003 - 20 Years Ahead of 99% of Cardiologists: Why Dr. Osborne Quit Heart Caths | ClearCardio

Hi, and welcome to Clear Cardio's Prevention is Power podcast, where we uncover the stories and strategies that are reshaping the fight against heart disease. I'm your host, J.D. Enright, and today I'm honored to share the incredible journey of a man who refused to accept the status quo in medicine. You know, most doctors go with the flow, following what the system tells them to do, but not Dr. John Osborne. He spent nearly three decades fighting against outdated practices and building a groundbreaking approach to prevent heart disease before it happens. Today, we'll dive into his story, his struggles, and his victories in the battle to save lives. Dr. Osborne, welcome to Clear Cardio's podcast. It's great to have you here. I've read and heard a lot about you. You happen to be my cardiologist, so I have some insight that. that obviously the audience doesn't have, but they're gonna get very soon. So, why don't you tell the audience a little bit about yourself?

Sure. Well, JD, thanks so much for having me here, and it's always a pleasure. And I think our chats are very enlightening.

We've had a few.

We had a few, and there'll be many more to come.

I'm sure.

So, a couple of things I think is Some of which is kind of amusing and just others, just kind of my own personal journey to become a preventive cardiologist. So I have to admit, when I was in 4th, 5th grade, up until—

I'm sorry, did you say 4th or 5th grade?

Yeah. Yeah.

Wow. You knew that long ago, huh?

Well, yes, to a degree. So my dad was a pilot in the Air Force.

I see.

And so up to 4th or 5th grade, roughly, I wanted to be a fighter pilot. That was it. That was my career path.

Okay.

Until I found out I had to wear glasses. So I realized pretty quickly that was not going to be a viable option.

Got it. They were very stringent back then. Yeah.

There was no LASIK and all that stuff. So anyway, I fell back on plan B, which is medicine. And then from that point on, I was monomaniacal. I wanted to go to medical school, learn about how everything works, because I knew that that's where the oracle that all is known comes from.

So you were an overachiever back then. It was either being a pilot Or being a doctor. There was no in-between. It's like, ah, I think I want to be a farmer, or maybe— not that there's anything wrong with that, but you knew what you wanted. Yeah. Yeah.

So, you know, I sort of went on that journey that— but I clearly knew where I wanted to go, which you'll find maybe amusing in a moment. So, cut, you know, cut to high school and through basically hook or crook, essentially, I spent one year undergrad and then went on to medical school. The next year. So I was 19 when I started medical school.

Oh my goodness.

Yeah.

Wow. Yeah, that's not normal.

I was pretty young. Yeah. Yeah. So anyway, I—

So you're a smart guy. Yeah, kind of.

At least I convinced somebody I was.

Oh, fair enough. Yeah. Yeah.

They let me pass.

Fair enough. Where'd you grow up?

Well, my dad was an Air Force pilot.

Oh, so everywhere. Everywhere.

Right. So I was born in the South. I've lived, I've lived Years and years up in the Northeast and Michigan, Pennsylvania, Mississippi, Florida.

Where do you call home now?

Well, I moved to Texas in 1997 when I finished my training, my fellowship, and have been here ever since. So 28 years in Texas. So I'm going to say Texas is home.

Okay, fair enough. Which, by the way, for those of you who don't know, we are filming this podcast here in Texas, in Dallas, Texas. And actually, that's where Clare Cardio, as you can see here, Clare Cardio, Which Dr. Osborne is the chief medical officer of, is located in Dallas, Texas, North Texas.

Yep. Yep. So been here 28 years. So I started medical school at 19. I was pretty young. And I thought, I'm 19. I couldn't even drink back then. Everybody else in medical school could. I couldn't. Not that I really cared about that at that point. I thought, well, maybe I'll do some research. I'm young, I got some time.

So you're doing research at 19?

Yeah. Oh, you got it.

Got it.

All right.

Med school, research, 19.

So I talked to some of my mentors at medical school there and they said, well, I mean, don't take a year and do research. We have an MD-PhD program. And if you do the MD-PhD program, it might take you 2 or 3 years, And, um, but you get a nice piece of paper, you got a whole nother degree. And while you're doing your PhD work, we will pay the entire cost of that. Plus we'll pay you a stipend every month. And I thought, this sounds pretty good.

How do you say no to that? I mean, like, if you had come to me and said, I'll do this and we'll pay for this, it would be a no-brainer.

And, and then for the last 2 years of medical school, we'll pay half the tuition.

Wow. So I said, Mom and Dad were like, yeehaw, let's do that.

Exactly. Sign me up. In fact, I will tell you, so I went to undergrad at Penn State, right? So, okay, you know, because being undergrad, yeah, it was fun.

They're the Nittanys, right?

The Nittany Lions.

Yeah, Nittany Lions.

Uh, of course, you know, now they're called State Penn, but, uh, okay, different story. But anyway, fair enough. Uh, so I spent one year there. My total cost was $1,000.

Wow.

For undergrad.

So there's a lot of people out there who hate you right now. They're like, you're a little boring. Me too.

I never share the story because it's embarrassing.

Yeah, no, no, it's pretty amazing actually.

Anyway, so—

You have an MD, PhD.

Correct.

Okay.

Right. And so I did my first 2 years of medical school and then went then to the PhD lab. And as it turns out, that particular lab, which was in the Department of Physiology, focused on cardiovascular physiology. So from there, you can see, it was pretty smart of me ultimately, as my professional career developed. What am I going to do? Am I going to become a dermatologist, a plastic surgeon, an orthopod? No.

That's when you specialize.

Yeah. Well, yeah. So, so the fact that my PhD work was in the endothelium and atherosclerosis, plaque buildup, nitric oxide, which of course has become a big, big deal over the last 30 years, That's what I did my PhD work in.

I see.

