Med School Minutes-Ep. 59 | The Science Behind Viagra w/ Dr. Arthur Burnett

In this episode of Med School Minutes, we sit down with Dr. Arthur Burnett, a Johns Hopkins urologist, researcher, and professor whose work helped unlock the science behind Viagra and reshape how medicine understands male sexual health.

In recognition of Black History Month, we reflect on Dr. Burnett’s groundbreaking career, his impact on men’s health research, and the importance of representation and mentorship in medicine.

From nitric oxide and vascular health to aging, prostate cancer, and longevity, this conversation explores how scientific discovery shapes both medicine and culture, and what future physicians should know.

🎙️ Topics covered:
• The science behind erectile dysfunction
• Nitric oxide and vascular health
• Aging, longevity, and prostate cancer
• Representation and mentorship in medicine
• Why there’s no shortcut to becoming an MD

00:00 Introduction & Episode Overview  
00:41 Meet Dr. Arthur Burnett (Johns Hopkins, Urology & Research)  
05:50 The Science Behind Viagra and Nitric Oxide  
12:42 How ED Research Changed Medicine and Culture  
23:05 Aging, Longevity, and Men’s Vascular Health  
28:10 Prostate Cancer, Screening, and What Men Should Know  
38:43 Representation, Mentorship, and Diversity in Medicine  
47:44 Advice for Future Physicians and Final Thoughts  

#MedSchoolMinutes #MensHealth #MedicalPodcast #Urology #SaintJamesSchoolOfMedicine #SJSM

Transcript

Intro

SPEAKER_03 0:01

Hello, and welcome to another episode of the Med School Minutes Podcast, where we discuss what it takes to attend and successfully complete a medical program. This show is brought to you by St. James School of Medicine. Here is your host, Kashik Gua.

Meet Dr. Arthur Burnett (Johns Hopkins, Urology & Research)

SPEAKER_04 0:19

Welcome to another episode of Med School Minutes where we talk about everything MD related with a focus on international students, specifically students from the Caribbean. Today we're talking about something half the internet pretends not to care about, and the other half is obsessed with. And we're talking to a physician whose work has quietly changed it forever. Our guest today is Dr. Arthur Burnett, a urologist, surgeon, professor, and scientist at Johns Hopkins, whose research helped unlock the science behind drugs like Viagra. He spent decades studying male sexual health, aging, and prostate cancer, which means he's probably taught more about penises than anyone you know professionally. This conversation is about longevity, medicine, and how science quietly changes culture. Let's welcome Dr. Burnett. Thank you so much for taking the time, Dr. Barnett, to uh come on our podcast. Uh like every other guest, I would really like you to uh introduce yourself for our uh viewers.

SPEAKER_02 1:25

Absolutely. Well, uh my name is uh Arthur Burnett, Dr. Arthur Burnett, although colleagues and friends call me Bud. I happen to be a full professor of urology at the Johns Hopkins uh uh medical institutions, uh where I've been in practice uh for more than 30 years. Uh actually I had come to this institution about almost 45 years ago for medical school training, and then went through medical school and residency and surgery and then urology. Uh my career uh does span being an active clinician and surgeon, as well as uh a researcher, a scientist, uh, with a focus in uh prostate cancer, men's health, sexual uh health, uh, and uh have uh participated in a range of activities uh uh that include being an active surgeon, being a researcher, uh, being an educator uh for my fellows, my residents, uh a bit of a humanitarian as well as an advocate uh in the general uh public uh with regard to uh men's health and prostate cancer issues uh primarily.

SPEAKER_04 2:28

So um uh I do want to uh touch upon uh a couple of things. One is uh if I'm not mistaken, I believe you were the first African-American uh faculty member at Johns Hopkins, is that right?

SPEAKER_02 2:41

Well, in urology, uh certainly as a faculty member beyond just an instructorship level, uh I was able to come on faculty and really have been now a full professor here at Johns Hopkins. Uh gosh, uh uh probably 22, 23 years, something of that sort. So really I've ascended the ranks and really the first to get to this kind of a level at uh this sort of institution.

SPEAKER_04 3:04

Absolutely. And um uh I do want to talk a little bit about that experience. Um uh first of all, obviously, you know, I do want to uh wish you a very happy Black History Month. Um and uh this is a very opportune moment to have this discussion, but uh since you have broken a lot of glass ceilings, um, so to speak, uh what were there any challenges uh when you were uh taking this role? Was this an uh ambition when you started at Johns Hopkins, or is this something that kind of happened as you were, you know, your career just progressed?

SPEAKER_02 3:46

Yes, yes. Well, you know, certainly there have been obstacles, there have been challenges in various ways. Um nothing from within myself. Uh and I think I've been fortunate to to get on the right track early in life, uh, with some early education support from my parents and and able to get into some early educational uh uh uh kind of activities and and schooling that that uh got me on a track uh to just perform as well as anybody out there. And I never personally thought that I I viewed myself in any different way than than anybody else uh along any of my peer levels, uh, that I felt that my performance needed to be as well as anybody's and really in some ways maybe even outdistanced uh uh some of my class members uh going even way back uh to to to uh uh to the most basic elementary years. Uh and and and I just felt that just just uh striving toward excellence is something that all of us should do, uh irrespective of our background or race or anything else of that sort. And just performing along the way, I've achieved these ranks while uh that while still I guess others may have perceived and certainly I recognized this that that um I was somewhat unique. Uh, but that wasn't the driving motivation. It was really just more of wanting to always excel. And uh and there and there were obstacles, yes. I can tell you obstacles uh relate to uh those who may almost judge individuals of of backgrounds uh uh uh uh prior to even meeting people. I've had patients walk in the door and say, Oh, you're the famous Dr. Burnett. And I can tell that they're a little surprised uh um because I didn't quite look like uh what they somebody might uh typically think of as the you know the kind of uh the professor you would think at a at a j at an institution like this. But uh but I've not been taken uh back by any of that. Uh I just kind of understand that uh our society needs to grow. And um and I've just made able to just uh proceed and and and overcome the challenges and and uh and excel nonetheless.

