Contact Dr. Boon
Fibroids1: When did you know you wanted to be a doctor?
Dr. Bonn: I had a number of physician mentors when I was a teenager in my hometown outside of New York City, and although I was slow to come around to the idea of being a doctor; I always enjoyed science, biology in particular, and thought, in the back of my mind that being a physician would be the best way to put it together.
Fibroids1: Did you find you first became interested in becoming a doctor before becoming involved directly in your specialty, interventional radiology?
Dr. Bonn: Because I came into medicine slowly and without too many road signs as to which way I wanted to go, I kept my eyes and ears open throughout medical school as I considered my options. I started out with the intention of being an IR out of medical school because I had a particularly compelling and wonderful teacher as a mentor at the University of Virginia, who stirred my interest in IR early on. His name is Charles Tegtmeyer and he was one of the "leading lights" in interventional radiology’s infancy. He was a pioneer in renal angioplasty who met an untimely and early death; otherwise I suspect he would have been your first Hero.
Sure enough, since I was still in search mode, even though I was on my way to being an IR, I was temporarily distracted by surgery and did 3 years of a surgical residency before I realized that even though it’s a wonderful field, it didn’t seem that it was open for innovation or being on the cutting edge. I realized that IR was really where the new innovations were to be found; so I switched over residencies mid-stream, which isn’t too common.
Fibroids1: That’s quite uncommon – did you meet with resistance in your university setting or were people fairly cooperative with your decision?
Dr. Bonn: There wasn’t so much resistance as a mixture of encouragement and discouragement. People who were more traditionalists felt as though it wasn’t the best decision to switch careers midstream like that. But there were others who understood my motive and could see a bit better into the future, so they were encouraging. Even though it took a few years of extra time, I ended up inadvertently with a better training in IR since our specialty has increasingly become more clinical, and I feel as though my surgical training, however brief, was a very important foundation.
Fibroids1: One sort of noticeable schism between the mindset of a traditional surgeon versus minimally-invasive IRs and OB-GYNs is that there has been some tension between the surgeon’s idea that "to cut is to cure" and the IR's thought that "maybe we don’t need to go in so far that way" even though the technology in question is still relatively new and everyone is still nervous about it. As a result, clinicians are reluctant to take the risk in their practice.
Dr. Bonn: You hit the nail right on the head. Doctors are people too: they come with all sorts of different characters and they bring their personalities into their careers right from the beginning. I looked around at the surgeons I was learning from and they were wonderful teachers, but they were always put in the position of being the savior for a bad situation. And they were the last ones people were coming to – if they didn’t succeed nobody could, and most of the time they succeeded wonderfully. And it built up in me a sense that with surgery, no matter how challenging for the patient you could fix the problem. So you become used to the idea over time that this is not all that difficult and you’ve pulled sick people through tough situations; you forget it’s difficult for the patient too and you get a false sense of optimism.
The other half of that is that, on the whole, surgeons tend to be trained as traditionalists - and in a conservative manner. There is a long history of "giants" in the field with incredible discoveries and as a trainee you try to emulate them and you want to be as good as your mentors, which in the past has tended to mean you want to duplicate and replicate what they do rather than invent something new.
And it seems that traditionally, surgery is based on empirical and tactile data that surgeons gather and pass along to their colleagues; with IR, there is a lot of need for creative and imaginative thinking.
As I grew to be comfortable with my approach to medicine, I became comfortable with the idea of innovation and developing new, safe therapies for patients. We were at a time when the door was open and someone just had to step through to take advantage of new technologies: in imaging and in small-parts manufacturing (things like balloon catheters and stents). At the same time these innovative therapies came with their own problems in that everything described is very technology-oriented and technique-oriented - and medicine in the past has been mostly organ-system-oriented. So here we were developing a field based on technology of imaging and tools – and the challenge for us and for our patients has been how to fit into the medical establishment yet at the same time produce innovations and be viable as a specialty.
It’s been a challenge for patients and the lay public to understand where the innovations are coming from and who these specialists are so that when new therapies come along, patients ask, do they trust the specialists (who they’ve never heard about) or do they trust their traditional doctors who are expressing caution and concern?
Fibroids1: And how do you respond to that? Some of the struggle is just in gaining patient trust and acceptance with these new technologies. A physician needs to be able to gauge what kind of patient he’s dealing with to present a technology in a way where patients don’t automatically close off a viable treatment option because it may be threatening.
Dr. Bonn: That’s very true. This is where I go back to my surgical training as being so valuable because it gave me a couple years of just sitting and listening with patients, talking with them, understanding their issues, and really feeling comfortable with the idea of being a physician. Although interventional radiology training itself is becoming more and more like this I got a very intense dose early in my career. I feel very comfortable identifying what a patient’s issues are, what drives them, what bothers them, and I’ve also been very interested in education, both of other physicians and of patients. I enjoy the act of discovering these new innovations with a patient, explaining and trying to put them in terms that each individual can understand.
Fibroids1: When medicine is transformed into constant inquiry and dialogue between patients and doctors or students and doctors, do you find that it, across the board, is useful in forming successful modes of communication?
Dr. Bonn: It’s universal. It’s probably just more common in more traditional fields. It’s in greater demand now in IR because you’re not only trying to prove what you do is safe and effective, you’re also constantly educating physicians and the public who are unaware of what you do and are in the process of discovery with you. And that’s been both the challenge and the curse. It’s a wonderful thing to rise to that challenge, but it can be a curse that prevents some of the development of our field. For example, something like fibroid embolization is this great innovation, but it requires many years of proof and telling gynecologists, referring clinicians and patients that this really is safe and is effective, even if we don’t have a whole lot of data, but all the data is pointing in the same direction. We spend a lot of time and energy putting the message out, and hoping that it’s heard.
