Designing for Health: Helping Cardiac Patients Live Well, Not Just Live with Samuel Sears, Ph.D.

Intro: 

Hello and welcome to the In Network podcast feature, Designing for Health. I’m Nordic’s Chief Medical Officer, Dr. Craig Joseph.  

Before we dive in, imagine a psychologist who has spent more than three decades embedded inside a cardiology practice, becoming one of the most frequently cited researchers in the world on implantable defibrillators. That’s exactly who today’s guest is.  

In this conversation, Dr. Sam Sears and I explore a deceptively simple question: Is keeping patients alive enough, or should healthcare systems be equally focused on helping them live well? We discuss what happens after cardiac emergencies, why patients and physicians often see the same event very differently, and how psychology can bridge that gap.  

For healthcare executives and physician leaders, this episode offers a compelling look at what truly comprehensive care might look like when mind, body, technology, and human experience finally work together.  

Let’s plug in. 

Craig Joseph MD, FAAP, FAMIA: 

Welcome to the show, Doctor Sam Sears. How are you, sir? Hey. Doing great. 

Sam Sears, PhD: 

Thanks for having me on. 

Craig Joseph MD, FAAP, FAMIA: 

You are a doctor, not a physician. You have a PhD, so I want to throw that out there. Many of our guests are physicians, but I’m going to call you a physician. Adjacent. Where do we find you today? 

Sam Sears, PhD: 

Well, today I’m sitting at the East Carolina Heart Institute, where I’m a professor at the East Carolina University. I’m here in the cardiology department because I am an embedded psychologist in that I run. I run with the horses, but I’m a zebra. 

Craig Joseph MD, FAAP, FAMIA: 

I love that concept of you’re embedded in cardiology. You’re a psychologist embedded in cardiology for decades now. Kind of give us an explanation. I don’t suspect that you, you, you know, went to graduate school thinking you were going to be doing this. Is that the case or did you have, you know, the big picture in your mind when you started? 

Sam Sears, PhD: 

No, I grew up in Orlando, Florida. I went to the University of Florida to play wide receiver and try to get to the National Football League. I got hurt and got interested in how people got better, and along the way I found psychology and decided to go to graduate school. I got into the University of Florida, so I stayed there. 

There was a major emphasis in the clinical psychology program there in heart transplant, so I got to involve myself on transplant teams as a graduate student, did my dissertation on predicting outcomes, psychological outcomes and transplant, and became a young professor there, graduated and became a professor right there in the same department. But what was most interesting about that is I, like many in the advanced heart failure field, was frustrated by the low number of transplant or organs available. And along came this device that everybody was getting, you know, 1995 and our patients with advanced heart failure were getting these implantable cardioverter defibrillator ICDs. Yep. Were pretty active. They were rudimentary compared to what we have today. They shocked a lot. They shocked anything that looked fast or irregular. And they kind of overdid it. Okay. Shock rates in the realm of 40% per year potentially. 

Craig Joseph MD, FAAP, FAMIA: 

Wow. 

Sam Sears, PhD: 

Basically almost one out of two patients getting shocked in a given year across the course of my career. Now we’re down in the 4 to 6% range of shots per year for primary prevention patients. And it changes. But to give you a benchmark, you know, massive changes in the rates of shock. So I got interested in how people get better. I grabbed this technology that came along called him defibrillator. It was it was relatively rarely used at the time. It was about 5000 maybe people a year getting them in 95. In 1995 today were well above 250,000 Americans a year. Getting them. The clinical trials have subsequently showed that they save lives and their gold standard. 

Craig Joseph MD, FAAP, FAMIA: 

And when we were kind of preparing for this session, we learned that we graduated around the same time from high school, both of us in Florida. Yeah. Now you agreed. I went to the University of Miami at the same time you were at the University of Florida. Unlike you, I did not try to play football. I’m alive. I’m alive today as a result of me not trying to play collegiate football. But I think you agreed that University Miami is a far superior institution, and we agree to that. So let’s just move on. We don’t need to relitigate that now. 

Sam Sears, PhD: 

Sure. Well, I’ll hold my tongue on that one as a guest. 

Craig Joseph MD, FAAP, FAMIA: 

All right. Thank you. Let the record show that he didn’t argue with me even though he wants to. Very much so. You became interested in heart failure and ICDs, implantable cardioverter defibrillator. And that was 25 years ago, right? 30 years ago. 