The Science Behind Viagra and Nitric Oxide

SPEAKER_04 5:49

Right. And uh uh you made a comment about the uh famous Dr. Barnett, just so for our audiences, I do want to uh preface that uh and elaborate on that a little bit. Uh you had a hand in uh maybe not directly, but definitely had a significant role to play in the development of one of the drugs that has culturally changed mankind and probably culturally the most significant drug in the last 50 years, at least that's my opinion. Um why don't you tell us a little bit about that?

SPEAKER_02 6:23

Sure, sure. Well, thank you for indulging me. Uh you know, I I certainly have been gratified to have been at an institution like Johns Hopkins and have a variety of collaborators and and opportunities along the way. Um not that uh anything at a place like Johns Hopkins here, that everything is just laid out in front of you. There's opportunities, but you you know, you you gotta be able to kind of step forward here and and and create a path. And I've been able to do that. So in brief, um you're right, the this the medication uh that we all know of, an erectile dysfunction treatment, uh uh often known as Vigra, uh the drug named Sildenophil, uh that was the first drug, and now there are a few in this class uh that are used to treat erectile dysfunction. And uh many may know the serendipitous story of how the drug was being studied uh by uh the manufacturer for a heart ailment called angina, uh, and as how some of the patients were were taking the medication thinking that it would help uh increase circulation in the in the blood vessels that supplied the heart. Uh and during the midst of the trial, uh the uh patients uh involved kind of proclaimed, oh, well, I I don't know how it's helping my heart, but gosh, I don't stop this, don't stop this treatment here in this trial I'm in, because I'm getting better erections. Uh and that there is some sort of serendipity in terms of how that that kind of went in a in a sideways direction then to become an erectile dysfunction drug. But part of the story behind all of that was the recognition that uh the the the medication itself um known as the phosph phosphodesterase type 5 inhibitor. And uh for the audience I'll I'll just leave it as a PD5 inhibitor. Um uh it would turned out to be part of a pathway that uh was being described in the scientific field as the the mysterious story behind how erections occurred. And and around that same era, which is around the early 1990s, I was involved with uh research here at the Johns Hopkins Medical Institutions investigating the science behind penile erections, uh, in part because I led you know a lot of questions about how we were managing men for this condition. Back when I trained in the mid to late 1980s, uh I was really dismayed that we really did not understand erection disorders, and that we did not have good treatments for men. Uh, we were a little dismissive, just said, here's some supplements. If not, we've got kind of most primitive-looking penile prosthetic devices to put in somebody's penis. And I said, you know, we really need to understand this disorder better. And of course, this is an institution that promotes scientific discovery. And so along the way then I said, well, let me understand the mechanism of penile erection. I I really went about some intensive work understanding uh the neurotransmitters involved, the various factors that make the erectile tissue respond. And I learned that a a neuroscience group here at Johns Hopkins was studying this chemical called nitric oxide in the brain and had developed some techniques to understand uh the various uh uh uh uh pathways, the enzymes that make uh this this chemical uh factor, and uh the science of how it worked uh as it was emerging in some other vascular systems of the body, blood vessel systems, that is. And of course, penile erection is a blood vessel system. Uh it really is. Uh an amazing organ, the penis here. Um but um with that uh you know, I think I originated some ideas about how it had to do with uh sickle cell disorders and erection disorders and sickle cell disease, uh often known as priopism, prolonged erections, and then really built on that science uh and um carried out some some scientific work in the basic science research laboratory that proved that this chemical was the elusive mediator of penile erection, uh, that it's released from nerve endings and the and some of the blood vessel linings that created the erectile tissue response that allowed blood flow to occur in the penis. And I was able to first author uh an article in in the journal called Science, which is the most preeminent uh scientific journal really in the world, as the first author as a urology chief resident, who would ever thought of that, that somebody at that level and in urology and as a surgeon would ever write a major scientific article. Um but uh that along with many articles that followed uh does characterize my scientific career. And I guess people have cu have then acknowledged that I was the guy who really put it on the map as a physiologic mediator and neurotransmitter of penile erection. Uh, and uh that was the foundation for the scientific pathway uh by which uh it was understood that uh this PD5 inhibitor uh that was studied kind of a completely in a separate way was uh was then recognized and say, wait a second, this this is the pathway that's being described uh for penile erection as we put it on the map. And and of course, I should acknowledge there are other investigators um at various other medical centers uh here and there working in various other ways studying uh cardiovascular diseases, hypertension, uh, and maybe some other foundational work as well. But I guess we're uh we we meaning my group here um working with the neuroscientists here at Johns Hopkins, uh, we were able to really put the them the you know the seminal article out there that that critically advanced the field.

How ED Research Changed Medicine and Culture

SPEAKER_04 11:41

That's amazing. Um when you were going down this road, did you imagine the um so you know I mean again the saying is always is that uh uh you know culture f culture follows the medicine. I mean, uh you've changed uh indirectly the lives of practically every senior citizen. Uh I mean, and and and that's something that we will get into uh a little later about longevity. But uh generally speaking, uh this was an issue as men get older. Um uh erectile dysfunction is uh was always known that, you know, okay, it happens, and if it happens, you know, there's not much that can be done about it. But uh obviously uh your research has uh again, I've said this already, but it's kind of revolutionized uh culturally at least, revolutionized um the way uh men look at themselves, the way the way men age, even. And did you think that when you were doing this research that this would have such far-reaching and such incredible uh such an incredible cultural influence of your research, of your scientists?