Fibroids1: Do you think it’s important to educate new doctors, new interventional radiologists as they come along to be very disclosing with patients? Such as, "yes you will experience pain," and to communicate to patients realistic expectations of how they’re going to feel after this treatment?
Dr. Bonn: I think ‘realistic’ is the operative word there. Marketing in medicine has real risks. I want to treat a patient who has the best understanding of all the alternatives, who embraces the treatment I am about to give to him or her with a full understanding of its risks and benefits, and not feel afterwards as though they have been "marketed to," but instead feel as though they have all the information needed, and have made an informed decision. I think there are also physiologic implications. One of the great things I observed as a surgical resident was the power of positive thinking: the differences with which different patients’ personalities played into their recovery. The more optimistic, positive outlook person seemed to recover more easily than the negative person from the same procedure, same risks, same everything physiologically. The honest discussion with a patient who really embraces the treatment beforehand and during has huge benefits afterwards, for the patient especially.
Fibroids1: Absolutely. In terms of forthcoming technology, for example in the next 5 to 10 years, are there any buzzwords you think are important to discuss or anything you’re particularly excited about to use in your career?
Dr. Bonn: To give a broad answer, we’re going to see many developments in oncology, IR applied to various subspecialized areas of oncology. It’s going to be everything from just being the delivery system of various treatments to developing some of those treatments because we have those innovative mindsets that old ways of thinking can be challenged and new ideas can be developed. In oncology, the field is ripe for new innovation. We’re in a great position to be there. I see that as one major area of impact.
Fibroids: Are you talking about more targeted and less invasive treatments of malignancies within the body?
Dr. Bonn: Exactly. And delivering in minimally invasive ways new innovations of treatments, something as simple as ablations (which is more a mechanical therapy) to various chemotherapy agents or gene-based treatments.
Fibroids1: Would it be possible to use embolization to target chemotherapy to a very specific part of the body without negatively impacting other parts of the body?
Dr. Bonn: It’s already going on in the field of chemo-embolization. Tying chemotherapy and embolization treatments together reaps tremendous benefits. You are able to give greater doses to limited areas of the body where it can do the most good, and at the same time minimize the systemic side effects.
Fibroids1: And do you see minimally invasive treatments as becoming big within the next 5 to 10 years?
Dr. Bonn: I think IR is undergoing a very large, almost revolutionary change now because we have watched as turf issues have eroded a lot of our control over innovations. At the same time we realize that we have a lot of assets within our field that can be utilized if we become real physicians, if we respond to the need and not just remain secondary consultants, but real primary care deliverers and true physicians in the full sense of the word.
Interventional radiologists are beginning to mediate the field between secondary and primary care.
What’s been a remarkable change in how we view ourselves is our increasing ability to relate directly to our patients and to form relationships that are lasting. For instance, we have a very busy chemoembolization and immunoembolization practice. The latter is a subspecialized form of chemoembolization for melanoma tumors. When they metastasize to the liver, melanoma of the eye is a very rapidly growing tumor. It has been found to be sensitive not just to chemotherapy agents in the traditional sense, but to immunologic agents specifically, delivered in the same way as chemotherapy is delivered to a primary liver tumor.
One of the great side effects of this innovative approach we’ve seen is that we have developed wonderful long-term relationships with patients who are doubling or tripling their expected life span after having received some pretty devastating news.
That’s great news. When you can tell a cancer patient that the treatment will not make him as sick as the disease, it is a huge step forward towards improving the cancer patient’s quality of life. This is especially important when dealing with a terminal illness.
I had the fortunate ability to work at the Sloan-Kettering Cancer Institute during my summers in college. I had a glimpse of the old era of the silver bullet chemotherapy, the search for the magic chemotherapy agent that was going to cure all cancer. And then I watched the whole field evolve quickly into a combination of that philosophy plus immunologic tools, ways of using the body’s own immune system to attack cancer selectively, and now here we are a couple decades later. We’re putting all that together with high technology and interventional techniques to deliver these agents. What goes around comes around, in a sense.
Fibroids1: It enables you to build this arsenal of many weapons rather than a few strong treatments. You’ve covered many of the challenges that patients may encounter with new medical technologies. My next question is: how would you recommend that patients go about finding a good IR for a problem they may have?
Dr. Bonn: I would send them right to the Society of Interventional Radiology website, which is SIRweb.org. It is great for locating an IR near you, or locating an IR with a particular area of interest. It also has wonderful information for patients on a variety of topics.
Fibroids1: Once they find an IR who they might want to further a relationship with, what questions should they ask that person to be sure he or she could meet their needs as a physician?
Dr. Bonn: One thing they’d need to know is: is that an area of interest for that particular IR? Because although we used to be generalists and cover all of IR, and I still do to a degree, the field has become so broad and so deep that it is impossible to be a master of all, so even now there are many subspecialties within IR. In our small practice, two of my colleagues specialize in oncology, and two of us specialize in fibroid embolization while the others do not. So you’d want to know if this is an area of particular interest for that IR. Then you might want to know, what sort of training has that person had? Have they had a fellowship or an internship in IR, for example, versus doing general radiology and then practicing IR?
Fibroids1: Is there anything else you’d like to add?
Dr. Bonn: One thing we haven’t really talked about too much is research and the future. I have been lucky to be named chairman of the Society of Interventional Radiology Foundation. It has renewed and revived interest in research and education in our field. The SIR has seen the need to devote more attention and resources to the future, which has been created by research. The foundation has a renewed mission and goal to bring IR innovations to its members and ultimately to the public and to patients. That’s been exciting for me this year because it’s a totally organized and revived foundation.
With the help of an enormous number of dedicated physicians and the energy of so many talented enthusiasts, we can see a bright future ahead for our patients.
Contact Dr. Boon