Sam Sears, PhD: 

It was 33 years ago. Yeah. 

Craig Joseph MD, FAAP, FAMIA: 

A while. And so how I’m so I’m just I’m fascinated by an embedded psychologist. Can you kind of describe what that means in, in a, in a typical day, are you going and seeing patients at the same time as the cardiologist in the same clinic, or is there a separate. You know, I’m a I’m a cardiac patient. I go see an cardiologist from time to time. Would I be seeing you the same time or is it some patients? How does that all work? 

Sam Sears, PhD: 

Yeah. So a visit with me. I’m in a group of, I don’t know, 30 cardiologists or so and cardiac surgeons. I’m just another doctor that has appointments just like anybody else. Everything’s identical. I’m just another provider in a different room. And that’s how we set it up on purpose. We wanted psychological care to be both normal, normative, routine and non stigmatized. That’s how we do it. The room next to me may have a preventive cardiologist in the room on the next side might be a heart failure. Cardiologist in my room just happens to have my patients in there. And I have trainees, both psychology trainees. And then I work closely with the cardiology fellowship as well. So I’m a co-director of the fellowship. 

So over the course of these 30 years, what I’ve tried to do is contribute significantly to cardiology and psychology in order to be able to run in both circles. And, you know, much like your work, I really believe in the collisions of disciplines and collisions of guilds, because I think new stuff happens when two sets of experts collide in and it’s like the reasons Peter Buttercup or something, you know, you get peanut butter and you like Peter and butter, you like chocolate, you collide them together and boom, you have this new thing that happens. And I believe that’s necessary for us to close some of the gaps that medicine, American medicines provided. The guilds produce small fissures between. Bodies of knowledge. Patients fall in those gaps and there’s really no one to pull them out. And I believe there’s some I think there’s some real action where the disciplines touch. 

Craig Joseph MD, FAAP, FAMIA: 

Correct me if I’m wrong on this. You’re the number ten in terms of frequency. Number 10th, the 10th most frequent cited, frequently cited scholar about ICDs is implantable defibrillators. Out of like 40,000 people who have written about ICDs. And so that’s fine. That’s well and good. You’re a professor, but you’re a psychologist. Almost everyone, I think, would have expected a cardiologist to be on the, you know, the top 20. So like, how do you decide what you’re going to study and what are some of the things that you study to get published so frequently? 

Sam Sears, PhD: 

It has mostly to do with looking for problems to solve. I try to walk in cardiologists shoes and see the way they see it. So what are the challenges they face? Patient to patient, clinic to clinic, procedure to procedure, and try to look at the ways in which psychological expertise could improve the outcome. So it’s very frustrating. A patient will come in to a, let’s say a cardiac physiologist and say, I got shocked twice. And they’re very angry because the shock is uncomfortable. And the electrophysiology says, whoopee, this is just what we wanted. We saved your life. Fantastic. And the patient goes, well, what kind of deal is that? And the discrepancy between the cardiologist expectation and experience and the patient expectation and experience is completely divergent. 

Craig Joseph MD, FAAP, FAMIA: 

Yeah. 

Sam Sears, PhD: 

So my job is to both understand what why did the cardiologist say whoopee to somebody who was clearly distressed? And why did somebody who was distress come looking to the cardiologist to somehow feel psychologically validated? Both come to the situation with two totally different expectations and experiences. And so when we stepped into that gap and said, send that patient to me and we say instead of anything we say, well, I must have shook you up. 

Craig Joseph MD, FAAP, FAMIA: 

Yeah. 

Sam Sears, PhD: 

I must. I can see how that shook up, because it shakes you up in the present. Are you safe in the present? It shakes you up in the future. And you go, hey, man, is this going to happen again tomorrow? 

Craig Joseph MD, FAAP, FAMIA: 

Right? 

Sam Sears, PhD: 

Am I going to live? Am I going to keep living? And so it starts to shake the confidence and the knowns and the unknowns start to be out of kilter. Our patients then start to look for anything that’s security, validating or predicting to reduce the doubt, uncertainty and fear. Or FUD, as we say in the investment fear uncertainty gal. 