And it was great. So I did that over the next 3 years, finished up all the PhD work, and then went back to my last 2 years of medical school, then finished out the rest of my medical school. So I'm back in the— wearing the white coat, back playing like I'm a doctor, that kind of stuff. And by that point, with a PhD in cardiovascular physiology, I was actually very, very fortunate inasmuch as my future was incredibly constrained. I basically, unless I wanted to, like, throw away a PhD in cardiovascular physiology, you know, I was either going to become a cardiac surgeon or a cardiologist. Right. So it had to be in the cardiac realm. Right. Because I loved it. It was great. I had my PhD in it. Be kind of stupid to become an orthopod with a PhD in cardiovascular physiology. So—

Of course, you'd be stupid doing it. Yes. Yeah. For those of us—

And this is not a joke about being an orthopod either. So in fact, I decided not to become a carpenter. I decided to do plumbing and electrical.

Fair enough. Got it. Yeah, I got it. Exactly. Which we brought up in one of the other podcasts. Yeah.

You could reference that other podcast.

Yeah. Yeah. The plumbing and the electrical side of things.

Yeah. Plumbing and electrical. So anyway, so I did my— finished up the rest of medical school, rotated in cardiac surgery, Found I really hated it. It was really boring. Sorry, my cardiac surgery colleagues. You're standing on your feet all day. You're looking into a little bloody hole. Very unpleasant. Patients would come in.

Yeah, that sounds unpleasant.

You fix them. They disappear. There was no patient relationship, right? Yeah.

Because they're coming to see you because they're really sick.

Yeah. And then you're going to fix them and then they're out the door. And then, you know, if you do everything right, you'll never see them again.

Yeah.

Right. Well, that's just not my kind of personality.

Yeah.

So I then, you know, rotated in cardiology and thought, I love this. This is great. Okay. Yeah. So with that background, I went to school in Pennsylvania. The next step is, I wanted to be the best dadgum cardiologist there is. So how do you become the best dadgum cardiologist there is? How do you— Go to the best dadgum cardiology training program. Which is Brigham and Women's Hospital, Harvard Medical School.

Oh, okay. Harvard guy.

So back then, this is all arguable, which is a better law school? Yale, Harvard, Stanford. But yeah, you know, same thing in cardiology. Yeah. I think Brigham and Women's Hospital, it's got a weird name, but it's now Brigham and Women's Hospital, then later in the '90s merged with Mass General that you may have heard. Now it's Mass General Brigham. Brigham.

Famous.

So that's where I trained. So all Harvard, blah, blah, blah.

Got it.

And so I wanted to go to the best cardiology training program, which is at Brigham and Women's Hospital, or the Brigham, as we call it. And so what's the best way to get to the Brigham cardiology training fellowship? You do your internship and residency at the Brigham.

I see. Right?

So that then dictated—

So you paid your dues.

The next 7 years of my life.

I was just going to say.

So it started with the conclusion and then I went to the beginning to figure out how to get there.

You got it.

So finished up my MD-PhD, was fortunate enough, applied to the Brigham, and they accepted me as an intern, then did my residency there. In fact, they had a very special program back then called a research residency where you could split your time for people that were doing research, half clinical and half doing research.

That sounds fantastic.

It was fantastic.

Yeah, because you're doing the practical as well as the theoretical.

Exactly. So I could still continue my research. And yet do the clinical stuff I had to do. So it was fantastic. It was great. Phenomenal place to train, just incredibly brilliant people. I can't tell you how many people, colleagues of mine and interns—

Well, I'm from Boston. I grew up in Massachusetts, so it's very close to my heart.

Yeah, exactly. So did my residency, and then I got selected for the very highly competitive fellowship there, did my fellowship in Cardiology. So internship residency is 3 years. Cardiology is another 4 years. And then half of that time was clinical and I specialized in non-invasive cardiology. So that's echocardiography, ultrasound of the heart.

Everything but slicing someone open.

Yeah.

Yeah.

So I was going to leave that to my colleagues. That really didn't interest me much.

Got it.

But in my cardiology fellowship training on the clinical part, We learned to do heart cath angiograms, right? So go through people's groin and take pictures and all that. And that was the gold standard.

And we talked about that on a different podcast. Yeah.

So that was kind of the gold standard, how to detect blockages. Because frankly, we knew stress testing, not terribly accurate, only diagnoses—

Even back then?

Oh, gosh. Yeah. And again, that technology is very, very mature technology. It has not changed over the last 50 years.

No kidding.

Yep. So, but that's what I was interested in learning about. There was no such thing as preventative cardiology back then, right? That concept wasn't even an idea.

You hadn't pioneered it yet.

I had not pioneered it yet.

Yes.

I hadn't made a name yet.

You were still Philip Puss and Vinegar going out there, got to do things the way they need to be done.

But I remember, so we're at the preeminent cardiology training program. cardiology practice program in the nation, probably in the world. And we would get people coming from all over New England particularly, but all over the states.

All over the world, really?

All over the world.

Yeah.

We had some of the royalty from Jordan come and visit us.

I was going to say the Saudis and Jordanians and Emirates.

Yeah. So it was a very interesting place to practice. Would do an angiogram on them, right? So not every place had a heart cath. Now then, they're ubiquitous now. But we'd come and they'd come here and we'd do their heart cath, right? And so we would do the heart cath and we would use this term as we'd look at the pictures. And we'd say, it looks lumpy bumpy, right? So not nice and smooth, right? You could tell there was a little bit of irregularity, Right? And we'd say it's like—

Well, nothing definitive. So you called it lumpy bumpy.

Lumpy bumpy.

That's really scientific, isn't it?

That's our language.

Lumpy bumpy? If I had a cardiologist come to me and say, well, we did an angiogram, it's a little lumpy bumpy, I'd be like, get out. Do you want crayons for that too?

Well, yeah, this is all what we talked about in the cath lab when the patient's asleep.

Oh, oh, I see. Okay, fair enough.

Yeah, this is not— Okay.

No, no, you're gonna be okay.

We don't see any significant blockages. In the cath lab, we'd say it's lumpy bumpy. Right.

Got it.

