 1823, I learned there have been fifteen popes since 1823. So, there are fewer editors in chief than there are popes over that 200 years.

Dr. Horton: (laughs) I didn't know that.

Shiv: Now, you know. (laughs)

Dr. Horton: That's a good statistic. 

Shiv: You started as a physician. You've obviously had an incredible career both in medicine and in publishing. What is your advice for our audience as they approach their careers in health and medicine about how they can maximize their impact in the ways that you've done?

Dr. Horton: Well, I'm verging on being an old man now, so you should never listen to the advice of a man like me. However, since you asked me, I will give some. (laughs) I think there are two things for me that I've always certainly found very valuable in guiding me that I hope might be helpful in guiding others. 

The first one is, never ever lose your capacity to be shocked by the injustices that you see around you. Remember when you were a child and you saw something that you didn't think was right and you couldn't understand it and you'd say to your parents, "But that's not fair. How can that be?" Your parents would try and give you some explanation, but you'd thought that was wrong as a child. The problem is, as we grow up, we become normalized to injustice and so we don't get angry about it. We don't get frustrated about it. We don't care about it in the same way. So, never lose your capacity that you had when you were a child to be shocked by the injustices around you. Because the moment we lose that capacity, the moment we're no longer shocked by those injustices, then we've given up hope as a species. We should be fighting for each other. 

The second bit comes from medicine -- it's why I love the subject I work in -- never lose your capacity to be shocked by the excitement that comes from medicine and the solutions that medicine and medical science can offer. Medicine, for me, anyway, is the most beautiful discipline because the skills it teaches you, the knowledge it gives you, the possibility of human connection...what other discipline gives you all that?

I'm not sure if you're allowed to do this in today's world of infection control, but in my day, you could go and sit on the edge of a patient's bed and talk to a patient in the middle of the night and they would tell you things about their life that they wouldn't even tell their own family. The enormous possession of trust that the physician or health worker has in relation to the patient and the ability to influence the individual life and the community, society, the world around you is enormous based on the science that we generate and the work that we do. 

Those are the two things. Never lose your capacity to be shocked. Never lose your capacity to be excited about what medicine can do to address those injustices that you see.

Shiv: I love that. Maintaining that passion. Hopefully, that will itself keep people who are listening to this engaged. There's a lot of reasons to be not hopeful about the future, but that passion in finding those causes to fight for makes a lot of sense. 

I will say one thing about your caveat that people shouldn't listen to you because of your age. It reminds me of Arthur Clark's quote, which is, when a distinguished but elderly scientist states that something is possible, he's almost certainly right. When he states that something is impossible, he's very probably wrong. Luckily, you're saying a lot of things are possible.

Dr. Horton: (laughs) That's a good one. I like that. 

Shiv: Well, my last my last question for you is, is there anything else you'd want to share with our audience today that I haven't asked you about? I feel like this interview could go on for hours, but to be respectful of your time, I wanted to give it back to you. 

Dr. Horton: That's kind. I would just say that one of the things that I've always tried to do is keep your mind open to new ideas. One of the things that's most exciting about working at The Lancet is opening my email in the morning and seeing the papers that have been submitted. I still get a thrill from that thirty years on. The excitement of the new.

It is that point that we have seven and a half billion people on this planet and every one of those people can make a contribution to our happiness, advancing society, our health and well-being. The creativity of our species, the possibility of adding to knowledge...that is exciting and I never lose that. It's almost a childlike excitement. It's like opening your Christmas presents on Christmas morning and seeing what you're going to get. That's what it's like opening my email every morning. Don't lose that excitement. The excitement to the new, the excitement of extending the possibilities of life. How do you extend the possibilities of life? That's, I think, what drives me and that's fortunately the world that we've chosen to live in, in the world of health and medicine, and we're very privileged. 

Shiv: I agree. That's wonderful. One last sentiment on that is, I don't know if you keep a journal or a diary but I feel if you did, yours may look similar to da Vinci's. Walter Isaacson wrote a great biography of da Vinci. And one of the things that's interesting about da Vinci's journal is he'll be writing something or drawing a future flying helicopter or puzzling over how to make the Mona Lisa more lifelike, and then in the corner he would scribble, "Consider the woodpecker's tongue. What does a woodpecker's tongue look like?" He had this natural, childlike curiosity and sense of awe that he never lost over the course of his life. 

Dr. Horton: Absolutely. 

Shiv: That clearly is how he connected the dots. 

Dr. Horton: That's a beautiful example, Shiv, actually. I didn't know that. That's a great example. 

Shiv: It's a great book on da Vinci for sure. Dr. Horton, it's been a privilege and a pleasure to meet with you. Thanks so much for taking the time to share this with our audience.

Dr. Horton: It's great meeting you too, and thanks. All power to your work. 

Shiv: Likewise. Thanks again. Take care. 

Dr. Horton: Take care. 

Shiv: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show. Remember to do your part to Raise the Line and strengthen our healthcare system. We're all in this together.