Craig Joseph MD, FAAP, FAMIA: 

And this is not just the patient, right? Because, well, first of all, let’s be clear. Sometimes those shocks are yippee shocks. Hey, yeah, you would have been dead. So whatever happened, it’s probably better than the other thing that could have happened. But sometimes they’re not. Sometimes, as you mentioned before, there, it was a mistake and that the device thought it saw something. But in hindsight, having the electrophysiology the cardiologists look at, it wasn’t really there. So you kind of have to deal with that as well. And then you have to deal with the spouse. 

Sam Sears, PhD: 

Well, let me let me take that apart. So the unnecessary shock is a little bit like testing the safety net. And it’s like, hey, I believe the safety is there. I don’t need to fall out of the trapeze just to see if it’s there. Just because it worked properly isn’t also great. It’s sort of like saying, well, I crashed my new car and the seatbelts were fantastic. Well, yeah, but you kind of miss the rest of the story and being, you know, saved by a defibrillator. Sometimes it can feel like that to face. It’s like you’re celebrating the seatbelt. My car is damaged and in their standpoint, celebrating the defibrillator. It’s like saying you destroyed my future. I don’t know what my future holds now because it’s actually the condition that drove it. 

Right? I mean, the device is a bystander trying to help, but this disease that marches on, whether it be heart failure or channel or other kinds of anomalies that cause people to go into ventricular arrhythmias, the defibrillator doesn’t know which one, does it. It simply sees the manifest, the phenotype of the of the disease. When we validate people who are going through medical problems, we get them back on the right track. Too often, medicine is technically sound without necessarily being human factor sound, which is human. Humans need something more than just everything to work. They need a validation of the experience, or they become isolated or alienated or uncertain. 

Craig Joseph MD, FAAP, FAMIA: 

So how are you involved in and that so I it sounds like you’re not seeing every patient now that has an ID placed or one of your colleagues. 

Sam Sears, PhD: 

Yeah, there’s way too many of them. So I look for fentanyl events. Yeah. 

Craig Joseph MD, FAAP, FAMIA: 

So talk to me about that. So how do you decide. How does one decide at another institution. Hey this is a patient that we should make sure has that kind of safety net as opposed to the other patients. 

Sam Sears, PhD: 

Well, I think sentinel events kind of introduce themselves to the. So when patients come in and, and let’s say they’ve had a shock or they’ve had some sort of malfunction of the device or they’ve had syncope, or they’ve had a situation where they keep ducking out and they don’t go. They don’t go see a ball game they want to go to. They don’t go to the mall. They don’t go disengage from life. These are sentinel events because the patient’s showing you they’re not doing well. And that’s one of the reasons our research is focused on patient movement so much, because it’s kind of like a objective marker of distress. So central events are in which the providers not sure what to do. 

Frankly. And one of the things we’ve done is try to equip providers of all sorts with ways to both validate the patient and then move to behavioral engagement. So, yes, that shook you up. Yes, I understand you’re worried about the future. So here’s how we deal with the future by managing it today, by restoring behavior today. You know, after a medical checkup, make sure everything’s stable. We don’t have some sort of underlying condition that’s unaddressed. Having said that, get people back into the swing of things as soon as possible, because otherwise you start an avoidance cycle, which is hard to break sometimes. 

Craig Joseph MD, FAAP, FAMIA: 

How does a cardiologist know about those things? Are these questions that they’re asking because I suspect being a specialist or if you’re a heart failure cardiologist, a sub specialist like you are just going right for, hey, how’s the device working? Have you had any symptoms? Not hey, tell me about, you know, your life. Where are you going? To the ballpark. Oh, you hate the ballpark. Okay, that was a bad question. I guess I’m asking, are people really are cardiologists across the country who are seeing these kinds of patients really sending them looking for sentinel events and sending them to you or to your colleagues? 

Sam Sears, PhD: 

I guess the answer is yes or no. Yes, they are noticing them, but there’s often no one to send them to. So that’s one of the reasons that there’s not really a workforce to match the tidal wave of cardiac patients nationally, or the Sentinel events nationally. I think if you if you are in an institution that says we’re for comprehensive outcome, we don’t want to just have people live, we want to people we want people to live well. We want to focus beyond getting off the surgical table and instead being able to go and live life well, then how the patient understands what’s wrong with them, how the patient engages in their care, and how the patient engages in their life become part and parcel to the to the service provided, which is some sort of medical service. 