And we kind of blow it off. But nothing major. Lumpy bumpy. Yeah. Right. No blockages.

No blockages.

Because it was all about finding the blockages. If you found a blockage, we'd put a stent in, we'd send you to bypass surgery. We did all that. But lumpy bumpy, meh, you're fine.

Right. Send him home. Send him home.

Send him home. Right. We wouldn't do anything.

Come back in 3 years.

Exactly. We need to let you marinate.

Oh, that's a warning sign.

Yeah. Yeah. Right.

Come back.

Well, so we'd use that terminology and we'd go lumpy bumpy and I'd go, wait a minute. How do we fix it? This is important.

Yeah. Yeah.

This is like a polyp. So you're telling somebody who has a polyp, you're fine and have a nice life until you get colon cancer. And I'm thinking—

Come back when we have to give you chemo.

Yeah. This is not good.

No.

Right? So I was kind of shocked.

So you were awake then.

Yeah.

And I thought, wait a minute. Not woke, not woke, but awake.

This lumpy bumpy stuff is important.

Yeah.

But even back then, we knew the began to have a better appreciation of the biology, we knew even back then that what we could see on a heart cath, an angiogram, a cardiac catheterization, all synonyms, right, is I could only see the donut hole. Right?

Yeah.

We also knew the disease starts in the donut. And then even maybe at that point, it was very, very early on, but certainly later in the next several years, we found out it starts in the donut, And it doesn't grow inward, it grows outwards. So the vessel literally gets bigger in order to maintain the donut hole.

All right. So for those of us who are very visual— You don't understand donuts or donut holes? Yeah. So let's talk through that. So if you're talking about an artery, right? And so you're saying that—

So these are the vessels that supply all the blood flow to your heart and then everywhere else.

Fair enough. So if you bleed, Yeah, you die, right?

Well, yeah, I mean, yeah, but it all stops eventually.

Fair enough. Yeah, unfortunately. So you're doing this, you're in school, you're doing the training on this stuff. You see, you send that, you do an angiogram, which is what?

We'd put a catheter, a hollow tube. I call it a silly string.

Silly string.

About 3 feet long or so. We'd feed it down here. We'd, with the magic, right? We'd then advance that all the way up against the stream like a salmon.

Just teasing the heebie-jeebies, just thinking about it.

Up into the heart. And then once it was in the heart, we'd inject dye with our hands and then take a moving picture of that and then just watch that dye flow down the blood vessel.

All right. And so that's when you say it looks lumpy, bumpy. And most people would say, if there's not a blockage, if there was a blockage, then there's all kinds of things you do.

What are you doing here?

You got to go catheter and all that and the expensive whatever.

And by the way, about 70% of the time looks fine.

Okay. It looks fine. Which is scary by itself because we know that to not be the case anymore. But okay. So it's lumpy bumpy. And in your mind, you shouldn't be just sending them home. You should be figuring out how to prevent it from getting more lumpy bumpy.

How the lumps and bumps don't turn into blockages.

Blockages. Right. But that wasn't the standard. But you're thinking this, so you're thinking, okay, that was the inception of Dr. John Osborne's preventive cardiology brain mindset, right? Which is why I'm thankful you did that, because it was a pivot point for you and me, because you basically saved my life as well. And I'll be doing another podcast specifically about that and my experience in the process. But so from that point on—

Tune in. You want to hear all the gory details.

Yes, it's gory. Not so great, actually, but it's interesting.

But a happy ending.

So you figured out, okay, now what? So you see the lumpy bumpy, there's got to be a better way to handle this because you know the way that if your arteries are a tube or like a pipe, we talk about pipes and some of the other things because I think more people can relate to that. The— if this is your artery here, the plaque builds up outside, inside the artery wall, not inside the tube, on the outside. And what you're describing is it pushes out this way.

Well, the hole, the channel, we call it the lumen, is the same.

Stays the same. So even if you had a camera up there, you wouldn't see any—

And I'm looking down the hole.

You wouldn't see Can't see it. Plaque or any kind of buildup.

And in fact, if I had some lumpy bumpy, I mean, that's really bad.

Yeah.

Because I'm already seeing it begin to grow into the donut hole, I like to call it.

Right.

And I have no idea what's out in the donut.

You have no idea how much plaque, how dangerous it is, what type of plaque is it.

Exactly.

But you don't have the tools back then to know. No, no.

Didn't exist.

So you're just saying, so all these cardiologists are going, it's lumpy bumpy. But there's no obstruction.

So back to Albany.

Send him or her home. And then weeks later, months later, maybe a year later, these people are dying of a heart attack or stroke.

Yeah.

Okay. Keep going. This is really interesting. It's horrifying, but it's interesting.

So that was the concept, right? So I did my training in non-invasive techniques, right? So I really didn't have any interest in stenting or ballooning. Because frankly, I was already thinking, but wait a minute, that's so far down the line.

So stenting and ballooning, for those of us, it's not like taking an air balloon ride, right? Or stenting your growth. What is a stent or balloon?

Yeah. And I say stents and balloons. So early on, this goes back to late '70s, we'd find a blockage and then we'd take a very small balloon on the end of that big long tube catheter.

Like a balloon balloon? Like a real balloon?

Yeah, it's literally a balloon. Right? But uninflated, we'd slide it where the blockage is, and then we'd blow the balloon up.

With regular air?

So it's a long cylindrical balloon. Well, and then, I mean, like a tire pump, basically.

No kidding.

Yeah. Right?

It sounds so basic.

No, it's incredibly crude. Right? People think we use cameras, we have a camera up there. No, no, no. All we're doing is injecting dye. We're taking a little moving X-ray picture of it. And literally watching the dye flow down the vessel.

So this is— okay. Wow.

It's 2-dimensional.

This is back in the old days.

Well, yeah, but this is how we still do it.

Oh, really? Yeah.

So the heart cath, by the way, was accidentally discovered in the late '50s by a guy named Mason Sones at Cleveland Clinic. And I say accidentally because it was thought that if you injected dye directly down the blood vessel of the heart, You'd fibrillate, you'd go into a dangerous heart rhythm, and you'd die.