SPEAKER_02 12:55

Well, thank you for uh yeah suggesting that uh I might have had some sort of premonition about all that, but you know, in all uh truthfulness, I guess it was just a matter here of just uh the the pure joy of the science, uh, and realizing I think that uh they was going to be impactful, uh, whereby uh the you know there there's other precedents out there, uh other discoveries that have led to advances in medicine, uh, and just the pure joy of working on it and then thinking through that uh perhaps this would lead uh to uh ways in which we can help men with erection disorders, and not just older men, uh, but also men having various disease states. You know, that we we recognize that erectile dysfunction is prevalent. We use this word erectile dysfunction, ED rather than impotence these days. At that term, it's uh very negative and and maybe not too specific, but erection issues uh are common. Uh and as the field was evolving even from the 80s and 90s, that you know, we were saying that, you know, we'd recognize that this is a condition uh we we can talk about, that it's not such a taboo subject. It happens in men getting older who have uh uh various other disease states from from cardiovascular health issues, diabetes, metabolic disorders, all these kinds of things uh that that can be a physical problem and the and erections is a vascular um kind of phenomenon. Uh blood vessel function in the penile area mimics what goes on elsewhere in the body. So so so really the the impact of it uh I think has been tremendous in various ways. It's led to new scientific developments, as we talked about, uh oral medications, uh the PD5 inhibitors to treat erectile dysfunction, but also really understanding uh uh uh how the the the uh male organs work and how maybe even the female organs work uh in that part of the body, uh in the lower urinary tract and genital area. So so really it's been quite a quite a journey, uh, and um I'm just glad I've been able to make some impact.

SPEAKER_04 14:50

I mean, I think not some, I think you your impact is definitely outsized. But um one question I do have is that obviously uh you know uh right now I think every middle-aged uh man if on their social media feeds, on their emails, banners, we all get uh these advertisements for uh C L and Viagra. But it's almost changed the nature of the drug as a um uh almost like a health supplement. At least that's how a lot of these newer companies, and and I can only assume that uh the the patent for Viagra might have expired, which is why it's become a very generic drug now. But it's being marketed essentially as a health supplement as opposed to a drug that has a specific um uh you know effect. What are your thoughts on that? Is that safe? Is that not safe?

SPEAKER_02 15:50

Well, you know, I think that um as you're discussing it, you know, the role of this medication um yeah may have been expanded. Uh there are a number of implications suggesting that just taking it for your general uh the cardiovascular health might be beneficial. Maybe it's being used in some instances with some uh promoting the idea that it's uh it's just as useful as the vitamin almost, or supplement, as you're you're saying. Um, it's certainly my view on it uh is maybe my own view. Uh I'm not sure uh you know whether there's any any uh you know proven authority here that has to say it's one way or the other. But you know, I think it does have the the indications that it was approved for, uh, which is treating erectile dysfunction. It's also uh a similar kind of drug that's been used for pump for pulmonary hypertension and maybe some other true indications. Whether it really just helps your general vascular health uh has been an area of interest. And I think there may be some scientific support for that. Uh so um d do I think it's still potentially uh advantageous in that role? Conceivably, yes. Um certainly I I feel strongly about its role in which it it's been well studied, uh always kind of following the this the you know the science. Um at the same time, um a remark might well be might well be uh that since it's seemingly such a safe medication, really it doesn't uh have uh much uh other significant long-term adverse effects in any way. So if it can be potentially beneficial without really harming anybody, then I'm I'm I'm gonna generally be supportive of that.

SPEAKER_04 17:23

Okay. That's uh good to know because uh you know, as I keep mentioning, that this has uh has a significant cultural impact. And uh as I was uh reading up, it seems like uh one of the unintended consequences is that it apparently uh revolutionized the adult entertainment industry.

SPEAKER_02 17:42

So well, maybe so. Again, it has those implications, and yeah, and I guess we can all be amused about some of these other directions it's going in as. But you know, I think that but the point I would also offer now, just in terms of a conversational thing, you know, uh discussion you you and I are having is is this you know the what are the potential uh implications that uh that are using these kind of medications with a sense of you have to be on it because you need it to perform. Um perhaps some of the the unfortunate negative uh connotations, the one thing I'm a little dismayed with, for example, is the sense that even some young men, maybe even their in 20s uh years of age, um, are feeling compelled that they have to perform uh in in a way that may be unrealistic. And perhaps uh they're unfortunately maybe compelled by societal forces, uh maybe even even their their their their uh uh partners that they're saying, uh, why can't you uh keep an erection for 10 hours? Why can't you uh perform better? Blah, blah, blah. And we're and and this may may actually have some some challenging negative implications on on what is realistic about male performance. And so, you know, I I think that uh a good discussions from maybe authorities like myself just to kind of put things in some perspective uh and try to be realistic about what male sexual health is all about really is important for us to talk about as well.