So the technical expertise is a must. Of course, that’s the cynic one on, but the rest of the story usually involves attending to what somebody thinks and feels about their future. And cardiac rehab is a magic bullet in many ways. Cardiac rehab gives institutions that don’t have necessarily psychological expertise an option to get people moving. And it turns out many people, once they start to move and test their fears, will transcend some of the anxiety. That and so it’s a magic bullet. It does more than it should, which is great. But sometimes people get stuck anyway. And those are patients that we’ve got to catch. So disengagement is one of the easiest ways because you can ask the spouse, is there anything he’s avoiding? And then you ask the patient, is there anything you’re avoiding because you’re worried about your heart? 

And they may say, oh yeah, man, I’m never going to pick up anything more than 5 pounds. I’m never going to engage in intimacy. I sure as heck don’t want to go back to work, blah, blah, blah. Well, now you have a disengagement syndrome that is usually almost always not from a cardiac perspective. We have a few conditions where we still kind of keep people prohibited from doing too much. 

Craig Joseph MD, FAAP, FAMIA: 

So it sounds like there’s not enough of you. 

Sam Sears, PhD: 

Mental health professionals are not ready to do what I’m proposing they need to do. I’m trying to lead the way on that. 

Craig Joseph MD, FAAP, FAMIA: 

So tell me more about that. How if I’m listening and I am a, you know, the CEO of a health care system and we have a big cardiology department. And I agree with your statement that you just said, which is I’m not looking for patients, our patients, to live. I’m looking for our patients to live. Well, yeah. How do I know if I have enough psychologists who are kind of focused? And is it just psychologists, or are we talking about social workers and other kind of extenders? 

Sam Sears, PhD: 

Yeah, I mean, it can be really anyone that’s it has mental health training. It can be social worker, psychiatrist or psychologist. Well, I’ll give you an example. Cancer recent study looked at the top 100 Cancer Institute, something like that. 83% had a psychologist psychiatrist social worker ready to go. We don’t have any such data in cardiology, but we think it’s below 10%. Wow. It’s probably below 5%. So we don’t actually know how many psychologists, psychiatrists, social workers who would even be ready if someone made the call. Now, what it generally does is just go to general consultation psychiatrist, a psychologist, and they come in and they do a reasonable job, but it’s not highly disease specific. And you could imagine somebody calling and saying, well, I’d like for this kind mental health provider to come by and see my patient. 

The first thing the patient says is I got shot four times and the mental health provider says, for what? What were you plugging in? You know, and so, you know, it’s there. And many physicians would walk in and not necessarily know what to do with an Ice patient. So medicine’s marching on the highest the highest specialty aspects of, of specialty care makes it a much harder a barrier to entry for non-experts. This is an issue. You know, what we’ve done here at East Carolina University is we combine the training of cardiologists, psychologists so that they know each other all the time. And when many of our graduates leave, they say, well, I got to have a psychologist. I mean, you guys don’t have psychologists around here. Yeah. Like who takes care of your post shock patients? 

Who takes care of people with recurrent chest pain, who takes care of people who are having trouble with heart failure and hearing who gets people exercising again? What are we going to do about what are we going to do about these people who are too afraid to move? When the value proposition is demonstrated, it’s more likely to be sought after. And I think that’s what we’re trying to do. If I was a hospital executive, I’d say, hey, man, we’re we got the comprehensive care plan here. Here at hospital X, we got the mind body deal going. And we don’t we don’t just say it, we say, look for your mind. We’ve got these specialists for your body. We got these specialists. 

And then for your life, we’ve got people who want to help you with spirituality, nutrition and. And I don’t mean that in some way. I mean hard hitting, evidence based, peer reviewed evidence. That’s why I wrote so many papers. I never set out to be some big author. I set out to basically demonstrate to cardiologists that there was no such thing as cardiology without psychology, that the human nature of having a significant medical problem with your heart means that one’s mind, one’s perceptions, one’s feelings, one’s functions all fall into the scope of that care. 