Because you keep— you would basically be replacing blood with contrast. Contrast, which has no oxygen in it.

Exactly.

Okay, but that didn't happen.

Well, accidentally, on one of those days in the late '50s, they were injecting dye into the heart, into the aorta, right, just above the arteries, and the catheter slipped. And they watched the dye go down the vessel, and they're thinking, Uh-oh, patient's dead, right? Better go talk to the next kid.

Hope you have good insurance.

Yeah, exactly. Nothing happened. So they go, wait a minute, you should have died. So that is how accidentally heart catheterization was invented, right? They didn't die.

It wasn't invented. It was discovered.

Yeah. Well, yeah.

By accident.

So, but if you look at it in reality, since late '50s to now it's 2025, It's the same technology, right? Imagine we invented rotary phones and then just say, that's as good as it gets.

Wow.

Yeah, so nothing happened. Okay, and, and again, it's 2-dimensional. Yeah, right, it's analog. Yeah, I can turn up the speed, I can make it go back and forth, I can reverse it. Yeah, but I cannot manipulate that data like we manipulate things like CAD/CAM.

Got it.

3D turning, AI, all that kind of crap.

No. Things that we use here at Clear Cardio.

Yeah, every day, right?

Every day.

So anyway, an aside. So we did not have the tools, right? So I said, this is really interesting. I think this is really interesting. And on my research side, my PhD side, I was busy working out the pathways, how this occurs, what happens at the lining of the vessel, what causes plaque, tools we could use to stop it and reverse it, right?

So that's why I think you're so unique. And that's, that's what I think that was the catalyst. It's not just the MD, not just being a cardiologist, but having the PhD. A PhD, you're inquisitive, you're questioning, you're doing thesis, you're not just studying. Not that MDs are— I mean, brilliant genius who invent all kinds of things.

Yeah, keep it coming.

But I'm just saying, but The combination of the MD-PhD gives— it's kind of the yin and the yang, because now you want to know why things are happening, not just following procedure, what everybody's done. Like, like doctors, they go through medical school and they're trained and supervised by mentors, which is a great process because you learn whatever, but they're not researchers necessarily.

It's kind of rinse, lather, repeat.

Right. They're not innovating necessarily. They're just doing what they're told to do. And, and what gets the job done versus the research side, the investigative side, which is your PhD side, really is what brought that together. So keep going. This is interesting.

So the tools didn't exist, but I could see where the— where they were lacking, right? We had the biology that told us other things were going on. We had no way of visualizing that.

Okay.

So I go, okay, this is interesting. The tools aren't ready yet, but I'm really fascinated with this. So I finished my training. I come down to Texas, get my first job down here, join a very large cardiology group. And—

Here in Dallas or?

Yeah.

Okay.

In Dallas. So at that point, a large cardiology group was like 70 people.

Wow. What are they now?

Now that's called a good start.

What are they now? Hundreds? Thousands?

Oh, they've evolved and broken up and reformed and all that. But yeah, it was a big group. And I was brought down here to run their non-invasive stuff, right? Echo lab and stress tests and all that stuff. And so—

It wasn't called preventive, Dev, back then. It was just non-invasive.

No, no, there wasn't even— those 2 words were not used together.

Yeah. So what year was this, roughly?

So this is '97.

'97. So yeah, I mean, people doing aerobics in '97. So like, '80s and '90s— Sweating to the oldies. Fonda workout, whatever. You know, she came out. Disco balls were still around. Yeah, right. I wasn't even married yet, you know, and that's amazing. A life before marriage. Whole nother podcast there. Yeah. But anyway, so, so yes.

So good thing we didn't know each other.

People weren't worried well back then, and they were talking about like, not really. I mean, yeah, there was diabetic medicine, but it wasn't really heart disease like plaque, heart attacks, strokes.

We're just kind of like, I don't know, you're fine.

Yeah.

And then you're not.

And then you're not. It's just part of life. And then it just happens.

Yeah.

Right? Growing up, they throw you out of the door at my house, come back when it's dark out. If you survived, yay. If you didn't, well, that's life. That's the—

And we'll have another one.

That's it.

They're cheap.

That's it.

Yeah.

Exactly.

So came to Texas and just started doing my cardiology thing. And then a buddy of mine that I happened to know was playing around with the very, very kind of crudest, earliest— we talk about rotary phones. Well, he had the rotary phone of a cardiac CT machine. And I won't go into the details. It's kind of interesting. You'd find this in a museum.

Was there a guy on a bicycle generating the electricity?

Pretty much.

Tesla?

Yeah, pretty much. Yeah, the original Tesla.

Yeah, the original, where they turn the crank.

And so I began to play around with this machine. And there was no data, no literature, nobody to train. So I just on-the-job training. It's okay. So I began to see with this early technology, this is like 2001 or so, that with the evolution of technology, hardware, software that was coming to play, that this could evolve into something that would allow us to see the blood vessels and see not just the channel, the lumen, the donut hole, I like to call it, but out into the donut. So I did several hundred of those exams with this ancient technology. But 100— but I wasn't ready to say, okay, this is ready to rock and roll, this is not ready for primetime. And so I also did heart casts on all of them. So I had 100% correlation with what it looked like on the crude early cardiac CT with the angiogram. So I could go, oh, okay, so it looks like this on the heart cath.

So you could connect the dots there and compare and contrast.

Exactly right.

Pun intended.

What did I, what did I see in the CT that I couldn't see in the heart cath? Uh, you know, how much blockage was there on the heart cath? What does that mean? What does that look like on the cardiac CT? 2005 was a seminal year. So in 2005, I convinced my other partners The other 70. We needed to buy this really expensive machine called a multi-slice cardiac CT machine. It had 64 slices.

Oh my God. That was state of the art. Now they're like 600 and something, right?

640.

Wow.

iPhone 1, iPhone 16.