SPEAKER_04 19:07

Right, right. Well, I mean, uh I I definitely uh I do know that there seems to be a movement, at least in social media, about uh the reality. But talking about uh uh unrealistic expectations, uh this seems to permeate across uh different silos in society. For example, what I mean by that is not just how um people need to perform in the bedroom, but also in life. For example, uh there's been this big movement a couple of months ago about how much people should be earning. And uh interestingly speak, uh interestingly, there are statistics in the Department of Labor, and everybody puts out what the average median income uh average uh per capita GDP household per household is, and then uh you have people going on TikTok and saying, Oh, I made$800,000 last year, 900,000. I mean, and and that's not realistic for the vast majority of people. And and sure, there are unicorns everywhere, but uh and I think that this generally the social media just really um brings about uh a false sense and and and we see that uh again uh the word disinformation has been used so much across the board, but when it comes to these kinds of things, it really is uh very, very uh challenging to do that. And then you know, when somebody sees that they just look at that one video without doing any further research and they take it uh for at that hey, this is what is the norm. In your opinion, how could we possibly um you know fight that this sort of uh you know disinformation, or let me just rephrase that as saying some people get a lot of glamour by saying, hey, this is what I used, this is what I did, um, and then everyone's kind of jumping on a bandwagon, especially when it comes to influencers. A lot of influencers tend to do that.

Aging, Longevity, and Men’s Vascular Health

SPEAKER_02 21:13

What are your thoughts? Well, you you're sp well my thoughts are I think that uh you know this may be a uh a global phenomenon, not just in male sexual health, but maybe just uh in terms of just uh general uh health or maybe even just general life activity, as you're saying, um that uh that um you know some of the messaging that goes on is counterproductive. And you know, yeah I congratulate you and and and perhaps others who in a similar way say, well, we need to speak to real credible individuals like myself, um to help provide messaging that's healthy, not unhealthy. Uh because again, if we create uh some sort of um false narrative and some sort of uh discussion of of expectations that are not realistic, uh while it may sound glamorous, it may make some sort of headlines here or there. It does potentially fuel anxiety in our in our in our in our in our public. And that may speak to you know how our society uh may be different than uh maybe other places even around the world as I've traveled quite a bit, you know, of course you kind of get a sense that in America we create all of these expectations perhaps uh in many ways. And then next thing you know everybody is is all anxious and everybody's stressed and everybody needs some antidepressants. And uh you know maybe that's just just it's almost it's almost created uh unfortunately where that's not really necessary or appropriate. So I'm glad to be on the show for this instance as far as where I can be an authority in anything. I'll I'll I don't want to overstep my bounds, but in my lane I'll talk about uh you know men and male sexual health and things of that sort. Uh but to just create more realistic uh uh narratives uh I'm glad to be part of that dialogue and just really help men understand uh really what what their sense of manhood should really be about.

SPEAKER_04 23:05

Well I mean uh since we are setting the record straight uh I think you know again I think uh bedroom habits are also one of the things that uh is like uh income levels people don't necessarily talk about it openly or if they do talk about it it tends to be incredibly uh inflated for the most part um from your experience uh what would be a norm as far as uh a general performance time for example generally speaking yeah well you know I think that uh you know that generally speaking we we're not talking about hours you know performance time you know which which may be kind of where there's some sort of you know the sense that that's the whatever everybody should be aiming for.

Prostate Cancer, Screening, and What Men Should Know

SPEAKER_02 23:49

That's truly unrealistic I don't think you know I you know I think whatever anybody's comfortable with I don't want to set any limits per se but just so that uh individuals know that that that you know being able to perform in the bedroom uh for some realistic uh half hour hour or something or even less is still very normal and very acceptable uh and don't uh don't minimize uh who you are as a man if you say well you know I think my neighbor is still going there for you know oh all night long or something right I mean that's that's that's that's just that's just uh just in the movies that's yeah that's all in that's all in Hollywood guys come on um so what one other aspect that you really focus on is uh vascular health and and uh men's prostate and prostate cancer that's uh one of your areas of expertise if I'm not mistaken um I I I do have uh a question I know that there is always a debate that uh you know human beings have played God and uh we have uh extended our um longevity far beyond than intended um and I know that is uh very debatable but uh I think uh in the United States the average life expectancy is about 79 80 years uh in Japan I think it's 83 uh globally I think it's uh well into the 70s um and do you think that the uh reason um prostate cancer prostate cancer wasn't uh uh uh a major cause of concern in the early 1900s where average life expectancy was dramatically lower but now obviously the incidence with people living longer men living longer it's become uh apparent do in your opinion do you think that the human body is not or at least the male human body is not designed to live that long what is your take because obviously you're you're having diseases uh that normally wouldn't manifest if we were following whatever our natural design would be which is not living those 70s modern science is going to continue to surprise us uh um you know who would have thought even a generation or two back we'd even live to be in the 70s and 80s um the reality is is that there are many cultures uh many regions of the world where the uh the individuals live into their hundreds um you know we we see these documentaries and exposed days of of of individuals let's say in Japan who are living in in their hundreds right um what the I think what this speaks to us is is that uh you know how well we live our lives uh and and how we you know perhaps uh take care of ourselves along the way um it may dictate how long we live um you know there's always the the amusing adage that if I knew I was going to live this long I would have taken better care of myself and and uh and and uh you know I guess I guess that speaks to the fact that that person has been taking care of themselves. Because I think there are some factors here uh just for the audience to to just recognize uh that can adversely impact your health and if we just change our ways and maybe do it as early as you can in life and it's never too late to make changes, do that. So for example, cigarette smoking. Adversity is going to affect your cardiovascular health, may affect your longevity. You know, a good balanced diet, a certain level of activity and fitness even in your later years, being uh functional in terms of uh having activities in life, having individual individuals you interact with and converse with and think with even in your older years, keep your mind active a certain amount of just restfulness and getting a good normal sleep. I think these are all you know now increasingly observed factors, keeping a good weight uh and and maintaining a certain level of fitness uh which I've mentioned um and and and then I think obesity and and and poor diet habits in the United States probably has impacted negatively on longevity. So we can make these kinds of changes in the in basic our lifestyle it'll help your general health your longevity and also help your your your your male sexual health the meaning of that too that's excellent.