Craig Joseph MD, FAAP, FAMIA: 

Let’s talk about some of those some of that research. One thing that you would mention when we’re preparing for this call was that you’re interested in data from outside the clinic, not necessarily just from inside the clinic. Now, electrophysiology, which are for people who don’t know, those are cardiologists who have extra training in the electrical system of the heart and cardiologists in general. Boy, they are inundated with data. And especially if you have an implantable device, it is constantly collecting data and can be downloaded every night. In fact, tell me about some of the data that you’re interested in that’s not collected through that device. 

Sam Sears, PhD: 

All of these different devices tell us they have accelerometers in them. And so they follow from being a rate responsive pacing response in the device. So the device is all had this in but for a different reason over time. Now we can use the accelerometer in the pacemaker and the defibrillator. And even now the loop recorder a diagnostic device and all of those give us activity information. Each of the different companies has a proprietary way of doing them, but for the sake of simplicity, each minute of a patient with a device is scored as active or inactive. So essentially a zero or a one. And it uses it uses criteria like how much jostling essentially the device had from the ground to gravity relationship to do that. 

And what we’ve shown is that for the defibrillator patient, after experiencing a sentinel event, it takes almost 90 days before the patient gets back to baseline. Wow. The problem is the baseline is three hours and five minutes a day. So that means that the average heart patient with the state of the art technology, a device that can monitor, evaluate and provide a treatment in seconds. The average patient moves about three hours and five minutes a day. Well that’s interesting. Okay, well, one shock, it goes to two hours, and then it takes 90 days to get back to three hours and five minutes. Now we then then ask the question, what about what about patients that don’t have essentially a life threatening disorder and a life saving shot? 

What about somebody with a loop record? So these are patients that just have palpitations, but we haven’t caught them doing it. So we put in this little loop recorder in order to evaluate heart rhythms 24 hours a day for three years. So we wonder, well, how active are these patients? What turns out they’re even less active two hours and 20 minutes a day, suggesting that when people aren’t sure what’s wrong with them, in this case, they have a degree of medical uncertainty. It’s not severity because the ICU patients are significantly clinically worse. These patients with unknown diagnosis may be even less active in some sort of self-protective response. And only the accelerometer could have told us that because in clinic there, they walk in, they’re fine. They’re chewing gum, you know, having fun. But the accelerometer tells a different story. And that’s where I think the future is. 

When we have different streams of information outside of the clinic, where the diagnostic conundrums will be better solved anyway, I think activity is a canary in the mind. I think people stop, start showing problems by disengagement due to both mental and physical cues way before they come in and say, doc, I just don’t feel good. I’m tired or I. I’ve been short of breath. I don’t think we need to wait for that. And no one else in the tech sector does either. I mean, all tech sector is moving toward biomedical systems that can tell us pressures are changing in the heart well before they start to gain weight and show it on a scale. And thus the beginning of a heart failure episode. Arrhythmias are going to be a little bit more complicated. But certainly atrial fibrillation is one that we start to catch earlier and earlier and adjudicate it and solve it before it becomes a clockmaker. That creates other kinds of problems. 

Craig Joseph MD, FAAP, FAMIA: 

Sure. So it’s funny when you when you mentioned accelerometers, I was thinking of my watch or, you know, a Fitbit, you know, one of the wearable devices, but not realizing that I. It sounds like a lot, if not all, implantable devices also have these things for various reasons and can be used. Even though I was going to use the word co-opted. You know, it sounds like the intention of the of the device maker when putting accelerometer, and there was not to help you figure out where the patient is. They did that for other reasons, but that the data are there and you can use them in any way you need to. 

Sam Sears, PhD: 

Yeah. And just to be clear, to highlight a point you made earlier, we’ve published a number of papers now, and we have numbers of papers about these accelerometers. But the clinical uptake has been slow. And I think it’s because more clinical parameters are not helpful yet to cardiology. We still need a data reduction strategy for the practicing clinician. And so, you know, ultimately our work has got to move upstream into the device makers and say, okay, we need a normative field for activity change and for high and low activities so that it becomes a simple message to the clinician who’s trying to make decisions quickly. Presently, the clinician simply has too much data to look at, and mortality related things are the first thing that can they think about appropriately. But remember that activity level is so closely marked it traces along both mental and physical health. It is a canary that’s very smart. Activity is a canary in the mind that’s telling us there’s a problem before there’s a problem. 