Yeah. Well, before iPhone, it was probably with the big brick that they called— Yeah, exactly.

It was the brick.

Remember the brick in the '80s and '90s? Yeah. Your car? Yeah, exactly. It came in a suitcase.

Yeah, exactly.

Oh, your cell phone.

And you couldn't even afford the bills.

That's right.

Right?

Yeah.

We got a 64-size CT. We're one of the first practices in the US to have one on our own private practice in our office. And then again, I had to train myself. There was no training program, right? And so we hired 2 fantastic cardiac CT techs, right? They had years of CT training, right? Using it to look at bellies and chests and heads and all that stuff.

So you can use it for everything. Yeah.

It's a great tool for lots of stuff. But of course, they had zero experience doing cardiac CT, which is fairly tricky, right?

Was that a big machine?

Uh, it would fill up about a third of this room.

Okay.

So yeah, and, and at that point—

A couple hundred square feet.

Yeah, and, and this is 2005, we're talking about $1.2 million, so pretty, pretty pricey back then.

So I convinced somebody to do this.

And so I said, I'm gonna hire 2 great CT techs, and then the 3 of us Taught each other cardiac CT because I kind of knew—

20 years ago.

Yeah, I kind of knew what we needed to do and the images I wanted. And they knew the machine. They just didn't know what I wanted. So basically, we started doing it. And it really wasn't that hard, I have to admit, because they were really fantastic. And—

Yeah, says the guy that was in med school at 19. Yeah, it wasn't very hard. Yeah.

So So 2005, we began to do cardiac CT. And almost immediately, I realized, holy crap, this is the holy grail of imaging. Because I can see the channel, I can see the hole, I can see blockages. But most importantly, I can see the wall.

I think we have an image. Can we get an image here? I think we have an image of an actual— what you're talking about. I think it would be important.

Have Vanna White pull it up for us.

She's off camera right now. She's amazing. There we go.

So on a heart cath, All the gray is all I can see. Okay, that's lumpy bumpy. There's no blockage.

Lumpy bumpy. So you're only looking inside the pipe. All I can see is inside the pipe, right?

So lumpy bumpy.

But you can't see any of the color on the outside.

All of this stuff, yeah, completely invisible.

So what is that stuff?

This is plaque.

That's plaque.

And as it turns out, there's different kinds of plaque.

Okay. And plaque's what kills you. This is the stuff that kills you. This gives you the heart attack and stroke.

Again, this is an incredibly slow glacial process, right? This plaque probably started 20 to 30 years ago.

No kidding. So the plaque that I found that I have probably started when you were— when you first got your first CT scan?

Just about.

Yeah. Okay. The 64-slice ancient Tesla version.

Exactly.

Okay.

Right. Yeah. Back then.

Wow.

Yeah. You were already forming plaque back then. You just had no idea.

Wow. I was in my 20s.

And until we had this technology, no one could.

Yeah.

So on a heart cath, all I could see was the channel. That's it. All this stuff out here, all the colored stuff, couldn't see it. And nor could I see, more importantly too, I couldn't see what kind of plaque it is, because what kind of plaque becomes incredibly important.

Super important.

This is really dangerous plaque. This is the plaque that ruptures and kills you. This is calcified plaque. It's been there a long, long time. It's evolved from this. It's evolved to that. It's just going to sit there. It's a dead end. This is the cinder cone. This is the extinct volcano. This is the erupting Krakatoa.

Got it.

Okay.

So this is super important. So all of a sudden you're discovering— Now I can see all this. It's like walking on the moon for the first time. Right.

So I was doing heart cath back then, $20,000 just for diagnostic pictures. Invasive, got to put you out, blah, blah, blah. And all I could see was the channel. So with cardiac CT—

That's not healthy at all.

Well, it's what we had.

It's lumpy bumpy.

So once we had the cardiac CT and I could see all of this, then I'm going, this is stupid.

But you could see all of that though, right?

Well, I could differentiate.

Because this is brand new tech.

This stuff.

Yeah.

But I couldn't break it up into all the colors. This is where AI comes in.

This is our new stuff.

Yeah, this is new. But it was a big break.

But back then it was light years.

So I could see the channel. And then suddenly, I was seeing the entire vessel with all that plaque, right?

Interesting.

So the light bulb went on vigorously. And I realized, wait a minute, I could spend— or someone could spend, insurance could pay $20,000 for an invasive procedure, risk of complications, you could have strokes and heart attacks, bleeding, infections, all that kind of stuff. I'm putting things directly in your heart. Or I can spend 5% of the cost, get better pictures, more accurate pictures, see all the stuff that I couldn't see in a heart cath. Plus, at the same time, by the way, when we do this, we're getting these high-resolution pictures. So everything else inside the chest, I can see your lungs, your aorta, your esophagus, your liver, your stomach, your spleen, your spine. Everything else I can see as well. Okay, your heart valves. If you had old heart attacks, if you have congenital heart disease, holes in the heart, we'll get all that.

Wow.

Later on. But anyway, in other words, this was the key thing, but you got a whole bunch of free data, right? But most importantly, holy moly, I can now see what's happening in the donut or in the wall of the pipe. I could never see that before.

I could just see the channel. So a light bulb goes off.

Right.

And you're like, wait, what are we doing?

Right.

And why?

Yeah. So I quit doing hair casts.

Wait a minute, you just stopped?

Stopped. Because I'm going 5% of the cost.

So this is 2005, 2006.

Cheaper, safer, simpler, easier, cheaper, better, more accurate. Stress tests, ancient history. Heart cath, angiograms, ancient history.

So 20 years ago, you decided there was a better way of doing this, less invasive, way more accurate, and better for the patient.

5% of the cost.

5% of the cost.

None of the complications.

None of the complications. of the invasiveness, going under general anesthesia, none of that stuff, right? And it's way more accurate. And now you can service a patient better. So what did you tell your colleagues? What did they say?