SPEAKER_04 28:10

So um from what I've heard again I'm not a physician by training um but the I've heard that most men with a very relatively high uh incidence rate will get prostate cancer as they get older. Is that true?

SPEAKER_02 28:29

Well we know that prostate cancer uh is a prevalent uh cancer prevalent disease state um but it is a cancer uh but we're also uh recognizing how we consider this and it it is something that occurs just just by way of epidemiology the basic uh population incidence if you will uh in men as they get older is not common in men in their teenage years let's say uh but it may be to some extent a phenomenon of just you know the prostate goes through a lifespan and cancer can develop them in them as the years accumulate. But I'll leave this with you as well that that not all prostate cancer is so pathologic that it definitely is going to be a life ender, if you will. We're doing a better job in my field as a urologic surgeon uh as well as scientists in this area of men's health and prostate cancer to recognize that not all prostate cancers are the same, that it is a broad spectrum disease, uh that there's some forms of it that are very uh uh low profile and and unaggressive and likely to just be present as men get older but may never have any kind of consequence in that man's life. So so as we do a better job of of um of uh of of evaluating men, uh characterizing what the prostate cancer threat is on a man-by-man basis. Uh some men we say, you know, you have cancer, but that prostate cancer that is but let's put you on an active surveillance protocol that's monitor things and and put this in perspective also with their expected longevity and health situation. Yes some prostate cancers can claim lives and so all men should get checked out as you get a little older in their years and uh and and thus take action if it fits a profile that is it's more of a threat. But um but we realize that this is not a uniformly uh same disease in everybody now.

SPEAKER_04 30:18

Okay.

SPEAKER_02 30:18

And um I think uh uh at least amongst uh uh my friends and I'm middle-aged um does an enlarged prostate uh mean that uh there is a higher incidence there might there might be a higher incidence of prostate cancer well um again a higher age just means that I think it's more prevalent uh it's just we know that the prostate may go through some sort of evolution of of just time and and cancer uh the prostate that occurs in men getting in their 50s 60s 70s and older than than in your teen and early adulthood does that um so we just know know that to be so but but again uh that's why you you know some of the society guidelines are indeed get screened as you get to a certain age range uh in the 50s or so or maybe those with a strong family history or African American race you may want to get a a screening done in your 40s and the screening is a PSA test a blood test but get but get evaluated get evaluated is the right thing to do.

SPEAKER_04 31:22

Okay. I know we talked a lot about uh your expertise but uh one of the unique uh features and I I will say this in my uh uh role I speak to more program directors and physicians than actually most physicians do but um uh and and one thing I've noticed is that physicians tend to pick and choose they either go into research or they become clinicians um and while being a clinician they kind of dabble in education but it seems like you have kind of nailed down all three of these aspects very very well you've done extensive research as we discussed earlier you're obviously a professor at Johns Hopkins so you've got the education part done but you also have an active practice how did you manage to do all three of these or or or equally support these three pillars of your career career?

SPEAKER_02 32:17

Yes yes well it's certainly been a uh bit of a journey uh and uh uh the way I think I managed it is just uh um in a way um uh have had fortunate opportunities uh to uh meet uh these the different dimensions of a career uh and um excel in each of these. Uh maybe that's been uh a bit of my uh challenge recording to my wife I I I have too many too many things on the plate. Uh uh and then maybe that that speaks to just the the the success I've had and the good fortune I've had to have uh some some talents bestowed upon me that I'm able to to excel in all these areas and and balance them in such a way that uh they they complement each other and still allow me to to feel like I'm fulfilling my best uh uh uh uh uh uh uh talents uh uh and to be put to be put to good use. And um I've just just been able to to thrive along those ways and and uh consider myself fortunate to to to to have these opportunities and to be successful with them.

SPEAKER_04 33:22

Right. And do you think that along uh along your career there might have been some major sacrifices that you might have made?

SPEAKER_02 33:31

Well I think so I mean uh we we all uh have only so many hours in a day right and so uh so I may put in a few more hours in the next and uh you know have made compromises here and there I may have missed a few uh evening dinners and things of that sort uh but uh but that's uh comes along with it so that's that's part of the reality.

SPEAKER_04 33:54

Would you say to put it very bluntly are there any regrets or things that you would have done differently if when you look back on your career?

SPEAKER_02 34:02

No, no real regrets. You know sometimes little things you might say I might have done a little differently it may have slowed down here and there I may have you know created another you know the personal uh the direction here and there I don't think these are regrets though. Yeah I've I've had a happy family life I've had a good personal life I've had a good professional life I feel fulfilled I feel like I've had some uh impact uh in a very positive way uh so uh summing everything up I I I I think that uh uh there's nothing I would feel strongly about that I've done in a way that I truly regret.