Craig Joseph MD, FAAP, FAMIA: 

That’s a super interesting I’ve certainly heard that. But I was kind of thinking, you know, you hear it about depression or you, you know, you hear it about diabetes, but this idea, that boy, it’s true for a lot of things. It just, are you moving? Are you active? And one is asking the question then two is actually not asking the question of the patient because a lot of us would be like, yeah, I think I’m very active. How many hours? You know, seven hours a day. And okay, well, the data don’t support that statement. If you have a wearable or an implantable device and kind of using that. And again, as you say, certainly I think lots of people, physicians especially, are overwhelmed with the data that they’re given. Again, in cardiology, it’s worse. 

Sam Sears, PhD: 

You know, we’ll get there. We’ll get AI is going to help us get there. That’s a very concrete AI solution. There already a number of those that that are pretty smart. I’ll tell you about one other thing and I’ll round up this point. The role of device data is that it probably gives us a data set that’s separate from the patient experience and symptom, even though they should be the same. To give you an example, one of my doctoral students may have. Sergeant just published a paper with us where he looked at the relationship between patient trigger recordings. So that’s when somebody has a device like a loop and they say, I’m having symptoms, and they press a button and the recorder pays attention and locks it down. And it turns out in a sample of almost two over 2000 patients with loop records, the relationship between I’ve got a symptom, I don’t feel good and the device saying something’s wrong with almost no relationship, really. 

Yeah, and this was in over 800 patients clicking. And I got a problem. I got a problem. Now what does that mean? I think what it means is that we’re going to continue to have patients report symptoms, and they go and seek care because they have a symptom. And we’re going to have a physiology symptom, if you will. That’s asymptomatic or symptomatic. And those two data sets move forward interacting and influencing each other. But both deserve their own their own attention. And I think the tendency is to simply say all that matters is physiology. No, that’s true for a technical standpoint. But if the patient is expecting symptoms or over interpreting signals that become symptoms that become accessing care, then we have two separate sets of data. 

And to be a patient in the future becomes more complicated. And so I just think there’s a very interesting ideas. I think both are really important. Neither should be dismissed. Both matter and smart systems in the future are going to have ways in which people can talk about symptoms, be validated and know when to get care at smarter times. It happens now on Facebook groups, but that’s not the right way to do it. Eventually, I think we’re going to need ways in which people can report symptoms, have some physiology, and then have a reassurance check maybe to reduce accessing care because these patients are symptomatic and for many, they feel like the stakes are very, very high. And they could be. But we put good safety nets in place to. 

Craig Joseph MD, FAAP, FAMIA: 

Maybe talk a little bit more about the Facebook groups. Are they going there because there’s no other option. 

Sam Sears, PhD: 

I think. So when we’ve done research looking at these social media groups, they are a group of worried patients. So we gave a set of measures of shopping to a to a web based group and said, you know, if I or be approved and all that stuff and put it through and said, hey, you guys, everybody who comes on, if you’re willing, fill this out, go through the informed consent and fill out these things to send it to us. And what we showed was that the people hitting those sites were highly anxious. They would have met clinic. Many of them would have met clinical criteria for anxiety, significant clinical anxiety if they had presented in person, suggesting that there is there’s a need. There has not been met all over the world. People survive medical problems now, and they have to learn to cope with what happened and what could happen. 

And I think in the past, when bad things happen to people, most of them passed away. And so they didn’t need to learn how to cope. They just needed to learn how to, you know, essentially have dignity in their disease. But now learning to cope, learning to resume life. These are skills that are not common. It is not normal to say I had this cardiac arrest, but now I’m back at work and the same place where the cardiac arrest happened and I’m fine. I mean, that’s just not that’s not how human being memories are put together. That’s not how major life experiences are encoded in the brain. We don’t simply just walk over them. I’m not asking you to also send everybody to psychotherapy either. I think people are tough. I think I think the vast majority of people have great resilience and they, they knock down doors and I get to I get to be there every, every day and watch them overcome fears and threats that I could never imagine. 

I mean, when people are amazing, I mean regular old people. On the other hand, you know, some people get stuck and they are frightened by what happened and they need time to unpack that. So I don’t want to make people a bunch of victims. I want to make a bunch of survivors. I want to kick them down doors and living life again. But sometimes they need a little coach. 