So that's a great question. So light bulb went on, going, wait a minute, everything I thought I knew was— I mean, I kind of knew, but I just didn't have the tools. Why am I going to the hospital anymore? Why am I cathing people? It's stupid. It's ridiculous. You don't need to do any of that anymore.

Aren't they still cathing people today?

Oh yeah.

Okay. That was 20 years ago.

Millions. Millions a year.

How many?

Millions.

Millions of people are doing what you did 20 years ago. Okay. Keep going.

So basically the gist of that was, I joined this group. I was with them for about 10 years. This was 2005. By 2007, I just got so emotionally fed up with it. Because I just thought, why are we still doing stress tests, heart casts? I mean, there's a far, far cooler way.

Like, who were you like, you were, you were going to a conference?

In a polite way, my, my colleagues, showing them pictures, right? Most of them were like, yeah, that's kind of cool and interesting. But I'm off to the cath lab. Because that's what they knew. That's the tool.

That's what they're trying to do. Was it a money thing back then or was it just, yeah, I'm not interested in really evolving?

There was a fair amount of training you had to do to be able to do this, get good techniques right. Okay.

So they felt they put the time and effort in. I'm going to cath lab some— I'm going to cath some people.

Yeah. And plus you're making 20 times more.

Okay. Fair enough.

Hospitals have to.

So it was a monetary thing. The hospitals have to.

Part of that, right? Organizational, institutional.

We talk about all this other stuff and—

Yeah. Organizational, institutional apathy and inertia and blah. Plus, You know, money-wise? Oh yeah. I mean, if you want to make money, you do stress tests and hard casts, right?

Yeah.

So you take a vow of poverty to do this.

I highly recommend if you haven't already watched our other podcasts, we do a couple of other podcasts specifically around cost of healthcare and lack of healthcare and insurance and all the stuff that goes into it. And we're touching a little bit on that. So we're being a little coy, but I highly recommend you check it out. But it is, it is a problem.

And by the way, do subscribe, Yes. You can see all the podcasts when they come out and stuff. Yeah.

They're really good.

So within 2 years, right? So my cath, my doing heart cath stopped in 2005. So since 2005, as a cardiologist, has been maintained at a steady zero ever since.

Not a single heart cath. No.

Why?

But all your colleagues are out there and you're telling everybody about this, right? Oh yeah. And they're going—

for 20 years.

20 years.

On the mountaintop.

Okay. And you're saying it's beneficial to the patient, it's lowered costs to the patient, and it's less invasive, and it's more— you're getting more information to the patient, right? Which means you as a physician, as a cardiologist, can make better decisions on behalf of the patient. All right.

So for me, there's no—

Nobody's listening.

For those reasons, right? Inertia and apathy.

I get it. Money and—

Money and all that stuff.

Just laziness in general.

So it drove me so crazy because everybody else is kind of doing the same old, same old. I'm going, this is ridiculous. If you do this, there's no need for stress tests, heart cath, people being hospitalized, the heart attack that comes out of the blue. It's just, it's done. And so by 2007, I said, okay guys, I'm out of here. So I set up my own practice as a solo guy, as a unicorn.

Yeah. That's a unicorn.

That's a unicorn.

Sasquatch.

Bigfoot.

You found Bigfoot.

Me, solo, Sasquatch.

You've seen him today. Yes.

And I bought my own CT scanner.

Okay.

And then all the other stuff. And that was the next 10 years. So 10 years of basically being a cardiologist and never going to the cath lab because I didn't have to anymore.

Wow. And providing better care.

Yeah.

Now, admittedly, there's still a need for cath labs, right?

I would argue, so for anybody in the audience, there is a role for the cath lab to fix things.

Right. Mechanicals.

Yeah. Right. Stents, balloons. We can do all kinds of crazy stuff.

When it's necessary.

We can put in valves. So we can fix things in the cath lab. I would argue that is the role of the cath lab, not for diagnosis.

Got it.

Because I can make a better diagnosis with a test that costs 5%, none of the risk, better data, This is the place to make the diagnosis, to have heart disease, don't have heart disease, what kind of heart disease, what kind of plaque I have. That should be done with cardiac CT. The cath lab, which is still used diagnostically, right? I need to see what's going on. We better do a heart cath. It's the gold standard. They still say exactly the same words. They do that.

But it's not true.

It's not true.

Well, for mostly, unless you've got a, what did you say, 70% blockage or better?

Right. I'm going to know that from your CT. And then before we do the heart cath, squeeze dye in your arteries, I already know exactly where it is, what it looks like, where it's located, whether it's lipid-rich, calcified, whatever. All those things are important if you want to stent it. And I know all that. I got my roadmap before you ever go to the cath lab.

See, that makes way more sense to me. And I bet you it does for our viewers as well. Why would— that's like saying, I'm trying to find an analogy here that works best. That's like, let's go in and tear apart your engine and replace the valves if you—

And when we've torn apart the engine, we'll see if the valves are bad.

Yes.

Well, why don't you know that first of all?

Yes. If you had a tool that you could X-ray, like you literally X-ray or do some type of imaging, that would show you that they're bad and which ones are bad. Wouldn't you want to do that first if it costs you, let's just say, $1,000 to do the imaging and then have a diagnosis and then go in and just repair one valve? Although I don't know if that's the right thing because sometimes you have to replace all of them. I don't know in the cars, but I'm not a mechanic. But the point is, it's way— to me it makes way more sense.

Or actually, I'll tell you the real analogy is this. Okay, so In the 1980s, we developed laparoscopic cholecystectomies. That is the fancy term for we take your gallbladder out through little tiny scopes.

Ah.

So up until that point, if you had your— have your gallbladder out—

Huge scar, right?

Big scar, right?

Yeah.

We have to cut through multiple muscles.

Yeah.

Right? So you're going to be in the hospital for probably a week recovering.

Yeah.

And then several weeks of recovery thereafter.

And the scarring.

And the scarring, complications, cost, risk, whatever. So as a medical student, they began to do laparoscopic cholecystectomies. So doing it with scopes. But what led to that—

I like it when you said just pulling out your gallbladder.