SPEAKER_04 34:38

Dr. Brent you absolutely need to be the spokesperson for the medical profession across the board because um when we talk to a lot of young people nowadays uh I I get this term a lot that the juice is not worth the squeeze. And it really annoys me when I hear that um because I genuinely feel that uh you know in my opinion there there there are only um four real professions I I'm an accountant by training it's I don't consider that to be a real profession. I mean it's it's it's needed and necessary but what I would call civilization building professions uh doctor farmer uh engineer and teacher if you put these four professions on a deserted island you will get civilization if you put an accountant on uh on an accountant lawyers and consultants on an island there's no civilization um so uh I I genuinely think physicians is one of the true civilization building professions but the problem that we generally face is that uh because it takes so long and it it is it's grueling it's probably I would say the hardest um profession out there I I'm a certified public accountant but I can tell you I've seen the USMLE test I've seen the amount of work that goes into it I've seen how uh the exams get changed regularly to keep students on their toes there's nothing like it and yes people can say that my profession is very hard but there's nothing like uh physicians and for somebody to come and say that you know you've had a very fulfilling life I really really think that that is something that a lot of young people really need to hear because uh you've obviously done things because you wanted to not because on social media somebody comes and says that this is you know if I did this the money comes at the end of it. I mean and and yes doctors make a lot of money but they also make about eight fifteen uh in some cases twenty years of sacrifice before getting to that goal and I really really think you should get out there and tell young people that what you just said that everything can be fulfilled and you can have everything you want and there might might be a couple of sacrifices here and there but at the end of it it'll be all worth it. And uh that that's that was a really beautiful thing.

SPEAKER_02 37:10

Well I appreciate your comments on that and you know I you provide a perspective that uh you know had has actually even as we're having this conversation now uh has enabled me to to to consider what you're saying on even a deeper level because again I don't dwell on these things. I guess maybe it's just second nature to some extent but but I but I agree with you that that uh you know the at least for me um you know yes some sacrifices early in life are made to some uh compromises to get to a certain level uh because to be a competent uh uh physician and be a trust uh trusted individual with people's lives you gotta you gotta realize the reality of that and and the seriousness of that uh but there's great rewards in all this and uh perhaps the the the messaging again we talked about this earlier needs to be put out there where you know that to achieve important things in life sometimes it does require a little hard work. Maybe we we've kind of created kind of an impression out there that you know only work so hard and and things are going to be challenging but don't don't feel badly just go ahead and you know take this this this easier path and and so forth. But you know sometimes that's not always the right way to do things. And and and and and and working a little harder, striving a little farther, um achieving a certain thing that you feel is what your potential is, there can be great satisfaction in the long run with that. So if I'm an example of that, let that be that example uh to others that uh uh that um yeah you you you you feel fulfilled if you if you really earn something well you know that's that's the that's the truth.

Representation, Mentorship, and Diversity in Medicine

SPEAKER_04 38:42

Right. Um so uh switching gears a little bit I do want to talk about um the medical profession in the United States as it stands today. In the United States uh African American population is give or take 15%. However there are less than six percent of practicing physicians who are African American and I believe uh there is some um definite efforts to potentially increase that number but it's nowhere near representative of what the overall population looks like. What are your thoughts on that generally speaking?

SPEAKER_02 39:17

Do you think the United States medical system is really doing enough to have uh a physician workforce that is representative of the population Yeah so I do have a certain sensitivity about this and and certainly recognized it and in fact that's been a purpose in my career uh in in so many ways. And the your in urology that number is probably about two percent. Wow about two percent of the urology workforce is truly African American and our population does represent a much more diverse group than than that. So I I think there's something to be said about a workforce that does represent the population uh that does help uh uh address uh the the healthcare needs of populations where individuals may say I would like to see a physician that looks like me, that behaves like me, that can understand me, who may have a certain degree of cultural sensitivity and be able to address my my needs. And so I I I've recognized that, have been very involved in mentorship, very involved in in being a role model, involved in a lot of activities to try and bring bring along the next generation, try to expand uh the the um uh uh uh uh uh the the the entry of of of individuals of diverse backgrounds. Because I think that's needed in our population. Right. So my so you're hearing me to g get to your answer. Do I do I have a certain awareness of that, a certain uh take on all of this? And my answer is yes, I have a take on this, that we need to improve this and we need to uh uh do take some constructive uh uh um uh efforts uh and and and directions uh to achieve this. Maybe we need to even implement policies. Uh I think unfortunately uh there has been, I think in recent uh years here some sense that that uh uh that may that may not be that important. I would feel uh to the contrary. And and and and and and I'm doing the best I can do on a personal level, but also be involved in societies, be involved in in in in a variety of other programs that hopefully can bring along uh individuals uh even at at uh college levels or even before to say get on the right path here. And and if you can certainly uh uh seek out the best opportunities to to to to uh continue on with your education and then uh get to medical school and then enter the ranks uh of of of medical school training and become a physician I'm gonna certainly champ champion that as best I can do.

SPEAKER_04 41:49

Okay. Well I mean uh I I would like to point out that uh you know this is where so a school like ours uh I work for St. James School of Medicine which is in St. Vincent um I I was really surprised and and we figured this out a couple of years ago that of all the residents we produce uh about uh a hundred residents every year about uh eleven to thirteen percent of those residents are African American in contrast in the United States only about five uh four to six percent of residents being produced are uh and this includes uh DO schools if I'm not mistaken um uh are are residents however uh the matriculation class sizes for uh US schools and our schools is roughly the same for African Americans but uh the overall attrition for in in US schools for African American population is two to three times higher than that of Americans uh or or or non-African American students who start medical school and I couldn't really find any information on uh why that attrition is higher would do you have any insights why that might be at all um and is is as an instant as an institution do you think because in our school uh the attrition is uniform it's not different uh essentially what I'm trying to say is that uh in a Caribbean school in a school like ours the attrition for the matriculants coming in are African American matriculants and non-African American matriculants is the same whereas in a US school the attrition is dramatically higher for African American students. So for example the matriculant uh about 10 to 12 percent of matriculants in uh US schools and this is across the board I'm not talking about one specific school this is all the US graduates uh is about 10 to 12 percent whereas only about four to six percent are b uh Doctors are being produced. Whereas across the board, when you look at all US schools, their attrition is a sub 20%, which is I would say it's a pretty good number. Um any insights as to what institutions can potentially do to ensure that uh the African American population is at the very minimum has has the same attrition than the wider population. Especially I'm I'm asking you this question largely because you have been involved with so much of education, and I'd just like to pick your brain on this.