Craig Joseph MD, FAAP, FAMIA: 

Makes complete sense to me. Kind of continuing down this this more some of your research or some of your work you have you’ve grants to evaluate most. It sounds like FDA approved cardiac technology. And so you’re looking at that. But and one thing that as we’re preparing you mentioned was that the FDA establishes utility but not value. Yeah. And I’m interested in unpacking that. What do you mean? If the FDA says the device works, then it works. Isn’t it valuable? To whom and how? I guess. 

Sam Sears, PhD: 

So the vagueness FDA is trying to protect patients. It doesn’t necessarily mean that it produces the outcome the patient sought in that device. You know, the current ideas is the FDA is interested in feels, function and survival. Well, it’s very good at survival. The feels and function, in my view, is the psychology of emotion and the psychology of action. And in both of those things, what we’re trying to do is complete the story. Again, the story is this technology has solves or treats this one problem, but the patient experience, the acceptance of both how the technology works and the ability to trust that technology is a it’s a much more sophisticated expectation about patients than simply, well, I laid on the table name planted me. 

Well, that’s, that’s relatively easier compared to okay, can you trust that technology. Can you go out and again it comes back to behavior. It comes back to the acceptance of a technology. In order for it to restore function. And function is not simply can I do something? It’s will I do something? Am I willing to exert myself? Am I willing to put my fear aside, that I might provoke something because I restored the activity that I was afraid of? And I think these things are they’re great. They’re great moments to see people overcome things. You know, I think my favorite things to look at is when people overcome fear and challenges and they perform under pressure. 

You know that the Sally Sullenberger of the world, that the athletes that come back, you know, that have had a cardiac arrest and, you know, when they come back like, wow, that’s amazing. Right? Comebacks are well, I just my, my, my secret driving force is I love comebacks, man. I love people encounter terrible things and somehow find a way back. The human spirit is amazing. I love that stuff, man. 

Craig Joseph MD, FAAP, FAMIA: 

Well, I there’s no way I’m not going to go and talk about Christian Eriksen at this point. 

Sam Sears, PhD: 

Oh, great. 

Craig Joseph MD, FAAP, FAMIA: 

You have just you have just put him on a silver platter for us. So we recently had the World Cup here in the United States. And a lot of people have been exposed to what the rest of the world calls football, but we call soccer. Christian Eriksen is a Danish, I think, Danish player. He played for my team that I support in the English Premier League and moved on and was playing a game and collapsed in the middle of the game, just literally fell backwards. I never found out. Exactly. Maybe it’s available, maybe not. You know what? What problem he had. But I know that he did get in a plant, a bull defibrillator and came back. Came back, but then maybe a year, year or two later playing soccer with a device which I didn’t know you could do, kind of the opposite of most of the patients that we’ve been discussing today who are afraid to go and push the limits. 

And here’s a professional athlete at the top of his game who has a essentially his heart. His heart stopped and needed CPR, got this device. And then it happened again in the middle of a game where he kind of fell backwards. This time, though, no CPR. This time the device he had, the device, it worked and he was able to walk off the pitch. And so what do you see in that? Is that instructive in some way? Is that the way it’s supposed to be? Should what are we supposed to learn from that? 

Sam Sears, PhD: 

Well, there’s so many lessons. The Christian Eriksen story is a courageous one, and one that I think has a number of lessons, stories, the fact that there was immediate medical attention to save his life from his first cardiac arrest, secondly, that the implantable defibrillator was there to produce the safety, that from there, on allowing him to return to the action and then him returning to world class action as an elite soccer player in the Premier League and World Cup, he is. He played in the World Cup, he is an elite athlete. And then about I think about June or so, June 2026, he had a incident where he passed out on the pitch and the rotor shocked him and he did walk up. And he’s currently undergoing rehabilitation efforts. It’s not clear what exactly wants to be next because this is no longer really about the defibrillator. 

This is more about is his disease changing or progressing in some way that makes it harder for him to restore function at this level. So the good news is that defibrillator is not part of any limiting plan much anymore. Sports cardiology continues to do risk assessment and shared decision making around a lead athletes who can make decisions. We no longer have the strong prohibitions we had before about. Absolutely not. You’re done. Your career is over. Today. We have a much more shared decision making. A lead athletes have a much more complicated set of stakeholders and engaged to persons in their lives and their career. It’s no longer just about saving their life. It’s about saving a career. I like that problem. It’s a good problem to have in a way before we assign lightning everybody. 