Yeah.

Through some little holes. Yeah.

But what led to that was in the early '70s, and then by the early '80s, But also too, during that time we had ultrasound, CT, and MR. So before then, we didn't have imaging of the belly. So you could have what we call an acute belly, right? Something's going on. Could be really bad. It could be appendix, it could be a gallbladder, it could be a blockage in your bowel.

Intestines or something?

Intestines, right? Could be bad cancer, whatever.

Hernias.

Or it could be a really bad case of gastroenteritis.

You just got to fart.

We would do—

Is that what you're saying? You just got to fart.

So we would do what we called It's no longer relevant anymore.

Yeah.

We would do an exploratory laparotomy, which means we're going to cut your entire belly from here to here. We're going to feel your gallbladder, literally feel your gallbladder. We're going to feel your appendix. We're going to—

This sounds so awful.

Run your bowel. Oh, this is in the operating room under anesthesia, by the way. We're going to run your bowel. So literally take our fingers and your bowel to feel If there's tumors, cancers, obstructions in the bowel.

Oh, that sounds like— I feel like we're in the 1700s or something.

Incredibly expensive. They bleed you.

They bleed you. Yeah.

No, I mean, it was bleeding and leeches.

Oh my God.

And so incredibly expensive. And if you did that, if they didn't find anything, you're still in the hospital for a week, weeks of recovery, because we cut all these muscles in the front of your belly. And guess what? You should have farted. Right?

Okay. So let's apply this to cardiology now. Same thing.

So that was the concept, right? We did exploratory laparotomy. Well, if you did that today, you'd go to jail.

Yes.

You would lose your license. It's irrelevant.

Why?

Because we have imaging.

We have imaging.

Right?

So you're this—

We had imaging 20 years ago that was already ripe. It's only gotten better with AI and all those things.

Well, that's what ClearCardio does. I mean, that's all about the imaging.

But we had the tools.

Yeah.

To eliminate diagnostic angiograms, heart caths, 20 years ago. And you know what? We're still doing the cardiac, the cardiovascular equivalent of the exploratory laparotomy. Still.

Wow. So your frustration level must have been through the roof. I mean, knowing what you know and, and every— and the kind of person that you are, and you're talking to these patients.

It was just, yeah, you know, I couldn't do it. And the best way to do it I set up my own practice, I get my own machine, and I just run with it.

So that was in 2017, up to 2017.

Yeah, about 2014. I then got recruited to another hospital. They put in an even better CT machine. So they knew what lured me in. Right.

That's my soft spot. Okay. So they dangled a little carrot in front of you.

Yeah. So these things always evolve.

That's the scientific—

So I start out with the iPhone 1 and I was able to buy the iPhone 4. They had an iPhone X.

Got it.

I was like, ooh, okay. Shiny things. So anyway, I spent a few years there and then—

And you're on the lecture circuit too. You do some lectures. Yeah.

Yeah. I mean, trying to educate my colleagues.

Still out there. You've been fighting this fight, banging your head against the wall.

So here's how slow things move in cardiology. So I told you I had been doing cardiac CT 25 years ago with early crude machines, but it was very, very crude. 2005 equipment came when became commercially available that the cath lab was irrelevant. So 2005, 20 years ago, left the cath lab never never to go back and delighted. But what's fascinating is that again that was 20 years ago. Lots of studies literature etcetera has come out. There's a whole society dedicated to this called the SCCT, the Society for Cardiac CT. It's a small group, maybe 1,200 docs. We have radiologists, cardiologists.

It's getting a lot of noise now, isn't it?

Oh yeah.

There's a lot of noise about that.

Yeah. But it's always been in the background, right? Whereas a meeting like the American College of Cardiology is 25,000 people. This is 1,200 for Society of Cardiac CT. By 2021, so October of '21, finally my colleagues— now this is 16 years after I stopped cathing people. My colleagues now say, and this is the guideline was published in October of '21.

So just recently?

Yeah, recently. Right. If post-COVID.

I was just going to say post-COVID.

If you have chest pain, right? We're trying to figure out if you have heart disease or not. Cardiac CT is now the chosen tool.

Wow.

16 years after my light bulb went on.

Wow. And yet—

You've been yelping from the rooftops. It's 2025. Yes. Are we doing more? Yes. It's growing nicely, but we're still doing millions of invasive cardiac catheterizations every year.

But you're not doing that at Clear Cardio anymore.

No.

Clear Cardio—

I gave it up.

Ever. Yes. So Clear Cardio—

I swore it off.

Yes. So now what are we doing at Clear Cardio? Now that you've gone through all of that stress and pressure and pushback—

So now we're using 2025 versions of cardiac CT. So it went from 64-slice to 640-slice.

Wow.

Lower radiation, better pictures, better resolutions. 10 times. 10 times, right? And the really massive breakthrough in the last few years is now we can take all of this data, literally gigabytes worth of data, send it up to the cloud, use AI tools, to look at every single pixel. And by the way, every one of these pixels here, we can see maybe 50 to 100 shades of gray between white to black. Every single electronic pixel has over 2,000 shades of gray encoded into it that we cannot see.

But the AI tools—

AI can. So it's going to analyze every single one of those millions of pixels. It's going to analyze every pixel across over 2,000 shades of gray.

And that's important why?

Well, because it just gives us the ability to see stuff we cannot see with our eyes.

And also, I understand it quantifies a type of plaque.

Exactly. So it will then—

It's a matter. It's real matter.

Identify the plaque. It will quantify the plaque down to a 10th of a cubic millimeter. So imagine a period at the end of a sentence and a 10th of that period.

Wow.

That's the resolution we get. Then it will then identify these different kinds of plaques. Lava, intermediate lava, extinct cinder cone. And then lastly, will tell us how much plaque we have in the whole heart, per vessel, per segment, and then break it up into the different kinds of plaque.