SPEAKER_02 44:34

Yeah, yeah. Well, I I I don't know whether I've done enough uh uh thorough uh research into the field to to give you the very best authoritative response, but but but uh just by way of observation, um you know I do have a sense uh that uh there may be uh some uh obstacles uh that um uh may be encountered by some. That the the the the the you know in the United States uh perhaps the the the cost of schools is great, and not that there's any less anywhere. Uh that that uh maybe there's better support uh in some places than others in terms of the school support, the the school programming. Um uh there may be uh uh maybe some other competing issues, uh uh some other career directions that that uh uh are redirecting some uh with opportunities in the United States, perhaps. Um, we we kind of almost kind of anecdotally say everybody just wants to go to Wall Street and make a fast buck as opposed to instead of enduring the the years of training in medical school in the few United States, maybe these opportunities exist where uh whereas maybe they're not quite so easy in other professions elsewhere. Um all of this is to say that um there there may be uh a variety of factors in play. Uh maybe there's there's just a better sense of of uh support structures uh that occur in in in certain areas. Maybe your school is done a better job of that. So if you're asking what do I think is the causes, that's it. What do I think can be done better? Well, I think all these elements um need to be possibly recognized and and then better messaging and better opportunities need to be uh continue to be made to re to address the problem.

Advice for Future Physicians and Final Thoughts

SPEAKER_04 46:20

Right. So from my experience from our school students, um there is a very, very strong correlation of uh academic superiority with household income. If they're coming from rich families, essentially uh the kids that come in tend to do very well. And from my observation, I think just statistically speaking, um the uh average household income of an African American family is around 56,000 in the United States. Uh whereas uh the the uh the overall uh household income in the United States is about uh uh eighty-six, eighty-seven thousand. It's it's gone down slightly, but um that's you know a significant there's a significant gap there. And if anecdotally speaking, if uh students from wealthier households tend to do better, I think that that might be uh a causation right there, that unless this uh uh income divide is g uh is bridged and uh uh and unless there is an effort made to uh you know um deliberately and and uh bridge that gap, I just don't think because you know, I mean it it it's a fact, medicine you have to study really long hours. I mean, we advise our students to hit the books uh at least eight to ten hours a day, if not more. Um and if you have to worry about uh earning money, uh figuring out where your next meal is coming from, it's just very, very difficult. This is not to say that people don't do it, but generally speaking, this is a really big impediment. Um and I mean I I don't uh necessarily know what institutionally uh even even at a school level like ours, uh which is much, much smaller than any United States state school can possibly do to potentially encourage that. Obviously, tuition is is the tuition costs uh they are what they are. Uh but other than that, i in your opinion, is there something that schools can really pointedly do to help students far from potentially disadvantaged backgrounds?

SPEAKER_02 48:54

Well, you know, you speak to um you know the the the element of uh of this cost to go to school and and household income, you know, the finances is a big deal. I mean, and and within that there may be a surrogate of just the other constraints and challenges that a family and a and a student may have. You know, no doubt if that person is concerned about uh just just uh uh the uh the paying the bills and they have to come somehow figure out where the money's coming from, and even taking supplement jobs or families making sacrifices, this and that, all these can weigh on the individuals, no doubt about it. So you know, the the easy answer is to uh you know continue to to to uh accept the reality uh that uh some students do need some financial help. Uh and and how do we do it? Uh we make uh uh schools can make uh efforts to figure out how they can understand uh the household income of an individual, um their family uh uh situation, uh, and uh create opportunities. Now, at the same time, I think the reality is all of us need to uh recognize that there's skin in the game for everybody here.

SPEAKER_01 50:03

Right.

SPEAKER_02 50:03

Uh and and I could say in my personal career, you know, I I I went to school uh on the Army way back. Um I I I I you know, that's uh so I I you know I I I went to college as an Army R O T C cadet.

SPEAKER_01 50:17

Right.

SPEAKER_02 50:17

I finished I fin I finished as an Army officer and was able to get my career jump started that way. Um my family did have some uh support. Um my father had me on to professional school, but it wasn't working with the government. You know, he he he had you know you know a sal a salary that was fairly modest and uh household income wasn't great. And uh just based on family size and this and that. Uh and I at age 17, I d I I basically told my parents I got this as one of the older children, and um and and went to school uh on the Army and almost self-made my way through. So so everybody needs to think about all the possible ways in which they may have to make some life sacrifices, do some things. Yes, that's something that I had to do and make a decision about. Um so the students may have to make some decisions, schools may have to make some decisions, and they may have to figure out how we can make sure that student gets there. Of course, uh the if I if I'm an example, you know, yeah, I've made some decisions and um look where I am now. Um and so so uh so yes, schools can make make um uh steps forward, uh, but everybody uh who are all the stakeholders may have to think about you know what what are what are the ways in which you can uh make the right decisions and move forward.

SPEAKER_04 51:31

Right. Um do you think that um this you know the hard work, the divide, or whatever we what we're talking about? Are there any cultural um uh influences? So for example, we hear this and we hear this from all these Fortune 500 companies saying, oh, you know, Gen Z is unemployable, they're lazy, yada yada. Do you do you see that in your experience?