So all of those things are learned or lessons learned. I think the most current one, the current one that has to do with where its current status is as well. So he can play, should he? And you know what will keep him safe? Because all of us are more than our jobs, right? I mean, he he’s a he’s apparently a nice young man. We want to help people thrive and flourish and live their lives out. We want to prevent premature death. We know we can’t prevent death. We’re preventing premature death. And a healthy 30 something year old elite athlete is awfully premature to be having potentially life threatening ventricular arrhythmias. So we want to be we wanted to be thoughtful about that. 

And I think the lessons learned are that wow, what an amazing comeback. He may make another amazing comeback. Or he may say, I did it. I made that comeback. And isn’t that enough? Isn’t that a degree of conquering one’s fears? I don’t know that he has to come back again for us to say the mental, the mental makeup of this young man, the support that he received from his family, that support from his medical team, the technologic support from a defibrillator, the fan support, all those things that went into this guy’s life. Hey! We won. Now what do you want to do next? Do you want to do this again, or do we? Or is it time to move on? I think those are the things that he will have to consider and age comes into it. I mean, you can’t be an elite footballer forever, so he will be interesting to see what happens. 

The most recent headlines from Denmark that I’ve read is that he’s in rehabilitation. I assume he’s in kind of a cardiac rehab type setting, getting used to exertion, getting used to pressing and pushing again. And, and I think probably reassessing where his cardiac function is right now. 

Craig Joseph MD, FAAP, FAMIA: 

We have come to the point where I’m going to ask you the last question, because we’ve run out of time. I’d love to keep quizzing you and getting more information from you. But let me ask you this question. We always ask this question at the end, which is, is there something in your life that’s so well designed that it brings you joy whenever you use it or interact with it? And I think we we’ve agreed it can’t be an implant right? Device. Although it could be. So I’ll let you go. What is it? 

Sam Sears, PhD: 

I have a, I think an unusual one. I’m a big fan of art, of shaving. Okay. And is this shaving cream that comes in a in a jar, and you put it into a bowl and whip it? Like the old days when they used to use a horse brush to stir up the shaving cream. And so here’s why I think it’s cool. Art of shaving is it takes something that’s kind of a daily activity that’s kind of boring and makes it fun and interesting. And as you can see, I’ve got a lot of coverage here. Right? I got a lot of I got a lot of art to create here with a bald head and a clean shaven face every day. 

Art of shaving has a number of these of fragrances. You whip it up and it’s and it makes a boring activity celebratory like, here’s a new day. We’re going to whip it up and it creates this foam. So I get tickled every morning about it because I think shaving kind of boring. But this whole like it’s like an exaggerated it’s a, it’s a Tom Sawyer type response where painting the fit, the painting the fence suddenly looks fun. Shaving suddenly looks fun while you whip this up. I think that’s an incredible design. And honestly, it’s also interesting because it’s an old design. That’s how people use to shape. Yeah, I think it’s a throwback and surprise of design. And that’s why I think Art of shavings an interesting, well-designed product. 

Craig Joseph MD, FAAP, FAMIA: 

I love it. Doctor Sam Sears, thank you so much. Thank you for all the work that you did and you’re doing, and you’re going to do. And thank you for explaining a lot of it to us. And we might have to I’ve been threatening this recently. We might have to have you on again to get to some of the other stuff that we didn’t have time to, to, to connect with.  Again. Thank you. Appreciate your time. 

Sam Sears, PhD: 

Thank you. Appreciate it. 

Outro: 

Thanks for tuning in. We hope you enjoyed today’s episode. For more on Dr. Sears, see his academic and Google Scholar profiles with links in the show notes, as well as other interesting readings.  

Check back for more episodes of Designing for Health wherever you listen to podcasts or on NordicGlobal.com. We’ll see you again next time on Designing for Health.  

 Links:  

 ECU profile: https://psychology.ecu.edu/people/sears/   

Google Scholar profile: https://scholar.google.com/citations?user=EKXsdscAAAAJ&hl=en   

Heart Rhythm TV interview:  https://www.youtube.com/watch?v=DNbvIVH3KZU  

ICD support groups: Are they still relevant now? https://www.sciencedirect.com/science/article/pii/S2666501825001229