Well, listen, you are absolutely in your heyday now. I mean, we're at the— we're certainly not at the pinnacle because it's accelerating, of course, the technology. And I would say of all the companies, and I'm a little biased because I happen to be the CEO of Cleo Cardio, this is not Meant to be a commercial by any means, but we're just talking about facts here. And for you in your career, if we discuss in this podcast your incredible career, what you've brought to the industry, it's for you, you're getting to that point where people are going, ah, I get it.

Right.

He was right. He was right. The tech is there. The tech is easier to use. You don't necessarily have to be as smart as you to use it, right? You've paved that way, right? And you've given the guys and girls out there who are innovating these types of imaging systems something to want to innovate for. You're using it, right? You know what they say, it's supply and demand, and also that The mother of all invention is what? Necessity, right? And you're making it necessary for these guys and these young men and women out there who are innovating in this space, in the imaging space, in the AI space, to want to innovate more because they have someone to give it to. They can feed patients because doctors are pulling now. It's not just a push anymore. You're pulling it into the market.

Well, and now patients are beginning to— understand this. It's complex, right? I mean, usually just go, well, whatever the doctor says, right? But now they're beginning to go, wait a minute, hold on. I mean, it's fascinating. I want to know. People maybe hang out with me. We'll go through this. And then they go back to their cardiologist and say, well, what about a cardiac CT? And they'll go, oh yeah, we don't do those here. I don't do them, or they're not very good or whatever, blah, blah, blah. And then when do you want to do your heart cath? And it's still happening.

Yeah. And that's unfortunate.

That's why we're here.

And we're still fighting that fight. And you're still fighting that fight. And I thank you on behalf of myself as a patient. And a lot of my colleagues are patients and family members are patients and have gone through the Clear Chordae program, which is why I'm so passionate about it and want to help you get your message out there and help make it easier for you. So in closing, if you could say anything, To cardiologists out there who are aspiring, getting into the field, or even the cardiologists who've been in the field for a while and are frustrated because they've had to go through a lot of— they think the way you do. What would you say to these young people and some of these cardiologists who are in the space even now? What would you say to them, kind of encourage them or guide them?

Focus on the patient, do right by the patient, and all the details will take care of themselves. And that's really what I've always been oriented to and what I've done.

Yeah.

I mean, think about what's the best way to take care of the patient and the details take care of themselves. We're stuck in a weird conundrum, a weird paradox where worldwide, and also again, by far the leading cause of death in the US, 20 million people in the world will die of cardiovascular disease. At the same time—

Every year?

Well, that is true. Every year, year in, year out.

And how many of them will have a symptom?

About half.

So half of the people, so 10 million people will drop dead of a heart attack or stroke without a single symptom.

Right.

God, that's amazing.

Right. And we do all this stuff for cancer. We do screening, we do colonoscopies, we do Pap smears, and we should, and that's fantastic, right? But heart disease kills more people than the next 7 causes of death, including All the cancers combined?

All of them.

All the cancers, plus the next 7—

Wow.

Next 5 cause of death, right?

Wow. But yet we're not— they haven't embraced this.

And what have we done to identify heart disease that kills more people than anyone and has been doing so for the last 100 years? What do we do to identify it early? What do we do to identify the polyps rather than waiting for the cancer? Well, we look at risk factors. You look like somebody who might have plaque. You look like someone who doesn't have plaque. Well, do I have plaque? I don't know. It's crazy. So persevere. The technology is out there. The truth is out there, to paraphrase The X-Files.

You're dating yourself.

Trust but verify. Trust but verify. And just focus on the patient. Take good care of the patient. Think about what is the best for the patient. It's wonderful to have this technology because I now can exist in a binary world. You got disease, you don't have disease. There's no, well, your stress test looks okay, knowing they're not very accurate, or your EKG looks okay, knowing they're not very accurate. I mean, it's just, it's there, it's not. And if we find something, that's fine. We'll take care of it. We have incredibly effective tools. That's a whole nother podcast.

Yeah.

Or if it's not, which is awesome too, it's fantastic. You don't have the disease. It's just not there. And I'm not saying you're not having symptoms, your stress test looks fine. We looked with a microscope and you don't have it.

That's inspiring. And you're inspiring. And I can feel the passion. And I'm sure our viewers and listeners can feel that passion. It's coming through. Yeah.

So one of my favorite quotes is from the philosopher Schopenhauer, right? So he says, All knowledge, all innovation goes through 3 phases. Okay, you may have heard this. It's great. It's worth saying if you haven't heard it before. The first phase is you're completely denied. You're, you're said to be insane. It's silly. It'll never work. This needs to be absolutely forgotten.

I hear about that about me all the time.

Next phase, if you still persevere long enough and they don't shut you up, is they say, well, yeah, there's some validity occasionally, rarely, there may be a role for this or whatever, in a very, very small way. It'll be a little footnote in history, but it's of no major concern. It doesn't carry the field.

Yeah.

The third phase is when everyone goes, oh, yeah, I knew this all the time. That's why I started doing it 20 years ago.

Yeah, yeah, yeah. Everybody jumps on board, right?

Exactly.

Yeah.

So, I, you know, I, one of my mentors told me that 20 years ago, right after coming to Texas. And I, I have absolutely, you know, carried that with me ever since then. And it is absolutely true. And it's nice to be in the third part of that phase.

Yeah. Well, you definitely are. And I know, you know, um, Clear Cardio is helping drive some of that. And I, and you are the heartbeat and the, and the passion behind Clear Cardio. I'm happy to be part of it. Uh, and I'm glad that we were, we're able to sponsor these types of podcasts and get this information out. So, so thank you, Dr. Osborne. I really appreciate it.

A pleasure.

So stand by. We're going to have a lot more podcasts coming out with Dr. John Osborne, myself, JD Enright, chairman and CEO of, of Clear Cardio. And, uh, if you have any comments or questions, feel free to post them down below in the comment section. Um, subscribe to our podcasts and, uh, and look out for more. So thank you very much. See you guys.

Cheers.

Bye-bye.