SPEAKER_02 52:00

Well, you know, I hate to stereotype about any of this sort of thing. I think that every generation likes to talk about the next generation. You know, here I am as as a baby boomer and probably my generation was being being mis mischaracterized maybe by a generation before. I don't know. But uh but but uh but I think that you know the you know the world evolves. Uh we have very various conveniences that we didn't have back then, you know, you know, then the way of of of of just daily life existence. You know, we can come with all kinds of things, you know, having you know cell phones, having a convenience of uh better transportation, who you know, all these kinds of things. Um but but I do think that um you know a certain work ethic is something that I think you're you're you're alluding to here uh is there in the in the younger generation in in some ways, many ways. Uh but but and I'm sure in my generation there are some who uh uh were stronger work ethics uh than others. Um so I don't want to over over over characterize the younger population. But I do hope uh that uh the you know wherever uh uh generation we're speaking of, uh that uh you know the the basics uh uh the the the principles of of of working hard and achieving uh some life fulfillment uh should be there and and then and hopefully we can instill that in our young people as well.

SPEAKER_04 53:20

Well, I mean the reason I asked you this question is that I think uh there is an internal debate from um our side at least, is that instead of just blaming them, which every day you will see some Fortune 500 CEO saying that they're unemployable, yada yada yada. But as institut most institutions are currently run by people who are millennials, uh that's what I am, that's basically the generation immediately after the boomer generation. Are we not creating enough engagement? Because the world has changed so dramatically. Even uh when I grew up, I grew up very similar to uh uh uh a tech tech interface that you're used to. We would pick up the phone and call people, we would go to somebody's house, there's no texting, there's no uh Zoom calls. Uh but things have changed quite a bit. Uh you know, when I tell my daughter that uh we missed a show because we had to be somewhere and there was no DV. There, I forget they don't even know what D VR is. I just can come back and play it on TV anymore.

SPEAKER_01 54:33

CD players.

SPEAKER_04 54:36

They they they can't understand what I'm talking about. But as institutions, are we failing to engage with the next generation? Is that really what the problem is?

SPEAKER_02 54:50

Yeah, well, you know, it's yeah I hope that we can continue to engage. Uh, you know, the the the younger population might say we're out of touch with some things, you know, so so I can kind of maybe go both ways, I guess. Uh but as I mentioned before, the there are some modern conveniences. Uh the technologies have changed the face of a lot of how we live our lives these days. Um sometimes in a in a in a detrimental way, as you're saying, you know, you know, with back uh millennials and baby boomers, you know, I think we had to be much more interactive and develop people skills and and and and and you know put in the hours that that maybe uh the the the the younger generations don't feel that that it's quite necessary. And uh and unfortunately the you know technology maybe has made this these sort of things so convenient that that uh they just don't see it any other way. But but uh we recognize how essential it is to have human interaction and have the humanity of things and and and and really that to really achieve something, you've got to put in the time, not just you hit a button and you know chat GBT your way through through life. Um you know, so so uh it is unfortunate. Uh that's hopefully we can continue to kind of convey the message that that uh you know that there are there there's there's something to be said about you know putting in the time and and and having some human interaction that that we maybe we're missing these days.

SPEAKER_04 56:13

Right. Uh one final question before we uh sign off, uh Dr. Burnett, is that if you had the modern conveniences, the technologic, conve technological conveniences that are available today, do you think your research would have been any different than you did back in the back in the day?

SPEAKER_02 56:33

Yeah, so would it have been any different? Interesting thought. Um I think it would have occurred a lot faster, perhaps. Okay. Uh at the same time, um, maybe I have a greater appreciation of just what it took to make these discoveries back then. Where the things are too easy these days, you don't feel really necessarily appreciated as well. Um uh but uh I I think I still would have probably the you the valued uh even some of the modern technology to accomplish the work, uh maybe in a more efficient or faster way. Uh but I think I still would have appreciated it, and I probably still would have uh taken advantage of whatever the convenience are nowadays to to do that. I I think really what's key here is for young people to you know continue to think well, continue to make good hypotheses, try to think through what are things that need to be discovered and how to get there. And if you get there faster, well, it still can be suspelling, it still can be hopefully impactful.

SPEAKER_04 57:25

Excellent, excellent. Well, thank you so much, Dr. Burnett. We really appreciate your time. This was very, very insightful, um, especially your um incredible career. We've talked about so many different topics today. Yeah. Thank you so much for your time. Really appreciate it.

SPEAKER_02 57:43

Well, absolutely. Well, delightful to be on the phone with you or on the podcast here with you. And um, I hope that uh this reaches an audience and it does have uh a very important and uh impactful uh effect on everybody.

SPEAKER_04 57:58

Thank you very much, Dr. Burnett, for a very insightful conversation. Uh all right, so that was Dr. Burnett, whose work helped change how men think about aging, health, and sexuality. If you learned something, laughed a little, or realized medicine is way more interesting than you were told. Download the episode, like it, and follow the podcast. It goes a long way for our production team. You can find us on all major platforms, Apple Podcasts, Spotify, and YouTube. Share it with somebody who should probably hear it. More conversations like this will be coming soon. And remember, there's no shortcut to becoming an MD.

SPEAKER_03 58:34

Thank you so much for tuning into our show. We hope you enjoyed another episode of Med School Minutes. If you like our content, please follow us and receive notification when a new show is posted. This podcast is brought to you by St. James School of Medicine. For a video version of this podcast, please check us out on sjsm.orgslash video.